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Meyerowitz EA, Sanchez S, Mansour MK, Triant VA, Goldberg MB. Isolated Cerebral Mucormycosis in Immunocompetent Adults who Inject Drugs: Case Reports and Systematic Review of the Literature. Open Forum Infect Dis 2020; 7:ofaa552. [PMID: 33409328 PMCID: PMC7765436 DOI: 10.1093/ofid/ofaa552] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/05/2020] [Indexed: 01/16/2023] Open
Abstract
Background Mucormycosis involves life-threatening rapidly progressive angioinvasion with infiltration across tissue planes, resulting in necrosis and thrombosis, most commonly seen in the setting of immunocompromised states. We describe 2 cases of isolated cerebral mucormycosis in immunocompetent adults and describe this syndrome in detail in the context of a systemic literature review. Methods Using the criteria (1) isolated cerebral disease, (2) mucormycosis (by polymerase chain reaction, culture, or pathology), and (3) affected an immunocompetent individual, we identified 53 additional cases from 1969 to 2020. Results Of these 55 cases, ~60% occurred in men, >70% were in patients under age 35, 92% were associated with intravenous drug use, and >85% had infection centered in the basal ganglia. Many presented with cranial nerve deficits, headache, focal weakness, or altered mental status. Conclusions No patient survived without amphotericin, and steroid administration was associated with worse outcomes. Given the current opioid crisis, this syndrome may be seen more frequently.
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Affiliation(s)
- Eric A Meyerowitz
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarimer Sanchez
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael K Mansour
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Virginia A Triant
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marcia B Goldberg
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
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Zhao TJ, Yang QK, Bi LD, Li J, Tan CY, Miao ZL. Prognostic value of DCTA scoring system in heart failure. Herz 2020; 46:243-252. [PMID: 33084909 DOI: 10.1007/s00059-020-04993-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the prognostic value of a novel scoring system, based on D‑dimer, total cholesterol, high-sensitivity cardiac troponin T (hs-cTnT), and serum albumin levels, in patients with heart failure. METHODS A total of 221 patients diagnosed with heart failure between May 2016 to January 2020 were enrolled in this retrospective study. The prognostic significance of the biomarkers D‑dimer, total cholesterol, hs-cTnT, and serum albumin was determined with univariate and multivariate Cox proportional hazard models. A novel prognostic score based on these predictors was established. The Kaplan-Meier method and log-rank test were used to compare the adverse outcomes of patients in different risk groups. RESULT Results from univariate and multivariate analyses showed that high D‑dimer, low serum albumin, high hs-cTnT, and low total cholesterol levels were independent prognostic factors for adverse outcomes (D-dimer >0.63 mg/l, HR = 1.84, 95% CI = 1.16-2.94, p = 0.010; serum albumin >34 g/l, HR = 0.67, 95% CI = 0.45-0.99, p = 0.046; hs-cTnT >24.06 pg/ml, HR = 1.65, 95% CI = 1.08-2.53, p = 0.020; total cholesterol >3.68 mmol/l, HR = 0.63, 95% CI = 0.43-0.92, p = 0.017). Moreover, all the patients were stratified into low-risk or high-risk group according to a scoring system based on these four markers. Kaplan-Meier analyses demonstrated that patients in the high-risk group were more prone to having adverse outcomes compared with patients in the low-risk group. CONCLUSION D‑dimer, total cholesterol, hs-cTnT, and serum albumin levels were independent prognostic factors in the setting of heart failure. A novel and comprehensive scoring system based on these biomarkers is an easily available and effective tool for predicting the adverse outcomes of patients with heart failure.
