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Addasi Y, Nguyen AH, Sabri A, Ahmad F, Rangray R, Velagapudi M. Gastrointestinal Mucormycosis: A Clinical Review. Gastroenterology Res 2023; 16:249-253. [PMID: 37937225 PMCID: PMC10627358 DOI: 10.14740/gr1662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/02/2023] [Indexed: 11/09/2023] Open
Abstract
Mucormycosis is a devastating fungal infection that is usually seen in immunocompromised hosts. It is caused by fungi of the subphylum Mucoromycotina, order Mucorales, with most cases caused by Mucor, Rhizopus, or Rhizomucor species. It can involve any organ system and can disseminate in severe cases. Lately, there has been an increased number of reports for mucormycosis infection in immunocompetent patients. Gastrointestinal system involvement is rare compared to other organ systems but has been increasingly reported in the literature. Mucormycosis can affect any part of the gastrointestinal tract and lead to different presentations depending on the area of involvement. Due to the paucity of the condition, there has been no specific guidelines on how to treat gastrointestinal mucormycosis. In this review, we discuss the risk factors of gastrointestinal mucormycosis, clinical presentation, approach to diagnosis, and most recent treatment modalities for gastrointestinal mucormycosis.
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Affiliation(s)
- Yazan Addasi
- Department of Internal Medicine, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | | | - Ahmed Sabri
- Department of Pathology, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Faran Ahmad
- Department of Infectious Diseases, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Rajani Rangray
- Division of Gastroenterology, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Manasa Velagapudi
- Department of Infectious Diseases, CHI Health Creighton University Medical Center, Omaha, NE, USA
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Sharma A, Goel A. Mucormycosis: risk factors, diagnosis, treatments, and challenges during COVID-19 pandemic. Folia Microbiol (Praha) 2022; 67:363-387. [PMID: 35220559 PMCID: PMC8881997 DOI: 10.1007/s12223-021-00934-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/15/2021] [Indexed: 12/29/2022]
Abstract
Mucormycosis is a deadly opportunistic disease caused by a group of fungus named mucormycetes. Fungal spores are normally present in the environment and the immune system of the body prevents them from causing disease in a healthy immunocompetent individual. But when the defense mechanism of the body is compromised such as in the patients of diabetes mellites, neustropenia, organ transplantation recipients, and other immune-compromised states, these fungal spores invade our defense mechanism easily causing a severe systemic infection with approximately 45-80% of case fatality. In the present scenario, during the COVID-19 pandemic, patients are on immunosuppressive drugs, glucocorticoids, thus are at high risk of mucormycosis. Patients with diabetes mellitus are further getting a high chance of infection. Usually, the spores gain entry through our respiratory tract affecting the lungs and paranasal sinuses. Besides, they can also enter through damage into the skin or through the gastrointestinal route. This review article presents the current statistics, the causes of this infection in the human body, and its diagnosis with available recent therapies through recent databases collected from several clinics and agencies. The diagnosis and identification of the infection were made possible through various latest medical techniques such as computed tomography scans, direct microscopic observations, MALDI-TOF mass spectrometry, serology, molecular assay, and histopathology. Mucormycosis is so uncommon, no randomized controlled treatment studies have been conducted. The newer triazoles, posaconazole (POSA) and isavuconazole (ISAV) (the active component of the prodrug isavuconazonium sulfate) may be beneficial in patients who are refractory to or intolerant of Liposomal Amphotericin B. but due to lack of early diagnosis and aggressive surgical debridement or excision, the mortality rate remains high. In the course of COVID-19 treatments, there must be more vigilance and alertness are required from clinicians to evaluate these invasive fungal infections.
