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PubMed1998

[Paranasal mucormycosis with involvement of the sphenoid sinus].

Mucormycosis with hemipansinusitis and left orbital involvement was observed in a 66-year-old diabetic woman. Diagnosis was confirmed by mycology and pathology examinations. The patient was treated surgically with wide exeresis of necrotic tissue and medically with amphotericin B and insulin. Cure was obtained after three months of treatment at the cost of retraction of the left nostril due to infectious lysis and resection of the nasal infrastructure. The sinus involvement was exceptional compared with reports in the literature. Mucormycosis is an uncommon condition caused by opportunistic infection in immunodepressed subjects. The causal agent is a fungus belonging to the Rhizopus, Absidia or Mucor genera. Prognosis is poor with overall mortality reaching 50%.

Aged↗

PubMed1997

[Pulmonary mucormycosis infection in a boy with AIDS].

It is described a pulmonary mucormycosis in an 11-year-old child with AIDS. The diagnosis was obtained by direct examination of the bronchial aspiration. The non-septate, hyaline, dichotomous, pathognomonic cenotic hyphae of this disease were observed. The child was cured with the specific treatment with Amphotericin B, since he died a year later and this affection did not appear in the necropsy. This combination of pulmonary mucormycosis and AIDS has never been reported in Cuba.

AIDS-Related Opportunistic Infections↗

PubMed1998

[An autopsy case of rhino-orbito-cerebral mucormycosis associated with multiple cranial nerve palsy and subsequent subarachnoid hemorrhage].

We report an autopsy case of 53-year-old male with poor controlled diabetes mellitus and hepatocellular carcinoma who developed rhino-orbito-cerebral mucormycosis. Initial complaints were epistaxis and headache followed by a sudden blindness, the 2nd through 7th cranial nerve palsy and diabetes inspidus. Laboratory data revealed that he had liver cirrhosis due to hepatitis C virus infection and diabetes mellitus. Head CT and MRI showed no significant findings. Eleven days after the onset, he died of subarachnoid hemorrhage. The postmortem examination revealed severe infiltration of numerous mucors in the sphenoid sinus, cavernous sinus and bilateral internal carotid arteries. Severe granulomatous vasculitis was seen in the cavernous portion of the bilateral internal carotid arteries. Thus, we considered that this case had been caused by the infiltration of mucors to the cavernous sinus, resulting in the obstruction of ophthalmic arteries. Rupture of the right internal carotid artery was seen at the branching portion of the ophthalmic artery, demonstrating the cause of his death. We would like to emphasize that rhino-orbito-cerebral mucormycosis should be ruled out if we examine a nondiagnostic case of diabetes mellitus or immunosuppressed disease associated with rapid multiple cranial nerve palsy following the orbital symptoms.

Abducens Nerve↗

PubMed1998

[Benign maxillofacial mucormycosis. Report of a case and review of the literature].

Mucormycosis is a rare and often lethal infection caused by an opportunistic fungus of the Phycomycetes class. This microorganism is a saprophytic aerobial fungus common in nature and in oral mucosae, nose, paranasal sinus and throat. Mucormycosis has been described in various clinical forms: rhinocerebral, pulmonary, systemic, cerebral and cutaneous, always in immunodepressed patients, with rapid evolution and high rate of mortality. However, rare cases involving maxillofacial area are described in healthy patients with benign evolution and good prognosis as in a case observed at the Department of Maxillofacial Surgery of the University of Naples "Federico II".

Adult↗

PubMed2004

Zygomycosis (mucormycosis): emerging clinical importance and new treatments.

