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Muthu V, Agarwal R, Dhooria S, Sehgal IS, Prasad KT, Rudramurthy SM, Aggarwal A, Chakrabarti A. Mucormycosis in Human Immunodeficiency Virus-Infected Individuals: A Systematic Review of Case Reports. Mycopathologia 2023; 188:755-763. [PMID: 37501018 DOI: 10.1007/s11046-023-00775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
Mucormycosis in human immunodeficiency virus (HIV) infection is uncommon; notably, many cases have additional predisposing factors. Whether mucormycosis differs in HIV-affected individuals with and without additional risk factors (e.g., neutropenia, diabetes mellitus, and transplantation) remains unclear. In this systematic review, we identified 94 cases of HIV and mucormycosis classifiable into three groups: (1) HIV with additional risk factors (n = 50), (2) intravenous drug users (IVDU, n = 24), and (3) no other risk factor (n = 19) for mucormycosis. The most common presentation in IVDU was renal (41.7%) and cerebral mucormycosis (39.2%), whereas rhino-orbital mucormycosis (ROM, 4.2%) was uncommon. In the other two groups, ROM was the most common presentation. Rhizopus was the most frequently isolated Mucorales; however, in IVDU, Lichtheimia was the most common. The overall mortality was 53% and not significantly different in the three groups. Mucormycosis in HIV-infected individuals is rare without additional risk factors or IVDU.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Ashutosh Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Damaraju V, Agarwal R, Singh Sehgal I, Khadwal A, Bal A, Rudramurthy SM, Muthu V. Ibrutinib and tracheal mucormycosis: A case report and systematic review of literature. J Mycol Med 2023; 33:101414. [PMID: 37523991 DOI: 10.1016/j.mycmed.2023.101414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/13/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023]
Abstract
Ibrutinib, a Bruton tyrosine kinase (BTK) inhibitor, has been approved for various hematological malignancies. Invasive aspergillosis is a known complication of ibrutinib, but mucormycosis is rare. We describe the case of a 70-year-old man with mantle cell lymphoma infiltrating the trachea, managed with a tracheobronchial stent and ibrutinib. He had improved one month after treatment, and we removed the airway stent. Four months later, he developed tracheal nodules confirmed to be tracheal mucormycosis and responded to liposomal amphotericin B (3.5 g) followed by posaconazole. After transient improvement, the tracheal lesions recurred, the biopsy showed lymphoma (with no evidence of mucormycosis), and he died. A systematic review of the literature identified 20 additional cases of ibrutinib-associated mucormycosis. Most of the 21 patients included were men (95%), and ibrutinib was the only risk factor in 15.7%. The reported mortality was 31.6% (6/19), attributable to mucormycosis in half the cases.
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Affiliation(s)
- Vikram Damaraju
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Alka Khadwal
- Department of Clinical Hematology and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Alramadhan SA, Sam SS, Young S, Cohen DM, Islam MN, Bhattacharyya I. COVID-related mucormycosis mimicking dental infection. Oral Maxillofac Surg Cases 2023; 9:100310. [PMID: 37193535 PMCID: PMC10163790 DOI: 10.1016/j.omsc.2023.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/10/2023] [Accepted: 05/01/2023] [Indexed: 05/18/2023] Open
Abstract
A recent increase in the prevalence of mucormycosis of the head and neck in patients who have recovered from COVID-19 following hospitalization has been reported. A Majority of the cases have been reported from India. Conditions such as diabetes mellitus, use of corticosteroids for other autoimmune conditions, organ transplant, immunosuppression, immunodeficiency, and malignancies especially hematologic ones, are all known risk factors for mucormycosis. Recently, hospitalization for COVID-19 has been added to the list of risk factors for opportunistic mucormycosis infection. This is likely attributable to the high doses and prolonged use of corticosteroids in the treatment of hospitalized COVID-19 patients. Case Description: Two patients with post-COVID-19 associated rhinocerebral mucormycosis presented with profound unexplained dental disease including tooth mobility and dental abscess mimicking periodontal disease. The patients were previously hospitalized for COVID-19 and received prolonged treatment with high doses of corticosteroids. The patients responded well to the surgical debridement with or without antifungal therapy. Conclusion: Oral healthcare providers including oral and maxillofacial surgeons, dentists, dental hygienists, and other dental practitioners can play a vital role in the recognition and early diagnosis of rhinocerebral mucormycosis given the large number of patients with severe COVID-19 infection who have recovered following hospitalization and/or received long-term high doses of immunosuppressive treatment.
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Affiliation(s)
- Saja A Alramadhan
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Sumita S Sam
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Shaun Young
- Private Practice Limited to Oral and Maxillofacial Surgery at MOSAIC Maxillofacial Surgical Arts and Implants Center, Tampa, FL, USA
| | - Donald M Cohen
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Mohammed N Islam
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Indraneel Bhattacharyya
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
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Lynch JP, Fishbein MC, Abtin F, Zhanel GG. Part 1: Mucormycosis: Prevalence, Risk Factors, Clinical Features and Diagnosis. Expert Rev Anti Infect Ther 2023. [PMID: 37262298 DOI: 10.1080/14787210.2023.2220964] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/30/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Mucormycosis (MCR) is caused by filamentous molds within the Class Zygomycetes and Order Mucorales. Infections can result from inhalation of spores into the nares, oropharynx or lungs, ingestion of contaminated food or water, or inoculation into disrupted skin or wounds. In developed countries, MCR occurs primarily in severely immunocompromised hosts. In contrast, in developing/low income countries, most cases of MCR occur in persons with poorly controlled diabetes mellitus and some cases in immunocompetent subjects following trauma. Mucormycosis exhibits a propensity to invade blood vessels, leading to thrombosis and infarction of tissue. Mortality rates associated with invasive MCR are high and can exceed 90% with disseminated disease. Mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM); (2) pulmonary; (3) cutaneous; (4) gastrointestinal or renal (5); disseminated; (6) uncommon (focal) sites. AREAS COVERED The authors discuss the prevalence, risk factors and clinical features of mucormycosis.A literature search of mucormycosis was performed via PubMed (up to November 2022), using the key words: invasive fungal infections; mold; mucormycosis; Mucorales; Zyzomyces; Zygomycosis; Rhizopus, diagnosis. EXPERT OPINION Mucormycosis occurs primarily in severely immunocompromised hosts. Mucormycosis can progress rapidly, and delay in initiating treatment by even a few days worsens outcomes.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, the David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Fereidoun Abtin
- Section of Radiology Cardiothoracic and Interventional, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - George G Zhanel
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba
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Abstract
Purpose of the Review To describe the epidemiology and risk factors for Coronavirus disease-19 (COVID-19)-associated mucormycosis (CAM) based on current published literature. Recent Findings COVID-19 is associated with an increased risk of secondary infections. Mucormycosis is an uncommon invasive fungal infection that typically affects people with immunocompromising conditions and uncontrolled diabetes. Treatment of mucormycosis is challenging and is associated with high mortality even with standard care. During the second wave of the COVID 19 pandemic, an abnormally high number of CAM cases were seen particularly in India. Several case series have attempted to describe the risk factors for CAM. Summary A common risk profile identified for CAM includes uncontrolled diabetes and treatment with steroids. COVID-19-induced immune dysregulation as well as some unique pandemic specific risk factors may have played a role.
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Affiliation(s)
- Khadija Tayabali
- Institute of Human Virology, University of Maryland Medical Center, 725 W Lombard St, S211A, Baltimore, MD 21201 USA
| | | | - Shivakumar Narayanan
- Institute of Human Virology, University of Maryland Medical Center, 725 W Lombard St, S211A, Baltimore, MD 21201 USA
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Muthu V, Agarwal R, Rudramurthy SM, Thangaraju D, Shevkani MR, Patel AK, Shastri PS, Tayade A, Bhandari S, Gella V, Savio J, Madan S, Hallur VK, Maturu VN, Srinivasan A, Sethuraman N, Sibia RPS, Pujari S, Mehta R, Singhal T, Saxena P, Gupta V, Nagvekar V, Prayag P, Patel D, Xess I, Savaj P, Panda N, Rajagopal GD, Parwani RS, Patel K, Deshmukh A, Vyas A, Sistla SK, Padaki PA, Ramar D, Sarkar S, Rachagulla B, Vallandaramam P, Premachandran KP, Pawar S, Gugale P, Hosamani P, Dutt SN, Nair S, Kalpakkam H, Badhwar S, Kompella KK, Singla N, Navlakhe M, Prayag A, Singh G, Dhakecha P, Chakrabarti A. Multicenter Case-Control Study of COVID-19-Associated Mucormycosis Outbreak, India. Emerg Infect Dis 2023; 29:8-19. [PMID: 36573628 PMCID: PMC9796192 DOI: 10.3201/eid2901.220926] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We found inappropriate glucocorticoid therapy and zinc supplementation were significantly associated with these illnesses. We performed a case–control study across 25 hospitals in India for the period of January–June 2021 to evaluate the reasons for an COVID-19–associated mucormycosis (CAM) outbreak. We investigated whether COVID-19 treatment practices (glucocorticoids, zinc, tocilizumab, and others) were associated with CAM. We included 1,733 cases of CAM and 3,911 age-matched COVID-19 controls. We found cumulative glucocorticoid dose (odds ratio [OR] 1.006, 95% CI 1.004–1.007) and zinc supplementation (OR 2.76, 95% CI 2.24–3.40), along with elevated C-reactive protein (OR 1.004, 95% CI 1.002–1.006), host factors (renal transplantation [OR 7.58, 95% CI 3.31–17.40], diabetes mellitus [OR 6.72, 95% CI 5.45–8.28], diabetic ketoacidosis during COVID-19 [OR 4.41, 95% CI 2.03–9.60]), and rural residence (OR 2.88, 95% CI 2.12–3.79), significantly associated with CAM. Mortality rate at 12 weeks was 32.2% (473/1,471). We emphasize the judicious use of COVID-19 therapies and optimal glycemic control to prevent CAM.
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Agarwal SS, Anand P, Rao S, Galhotra V. Site-Based Comparative Analysis of Sample Collection Through Direct Biopsy and Nasal Swabs for Early Diagnosis of Post-COVID Rhinomaxillary Fungal Infection Using Potassium Hydroxide Mounting: A Retrospective Cohort Study. J Maxillofac Oral Surg 2022:1-9. [PMID: 36337300 PMCID: PMC9628568 DOI: 10.1007/s12663-022-01812-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/10/2022] [Indexed: 01/24/2023] Open
Abstract
Aim To perform site-based comparative analysis for samples collected from the nasal region and oral cavity subjected to microscopic detection of fungal hyphae in KOH mount in a group of patients with rhinomaxillary mucormycosis. Methodology Forty patients fulfilled eligibility criteria. The diagnostic outcome of detection of fungal hyphae from the KOH samples obtained was the primary endpoint of the study. Based on this, the samples were grouped into three groups viz-oral, nasal and both. The secondary outcome was to check if there was any diagnostic delay in these three groups of patients. Results The mean number of days for delayed diagnosis for oral site involvement was 56.33 ± 37.53, for nasal involvement was 32.86 ± 19.53 and for both oral and nasal involvement was 22.00 ± 12.94. This difference was statistically significant at p = 0.03. The mean delay in diagnosis was significantly less when both oral and nasal regions are involved as compared to the only oral region involved at P = 0.01. Conclusion To avoid the chance of delayed diagnosis or false-negative results, it is best to collect samples from both nasal tissues and the most representative site in the dentoalveolar segment depending on the extensiveness of the disease.
