Rhizopus cohnii as the cause of skin mucormycosis

The authors report the case of the mucormycosis of the skin. The diagnosis was made on the presence of <i>Mucoraceae</i> hyphe in the through examination, histology and the positive culture of the material taken from the ulcerations of patients skin. The isolated fungus was identified as <i>Rhizopus cohnii</i>.

[Invasive aspergillosis in autopsy material of patients treated at the Institute of Tuberculosis and Chest Diseases during the years 1993-2000]

The aim of this paper is an analysis of clinical documentation and results of autopsy of 21 patients (pts) who died of invasive aspergillosis (IA) in the Institute of Tuberculosis and Chest Diseases in years 1993-2000 and the assessment of predisposing factors for IA. In 17 pts IA was the main and in other 4 only an accessory cause of death. All pts were treated with corticosteroids and/or cytostatic drugs--because of lung cancer (11 pts), cancer in other site (2 pts), haematologic disorders (2 pts), Wegener's granulomatosis (1 pt), polymyositis (1 pt), idiopathic pulmonary fibrosis (1 pt) and other diseases (3 pts). In 15 out of 21 pts granulocytopenia was revealed (from 0.008 x 10(9)/L to 0.82 x 10(9)/L) on an average one month before death. In 15 pts IA was limited to the lungs, in 6 others there were also fungal lesions in brain, kidneys, liver, spleen and heart. Pts with disseminated form of IA had significantly lower granulocyte count and were treated with higher doses of corticosteroids than others. Immunosuppressive drugs and granulocytopenia can be regarded as predisposing factors. Fatal course of IA depended also on the late diagnosis.

[Microbial analysis of clinical material taken from patients at the Oncology Center, Maria Skłodowkda-Curie Institute in Warsaw in 1997]

An analysis was carried out of the microbiological investigations of clinical material samples obtained from the patients of two oncology centres belonging to the Warsaw Oncology Centre. Microorganisms cultured from urine, blood, catheters, smears of wounds and other materials were analysed. From 4839 clinical material samples from the Ursynów centre 1755 bacterial strains were isolated. From 423 samples from the centre in Wawelska Street 171 strains were obtained. In infections of patients from the centres the number of Gram-positive cocci was twice that of Gram-negative rods. In the investigated clinical material S. aureus was the most frequently isolated Gram-positive coccus, while E. coli was the most frequent species among Gram-negative bacteria. In the infections of oncological patients a considerable frequency was noted of yeast-like fungi, especially C. albicans. Particularly disquieting was the increasing number of isolates of C. glabrata and C. krusei strains resistant to fluconazole.

[Invasive pulmonary aspergillosis caused by Aspergillus ochraceus]

Invasive pulmonary aspergillosis (IPA) is a frequent complication in patients with severe neutropenia resulting from cytotoxic chemotherapy. In Europe, Aspergillus fumigatus is most common pathogen of IPA. In our case, IPA was recognised in 54 year old female suffering from acute lymphoblastic leukemia with pancytopenia. The patient developed severe granulocytopenia during chemotherapy. Chest radiograph revealed progressive bilateral infiltrations with cavitation. In sputum culture Aspergillus ochraceus was found. The results of precipitating tests were positive for A. ochraceus and A. fumigatus. Treatment with amphotericin B was used successfully leading soon to clinical improvement, yet radiological lesions remained largely unchanged. The patient received itraconazole, which was very effective and caused almost complete regression. Two episodes of IPA recurrence were treated with antifungal therapy with good results.

[A case of skin cryptococcosis in systemic lupus erythematosus]

Here is presented a case of woman treated by immunosuppressive preparations because of systemic lupus erythematosus with ski manifestations as tubercles and ulcerations on skin of trunk and extremities. On the basis of histological examination of tubercle skin specimens and mycological examinations of material obtained from skin ulcerations cryptococcosis was diagnosed. Disease was limited to skin that was an entry of infection. Patient was treated by Amphotericin B administered intravenously and Flucitosine per os. Amphotericin B was also applied topically. The results of cultures became gradually negative, up to total disappearance of fungus cells in direct specimens, prepared from examined material. After treatment continuing for 5 months only discoloured scars were observed on sick skin.

[Pulmonary aspergilloma caused by Aspergillus niger]

The authors present a case report of a 66 year old male that was admitted due to pulmonary lesions with cavitation localized in the upper left lobe. In the cavity an abnormal mass could be seen. In the differential diagnosis malignancy and tuberculosis were excluded. Fungi were cultured from the bronchial washings and sputum. Their morphological characteristics allowed them to be typed as Aspergillus niger. Slides from the thick, mucoid, black sputum demonstrated typical forms of the fungus. Polarized microscopy demonstrated calcium oxalate crystals. The final diagnosis was pulmonary aspergilloma caused by A.niger complicating a pulmonary abscess in the course of a pneumonia.

[Further studies on the occurrence of mycoses in the bronchial stump and bronchial anastomosis or trachea]

In the years 1980-1985 sutures were removed endoscopically from stumps and anastomoses in 52 patients operated in the years 1969-1985. The total number of bronchoscopies was 154, in 88 protruding threads into the airway lumen were removed. Interval between removal of first suture and date of surgery ranged from 0.5 to 192 months. Mycotic infection was diagnosed in 5 cases (9.6%). The causative agents being Aspergillus fumigatus and Candida albicans. In all cases removal of protruding threads lead to a complete cure. It was found that incidence of such mycotic infections decreased from 20.2% observed during the years 1962-1979 to 9.6% in the years 1980-1985.

[Bacterial infections in pulmonary aspergilloma]

28 cavernoscopies were carried out in 26 patients. Complete or partial removal of mycetomas was achieved in 18 patients with 20 caverns. Under aerobic conditions Aspergillus fumigatus was cultured from the 28 removed mycetomas in 22 cases (78.6%) and bacterial organisms in 20 (71.4%). Bacteria were isolated from mycetomas that had demonstrable A. fumigatus organisms as well as from those that did not have them. In all infected mycetomas Gram negative rods were cultured, in only 4 cases Gram (+) cocci were found. Only in two cases of mycetomas under anaerobic conditions Gram (+) cocci were cultured. In most patients the organism could be demonstrated in sputum as well as in mycetomas. In 18 patients the pathogenic organism disappeared from sputum after removal of mycetomas. Also following removal of aspergillomas a decrease of sputum production was noted and it changed its character from purulent to mucoid.