Mucormycosis: association with deferoxamine therapy

Daly, Annemarie L.; Velázquez, Luis Ángel; Bradley, Suzanne F.; Kauffman, Carol A.

doi:10.1016/0002-9343(89)90666-9

Cited by 9 publications

(19 citation statements)

References 4 publications

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“…The major risk factors for mucormycosis are diabetic ketoacidosis, neutropenia, iron overload, deferoxamine therapy, and protein-caloric malnutrition (60,276). Mucormycosis is an extremely rare infection in normal hosts, suggesting that fungal virulence factors are operative only when a specific aspect of host defense breaks down.…”

Section: Agents Of Mucormycosismentioning

confidence: 99%

Virulence factors of medically important fungi

1996

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Human fungal pathogens have become an increasingly important medical problem with the explosion in the number of immunocompromised patients as a result of cancer, steroid therapy, chemotherapy, and AIDS. Additionally, the globalization of travel and expansion of humankind into previously undisturbed habitats have led to the reemergence of old fungi and new exposure to previously undescribed fungi. Until recently, relatively little was known about virulence factors for the medically important fungi. With the advent of molecular genetics, rapid progress has now been made in understanding the basis of pathogenicity for organisms such as Aspergillus species and Cryptococcus neoformans. The twin technologies of genetic transformation and "knockout" deletion construction allowed for genetic tests of virulence factors in these organisms. Such knowledge will prove invaluable for the rational design of antifungal therapies. Putative virulence factors and attributes are reviewed for Aspergillus species, C. neoformans, the dimorphic fungal pathogens, and others, with a focus upon a molecular genetic approach. Candida species are excluded from coverage, having been the subject of numerous recent reviews. This growing body of knowledge about fungal pathogens and their virulence factors will significantly aid efforts to treat the serious diseases they cause.

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Section: Agents Of Mucormycosismentioning

confidence: 99%

Virulence factors of medically important fungi

1996

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“…14 Deferoxamine treatments for iron or aluminum overload states are clearly associated with an increased risk of zygomycotic infections. [15][16][17] Disseminated disease, isolated gastrointestinal infection, or limited rhinocerebral or pulmonary involvement, due to Rhizopus species or Cunninghamella bertholletiae have been described among hemodialysis patients receiving maintenance deferoxamine chelation therapy, in the absence of other known risk factors. Daly et al speculated that deferoxamine enhances fungal growth by providing free iron to these organisms.…”

Section: Host Defenses and Predisposing Factorsmentioning

confidence: 99%

“…Daly et al speculated that deferoxamine enhances fungal growth by providing free iron to these organisms. 16 The amount of free iron available for microbial growth in human serum and tissue is very low because nearly all iron is either stored or bound to proteins such as transferrin and lactoferrin. Microorganisms have evolved a mechanism to sequester host free iron, by secreting siderophores-small organic compounds with a high affinity for iron, which trap and deliver iron to the microbe.…”

Section: Host Defenses and Predisposing Factorsmentioning

confidence: 99%

“…The diagnosis of zygomycosis is extremely challenging, with many cases being undetected or misdiagnosed until autopsy. 16 Accordingly, it is important for physicians who care for high-risk immunosuppressed patients to maintain a high index of suspicion for all types of invasive mycoses if fever or other suggestive symptoms are present. In the clinical setting, the overlaps in presentation and radiographic imaging between aspergillosis and zygomycosis are notable.…”

Section: Diagnosismentioning

confidence: 99%

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Zygomycosis

Freifeld¹,

Iwen

2004

Semin Respir Crit Care Med

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Zygomycosis is an invasive mycotic disease caused by fungi in the class Zygomycetes. Within this class, the most common species associated with infection include Absidia corymbifera, Apophysomyces elegans, Cunninghamella bertholletiae, Rhizomucor pusillus, Rhizopus microsporus var. rhizopodiformis, and Rhizopus arrhizus. These fungi all produce characteristic hyphal forms in tissue that are variable in width, produce haphazard branching, and lack septation. Although these fungi are ubiquitous in the environment, they are opportunists causing invasive disease in compromised hosts with a high mortality even when aggressive antifungal therapy and surgical intervention are utilized. Clinically, the disease most often affects the sinus with or without pulmonary involvement; direct extension from sinuses into cerebral tissue is not uncommon. This article describes the general clinical features of zygomycosis, with an emphasis on management in the setting of immunosuppression.

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“…23,24 Use of deferoxamine in patients in iron overload states is a well established risk factor for zygomycosis. [25][26][27] However, other chelators may deprive the organism of iron. In murine models other iron chelators, such as deferiprone, have a beneficial effect in improving outcomes of experimental murine zygomycosis, and deferasirox has been successfully used as part of a salvage regimen in a case of rhinocerebral mucormycosis.…”

mentioning

confidence: 99%

Pulmonary Zygomycosis

Pyrgos

Shoham

Walsh

2008

Semin Respir Crit Care Med

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Zygomycosis has emerged as an increasingly common infection in immunocompromised patients. Although the majority of these cases are community acquired, hospital outbreaks have been described, linked to the use of contaminated products. Risk factors for development of zygomycosis include uncontrolled diabetes mellitus, neutropenia, use of immunosuppressive medications, and iron overload states. Recent studies have shown the central role of iron in the pathogenesis of zygomycosis and the effect of disease states such as ketoacidosis and hyperglycemia on the availability of iron to the Zygomycetes. These organisms most commonly infect the sinuses, lungs, central nervous system, and skin and soft tissues. Diagnosis often involves invasive procedures, including deep tissue biopsy, because radiological studies are not specific for this disease, and other less invasive diagnostic modalities have not yet been proven to be sensitive or specific. Treatment may require a combined medical and surgical approach in these frequently frail patients; yet, even with such aggressive measures the mortality of zygomycosis remains high.

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Mucormycosis: association with deferoxamine therapy

Cited by 9 publications

References 4 publications

Virulence factors of medically important fungi

Virulence factors of medically important fungi

Zygomycosis

Pulmonary Zygomycosis

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