Fungal Cerebritis from Intravenous Drug Abuse

Wetli, Charles V.; Weiss, Steven D.; Cleary, Timothy J.; Györi, Eva

doi:10.1520/jfs11658j

Cited by 51 publications

(16 citation statements)

References 25 publications

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“…Mucormycosis of the central nervous system may be part of the progression of the disease from a rhino-orbital route or a clinical manifestation limited to the central nervous system [51,104,164,228,229]. Intravenous drug users have a particular predisposition to mucormycosis limited to the central nervous system [122,183,[230][231][232][233][234][235], although this manifestation has proven to be anecdotal among immunocompetent patients [85]. The involvement of basal lymph nodes and the presence of lesions on magnetic resonance imaging scans are usual [231].…”

Section: E N T R a L N E R V O U S S Y S T E M I N V O L V E M E N Tmentioning

confidence: 99%

Mucormycosis: an emerging disease?

Bouza

Muñóz

Guinea

2006

Clinical Microbiology and Infection

137

127

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A B S T R A C TMucormycosis is the third invasive mycosis in order of importance after candidiasis and aspergillosis and is caused by fungi of the class Zygomycetes. The most important species in order of frequency is Rhizopus arrhizus (oryzae). Identification of the agents responsible for mucormycosis is based on macroscopic and microscopic morphological criteria, carbohydrate assimilation and the maximum temperature compatible with its growth. The incidence of mucormycosis is approximately 1.7 cases per 1000 000 inhabitants per year, and the main risk-factors for the development of mucormycosis are ketoacidosis (diabetic or other), iatrogenic immunosuppression, use of corticosteroids or deferoxamine, disruption of mucocutaneous barriers by catheters and other devices, and exposure to bandages contaminated by these fungi. Mucorales invade deep tissues via inhalation of airborne spores, percutaneous inoculation or ingestion. They colonise a high number of patients but do not cause invasion. Mucormycosis most commonly manifests in the sinuses (39%), lungs (24%), skin (19%), brain (9%), and gastrointestinal tract (7%), in the form of disseminated disease (6%), and in other sites (6%). Clinical diagnosis of mucormycosis is difficult, and is often made at a late stage of the disease or post-mortem. Confirmation of the clinical form requires the combination of symptoms compatible with histological invasion of tissues. The probable diagnosis of mucormycosis requires the combination of various clinical data and the isolation in culture of the fungus from clinical samples. Treatment of mucormycosis requires a rapid diagnosis, correction of predisposing factors, surgical resection, debridement and appropriate antifungal therapy. Liposomal amphotericin B is the therapy of choice for this condition. Itraconazole is considered to be inappropriate and there is evidence of its failure in patients suffering from mucormycosis. Voriconazole is not active in vitro against Mucorales, and failed when used in vivo. Posaconazole and ravuconazole have good activity in vitro. The overall rate of mortality of mucormycosis is approximately 40%.

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Section: E N T R a L N E R V O U S S Y S T E M I N V O L V E M E N Tmentioning

confidence: 99%

Mucormycosis: an emerging disease?

Bouza

Muñóz

Guinea

2006

Clinical Microbiology and Infection

137

127

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“…For species that do not produce the teleomorph in culture, DNA sequence analysis would be needed for their correct placement. Acremonium alabamense, which was reported to be the etiologic agent of one case of human infection (579), is the anamorph of Thielavia terrestris, a member of Sordariales.…”

Section: Unitunicate Pyrenomycetesmentioning

confidence: 99%

Developments in Fungal Taxonomy

1999

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SUMMARY Fungal infections, especially those caused by opportunistic species, have become substantially more common in recent decades. Numerous species cause human infections, and several new human pathogens are discovered yearly. This situation has created an increasing interest in fungal taxonomy and has led to the development of new methods and approaches to fungal biosystematics which have promoted important practical advances in identification procedures. However, the significance of some data provided by the new approaches is still unclear, and results drawn from such studies may even increase nomenclatural confusion. Analyses of rRNA and rDNA sequences constitute an important complement of the morphological criteria needed to allow clinical fungi to be more easily identified and placed on a single phylogenetic tree. Most of the pathogenic fungi so far described belong to the kingdom Fungi; two belong to the kingdom Chromista. Within the Fungi, they are distributed in three phyla and in 15 orders (Pneumocystidales, Saccharomycetales, Dothideales, Sordariales, Onygenales, Eurotiales, Hypocreales, Ophiostomatales, Microascales, Tremellales, Poriales, Stereales, Agaricales, Schizophyllales, and Ustilaginales).