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Affiliation(s)
- Subham S. Agarwal
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Raipur, India
| | - Preetha Anand
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Raipur, India
| | - Santhosh Rao
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Raipur, India
| | - Virat Galhotra
- Department of Dentistry, All India Institute of Medical Sciences, Raipur, India
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Islam MR, Rahman MM, Ahasan MT, Sarkar N, Akash S, Islam M, Islam F, Aktar MN, Saeed M, Harun-Or-Rashid M, Hosain MK, Rahaman MS, Afroz S, Bibi S, Rahman MH, Sweilam SH. The impact of mucormycosis (black fungus) on SARS-CoV-2-infected patients: at a glance. Environ Sci Pollut Res Int 2022; 29:69341-69366. [PMID: 35986111 PMCID: PMC9391068 DOI: 10.1007/s11356-022-22204-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/20/2022] [Indexed: 05/28/2023]
Abstract
The emergence of various diseases during the COVID-19 pandemic made health workers more attentive, and one of the new pathogens is the black fungus (mucormycosis). As a result, millions of lives have already been lost. As a result of the mutation, the virus is constantly changing its traits, including the rate of disease transmission, virulence, pathogenesis, and clinical signs. A recent analysis revealed that some COVID-19 patients were also coinfected with a fungal disease called mucormycosis (black fungus). India has already categorized the COVID-19 patient black fungus outbreak as an epidemic. Only a few reports are observed in other countries. The immune system is weakened by COVID-19 medication, rendering it more prone to illnesses like black fungus (mucormycosis). COVID-19, which is caused by a B.1.617 strain of the SARS-CoV-2 virus, has been circulating in India since April 2021. Mucormycosis is a rare fungal infection induced by exposure to a fungus called mucormycete. The most typically implicated genera are Mucor rhyzuprhizopusdia and Cunninghamella. Mucormycosis is also known as zygomycosis. The main causes of infection are soil, dumping sites, ancient building walls, and other sources of infection (reservoir words "mucormycosis" and "zygomycosis" are occasionally interchanged). Zygomycota, on the other hand, has been identified as polyphyletic and is not currently included in fungal classification systems; also, zygomycosis includes Entomophthorales, but mucormycosis does not. This current review will be focused on the etiology and virulence factors of COVID-19/mucormycosis coinfections in COVID-19-associated mucormycosis patients, as well as their prevalence, diagnosis, and treatment.
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Affiliation(s)
- Md. Rezaul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Md. Mominur Rahman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Md. Tanjimul Ahasan
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Nadia Sarkar
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Shopnil Akash
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Mahfuzul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Fahadul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Most. Nazmin Aktar
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Mohd Saeed
- Department of Biology, College of Sciences, University of Hail, Hail, Saudi Arabia
| | - Md. Harun-Or-Rashid
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Md. Kawsar Hosain
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Md. Saidur Rahaman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Sadia Afroz
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207 Dhaka, Bangladesh
| | - Shabana Bibi
- Department of Biosciences, Shifa Tameer-E-Millat University, Islamabad, Pakistan
- Yunnan Herbal Laboratory, College of Ecology and Environmental Sciences, Yunnan University, Kunming, 650091 China
| | - Md. Habibur Rahman
- Department of Pharmacy, Southeast University, Banani, Dhaka 1213 Bangladesh
- Department of Global Medical Science, Wonju College of Medicine, Yonsei University, Wonju, 26426 Korea
| | - Sherouk Hussein Sweilam
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942 Saudi Arabia
- Department of Pharmacognosy, Faculty of Pharmacy, Egyptian Russian University, Cairo-Suez Road, Badr City, 11829 Egypt
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Muthu V, Dhaliwal M, Sharma A, Nair D, Kumar HM, Rudramurthy SM, Sehgal IS, Choudhary H, Panda N, Chakrabarti A, Agarwal R. Serum glucose-regulated protein 78 (GRP78) levels in COVID-19-associated mucormycosis: results of a case-control study. Mycopathologia 2022; 187:355-362. [PMID: 35727491 PMCID: PMC9209319 DOI: 10.1007/s11046-022-00645-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In experimental models, the expression of glucose-regulated protein 78 (GRP78) in endothelial cells played a role in the pathogenesis of mucormycosis. However, the role of GRP78 in COVID-19-associated mucormycosis (CAM) has not been studied. We hypothesized that serum GRP78 levels are elevated in subjects with CAM. OBJECTIVE To compare the serum GRP78 levels in subjects with CAM and COVID-19 controls without mucormycosis. DESIGN AND SETTING We performed a hospital-based, case-control study between 1 April 2021 and 31 May 2021. PARTICIPANTS We enrolled 24 subjects each of CAM and COVID-19 subjects without mucormycosis. We also measured serum GRP78 levels in ten healthy controls. EXPOSURE The primary exposure studied was serum GRP78 concentration, estimated using a commercially available ELISA kit in stored serum samples. RESULTS We found the mean ± standard deviation (SD) serum GRP78 levels significantly higher (p = 0.0001) among the CAM (374.3 ± 127.3 pg/mL) than the COVID-19 (246.4 ± 67.0 pg/mL) controls. The proportion of subjects with an abnormal GRP78 level (> mean [184.8 pg/mL] plus two SD [23.2 pg/mL] of GRP78 from healthy participants) was 87.5% and 45.8% in the CAM group and COVID-19 controls, respectively. Serum GRP78 level was independently associated with CAM (odds ratio 1.011; 95% confidence interval [1.002-1.019]) after adjusting for diabetes mellitus and hypoxemia during acute COVID-19. CONCLUSION Serum GRP78 levels were significantly higher in CAM than in COVID-19 controls. Further studies are required to the role of GRP78 in the pathogenesis of CAM.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Manpreet Dhaliwal
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunima Sharma
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Nair
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - H Mohan Kumar
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Hansraj Choudhary
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Panda
- Department of Otorhinolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India.
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Zhang Y, Sung AH, Rubinstein E, Benigno M, Chambers R, Patino N, Aram JA. Characterizing patients with rare mucormycosis infections using real-world data. BMC Infect Dis 2022; 22:154. [PMID: 35164701 DOI: 10.1186/s12879-022-07115-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Invasive mucormycosis (IM) is a rare and often life-threatening fungal infection, for which clinical and epidemiological understanding is lacking. Electronic health record (EHR) data can be utilized to elucidate large populations of patients with IM to address this unmet need. This study aimed to descriptively assess data on patients with IM using the Optum® EHR dataset. METHODS US patient data from the Optum® deidentified EHR dataset (2007-2019) were analyzed to identify patients with IM. Patients with hematologic malignancies (HM), at high risk of IM, were selected and sorted by IM diagnosis (ICD9 117.7; ICD10 B46). Demographics, comorbidities/other diagnoses, and treatments were analyzed in patients with IM. RESULTS In total, 1133 patients with HM and IM were identified. Most were between 40 and 64 years of age, Caucasian, and from the Midwest. Essential primary hypertension (50.31%) was the most common comorbidity. Of the 1133 patients, only 33.72% were prescribed an antifungal treatment. The most common antifungal treatments were fluconazole (24.27%) and posaconazole (16.33%), which may have been prophylactic, and any AmB (15.62%). CONCLUSIONS A large population of patients with IM were identified, highlighting the potential of analyzing EHR data to investigate epidemiology, diagnosis, and the treatment of apparently rare diseases.
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Parra Fariñas R, Alonso-Sardón M, Velasco-Tirado V, Galindo Pérez I, Carbonell C, Álvarez Artero E, Romero-Alegría Á, Pardo-Lledías J, Belhassen-García M. "Increasing Incidence of Mucormycosis in Spanish inpatients from 1997-2018". Mycoses 2021; 65:344-353. [PMID: 34951054 DOI: 10.1111/myc.13418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/07/2021] [Accepted: 12/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mucormycosis is a worldwide angio-invasive fungal infection that is associated with high morbidity and mortality. A few European studies have focused on the epidemiology. METHODOLOGY A retrospective longitudinal descriptive study was performed with inpatients diagnosed with mucormycosis (ICD-9-CM, code 117.7, cases 1997-2015; and ICD-10, code B46, cases 2016-2018; along with length of hospital stay) in Spanish public hospitals between 1 January 1997 and 31 December 2018. Data were obtained from the Minimum Basic Data Set (CMBD in Spanish). PRINCIPAL FINDINGS A total of 962 patients were recorded; 665 were men. The mean age (±SD) was 55±18.8 years. The annual incidence rate increased from 0.74 to 1.24 cases per million person-years. The lethality rate was 31.3%. Renal failure (41.6%) and hematological malignancy (36.3%) were the main factors involved. CONCLUSIONS Mucormycosis is a rare infectious disease in Spain, but it has had a significantly increased incidence in the last two decades. Being an adult male and having diabetes, neoplasm or renal failure are the main factors associated. High mortality is usually associated mainly with hematological malignancy and renal failure. CMBD studies could be an efficient tool for assessing changes in the epidemiology of mucormycosis.
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Affiliation(s)
- Raúl Parra Fariñas
- Servicio de Medicina Interna, Hospital Marques de Valdecilla, Universidad de Cantabria, Spain
| | - Montserrat Alonso-Sardón
- Area of Preventive Medicine and Public Health, University of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Salamanca, Spain
| | - Virginia Velasco-Tirado
- Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca (CAUSA), CIETUS, IBSAL, Salamanca, Spain
| | | | | | - Elisa Álvarez Artero
- Servicio de Medicina Interna. Hospital Rio Carrión. Complejo Asistencial de Palencia (CAUPA), Avenida Donantes de Sangre S/N, 34005, Palencia, España
| | | | - Javier Pardo-Lledías
- Servicio de Medicina Interna, Hospital Marques de Vadecilla, Universidad de Cantabria, Instituto de Investigación Valdecilla (IDIVAL), Spain
| | - Moncef Belhassen-García
- Internal Medicine, Infectious Diseases Section, CAUSA, IBSAL, CIETUS, University of Salamanca, Paseo San Vicente 58-182, 37007, Salamanca, Spain
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12
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Yuvaraj M, Mathapati PM, Seena CR, Ramaswami S. Gastric mucormycosis with splenic invasion a rare abdominal complication of COVID-19 pneumonia. J Clin Imaging Sci 2021; 11:62. [PMID: 34877069 PMCID: PMC8645494 DOI: 10.25259/jcis_161_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/25/2021] [Indexed: 12/02/2022] Open
Abstract
Mucormycosis (previously called zygomycosis or phycomycosis) is an uncommon opportunistic infection with the gastrointestinal form being the rarest occurrence and one of the most lethal infections known to humanity. The most common risk factors predisposing to develop gastric mucormycosis are uncontrolled diabetes mellitus, stem cell transplantation, or underlying any hematologic malignancy and major trauma. Pain abdomen, hematemesis, and melena are common symptoms which the patient presents. The exact diagnosis of gastric mucormycosis can be missed due rarity of the disease. A high level of suspicion is required in the early diagnosis and management of disease, particularly in immunocompromised patients. The radiological imaging modalities such as CT scan or MRI of the abdomen initially usually reveal non-specific findings such as mucosal wall thickening, mass, and reactive lymphadenopathy and prompt additional investigation with endoscopic or surgical biopsy of the lesions. The disease outcome and mortality are very high with gastrointestinal mucormycosis.
