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Li L, Zhen X, Wang W. Clinical Characteristics and Prognoses of Mucormycosis in Four Children. Infect Drug Resist 2024; 17:1971-1978. [PMID: 38779351 PMCID: PMC11110804 DOI: 10.2147/idr.s462725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
Background Mucormycosis is a fatal invasive fungal infection that commonly affects immunocompromised children. The aim of our study was to investigate the clinical manifestations, treatments, and prognosis of pediatric patients with mucormycosis. Methods We conducted a retrospective search in Shenzhen Children's Hospital from July 2013 to July 2023 for all patients with mucormycosis. The clinical manifestation, pathogen detection, radiology, treatments, and prognosis were analyzed. Results Four cases were identified. Underlying conditions included acute myeloid leukemia with myeloid sarcoma (n = 1), thalassemia (post-allogeneic hematopoietic stem cell transplantation; n = 1), systemic lupus erythematosus (n = 1), and bilateral nephroblastoma (post-bilateral nephrectomy; n = 1). Two patients were disseminated mucormycosis, one case was pulmonary mucormycosis, and one case was cerebral mucormycosis. Fever, cough, and dyspnea were the main clinical symptoms of pulmonary mucormycosis, headache was the main clinical symptom of cerebral mucormycosis. Lung CT findings included consolidation, multiple nodules, halo sign, air crescent sign, and pleural effusion. The contrast-enhanced CT showed pulmonary artery and pulmonary vein occlusions in two patients and pseudoaneurysm in two patients. Amphotericin B formulations were administered as first-line therapy in all cases; in three cases, Triazole was administered in combination with amphotericin B. Conclusion Mucormycosis is a life-threatening disease involving multiple systems. Aorta pseudoaneurysm is a rare and fatal complication, enhanced CT can assist in diagnosis. Early diagnosis and appropriate therapeutic strategies are needed.
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Affiliation(s)
- Li Li
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Xiaoli Zhen
- Department of Radiology, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Wenjian Wang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
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2
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Suri V, Sahu N, Suri K. An unusual presentation of cryptogenic pulmonary mucormycosis related to COVID-19 infection – A case report. APOLLO MEDICINE 2023. [DOI: 10.4103/am.am_94_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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3
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Cerebrovascular Involvement in Mucormycosis in COVID-19 Pandemic. J Stroke Cerebrovasc Dis 2021; 31:106231. [PMID: 34890962 PMCID: PMC8606282 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106231] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 12/17/2022] Open
Abstract
Background Many countries have seen an unprecedented rise of cases of coronavirus disease 2019 (COVID-19) associated mucormycosis (CAM). Cerebrovascular involvement in CAM has not been studied so far. We describe clinico-radiological manifestations of cerebrovascular complications observed in CAM. Methods In this multicentric retrospective observational study from India, patients with CAM who developed cerebrovascular involvement were studied. Their demographics, risk factors, clinical manifestations, imaging, laboratory profile and outcomes were noted. Results Out of 49 subjects with cerebrovascular involvement, 71.4% were males while average age was 52.9 years. Ischemic stroke was commonest (91.8%) followed by intracranial haemorrhage (6.1%) and subarachnoid haemorrhage (2%). The incidence of cerebrovascular complications in CAM was found to be 11.8% in one center. Cerebrovascular symptoms appeared a median of 8.3 days from the onset of mucormycosis. Commonest presentation of mucormycosis was rhino-orbito-cerebral syndrome in 98%. Diabetes mellitus was present in 81.7%. Forty percent developed stroke despite being on antiplatelet agent and/or heparin. Amongst subjects with ischemic strokes, location of stroke was unilateral anterior circulation (62.2%); bilateral anterior circulation (17.8%); posterior circulation (11.1%) and combined anterior and posterior circulation (8.9%). Vascular imaging revealed intracranial occlusion in 62.1%; extracranial occlusion in 3.4% and normal vessels in 34.5%. Mortality was 51% during hospital stay. Conclusions Cerebrovascular involvement was seen in 11.8% patients of CAM. Angio-invasive nature of the fungus, prothrombotic state created by COVID-19, and diabetes were important causative factors. Subjects with CAM should be screened for involvement of the brain as well as its vessel. Antiplatelet agents/heparin did not seem to provide complete protection from this type of stroke.
