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García-Carnero LC, Mora-Montes HM. Mucormycosis and COVID-19-Associated Mucormycosis: Insights of a Deadly but Neglected Mycosis. J Fungi (Basel) 2022; 8:445. [PMID: 35628701 PMCID: PMC9144279 DOI: 10.3390/jof8050445] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023] Open
Abstract
The ongoing COVID-19 pandemic has quickly become a health threat worldwide, with high mortality and morbidity among patients with comorbidities. This viral infection promotes the perfect setting in patients for the development of opportunistic infections, such as those caused by fungi. Mucormycosis, a rare but deadly fungal infection, has recently increased its incidence, especially in endemic areas, since the onset of the pandemic. COVID-19-associated mucormycosis is an important complication of the pandemic because it is a mycosis hard to diagnose and treat, causing concern among COVID-19-infected patients and even in the already recovered population. The risk factors for the development of mucormycosis in these patients are related to the damage caused by the SARS-CoV-2 itself, the patient's overstimulated immune response, and the therapy used to treat COVID-19, causing alterations such as hyperglycemia, acidosis, endothelial and lung damage, and immunosuppression. In this review, the molecular aspects of mucormycosis and the main risk factors for the development of COVID-19-associated mucormycosis are explained to understand this virus-fungi-host interaction and highlight the importance of this neglected mycosis.
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Affiliation(s)
- Laura C. García-Carnero
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Noria Alta s/n, col. Noria Alta, C.P., Guanajuato 36050, Mexico
| | - Héctor M. Mora-Montes
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Noria Alta s/n, col. Noria Alta, C.P., Guanajuato 36050, Mexico
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2
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Jung H, Kim GJ, Oh TH. Successful Management of a Rare Gastric Mucormycosis Presenting with Massive Melena in a Polytrauma Patient. Int Med Case Rep J 2020; 13:531-535. [PMID: 33116945 PMCID: PMC7585504 DOI: 10.2147/imcrj.s279495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023] Open
Abstract
Mucormycosis is a rare, life-threatening, and opportunistic fungal infection that usually occurs in immunocompromised patients. Rhinocerebral and pulmonary manifestations are the common form. The rare form of gastrointestinal mucormycosis occur in all parts of the alimentary tract, with emphasis on the stomach being the most common site. Primary gastric mucormycosis following traumatic injury is an extremely rare form that is usually lethal; thus, only a few cases of survival have been reported even after early diagnosis and aggressive surgical resection, combined with antifungal treatment. We herein report a case of delayed-onset gastric mucormycosis in a polytrauma patient without predisposing factors, which was successfully treated by antifungal medical therapy alone with no surgical debridement.
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Affiliation(s)
- Hanna Jung
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Gun Jik Kim
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Tak-Hyuk Oh
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
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3
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Giacobbe DR, Riccardi N, Vena A, Bassetti M. Mould Infections of Traumatic Wounds: A Brief Narrative Review. Infect Dis Ther 2020; 9:1-15. [PMID: 32072492 PMCID: PMC7054562 DOI: 10.1007/s40121-020-00284-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Indexed: 01/06/2023] Open
Abstract
Mould infections may follow traumatic injuries, with direct fungal inoculum in the site of injury and subsequent angioinvasion, possibly resulting in tissue necrosis and systemic dissemination. The pathogenesis of mould infections following trauma injuries presents unique features compared with classical mould infections occurring in neutropenic or diabetic patients, because a large fraction of post-traumatic mould infections is observed in previously healthy individuals. Most of the published clinical experience and research on mould infections following traumatic injuries regards soldiers and infections after natural disasters. However, following trauma and soil contamination (e.g., agricultural or automotive injuries) other immunocompetent individuals may develop mould infections. In these cases, delays in correct diagnosis and treatment may occur if pertinent signs such as necrosis and absent or reduced response to antibacterial therapy are not promptly recognized. Awareness of mould infections in at-risk populations is needed to rapidly start adequate laboratory workflow and early antifungal therapy in rapidly evolving cases to improve treatment success and reduce mortality.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. .,Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy.