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Affiliation(s)
- M Yuvaraj
- Department of Radio-diagnosis, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Pavankumar M Mathapati
- Department of Radio-diagnosis, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
| | - C R Seena
- Department of Radio-diagnosis, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Sukumar Ramaswami
- Department of Radio-diagnosis, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
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13
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Nambiar M, Varma SR, Damdoum M. Post-Covid alliance-mucormycosis, a fatal sequel to the pandemic in India. Saudi J Biol Sci 2021; 28:6461-6464. [PMID: 34305427 PMCID: PMC8270736 DOI: 10.1016/j.sjbs.2021.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 12/17/2022] Open
Abstract
As the battle against the deadly Covid-19 pandemic is still continuing worldwide, several complications are being reported in patients who have recovered post-covid. One such lethal complication being reported in patients in India in recent times, who have tested positive for Covid-19 and are gradually recovering, is a fungal disease called Mucormycosis or the black fungus. With several hundreds of cases being reported all over the country, it has triggered an additional wave of panic among the general public. Post-Covid-19 patients who are more vulnerable to Mucormycosis are those with a history of poorly controlled diabetes mellitus and also those who are immuno-compromised and have been treated with steroids and other drugs for Covid-19. The aim of this short review is to briefly cover the epidemiology of mucormycosis, its possible pathophysiology in Post Covid scenario, the clinical presentation and its diagnosis and management.
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Affiliation(s)
- Manjusha Nambiar
- Department of Periodontics, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Banguluru, Karnataka State 560032, India
| | - Sudhir Rama Varma
- Department of Clinical Sciences, Ajman University, Ajman, United Arab Emirates.,Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Marah Damdoum
- Department of Clinical Sciences, Ajman University, Ajman, United Arab Emirates
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14
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Fernández-García O, Guerrero-Torres L, Roman-Montes CM, Rangel-Cordero A, Martínez-Gamboa A, Ponce-de-Leon A, Gonzalez-Lara MF. Isolation of Rhizopus microsporus and Lichtheimia corymbifera from tracheal aspirates of two immunocompetent critically ill patients with COVID-19. Med Mycol Case Rep 2021; 33:32-7. [PMID: 34307008 DOI: 10.1016/j.mmcr.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022] Open
Abstract
We describe two fatal cases of COVID-19 in which Rhizopus microsporus and Lichtheimia corymbifera were cultured from endotracheal aspirate samples. Both patients had no underlying comorbidities other than obesity. Despite antifungal therapy, both cases developed septic shock and progressive refractory hypoxemia without evidence of other underlying infections. It is unclear whether isolation of these fungal organisms represents invasive disease or corresponds to an epiphenomenon of critical illness. Yet, patients suffering from COVID-19 may be at risk of superinfection from a broader range of fungal organisms than previously thought.
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15
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Yousaf M, Salameh S, Haq IU, Alhyassat S, Thomas M, Hussain A, Wani M, Massad E, Hadi HA, Sattar HA, Hameed M. Challenges in the diagnosis of pulmonary mucormycosis in a diabetic with a review of literature. Respir Med Case Rep 2021; 33:101474. [PMID: 34401308 PMCID: PMC8349084 DOI: 10.1016/j.rmcr.2021.101474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022] Open
Abstract
Diabetes Mellitus appears to be the most common underlying condition associated with mucormycosis; a rare opportunistic fungal infection associated with high morbidity and mortality. Pulmonary mucormycosis may mimic pneumonia and thus pose challenges in achieving a timely diagnosis critical to successful outcomes. We present a case of a 65-year-old diabetic who presented with fever and haemoptysis that was managed as pneumonia. A bronchial alveolar lavage grew Rhizopus mould that was thought to be a contaminant as he responded well to antibiotics. He required another admission in 4 weeks due to worsening symptoms. Failure to respond to antibiotics and ongoing clinical and radiological deterioration led to a lobectomy that confirmed a diagnosis of pulmonary mucormycosis. He responded well to surgical resection and antifungal therapy with a complete recovery. Elusive clinical presentation and insensitive conventional diagnostic techniques may make the diagnosis of mucormycosis challenging. Our case reports highlight the issues involved in the diagnosis and management of pulmonary Mucormycosis mimicking as pneumonia.
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Affiliation(s)
- Muhammad Yousaf
- Hazm Mebaireek Hospital, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Sarah Salameh
- Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.,Communicable Diseases Centre, Hamad Medical Corporation, Qatar
| | - Irfan Ul Haq
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Samir Alhyassat
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Qatar
| | - Merlin Thomas
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Aisha Hussain
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohd Wani
- Department of Cardiothoracic Surgery, Hamad Medical Corporation, Qatar
| | - Ehab Massad
- Department of Cardiothoracic Surgery, Hamad Medical Corporation, Qatar
| | | | | | - Mansoor Hameed
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
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16
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Banerjee I, Robinson J, Asim M, Sathian B, Banerjee I. Mucormycosis and COVID-19 an epidemic in a pandemic? Nepal J Epidemiol 2021; 11:1034-1039. [PMID: 34290893 PMCID: PMC8266401 DOI: 10.3126/nje.v11i2.37342] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022] Open
Abstract
Mucormycosis and aspergillosis are rare, invasive and life-threatening infections primarily caused by Rhizopus arrhizus and Aspergillus fumigatus with higher case fatality rates (>50%), respectively. Invasive Aspergillosis and Mucormycosis have been established and recognized as complications of the SARS-CoV-2 infection. Such cases have been intimately linked and related to prior corticosteroid therapy. With the new highly infectious Delta strain (B.1.617.2 and B.1.617.2.1 or AY.1) of the coronavirus which is running rampant throughout India causing unprecedented death tolls, a new crisis is evolving. Invasive "black fungus" (Mucormycosis) is creating an epidemic within a global pandemic. The unique socio-economic, genetic and health status of Indian population culminates into a melting pot which sustains the viable triad for the "black fungus" infection to gain a stronghold. Diabetes mellitus, immunosuppression and the current COVID-19 global pandemic with its massive surges in the country have produced the "perfect storm." Ophthalmologist across India have reported a surge in invasive Mucormycosis cases with a rise in orbital compartment syndrome often calling for radical procedures such as enucleation surgeries. The "black fungus" pandemic and invasive Mucormycosis resulted in the sinister secondary infections and complications are closely linked with the COVID-19 infection in India. It is therefore of the upmost importance that neighbouring countries particularly Nepal and other Asiatic nations take great cognizance of this indolent "black fungus killer" and ensure new screening and testing protocols for early identification to ensure effective management.
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Affiliation(s)
| | - Jared Robinson
- Sir Seewoosagur Ramgoolam Medical College, Belle Rive, Mauritius
| | | | - Brijesh Sathian
- Geriatric and long term care Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Indraneel Banerjee
- Uro oncologist and Robotic Surgeon, Apollo multi speciality Hospitals, Kolkata, West Bengal, India
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17
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Khatri A, Chang KM, Berlinrut I, Wallach F. Mucormycosis after Coronavirus disease 2019 infection in a heart transplant recipient - Case report and review of literature. J Mycol Med 2021; 31:101125. [PMID: 33857916 PMCID: PMC8017948 DOI: 10.1016/j.mycmed.2021.101125] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/15/2022]
Abstract
Mucormycosis is an invasive fungal infection (IFI) due to several species of saprophytic fungi, occurring in patients with underlying co-morbidities (including organ transplantation). During the ongoing Coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal co-infections occurring in COVID-19 patients, including COVID-19 associated pulmonary aspergillosis (CAPA). We describe a case of mucormycosis occurring after COVID-19, in an individual who received a recent heart transplant for severe heart failure. Two months after heart transplant, our patient developed upper respiratory and systemic symptoms and was diagnosed with COVID-19. He was managed with convalescent plasma therapy and supportive care. Approximately three months after COVID-19 diagnosis, he developed cutaneous mucormycosis at an old intravascular device site. He underwent extensive surgical interventions, combined with broad-spectrum antifungal therapy. Despite the aggressive therapeutic measures, he died after a prolonged hospital stay. In this case report, we also review the prior well-reported cases of mucormycosis occurring in COVID-19 patients and discuss potential mechanisms by which COVID-19 may predispose to IFIs. Similar to CAPA, mucormycosis with COVID-19 may need to be evaluated as an emerging disease association. Clinicians should be vigilant to evaluate for invasive fungal infections such as mucormycosis in patients with COVID-19 infection.
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Affiliation(s)
- Akshay Khatri
- Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 400 Community Drive, Infectious Diseases Suite, 11030 Manhasset, NY, USA.
| | - Kai-Ming Chang
- Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 400 Community Drive, Infectious Diseases Suite, 11030 Manhasset, NY, USA.
| | - Ilan Berlinrut
- Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 400 Community Drive, Infectious Diseases Suite, 11030 Manhasset, NY, USA.
| | - Frances Wallach
- Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 400 Community Drive, Infectious Diseases Suite, 11030 Manhasset, NY, USA.
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18
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Galletta K, Alafaci C, D'Alcontres FS, Maria ME, Cavallaro M, Ricciardello G, Vinci S, Grasso G, Granata F. Imaging features of perineural and perivascular spread in rapidly progressive rhino-orbital-cerebral mucormycosis: A case report and brief review of the literature. Surg Neurol Int 2021; 12:245. [PMID: 34221576 PMCID: PMC8247725 DOI: 10.25259/sni_275_2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/30/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Rhinocerebral mucormycosis (ROCM) is an opportunistic fungal infection originating from the paranasal sinuses with extension to the brain. A delayed diagnosis can rapidly result in a poor prognosis. ROCM commonly affects patients with diabetes or immunocompromised states with a variable progression. Case Description: We report the case of a 59-year old patient with an untreated diabetes who developed a ROCM with rapidly progressive neurological symptoms. From the onset of sinus pain, nasal congestion, he rapidly developed facial swelling and masticatory dysfunction. The patient underwent sinus surgery which allowed Rhizopus oryzae to be isolated. Accordingly, a systemic therapy by intensive intravenous amphotericin B was started. Nevertheless, the infection rapidly resulted in bilateral cavernous sinuses thrombosis and occlusion of the left internal carotid artery providing the subsequent patient death. Conclusion: Mucormycosis is a life-threatening fungal infection in diabetic and/or immunosuppressed patients. Our case demonstrates the three main mechanisms for infection spreading that are direct, perineural, and perivascular diffusion. Clear identification of the main risk factors, proper assessment of clinical features, and radiological findings may improve the chance for an early diagnosis and patient survival.