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Affiliation(s)
- Tian-Jun Zhao
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, No.33 Wenyi Road, Shenhe District, 110016, Shenyang, China
| | - Qian-Kun Yang
- Department of Bone and Soft Tissue Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, 110042, Shenyang, China
| | - Li-Dan Bi
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, No.33 Wenyi Road, Shenhe District, 110016, Shenyang, China
| | - Jie Li
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, No.33 Wenyi Road, Shenhe District, 110016, Shenyang, China
| | - Chun-Yu Tan
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, No.33 Wenyi Road, Shenhe District, 110016, Shenyang, China
| | - Zhi-Lin Miao
- Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, No.33 Wenyi Road, Shenhe District, 110016, Shenyang, China.
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Kerezoudis P, Watts CR, Bydon M, Dababneh AS, Deyo CN, Frye JM, Kelley PC, Kemp AM, Palraj BV, Pupillo GT. Diagnosis and Treatment of Isolated Cerebral Mucormycosis: Patient-Level Data Meta-Analysis and Mayo Clinic Experience. World Neurosurg 2018; 123:425-434.e5. [PMID: 30415043 DOI: 10.1016/j.wneu.2018.10.218] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Isolated cerebral mucormycosis is a rare and serious infection associated with intravenous drug abuse. METHODS We performed a comprehensive meta-analysis of cases reported in studies and have included an unreported case from our institution. We searched PubMed/Medline, EMBASE, Scopus, Cochrane Databases, and our institution's electronic medical health records from inception through March 31, 2018. The cases were considered isolated (only affecting the cerebrum, cerebellum, or brainstem) if the absence of other primary sources of infection had been documented. Continuous variables were summarized using the median and interquartile range and categorical variables using frequencies and proportions. The relationships between variables were tested using the Wilcoxon rank sum and Pearson χ2 tests. RESULTS A total of 130 studies (141 patients) met the eligibility requirements and were screened; 68 patients were included. The median age was 28 years (interquartile range, 24-38); 57% were men. Most patients had a history of intravenous drug abuse (82%), and 20% had positive human immunodeficiency virus findings. The lesion location was mostly supratentorial (91%), especially in the basal ganglia (71.2%). The cultures were positive in 38%, with Rhizopus the most common organism (59%). The mortality rate was 65%. The survivors were significantly more likely to have received amphotericin B (92% vs. 43%; P < 0.001) or to have undergone stereotactic aspiration (58% vs. 25%; P < 0.01). CONCLUSIONS Isolated cerebral mucormycosis has a pooled mortality rate of 65%. The presence of lesions in the basal ganglia, rapidly progressive symptoms, and a history of intravenous drug abuse should raise suspicion for the early initiation of amphotericin B and stereotactic aspiration.
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Affiliation(s)
| | - Charles R Watts
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurosurgery, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, Wisconsin, USA.
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ala S Dababneh
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA; Department of Infectious Diseases, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, Wisconsin, USA
| | - Christopher N Deyo
- Department of Hospital Medicine, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, Wisconsin, USA
| | - Judson M Frye
- Department of Radiology, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, Wisconsin, USA
| | - Parker C Kelley
- Department of Neurosurgery, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, Wisconsin, USA
| | - Anna M Kemp
- Department of Pathology, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, Wisconsin, USA
| | - Bharath V Palraj
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA; Department of Infectious Diseases, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, Wisconsin, USA
| | - Gregory T Pupillo
- Department of Neurology, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, Wisconsin, USA
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4
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Hadley C, Haneef Mohamed AW, Singhal A. Central nervous system fungal infection in a young male with a history of intravenous drug abuse and hepatitis C. Radiol Case Rep 2017; 12:590-596. [PMID: 28828132 PMCID: PMC5551908 DOI: 10.1016/j.radcr.2017.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 02/28/2017] [Accepted: 03/11/2017] [Indexed: 11/17/2022] Open
Abstract
A young male, with a known history of hepatitis C and heroin abuse, was admitted to the emergency department with altered sensorium, left-sided weakness, and no meningeal signs. Initial computed tomography imaging showed hypodensity involving right basal ganglia with mass effect but no hemorrhage. Magnetic resonance imaging revealed multiple nonenhancing small foci of restricted diffusion involving the right basal ganglia, T2 and FLAIR hyperintensity within the right basal ganglia, and internal capsule with mild surrounding edema. The patient was treated for encephalitis and atypical stroke given the history of intravenous drug abuse. Follow-up imaging showed worsening of the brain lesions, with involvement of the contralateral basal ganglia with necrosis and peripheral enhancement. Brain biopsy was ultimately performed and suggested infection with Aspergillus species and associated parenchymal infarction. The patient was treated with voriconazole with subsequent significant clinical improvement.
