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PubMed2004

Paranasal sinus mucormycosis in an immunocompetent host: efficacy and safety of combination therapy with Liposomal Amphotericin B and adjuvant rHuGM-CSF.

Invasive mucormycosis is a well-documented disease in the immunocompromised patient, but in recent years it has been reported increasingly in immunocompetent patients. We report a case of maxillary paranasal sinus mucormycosis in an immunologically competent host that was successfully treated with surgery and combined liposomal amphotericin B and rHuGM-CSF. We discuss the emerging incidence of invasive zygomycosis in immunocompetent patients and the potential clinical application of immunotherapy as adjunctive therapy for invasive mucormycosis in association with liposomal amphotericin B and surgical debridement.

Aged↗
PubMedDate not supplied

Graft mucormycosis in a renal allograft recipient.

Mucormycosis is a rare but potentially lethal fungal infection in the renal allograft recipient. Renal allograft mucormycosis is extremely rare. To date, only five cases have been reported in the literature. We report a case of renal allograft mucormycosis, where this complication developed 18 months after transplantation following treatment for acute rejection with high dose steroids and antithymocyte globulin.

Antilymphocyte Serum↗
PubMedDate not supplied

Isolated breast mucormycosis.

Mucormycosis is unusual in surgical practice. Awareness of the classical findings leads to early detection. Excisional therapy whenever possible along with systemic antifungal treatment is the key to successful outcome. A 70 year old female, a known case of diabetes mellitus and chronic obstructive pulmonary disease, on inhalational steroids and oral hypoglycemic agents, presented to us with complaints of sudden onset pain, redness and swelling of left breast. A diagnosis of severe mastitis was made and a release incision was taken. The entire breast became gangrenous in next 24 hours and simple mastectomy had to be performed as a life saving measure. Histopathology revealed mucormycosis of breast. To the best of our knowledge this is the first reported case of mucormycosis of breast in the English literature.

Aged↗
PubMed1990

Pulmonary mucormycosis: the first case with preoperative diagnosis and successful surgical treatment in Taiwan.

Pulmonarycosis is a rare disease, which refers to an infection by fungi belonging to the order Mucorales. This organism usually invades the skin, nose mouth, paranasal sinus, gastrointestinal tract, lung, brain, eyes and so forth. It usually occurs in patients with diabetes mellitus, hematological malignancy or other immunocompromised states. Until recently, this disease was rarely diagnosed before death. We report a case of pulmonary mucormycosis in a woman with poorly controlled diabetes mellitus. This is the first case in Taiwan of pulmonary mucormycosis diagnosed preoperatively and treated successfully by lobectomy only. Persistent pulmonary lesions resistant to antibiotic treatment in high risk patients should arouse the suspicion of mucormycosis. Prompt bronchoscopic examination, open lung biopsy and transthoracic pulmonary aspiration cytology and biopsy should be done. Surgical resection of localized lesions remains the treatment of choice.

Aged↗
PubMedDate not supplied

Mucormycosis: a community hospital perspective.

Mucormycosis (synonymous with phycomycosis and zygomycosis) is a devastating fungal infection which usually involves patients with diabetes mellitus, often complicated by ketoacidosis, and malignant neoplasms, commonly leukemia and lymphoma. Clinical manifestations include rhinocerebral, pulmonary, disseminated, isolated cerebral, gastrointestinal and cutaneous disease. Common to all forms of mucormycosis is vascular invasion with production of necrotic tissue. The diagnosis is achieved by demonstrating broad, non-septate hyphae with right-angle branching in a tissue biopsy specimen. Successful treatment consists of early diagnosis, intensive systemic antifungal therapy with amphotericin B, aggressive surgical debridement and control of the underlying disease. In our experience with mucormycosis at Huntsville Hospital, the patients were immuno- compromised and the infection was restricted to the lung. Despite use of amphotericin B in all patients, the only one who survived underwent surgical section of infected tissue.

Amphotericin B↗
PubMed1990

Rhino-orbital cerebral mucormycosis.

Rhino-orbital cerebral mucormycosis is the most common manifestation of mucormycosis. In debilitated or acidotic patients, the presence of necrotic tissue should alert the examiner to the possibility of mucormycosis. Radical operation and proper management with early diagnosis should increase the patient's chance of survival.

Brain Diseases↗
PubMed1990

[Mucormycosis. The disease spectrum in 13 patients].