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Affiliation(s)
- Ayushi Sharma
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, 281 406, Mathura, UP India
| | - Anjana Goel
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, 281 406, Mathura, UP India
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Huang H, Xie L, Zheng Z, Yu H, Tu L, Cui C, Yu J. Mucormycosis-induced upper gastrointestinal ulcer perforation in immunocompetent patients: a report of two cases. BMC Gastroenterol 2021; 21:311. [PMID: 34404350 PMCID: PMC8370051 DOI: 10.1186/s12876-021-01881-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 07/10/2021] [Indexed: 01/17/2023] Open
Abstract
Background Gastrointestinal mucormycosis (GIM) is a rare, opportunistic fungal infection with poor prognosis. Clinically, it is difficult to diagnose GIM owing to its nonspecific clinical symptoms and poor suspicion. The estimated incidence of GIM is inaccurate, and most cases are diagnosed accidentally during surgery or upon postmortem examination. GIM usually occurs in patients with immune deficiencies or diabetes. Here, we report two cases of immunocompetent young patients with GIM who had good prognosis after treatment. Compared to other case reports on GIM, our cases had unusual infection sites and no obvious predisposing factors, which make it important to highlight these cases. Case presentation The first case was that of a 16-year-old immunocompetent boy who was admitted with gastrointestinal bleeding and perforation due to a gastric ulcer. Strategies used to arrest bleeding during emergency gastroscopy were unsuccessful. An adhesive mass was then discovered through laparoscopy. The patient underwent type II gastric resection. Pathological examination of the mass revealed bacterial infection and GIM. The second case was of a 33-year-old immunocompetent woman with a recent history of a lower leg sprain. The patient subsequently became critically ill and required ventilatory support. After hemodynamic stabilization and extubation, she presented with hematemesis due to exfoliation and necrosis of the stomach wall. The patient underwent total gastrectomy plus jejunostomy. The pathology results revealed severe bacterial infection and fungal infection that was confirmed as GIM. The patient fully recovered after receiving anti-infective and antifungal treatments. Conclusions Neither patient was immunosuppressed, and both patients presented with gastrointestinal bleeding. GIM was confirmed via pathological examination. GIM is not limited to immunocompromised patients, and its diagnosis mainly relies on pathological examination. Early diagnosis, timely surgical treatment, and early administration of systemic drug treatment are fundamental to improving its prognosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01881-8.
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Affiliation(s)
- Hongyun Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Lang Xie
- Department of General Surgery of Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Zheng Zheng
- Department of General Surgery of Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Hanhui Yu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Lingjing Tu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Chunhui Cui
- Department of General Surgery of Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Jinlong Yu
- Department of General Surgery of Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China.
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Chiang TH, Lee YW, Tan JH, Kao CC, Chang CC, Fang KC. Mucormycosis causing massive lower gastrointestinal bleeding: a case report. BMC Gastroenterol 2021; 21:272. [PMID: 34215188 PMCID: PMC8252205 DOI: 10.1186/s12876-021-01846-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lower gastrointestinal bleeding (LGIB) is very common in the hospital setting. Most bleedings stop spontaneously, but rare infectious causes of LGIB may lead to rapid and serious complications if left untreated and are sometimes very difficult to diagnose preoperatively. CASE PRESENTATION We described a young man with poorly controlled Type I diabetes mellitus and chronic alcohol abuse who presented with acute altered mental status. During his hospitalization for treatment of diabetic ketoacidosis, acute renal failure, and sepsis, he suddenly developed massive hematochezia of 1500 mL. Colonoscopy was performed and a deep ulcer covered with mucus with peripheral elevation was noted at the transverse colon. Biopsy of the ulcer later revealed nonpigmented, wide (5-20 µm in diameter), thin-walled, ribbon-like hyphae with few septations and right-angle branching suggestive of mucormycosis demonstrated by Periodic acid-Schiff stain. He received 2 months of antifungal treatment. Follow up colonoscopy post-treatment was normal with no ulcer visualized. CONCLUSIONS Early diagnosis and treatment of gastrointestinal (GI) mucormycosis infection is critical but can be challenging, especially in the setting of massive hematochezia. Therefore, clinical awareness for immunocompromised patients and prompt antifungal prophylaxis in cases with high suspicion of infection are essential.