PURPOSE OF REVIEW: New importance has been given to zygomycosis, as what was uncommon is no longer. Zygomycosis (mucormycosis) typically occurs in patients with leukemia, with solid-organ transplants or bone marrow transplants, with diabetic ketoacidosis, in those who have received steroids or are neutropenic, and after desferioxamine therapy. Often, both diagnostic and therapeutic measures are performed too late and are inadequate. Mortality rates may be as high as 80% in infected transplant recipients. Zygomycosis also appears to have made a subtle increase in incidence: up to 8% in autopsied patients with leukemia, and 2% in allogenic bone marrow transplant patients. Most infections are acquired by inhalation, ingestion, or trauma. They rapidly infarct blood vessels, resulting in necrosis of surrounding tissue. Over the past few years, new diagnostic procedures, susceptibility tests, and drugs have entered the clinic, and these advances are discussed in the review. RECENT FINDINGS: With the rise in number of cases of 'zygomycosis', new scrutiny has been directed at the terms 'zygomycosis' and 'mucormycosis'. This review explains their differences and the attending relevance for the clinician. Diagnostic methods include new molecular detection assays and new susceptibility testing options. New treatment options will soon exist with triazole antifungal agents. The first one expected to enter clinical practice is posaconazole in 2005. Its metabolism, pharmacokinetics, in-vitro and in-vivo activity, and clinical study results are described. Finally, we present our approach to zygomycosis. SUMMARY: This review discusses key elements to laboratory diagnostic and susceptibility procedures and new treatment options.

Antifungal Agents↗

PubMed1998

Complications of mucormycosis: total gastrectomy for emphysematous gastritis.

Emphysematous gastritis and mucormycosis are two different entities and both are very rare in clinical practice. Emphysematous gastritis secondary to mucormycosis has not been described in literature so far. We would like to report such a case for the first time and review the relevant literature and clinical implications.

Journal Article↗

PubMed2005

Mucormycosis: a devastating fungal infection in diabetics.

Mucormycosis is a highly invasive, devastating and usually fatal fungal infection of the sinuses, brain, or lungs that occurs primarily in people with immune disorders. Despite advances in diagnosis and treatment, a high mortality still exists. We present a middle aged diabetic male with this serious fungal infection involving nose, paranasal area and adjacent periorbital regions with a high risk of progressing further towards the dura mater. He was promptly diagnosed and managed with serial surgical debridements with systemic antifungals and was later fitted with a nasal prosthesis.

Combined Modality Therapy↗

PubMed1977

Cutaneous infarction. Manifestation of disseminated mucormycosis.

We describe the second reported case of cutaneous infarction as a manifestation of disseminated mucormycosis. The lesion, which closely resembled ecthyma gangrenosum, occurred in a leukemic patient who was on a regimen of broad-spectrum antibiotics. In this case as in the only other reported case, Mucor pusillus was the cause.

Adult↗

PubMed1978

Mucormycosis. A complication of critical care.

Lethal nosocomial mucormycosis developed in three previously well individuals while they were receiving intensive care for acute hemorrhagic pancreatitis, for cardiogenic shock, and for a ruptured intra-abdominal aortic aneurysm. In two cases, the condition was first seen as progressive cavitary pneumonia refractory to antibacterial therapy; Mucoraceae was identified in all three patients only at autopsy. Each patient had received large doses of corticosteroids and broad-spectrum antibiotics, and all had suffered from respiratory failure, acute renal failure with acidosis, and severe hyperglycemia in association with total parenteral nutrition. Mucoraceae should be regarded as an additional nosocomial pathogen in the setting of advanced life-support care.

Acidosis↗

PubMed1999

Pulmonary mucormycosis: the last 30 years.

Pulmonary mucormycosis is relatively uncommon but an important opportunistic fungal infection in immunocompromised persons. The literature on the subject is sparse. We describe a recent case and review the literature to delineate the clinical characteristics of this infection. We searched the MEDLINE database for articles published in the English-language literature since 1970 and carefully analyzed 87 cases. The main risk factors were diabetes mellitus, hematologic cancers, renal insufficiency, and organ transplantation. Several patients had no apparent immune compromise. There was a predilection for involvement of the upper lobes. Air crescent signs on chest x-ray films were predictors of pulmonary hemorrhage and death from hemoptysis. Fiberoptic bronchoscopy was a useful diagnostic method, and histopathologic examination was more sensitive than fungal cultures. The overall survival rate was 44%. Patients treated with a combined medical-surgical approach had a better outcome than patients who did not undergo surgery. Thus, this relatively rare but often fatal disease should be suspected in immunocompromised patients who fail to respond to antibacterial therapy. Early recognition and aggressive management are warranted to maximize chances for cure. Optimal therapy requires systemic antifungal therapy, surgical resection, and, when possible, control of the patient's underlying disease.

