Pulmonary mucormycosis: Results of medical and surgical therapy

Tedder, Mark; Spratt, John A.; Anstadt, Mark P.; Hegde, Sanjay S.; Tedder, Stephen D.; Lowe, James E.

doi:10.1016/0003-4975(94)90243-7

Cited by 399 publications

(382 citation statements)

References 27 publications

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“…Pulmonary consolidation is a common finding followed by solitary nodule, diffuse lobar involvement, abscesses and cavitations. 5 Chakrabarti et al, reported two cases of cavitory pulmonary mucormycosis. 6 In this case the patient had perplexing deteriorating radiological findings, which were out of proportion to clinical condition.…”

Section: Discussionmentioning

confidence: 99%

Fatal massive hemoptysis: An autopsy study

Misra

Roy

Dutta

et al. 2015

Medical Journal Armed Forces India

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Section: Discussionmentioning

confidence: 99%

Fatal massive hemoptysis: An autopsy study

Misra

Roy

Dutta

et al. 2015

Medical Journal Armed Forces India

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“…2,3 A review of patients with pulmonary mucormycosis found that mortality was significantly lower in patients treated surgically rather than medically (11% vs 68%, P = 0.0004). 11 Unfortunately, the patient was not considered to be a suitable candidate for surgery and was treated with optimal medical therapy in the form of highdose liposomal amphotericin B. Antifungal agents penetrate infarcted tissue poorly and this is the probable reason why medical treatment alone is often ineffective. Other experimental strategies can be used such as granulocyte transfusions and cytokines such as GM-CSF.…”

Section: Discussionmentioning

confidence: 99%

Fatal invasive cerebral Absidia corymbifera infection following bone marrow transplantation

Paterson

Marshall

Shaw

et al. 2000

Bone Marrow Transplant

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Summary:A 56-year-old dairy farmer received a fully HLA matched unrelated donor marrow transplant for high risk CML in chronic phase. His early post-transplant course was complicated by a series of massive intracerebral bleeds and by sepsis related to a malignant otitis externa. The microbial pathogen isolated from ear swabs was found to be Absidia corymbifera, but CT scan at the time showed no intracerebral extension. Despite neutrophil engraftment and aggressive antifungal management he succumbed. Autopsy revealed invasion of Absidia into the brain from the ear. We speculate that colonisation by Absidia resulted from occupational exposure. Bone Marrow Transplantation (2000) 26, 701-703. Keywords: zygomycosis; Absidia corymbifera; bone marrow transplantation; leukaemia Zygomycosis is an uncommon, although frequently lethal, opportunistic fungal infection caused by members of the order Mucorales most commonly Rhizopus, Absidia and Rhizomucor. 1 These fungi are ubiquitous saprophytes found in soil, manure, plants and decayed food, and can be pathogenic in immunocompromised patients. 1 Zygomycosis is most commonly seen in patients with diabetic ketoacidosis but the incidence in those with haematological malignancies is increasing, probably as a result of newer, more aggressive chemotherapy and bone marrow transplantation regimens. 1,2 Rhinocerebral involvement is the commonest presentation overall although pulmonary infection is more common in haematology patients. 1,3 We describe an unusual case of zygomycosis in a dairy farmer with CML who had undergone an HLA matched unrelated donor bone marrow transplant (BMT). Case reportA 56-year-old dairy farmer had high risk CML, having trisomy 8 in addition to the Philadelphia chromosome. His disease had failed to respond to alpha-interferon and he therefore underwent high-dose chemotherapy, followed by a T cell-depleted, fully matched unrelated donor BMT. He was an extremely fit and well man who gave no significant past medical history. He tolerated the conditioning regimen consisting of Campath-lH, fludarabine, cyclophosphamide and single fraction TBI very well with no significant complications.On day +4 post transplant, he complained of pain in his right ear, which had developed over the previous 12 h. Direct questioning revealed intermittent earache over several years, which he had previously not disclosed. Direct view of his right eardrum revealed no obvious erythema of the tympanic membrane which was intact. Although afebrile, swabs were taken from the ear and throat and he was commenced on piperacillin/tazobactam 4.5 g three times a day. On day +5 the pain extended to the right jaw and he developed a lower motor neurone right VIIth cranial nerve palsy. The tympanic membrane now looked swollen and erythematous with purulent material in the external auditory canal, which was thought to represent malignant otitis externa by the ENT surgeons, who recommended additional topical gentamicin drops. Urgent CT scan showed some opacification of the right mastoid with soft ti...

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“…Surgery, when feasible, is useful for debulking infection and preventing spread to contiguous structures, and is associated with decreased mortality compared to medical treatment alone. 14,15 In current practice, amphotericin is the sole antifungal agent licensed by the US Food and Drug Administration for the primary therapy of mucormycosis. Antifungal treatment options consist of lipid formulations of amphotericin B, amphotericin B deoxycholate, or posaconazole.…”

Section: Discussionmentioning

confidence: 99%

Isolated pulmonary cavitary mucormycosis in uncontrolled diabetic, diagnosed by fiber-optic bronchoscopy and completely managed medically

2017

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Pulmonary mucormycosis is rare life‐threatening infection affecting mostly immunocompromised individuals such as diabetes mellitus, hematological malignancies, chronic renal failure, post transplantation etc. Based on the anatomic site involved, mucormycosis can be one of several forms, such as rhinocerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and uncommon presentations that include endocarditis, osteomyelitis, peritonitis, and renal infection. Pulmonary infection is the most common form of mucormycosis recognized in patients with hematological malignancy and remains the second most common presentation after rhinocerebral infection in diabetic patients. Its presentation in the lungs may mimic cavitary diseases like tuberculosis, mass lesions as in malignancies and non-resolving pneumonias. Here we report a case of isolated pulmonary mucormycosis in an uncontrolled diabetic male patient with a cavitary lesion. Diagnosis was made with a bronchoscopic biopsy and treatment was completely medical with liposomal amphotericin B.

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Pulmonary mucormycosis: Results of medical and surgical therapy

Cited by 399 publications

References 27 publications

Fatal massive hemoptysis: An autopsy study

Fatal massive hemoptysis: An autopsy study

Fatal invasive cerebral Absidia corymbifera infection following bone marrow transplantation

Isolated pulmonary cavitary mucormycosis in uncontrolled diabetic, diagnosed by fiber-optic bronchoscopy and completely managed medically

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