Diagnosis and Treatment of Mucormycosis in Patients withHematological Malignancies［Translated Article］

Abstract

The risk of invasive fungal infections (IFIs) is extremely high in patients with hematological malignancies due to the prolonged and profound neutropenia and immunosuppression after chemotherapy and hematopoietic stem cell transplantation. There has been increasing interest in mucormycosis despite its relatively uncommon occurrence, because occasional breakthrough infections have been observed under anti-Aspergillus prophylaxis. The aggressive nature of mucormycosis easily leads to high mortality because of delays in diagnosis and incorrect treatment decisions, which are due in part to lack of adjunctive diagnostic tools and having similar clinical and radiological features with invasive aspergillosis. The only currently available antifungals against Mucorales in Japan are amphotericin B formulations. Thus, comprehensive therapeutic strategies, including surgery, should be considered to achieve a successful outcome.

Pulmonary Actinomycosis and Mucormycosis Coinfection in a Patient With Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia Undergoing Chemotherapy

“…For patients who need HSCT, mucormycosis must be treated before HSCT is performed. The causative organisms of mucormycosis are resistant to antifungal drugs other than amphotericin B formulations, and the immediate initiation of L-AMB at dose of ≥5 mg/kg is recommended in cases in which mucormycosis cannot be ruled out 3,4. Despite the lack of L-AMB treatment, our patient became afebrile and CT findings partially improved after the initiation of ABPC, suggesting that actinomycosis subsided with the treatment of ABPC and mucor infection was not still active during this period.…”

Mucormicosis orbitorrinocerebral: el manejo más allá de la cirugía. Informe de caso clínico y revisión de la literatura

“…Los pacientes con diabetes tienen mejor pronóstico que otros pacientes con otras causas de inmunocompromiso. Los pacientes con afectación intracraneal, neutropenia, malignidad activa o que no reciben cirugía como parte de su terapia tienen un peor pronóstico (1,5).…”

“…El Rhizopus arrhizus es el agente más común en todo el mundo, seguido de Lichtheimia, Apophysomyces, Rhizomucor, Mucor y especies de Cunninghamella (3,6); son organismos termotolerantes y generalmente se encuentran en la materia orgánica en descomposición, son vasotrópicos y angioinvasivos con predilección por la lámina elástica interna de los vasos, por lo que inducen arteritis y oclusiones trombóticas; esto resulta en isquemia, necrosis hemorrágica y coagulativa, infarto isquémico, daño endotelial venoso, aneurismas, pseudoaneurismas y gangrena (6,7). El espectro de mucormicosis varía desde el cutáneo, rinocerebral y sinopulmonar hasta infecciones diseminadas y fatales (5,6,8).…”

Mucormycosis with pulmonary, renal, pancreatic and spleen involvement detected by 18F-FDG PET/CT in a patient who underwent allogeneic stem cell transplantation. Report of case

“…Although it has demonstrated its utility in a limited number of patients with lung, brain, hepatic and splenic candidiasis or mould infections [4,5], as well as cryptococcosis [6], there have been few publications concerning mucormycosis [1,7]. It usually presents as rhino-orbital-cerebral [1] or pulmonary [8] mucormycosis but is much less frequent in other locations as gastrointestinal, skin or other regions [9,10]. Its early diagnosis is mandatory, as a delay of treatment can significantly increase mortality [11].…”