| | - Niccolò Riccardi
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
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Schwarz P, Cornely OA, Dannaoui E. Antifungal combinations in Mucorales: A microbiological perspective. Mycoses 2019; 62:746-760. [PMID: 30830980 DOI: 10.1111/myc.12909] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 12/24/2022]
Abstract
Mucormycosis mostly affects immunocompromised patients and is associated with a high morbidity and mortality despite currently available treatments. In that context, combination therapy might be the key to a better outcome for these patients. Purpose of this review is to summarise and to discuss the current combination data obtained in vitro, in vivo in animal models of mucormycosis, and in patients. In vitro combination studies showed that most of the interactions between antifungal drugs were indifferent, even though that some synergistic interactions were achieved for the combination of echinocandins with either azoles or amphotericin B. Importantly, antagonism was never observed. Animal models of mucormycosis focused on infections caused by Rhizopus arrhizus, neglecting most other species responsible for human disease. In these experimental animal models, no strong interactions have been demonstrated, although a certain degree of synergism has been reported in some instances. Combinations of antifungals with non-antifungal drugs have also been largely explored in vitro and in animal models and yielded interesting results. In patients with ketoacidosis and rhino-orbito-cerebral infection, combination of polyene with caspofungin was effective. In contrast, despite promising experimental data, adjunctive therapy with the iron chelator deferasirox was unfavourable and was associated with a higher mortality than monotherapy with liposomal amphotericin B. More combinations have to be tested in vitro and a much larger panel of Mucorales species has to be tested in vivo to give a valuable statement if antifungal combination therapy could be an effective treatment strategy in patients with mucormycosis.
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Affiliation(s)
- Patrick Schwarz
- Department of Internal Medicine, Respiratory and Critical Care Medicine, University Hospital Marburg, Marburg, Germany.,Center for Invasive Mycoses and Antifungals, Philipps University Marburg, Marburg, Germany
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), ZKS Köln, University of Cologne, Cologne, Germany.,Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Eric Dannaoui
- Université Paris Descartes, Faculté de Médecine, AP-HP, Hôpital Européen Georges Pompidou, Unité de Parasitologie-Mycologie, Paris, France.,Dynamyc Research Group (EA 7380), Paris Est Créteil University, Créteil, France
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5
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Combined Medical and Surgical Management of Hepatic Mucormycosis in an Adult with Acute Myeloid Leukemia: Case Report and Review of the Literature. Mycopathologia 2018; 184:155-158. [PMID: 30062389 DOI: 10.1007/s11046-018-0289-y] [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: 04/13/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
Hepatic mucormycosis is a disease caused by a ubiquitous fungus which is especially important in patients with hematologic malignancies. We present a case of an adult patient with acute myeloid leukemia who developed the infection after undergoing chemotherapy. His successful management was an integrated approach of a minimally invasive surgical resection with anti-fungal therapy. We describe the management of this patient and a review of the literature.
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6
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Kaur H, Ghosh A, Rudramurthy SM, Chakrabarti A. Gastrointestinal mucormycosis in apparently immunocompetent hosts—A review. Mycoses 2018; 61:898-908. [DOI: 10.1111/myc.12798] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/09/2018] [Accepted: 05/25/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Harsimran Kaur
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
| | - Anup Ghosh
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
| | - Shivaprakash M. Rudramurthy
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
| | - Arunaloke Chakrabarti
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
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A Young, Immunocompetent Woman with Small Bowel and Hepatic Mucormycosis Successfully Treated with Aggressive Surgical Debridements and Antifungal Therapy. Case Rep Infect Dis 2017; 2017:4173246. [PMID: 29435377 PMCID: PMC5757106 DOI: 10.1155/2017/4173246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/29/2017] [Indexed: 11/18/2022] Open
Abstract
A 24-year-old woman with coeliac disease and transient neutropenia developed mucormycosis with extensive involvement of the liver and small intestine. She was successfully treated with aggressive surgical debridements and long-term antifungal therapy with liposomal amphotericin B and posaconazole.
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8
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Chow KL, McElmeel DP, Brown HG, Tabriz MS, Omi EC. Invasive gastric mucormycosis: A case report of a deadly complication in an immunocompromised patient after penetrating trauma. Int J Surg Case Rep 2017; 40:90-93. [PMID: 28946029 PMCID: PMC5614730 DOI: 10.1016/j.ijscr.2017.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 01/01/2023] Open
Affiliation(s)
- Kevin L Chow
- University of Illinois at Chicago, 1740 W Taylor St, Chicago, IL 60612, United States.