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Affiliation(s)
- Karol Galletta
- Department of Biomedical, Dental Science and Morphological and Functional Images, Messina, Italy
| | - Concetta Alafaci
- Department of Biomedical Sciences and Morphological and Functional Imaging, Section of Neurosurgery, Messina, Italy
| | | | - Mormina Enrico Maria
- Department of Biomedical, Dental Science and Morphological and Functional Images, Messina, Italy
| | - Marco Cavallaro
- Department of Biomedical, Dental Science and Morphological and Functional Images, Messina, Italy
| | - Giorgia Ricciardello
- Department of Biomedical, Dental Science and Morphological and Functional Images, Messina, Italy
| | - Sergio Vinci
- Department of Biomedical, Dental Science and Morphological and Functional Images, Messina, Italy
| | - Giovanni Grasso
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Neurosurgery, University of Palermo, Palermo, Italy
| | - Francesca Granata
- Department of Biomedical, Dental Science and Morphological and Functional Images, Messina, Italy
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19
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Garg D, Muthu V, Sehgal IS, Ramachandran R, Kaur H, Bhalla A, Puri GD, Chakrabarti A, Agarwal R. Coronavirus Disease (Covid-19) Associated Mucormycosis (CAM): Case Report and Systematic Review of Literature. Mycopathologia 2021; 186:289-298. [PMID: 33544266 PMCID: PMC7862973 DOI: 10.1007/s11046-021-00528-2] [Citation(s) in RCA: 301] [Impact Index Per Article: 100.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/15/2021] [Indexed: 12/16/2022]
Abstract
Severe coronavirus disease (COVID-19) is currently managed with systemic glucocorticoids. Opportunistic fungal infections are of concern in such patients. While COVID-19 associated pulmonary aspergillosis is increasingly recognized, mucormycosis is rare. We describe a case of probable pulmonary mucormycosis in a 55-year-old man with diabetes, end-stage kidney disease, and COVID-19. The index case was diagnosed with pulmonary mucormycosis 21 days following admission for severe COVID-19. He received 5 g of liposomal amphotericin B and was discharged after 54 days from the hospital. We also performed a systematic review of the literature and identified seven additional cases of COVID-19 associated mucormycosis (CAM). Of the eight cases included in our review, diabetes mellitus was the most common risk factor. Three subjects had no risk factor other than glucocorticoids for COVID-19. Mucormycosis usually developed 10–14 days after hospitalization. All except the index case died. In two subjects, CAM was diagnosed postmortem. Mucormycosis is an uncommon but serious infection that complicates the course of severe COVID-19. Subjects with diabetes mellitus and multiple risk factors may be at a higher risk for developing mucormycosis. Concurrent glucocorticoid therapy probably heightens the risk of mucormycosis. A high index of suspicion and aggressive management is required to improve outcomes.
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Affiliation(s)
- Deepak Garg
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Raja Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Goverdhan D Puri
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India.
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20
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Muthu V, Agarwal R, Dhooria S, Sehgal IS, Prasad KT, Aggarwal AN, Chakrabarti A. Has the mortality from pulmonary mucormycosis changed over time? A systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:538-549. [PMID: 33418022 DOI: 10.1016/j.cmi.2020.12.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/25/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Pulmonary mucormycosis (PM) is increasingly being reported in immunocompromised patients and has a high mortality. Our aim was to assess the mortality of PM and its trend over time. We also evaluated the role of combined medical-surgical therapy in PM. METHODS We performed a systematic review of Pubmed, Embase, and Cochrane central databases. Studies were eligible if they described at least five confirmed cases of PM and reported mortality. We also assessed the effect of combined medical-surgical therapy versus medical treatment alone on PM mortality. We used a random-effects model to estimate the pooled mortality of PM and compared it across three time periods. The factors influencing mortality were assessed using meta-regression. We evaluated the risk difference (RD) of death in the following: subjects undergoing combined medical-surgical therapy versus medical therapy alone, subjects with isolated PM versus disseminated disease, and PM in diabetes mellitus (DM) versus non-DM as a risk factor. RESULTS We included 79 studies (1544 subjects). The pooled mortality of PM was 57.1% (95% confidence interval [CI] 51.7-62.6%). Mortality improved significantly over time (72.1% versus 58.3% versus 49.8% for studies before 2000, 2000-2009, and 2010-2020, respectively, p 0.00001). This improved survival was confirmed in meta-regression after adjusting for the study design, the country's income level, and the sample size. Combined medical-surgical therapy was associated with a significantly lower RD (95%CI) of death: -0.32 (-0.49 to -0.16). The disseminated disease had a higher risk of death than isolated PM, but DM was not associated with a higher risk of death than other risk factors. CONCLUSIONS While PM is still associated with high mortality, we noted improved survival over time. Combined medical-surgical therapy improved survival compared to medical treatment alone.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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21
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Badiee P, Jafarian H, Ghasemi F. Molecular epidemiology of zygomycosis and their related factors in tertiary referral centers in southern Iran. J Infect Dev Ctries 2020; 14:1424-1430. [PMID: 33378285 DOI: 10.3855/jidc.12997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/11/2020] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION For the best management of the zygomycosis in immunocompromised patients, the present study aims to detect and identify the etiologic agents by DNA sequencing method and their related factors in clinical samples of patients. METHODOLOGY Clinical samples from 1,058 patients admitted in 11 university hospitals in Shiraz, Southern Iran were collected between July 2015 and July 2018. All samples (bronchoalveolar lavage, sputum, blood, tissue) were examined by routine microscopic and culture tests for zygomycetes. The etiologic agents were identified by the molecular method and sequencing. RESULTS Direct microscopic examinations or pathology smear, culture, and PCR were positive in 61 (5.8%), 15 (1.4%), and 103 (9.7%) patients, respectively. According to EORTC/MSG criteria, the rates of proven, probable, and possible zygomycosis were 59.2% (61/103), 14.6% (15/103), and 26.2% (27/103 patients), respectively. The most prevalent etiologic agents according to sequencing were Rhizopus oryzae (44 cases), Rhizopus microsporus (31 cases), Rhizopus stolonifer (15 cases). Twenty-two patients (21.4%) with positive PCR died. There were significant relations between zygomycosis and the underlying disease (p = 0.043) and prior antifungal therapy (p = 0.023). White blood cell count was in the normal range in 14.1% of patients, and the means of erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) were 65 mm/hour and 57 mg/L, respectively. CONCLUSIONS Molecular methods and sequencing may have considered as suitable tools to diagnose zygomycosis. Identification of the etiologic agents may be considered as the future antifungal therapy and management of the respective patients.
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Affiliation(s)
- Parisa Badiee
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hadis Jafarian
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Fatemeh Ghasemi
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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22
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Halvorson TS, Isaacson AL, Ford BA, Firchau DJ. The Postmortem Features of Mucormycosis. Acad Forensic Pathol 2020; 10:72-80. [PMID: 33282040 DOI: 10.1177/1925362120960918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/23/2020] [Indexed: 11/15/2022]
Abstract
Mucormycosis is a rare and severe invasive fungal infection caused by ubiquitous fungi of the order Mucorales. Infection often occurs in immunocompromised hosts and includes cutaneous, pulmonary, gastrointestinal, rhinocerebral, and disseminated forms of disease. Although the clinical characteristics of mucormycosis are well established, infection can be difficult to diagnose antemortem, resulting in frequent postmortem diagnoses. Despite this, the gross appearance of mucormycosis at autopsy has not been well described. In the present report we illustrate the gross and histologic findings in four autopsy cases of mucormycosis, including one case of pulmonary disease and three cases of disseminated mucormycosis with cerebral, pulmonary, hepatic, renal, and gastrointestinal involvement. In all cases autopsy examination demonstrated characteristic hemorrhagic infarcts with a targetoid appearance in the affected organs. These findings are secondary to fungal angioinvasion with subsequent thrombosis and tissue necrosis. Mucormycosis should be suspected at autopsy when these characteristic infarcts are identified within the proper clinical context, and a high suspicion for atypical infections should be maintained postmortem in immunosuppressed patients.
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23
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Monte Junior ESD, Santos MELD, Ribeiro IB, Luz GDO, Baba ER, Hirsch BS, Funari MP, de Moura EGH. Rare and Fatal Gastrointestinal Mucormycosis ( Zygomycosis) in a COVID-19 Patient: A Case Report. Clin Endosc 2020; 53:746-749. [PMID: 33207116 PMCID: PMC7719411 DOI: 10.5946/ce.2020.180] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/05/2020] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus disease (COVID-19) quickly spread to all continents. However, data regarding all the signs and symptoms of COVID-19 are insufficient. Patients with COVID-19 might present higher susceptibility to fungal coinfections. Mucormycosis is a rare and often life-threatening fungal disease characterized by vascular invasion by hyphae, resulting in thrombosis and necrosis. This is the first case report of mucormycosis in a COVID-19 patient. An 86-year-old male patient was admitted to the emergency room with acute diarrhea, cough, dyspnea, and fever from 5 days prior. Blood tests revealed a hemoglobin level of 14.3 mg/dL. Five days following the admission, the patient presented with melena and a hemoglobin level of 5.6 mg/dL. A transfusion of three units of red blood cells was required. Esophagogastroduodenoscopy revealed two giant gastric ulcers with necrotic debris and a deep hemorrhagic base without active bleeding. Furthermore, biopsies confirmed mucormycosis. Despite intensive care, the patient died 36 hours after the esophagogastroduodenoscopy.
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Affiliation(s)
| | - Marcos Eduardo Lera Dos Santos
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Gustavo de Oliveira Luz
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Elisa Ryoka Baba
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Bruno Salomão Hirsch
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Mateus Pereira Funari
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
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Al Hassan F, Aljahli M, Molani F, Almomen A. Rhino-orbito-cerebral mucormycosis in patients with uncontrolled diabetes: A case series. Int J Surg Case Rep 2020; 73:324-327. [PMID: 32738774 PMCID: PMC7393455 DOI: 10.1016/j.ijscr.2020.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/12/2020] [Accepted: 07/12/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Mucormycosis is a rare, aggressive, and invasive disease with a fatal outcome. It most commonly affects patients with compromised immunity, particularly those with poorly controlled diabetes. We present a case series of patients with uncontrolled diabetes and mucormycosis. PRESENTATION OF CASE We present a series of three patients with uncontrolled diabetes, with main symptoms of paranasal sinusitis, nasal discharge, ophthalmic changes, and facial nerve involvement. Diagnoses of mucormycosis were made via microbiological testing and computed tomography. These cases were managed by combination therapy of tight glycemic control, urgent endoscopic sinus debridement, and antifungal therapy. DISCUSSION Diagnosing rhino-orbito-cerebral mucormycosis requires a high degree of suspicion and both microbiologic and microscopic evidence. Better clinical outcomes can be obtained by combining medical and surgical management. CONCLUSION We describe our experience in handling three cases of poorly controlled diabetes with rhino-orbito-cerebral mucormycosis.
