Pulmonary Mucormycosis Presenting as Nonresolving Pneumonia in a Patient With Diabetes Mellitus

Panigrahi, Manoj Kumar; Rajaram, M.; Kumar, Senthil; Toi, Pampa Ch

doi:10.4187/respcare.03205

Cited by 16 publications

(23 citation statements)

References 7 publications

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“…Diagnosing IFT is considerably difficult because of the nonspecific clinical manifestations and the lack of a diagnostic tool to distinguish colonization from infection [2, 12, 32, 33]. Radiological findings are usually nonspecific in patients with aspergillosis.…”

Section: Discussionmentioning

confidence: 99%

“…They proposed Aspergillus -positive lower respiratory tract specimen culture as the entry criterion and that physicians should increasingly consider the possibility of invasive pulmonary aspergillosis [20, 22, 37]. However, the rate of positive fungal culture results for BAL fluid is only 25–77% and can further decrease after antifungal therapy [13, 31, 32]. In our patients, less than 30% had positive cultures for fungi before bronchoscopy, and 20% had negative BAL fluid cultures after bronchoscopy.…”

Section: Discussionmentioning

confidence: 99%

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Invasive fungal tracheobronchitis in mechanically ventilated critically ill patients: underlying conditions, diagnosis, and outcomes

Lin

Liu

Chang

et al. 2017

Ann. Intensive Care

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BackgroundInvasive fungal tracheobronchitis (IFT) is a severe form of pulmonary fungal infection that is not limited to immunocompromised patients. Although respiratory failure is a crucial predictor of death, information regarding IFT in critically ill patients is limited.MethodsIn this retrospective, multicenter, observational study, we enrolled adults diagnosed as having IFT who had been admitted to the intensive care unit between January 2007 and December 2015. Their demographics, clinical imaging data, bronchoscopic and histopathological findings, and outcomes were recorded.Results This study included 31 patients who had been diagnosed as having IFT, comprising 24 men and 7 women with a mean age of 64.7 ± 13.7 years. All patients developed respiratory failure and received mechanical ventilation before diagnosis. Eighteen (58.1%) patients had diabetes mellitus, and 12 (38.7%) had chronic lung disease. Four (12.9%) patients had hematologic disease, and none of the patients had neutropenia. Twenty-five (80.6%) patients were diagnosed as having proven IFT, and the remaining patients had probable IFT. Aspergillus spp. (61.3%) were the most common pathogenic species, followed by Mucorales (25.8%) and Candida spp. (6.5%). The diagnoses in six (19.4%) patients were confirmed only through bronchial biopsy and histopathological examination, whereas their cultures of bronchoalveolar lavage fluid were negative for fungi. The overall in-hospital mortality rate was 93.5%.ConclusionsIFT in critically ill patients results in a high mortality rate. Diabetes mellitus is the most prevalent underlying disease, followed by chronic lung disease. In addition to Aspergillus spp., Mucorales is another crucial pathogenic species. Bronchial lesion biopsy is the key diagnostic strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Invasive fungal tracheobronchitis in mechanically ventilated critically ill patients: underlying conditions, diagnosis, and outcomes

Lin

Liu

Chang

et al. 2017

Ann. Intensive Care

View full text Add to dashboard Cite

show abstract

“…Mucormycosis is a rare fungal infection from Rhizopus, Mucor, Lichtheimia, Cunninghamella berthollethiae species [1,2]. The spores are generally inhaled or enter through open wounds and then germinate in the host forming hyphal elements [1][2][3][4]. Rhinocerebral and pulmonary forms are the most common manifestations of mucormycosis encountered at 55 and 30 percent respectively [5].…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperatively pictures were taken of the right middle and lower lobes, showing bronchial necrosis (Figure 3). The lower lobe parenchyma was severely diseased suggested from 5 mg/kg/day to 10 mg/kg/day up to 10 mg/kg/day to 15 mg/kg/day [2][3][4][23][24][25]. Further trials are ongoing to determine appropriate doses of amphotericin B.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have found combination therapy beneficial while others have found superior results with amphotericin monotherapy [5]. Antifungals such as voriconazole and caspofungin are not effective against Mucor and prophylaxis with these drugs has been shown to be associated with Mucor infections [4]. However, a combination of amphotericin B and caspofungin was associated with improved therapy in 41 patients with biopsy-proven rhinoorbital cerebral mucormycosis [2,30].…”

Section: Discussionmentioning

confidence: 99%

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