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PubMedDate not supplied

Mucormycosis in the immunocompromised host.

We are presenting two typical case histories of mucormycosis in patients with acute leukaemia which illustrate some of the important features of this infection in compromised hosts. In such patients, mucormycosis is mostly pulmonary or widely disseminated and often has a rapidly fatal course. A microbiological diagnosis from blood or sputum is difficult to establish. Mucormycosis or other fungal infections should be suspected in compromised patients with infections which do not respond to adequate antibiotic therapy.

Acute Disease↗

PubMed1996

Role of granulocyte colony-stimulating factor in the treatment of mucormycosis.

Several problems in the management of life-threatening mucormycosis remain unresolved, necessitating new methods of management. Four patients with histopathologically proven rhinocerebral mucormycosis were treated with high cumulative doses of granulocyte colony-stimulating factor (G-CSF). All had multiple predisposing factors for mucormycosis, particularly leukemia and neutropenia. Two patients refractory to fluconazole therapy were treated with liposomal amphotericin B. The improvement in clinical manifestations was closely related to neutrophil recovery, and all patients were alive at the end of therapy. In addition to surgical debridement and antifungal therapy, G-CSF seems to have played a role in their survival.

Adult↗

PubMed2002

Primary cutaneous mucormycosis complicating the use of adhesive tape to secure the endotracheal tube.

PURPOSE: To report a rare case of primary cutaneous mucormycosis (PCM), complicating securing of the endotracheal tube with adhesive tape. CLINICAL FEATURES: A 39-yr-old woman with systemic lupus erythematosus (SLE) developed four annular, punched out ulcers with a necrotic centre and elevated border in a linear distribution over the left cheek, under the tape securing the endotracheal tube. A tissue biopsy revealed broad, branching, nonseptate hyphae found in epidermis and dermis consistent with mucormycosis, best demonstrated with silver staining. Cultures were positive for Rhizopus species. Treatment with iv amphotericin B was successful. CONCLUSION: Because of the rarity of the disease and the difficulty of culturing the causative organism, diagnosis of mucormycosis is often elusive. Tissue biopsy and microscopic visualization of nonseptate hyphae with right-angled branching are the only methods for making the diagnosis. Skin biopsy of new ulcerative or plaque-like lesions should be obtained in immunocompromised patients. Early diagnosis and prompt treatment are critical for favourable outcomes in PCM.

Adhesives↗

PubMed2001

Mucormycosis resulting in a pseudoaneurysm in the spleen.

Mucormycosis is an uncommon and frequently fatal fungal infection. It characteristically affects patients with diabetes mellitus or patients with severe immunosuppression. The hallmark of mucormycosis infection is tissue infarction and vascular invasion. We present clinical data and imaging studies of a 16 year-old child with acute lymphoblastic leukemia complicated by disseminated mucormycosis resulting in a pseudoaneurysm of the spleen. This was successfully managed by a combination of systemic antifungal therapy (Amphotericin B) and surgery (splenectomy). This entity has not been described in the literature.

Adolescent↗

PubMedDate not supplied

Subclavian artery occlusion and pseudoaneurysm caused by lung apex mucormycosis: successful treatment with transcatheter embolization.

Subclavian artery pseudoaneurysm and occlusion in young patients are usually post-traumatic. We report the case of a 33-year-old diabetic woman with subclavian artery occlusion and pseudoaneurysm formation caused by pulmonary mucormycosis infection. The patient presented with diabetic ketoacidosis, Horner's syndrome, and absent left arm pulses. A cystic lesion of the left lung apex was found by imaging, was surgically resected, and was histologically diagnosed as mucormycosis infection. Magnetic resonance angiography depicted a left subclavian artery pseudoaneurysm and occlusion adjacent to the mucormycosis lesion. To protect against thromboembolic complications and rupture, the pseudoaneurysm was embolized with coils. The patient is clinically well 1 year after the intervention with no perfusion of the pseudoaneurysm.

Adult↗

PubMed2004

Combined mucormycosis and aspergillosis of the oro-sinonasal region in a patient affected by Castleman disease.