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Affiliation(s)
- Fatimah Al Hassan
- Department of Surgery, King Fahad Specialist Hospital, Al Muraikebat Area, Ammar Bin Thabet Street, PO Box 15215, Dammam, 31444, Saudi Arabia.
| | - Marwah Aljahli
- Department of Surgery, King Fahad Specialist Hospital, Al Muraikebat Area, Ammar Bin Thabet Street, PO Box 15215, Dammam, 31444, Saudi Arabia
| | - Fadel Molani
- Department of Medical Imaging, King Fahad Specialist Hospital, Al Muraikebat Area, Ammar Bin Thabet Street, PO Box 15215, Dammam, 31444, Saudi Arabia
| | - Ali Almomen
- Department of Surgery, King Fahad Specialist Hospital, Al Muraikebat Area, Ammar Bin Thabet Street, PO Box 15215, Dammam, 31444, Saudi Arabia
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Chaiyasate S, Salee P, Sukapan K, Teeranoraseth T, Roongrotwattanasiri K. Rhinofacial entomophthoramycosis case series, the unusual cause of facial swelling. Ann Med Surg (Lond) 2020; 57:41-45. [PMID: 32714524 PMCID: PMC7369423 DOI: 10.1016/j.amsu.2020.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/07/2020] [Accepted: 07/11/2020] [Indexed: 10/28/2022] Open
Abstract
Background Rhinofacial entomophthoramycosis is a specific fungal infection of the skin and subcutaneous tissue. It is considered as a rare and neglected disease in tropical and subtropical areas. We would like to present our cases to aid other physicians in the improved recognition of typical cases. Materials and methods A retrospective review was performed on patients with the diagnosis of Conidiobolomycosis or Entomophthoramycosis in Chiang Mai University Hospital, Thailand, from January 2009 to May 2019. There were seven cases with a definite pathologic report or culture in this review. Results All seven patients were men and were referred to the university hospital for diagnosis. The mean age was 53 ± 15.7, ranging from 27 to 71 years. Most of the patients (85.7%) presented first with nasal or rhinofacial swelling and nasal obstruction. The definite diagnosis came from clinical presentation and investigation with a tissue biopsy, culture and communication among physicians. Patients responded well with a combination of medical treatment, including potassium iodide (KI), co-trimoxazole, or itraconazole. Conclusion Rhinofacial entomophthoromycosis or Conidiobolomycosis typically can be diagnosed under a suspicious clinical presentation. The obvious clinical response can be seen within several weeks after medication.
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Affiliation(s)
- Saisawat Chaiyasate
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Parichat Salee
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Kornkanok Sukapan
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Tanyathorn Teeranoraseth
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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26
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Hiramoto R, Miyachi M, Nitta Y, Yoshida H, Kuwahara Y, Tsuchiya K, Iehara T, Yarita K, Kamei K, Hosoi H. Detection of circulating fungal DNA by polymerase chain reaction in a fatal case of Cunninghamella bertholletiae infection. IDCases 2020; 20:e00760. [PMID: 32461900 PMCID: PMC7240320 DOI: 10.1016/j.idcr.2020.e00760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 03/22/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Cunninghamella bertholletiae although rarely causing mucormycosis, is responsible for the highest mortality among mucormycetes. The diagnosis of mucormycosis is challenged by the absence of specific biomarkers. Herein, we report a fatal case of C. bertholletiae infection and detection of its DNA in the serum by polymerase chain reaction (PCR). Presentation of case A 23-year-old male with refractory osteosarcoma was admitted with multiple lung metastases. He was on oral voriconazole prophylaxis after pulmonary aspergillosis. He suffered from fever during temporary neutropenia following chemotherapy and showed several neurological and respiratory symptoms. Despite liposomal-amphotericin B administration, the symptoms rapidly progressed, and he died five days after the onset of neurological symptoms. We retrospectively evaluated the filamentous fungus isolated after his death from gastric juices. Based on the sequence of the internal transcribed spacer (ITS) region we identified the fungal isolate as C. bertholletiae. A 146-bp portion of the D1/D2 region was quantified by quantitative-PCR using DNA extracted from the serum. C. bertholletiae DNA load in the serum was 18.0 copies/μL on the day of onset of neurological symptoms, with the highest (101.0 copies/μL) on the day of his death. Discussion Detection of circulating DNA of mucormycetes in the blood would greatly enhance the diagnosis of mucormycosis. Rapid diagnosis might alleviate mortality due to mucormycosis. Conclusion The present case-report suggests that the quantification of C. bertholletiae DNA in the serum could be useful for the diagnosis and evaluation of mucormycosis pathogenesis in patients.
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Affiliation(s)
- Rika Hiramoto
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Mitsuru Miyachi
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yoshihiro Nitta
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hideki Yoshida
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yasumichi Kuwahara
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kunihiko Tsuchiya
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tomoko Iehara
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kyoko Yarita
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Katsuhiko Kamei
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Hajime Hosoi
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Patel A, Kaur H, Xess I, Michael JS, Savio J, Rudramurthy S, Singh R, Shastri P, Umabala P, Sardana R, Kindo A, Capoor MR, Mohan S, Muthu V, Agarwal R, Chakrabarti A. A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India. Clin Microbiol Infect 2019; 26:944.e9-944.e15. [PMID: 31811914 DOI: 10.1016/j.cmi.2019.11.021] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/12/2019] [Accepted: 11/17/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To describe the epidemiology, management and outcome of individuals with mucormycosis; and to evaluate the risk factors associated with mortality. METHODS We conducted a prospective observational study involving consecutive individuals with proven mucormycosis across 12 centres from India. The demographic profile, microbiology, predisposing factors, management and 90-day mortality were recorded; risk factors for mortality were analysed. RESULTS We included 465 patients. Rhino-orbital mucormycosis was the most common (315/465, 67.7%) presentation followed by pulmonary (62/465, 13.3%), cutaneous (49/465, 10.5%), and others. The predisposing factors included diabetes mellitus (342/465, 73.5%), malignancy (42/465, 9.0%), transplant (36/465, 7.7%), and others. Rhizopus species (231/290, 79.7%) were the most common followed by Apophysomyces variabilis (23/290, 7.9%), and several rare Mucorales. Surgical treatment was performed in 62.2% (289/465) of the participants. Amphotericin B was the primary therapy in 81.9% (381/465), and posaconazole was used as combination therapy in 53 (11.4%) individuals. Antifungal therapy was inappropriate in 7.6% (30/394) of the individuals. The 90-day mortality rate was 52% (242/465). On multivariate analysis, disseminated and rhino-orbital (with cerebral extension) mucormycosis, shorter duration of symptoms, shorter duration of antifungal therapy, and treatment with amphotericin B deoxycholate (versus liposomal) were independent risk factors of mortality. A combined medical and surgical management was associated with a better survival. CONCLUSIONS Diabetes mellitus was the dominant predisposing factor in all forms of mucormycosis. Combined surgical and medical management was associated with better outcomes. Several gaps surfaced in the management of mucormycosis. The rarer Mucorales identified in the study warrant further evaluation.
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Affiliation(s)
- A Patel
- Department of Infectious Diseases, Sterling Hospital, Ahmedabad, India; Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - H Kaur
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - I Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - J S Michael
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - J Savio
- St John's Medical College Hospital, Bangalore, India
| | - S Rudramurthy
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Singh
- Department of Microbiology, JIPMER, Pondicherry, India
| | - P Shastri
- Intensive Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - P Umabala
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - R Sardana
- Department of Microbiology, Indraprastha Apollo Hospital, New Delhi, India
| | - A Kindo
- Department of Microbiology, Sri Ramachandra Medical College, Chennai, India
| | - M R Capoor
- Vardhman Mahaveer Medical College and Safdarjang Hospital, New Delhi, India
| | - S Mohan
- Department of Microbiology, Christian Medical College, Ludhiana, India
| | - V Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Chakrabarti
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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28
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Athanasiadou KI, Athanasiadis DI, Constantinidis J, Anastasiou A, Roilides E, Papakonstantinou E. Successful treatment of rhinoorbital mucormycosis due to Rhizopus arrhizus with liposomal amphotericin B, posaconazole and surgical debridement in a child with neuroblastoma. Med Mycol Case Rep 2019; 25:10-14. [PMID: 31245270 PMCID: PMC6582074 DOI: 10.1016/j.mmcr.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/14/2019] [Accepted: 06/07/2019] [Indexed: 11/20/2022] Open
Abstract
Mucormycosis is a rare but potentially mortal opportunistic infection caused by Mucorales. We present a case of rhinoorbital mucormycosis in an 11-year old male with neuroblastoma successfully treated with aggressive surgical debridement and antifungal combination of liposomal amphotericin B and posaconazole. Our patient developed signs of paranasal sinus infection and culture of fine needle biopsy grew Rhizopus arrhizus. Prompt treatment and drastic surgical resection led to complete clinical and radiological recovery without evidence of mucormycosis relapse.
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Affiliation(s)
- Kleoniki I Athanasiadou
- Pediatric Oncology Department, Hippokration Hospital, Konstantinoupoleos 49, GR-546 42, Thessaloniki, Greece
| | - Dimitrios I Athanasiadis
- Department of Surgery, Papageorgiou University Hospital, Aristotle University of Thessaloniki, Region of Efkarpia, GR-564 03, Thessaloniki, Greece
| | - John Constantinidis
- Otorhinolaryngology Department, Papageorgiou University Hospital, Aristotle University of Thessaloniki, Region of Efkarpia, GR-564 03, Thessaloniki, Greece
| | - Athanasia Anastasiou
- Department of Radiology, Hippokration Hospital, Konstantinoupoleos 49, GR-546 42, Thessaloniki, Greece
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Hippokration Hospital, Aristotle University School of Medicine, Konstantinoupoleos 49, GR-546 42, Thessaloniki, Greece
| | - Evgenia Papakonstantinou
- Pediatric Oncology Department, Hippokration Hospital, Konstantinoupoleos 49, GR-546 42, Thessaloniki, Greece
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Hassan MIA, Voigt K. Pathogenicity patterns of mucormycosis: epidemiology, interaction with immune cells and virulence factors. Med Mycol 2019; 57:S245-S256. [PMID: 30816980 PMCID: PMC6394756 DOI: 10.1093/mmy/myz011] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/20/2018] [Accepted: 02/13/2019] [Indexed: 12/14/2022] Open
Abstract
Fungi of the basal lineage order Mucorales are able to cause infections in animals and humans. Mucormycosis is a well-known, life-threatening disease especially in patients with a compromised immune system. The rate of mortality and morbidity caused by mucormycosis has increased rapidly during the last decades, especially in developing countries. The systematic, phylogenetic, and epidemiological distributions of mucoralean fungi are addressed in relation to infection in immunocompromised patients. The review highlights the current achievements in (i) diagnostics and management of mucormycosis, (ii) the study of the interaction of Mucorales with cells of the innate immune system, (iii) the assessment of the virulence of Mucorales in vertebrate and invertebrate infection models, and (iv) the determination of virulence factors that are key players in the infection process, for example, high-affinity iron permease (FTR1), spore coat protein (CotH), alkaline Rhizopus protease enzyme (ARP), ADP-ribosylation factor (ARF), dihydrolipoyl dehydrogenase, calcineurin (CaN), serine and aspartate proteases (SAPs). The present mini-review attempts to increase the awareness of these difficult-to-manage fungal infections and to encourage research in the detection of ligands and receptors as potential diagnostic parameters and drug targets.
