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PubMedDate not supplied

Disseminated mucormycosis in healthy adults.

Three patients of disseminated mucormycosis are described. None had predisposing factors. Two of them presented with nonspecific symptoms along with acute renal failure and peritonitis. Third patient had fulminating primary cutaneous mucormycosis which disseminated later. Development of acute renal failure with smooth enlargement of both kidneys in an apparently healthy individual or appearance of mould in a wound should raise the suspicion of mucormycosis. The hallmark of the infection was vascular invasion and thrombosis. Antemortem diagnosis could be made in one patient only. All patients had progressive downhill course despite supportive treatment, antibiotic and amphotericin in-B in one patient.

Adult↗

PubMed2000

Peroxynitrite formation in the orbit of diabetics with rhinocerebral mucormycosis.

OBJECTIVE: To evaluate whether an intact respiratory burst exists within the orbit of diabetics with rhinocerebral mucormycosis. METHODS: Immunohistochemical detection of nitrotyrosine in the orbital tissue of diabetics requiring exenteration due to rhinocerebral mucormycosis. Nitrotyrosine is the stable product of the nitration of tyrosine residues by peroxynitrite. Peroxynitrite is a potent oxidant produced by the combination of superoxide and nitric oxide during the respiratory burst. RESULTS: Four specimens were analyzed. All showed focal areas of specific staining against nitrotyrosine of the walls and internal structures of fungal organisms. CONCLUSIONS: An intact respiratory burst is present in the orbit of diabetics during infection with rhinocerebral mucormycosis. Possible mechanisms of peroxynitrite's microbicidal effects and reasons for a deficiency in diabetics are discussed.

Adolescent↗

PubMed2000

Mucormycosis of the tibia: a case report and review of the literature.

Mucormycosis is an uncommon but highly aggressive fungal infection most commonly occurring in hosts who are immunologically predisposed to infection. Only seven previously documented cases of tibial osteomyelitis attributable to Mucorales infection exist in the literature. An unusual case is reported of mucormycosis osteomyelitis developing in a patient who was immunocompromised after routine tibial Steinmann pin placement for the application of traction. Surgical debridement and amphotericin B were not sufficient to control the infection, and the patient subsequently underwent above-knee amputation. To the authors' knowledge this is the first description of mucormycosis causing osteomyelitis as a result of Steinmann pin tract infection.

Bone Nails↗

PubMed2001

Rhinocerebral mucormycosis in a patient of acute renal failure.

Mucormycosis is the name for invasive fungal infection caused by mucorales. The disease is uncommon and produces serious and rapidly fatal infection in patients with serious pre-existing illness. The classical presentation of rhinocerebral mucormycosis is involvement of nasal mucosa with invasion of paranasal sinuses and orbit. We report a case of mucormycosis in an otherwise healthy female who had developed acute renal failure following gastroenteritis.

Acute Kidney Injury↗

PubMed2001

[Rhinocerebral mucormycosis: apropos of 4 new Tunisian cases].

Mucormycosis is a rare opportunistic infection but a fulminant disease. We report the 4 first cases of rhinocerebral mucormycosis diagnosed in Sfax region (Tunisia). They occurred in insulin dependent diabetes and developed varying clinical manifestations from facial cellulites to ocular and cerebral extension. The diagnosis of mucormycosis was not initially evoked, but confirmed tardively by anatomopathologic and mycologic examinations. The evolution was favourable in 2 cases by administration of amphotericine B associated with extensive surgical debridement and correction of the diabetes. Two patients had a fatal outcome. This infection has a severe prognosis and necessitates early diagnosis.

Adult↗

PubMed2000

Mucormycosis: a case study.

Throughout the history of mucormycosis, from the first case in humans reported in 1885 by Paltauf, through publication by Gregory et al of the first observation of rhino-orbital cerebral mucormycosis in 1943, to the report by Harris in 1955 of the first known survivor, little has changed in the diagnosis and outcome of this disease. Although mucormycosis of any form--cerebral, cutaneous, rhinocerebral, intestinal, or pulmonary--is still a rarity, it should be suspected in patients who are diabetic or immunocompromised. Administration of amphotericin B, surgical debridement of infected tissue, correction of the underlying cause, and use of adjunctive HBO therapy remain the standard treatments.