One case of aspergillosis and mucormycosis occurring in a patient with stage-IV Castleman disease was investigated. The patient, who had undergone polychemotherapy and was in otherwise good general condition, without lymphadenopathies or imbalance of the immune system, presented with a palatal ulceration that progressively involved the palatal mucosa and bone, the paranasal sinuses and the orbit. Repeated cultural examinations were always negative. He had undergone multiple cytological smears of the inflammatory infiltration and biopsies of both the oral and nasal mucosa, which resulted in extensive necrotic debris and suppurative inflammation, and, on the very last biopsy, fungal hyphae, spores and conidia were also detected. These were large, branching, mostly non-septate hyphae, associated with conidiophores and conidia, the latter appearing dark brown to black in the histological preparations. Following the diagnosis of combined mucormycosis and aspergillosis, the patient underwent prolonged topic and systemic antibiotic treatment that resulted curative. Mucormycosis usually is a fatal complication of head and neck or systemic disorders, leading to severe immune suppression. Nevertheless, early diagnosis may be achieved using a combination of special stains and may lead to effective antibiotic treatment and cure of the patient, even if associated with other opportunistic infections, such as aspergillosis.

Aged↗

PubMed2003

Primary cutaneous mucormycosis in an immunocompetent host: report of a case.

Cutaneous mucormycosis is an uncommon disease and it usually affects immunocompromised, diabetic, and trauma patients with contaminated wounds or patients with underlying malignancies. It is very rare to find this disease in immunocompetent, nondiabetic patients. We herein report a case of primary cutaneous mucormycosis in an immunocompetent and nondiabetic patient. Our patient was a 50-year-old veterinary doctor. He was diagnosed to have cutaneous mucormycosis of the anterior abdominal wall, and was treated with multiple debridements of the wound and intravenous amphotericin B therapy. He received a total of 1000 mg of amphotericin B. A high index of clinical suspicion and early institution of therapy in the form of surgical debridements and antifungal drugs are required to achieve a successful outcome.

Amphotericin B↗

PubMed2006

Diagnosis of invasive aspergillosis and mucormycosis in immunocompromised patients by seminested PCR assay of tissue samples.

Aspergillosis and mucormycosis are the most common mold infections in patients with hematological malignancies. Infections caused by species of the genus Aspergillus and the order Mucorales require different antifungal treatments depending on the in vitro susceptibility of the causative strain. Cultures from biopsy specimens frequently do not grow fungal pathogens, even from histopathologically proven cases of invasive fungal infection. Two seminested PCR assays were evaluated by amplifying DNA of zygomycetes and Aspergillus spp. from organ biopsies of 21 immunocompromised patients. The PCR assays correctly identified five cases of invasive aspergillosis and six cases of mucormycosis. They showed evidence of double mold infection in two cases. Both assays were negative in five negative controls and in two patients with yeast infections. Sequencing of the PCR products was in accordance with culture results in all culture-positive cases. In six patients without positive cultures but with positive histopathology, sequencing suggested a causative organism. Detection of fungal DNA from biopsy specimens allows rapid identification of the causative organism of invasive aspergillosis and mucormycosis. The use of these PCR assays may allow guided antifungal treatment in patients with invasive mold infections.

Adult↗

PubMedDate not supplied

Ocular invasion in mucormycosis.

The histopathologic findings in a case of ocular invasion in rhinocerebral mucormycosis are described. The findings of hyphae in the inner sclera and marked involvement of the posterior ciliary arteries suggested an arterial route of ocular invasion by fungus. Only five other cases of rhinocerebral mucormycosis with ocular fungal invasion have been reported to our knowledge. All six patients died from the infection. As a group, these cases suggest that the presence of ocular infiltration by fungus may indicate poor prognosis in rhinocerebral mucormycosis.

Aneurysm, Infected↗

PubMedDate not supplied

Cerebral mucormycosis: a case report.

Mucormycosis is an unusual complication in immunosuppressed and diabetic patients. Disseminated mucormycosis is even more unusual. One patient with both pulmonary and cerebral mucormycosis is presented. The clinical course is outlined and computed tomographic (CT) findings are presented.