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Affiliation(s)
- Mohamed I Abdelwahab Hassan
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, Adolf-Reichwein-Strasse 23, 07745 Jena, Germany
- Department of Microbiology and Molecular Biology, Institute of Microbiology, Faculty of Biological Sciences, University of Jena, Neugasse 25, 07743 Jena, Germany
- Pests and Plant Protection Department, National Research Centre, 33rd El Buhouth Street (Postal code: 12622) Dokki, Giza, Egypt
| | - Kerstin Voigt
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, Adolf-Reichwein-Strasse 23, 07745 Jena, Germany
- Department of Microbiology and Molecular Biology, Institute of Microbiology, Faculty of Biological Sciences, University of Jena, Neugasse 25, 07743 Jena, Germany
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30
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Deak L, Mudalagiriyappa S, Ballin A, Saxton D, Chakrabarti A. A Rhinofacial Conidiobolus coronatus Fungal Infection Presenting as an Intranasal Tumour. Sultan Qaboos Univ Med J 2019; 18:e549-e552. [PMID: 30988980 DOI: 10.18295/squmj.2018.18.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/09/2018] [Accepted: 09/27/2018] [Indexed: 11/16/2022] Open
Abstract
Conidiobolomycosis is a rare fungal infection that affects adults in tropical regions. We report a 42-year-old male patient who was referred to the Sulaiman Al Habib Hospital, Dubai, United Arab Emirates (UAE), in 2013 with excessive nasal bleeding and a suspected nasal tumour. He reported having briefly visited central India nine months previously. Computed tomography and magnetic resonance imaging showed a highly vascularised mass in the nasal cavity. However, after surgical excision, initial treatment with amphotericin B deoxycholate was unsuccessful and the disease progressed, leading to external and internal nasal deformation and necessitating further excision and facial reconstruction. Histopathological analysis of the second biopsy revealed Splendore-Hoeppli changes consistent with a fungal infection. Microbiological findings subsequently confirmed Conidiobolus coronatus. Subsequently, the patient was successfully treated with a combination of itraconazole and fluconazole. To the best of the authors' knowledge, this is the first report of a case of rhinofacial conidiobolomycosis from the UAE.
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Affiliation(s)
- Levente Deak
- Department of Ear, Nose & Throat, Suliaman Al Habib Hospital, Dubai, UAE
| | | | - Annelyse Ballin
- Department of Ear, Nose & Throat, Al Zahra Hospital, Dubai, UAE
| | - David Saxton
- Department of Ear, Nose & Throat, Suliaman Al Habib Hospital, Dubai, UAE
| | - Arunaloke Chakrabarti
- Center of Advanced Research in Medical Mycology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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31
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Tanaka Y, Toyotome T, Inokuma H, Watanabe KI, Kobayashi Y, Horiuchi N. Rhinocerebral Zygomycosis Due to a Lichtheimia ramosa Infection in a Calf: Neural Spread Through the Olfactory Nerves. Mycopathologia 2019; 184:141-6. [PMID: 30168079 DOI: 10.1007/s11046-018-0296-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
Here, we report a case of rhinocerebral zygomycosis due to a Lichtheimia ramosa infection in a calf. A histopathological examination revealed that a fungus had invaded the brain through the olfactory nerves. Lichtheimia ramosa was detected by polymerase chain reaction analysis of DNA extracted from formalin-fixed paraffin-embedded samples of the affected tissue. This is the first case of rhinocerebral zygomycosis to involve cattle. Also, this is the first such case to involve fungal invasion into the central nervous system through the cranial nerve itself, rather than through perineural tissue.
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32
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Jenks JD, Reed SL, Seidel D, Koehler P, Cornely OA, Mehta SR, Hoenigl M. Rare mould infections caused by Mucorales, Lomentospora prolificans and Fusarium, in San Diego, CA: the role of antifungal combination therapy. Int J Antimicrob Agents 2018; 52:706-712. [PMID: 30099056 DOI: 10.1016/j.ijantimicag.2018.08.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/29/2018] [Accepted: 08/04/2018] [Indexed: 12/31/2022]
Abstract
Non-Aspergillus invasive mould infections (IMIs) are associated with devastating morbidity and mortality rates and are increasingly diagnosed in immunocompromised hosts. The aim of this study was to describe the epidemiology and outcomes of non-Aspergillus IMIs at a university hospital in San Diego, California, USA. A retrospective chart review of the medical records of all patients with cultures growing non-Aspergillus moulds at the microbiology laboratory in the Center for Academic Laboratory Medicine, Department of Pathology, University of California, San Diego (UCSD) Health between mid-2014 and mid-2017 (3-year period) was performed. A total of 23 cases of non-Aspergillus IMI were identified, including 10 cases of mucormycosis, 8 cases of lomentosporiosis and 5 cases of fusariosis. Antifungal susceptibility testing was performed for 14 isolates, and 10/11 Fusarium and Lomentospora isolates had minimum inhibitory concentrations (MICs) of >16 µg/mL for voriconazole and/or posaconazole. Overall 180-day mortality was significantly lower among those who received combination antifungal therapy than among those who received single-agent therapy [3/13 (23%) vs. 9/10 (90%); P = 0.003]. In conclusion, Lomentospora prolificans (35% of non-Aspergillus IMIs) and Fusarium spp. (22%) accounted for high proportions of non-Aspergillus IMIs during the study period. Non-Aspergillus IMIs were detected in patients with various underlying diseases and were associated with high mortality rates, which was significantly lower in those who received antifungal combination therapy.
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Affiliation(s)
- Jeffrey D Jenks
- Department of Medicine, University of California, San Diego, San Diego, CA, USA.
| | - Sharon L Reed
- Department of Medicine, University of California, San Diego, San Diego, CA, USA; Department of Pathology, University of California, San Diego, San Diego, CA, USA
| | - Danila Seidel
- Department of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University Hospital Cologne, and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Philipp Koehler
- Department of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University Hospital Cologne, and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Oliver A Cornely
- Department of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University Hospital Cologne, and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Sanjay R Mehta
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Martin Hoenigl
- Department of Medicine, University of California, San Diego, San Diego, CA, USA; Department of Medicine, Medical University of Graz, Graz, Austria.
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Sharifpour A, Gholinejad-Ghadi N, Ghasemian R, Seifi Z, Aghili SR, Zaboli E, Abdi R, Shokohi T. Voriconazole associated mucormycosis in a patient with relapsed acute lymphoblastic leukemia and hematopoietic stem cell transplant failure: A case report. J Mycol Med 2018; 28:527-530. [PMID: 29807852 DOI: 10.1016/j.mycmed.2018.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/09/2018] [Accepted: 05/14/2018] [Indexed: 11/28/2022]
Abstract
The patients with hematologic malignancies and hematopoietic stem cell transplantation (HSCT) recipients are at high risk for invasive fungal diseases (IFDs) mainly due to the severe and prolonged neutropenia related to high-dose chemotherapy. Voriconazole prophylaxis is recommended for possible IFDs. Mucormycosis is a fulminant infection, which may occur after voriconazole prophylaxis for invasive aspergillosis in immunocompromised hosts. Here, we report mucormycosis after 4 months of voriconazole prophylaxis in a young patient with relapsed acute lymphoblastic leukemia and hematopoietic stem cell transplant failure and discuss the clinical manifestation, imaging, laboratory findings and therapeutic regimens. Clinician's awareness of this entity and timely diagnosis using conventional and molecular methods are the promising approach for the management of this devastating infection.
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Affiliation(s)
- A Sharifpour
- Department of Internal Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - N Gholinejad-Ghadi
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - R Ghasemian
- Antimicrobial Resistance Research Center, and Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Z Seifi
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - S R Aghili
- Department of Medical Mycology, School of Medicine/Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran.
| | - E Zaboli
- Department of Internal Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - R Abdi
- Department of Radiology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - T Shokohi
- Department of Medical Mycology, School of Medicine/Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran.
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Nakagun S, Okazaki M, Toyotome T, Sugiyama N, Watanabe K, Horiuchi N, Kobayashi Y. Fatal Pulmonary and Cerebellar Zygomycosis due to Rhizomucor pusillus in a Ringed Seal (Pusa hispida). Mycopathologia 2018; 183:979-985. [PMID: 29789990 DOI: 10.1007/s11046-018-0268-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 04/25/2018] [Indexed: 11/25/2022]
Abstract
A 4-year-old captive ringed seal (Pusa hispida) was treated with subcutaneous antibacterial injections for pus exuding wounds in the skin and associated blubber following a bite attack. Three months after the incident, the animal presented nystagmus and died the following day. At necropsy, there was a 25 × 18 × 25 mm well-delineated, opaque nodular mass in the lung, besides the skin ulcers and localized areas of discoloration in the blubber correlating with the bite wound and injection sites. Histopathology of the pulmonary mass demonstrated severe eosinophilic inflammatory infiltration among numerous intralesional fungal hyphae. The hyphae were irregularly branched, broad and aseptate, consistent of zygomycosis. Magnetic resonance imaging was conducted on the head, which was initially frozen intact, revealing diffuse areas of hyperintensity in the cerebellum. Restricted histopathologic examination of the cerebellum showed severe granulomatous inflammation well spread within the neuroparenchyma, associated with abundant intralesional fungal hyphae similar to those appreciated in the pulmonary mass. Molecular analyses of the fungi in the pulmonary and cerebellar tissue identified the etiologic agent in both sites as Rhizomucor pusillus. The likely route of infection is through inhalation of R. pusillus spores or fragmented hyphae from the environment that developed into an initial pulmonary infection, becoming the source of hematogenous dissemination to the cerebellum. The skin and blubber lesions likely contributed to immunosuppression. Zygomycosis is uncommon in pinnipeds, and the present report emphasizes the importance of considering zygomycete dissemination even when the primary focus is highly confined.
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Affiliation(s)
- Shotaro Nakagun
- Laboratory of Veterinary Pathology, Obihiro University of Agriculture and Veterinary Medicine, W2-11, Inada, Obihiro, Hokkaido, 080-8555, Japan.
| | - Masako Okazaki
- Okhotsk Tokkari Center, 2 Kaiyokoen, Mombetsu, Hokkaido, 094-0031, Japan
| | - Takahito Toyotome
- Diagnostic Center for Animal Health and Food Safety, Obihiro University of Agriculture and Veterinary Medicine, W2-11, Inada, Obihiro, Hokkaido, 080-8555, Japan
| | - Nobuki Sugiyama
- Uminonakamichi Animal Hospital, 6-2-31 Mitoma East Ward, Fukuoka, Fukuoka, 811-0201, Japan
| | - Kenichi Watanabe
- Laboratory of Veterinary Pathology, Obihiro University of Agriculture and Veterinary Medicine, W2-11, Inada, Obihiro, Hokkaido, 080-8555, Japan
| | - Noriyuki Horiuchi
- Laboratory of Veterinary Pathology, Obihiro University of Agriculture and Veterinary Medicine, W2-11, Inada, Obihiro, Hokkaido, 080-8555, Japan
| | - Yoshiyasu Kobayashi
- Laboratory of Veterinary Pathology, Obihiro University of Agriculture and Veterinary Medicine, W2-11, Inada, Obihiro, Hokkaido, 080-8555, Japan
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Loganathan S, Ajay G, Thyagarajan U, Gokul R. Invasive fungal infection in immunocompetent trauma patients - A case series. J Clin Orthop Trauma 2018; 9:S10-S14. [PMID: 29628692 PMCID: PMC5883914 DOI: 10.1016/j.jcot.2017.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/21/2017] [Accepted: 10/07/2017] [Indexed: 10/18/2022] Open
Abstract
Zygomycosis is the third leading cause of invasive fungal infection after candidiasis and aspergillosis. Although zygomycosis mostly affects immunocompromised individuals trauma may potentiate infection in immunocompetent individuals. The mortality rate of Zygomycosis is around 50% due to angioinvasion. Here we report a series of 5 cases of angio invasive fungal infection in immunocompetent individuals who sustained trauma in urban areas, out of which only one patient survived following high above knee amputation.