| | - David P McElmeel
- University of Illinois at Chicago, 1740 W Taylor St, Chicago, IL 60612, United States; Advocate Christ Medical Center, 4440 95th St, Oak Lawn, IL 60453, United States
| | - Henry G Brown
- Advocate Christ Medical Center, 4440 95th St, Oak Lawn, IL 60453, United States
| | - Muhammad S Tabriz
- Advocate Christ Medical Center, 4440 95th St, Oak Lawn, IL 60453, United States
| | - Ellen C Omi
- University of Illinois at Chicago, 1740 W Taylor St, Chicago, IL 60612, United States; Advocate Christ Medical Center, 4440 95th St, Oak Lawn, IL 60453, United States
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9
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Sun M, Hou X, Wang X, Chen G, Zhao Y. Gastrointestinal Mucormycosis of the Jejunum in an Immunocompetent Patient: A Case Report. Medicine (Baltimore) 2017; 96:e6360. [PMID: 28422828 PMCID: PMC5406044 DOI: 10.1097/md.0000000000006360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Gastrointestinal Mucormycosis (GIM) is a kind of opportunistic fungal infection with poor prognosis. It usually occurs in patients with immune deficiency. We reported a case of immunocompetent male patient. PATIENT CONCERNS This patient was presented as abdominal distension and gastrointestinal bleeding. DIAGNOSES A variety of hemostatic methods was ineffective to stop the bleeding. The patient finally received laparotomy, and the jejunum lesions were found. INTERVENTIONS Pathological examination confirmed it to be gastrointestinal mucormycosis in jejunum. OUTCOMES However, after systemic anti-fungi therapy, the patient died of septic shock. LESSONS The diagnosis mainly relies on pathological examination. Early diagnosis and early application of systemic amphotericin B liposome were fundamental for improving the prognosis.
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Affiliation(s)
| | | | - Xiaoting Wang
- Department of Intensive Care Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ge Chen
- Department of General Surgery
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Cutaneous mucormycosis secondary to penetrative trauma. Injury 2016; 47:1383-7. [PMID: 27126769 DOI: 10.1016/j.injury.2016.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/05/2016] [Accepted: 03/07/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Mucormycosis is a rare but serious sequelae of penetrating trauma [1-5]. In spite of aggressive management, mortality remains high due to dissemination of infection. We completed a review of literature to determine the most optimal treatment of cutaneous mucormycosis which occurs secondary to penetrating trauma. METHODS We completed a review regarding the management of mucormycosis in trauma patients. We selected a total of 36 reports, of which 18 were case-based, for review. RESULTS Surgical debridement is a primary predictor of improved outcomes in the treatment of mucormycosis [3,6,7]. Anti-fungal therapy, especially lipid soluble formulation of Amphotericin B, is helpful as an adjunct or when surgical debridement has been maximally achieved. Further research is needed to fully evaluate the impact of topical dressings; negative pressure wound therapy is helpful. CONCLUSION An aggressive and early surgical approach, even at the expense of disfigurement, is necessary to reduce mortality in the setting of cutaneous mucormycosis that results from penetrating trauma [4,8,9]. Anti-fungal therapy and negative pressure wound therapy are formidable adjuncts.
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Antony SJ, Parikh MS, Ramirez R, Applebaum B, Friedman G, Do J. Gastrointestinal Mucormycosis Resulting in a Catastrophic Outcome in an Immunocompetent Patient. Infect Dis Rep 2015; 7:6031. [PMID: 26500741 PMCID: PMC4593887 DOI: 10.4081/idr.2015.6031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/18/2015] [Accepted: 07/18/2015] [Indexed: 01/11/2023] Open
Abstract
We present a case of a middle-aged female who was admitted to the hospital with a respiratory infection and subsequently developed an acute surgical abdomen secondary to a perforated viscous. She was found to have mucormycosis of the intestinal tract and eventually succumbed to the sequelae of the infection.