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4
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Little JS, Cheng MP, Hsu L, Corrales CE, Marty FM. Invasive Fungal Carotiditis: A Rare Manifestation of Cranial Invasive Fungal Disease: Case Series and Systematic Review of the Literature. Open Forum Infect Dis 2019; 6:ofz392. [PMID: 31660355 PMCID: PMC6790399 DOI: 10.1093/ofid/ofz392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/02/2019] [Indexed: 12/17/2022] Open
Abstract
Background Rhinosinusitis, malignant otitis externa, and skull base osteomyelitis represent a spectrum of cranial invasive fungal disease (IFD). These syndromes have distinct characteristics, yet they may progress to involve similar structures, resulting in inflammation and invasion of the adjacent internal carotid artery (ICA). Invasive fungal carotiditis can have devastating consequences, including cerebral infarction, subarachnoid hemorrhage, and death. Methods We retrospectively studied all patients diagnosed with cranial IFD and carotid involvement at our institution from 2003 to 2018. We also searched Medline/PubMed for reports of Aspergillus or Mucorales cranial infections with ICA involvement. All cases with mycologic evidence of cranial IFD and radiographic or pathologic evidence of ICA involvement were included. Results We identified 78 cases of invasive fungal carotiditis between 1958 and 2018, including 4 cases at our own institution. Forty-one were caused by Aspergillus and 37 by Mucorales species. Presenting symptoms included vision changes (73%), cranial nerve palsy (69%), and headache (42%). Carotid events included occlusion, aneurysm formation, and vessel rupture. Cerebral infarcts occurred in 50% of cases. Mortality at 6 weeks, 12 weeks, and 2 years was 27%, 41%, and 71% respectively. The median time from symptom onset to death was 150 days for cases due to Aspergillus and 51 days for cases due to Mucorales species. Conclusions Invasive fungal carotiditis is a rare but morbid manifestation of cranial IFD. Early suspicion of IFD and administration of antifungal treatment, vascular imaging, and endovascular interventions should be considered to reduce the high mortality of this disease.
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Affiliation(s)
- Jessica S Little
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew P Cheng
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massaschusetts, USA
| | - Liangge Hsu
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Neuroradiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - C Eduardo Corrales
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Francisco M Marty
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massaschusetts, USA
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5
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Kashyap S, Bernstein J, Ghanchi H, Bowen I, Cortez V. Diagnosis of Rhinocerebral Mucormycosis by Treatment of Cavernous Right Internal Carotid Artery Occlusion With Mechanical Thrombectomy: Special Case Presentation and Literature Review. Front Neurol 2019; 10:264. [PMID: 30972005 PMCID: PMC6443639 DOI: 10.3389/fneur.2019.00264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/27/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Mucormycosis is a rapidly progressive, angioinvasive fungal infection that has a predilection for the paranasal sinuses and adjacent mucosa. Rhinocerebral mucormycosis (RCM) is the most common form and is known to invade the skull base and its associated blood vessels—leading to mycotic aneurysms, ischemic infarcts, and intracerebral hemorrhage. There are documented cases of mechanical thrombectomy in ischemic stroke due to RCM, however, there are no known cases that were diagnosed primarily by histological and pathological analysis of the embolus. We present a case of treatment of large vessel occlusion that led to the diagnosis and treatment of RCM. Case Presentation: A 21 year-old male inmate with history of type 1 diabetes presented with generalized weakness, abdominal pain, right eye blindness, and ophthalmoplegia after an assault in prison. He underwent treatment for diabetic ketoacidosis, but subsequently developed left hemiplegia and was found to have complete occlusion of his right internal carotid artery. He underwent successful mechanical thrombectomy and pathological analysis of the embolus revealed a diagnosis of mucormycosis. He completed a course of amphotericin B, micafungin, and posaconazole. With the aid of acute rehabilitation he achieved a modified Rankin score of 2. Discussion: We review the pathogenesis, diagnosis, and treatment of RCM. A comprehensive multidisciplinary approach is critical in the management of this often-fatal disease. Early diagnosis and treatment are essential in RCM as delaying treatment by more than 6 days significantly increases mortality. Treatment includes surgical debridement and intravenous antifungal therapy (amphotericin B + micafungin or caspofungin) for a minimum of 6–8 weeks.