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Delie A, Vlummens P, Creytens D, Steel E. Cutaneous mucormycosis as result of insulin administration in an AML patient: Case report and review of the literature. Acta Clin Belg 2017; 72:352-356. [PMID: 28019140 DOI: 10.1080/17843286.2016.1266802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We present a case of cutaneous mucormycosis in a patient with several important risk factors precipitating disease, namely underlying acute myeloid leukaemia and poorly controlled secondary diabetes. Inoculation was most likely caused by repeated minor trauma (insulin injection) at the site of infection. Treatment consisted of surgical debridement and liposomal Amphotericin B (LAmB) during 71 days. Posaconazole had already been initiated prior to infection as primary antifungal prophylaxis but was discontinued during follow-up as susceptibility testing later revealed resistance to posaconazole. Additional treatment with caspofungin and G-CSF was associated because of poor initial result to treatment. Caspofungin was later continued as monotherapy when LAmB had to be interrupted because of renal toxicity. Treatment was completed after closure of the surgical site. The patient was successfully treated and remains infection free for one year after initial diagnosis.
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Affiliation(s)
- Anke Delie
- Department of Haematology, Universitair Ziekenhuis Gent, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Philip Vlummens
- Department of Haematology, Universitair Ziekenhuis Gent, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - David Creytens
- Department of Clinical Pathology, Universitair Ziekenhuis Gent, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Eva Steel
- Department of Haematology, Universitair Ziekenhuis Gent, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
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Ochi T, Katayama Y, Okatani T, Imanaka R, Kyo K, Itagaki M, Katsutani S, Iwato K, Asaoku H. Successful haploidentical stem cell transplantation with prophylactic administration of liposomal amphotericin B after invasive pulmonary zygomycosis. Med Mycol Case Rep 2017; 18:1-4. [PMID: 28725544 PMCID: PMC5501889 DOI: 10.1016/j.mmcr.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 11/02/2022] Open
Abstract
A 54-year-old woman with acute myeloid leukemia (AML) achieved complete remission by induction chemotherapy, but developed zygomycosis after consolidation therapy. As zygomycosis could not be cured by liposomal amphotericin B and micafungin, left lower lobectomy was performed. As AML relapsed 7 months after onset, she received haploidentical stem cell transplantation under administration of liposomal amphotericin B. Despite experiencing severe acute graft-versus-host disease, she remains alive with no relapse of either zygomycosis or AML.
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Affiliation(s)
- Testuro Ochi
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1, Seiryomachi, Aoba-ku Sendai-shi, Miyagi 980-0872, Japan
| | - Yuta Katayama
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Takeshi Okatani
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Ryota Imanaka
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Kohei Kyo
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Mitsuhiro Itagaki
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Shinya Katsutani
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Koji Iwato
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Hideki Asaoku
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
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Andrey DO, Kaiser L, Emonet S, Erard V, Chalandon Y, van Delden C. Cerebral Rhizomucor Infection Treated by Posaconazole Delayed-Release Tablets in an Allogeneic Stem Cell Transplant Recipient. Int J Infect Dis 2016; 55:24-26. [PMID: 27988409 DOI: 10.1016/j.ijid.2016.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/30/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022] Open
Abstract
Mucormycosis (zygomycosis) is an emerging fungal disease in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients. A 30-year-old woman diagnosed with acute myelomonocytic leukemia and needing allo-HSCT presented pulmonary and cerebral infection due to Rhizomucor pusillus. This fungal infection was treated with surgical treatment and posaconazole delayed-release tablets. This strategy allowed reaching high drug levels that could not be obtained with the posaconazole solution.
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Affiliation(s)
- Diego O Andrey
- Service of Infectious Diseases, Department of Medical Specialties, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Laurent Kaiser
- Service of Infectious Diseases, Department of Medical Specialties, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Stéphane Emonet
- Service of Infectious Diseases, Department of Medical Specialties, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Veronique Erard
- Service of Infectious Diseases, Hôpital Fribourgeois, Chemin des Pensionnats 2, 1708 Fribourg, Switzerland
| | - Yves Chalandon
- Service of Hematology, Department of Medical Specialties, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Christian van Delden
- Service of Infectious Diseases, Department of Medical Specialties, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
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Abdollahi A, Shokohi T, Amirrajab N, Poormosa R, Kasiri AM, Motahari SJ, Ghoreyshi SM, Madani SA, Nikkhah M, Ghasemi M, Vahedi Larijani L, Didehdar M, Seifi Z, Gholinejad N, Ilkit M. Clinical features, diagnosis, and outcomes of rhino-orbito-cerebral mucormycosis- A retrospective analysis. Curr Med Mycol 2016; 2:15-23. [PMID: 28959791 PMCID: PMC5611692 DOI: 10.18869/acadpub.cmm.2.4.15] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose: Rhino-orbito-cerebral mucormycosis (ROCM) is a rare disease with acute and fulminant manifestation. This infection is associated with high morbidity and mortality rates. Herein, we reviewed the manifestations, underlying conditions, medical treatments, and surgical interventions in ROCM patients admitted to a tertiary referral center in northern Iran over a seven-year period. Materials and Methods: In a retrospective analysis, 15 cases of ROCM were identified from 2007 to 2013 in Bu Ali Sina Hospital, Sari, Iran. All the ROCM cases were clinically diagnosed and confirmed by histopathological and/or mycological examination. The relevant demographic data, clinical, ophthalmic, and neurologic manifestations, underlying conditions, medical treatments, and surgical interventions were recorded and analyzed. Results: The mean age of the patients was 54±11 years (age range: 28–70 years); 26.7% of the patients were male and 73.3% female (male: female ratio of 1: 2.7). Uncontrolled diabetes was noted in at least 86.7% (13/15) of the cases. The maxillary sinuses were the most frequently involved sites (66.7% of the cases) followed by the ethmoid sinus. Amphotericin B in combination with surgical debridement was used in the treatment of 80% of the cases. Furthermore, 73.3% of the patients who were diagnosed early and underwent medical and extensive surgical debridement of the infected tissues survived. Conclusion: Uncontrolled diabetes mellitus is considered to be the main predisposing factor for ROCM. To prevent and reduce mortality rate of this acute disease, early diagnosis based on clinical findings and biopsy is recommended.
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Affiliation(s)
- A Abdollahi
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - T Shokohi
- Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - N Amirrajab
- Department of Medical Laboratory Sciences, School of Paramedicine/Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - R Poormosa
- Department of Otolaryngology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - A M Kasiri
- Department of Otolaryngology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - S J Motahari
- Department of Otolaryngology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - S M Ghoreyshi
- Department of Otolaryngology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - S A Madani
- Department of Otolaryngology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - M Nikkhah
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - M Ghasemi
- Department of Pathology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - L Vahedi Larijani
- Department of Pathology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - M Didehdar
- Department of Medical Mycology and Parasitology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Z Seifi
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - N Gholinejad
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - M Ilkit
- Division of Mycology, Department of Microbiology, School of Medicine, University of Çukurova, Adana, Turkey
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Pana ZD, Seidel D, Skiada A, Groll AH, Petrikkos G, Cornely OA, Roilides E. Invasive mucormycosis in children: an epidemiologic study in European and non-European countries based on two registries. BMC Infect Dis 2016; 16:667. [PMID: 27832748 PMCID: PMC5105268 DOI: 10.1186/s12879-016-2005-1] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/29/2016] [Indexed: 01/23/2023] Open
Abstract
Background Mucormycosis has emerged as a rare but frequently fatal invasive fungal disease. Current knowledge on paediatric mucormycosis is based on case reports and small series reported over several decades. Contemporary data on a large cohort of patients is lacking. Methods Two large international registries (Zygomyco.net and FungiScope™) were searched for mucormycosis cases in ≤19 year-old patients. Cases enrolled between 2005 and 2014 were extracted, and dual entries in the two databases merged. Epidemiology, clinical characteristics, diagnostic procedures, therapeutic management and final outcome were recorded and analysed with SPSS v.12. Results Sixty-three unique cases (44 proven and 19 probable) were enrolled from 15 countries (54 in European and 9 in non-European countries). Median age was 13 years [Interquartile Range (IQR) 7.7] with a slight predominance (54.1 %) of females. Underlying conditions were haematological malignancies (46 %), other malignancies (6.3 %), haematopoietic stem cell transplantation (15.9 %), solid organ transplantation, trauma/surgery and diabetes mellitus (4.8 % each) and a variety of other diseases (7.9 %); in 9.5%, no underlying medical condition was found. Neutropenia was recorded in 46 % of the patients. The main sites of infection were lungs (19 %), skin and soft tissues (19 %), paranasal sinus/sino-orbital region (15.8 %) and rhino-cerebral region (7.9 %). Disseminated infection was present in 38.1 %. Mucormycosis diagnosis was based on several combinations of methods; culture combined with histology was performed in 31 cases (49.2 %). Fungal isolates included Rhizopus spp. (39.7 %), Lichtheimia spp. (17.5 %), Mucor spp. (12.7 %), Cunninghamella bertholletiae (6.3 %) and unspecified (23.8 %). Treatment comprised amphotericin B (AmB) monotherapy in 31.7 % or AmB in combination with other antifungals in 47.7 % of the cases, while 14.3 % received no antifungals. Surgery alone was performed in 6.3 %, and combined with antifungal therapy in 47.6 %. Crude mortality at last contact of follow-up was 33.3 %. In regression analysis, disseminated disease and prior haematopoietic stem cell transplantation were associated with increased odds of death, whereas the combination of systemic antifungal therapy with surgery was associated with improved survival. Conclusion Paediatric mucormycosis mainly affects children with malignancies, presents as pulmonary, soft tissue, paranasal sinus or disseminated disease and is highly lethal. Outcome is improved when active antifungal therapy and surgery are combined. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2005-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zoi Dorothea Pana
- 3rd Department of Paediatrics, Infectious Diseases Unit, Aristotle University School of Medicine, Hippokration General Hospital, Konstantinoupoleos 49, GR-546 42, Thessaloniki, Greece
| | - Danila Seidel
- Department of Internal Medicine, Clinical Trials Centre Cologne, ZKS Köln, Center for Integrated Oncology CIO Köln Bonn, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), German Centre for Infection Research, University of Cologne, Cologne, Germany
| | - Anna Skiada
- 1st Department of Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas H Groll
- Center for Bone Marrow Transplantation and Department of Paediatric Hematology and Oncology, Infectious Disease Research Program, University Children's Hospital, Muenster, Germany
| | | | - Oliver A Cornely
- Department of Internal Medicine, Clinical Trials Centre Cologne, ZKS Köln, Center for Integrated Oncology CIO Köln Bonn, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), German Centre for Infection Research, University of Cologne, Cologne, Germany
| | - Emmanuel Roilides
- 3rd Department of Paediatrics, Infectious Diseases Unit, Aristotle University School of Medicine, Hippokration General Hospital, Konstantinoupoleos 49, GR-546 42, Thessaloniki, Greece.
