1
|
Abstract
Intracranial mucormycosis is a very unusual presentation of an infection after a depressed skull fracture due to an assault. Only sporadic cases have been reported in the literature previously. A 30-year-old male with a traumatic brain injury following an assault, status-post debridement and elevation of a depressed skull fracture, was discharged home several weeks postoperatively. A CT scan of the head with contrast was obtained due to mental status changes and revealed an enhancing ring-shaped lesion in the right frontal lobe consistent with a brain abscess. The patient was taken to the operating room for image-guided excisional biopsy of the lesion, with pathology revealing mucormycosis.
Collapse
Affiliation(s)
| | - Namath S Hussain
- Department of Neurosurgery, Loma Linda University Medical Center
| |
Collapse
|
2
|
Schwartze VU, Jacobsen ID. Mucormycoses caused by Lichtheimia species. Mycoses 2014; 57 Suppl 3:73-8. [PMID: 25186921 DOI: 10.1111/myc.12239] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/22/2014] [Accepted: 02/25/2014] [Indexed: 11/26/2022]
Abstract
Mucormycoses are life-threatening infections with fungi from the order Mucorales (Mucoromycotina). Although mucormycoses are uncommon compared to other fungal infections, e.g. aspergillosis and candidiasis, the number of cases is increasing especially in immunocompromised patients. Lichtheimia (formerly Absidia) species represent the second to third most common cause of mucormycoses in Europe. This mini review presents current knowledge about taxonomy and clinical relevance of Lichtheimia species. In addition, clinical presentation and risk factors will be discussed. Proper animal infection models are essential for the understanding of the pathogenesis and the identification of virulence factors of fungal pathogens. To date, several animal models have been used to study Lichtheimia infection. A brief overview of the different models and the main conclusions from the infection experiments is summarised in this review.
Collapse
Affiliation(s)
- Volker U Schwartze
- Institute of Microbiology, Department of Microbiology and Molecular Biology, University of Jena, Jena, Germany; Leibniz Institute for Natural Product Research and Infection Biology, Department of Molecular and Applied Microbiology, Hans Knöll Institute, Jena, Germany
| | | |
Collapse
|
3
|
Chen CY, Fu YJ, Zu YG, Wang W, Mu FS, Luo M, Li CY, Gu CB, Zhao CJ. Biotransformation of saponins to astragaloside IV from Radix Astragali by immobilized Aspergillus niger. BIOCATALYSIS AND AGRICULTURAL BIOTECHNOLOGY 2013. [DOI: 10.1016/j.bcab.2013.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
4
|
Lineberry KD, Boettcher AK, Blount AL, Burgess SD. Cutaneous mucormycosis of the upper extremity in an immunocompetent host: case report. J Hand Surg Am 2012; 37:787-91. [PMID: 22305738 DOI: 10.1016/j.jhsa.2011.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 11/06/2011] [Accepted: 11/08/2011] [Indexed: 02/02/2023]
Abstract
Cutaneous mucormycosis, a relatively common infection in immunocompromised patients, remains rare in the immunocompetent patient outside the setting of major trauma. We report a case of an immunocompetent patient who developed left upper extremity Rhizopus infection following arterial puncture. Treatment included surgical debridement, liposomal amphotericin B, and hyperbaric oxygen wound therapy; the patient recovered fully. A review of the literature of cases of upper extremity Mucor infection is included for context. We feel that a high degree of suspicion for Mucor infection is warranted in patients with the described risk factors who do not respond to first-line antibiotics.
Collapse
Affiliation(s)
- Kyle D Lineberry
- College of Human Medicine, Michigan State University, Grand Rapids MI, USA.
