Two Cases of Disseminated Mucormycosis in Patients with Hematological Malignancies and Literature Review

Cuvelier, I; Vogelaers, Dirk; Peleman, Renaat; Benoît, Dominique; Marck, Van; Offner, Fritz; Vandewoude, K; Colardyn, Francis

doi:10.1007/s100960050207

Cited by 29 publications

(14 citation statements)

References 23 publications

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“…recently published studies of zygomycosis in patients with cancer consist of case reports or reports of small case series [7][8][9][10][11], with the exception of a study from 1987 through 1995 that included 37 patients with leukemia in 18 different institutions in Italy who had histopathologically proven zygomycosis [12]. All the previous studies required histopathology (mostly autopsy) for the diagnosis, and thus selected patients with more severe infection and poorer prognosis.…”

mentioning

confidence: 95%

Zygomycosis in the 1990s in a Tertiary-Care Cancer Center

Kontoyiannis

Wessel

Bodey

et al. 2000

Clinical Infectious Diseases

474

347

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Twenty-four patients with cancer met predetermined criteria for a diagnosis of zygomycosis over a 10-year period at our institution. All had hematologic malignancy, and most had either neutropenia or steroid use as a risk factor. Pulmonary involvement mimicking invasive aspergillosis was the most common presentation, and dissemination was seen in 58% of patients on whom autopsies were performed. Three-fourths of the patients with pulmonary zygomycosis had pathogenic microorganisms other than zygomycetes isolated from respiratory specimens. The sensitivity of cultures in detecting zygomycetes from respiratory specimens was low. A culture positive for zygomycetes was typically a preterminal finding in the fatal, acute cases. Two-thirds of the patients died. Favorable outcome seemed to correlate with lack of pulmonary involvement, surgical debridement, neutrophil recovery, and a cumulative total amphotericin B dose of 2000 mg. Therapy with high-dose amphotericin B, combined with aggressive surgery and immune reconstitution, offers the best chance for survival of cancer patients with zygomycosis.

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mentioning

confidence: 95%

Zygomycosis in the 1990s in a Tertiary-Care Cancer Center

Kontoyiannis

Wessel

Bodey

et al. 2000

Clinical Infectious Diseases

474

347

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“…Disseminated mucormycosis is usually diagnosed after the death of the patient from the infection. Occasionally metastatic cutaneous lesions permit an earlier diagnosis (3,5). In our cases, the infection was first detected in the spleen and cutaneous lesions were not present.…”

Section: Discussionmentioning

confidence: 78%

“…The major clinical diseases can be divided into five forms according to the site of involvement: rhinocerebral, pulmonary, gastrointestinal, cutaneous, and disseminated mucormycosis. Disseminated mucormycosis is an extremely rare condition with high mortality rate and generally occurs in severely immunocompromised patients (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Two Cases of Disseminated Mucormycosis in Patients following Allogeneic Bone Marrow Transplantation

Lee

Choi

et al. 2002

J Korean Med Sci

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We describe two cases of disseminated mucormycosis following allogeneic bone marrow transplantation (BMT). Both patients were suffering from chronic graft-ver-sus-host disease (GVHD) and treated with prolonged administration of corticosteroid. In both cases, the initial symptoms were high fever and left flank pain. Involved organs were the spleen, right kidney and the right lung in one case, and the spleen and the brain in the other. The diagnosis was confirmed by pathology after splenectomy. One patient, in whom the immunosuppressants could be discontinued, was treated with prolonged conventional and liposomal amphotericin B and 5-fluorocytosine. The other, in whom the immunosuppressants could not be discontinued due to extensive GVHD, was unresponsive to amphotericin B, and eventually died from the fungal infection. Although mucormycosis, especially the disseminated form thereof is infrequent, it should be considered in high-risk patients because early diagnosis and timely therapy combining antifungal drug or surgery and reduction of immunosuppression appear to improve the prognosis.

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“…Dissemination occurs through the hematogenous route and may originate from any of the above sites of primary infection; although, it seems to be more frequently associated with lung disease. The most common site of dissemination is the brain but other organs may also be involved [4,23].…”

Section: Disseminated Infectionmentioning

confidence: 99%