Adult↗

PubMedDate not supplied

Gastric mucormycosis.

Systemic mucormycosis is a rare fatal fungal infection that usually involves the nasopharynx. Gastrointestinal mucormycosis is rare, occurring in immunocompromised conditions and with advanced malignancies. We report a 35-year-old man, an alcoholic, admitted with acute abdomen. Endoscopy revealed an ulcerated plaque-like lesion in the stomach. Histology revealed mucormycosis of the stomach. The patient successfully underwent treatment with amphotericin-B.

Adult↗

PubMed2003

[A case of pulmonary mucormycosis diagnosed through video-assisted thoracoscopic surgery--report of a case].

We report a case of pulmonary mucormycosis successfully treated by medical methods only. The patient was a 51-year-old man with diabetes mellitus who presented with general fatigue and appetite loss. His chest radiograph and CT scan showed multiple thin-walled cavities in the left upper lobe. Because we could arrive at a clear diagnosis, video-assisted thoracoscopic surgery was performed. Lung biopsy of the left upper lobe revealed pulmonary mucormycosis. Our diagnosis was pulmonary mucormycosis with diabetes mellitus and alcohol addiction. The patient was treated with antifungal drugs--mainly amphotericin-B--while the diabetes mellitus was well controlled, and his diet and nutritional state was improved, resulting in the disappearance of symptoms, improvement of the radiological findings, and the absence of any relapse of the disease of at least 3 years.

Amphotericin B↗

PubMed1992

Indolent orbital apex syndrome caused by occult mucormycosis.

The chronic or indolent presentation of rhino-orbital mucormycosis, as defined by the presence of symptoms for more than 1 month before diagnosis, is extremely unusual. A 45-year-old man with stable diabetes presented with a right orbital apex syndrome and minimal ethmoid and sphenoid sinusitis. Progression was indolent, and the diagnosis was not made until 7 weeks after admission, when a third biopsy was prompted by new cavernous sinus and carotid artery thromboses. Mucormycosis was found. The patient improved on amphotericin B (2 g) and strict blood glucose control. A remarkable aberrant regeneration of the right oculomotor nerve was seen following treatment. He remains free of active disease 4 years later. Orbital symptoms in well-controlled diabetics, which may even remain stable for weeks and lack direct signs of tissue invasion, should raise the suspicion of mucormycosis.

Carotid Artery Thrombosis↗

PubMed2003

Cutaneous mucormycosis secondary to acquired reactive perforating collagenosis.

Acquired reactive perforating collagenosis (ARPC) is a rare perforating disease of the skin. It is characterized by hyperkeratotic papules with transepidermal elimination of degenerated material including collagen and elastic fibers. The disease presents clinically as umbilicated papules with a central adherent keratotic plug. Mucormycosis infection, caused by the molds of the class Zygomycetes and order Mucorales, generally occurs as an opportunistic infection. It presents most frequently in patients with diabetes mellitus, in patients with leukemia receiving chemotherapy, and in those on sustained immunosuppressive therapy. We describe a patient with type 2 diabetes mellitus and end-stage renal disease requiring hemodialysis in whom extensive cutaneous mucormycosis with secondary spread to the brain, lumbar spine, and breast developed in the setting of ARPC. To our knowledge, this is the first case report of a patient with ARPC who developed extensive cutaneous mucormycosis.

Collagen Diseases↗

PubMed2003

Liposomal amphotericin B treatment for rhinocerebral mucormycosis: how much is enough?

Rhinocerebral Mucormycosis is a potentially life-threatening disease, which affects mainly immunocompromised patients. Treatment options include reversing immunosuppression, surgery and systemic and local administration of anti-fungal medication. Amphotericin B is the primary agent employed, but its use is often limited by frequent side effects. Complexing Amphotericin B with lipid structures avoids most of the negative side effects, most importantly the dose-limiting nephrotoxicity. No consensus has been reached regarding the appropriate duration, rate of administration or total dose of treatment. We present a case of a patient suffering from Rhinocerebral Mucormycosis treated by extensive surgery and Liposomal Amphotericin B. He was treated for 29 days at a rate of 3 mg/kg/d and a total dose of 5.6 gram. The dose of Liposomal Aphotericin B used in previously published articles ranged from 1.5 mg/kg/d to 5 mg/kg/d. The response to treatment may be evaluated by physical examination, microbiological cultures, radiological and pathological studies. Taking into account the considerable cost of liposomal Amphotericin B and other lipid complexed formulations, it is imperative to find out what is the appropriate treatment regime for Rhinocerebral and other mucormycosis infections.