Mucormycosis is an uncommon infection caused by fungi of the order Mucorales. During an 8-year period, mucormycosis was diagnosed in 13 patients from three Madrid hospitals. There were 8 males and 5 females, with ages ranging from 21 to 75 years (mean 45 years). There were several underlying diseases, and 4 patients had more than one. Five had diabetes mellitus, 4 chronic renal failure, 2 acute myeloblastic leukemia, 2 were narcotic abusers and were infected by the human immunodeficiency virus (HIV), 1 had non-Hodgkin's lymphoma, 1 was a carrier of a renal allograft and 1 had systemic necrotizing vasculitis. There were different clinical presentations: rhino-orbital in 3, paranasal in 2, cutaneous in 2, pulmonary in 2, primary cerebral in 2, rhinocerebral in 1, and peritoneal in 1. The diagnosis was made during the first week in 6 patients, in the second week in 4, and it was delayed for more than one month in 2. Fresh examination of clinical samples was carried out in 3 patients and hyphae were visualized in all 3. Cultures were taken in 10 patients and they were positive in 7. All isolates were identified as Rhizopus sp. One patient died within 24 hours without being treated, 12 were treated with amphotericin B and 9 received surgical therapy. Six patients (46%) died. The involvement of central nervous system and the absence of surgical therapy were associated with a poor outcome. These results indicate that mucormycosis can develop in several clinical contexts and has a varying clinical presentation. It is a potentially curable infections when early diagnosed and appropriately treated.

Adult↗
PubMed1989

Survival after isolated cerebral mucormycosis.

Cerebral mucormycosis is a rare disorder caused by several genera of the family Mucoraceae. The genera Rhizopus, Absidia, and Mucor are the predominant pathogenic groups. Disease caused by these organisms usually complicates an underlying chronic illness, such as diabetes mellitus or malignancy. Cerebral involvement usually occurs from an ascending infection from the paranasal sinuses via the orbit and is usually associated with poorly controlled diabetes. The pulmonary system is the most common site of infection in patients with leukemia. Isolated cerebral mucormycosis not associated with head trauma or intravenous drug abuse is a rare disorder. We report what we believe to be the first successfully treated case of isolated cerebral mucormycosis in a patient with acute lymphocytic leukemia in remission.

Adolescent↗
PubMedDate not supplied

Survival of a heart transplant recipient after pulmonary cavitary mucormycosis.

Pulmonary infections can be a major complication of heart transplantation. Bacterial pneumonia has decreased markedly in the last few years among heart recipients receiving cyclosporine as immunosuppressive therapy. Fungal infections of the lung can cause serious problems in the compromised condition of these patients, with several deaths attributed to Aspergillus and Candida. To our knowledge, however, there has been no report of pulmonary mucormycosis in heart transplant recipients. We describe, therefore, a heart transplant patient with insulin-dependent diabetes mellitus who developed serious cavitary pulmonary mucormycosis. Diagnosis was made by transbronchial biopsy, and treatment required both prolonged administration of amphotericin B and surgical resection to effect a cure. The diagnostic problems and therapeutic considerations associated with pulmonary mucormycosis are discussed.

Amphotericin B↗
PubMed1988

The role of desferrioxamine in dialysis-associated mucormycosis: report of three cases and review of the literature.

We report 3 patients on maintenance hemodialysis who developed a fulminant, disseminated and fatal form of mucormycosis. The diagnosis was made by microscopy and culture in 1 case, yielding Rhizopus rhizopodiformis, and by post-mortem microscopy in the two other cases. These patients were receiving desferrioxamine (DFO) for aluminum overload and had no iron-overload. Ten similar patients, all (with only one possible exception) receiving DFO, have been reported from American centers. The mechanism by which DFO could precipitate mucormycosis is unsettled. The explanation might be that DFO acts as a siderophore to the Mucorales fungi. High serum levels of DFO in renal failure could enhance this mechanism. Epidemiological data, provided from an inquiry in 25 Flemish dialysis centers, support the association between DFO treatment and dialysis-associated mucormycosis.

Adult↗
PubMed1987

Otocerebral mucormycosis--a case report.

Mucormycosis is an often fatal infection caused by ubiquitous organisms of the order Mucorales. Infection is most commonly seen in the immunocompromised host, particularly in the setting of diabetic ketoacidosis. The most common presentation is with rhinocerebral involvement. We here report a case of otocerebral mucormycosis occurring in an elderly man with maturity onset diabetes who was not acidotic. The unusual site of infection delayed diagnosis until the pons had been invaded by the infecting organism which was demonstrated as a hypodense area on CT scan. Consequently radical excision of infected tissue was not feasible and the patient died. At post-mortem examination there was extensive infection and infarction of the parotid gland, inner ear and pons associated with arterial invasion by the fungus and septic cavernous sinus thrombosis. The case is described to demonstrate the existence of other modes of neurological presentation of mucormycosis apart from the well recognized rhinocerebral form. Early diagnosis is the key to successful therapy.

