Cutaneous Rhizopus and Aspergillus Infections in Five Patients With Cancer

Abstract

Primary cutaneous infection with Aspergillus species and Rhizopus species was observed in five patients between October 1986 and January 1988. All patients had an underlying hematological malignancy and were neutropenic. Four patients developed skin lesions with eschars at and around the site of intravenous catheter insertion. One patient had two lesions along the course of the intravenous line. The fifth patient developed the lesion on the left side of the lower part of the back subsequent to the appearance of a rash due to excessive perspiration. A diagnosis was made in each case by histopathological studies and cultures of skin biopsy specimens. The fungal organisms cultured were Aspergillus species in three patients and Rhizopus species in two patients. All patients were treated with amphotericin B. Three patients responded to antifungal therapy and local care without surgical débridgement. Two patients died of disseminated fungal infection. The development of cutaneous lesions due to opportunistic fungal pathogens seemed to have been related to the moist and humid conditions created by occlusive dressings or excessive perspiration.

Skin involvement as the first manifestation of systemic aspergillosis in patients after allogeneic hematopoietic cell transplantation

“…In these reports local trauma or skin maceration caused by adhesive tapes as well as surgical wounds, for instance caused by indwelling catheters or implantation of contaminated foreign material, play a major pathogenic role. 4,9 Secondary cutaneous dissemination of aspergillosis in immunosuppressed patients is exceedingly rare. Findlay et al 12 have estimated that secondary cutaneous involvement occurs with an incidence of less than 5% in disseminated aspergillosis.…”

“…The skin is a rare site of infection, 8 and cutaneous infections are most often found at the entry site of Hickman catheters. 4,7,9,10 Cutaneous aspergillosis is a poorly described entity …”

“…The skin is a rare site of infection, 8 and cutaneous infections are most often found at the entry site of Hickman catheters. 4,7,9,10 Cutaneous aspergillosis is a poorly described entity among hematopoietic cell recipients. 11 Here, we describe the clinical course of two patients after allogeneic HCT, who developed skin involvement as primary manifestation of systemic aspergillosis.…”

Zygomycetes in Human Disease

“…Traumatic implantation of spores in dirt has been seen in a number of patients (6,9,66,77,93,171,178,207,210,276,280,309,342,350,453). Needlestick exposures have been implicated in zygomycotic infections occurring at the site of medicine injection (77,158,215,361,474), catheter insertion sites (160,234,237,262,332), injection sites for illicit drug use (7,163,189,205,365,401,426,465,476,514), and tattooing (357). Insect bites or stings have also been implicated in disease transmission in cases of cutaneous and subcutaneous zygomycosis (33,152,159,199,203,233,372,494).…”

“…Leukemia (237,271,279,299,356), lymphoma (199), other hematologic malignancies (102,374,500), and organ or bone marrow transplantation, with their accompanying immunosuppressive regimens (188,235,308,313,330,425,440,511) have likewise been associated with Rhizopus infections. Many cases have described the use of steroids or broad-spectrum antibiotics as additional risk factors (213,215,308).…”