Early diagnosis and successful management of oral mucormycosis in a hematopoietic stem cell transplant recipient: case report and literature review

Epstein, Joel B.; Kupferman, Steven B.; Zabner, Rachel; Rejali, Ali Reza; Hopp, Martin L.; Lill, Michael; Tzachanis, Dimitrios

doi:10.1007/s00520-016-3170-x

Cited by 16 publications

(10 citation statements)

References 7 publications

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“…156 Sequential therapy with POSA to complete therapy following initial treatment with LFAB has been used with success. 109,122,250,251 POSA can be administered for treatment of IMIs via intravenous (IV) formulation (300 mg IV twice daily on day 1, then 300 mg once daily), oral suspension (800 mg orally daily in two or four divided doses), or as a tablet (300 mg orally twice daily on day 1, then 300 mg daily). The oral tablet is much better absorbed than the oral suspension and is significantly less affected by food or gastric acid suppression 229 ; thus, it is the preferred oral formulation when feasible.…”

Section: Prognosis Of Mucormycosismentioning

confidence: 99%

Mucormycosis

Reid

Lynch

Fishbein

et al. 2020

Semin Respir Crit Care Med

158

108

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Mucormycosis is an infection caused by a group of filamentous molds within the order Mucorales. Infections may result from ingestion of contaminated food, inhalation of spores into the nares or lungs, or inoculation into disrupted skin or wounds. In developed countries, mucormycosis occurs primarily in severely immunocompromised hosts (e.g., those with hematological malignancies, organ transplantation, neutropenia, autoimmune disorders, or other impairments in immunity). Only 6 to 10% of cases occur in subjects with no underlying disease. In contrast, in developing countries, most cases of mucormycosis occur in persons with poorly controlled diabetes mellitus or in immunocompetent subjects following trauma. Mucormycosis exhibits a marked propensity to invade blood vessels, leading to thrombosis, necrosis, and infarction of tissue. Mortality associated with invasive mucormycosis is high (> 30–50%), with 90% mortality associated with disseminated disease. Mortality rates are much lower, though still significant (10–30%), among patients with localized cutaneous disease.The diagnosis of mucormycosis relies upon histopathology and culture. Blood tests are of limited diagnostic value. Even with disseminated disease, blood cultures are usually negative. Mucorales have a distinct histological appearance, with irregular, nonseptate hyphae that branch at right angles. Cultures and/or polymerase chain reaction (PCR) are important to identify the genera.Based on anatomic localization, mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM), (2) pulmonary, (3) cutaneous, (4) gastrointestinal (GI), (5) disseminated, and (6) mucormycosis of uncommon sites. Among diabetics, ROCM is the most common clinical presentation, whereas lung involvement is uncommon. In contrast, among organ transplant recipients or patients with hematological malignancies (HemeM), pulmonary and disseminated diseases are most common. Mucormycosis can progress rapidly, and delay in initiation of treatment by even a few days markedly worsens outcomes.Due to the rarity of mucormycosis, randomized controlled therapeutic trials have not been performed. Lipid formulations of amphotericin B (LFAB) are the mainstay of therapy, but the newer triazoles, posaconazole (POSA) and isavuconazole (ISAV) (the active component of the prodrug isavuconazonium sulfate), may be effective in patients refractory to or intolerant of LFAB. Early surgical debridement or excision plays an important adjunctive role. Additional studies are required to assess the optimal duration of therapy as well as the specific roles of LFAB and the triazoles in the treatment of mucormycosis.

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Section: Prognosis Of Mucormycosismentioning

confidence: 99%

Mucormycosis

Reid

Lynch

Fishbein

et al. 2020

Semin Respir Crit Care Med

158

108

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“…222 Sequential therapy with POSA to complete therapy following initial treatment with LFAB has been used with success. 150,163,223,224 Less data are available regarding isavuconazole, but this azole displays in vitro activity against Mucorales 225 and successes have been cited in small trials. In a nonrandomized trial of patients with mucormycosis, 37 patients treated with isavuconazole were compared with matched controls treated with AmB (n ¼ 39).…”

Section: Prognosis Of Mucormycosismentioning

confidence: 99%

Fungal Infections Complicating Lung Transplantation

Clark

Weigt

Fishbein³

et al. 2018

Semin Respir Crit Care Med

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Lung transplantation is an increasingly utilized modality for treating advanced lung disease. However, lung transplant recipients (LTRs) experience high rates of infection-related mortality and, compared with other solid organ transplant recipients, are at increased risk of infectious complications given the intensity of immunosuppression employed, the presence of airway abnormalities after surgery and exposure of the allograft to the environment. Fungal infections, particularly mold infections, are problematic after transplantation as they are often associated with limited treatment options and poor outcomes. We describe the non- fungal infections occurring in LTRs, including their epidemiology, clinical features, and treatment.

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“…The principle risk factors associated with mucormycosis include uncontrolled diabetes and diabetic ketoacidosis, prolonged steroid therapy, persistent neutropenia, deferoxamine therapy, hematological malignancies, illicit use of intravenous drugs, autoimmune disorders, prophylaxis with voriconazole or echinocandins, and cutaneous or mucous membrane barrier due to trauma, burns and surgical wounds. However, it has also been described in patients with no underlying disease (5)(6)(7)(8)(9)(10). This infection is more common among people with suppressed immune systems, but it can rarely occur in people, who are otherwise healthy (11).…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and Treatment Outcome of Mucormycosis in Khuzestan, Southwest of Iran

Nashibi

Afzalzadeh

Mohammadi

et al. 2016

Arch Clin Infect Dis

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Background: Mucormycosis is an uncommon life-threatening fungal infection. The major risk factors of this infection include uncontrolled diabetes mellitus, prolonged steroid therapy, persistent neutropenia, hematological malignancies, autoimmune disorders, trauma, burns and surgical wounds. Objectives: The current study aimed to determine the epidemiology and treatment outcome of mucormycosis in Khuzestan province, southwest of Iran. Methods: This cross-sectional study was performed during a period of 10 years from April 2004 to March 2014 at Razi hospital in Ahvaz, southwest of Iran, during years 2004 to 2014. Demographic data, laboratory data, clinical features, antifungal treatment, the need for surgical debridement and the outcome were collected. Data were summarized using descriptive statistical methods and analyzed by SPSS version 15 software. Results: The study included 20 patients with a biopsy-proven diagnosis of mucormycosis. Regarding the findings, the mean age was 51.4 ± 9.7 years. Eighty-five percent of patients had uncontrolled diabetes mellitus. Findings showed that all the cases received amphotericin B, but surgical debridement was performed on 10 patients (50%). Most prevalent season of mucormycosis was winter (40%). Conclusions: Prognosis of patients that underwent surgery and medical therapy was significantly better than medical therapy alone (90% vs. 50% patient's survival).

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Early diagnosis and successful management of oral mucormycosis in a hematopoietic stem cell transplant recipient: case report and literature review

Abstract: The good outcome of this case highlights the subtle clinical changes that present early in mucormycosis and the importance of early detection and treatment of post-transplant oral infections by an experienced multidisciplinary team.

Cited by 16 publications

References 7 publications

Mucormycosis

Mucormycosis

Fungal Infections Complicating Lung Transplantation

Epidemiology and Treatment Outcome of Mucormycosis in Khuzestan, Southwest of Iran

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