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Affiliation(s)
- Celene Hadley
- Department of Neuroradiology, University of Alabama at Birmingham, 619 19th St South, JT N466, Birmingham, AL 35249, USA
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5
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Paur R, Wallner C, Hermann P, Stöllberger C, Finsterer J. Neurological Abnormalities in Opiate Addicts with and without Substitution Therapy. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:239-45. [DOI: 10.3109/00952990.2011.644001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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6
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Metellus P, Laghmari M, Fuentes S, Eusebio A, Adetchessi T, Ranque S, Bouvier C, Dufour H, Grisoli F. Successful treatment of a giant isolated cerebral mucormycotic (zygomycotic) abscess using endoscopic debridement: case report and therapeutic considerations. ACTA ACUST UNITED AC 2008; 69:510-5; discussion 515. [PMID: 17707491 DOI: 10.1016/j.surneu.2007.02.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 02/13/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cerebral mucormycosis without rhino-orbital or systemic involvement is an extremely rare condition mostly associated with parenteral drug abuse. CASE DESCRIPTION We report the case of a 42-year-old woman who presented with hemiparesis of the left side and altered mental status. Neuroradiologic workup demonstrated an inflammatory lesion involving the right basal ganglia. Proton magnetic resonance spectroscopy demonstrated features consistent with a pyogenic abscess. Computed tomography-guided stereotactic biopsy led to the diagnosis of cerebral mucormycosis. Parenteral AMB-L treatment was conducted, but the patient worsened clinically, presenting with a complete hemiplegia, and cerebral magnetic resonance imaging (MRI) scans demonstrated a voluminous abscess formation. Then, under stereotactic guidance, a surgical endoscopic debridement of the abscess cavity associated with the placement of an Ommaya reservoir was performed. Systemic and intralesional treatment with AmB associated with an adjunctive immune therapy was conducted. At 3-year follow-up, the patient had recovered partially from her left hemiplegia, allowing her to walk without help, and cerebral MRI scans showed complete resorption of the abscess. CONCLUSION Our good results suggest that surgical endoscopic debridement associated with intravenous and intracavitary antifungal therapy might be valuable in treating voluminous deep-seated mucormycotic lesions.
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Cuellar H, Riascos R, Palacios E, Rojas R, Molina P. Imaging of isolated cerebral mucormycosis. A report of three cases. Neuroradiol J 2007; 20:525-30. [PMID: 24299941 DOI: 10.1177/197140090702000509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 07/29/2007] [Indexed: 11/16/2022] Open
Abstract
Mucormycosis is a rare infection in immunosupressed patients caused by fungi from the family Mucoraceae. Three types of disease spread have been described: rhinocerebral, systemic and isolated. Isolated spread is the most uncommon form, usually resulting in death. It has been described in diabetics, immunosupressed patients and intravenous drug abusers. Neuroimaging can aid the diagnosis of this entity, but biopsy remains the only reliable method. Imaging findings of Mucormycosis include abscesses and hemorrhagic or ischemic infarcts, usually in the basal ganglia and frontal lobes. Single or multiple lesions have been described as well as meningoencephalitis. Understanding these findings can help to detect the infection in an early stage. We describe three cases of isolated cerebral mucormycosis; all of them were intravenous drug abusers with one patient also being HIV positive.