| | | | | | | |
Collapse
|
5
|
Mignogna MD, Fortuna G, Leuci S, Adamo D, Ruoppo E, Siano M, Mariani U. Mucormycosis in immunocompetent patients: a case-series of patients with maxillary sinus involvement and a critical review of the literature. Int J Infect Dis 2011; 15:e533-40. [DOI: 10.1016/j.ijid.2011.02.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 08/29/2010] [Accepted: 02/24/2011] [Indexed: 12/14/2022] Open
|
6
|
Vitrat-Hincky V, Lebeau B, Bozonnet E, Falcon D, Pradel P, Faure O, Aubert A, Piolat C, Grillot R, Pelloux H. Severe filamentous fungal infections after widespread tissue damage due to traumatic injury: six cases and review of the literature. ACTA ACUST UNITED AC 2010; 41:491-500. [PMID: 19353426 DOI: 10.1080/00365540902856537] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
We describe 6 cases of severe filamentous fungal infections after widespread tissue damage due to traumatic injury in previously healthy people. Additionally, we report 69 cases from an exhaustive 20-y review of the literature to investigate the epidemiological and clinical features, the prognosis and the therapeutic management of these post-traumatic severe filamentous fungal infections. Traffic (41%) and farm accidents (25%) were the main causes of injury, which involved either the limbs only (41%) or multiple sites (41%). Necrosis was the main symptom (60%) and Mucorales (72%) and Aspergillus (11%) were the 2 most frequent fungi causing infection. These infections required substantial surgical debridement or amputation (96%) associated with aggressive antifungal therapy (81%), depending on the responsible fungi. This study underlines the need for early, repeated and systematic mycological wound samples to guide and adapt surgical and antifungal management in these filamentous fungal infections.
Collapse
|
7
|
Successful triple combination therapy of disseminated absidia corymbifera infection in an adolescent with osteosarcoma. J Pediatr Hematol Oncol 2010; 32:131-3. [PMID: 20098334 DOI: 10.1097/mph.0b013e3181ca0dcf] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Mucormycosis are opportunistic infections mostly observed in immunocompromised patients. We report the case of a 13-year-old girl who suffered a systemic mucormycosis without presenting the usual risk factors. She was undergoing antineoplastic chemotherapy for advanced osteosarcoma of the femur with an uncommunicative pathologic fracture and pulmonary metastasis. Absidia corymbifera was isolated from skin lesions at the primary tumor site. She subsequently developed fungal pulmonary localizations and blood vessel thrombosis. Surgical treatment together with systemic, high doses of liposomal amphotericin B, posaconazole, and caspofungin cured the local infection and controlled systemic lesions. Unfortunately, the break in chemotherapy led to pulmonary metastasis progression.
Collapse
|
8
|
Waness A, Dawsari GA, Jahdali HA. The rise of an opportunistic infection called "Invasive Zygomycosis". J Glob Infect Dis 2009; 1:131-8. [PMID: 20300403 PMCID: PMC2840956 DOI: 10.4103/0974-777x.56256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Invasive zygomycosis is a devastating fungal infection seen mostly in immune-compromised patients. We present a case of a 48-year old diabetic man, with aplastic anemia, who developed severe pulmonary mucormycosis that led to his rapid demise despite early diagnosis and treatment with liposomal amphotericin B. We also conducted an extensive review of the pathogenesis of invasive zygomycosis, its history, predisposing factors, clinical aspects, diagnostic modalities, treatment options, morbidity and mortality.
Collapse
Affiliation(s)
- Abdelkarim Waness
- Department of Internal Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | - Hamdan Al Jahdali
- Department of Pulmonology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
9
|
Hajdu S, Obradovic A, Presterl E, Vécsei V. Invasive mycoses following trauma. Injury 2009; 40:548-54. [PMID: 18656189 DOI: 10.1016/j.injury.2008.03.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 03/16/2008] [Accepted: 03/18/2008] [Indexed: 02/02/2023]
Abstract
Invasive fungal infection may afflict people with trauma in two ways: either by entry into tissue via penetrating trauma or by haematogenous spread in critically ill people with polytrauma. Penetrating injury allows the advance of ubiquitously present fungi into the human body. Miniscule foreign material fosters the establishment and growth of fungi within the traumatically changed tissue. The seriousness of the infection depends upon the type of injury, the body area and the person's general condition. Usually, the infection is confined to the cutis and subcutis; the fascia, muscles and bones are rarely affected. In the presence of immunocompromise, however, the fungus may spread rapidly and cause systemic disease. The following overview will focus on fungal infection associated with open wounds and fractures, particularly eye injury and with near-drowning, tropical mycetoma and nosocomial conditions. Post-traumatic invasive fungal infections are rare, but the surgeon should be alert to this possibility in cases with chronic inflammation and deferred healing of injuries, with or without systemic inflammatory response.