Aged↗

PubMed2003

Safe and successful endoarterial infusion of liposomal amphotericin B in treatment of mucormycosis.

Mucormycosis is a rare invasive mycotic infection treated by antifungini or amphotericin B. We describe the case of a patient with septic fever and a necrotic lesion, with phlegmon of medial left thigh. Surgery was performed to drain the abscess content and to remove the necrotic tissue; mucormycosis was diagnosized by histological and culture tests and treated by intravenous amphotericin B. Since the lesion worsened, liposomal amphotericin B was directly infused into the left common iliac artery, with progressive improvement, and treatment was continued until complete recovery. Therefore, the endoarterial infusion of liposomal amphotericin B was a safe and successful treatment of advanced lesions of mucormycosis. In such lesions, intravenous general antibiotic administration probably is not sufficient to reach the whole infected area.

Adult↗

PubMed2003

Pulmonary mucormycosis presenting with recurrent laryngeal nerve palsy.

Pulmonary mucormycosis is an uncommon infection and its endobronchial form is rare. Fever, cough, dyspnoea and hemoptysis are the usual presenting symptoms. Hoarseness of voice, a rare manifestation of endobronchial mucormycosis, has been reported earlier but its exact anatomical basis was unclear. We report an instance of polypoid endobronchial mucormycosis and vocal cord paralysis in a patient with type I diabetes and diabetic ketoacidosis.

Adult↗

PubMed2004

[Garcin syndrome in a patient with rhinocerebral mucormycosis].

Garcin syndrome is characterized by an unilateral cranial nerves involvement without sensory or motor long-tract disturbances. It is usually caused by tumor infiltrating in the skull base with osteolytic changes on radiological study. We report a case of 64-year-old man with history of alcohol overintake, who admitted local hospital, because of right periorbital edema and facial swelling. He noted right ptosis 2 weeks prior to admission. Neurological examination revealed right multiple cranial nerves involvement including II, III, IV, V, and VI cranial nerves. MR imaging of the brain showed marked paranasal sinusitis and abnormal infiltration of right orbital fat. Orbital apex syndrome related to paranasal sinusitis was diagnosed, and antibiotics was administered. But a few days after admission, he developed a right VII, IX, X cranial nerve palsy. He was transferred to our hospital because of acute development of left hemiparesis and deteriorated consciousness. MR imaging of the brain showed right internal carotid artery (ICA) occlusion, and infarction in right middle cerebral artery (MCA)'s territory. The diagnostic biopsy of the paranasal sinus showed mucorales hyphae, indicating that the pathological diagnosis was mucormycosis. Despite of antibiotic therapy included of amphotericin-B administration and strict control of diabetic mellitus, his sinusitis was gradually spread. His condition progressively deteriorated, and finally died of sepsis. Post-mortem examination revealed a widespread mucor infiltration in the dura mater without skull bone invasion. This case presented with unilateral multiple cranial nerve involvements (Garcin syndrome) followed by left hemiparesis associated with rhinocerebral mucormycosis. It is suggested that mucormycosis should be considered in case of Garcin syndrome without osteolysis in the skull base.

Arterial Occlusive Diseases↗

PubMed2004

Cutaneous mucormycosis of the head and neck with parotid gland involvement: first report of a case.