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Abstract
Zygomycosis is a rare invasive opportunistic fungal infection that occurs in the setting of hematologic malignancies, chemotherapy-induced neutropenia, and immunosuppressive therapies. We report the first case of disseminated appendiceal zygomycosis due to Absidia spp. in a neutropenic patient who initially presented as acute appendicitis. A 63-year-old woman with acute myeloid leukemia presented as acute appendicitis while receiving induction chemotherapy and ultimately succumbed to overwhelming disseminated zygomycosis. Initial symptoms included loose stools and right lower abdominal pain unresponsive to broad-spectrum antibiotics. Clinical examination and cross-sectional imaging suggested acute appendicitis. The final diagnosis was established by histological evaluations of the ileocecectomy specimen, which showed angioinvasive fungal organisms within the necrotic appendiceal wall with characteristics typical of zygomycetes. Fungal cultures demonstrated Absidia spp. The patient was treated with amphotericin B but expired in the setting of fungal sepsis. A diagnosis of a fungal infection, including zygomycosis, should be considered in all chemotherapy-induced neutropenic patients who present with symptoms of acute appendicitis. A high index of clinical suspicion with prompt histologic and culture diagnosis of zygomycosis may reduce the high mortality and morbidity associated with zygomycosis of the gastrointestinal tract.
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Affiliation(s)
- Won-Tak Choi
- Department of Pathology, University of California at San Francisco, San Francisco, Calif., USA
| | - Tammy T Chang
- Department of Surgery, University of California at San Francisco, San Francisco, Calif., USA
| | - Ryan M Gill
- Department of Pathology, University of California at San Francisco, San Francisco, Calif., USA
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Raveenthiran V, Mangayarkarasi V, Kousalya M, Viswanathan P, Dhanalakshmi M, Anandi V. Subcutaneous entomophthoromycosis mimicking soft-tissue sarcoma in children. J Pediatr Surg 2015; 50:1150-5. [PMID: 25783300 DOI: 10.1016/j.jpedsurg.2014.11.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/23/2014] [Accepted: 11/13/2014] [Indexed: 11/24/2022]
Abstract
AIM Subcutaneous entomophthoromycosis (EM) is an uncommon fungal infection of childhood. This article is intended to draw the attention of pediatric surgeons to the fact that EM can mimic soft-tissue tumor. METHODS It is a retrospective review of 16 children treated for subcutaneous EM between 2000 and 2013. RESULTS The median age of patients was 3.5 years. The typical lesion was a discoid subcutaneous mass that can be easily lifted from deeper tissues (the doughnut lifting sign). Lesions were mostly distributed in the lower half of body. All the patients were immunocompetent. Correct clinical diagnosis was made only in 4 cases while others were mistaken for a tumor. All the 8 children who underwent wide excision of the pseudotumor had local recurrence. Supersaturated solution of potassium iodide was curative in 11 cases while addition of itraconazole was needed in one case. One child died of multi-drug resistant infection. The mean treatment duration was 4.7 months (range 2-8 months). CONCLUSION Subcutaneous EM can mimic soft-tissue tumor. High index of suspicion is essential to avoid misdiagnosis and inappropriate treatment. A newly described "doughnut-lifting sign' may be helpful in clinical diagnosis. Emergence of multi-drug resistant infection is a source of concern.
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Affiliation(s)
- Venkatachalam Raveenthiran
- Department of Pediatric Surgery, Sri Ramasamy Memorial (SRM) Medical College, Kattankulathur, Chennai, India; Hindu Mission Hospital, Tambaram, Chennai, India.
| | | | - Murugesan Kousalya
- Department of Microbiology, SRM Medical College, Kattankulathur, Chennai, India
| | | | | | - Viswanathan Anandi
- Department of Microbiology, Rajah Muthiah Medical College, Chidambaram, India
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Bowles RJ, Mitchell JJ, Price C, Ipaktchi K. Severe mycosis as a rare infection after a corn auger injury of the hand: a case report. Patient Saf Surg 2015; 9:22. [PMID: 28428824 DOI: 10.1186/s13037-015-0061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 04/15/2015] [Indexed: 11/19/2022] Open
Abstract
Mucormycosis is a rare but serious infection that can be seen in immunocompetent individuals who experience traumatic injury. The authors report a case in a 28 year-old man who sustained a mangling hand injury in a corn augur accident. After initial aggressive debridement ongoing tissue necrosis was seen, and in subsequent biopsies invasive mucormycosis was diagnosed. The patient was successfully managed with immediate surgical debridement and antifungal medication and showed no sign of infection at six-month follow-up.
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44
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Alseady A, Baharoon S. Acute cutaneous zygomycosis of the scalp: A case report and literature review. J Infect Public Health 2015; 8:377-81. [PMID: 25843449 DOI: 10.1016/j.jiph.2014.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 12/17/2014] [Indexed: 11/30/2022] Open
Abstract
Cutaneous zygomycosis is the third most common form of zygomycosis. However, scalp involvement is rare for this disease. In this study, we present a case of acute zygomycosis in a diabetic patient who was effectively treated with local debridement, amphotericin B lipid complex and posaconazole.
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Affiliation(s)
| | - Salim Baharoon
- College of Medicine, King Saudi bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Dodémont M, Hites M, Bailly B, Trepant AL, De Mendonça R, Denis O, Jacobs F, Montesinos I. When you can't see the wood for the trees. Mucor circinelloides: A rare case of primary cutaneous zygomycosis. J Mycol Med 2015; 25:151-4. [PMID: 25840851 DOI: 10.1016/j.mycmed.2015.02.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/13/2015] [Accepted: 02/19/2015] [Indexed: 12/28/2022]
Abstract
A patient with refractory diffuse lymphoma treated for pulmonary invasive aspergillosis developed a concomitant primary cutaneous mucormycosis. The mucormycete was identified by sequencing as Mucor circinelloides. This case confirms the importance of a rapid pathogen diagnosis in immunocompromised patients and the usefulness of molecular methods for identification of rare fungal species.
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Affiliation(s)
- M Dodémont
- Laboratory of Bacteriology, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
| | - M Hites
- Department of Infectious Diseases, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - B Bailly
- Department of Haematology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - A-L Trepant
- Department of Pathology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - R De Mendonça
- Laboratory of Bacteriology, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - O Denis
- Laboratory of Bacteriology, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - F Jacobs
- Department of Infectious Diseases, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - I Montesinos
- Laboratory of Bacteriology, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Pajpani M, Webb R. Lingual necrosis caused by mucormycosis in a patient with aplastic anaemia: case report. Br J Oral Maxillofac Surg 2014; 52:e144-6. [PMID: 25300888 DOI: 10.1016/j.bjoms.2014.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 09/16/2014] [Indexed: 11/20/2022]
Abstract
Mucormycosis is a rare but aggressive fungal infection that predominantly affects immunocompromised patients. We report a case that highlights the importance of knowledge to enable prompt diagnosis and management of an otherwise fatal phenomenon.
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Imbernón A, Agud JL, Cuétara MS, Casqueiro JC, Nuñez P, Domínguez AR, Bullido E, Stchigel AM. Successful therapy of progressive rhino-orbital mucormycosis caused by Rhizopus arrhizus with combined and sequential antifungal therapy, surgery and hyperbaric therapy. Med Mycol Case Rep 2014; 6:51-4. [PMID: 25383316 DOI: 10.1016/j.mmcr.2014.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 09/26/2014] [Indexed: 12/31/2022] Open
Abstract
We present a case of rhino-orbitary mucormycosis which progressed despite liposomal amphotericin and early surgical debridement. Combined echinocandin and high dose liposomal amphotericin, repeated debridement, prolonged therapy with hyperbaric oxygen and continued therapy with posaconazole, along with strict diabetic control, allowed cure without disfigurement.
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48
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Enani MA, Alharthi BN, Dewanjee N, Bhat NA, Fagih M. Spontaneous gastric ulcer perforation and acute spleen infarction caused by invasive gastric and splenic mucormycosis. J Glob Infect Dis 2014; 6:122-4. [PMID: 25191054 PMCID: PMC4147422 DOI: 10.4103/0974-777x.138509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mucormycosis is a rare life-threatening fungal infection mostly affecting immunocompromised hosts. The main categories of human disease with the Mucorales are sinusitis/rhinocerebral, pulmonary, cutaneous/subcutaneous, gastrointestinal and disseminated disease. Other disease states occur with a much lower frequency and include cystitis, vaginitis; external otitis and allergic disease. We report a diabetic patient with comorbidities, who developed gastric perforation clinically indistinguishable from perforated peptic ulcer due to invasive gastric mucormycosis complicated by spleen infarction.
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Affiliation(s)
- Mushira Abdulaziz Enani
- Department of Medicine, Infectious Diseases Section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Bandar N Alharthi
- Department of Surgical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nancy Dewanjee
- Department of Surgical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nadeem A Bhat
- Department of Surgical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mosa Fagih
- Department of Pathology and Clinical Laboratory Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
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Al-Maani AS, Paul G, Jardani A, Nayar M, Al-Lawati F, Al-Baluishi S, Hussain IB. Gastrointestinal Basidiobolomycosis: First case report from Oman and literature review. Sultan Qaboos Univ Med J 2014; 14:e241-e244. [PMID: 24790749 PMCID: PMC3997543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/26/2013] [Accepted: 01/05/2014] [Indexed: 06/03/2023] Open
Abstract
Gastrointestinal basidiobolomycosis (GIB) is a rare fungal infection with few reported cases worldwide. We report here the first case diagnosed in Oman in a previously healthy 5-year-old Omani female child who had been thought initially to have an abdominal malignancy. The case was referred to the Royal Hospital, Muscat, Oman, in July 2012. She was treated successfully with surgical resection and prolonged antifungal therapy (voriconazole). Physicians, including clinicians, radiologists and pathologists, should have a high index of suspicion for GIB when a patient presents with an abdominal mass and fever.
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Affiliation(s)
| | - George Paul
- Departments of Child Health, Royal Hospital, Muscat, Oman
| | | | | | | | | | - Ibrahim B. Hussain
- Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Strasfeld L, Espinosa-Aguilar L, Gajewski JL, Stenzel P, Pimentel A, Mater E, Maziarz RT. Emergence of Cunninghamella as a pathogenic invasive mold infection in allogeneic transplant recipients. Clin Lymphoma Myeloma Leuk 2013; 13:622-8. [PMID: 23850285 DOI: 10.1016/j.clml.2013.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 05/01/2013] [Accepted: 05/02/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Lynne Strasfeld
- Division of Infectious Diseases, Oregon Health and Science University, Portland, OR.
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