Pulmonary mucormycosis in diabetic renal allograft recipients

Latif, Sajid; Saffarian, Nasser; Bellovich, Keith; Provenzano, Robert

doi:10.1016/s0272-6386(97)90211-0

Cited by 35 publications

(21 citation statements)

References 19 publications

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“…Sporadic literature reports have shown this species to be mostly associated with patients who are severely immunocompromised, especially those patients undergoing therapy for leukemia or those who have uncontrolled diabetes (17,25). Infection types include primary cutaneous disease with or without dissemination (14,18,21,31), primary pulmonary disease with or without dissemination (3,7,15,17,23,25), and sinusitis with or without orbital participation or involvement of the brain (1,5,6). In all cases, the identification of Rhizomucor species was based on morphological observations, with biochemical tests used in some cases.…”

Section: Discussionmentioning

confidence: 99%

Molecular Identification of Rhizomucor pusillus as a Cause of Sinus-Orbital Zygomycosis in a Patient with Acute Myelogenous Leukemia

et al. 2005

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Sinus-orbital zygomycosis caused by Rhizomucor pusillus in a patient with acute myelogenous leukemia is described. Identification was achieved by sequencing of the internal transcribed spacer (ITS) regions of the rRNA gene and by expression of zygospores in mating. This report highlights the value of ITS sequencing as a diagnostic tool for the identification of R. pusillus and expands the understanding of infection types caused by this zygomycete. CASE REPORTA 62-year-old male Native American rancher from Nebraska was diagnosed with acute myelogenous leukemia. He was treated with standard induction and consolidation chemotherapy followed by a low-intensity related allogeneic peripheral stem cell transplant. The patient received fluconazole prophylaxis and was placed on granulocyte-macrophage colony-stimulating factor (GM-CSF) on the day of transplant. On day 8 posttransplant (PT) the patient had an absolute neutrophil count of 300 cells per mm 3 and complained of nasal congestion. A nasal washing was positive for parainfluenza virus, but cultures for bacteria and fungi were negative. A computed tomography scan of the sinuses showed pansinusitis. On day 9 PT, the absolute neutrophil count was 1,380 cells per mm 3 , at which time GM-CSF was discontinued. Over the next 4 days, the sinusitis symptoms continued with the development of right-sided periorbital edema. On day 13 PT a magnetic resonance image confirmed pansinusitis with diffuse mucosal thickening and bilateral proptosis. Broad-spectrum antibiotics were initiated. The patient was subsequently taken to the operating room for a bilateral total ethmoidectomy and sphenoidectomy; culture and histopathological exam of tissue were negative for pathogens. Amphotericin B (AMB) lipid complex (Abelcet; Enzon Pharmaceuticals, Bridgewater, NJ) was started at 5 mg per kg for presumed fungal sinusitis. Over the next 3 days, the patient had fever spikes to 39.5°C, and on day 16 PT he developed complete loss of vision in the right eye with orbital fixation. On day 18 PT, the patient underwent a bilateral total ethmoidectomy, bilateral maxillary and sphenoid debridement, and a right orbitotomy. The pathological exam of the sphenoid and ethmoid tissues reported "fibrovascular changes and acute inflammation with necrosis containing broad and irregularly shaped non-septate hyphae." Based on diagnosis of an invasive mold infection, the AMB lipid complex was increased to 7.5 mg per kg, AMB nasal irrigation was also initiated, and GM-CSF was restarted. Fungal cultures from the sinus biopsy material plated onto Sabouraud dextrose agar (Remel, Lenexa, Kansas) incubated at 30°C grew a mold within 4 days that was morphologically identified as a Mucor species. Sinus tissue extract and a subculture of the isolate were subsequently submitted to the Molecular Mycology Laboratory at the University of Nebraska Medical Center (UNMC) for further evaluation. DNA extracted from both the sinus tissue and the culture isolate was tested using a molecular assay targeting the internal transcribed s...