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Affiliation(s)
- H Cuellar
- Department of Endovascular Therapy , Interventional Neuroradiology Fellow, Clinica Nuestra Señora del Rosario; Madrid, España -
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8
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Verma A, Brozman B, Petito CK. Isolated cerebral mucormycosis: Report of a case and review of the literature. J Neurol Sci 2006; 240:65-9. [PMID: 16269155 DOI: 10.1016/j.jns.2005.09.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Revised: 09/06/2005] [Accepted: 09/08/2005] [Indexed: 11/18/2022]
Abstract
Isolated cerebral mucormycosis is a rare but life-threatening infection that generally occurs in patients with intravenous drug abuse or immune deficiency. We report a case of primary cerebral mucormycosis in a healthy adult. Whole body autopsy in this case revealed cerebral mucormycosis with prominent vascular pathology and hemorrhagic necrosis. No nasal sinus, orbital or other primary locus of fungus infection was discovered. Review of the previously reported 30 cases of isolated cerebral mucormycosis revealed associated systemic predisposition in 11 patients and history of intravenous drug abuse in 17 cases. In the remaining two cases, the diagnosis of fungal infection was made only after surgical exploration. Early tissue diagnosis and the consequent surgical excision of the necrotic tissue and aggressive antifungal therapy might salvage life in this fatal condition.
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Affiliation(s)
- Ashok Verma
- Department of Neurology, University of Miami School of Medicine, 1150 NW 14 Street, Suite 701, Miami, FL 33136, USA.
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9
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Büttner A, Weis S. Central Nervous System Alterations in Drug Abuse. FORENSIC PATHOLOGY REVIEWS 2004. [DOI: 10.1007/978-1-59259-786-4_4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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10
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Sharma RR, Pawar SJ, Delmendo A, Lad SD, Athale SD. Fatal rhino-orbito-cerebral mucormycosis in an apparently normal host: case report and literature review. J Clin Neurosci 2001; 8:583-6. [PMID: 11683615 DOI: 10.1054/jocn.2000.0818] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Fungal infections of the central nervous system (CNS) are fortunately rare but remain challenging problems occurring mostly in immunocompromised individuals, with protean manifestations, unpredictable course and unfavorable outcome in many cases despite aggressive neurosurgical intervention and recent antifungal drugs. Rhino-orbito-cerebral mucormycosis is a potentially lethal opportunistic fungal infection with rapid progression and high mortality. Its pathogenic nature becomes evident when the patient's general resistance is compromised. We present a case of an invasive rhino-orbito-cerebral mucormycosis in an apparently normal adult who initially developed mild paranasal sinusitis and later developed status epilepticus and despite an aggressive management died. Interesting clinical, neuroimaging and histological findings are described, and the possibility of fatal mucormycosis in an apparently normal host is highlighted.
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Affiliation(s)
- R R Sharma
- The National Neurosurgical Centre & Department of Anaesthesiology, Khoula Hospital, PC-116, Mina-Al-Fahal, Muscat, Sultanate of Oman.
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11
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Abstract
A broad spectrum of neuropathologic changes are encountered in the brains of heroin abusers. The main findings are due to infections, either due to bacterial spread from bacterial endocarditis, mycoses, or from HIV-1 infection. Other complications include hypoxic-ischemic changes with cerebral edema, ischemic neuronal damage and neuronal loss, which are assumed to occur under conditions of prolonged heroin-induced respiratory depression, stroke due to, for example, thromboembolism, vasculitis, septic emboli, hypotension, and positional vascular compression. Myelopathy is believed to be the result of an isolated vascular accident within the spinal cord due to an as yet unknown mechanism. A distinct entity, spongiform leukoencephalopathy, has been described mainly after inhalation of pre-heated heroin. A lipophilic toxin-induced process was considered to be due to contaminants and to be induced or enhanced by cerebral hypoxia, but a definite toxin could not be identified. At the cellular level, abnormalities in signal transduction systems and changes of various receptor densities have been reported. The exact etiology of the different neuropathological alterations associated with heroin abuse is still unclear, but may also be related to additional substances used as adulterants.