Aged↗
PubMed1986

Pulmonary mucormycosis presenting with Horner's syndrome. Report of a medical cure.

A patient with pulmonary mucormycosis caused by Rhizopus oryzae was treated with a total dose of intravenous amphotericin B 2060 mg which resulted in medical cure. This is the first reported medical cure in the RSA of pulmonary mucormycosis. Mucormycosis with brachial plexus involvement and Horner's syndrome has not been previously reported.

Amphotericin B↗
PubMedDate not supplied

Hospital-acquired gangrenous mucormycosis.

A post-operative diabetic patient who had been treated for Serratia marcescens bacterial sepsis developed recurrent thrombosis of the left femoral artery following intra-arterial instrumentation. Pathological examination of arterial thrombus ultimately demonstrated invasive mucormycosis of the femoral artery and cultures of this material grew Rhizopus oryzae. The occurrence of cutaneous and subcutaneous mucormycosis is reviewed, as well as recently recognized nosocomial risk factors for mucormycosis, such as elasticized bandages and wound dressings.

Bandages↗
PubMed1980

Mucormycosis in transplant patients.

Cutaneous mucormycosis in a renal transplant recipient resulted in gangrenous cellulitis of the neck at an internal jugular cannula site. This nosocomial process was due to a histologically confirmed infection, and cultures revealed Mucor sp. The patient died despite surgical debridement and amphotericin B therapy. Cutaneous mucormycosis is a relatively rare entity with only 12 cases previously reported. In renal transplant patients only nine cases of renal transplant patients only nine cases of mucormycosis have been reported and only one was cutaneous. Also, this case reported is the second originating at an intravenous cannula site; the first recorded patient was diabetic.

Amphotericin B↗
PubMed1982

Mucormycosis: case presentation and discussion.

Mucormycosis is encountered in patients with diabetes mellitus, as well as other debilitating diseases. The fungus is ubiquitous, but only certain types of patients become afflicted with this disease. Early diagnosis, control of the underlying disease, drug therapy, and surgical treatment can save the lives of patients with this infection. One should not be reluctant to think of mucormycosis in a differential diagnosis. Mucormycosis is becoming more frequently diagnosed.

Abscess↗
PubMed1980

Hyperbaric oxygen in the treatment of rhinocerebral mucormycosis.

Hyperbaric oxygen therapy was utilized in a case of fulminant mucormycosis of the maxilla, orbit and temporal bone. The patient had refused radical surgery and death seemed iminent in spite of aggressive medical management of diabetic ketoacidosis, amphotericin B and wide surgical drainage of the maxillary and ethmoid sinuses with orbital decompression. Hyperbaric oxygen was instituted on the following theoretical premises: 1. It would provide oxygenation of tissues distal to occluded arteries, thereby increasing local survival and decreasing acidosis, 2. resultant lessening of acidosis would slow or inhibit rapid growth of the organism, and 3. oxygen in sufficient concentration is fungicidal. The rapid progress of the mucormycosis was arrested. Cultures of tissue prior to hyperbaric oxygen treatment produced heavy growth of Rhizopus, and tissues cultured after therapy grew only bacterial contaminants. The patient survived for 3 mo. only to succumb to Pseudomonas meningitis secondary to necrotic bone and epidural abscess of the middle cranial fossa. Rhinocerebral mucormycosis is a fulminant and frequently fatal disease. No survivors were reported before extensive surgical debridement was utilized. Survival improved to 50% with the addition of amphotericin B. Early diagnosis and correction of underlying acidosis has further improved this to 85%. The response to hyperbaric oxygen in this case report possibly introduces a promising new adjunct to therapy of this serious disease.

Adult↗
PubMed1995

Acute rhinocerebral mucormycosis caused by Rhizopus arrhizus from Sri Lanka.

Rhinocerebral mucormycosis is a rare fungus infection reported mainly from the United States of America and Europe. The disease is caused by zygomycete fungi, most often by a Rhizopus species. Diagnosis is often made post-mortem and in many instances culture identification of the fungus responsible has not been performed. A case of culturally proven rhinocerebral mucormycosis is described for the first time in Sri Lanka. The patient was a 56-year-old male who had been treated for diabetes mellitus for 17 years. He had typical symptoms of numbness and loss of sensations over the temporal region, followed by loss of vision and proptosis, all on the right side of his face. The diagnosis of rhinocerebral mucormycosis was confirmed by microscopic examination and culture of material obtained from the retro-orbital space. The patient died before effective antifungal therapy could be instituted.

Acute Disease↗