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Affiliation(s)
- Samir Kashyap
- Department of Neurosurgery, Riverside University Health System, Moreno Valley, CA, United States.,Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, CA, United States.,Redlands Community Hospital, Redlands, CA, United States
| | - Jacob Bernstein
- Department of Neurosurgery, Riverside University Health System, Moreno Valley, CA, United States.,Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, CA, United States.,Redlands Community Hospital, Redlands, CA, United States
| | - Hammad Ghanchi
- Department of Neurosurgery, Riverside University Health System, Moreno Valley, CA, United States.,Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, CA, United States.,Redlands Community Hospital, Redlands, CA, United States
| | - Ira Bowen
- Department of Neurosurgery, Riverside University Health System, Moreno Valley, CA, United States.,Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, CA, United States.,Redlands Community Hospital, Redlands, CA, United States
| | - Vladimir Cortez
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, CA, United States.,Redlands Community Hospital, Redlands, CA, United States
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6
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Vishnu Swaroop Reddy N, Natti RS, Radha T, Sharma M, Chintham M. Skull Base Mucormycosis in an Immunocompetent Patient: A Case Report and Literature Review. Indian J Otolaryngol Head Neck Surg 2019; 71:140-143. [PMID: 30906732 DOI: 10.1007/s12070-018-1428-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022] Open
Abstract
To demonstrate the affection of skull base by mucormycosis in an immunocompetent individual. Mucormycosis is an opportunistic infection principally seen in immunocompromised individuals, but recently being increasingly recognized in otherwise healthy individuals. Skull base involvement secondary to otogenic nidus, mimicking otitis media was rarely reported. A 34 year-old male, an otherwise healthy patient presented with facial nerve palsy followed by trismus, neck swelling and neck stiffness. Radical mastoidectomy with tympanoplasty and Facial nerve decompression along with Endoscopic guided debridement of sinuses and pterygopalatine fossa followed by medical treatment for 14 weeks. Facial nerve functioning, dry ear canal and relief from other symptoms. Surgical debridement and post op Anti fungal treatment improved the facial nerve function to House brackmann grade-II and also provided relief from trismus and stiffness and improved the overall general condition of the patient. Mucor is a saprophytic organism, which can cause extensive progression, regardless of the immune status. To the best of our knowledge, this is one of the very few rare cases that have been reported in the context of skull base mucormycosis in immunocompetent individuals. Surgical debridement followed by anti fungal therapy continues to remain the mainstay of treatment.
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Affiliation(s)
| | - Raja Sekharam Natti
- Department of ENT, Care Hospitals, Banjara Hills, Hyderabad, Telangana 500034 India
| | - T Radha
- Department of ENT, Care Hospitals, Banjara Hills, Hyderabad, Telangana 500034 India
| | - Manoj Sharma
- Department of ENT, Care Hospitals, Banjara Hills, Hyderabad, Telangana 500034 India
| | - Murali Chintham
- Department of ENT, Care Hospitals, Banjara Hills, Hyderabad, Telangana 500034 India
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7
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Rangwala SD, Strickland BA, Rennert RC, Ravina K, Bakhsheshian J, Hurth K, Giannotta SL, Russin JJ. Ruptured Mycotic Aneurysm of the Distal Circulation in a Patient with Mucormycosis Without Direct Skull Base Extension: Case Report. Oper Neurosurg (Hagerstown) 2019; 16:E101-E107. [PMID: 29800469 DOI: 10.1093/ons/opy127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/24/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Infectious intracranial aneurysms are a rare subset of intracranial aneurysms caused by bacterial, fungal, or viral sources. Intracranial aneurysms of fungal etiology carry a high mortality risk and typically occur in immunocompromised patients via direct extension of skull base infections, or more rarely, after intracranial surgery. CLINICAL PRESENTATION We present the case of a 27-yr-old female with systemic lupus erythematous and primary pulmonary mucormycosis, who suffered a subarachnoid hemorrhage from a ruptured fusiform distal middle cerebral artery aneurysm. Despite undergoing a successful extracranial-to-intracranial bypass and aneurysm excision, the patient ultimately died following progressive disseminated infection and a secondary intracranial hemorrhage of unknown etiology. Pathological examination of the excised artery confirmed Mucor infection. CONCLUSION To the best of our knowledge, this case represents one of the first mycotic cerebral aneurysms from mucormycosis in a patient without an underlying skull base infection or previous intracranial surgery. Despite optimal surgical management, clinical outcomes for mycotic cerebral aneurysms are largely dependent on the success of medical therapies at controlling systemic disease.