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Affiliation(s)
- A Büttner
- Institute of Legal Medicine, University of Munich, Frauenlobstrasse 7a, 80337, Munich, Germany
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12
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Zarei M, Morris J, Aachi V, Gregory R, Meanock C, Brito-Babapulle F. Acute isolated cerebral mucormycosis in a patient with high grade non-Hodgkins lymphoma. Eur J Neurol 2000; 7:443-7. [PMID: 10971606 DOI: 10.1046/j.1468-1331.2000.00089.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 57-year-old female in complete remission of grade IV non-Hodgkin lymphoma whilst on intensive chemotherapy, suddenly developed unilateral hemispheric stroke with a fatal outcome in 3 days. She was apyrexial and had received antifungal prophylaxis during her treatment. Post-mortem examination showed complete thrombosis of the internal carotid artery leading to infarction in the territory of the middle and anterior cerebral arteries. Microscopic examination of the brain showed involvement of intra-cranial vessel walls and brain parenchyma by mucormyces, with no evidence of systemic mucormycosis. Isolated cerebral mucormycosis is a rare occurrence, more commonly found in intravenous drug abusers, but can occur in patients with haematological malignancy.
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Affiliation(s)
- M Zarei
- Department Royal Berkshire Hospital, Reading, UK.
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13
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Adler DE, Milhorat TH, Miller JI. Treatment of rhinocerebral mucormycosis with intravenous interstitial, and cerebrospinal fluid administration of amphotericin B: case report. Neurosurgery 1998; 42:644-8; discussion 648-9. [PMID: 9527000 DOI: 10.1097/00006123-199803000-00037] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE Rhinocerebral mucormycosis is extremely difficult to treat. Approximately 70% of patients are poorly controlled diabetics, and many of the remainder are immunocompromised as a consequence of cytotoxic drugs, burn injuries, or end-stage renal disease. Despite standard treatment consisting of surgical debridement and the intravenous administration of amphotericin B, rhinocerebral mucormycosis is usually a fatal disease. CLINICAL PRESENTATION We describe the case of a 16-year-old male patient with juvenile onset diabetes mellitus who presented with fever, right-sided hemiparesis, and dysarthria. Axial view computed tomography revealed abscess formation in the left basal ganglia and frontal lobe, which was proven by stereotactic biopsy to contain Rhizopus oryzae. INTERVENTION Intravenous administration of amphotericin B (30-280 mg/dose) was begun on the day of admission. On hospital Day 20, after the occurrence of frank abscess formation, the lesion was aggressively debrided. Despite these therapies, there was neurological deterioration characterized by the development of hemiplegia and aphasia. Sequential computed tomographic scans enhanced with contrast medium demonstrated progressively enlarging lesions. Ommaya reservoirs were placed into the abscess cavity and the frontal horn of the contralateral lateral ventricle. The patient was then treated with intracavitary/interstitial injections of amphotericin B during the course of 80 days and three doses of intraventricular amphotericin B. Clinical and radiographic improvement was achieved after treatment. Two years after the initial diagnosis, magnetic resonance imaging of the brain showed no evidence of disease and an examination revealed a neurologically intact and fully functional patient. CONCLUSION We conclude that with an infection as morbid as rhinocerebral mucormycosis, it is advisable to use surgical debridement and all available routes for delivering amphotericin B to infected cerebral parenchyma, which include intravenous, intracavitary/interstitial, and cerebrospinal fluid perfusion pathways.
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Affiliation(s)
- D E Adler
- Department of Neurosurgery, State University of New York, Health Science Center at Brooklyn, 11203, USA
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14
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Artico M, Pastore FS, Polosa M, Sherkat S, Neroni M. Intracerebral Aspergillus abscess: case report and review of the literature. Neurosurg Rev 1997; 20:135-8. [PMID: 9226675 DOI: 10.1007/bf01138199] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Intracranial aspergillosis is a rare pathologic condition, difficult to treat and often fatal, which generally affects immunodepressed patients. A case of brain abscess secondary to pulmonary localization in a patient with a non-Hodgkin lymphoma is described. The most significant clinico-pathological findings of intracranial aspergillosis are examined in the light of the relevant literature.