Cutaneous mucormycosis is an uncommon, life-threatening, opportunistic fungal infection that is a distinctly different entity from the more frequent although still uncommon rhinocerebral form that is better known to otolaryngologists. We describe what to our knowledge is the only reported case of cutaneous mucormycosis of the face with parotid gland involvement, which occurred in a 56-year-old man. The diagnosis was established by tissue biopsy. The patient was treated with antifungal medications and wide local debridement, including a total parotidectomy with sacrifice of the inferior division of the facial nerve. At the 2-year follow-up, he remained free of disease. Familiarity with the risk factors associated with the development of cutaneous mucormycosis is critical to determining the need for early tissue biopsy to confirm the diagnosis. Generally favorable clinical outcomes are associated with prompt and aggressive medical and surgical therapy.

Biopsy↗

PubMed2004

Rhinoorbital mucormycosis secondary to Rhizopus oryzae: a case report and literature review.

Mucormycosis is a form of fulminant invasive fungal infection of the sinonasal tract that often extends to the orbit, brain, palate, and skin. It is caused by members of the order Mucorales, and it is considered to be the most fatal fungal infection known to man because it is rapidly disseminated by the blood vessels. It is most commonly associated with diabetic ketoacidosis, hematologic malignancies, acquired immunodeficiency syndrome, and immunosuppressive therapy. This rare opportunistic infection exists in many forms, the most common of which is rhinocerebral mucormycosis. Treatment includes aggressive surgical debridement of the necrotic tissue combined with systemic antifungal therapy. In this case report, we describe the successful management of rhinoorbital mucormycosis, a subtype of the rhinocerebral variety, secondary to Rhizopus oryzae that developed in a patient with lymphoma. We review the diagnostic work-up and discuss the literature with respect to the presentation, pathophysiology, management, and outcome of the disease.

Antifungal Agents↗

PubMed2004

Carotid artery occlusion due to fulminant rhinocerebral mucormycosis.

Mucormycosis is a rare disorder with a potentially lethal course caused by an opportunistic fungus of the Phycomycetes family. Rhinocerebral mucormycosis (RCM) is an acute fulminant form of invasive fungal sinusitis occurring principally in individuals who are immunologically or metabolically compromised. This form originates from one of the paranasal sinuses and may spread to the orbit or the intracranial space either by direct extension or using the unique capability of spreading along vascular walls, leaving the bony structure intact. Carotid artery occlusion is a complication of RCM. Because of the rapidity with which this disease progresses, prompt and aggressive therapy is essential. The morbidity and mortality of this disease are directly related to the length of time before diagnosis and treatment. The diagnosis is difficult because invasive mucormycosis may be present with no mucosal changes and a normal sinus CT scan. It is a histological diagnosis. Treatment of RCM includes early diagnosis, correction of underlying conditions, early and radical surgical debridement, and lipid formulation of amphotericin B. Multiple surgeries are often necessary for adequate debridement. We report a case of carotid artery occlusion due to RCM and discuss the literature on its early signs and symptoms, pathophysiology, and treatment options.

Acute Disease↗

PubMed2004

[Bilateral lower lobectomies for pulmonary mucormycosis].

Mucormycosis is an extremely rare case of pulmonary mycosis, its prognosis is very poor, and known as an opportunistic infection among immunocompromised hosts accompanied with other primary chronic disease. We report here a case of bilateral lower lobectomies carried out by two-stage operation for pulmonary mucormycosis combined with diabetes mellitus (type I) and severe resistance to an antimycobiotics under biblicographical considerations. A 36-year-old female was diagnosed as a diabetes mellitus (type I), and has been administrated with an insulin injection in 1989 at the age of 22-year-old. The patient was suffered a dry cough in June and the bilateral abnormal shadows were pointed out by the chest X-ray film in November, 2002. By transbronchial lung biopsy, Mucor fungus was confirmed in grannulomatous lung specimen. Intravenous injection of amphotericin B could not be continued due to the unavoidable side-effects from this agent. As the lung mass shadow was enlarged increasing and strongly suggested an abscess, formation in its focus, and then the left lower lobectomy was performed as the first step of surgical treatment and the right lower lobectomy was done on the postoperative forty-fourth day as the second step. The postoperative prognosis was considerably uneventful. After bilateral lower lobectomies, the patient could try a walk and go upstairs with a moderate dyspnea. A possible surgical resection should be conducted for the pulmonary mucormycosis, when the medicinal therapy showed an uneffectiveness and/or an infectious lesion was shown as restricted lesion.

Adult↗