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Affiliation(s)
- Ting-Hsuan Chiang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yi-Wei Lee
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Jui-Hsiang Tan
- Division of Gastroenterology, Internal Medicine, Taipei Medical University Hospital, No. 252, Wuxing Street, Taipei, Taiwan, ROC
| | - Chih-Chin Kao
- Division of Gastroenterology, Internal Medicine, Taipei Medical University Hospital, No. 252, Wuxing Street, Taipei, Taiwan, ROC.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chun-Chao Chang
- Division of Gastroenterology, Internal Medicine, Taipei Medical University Hospital, No. 252, Wuxing Street, Taipei, Taiwan, ROC.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Kuan-Chieh Fang
- Division of Gastroenterology, Internal Medicine, Taipei Medical University Hospital, No. 252, Wuxing Street, Taipei, Taiwan, ROC. .,Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
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An unusual cause of bowel obstruction: Rhizopus Arrhizus diverticulitis. Med Mycol Case Rep 2019; 25:15-18. [PMID: 31431881 PMCID: PMC6580311 DOI: 10.1016/j.mmcr.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/24/2019] [Accepted: 06/07/2019] [Indexed: 11/23/2022] Open
Abstract
Mucormycosis is a fungal infection primarily afflicting immunocompromised or diabetic patients. Its presentation ranges from rhino-orbito-cerebral infections to disseminated mucormycosis with angioinvasion. We present a patient who developed a bowel obstruction one month after bone marrow transplant and was diagnosed with Rhizopus arrhizus diverticulitis despite antifungal therapy since transplantation. She underwent surgical removal with immediate fungal resurgence, declined further invasive intervention and was discharged on palliative isavuconazole. Seven months later she is alive with fungal containment.
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Kaur H, Ghosh A, Rudramurthy SM, Chakrabarti A. Gastrointestinal mucormycosis in apparently immunocompetent hosts—A review. Mycoses 2018; 61:898-908. [DOI: 10.1111/myc.12798] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/09/2018] [Accepted: 05/25/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Harsimran Kaur
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
| | - Anup Ghosh
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
| | - Shivaprakash M. Rudramurthy
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
| | - Arunaloke Chakrabarti
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
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Chow KL, McElmeel DP, Brown HG, Tabriz MS, Omi EC. Invasive gastric mucormycosis: A case report of a deadly complication in an immunocompromised patient after penetrating trauma. Int J Surg Case Rep 2017; 40:90-93. [PMID: 28946029 PMCID: PMC5614730 DOI: 10.1016/j.ijscr.2017.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 01/01/2023] Open
Affiliation(s)
- Kevin L Chow
- University of Illinois at Chicago, 1740 W Taylor St, Chicago, IL 60612, United States.
| | - David P McElmeel
- University of Illinois at Chicago, 1740 W Taylor St, Chicago, IL 60612, United States; Advocate Christ Medical Center, 4440 95th St, Oak Lawn, IL 60453, United States
| | - Henry G Brown
- Advocate Christ Medical Center, 4440 95th St, Oak Lawn, IL 60453, United States
| | - Muhammad S Tabriz
- Advocate Christ Medical Center, 4440 95th St, Oak Lawn, IL 60453, United States
| | - Ellen C Omi
- University of Illinois at Chicago, 1740 W Taylor St, Chicago, IL 60612, United States; Advocate Christ Medical Center, 4440 95th St, Oak Lawn, IL 60453, United States
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Sun M, Hou X, Wang X, Chen G, Zhao Y. Gastrointestinal Mucormycosis of the Jejunum in an Immunocompetent Patient: A Case Report. Medicine (Baltimore) 2017; 96:e6360. [PMID: 28422828 PMCID: PMC5406044 DOI: 10.1097/md.0000000000006360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Gastrointestinal Mucormycosis (GIM) is a kind of opportunistic fungal infection with poor prognosis. It usually occurs in patients with immune deficiency. We reported a case of immunocompetent male patient. PATIENT CONCERNS This patient was presented as abdominal distension and gastrointestinal bleeding. DIAGNOSES A variety of hemostatic methods was ineffective to stop the bleeding. The patient finally received laparotomy, and the jejunum lesions were found. INTERVENTIONS Pathological examination confirmed it to be gastrointestinal mucormycosis in jejunum. OUTCOMES However, after systemic anti-fungi therapy, the patient died of septic shock. LESSONS The diagnosis mainly relies on pathological examination. Early diagnosis and early application of systemic amphotericin B liposome were fundamental for improving the prognosis.
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Affiliation(s)
| | | | - Xiaoting Wang
- Department of Intensive Care Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ge Chen
- Department of General Surgery
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