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Affiliation(s)
- M Artico
- Institute of Neurosurgery, University of Rome Tor Vergata, Italy
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15
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Abstract
The literature on zygomycotic infection in HIV-positive patients is reviewed. A total of 28 patients have been reported. The risk factor for HIV infection was known in 22 of these and was sexual transmission in only six patients and intravenous (i.v.) drug use in 16 (73%). In the latter group, it is likely that i.v. drug injection was the entry route of the zygomycotic infection. The most prevalent clinical presentations of zygomycosis in the i.v. drug-using HIV-positive patients were cerebral, cutaneoarticular and renal (accounting for 88% of presentations in total). These presentations were much less common (18%) in a cohort of 116 patients belonging to the conventional risk groups for zygomycosis (HIV negative and no i.v. drug use). The isolated cerebral localization is the typical presentation of zygomycosis in HIV-negative i.v. drug users.
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Affiliation(s)
- J K Van den Saffele
- Unit of Renal and Infectious Diseases, Algemeen Ziekenhuis St.-Jan, Brugge, Belgium
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16
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Crowley P, Wilcox JA. Cerebral mucormycosis presenting a psychiatric distress. PSYCHOSOMATICS 1996; 37:164-5. [PMID: 8742545 DOI: 10.1016/s0033-3182(96)71585-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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17
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18
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Gollard R, Rabb C, Larsen R, Chandrasoma P. Isolated cerebral mucormycosis: case report and therapeutic considerations. Neurosurgery 1994; 34:174-7. [PMID: 8121556 DOI: 10.1097/00006123-199401000-00026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Cerebral mucormycosis (without associated involvement of and invasion from the nasal sinuses and turbinates) is an extremely rare opportunistic infection of the central nervous system. We report the case of an intravenous drug abuser (who was negative for the human immunodeficiency virus) who presented with hemiparesis on the right side, slurred speech, altered mental status, and an unsteady gait. Imaging studies revealed a large left-side basal ganglia lesion. A stereotactic biopsy obtained a tissue sample that revealed wide, nonseptated hyphal fragments with granulomatous inflammation. The patient was treated with 3 gm of amphotericin B during a 5-month period. The patient had no residual neurological dysfunction after treatment. Open surgical resection was not employed. This case suggests that stereotactic biopsy followed by long-term amphotericin B therapy, in lieu of open surgical resection, represents a viable treatment option for this rare disorder.
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Affiliation(s)
- R Gollard
- Department of Medicine, University of Southern California Medical Center-Los Angeles County
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19
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Epstein NE, Hollingsworth R, Black K, Farmer P. Fungal brain abscesses (aspergillosis/mucormycosis) in two immunosuppressed patients. SURGICAL NEUROLOGY 1991; 35:286-9. [PMID: 2008644 DOI: 10.1016/0090-3019(91)90006-u] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Although the mortality rate for fungal brain abscesses in immunosuppressed patients remains unacceptably high, this figure may be reduced if computed tomography or magnetic resonance imaging scans are performed more promptly in susceptible individuals with seemingly mild intracranial complaints. Earlier presumptive amphotericin B treatment and more timely surgical debridement may minimize neurological injury and enhance survival. These assumptions were only tentatively supported by the clinical courses of two patients, one an alert patient with promyelocytic leukemia and an aspergillosis brain abscess who survived, and the other, a comatose intravenous drug abuser with mucormycosis who died.
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Affiliation(s)
- N E Epstein
- Department of Surgery, North Shore University Hospital, Manhasset, New York
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20
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Abstract
A report is presented of a patient with cerebral mucormycosis without rhinosinusal or systemic evidence of the disease. The predisposing condition was drug-induced immunosuppression. Computed tomography (CT) showed focal areas of abnormal enhancement which correlated with necropsy findings of localised parenchymal brain damage; this represented encapsulated brain abscesses, a rare form of presentation of cerebral mucormycosis.