Adult↗

PubMedDate not supplied

Facial reconstruction after mucormycosis in an immunocompetent host.

Cutaneous mucormycosis in the immunocompetent patient is exceedingly rare. However, if the infection is not rapidly identified and aggressively treated, its progression is fast, fulminate, and characteristically fatal. This case report describes the treatment and surgical reconstruction of a previously healthy, immunocompetent girl after pervasive mucormycosis of the right face. The patient's diagnosis was established by tissue biopsy. She was promptly started on 1.5 mg/kg per day intravenous amphotericin B and underwent numerous surgical debridements resulting in a large defect of the right face. After 2 xenograft procedures the defect was covered with an autologous split thickness skin graft. During this procedure a submandibular 4 x 7-cm tissue expander with a remote occipital port was placed superficial to the platysma. Serial tissue expansion took place over 8 weeks without complication. The tissue expander was removed and the expanded flap was advanced over the freshly de-epithelialized defect. Revisional surgeries may yet be performed; notwithstanding, the patient and her parents are pleased with the current results. Although the management of cutaneous mucormycosis often involves disfiguring tissue resection, the current wealth of reconstructive modalities can greatly improve the aesthetic and functional outcomes of requisite therapy.

Amphotericin B↗

PubMed1997

Frozen section--guided surgical debridement for management of rhino-orbital mucormycosis.

PURPOSE: To present a new method of surgical treatment for rhino-orbital mucormycosis. METHOD: We treated a patient with extensive surgical debridement of mucormycosis with intraoperative frozen section guidance. The patient did not require exenteration. RESULT: Our patient survived with normal vision and no diplopia. CONCLUSIONS: Frozen section-guided surgical debridement in rhino-orbital mucormycosis may provide an alternative to traditional radical surgical excision. In selected cases, this new method of treatment may cause less morbidity than do traditional treatments.

Adult↗

PubMedDate not supplied

Serous retinal detachment in a patient with rhino-orbital mucormycosis.

BACKGROUND: Rhino-orbital mucormycosis is a difficult disease to treat. We report one case of rhino-orbital mucormycosis, complicated by serous retinal detachment, that responded to aggressive treatment. CASE: A 38-year-old man with diabetic ketoacidosis was referred to the emergency department of our hospital with fever, proptotic right eye, and complaint of lethargy. OBSERVATIONS: Fundus examination showed serous retinal detachment and focal lesions of retinitis with exudate at the inferior portion coincident with the position of opacification in the orbit on MRI. Fluorescein angiography showed pooling of dye in the detached retina and leakage from focal lesions of retinitis. We thoroughly removed the large necrotic materials in the orbit and sinus through the lower conjunctiva without enucleation or exenteration. Microscopic examination and culture of the necrotic materials that were removed from the orbit proved that the patient had mucormycosis. The serous retinal detachment improved 10 days after orbital debridement combined with intravenous and local (intraorbital) amphotericin B treatment. Visual acuity recovered to 20/50. CONCLUSION: We propose that inflammation of the sclera in close contact with necrotic fungi materials may cause serous retinal detachment.

Adult↗

PubMed1980

The changing spectrum of disease, etiology, and diagnosis of mucormycosis.

During the 20 year interval from 1958 to 1978 a change in the spectrum of disease, etiology, and diagnosis of mucormycosis was observed at The Mount Sinai Hospital. Although the rhinocerebral and pulmonary forms of mucormycosis were still the most frequent forms of disease, hospital acquired cutaneous and subcutaneous infections emerged. Since 1974, 14 of 15 cases of mucormycosis were diagnosed during life. Rizopus species, especially R. rhizopodoformis, have been the etiologic agents identified in 13 of 14 culturally proven cases. The presence or absence of antirhizopus fungistatic activity and antirhizopus antibody in the sera of six of the patients was correlated with the severity of clinical disease. Preliminary results showed a relationship between the extent of disease and the degree of serum fungistatic activity that was independent of antibody production.

