Successful treatment of mucormycosis peritonitis with liposomal amphotericin B in a patient on long-term peritoneal dialysis

Serna, Jorge Humberto; Wanger, Audrey; Dosekun, Akinsansoye K

doi:10.1016/s0272-6386(03)00797-2

Cited by 20 publications

(19 citation statements)

References 18 publications

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“…Brain involvement in the absence of sinus infection, endocarditis, and pyelonephritis occur occasionally, mainly in intravenous drug abusers (156,162,164,176). Other reports have described mucormycosis in bones (91,121), mediastinum (25,86), trachea (8,175), kidneys (172), and peritoneum associated with dialysis (4,136). Other unusual forms of infection include superior vena cava syndrome (51) and external otitis (110).…”

Section: Epidemiology and Disease Manifestationsmentioning

confidence: 99%

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

2005

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Mucormycosis is a life-threatening fungal infection that occurs in immunocompromised patients. These infections are becoming increasingly common, yet survival remains very poor. A greater understanding of the pathogenesis of the disease may lead to future therapies. For example, it is now clear that iron metabolism plays a central role in regulating mucormycosis infections and that deferoxamine predisposes patients to mucormycosis by inappropriately supplying the fungus with iron. These findings raise the possibility that iron chelator therapy may be useful to treat the infection as long as the chelator does not inappropriately supply the fungus with iron. Recent data support the concept that high-dose liposomal amphotericin is the preferred monotherapy for mucormycosis. However, several novel therapeutic strategies are available. These options include combination therapy using lipid-based amphotericin with an echinocandin or with an azole (largely itraconazole or posaconazole) or with all three. The underlying principles of therapy for this disease remain rapid diagnosis, reversal of underlying predisposition, and urgent surgical debridement

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Section: Epidemiology and Disease Manifestationsmentioning

confidence: 99%

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

2005

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“…A rare manifestation of zygomycosis is a primary renal form that is usually confirmed at autopsy [71,72] Although rare, bilateral renal zygomycosis should be suspected in any immunocompromised patient who presents with haematuria, flank pain, and unexplained anuric renal failure. Rare manifestations of zygomycosis are involvement of the peritoneal cavity in patients undergoing peritoneal dialysis [57,73–75], brain involvement without rhino‐orbital participation in leukaemic patients and intravenous drug abusers [76], and endocarditis in patients with artificial heart valves and rarely endocarditis on native heart valves. [77–79].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Clinical presentation of zygomycosis

Mantadakis

Samonis

2009

Clinical Microbiology and Infection

105

101

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Zygomycetes are filamentous fungi with a worldwide distribution. This class of fungi encompasses two orders, i.e. the Mucorales and the Entomophthorales. Members of the latter are associated with chronic cutaneous and subcutaneous infections that are limited to the tropics and rarely disseminate to internal organs. The order Mucorales includes several species involved in rhinocerebral, pulmonary, cutaneous, gastrointestinal and other less frequent infections in immunocompetent and immunocompromised individuals, and is characterized by a tendency to disseminate. Portals of entry of zygomycetes are usually the lungs, skin, and gastrointestinal tract. A characteristic property of zygomycetes is their tendency to invade blood vessels and to cause thrombosis-processes that result in subsequent necrosis of involved tissues. Risk factors associated with zygomycosis include prolonged neutropenia and use of corticosteroids, solid organ or haematopoietic stem cell transplantation, AIDS, poorly controlled diabetes mellitus, iron chelation with deferoxamine, burns, wounds, malnutrition, extremes of age, and intravenous drug abuse. Recently, the widespread use of voriconazole for prophylaxis or treatment of aspergillosis in patients with haematological malignancies has been linked with a rise in the numbers of cases of invasive zygomycosis. As the symptoms, clinical signs and imaging findings of these infections are non-specific, a high index of suspicion is required for timely diagnosis. Early diagnosis, correction of the underlying predisposing factors, aggressive surgical debridement of all infected tissues and lengthy administration of antifungals are the only potentially curative options for this rare but emerging invasive fungal infection.

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“…The fungi are present in our environment and are reportedly not transmittable from one individual to another (man or animal). Risk factors of Zygomycetes peritonitis are, among others, previous antibacterial medications, diabetes mellitus, and immunosuppressive treatments (29). Only one of the 16 cases of PD peritonitis due to Zygomycete was a result of direct contact with a pet-a Cockatoo biting the dialysis tubing system with a transmission of Mucor species (30).…”

Section: Diseases Transmitted From Animals To Humansmentioning

confidence: 99%

Pets-Related Peritonitis in Peritoneal Dialysis: Companion Animals or Trojan Horses?

Broughton

Verger

Goffin

2010

Seminars in Dialysis

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Infectious peritonitis is still a major concern in peritoneal dialysis (PD). Standard antibiotic regimens target common causative microorganisms such as Staphylococcus aureus and epidermidis or Pseudomonas aeruginosa. When the infection does not respond, unusual infective agents are to be considered including zoonoses-infections with an animal source. Companion animals or occupations involving animal contact favor the development of zoonoses, especially for immunocompromised patients such as those with end-stage renal disease. We reviewed the literature for all animals-related peritonitis in PD and analyzed data from our own PD unit and from the French-speaking registry for peritoneal dialyis (RDPLF) to assess both the frequency and the potential risk for PD patients in owning a pet or to working with animals. In a literature search, we identified 124 cases of PD peritonitis caused by 12 different zoonotic agents. Animals were involved in 24% of the cases. Overall mortality rate was 13.5% and Tenckhoff catheters had to be removed in 27% of the cases. The results from RDPLF analysis show that zoonotic microorganisms were responsible for 0.54% of the peritonitis episodes (51 out of a total of 9433 during a 9-year period). In our unit, zoonotic microorganisms were responsible for 0.03% of the peritonitis episodes (four out of a total of 128 during a 9-year period). Considering those results, some specific treatment recommendations can be made, but the major factor still remains prevention, by insisting on strict hygenic measures when a PD patient owns a pet.

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Successful treatment of mucormycosis peritonitis with liposomal amphotericin B in a patient on long-term peritoneal dialysis

Cited by 20 publications

References 18 publications

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

Clinical presentation of zygomycosis

Pets-Related Peritonitis in Peritoneal Dialysis: Companion Animals or Trojan Horses?

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