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“…In a study of 61 cases of vertebral osteomyelitis of nontuberculous creasingly frequent in patients with AIDS, the use of the terms / 9c68$$ju01 05-11-99 11:11:56 cida UC: CID seen in intravenous drug abusers [32,33]. Thirteen percent of Thoracic spine 19 (46.3) all patients with AIDS have a history of drug abuse, and 60%…”

Section: Case Reportsmentioning

confidence: 99%

“…Lumbosacral spine 22 (53.7) Duration of symptoms before diagnosis in w (n Å 25) of heterosexual patients with AIDS have been reported to have a history of drug abuse [32,33]. Exceptionally, rare cases Median 12 of invasive aspergillosis affecting normal immunocompetent patients have been reported [26,34].…”

Section: Case Reportsmentioning

confidence: 99%

Spinal Aspergillus Osteomyelitis

1999

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Aspergillus species are uncommon etiologic agents of vertebral osteomyelitis. We describe two patients with lumbar vertebral aspergillosis precipitated by the use of corticosteroids and review 39 cases in the literature. The mean age of the population was 40.04 years. There was male predominance (78% of cases), mainly lumbar involvement (53.7%), and monomicrobial nature of infection; 65.8% of the patients had predisposing factors, while 34.1% had none. Back pain (53.6% of cases) was the predominant symptom, while neurological deficits were present in 29.2% of the patients. White blood cell counts were elevated in 12.2% of the patients, and erythrocyte sedimentation rates were ú40 mm/h in 39%. The overall recovery rate was 68.3%, and the mortality rate was 26.8%. Although aspergillus osteomyelitis is primarily treated medically, certain cases may require surgical intervention.The widespread use of broad-spectrum antibiotics, corticotreatment showed resolution of the brain lesions, and serial determinations of the erythrocyte sedimentation rate (ESR) resteroids, and chemotherapeutic drugs has led to an increased frequency of opportunistic infections. However, the occurrence vealed a return to normal values. Six months later, she was readmitted to the hospital with an acute exacerbation of asthma of these infections in the spinal column is uncommon. Aspergillus is an ubiquitous saprophytic fungus widely disseminated and treated with intravenous steroids. in the environment. Although aspergillus infection may affect Eight months later, she was readmitted to the hospital with normal individuals, it is extremely rare in the absence of immulow-grade fever and unbearable low-back pain. A chest roentnosuppression. We report two cases of vertebral aspergillus genogram was unremarkable. Laboratory examination showed osteomyelitis of the lumbar spine that were precipitated by an ESR of 60 mm/h and a WBC count of 7.3/mm 3 , with 73% intravenous steroid therapy for other systemic diseases. Other segmented cells and 19% lymphocytes. Blood cultures were previously reported cases of spinal aspergillosis are reviewed.negative. Plain roentgenograms demonstrated destruction of the end plates of L5 and S1 vertebrae. An MRI of the lumbar spine showed osteomyelitis and diskitis of the L5-S1 disk Methods space. A MEDLINE search of the English-, French-, and Spanish-The patient underwent laminectomy with open biopsy of the language literature from 1966 to August 1998 and review of disk space and spinal fusion. Pathological examination of a reference lists for additional cases before 1966 yielded 39 cases biopsy specimen showed osteomyelitis with scattered giant of proven vertebral aspergillus osteomyelitis (tables 1 and 2). multinucleate cells containing particles of retractile material. Cases with radiological, gross, or histopathologic evidence of Grocott-Gomori methenamine -silver nitrate staining revealed vertebral aspergillus osteomyelitis were included in the review.fungal hyphae that were septated and branching at about 45Њ The a...

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Fungal Cerebritis from Intravenous Drug Abuse

Cited by 51 publications

References 25 publications

Mucormycosis: an emerging disease?

Mucormycosis: an emerging disease?

Developments in Fungal Taxonomy

Spinal Aspergillus Osteomyelitis

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