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Affiliation(s)
- A Escobar
- Department of Pathology, Instituto Nacional de Neurologia y Neurocirugia de México, México, DF
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21
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Test and teach Number Sixty-One: Part 2. Pathology 1989. [DOI: 10.3109/00313028909061081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Zygomycosis of the basal ganglia should be recognized as a syndrome in intravenous drug users associated with a culture-negative cellular CSF, fever, lethargy, and lesions apparent on contrast-enhanced CT scans of the head. The infection is most likely the result of intravenous inoculation of fungal spores. This entity is different from the rhinocerebral zygomycosis seen with diabetes mellitus and other diseases. In the rhinocerebral form, there are external signs of the disease with involvement of the orbit, paranasal sinuses, and palate. In these drug users, infection was directed to areas deep within the brain.
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Affiliation(s)
- G M Stave
- Department of Medicine, Medical College of Virginia/Virginia Commonwealth University, Richmond
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Kasantikul V, Shuangshoti S, Sampatanukul P. Primary chromoblastomycosis of the medulla oblongata: complication of heroin addiction. SURGICAL NEUROLOGY 1988; 29:319-21. [PMID: 3353844 DOI: 10.1016/0090-3019(88)90165-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A 20-year-old male heroin addict had a sudden onset of progressive medullary dysfunction and died within 12 days. Postmortem examination disclosed mycotic granulomas due to primary chromoblastomycosis strictly limited to the medulla oblongata and adjacent leptomeninges. Similar lesions were absent outside the central nervous system. Such pathologic lesions related to narcotic addiction have not been reported previously.
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Affiliation(s)
- V Kasantikul
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Kasantikul V, Shuangshoti S, Taecholarn C. Primary phycomycosis of the brain in heroin addicts. SURGICAL NEUROLOGY 1987; 28:468-72. [PMID: 3686329 DOI: 10.1016/0090-3019(87)90232-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Two heroin addicts had fatal primary phycomycosis of the brain. The first case is unique. A 28-year-old man displayed unusual symptoms of unilateral hydrocephalus confirmed by both computed tomography (CT) scanning of the brain and craniotomy. The nature of the fungal granuloma was verified histopathologically. The second case, a 40-year-old man, possessed bilateral basal ganglionic lesions in which the CT scanning suggested abscesses. Postmortem examination confirmed the presence of phycomycotic abscesses. There was no evidence of systemic mycoses in both cases. Review of the clinical features of this fatal complication in drug abusers and narcotic addicts disclosed that hemiparesis and facial weakness are common. Brain or CT scan along with brain biopsy are necessary for rapid diagnosis and prompt treatment.
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Affiliation(s)
- V Kasantikul
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Abstract
In addition to the well-known infectious complications of intravenous narcotic abuse, a much rarer and more recently recognized association between intravenous narcotic addiction and mucormycotic abscesses of the central nervous system has been described. Only four cases have been cited in the literature, with a mortality rate of 100 percent in this group. This report describes a narcotic abuser who presented with obstructive hydrocephalus and a mucormycotic abscess of the brain stem, and recovered. Central nervous system mucormycosis should be included in the differential diagnosis of drug abusers who present with a rapid deterioration in neurologic status.
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Anderson D, Matick H, Naheedy MH, Stein K. Rhinocerebral mucormycosis with CT scan findings: a case report. COMPUTERIZED RADIOLOGY : OFFICIAL JOURNAL OF THE COMPUTERIZED TOMOGRAPHY SOCIETY 1984; 8:113-7. [PMID: 6723274 DOI: 10.1016/0730-4862(84)90072-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A case of rhinocerebral mucormycosis in a diabetic patient is presented. The radiologic findings of the disease with differential diagnosis are reviewed. Almost complete cure with surgical excision and Amphotericin B was accomplished.
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