Acute Disease↗

PubMedDate not supplied

[Granulomatous hypodermitis revealing a cutaneous mucormycosis in an immunodepressed patient].

INTRODUCTION: Mucormycosis is an exceptional opportunist fungal infection, despite the ubiquitous nature of its pathogenic agents. It is sometimes revealed by primary cutaneous involvement and its prognosis is bad in the case of visceral dissemination. Our observation illustrates the need for early diagnosis and treatment of this infection. OBSERVATION: An immunodepressed, 45 year-old woman, had developed necrotic hypodermitis lesions on the lower limbs. The skin biopsy led to the diagnosis of mucormycosis. Despite treatment with liposomal amphotericin, the fungal infection worsened, spread to the organs (lungs and brain) and the patient died. DISCUSSION: This case report underlines the potential severity of mucormycosis, which is presently emerging in the onco-hematological field. The infection is sometimes revealed by inaugural ulcerated and/or necrotic cutaneous lesions. Its diagnosis must be evoked early so that salvage medical-surgical treatment can be initiated.

Brain Diseases↗

PubMed2002

Diabetic ketoacidosis and rhino-orbital mucormycosis.

Mucormycosis often develops in immunocompromised patients, particularly in patients with diabetic ketoacidosis. Unless early diagnosis and treatment is established mucormycosis leads rapidly to death. A 38-year-old woman was admitted to the hospital with a severe diabetic ketoacidosis. Her clinical status improved in 4 days as a result of aggressive medical treatment. She has complained left cheek pain on the 10th day and had a swelling of her left cheek, facial edema, a black eschar on the palate and nasal cavity in association with visual disturbance and total ophthalmology in a short time. CT scan revealed left orbital cellulitis and pansinusitis. Excessive surgical treatment was performed and liposomal amphotericin-B, 4 mg/(kg day) was applied. Extensive fungal invasion of the orbit and the sinuses was demonstrated in the pathological species and Rhizomucor species were yielded with culture. Repeated superficial debridement was also performed. After 10 weeks, she was discharged with suggestion of insulin treatment and liposomal amphotericin-B with progressively decreasing doses. At the 13th month following the presentation, the patient was free of disease as confirmed by serial imaging and under good glycaemic control with insulin treatment. Although mucormycosis is a fatal infection, early diagnosis and aggressive treatment may decrease mortality.

Adult↗

PubMed1997

Cutaneous mucormycosis with subsequent visceral dissemination in a child with neutropenia: a case report and review of the pediatric literature.

Primary cutaneous mucormycosis is a rare opportunistic fungal infection that is usually limited to the skin. We describe a primary cutaneous Rhizopus infection occurring at a site occluded by a sterile adhesive dressing in which the disease was viscerally disseminated at the time fo diagnosis. Mucormycosis should be considered in all ecthyma-like lesions in immunocompromised patients. It may be rapidly diagnosed by examination of hematoxylin-eosin and PAS-stained sections of the eschar base and a culture of a leading edge tissue aspirate. We review 21 cases of primary cutaneous mucormycosis in children and compare them with the present case.

Child, Preschool↗

PubMed2000

Renal mucormycosis in the HIV patient.

Mucormycosis is an increasingly recognized opportunistic infection. It usually affects patients with debilitating conditions such as cancer, diabetes mellitus, renal failure, and extensive burns. Mucor infection has also been described in human immunodeficiency virus (HIV) patients. The most common clinical presentations are the cerebral, cutaneous, and renal forms. We describe a unique case of bilateral renal mucormycosis presenting with renal failure in an HIV-infected patient. In the immunosuppressed host, a history of intravenous (IV) drug abuse associated with symptoms of pyelonephritis should alert the clinician to the possibility of mucor infection. Blood and urine culture are often negative. The diagnosis is made histologically in most cases. The treatment of HIV patients with mucormycosis and renal failure includes hemodialysis, nephrectomy, and intravenous amphotericin in addition to antiretroviral therapy. Bilateral renal involvement with Mucor carries a poor prognosis.

AIDS-Related Opportunistic Infections↗