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Affiliation(s)
- Shivani D Rangwala
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ben A Strickland
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Robert C Rennert
- Department of Neurosurgery, University of California, San Diego, California
| | - Kristine Ravina
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joshua Bakhsheshian
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kyle Hurth
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Steven L Giannotta
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jonathan J Russin
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California.,Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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8
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Rhinocerebral Mucormycosis With Temporal Artery Thrombosis in an Adolescent Following HLA-haploidentical Stem Cell Transplantation. J Pediatr Hematol Oncol 2018; 40:e461-e463. [PMID: 29200154 DOI: 10.1097/mph.0000000000001020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Rhinocerebral mucormycosis (RCM) can lead to internal carotid artery thrombosis. Here, we report the first case of RCM with temporal artery thrombosis following HLA-haploidentical stem cell transplantation in an adolescent presenting with low-grade fever, right mandibular pain, and right jaw claudication. This case suggests that RCM can cause temporal artery thrombosis and should be considered as a differential diagnosis in severely immunocompromised patients with maxillary sinusitis presenting with jaw claudication.
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9
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Yamaguchi J, Kawabata T, Motomura A, Hatano N, Seki Y. Fungal Internal Carotid Artery Aneurysm Treated by Trapping and High-Flow Bypass: A Case Report and Literature Review. Neurol Med Chir (Tokyo) 2016; 56:89-94. [PMID: 26804189 PMCID: PMC4756250 DOI: 10.2176/nmc.cr.2015-0206] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of unruptured fungal internal carotid artery (ICA) aneurysm and review the pertinent literature. A 79-year-old man presented with decreased visual acuity on the right side, and he was diagnosed with retrobulbar optic neuritis. Medical treatment with steroids resulted in Aspergillus meningoencephalitis spreading to the bottom of bilateral frontal lobes, caused by an intracranial extension of sphenoid sinusitis. Magnetic resonance imaging (MRI) performed 26 days after the start of antifungal therapy showed a denovo right ICA aneurysm projecting anteriorly into the sphenoid sinus. As the aneurysm grew rapidly, it was trapped surgically after establishing a high-flow bypass from the external carotid artery to the middle cerebral artery. The patient's postoperative course was uneventful. Anti-fungal medication was continued until plasma concentrations of beta-D-glucan decreased to within normal limits. Although fungal ICA aneurysm carries a high mortality rate, early detection and prompt treatment by trapping and high-flow bypass can lead to good clinical outcome.
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10
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Mengji AK, Yaga US, Gollamudi N, Prakash B, Rajashekar E. Mucormycosis in a surgical defect masquerading as osteomyelitis: a case report and review of literature. Pan Afr Med J 2016; 23:16. [PMID: 27200123 PMCID: PMC4856500 DOI: 10.11604/pamj.2016.23.16.8394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/01/2015] [Indexed: 12/28/2022] Open
Abstract
Mucormycosis is a rare, highly lethal opportunistic fungal disease affecting immune compromised and diabetic patients. Mucormycosis is considered as the 3rd most common invasive mycosis after candidiasis and aspergillosis in debilitating patients. It is caused by the filamentous fungi of the class zygomycetes. The infection usually begins in the nose due to inhalation of fungal spores. This fatal fungal disease needs a prompt and early definitive diagnosis, aggressive surgical therapy and high dose anti-fungal therapy. Here, we present a case report of Mucormycosis in a 64 year elderly diabetic male patient who was previously operated for myiasis and also the extensive review of the literature of the mucormycosis.