Adult↗

PubMed1982

Cerebral mucormycosis (Phycomycosis) in a heroin addict.

Cerebral mucormycosis was found at autopsy in a 27-year-old male narcotic addict with rapidly progressive focal neurologic signs. There was no evidence of rhinocerebral involvement of systemic illness, and a nuclide brain scan suggested brain abscess.

Adult↗

PubMed1985

Rhinocerebral mucormycosis in a diabetic ketoacidotic patient.

A 51-year-old, ketoacidotic diabetic with the rare neurological complications of rhinocerebral mucormycosis is reported. The clinical presentation was characterized by initial severe frontal headache, rapid visual loss with complete external ophthalmoplegia and intracranial spread by invasive fungal growth. Its course and fungostatic therapy with amphotericin B and ketoconazole are described and the literature reviewed.

Acidosis↗

PubMed1984

Computed tomography of rhinocerebral mucormycosis.

Rhinocerebral mucormycosis is a rare fungal infection which is frequently fatal. Survival depends on early diagnosis and immediate aggressive treatment. Previously described radiological changes have been non-specific. The CT features of two cases are described. Non-enhancement of the superior ophthalmic vein and ophthalmic artery appears to be a CT sign specific to this disease.

Adolescent↗

PubMed1983

Passive immunization in murine mucormycosis.

Antibody raised in mice against mycelial homogenates of Rhizomucor pusillus was effective in passive immunization against pulmonary and disseminated mucormycosis (phycomycosis) in immunocompromised mice. Mice intranasally inoculated and infected with Rh. pusillus and treated with antisera had a statistically significant increased resistance to infection and a diminished secondary dissemination of viable fungal fragments. Histological examination of infected lung tissues showed that antibody treated animals were apparently able to degrade hyphal fragments.

Animals↗

PubMed1983

Serological studies of a case of fatal craniofacial mucormycosis.

Counter-immunoelectrophoresis and indirect immunofluorescence tests were used in a fatal case of craniofacial mucormycosis. The indirect immunofluorescent test was rapid and more sensitive than counter-immunoelectrophoresis and provided estimation of serum antifungal antibodies (IgA, IgG and IgM). The high serum IgA titer (comparable to IgM) found in this case of acute infection suggests a role of IgA antibodies which needs further investigation.

Antibodies, Fungal↗

PubMed1977

Experimental mucormycosis in congenitally athymic (nude) mice.

Athymic nude (nu/nu) mice and their phenotypically normal (nu/+) littermates displayed a similar susceptibility to acute lethal infection with Absidia corymbifera. Although the clinical manifestations of acute infection were also similar in both groups, the nude mice tended to develop more extensive lesions and were less effective in eliminating viable A. corymbifera spores than their heterozygous littermates. The results suggested that thymus-dependent processes did not play an essential role in primary resistance to mucormycosis.

Animals↗

PubMed1991

Pulmonary mucormycosis presenting as massive fatal hemoptysis in a hemodialytic patient with chronic renal failure.

A 38 year old female patient died following massive hemoptysis occurring during maintenance hemodialysis for chronic renal failure. In addition to renal dysfunction, laboratory data showed low levels of serum immunoglobulins; chest X-rays did not reveal any abnormal shadows. For the last 11 months, the patient had not received deferoxamine. At autopsy, major bronchi were plugged with coagulated blood. Irregular thickening of the right main bronchial wall close to the lung hilus was noted. Light microscopic examination disclosed mycotic granulomata in the bronchial wall, where the pulmonary arterial wall was also involved. Immunostaining using specific antibody identified Mucor hyphae. The mucormycosis is a serious complication of chronic renal failure and hemodialysis. In the current case, it is likely that immune dysfunction rather than deferoxamine was the important predisposing factor to the growth of the fungus.

Adult↗

PubMedDate not supplied

Mucormycosis and ameloblastoma of the upper jaw.

We report a case of mucormycotic infection complicating a clinically silent ameloblastoma in an aged diabetic woman. Diagnosis was made by culture and biopsy of the affected tissue, where foreign-body granulomas were seen, an unusual inflammatory response for mucormycosis. A good outcome was achieved on the basis of radical surgery and amphotericin B infusion.

Aged↗