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Section: Discussionmentioning

confidence: 99%

Molecular Identification of Rhizomucor pusillus as a Cause of Sinus-Orbital Zygomycosis in a Patient with Acute Myelogenous Leukemia

et al. 2005

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“…Although most of these cases were seen in patients with leukemia (29,113,249,298,398,417,434,499), Rhizomucor infections have also been seen associated with neutropenia caused by aplastic anemia (174) and myelofibrosis (153). Treatment with steroids probably contributed to disease risk for a number of patients (29,174,249,257,398,417,434,499,504). Antibiotic use was seen in nearly every case of Rhizomucor cited in the literature.…”

Section: Mucor Speciesmentioning

confidence: 99%

Zygomycetes in Human Disease

Ribes¹,

Vanover-Sams²,

Baker³

2000

Clinical Microbiology Reviews

1,093

1,053

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“…Menos frecuentemente se ha reportado en pacientes diabéticos, sometidos a trasplante renal, infectados por VIH, e incluso en huéspedes inmunocompetentes 2,[29][30][31][32][33][34] . La zigomicosis pulmonar puede ocurrir también como parte de una infección diseminada y raras veces después de una enfermedad rinocerebral 1,34 .…”

Section: Mucormicosis Pulmonarunclassified

Mucormicosis en Pediatría

P¹,

2004

Rev. chil. infectol.

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IntroducciónTambién llamada phycomicosis o zigomicosis, (aunque este segundo término es más amplio y engloba además a infecciones causadas por Entomophtorales), es una afección causada por hongos saprófítos aeróbicos, generalmente no pató-genos para el hospedero inmunocompetente 1,2 . El desarrollo de enfermedad depende del estado inmune del huésped; los macrófagos y neutrófilos parecen ser el componente primario de la respuesta inmune contra estos microorganismos, previniendo la germinación de las esporas inhaladas 3 . El sello de la mucormicosis es la invasión vascular por hifas que conduce a la trombosis arterial, infarto secundario, trombosis venosa y hemorragia consecuente. Las razones de la afinidad del hongo por el tejido vascular son desconocidas y materia de especulación 2,5 . Los hongos del Orden Mucorales son microorganismos no fastidiosos que crecen en un rango de temperatura de 25 a 55° C, aeróbicos y demoran 2 a 5 días en formar colonias visibles a ojo desnudo. Las colonias tienen aspecto lanudo, a menudo parecen tenues puntos negros. Las especies de estos géneros desarrollan estolones, rizoides (en Rhizopus, Absidia y Rhizomucor) y el esporangio contiene en su extremo miriadas de esporangiosporas de 3-6 mm de diámetro cada una, que sirven como la forma de diseminación al medioambiente. La observación directa del tejido extraído, tratado con KOH al 10%, permite apreciar formas irregulares, hifas características largas y con ancho de 10 a 30 mµ, no septadas, que adoptan a menudo formas curvas o de cintas ramificadas en ángulo recto ( Etiología Mucormycosis in PediatricsMucormycosis is an infrequent infection caused by opportunistic fungi belonging to the Mucorales order; Mucoraceae family, whose characteristics are vascular invasion by hyphae, which determine thrombosis and tissue infarction. In generally affects patients with underlying diseases and produces serious invasive and often fulminant infections. Some of the risk factors leading to mucormycosis are diabetic ketoacidosis, immunosuppressive therapy, leukemia and lymphomas with prolonged neutropenia. Various clinical presentations are described, relating to anatomical site involved, being the rhinocerebral site, the most frequent one, specially in diabetic patients. Although this infection has a high morbidity and mortality, its prognosis has improved the last years, relating to therapeutic measures like correction of predisposing conditions, use of amphotericin B and early aggressive surgery. It is very important to suspect this infection in patients with predisposing conditions so an early diagnosis can be made.

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Pulmonary mucormycosis in diabetic renal allograft recipients

Cited by 35 publications

References 19 publications

Molecular Identification of Rhizomucor pusillus as a Cause of Sinus-Orbital Zygomycosis in a Patient with Acute Myelogenous Leukemia

Molecular Identification of Rhizomucor pusillus as a Cause of Sinus-Orbital Zygomycosis in a Patient with Acute Myelogenous Leukemia

Zygomycetes in Human Disease

Mucormicosis en Pediatría

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