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Affiliation(s)
- Suresh J Antony
- Department of Medicine, Division of Infectious Diseases, Texas Tech University Health Sciences Center , El Paso, TX, USA
| | - Monisha S Parikh
- Department of Medicine, Division of Infectious Diseases, Texas Tech University Health Sciences Center , El Paso, TX, USA
| | - Ruben Ramirez
- Department of Pathology, Gastroenterology and Surgery, Las Palmas Medical Center , El Paso, TX, USA
| | - Bruce Applebaum
- Department of Pathology, Gastroenterology and Surgery, Las Palmas Medical Center , El Paso, TX, USA
| | - Glen Friedman
- Department of Pathology, Gastroenterology and Surgery, Las Palmas Medical Center , El Paso, TX, USA
| | - Jennifer Do
- Department of Medicine, Division of Infectious Diseases, Texas Tech University Health Sciences Center , El Paso, TX, USA
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12
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Mucormicosis en pacientes con trauma grave. Med Intensiva 2014; 38:465-6. [DOI: 10.1016/j.medin.2013.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 10/15/2013] [Accepted: 10/22/2013] [Indexed: 11/18/2022]
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13
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Pozo Laderas JC, Pontes Moreno A, Pozo Salido C, Robles Arista JC, Linares Sicilia MJ. [Disseminated mucormycosis in immunocompetent patients: A disease that also exists]. Rev Iberoam Micol 2014; 32:63-70. [PMID: 25543322 DOI: 10.1016/j.riam.2014.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 01/01/2014] [Accepted: 01/21/2014] [Indexed: 11/28/2022] Open
Abstract
Mucormycosis is usually an acute angioinvasive infections, which leads to non-suppurative necrosis and significant tissue damage. It represents 1.6% of all the invasive fungal infections and predominates in immunosuppressed patients with risk factors. Incidence has been significantly increased even in immunocompetent patients. Due to finding a case of disseminated mucormycosis caused by Rhizomucor pusillus in a young immunocompetent patient, a systematic review was carried out of reported cases in PubMed of mucormycosis in immunocompetent adults according to the main anatomic locations, and especially in disseminated cases. A review of the main risk factors and pathogenicity, clinical manifestations, techniques of early diagnosis, current treatment options, and prognosis is presented. Taxonomy and classification of the genus Mucor has also been reviewed.
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Affiliation(s)
- Juan Carlos Pozo Laderas
- Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España; Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Córdoba, España.
| | | | - Carmen Pozo Salido
- Servicio Urología, Hospital Universitario Fundación Alcorcón, Madrid, España
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[Mixed invasive fungal infection due to Rhizomucor pusillus and Aspergillus niger in an immunocompetent patient]. Rev Iberoam Micol 2013; 32:46-50. [PMID: 23583263 DOI: 10.1016/j.riam.2013.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 02/23/2013] [Accepted: 03/26/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Mucormycosis infections are rare in immunocompetent patients, and very few cases of mucormycosis associated with aspergillosis in non-haematological patients have been reported. CASE REPORT A 17-year-old male, immunocompetent and without any previously known risk factors, was admitted to hospital due to a seizure episode 11 days after a motorcycle accident. He had a complicated clinical course as he had a mixed invasive fungal infection with pulmonary involvement due to Aspergillus niger and disseminated mucormycosis due to Rhizomucor pusillus (histopathological and microbiological diagnosis in several non-contiguous sites). He was treated with liposomal amphotericin B for 7 weeks (total cumulative dose >10 g) and required several surgical operations. The patient survived and was discharged from ICU after 5 months and multiple complications. CONCLUSIONS Treatment with liposomal amphotericin B and aggressive surgical management achieved the eradication of a mixed invasive fungal infection. However, we emphasise the need to maintain a higher level of clinical suspicion and to perform microbiological techniques for early diagnosis of invasive fungal infections in non-immunocompromised patients, in order to prevent spread of the disease and the poor prognosis associated with it.
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Invasive mold infections: virulence and pathogenesis of mucorales. Int J Microbiol 2011; 2012:349278. [PMID: 22121366 PMCID: PMC3206359 DOI: 10.1155/2012/349278] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 09/16/2011] [Indexed: 01/08/2023] Open
Abstract
Mucorales have been increasingly reported as cause of invasive fungal infections in immunocompromised subjects, particularly in patients with haematological malignancies or uncontrolled diabetes mellitus and in those under deferoxamine treatment or undergoing dialysis. The disease often leads to a fatal outcome, but the pathogenesis of the infection is still poorly understood as well as the role of specific virulence determinants and the interaction with the host immune system. Members of the order Mucorales are responsible of almost all cases of invasive mucormycoses, the majority of the etiological agents belonging to the Mucoraceae family. Mucorales are able to produce various proteins and metabolic products toxic to animals and humans, but the pathogenic role of these potential virulence factors is unknown. The availability of free iron in plasma and tissues is believed to be crucial for the pathogenesis of these mycoses. Vascular invasion and neurotropism are considered common pathogenic features of invasive mucormycoses.
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