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Affiliation(s)
- Ashwini Kumar Mengji
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Sangareddy, Telangana
| | - Uday Shankar Yaga
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Sangareddy, Telangana
| | - Nishanth Gollamudi
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Sangareddy, Telangana
| | - Bhanu Prakash
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Sangareddy, Telangana
| | - Edunuri Rajashekar
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Sangareddy, Telangana
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11
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Dusart A, Duprez T, Van Snick S, Godfraind C, Sindic C. Fatal rhinocerebral mucormycosis with intracavernous carotid aneurysm and thrombosis: a late complication of transsphenoidal surgery? Acta Neurol Belg 2013; 113:179-84. [PMID: 23135781 DOI: 10.1007/s13760-012-0151-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/15/2012] [Indexed: 12/13/2022]
Abstract
Mucormycosis is a rare opportunistic fungal infection. Rhinocerebral form of the disease mainly affects diabetic or immunocompromised patients. Mucormycosis have specific tropism for blood vessels leading to mucorthrombosis and less often to mycotic aneurysms. We report on a patient initially presenting with a severe sphenoid sinusopathy, who progressively evolved to cavernous sinus syndrome, internal carotid aneurysm followed by spontaneous thrombosis, chronic meningitis and ultimately fatal hypertensive hydrocephalus. Necropsy revealed a purulent infiltrate containing thin-walled, aseptate, right-angle branching, hyphae consistent with mucormycosis. His only relevant previous medical history was a transsphenoidal surgery for pituitary macroadenoma 21 years before. We hypothesize that post-surgical mucosal changes in the sphenoid sinus have been a favoring factor for delayed and invasive mucor infection.
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12
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Wallace E, Douglas C, Safdar N, Saint S, Centor RM. "Different strokes for different folks". J Hosp Med 2012; 7:258-61. [PMID: 22389319 DOI: 10.1002/jhm.1924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Eric Wallace
- Department of Medicine, Vanderbilt University, Nashville, TN 37212, USA.
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13
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Abstract
Effective management of invasive fungal infections (IFIs) depends on early individualized therapy that optimizes efficacy and safety. Considering the negative consequences of IFI, for some high-risk patients the potential benefits of prophylactic therapy may outweigh the risks. When using a prophylactic, empiric, or preemptive therapeutic approach, clinicians must take into account the local epidemiology, spectrum of activity, pharmacokinetic and pharmacodynamic parameters, and safety profile of different antifungal agents, together with unique host-related factors that may affect antifungal efficacy or safety. Therapeutic drug monitoring is increasingly recognized as important or necessary when employing lipophilic triazoles (itraconazole, voriconazole, posaconazole) or flucytosine. Because early diagnostics remain limited for uncommon, yet emerging opportunistic molds (e.g., Mucorales), and treatment delay is associated with increased mortality, early effective management often depends on a high index of suspicion, taking into account predisposing factors, host cues favoring mucormycosis, and local epidemiology. Antifungal options for mucormycosis are limited, and optimal management depends on a multimodal approach that includes early diagnosis/clinical suspicion, correction of underlying predisposing factors, radical debridement of affected tissues, and extended antifungal therapy. This article discusses strategies for the effective management of invasive mycoses, with a particular focus on antifungal hepatotoxicity.
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Affiliation(s)
- Dimitrios P Kontoyiannis
- Division of Internal Medicine, Department of Infectious Diseases Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
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14
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Pinto ME, Manrique HA, Guevara X, Acosta M, Villena JE, Solís J. Hyperglycemic hyperosmolar state and rhino-orbital mucormycosis. Diabetes Res Clin Pract 2011; 91:e37-9. [PMID: 21106269 DOI: 10.1016/j.diabres.2010.09.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 09/30/2010] [Indexed: 11/16/2022]
Abstract
Rhino-orbital mucormycosis is a fatal infection. Decompensated diabetes is the most common predisposing factor. Two male adults were admitted because of newly diagnosed diabetes with hyperglycemic hyperosmolar state and CT scan showed extensive pansinusitis and orbital inflammation. Treatment included surgical debridement and antifungal therapy. One patient died from a severe sepsis.
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Affiliation(s)
- Miguel E Pinto
- Endocrine Service, Cayetano Heredia Hospital, Lima, Peru.
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