Collapse
Affiliation(s)
- S Hajdu
- Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Wien, Austria.
| | | | | | | |
Collapse
|
10
|
Corti G, Mondanelli N, Losco M, Bartolini L, Fontanelli A, Paradisi F. Post-traumatic infection of the lower limb caused by rare Enterobacteriaceae and Mucorales in a young healthy male. Int J Infect Dis 2009; 13:e57-60. [DOI: 10.1016/j.ijid.2008.06.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 05/05/2008] [Accepted: 06/17/2008] [Indexed: 11/30/2022] Open
|
11
|
|
12
|
Almaslamani M, Taj-Aldeen SJ, Garcia-Hermoso D, Dannaoui E, Alsoub H, Alkhal A. An increasing trend of cutaneous zygomycosis caused byMycocladus corymbifer(formerlyAbsidia corymbifera): report of two cases and review of primary cutaneousMycocladusinfections. Med Mycol 2009; 47:532-8. [DOI: 10.1080/13693780802595746] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
13
|
Post-traumatic Lethal Form of Primary Cutaneous Zygomycosis in a Healthy Young Patient and Review of the Literature. J Taibah Univ Med Sci 2009. [DOI: 10.1016/s1658-3612(09)70105-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|
14
|
Liu ZH, Lv GX, Chen J, Sang H, She XD, Chen XJ, Sun JF, Shen YN, Zeng XS, Liu WD. Primary cutaneous zygomycosis due toAbsidia corymbiferain a patient with cutaneous T cell lymphoma. Med Mycol 2009; 47:663-8. [DOI: 10.1080/13693780902806647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
|
15
|
Slama A, Saghrouni F, Gaied-Meksi S, Mootemri R, Fathallah A, Khochtali H, Ben Said M. Mucormycose post-traumatique de la face : à propos d’un cas. J Mycol Med 2008. [DOI: 10.1016/j.mycmed.2008.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Invasive Mykosen und Trauma. Wien Med Wochenschr 2007; 157:482-9. [DOI: 10.1007/s10354-007-0463-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 07/11/2007] [Indexed: 10/22/2022]
|
17
|
Absidia Corymbifera in an immune competent accident victim with multiple abdominal injuries: case report. BMC Infect Dis 2007; 7:46. [PMID: 17531089 PMCID: PMC1891108 DOI: 10.1186/1471-2334-7-46] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 05/25/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We report a case of mucormycosis in a healthy 17-year-old accident victim with multiple abdominal injuries which was caused by infection with Absidia Corymbifera, a ubiquitous saphrophyte in the ground. CASE PRESENTATION The patient was admitted to hospital with massive abdominal trauma. During an 8-hour emergency operation he received transfusions of compacted red blood cells, plasma, platelets and hemagel. He developed a crush syndrome with acute renal failure, resolved with extra-corporeal dialysis and had to undergo splenectomy because of spleen hematoma. As wound secretion and central venous catheter (CVC) blood cultures and drainage fluid were positive for Enterococcus Faecium, Providentia Rettgeri, Hafnia Alvei and Candida Albicans, tecoplanin, metronidazole, imipenem, and flucanozole were administered. Although the CVC was changed high fever persisted and discharge continued from the large abdominal wound. Repeated tampons in different sections and wound secretion smears were positive for A. corymbifera. Flucanozole was stopped and liposomal amphotericin (Ambisome; 5 mg/Kg i.v.) given for over 3 months. The patient improved; fever gradually disappeared. After 8 days, tampons and wound secretion smears were negative for A. corymbifera. No other fungal infections developed. Drainage fluid was later positive for tecoplanin-resistant E. faecium and Pseudomonas Aeroginosa responding only to meropenem and ciprofloxacin. Abdominal computerized tomography visualized fluid accumulation around the iliac-femoral bypass. Abcess was ruled out when scintigraphy showed no tracer uptake. The lesion was drained. Drainage fluid cultures were negative for bacteria and fungi. Fluid accumulation gradually disappeared with prolonged antibiotic and antifungal therapy. One year after the accident the patient is in good health, with normal quality of life. CONCLUSION Successful outcome was due to early, specific antifungal therapy, at sufficiently high dosage which was prolonged for an adequate period of time. Early diagnosis of mucormycosis is essential for efficacious anti-fungal treatment and prevention of irreversible spread of mucormycosis to vital organs. It presupposes awareness that A. corymbifera infection can develop in healthy individuals who are stressed and traumatized through skin-ground contact in accidents.
Collapse
|