1/30. Postoperative mycobacterium chelonae endophthalmitis after extracapsular cataract extraction and posterior chamber intraocular lens implantation.OBJECTIVE: To describe a case of postoperative endophthalmitis caused by mycobacterium chelonae after extracapsular cataract extraction with posterior chamber intraocular lens implantation. DESIGN: Interventional case report. methods: The history and clinical presentation of a 66-year-old female patient, in whom a low-grade delayed-onset endophthalmitis and keratitis developed after extracapsular cataract extraction with posterior chamber intraocular lens implantation, is described. Microbiologic investigations of the scrapings of corneal infiltrate at the cataract incision site, aqueous humor and eviscerated material, and histopathologic study of eviscerated material and an enlarged cervical lymph node were performed. MAIN OUTCOME MEASURES: The clinical, histopathologic, and microbiologic findings in a case of low-grade delayed-onset endophthalmitis. RESULTS: Analysis of the direct smear of both the corneal infiltrate as well as the eviscerated material revealed acid-fast bacilli. M. chelonae was isolated from these specimens. Direct smear and culture of the aqueous humor were negative for bacteria (including mycobacteria) and fungus. Histopathologic examination of the eviscerated material showed a dense infiltration of polymorphonuclear leukocytes in the uveal tissue, extensive necrosis and hemorrhage, and exudates with hemorrhage in the vitreous cavity. Histopathologic examination of the lymph node revealed granulomatous inflammation with caseation necrosis, but did not reveal acid-fast bacilli. CONCLUSIONS: M. chelonae, although infrequent, should be considered an etiologic agent of delayed-onset, postoperative endophthalmitis and early bacterial diagnosis should help in institution of appropriate therapy.- - - - - - - - - - ranking = 1keywords = fungus (Clic here for more details about this article) |
2/30. Severe keratomycosis secondary to scedosporium apiospermum.PURPOSE: To report an unusual case of severe keratomycosis caused by scedosporium apiospermum without any known previous ocular injury, that resulted in a corneal perforation, which was treated with an emergency penetrating tectonic keratoplasty and later with phacoemulsification and astigmatic keratotomy to restore good visual function. methods: A 45-year-old woman with a history of multiple sclerosis presented with a severe and refractory corneal abscess in her right eye without any known prior injury. Corneal scrapings were obtained and stained for microscopic evaluation. The samples were sent for aerobic and anaerobic bacterial and fungal cultures. RESULTS: Microbiologic examination of the corneal scraping showed scedosporium apiospermum micelle. The fungal culture was sensitive to miconazole, itraconazole and voriconazole. Partial clinical improvement was achieved with hourly topical natamycin, amphotericin b, and systemic itraconazole application, although in vitro sensitivity tests showed resistance to the topical antifungal agents used. A corneal paracentral perforation occurred despite aggressive treatment. An emergency eccentric penetrating keratoplasty was performed with satisfactory results. Subsequent phacoemulsification and astigmatic keratotomy restored a good visual function. CONCLUSION: A fungal etiology should be suspected in a progressive and refractory corneal abscess. This report highlights the utility of microbiologic investigation to perform an early and accurate diagnosis. Aggressive medical treatment and even therapeutic penetrating keratoplasty to remove infected tissue could result in the maintenance of useful visual function. In view of the poor prognosis of this specific fungus, a closer observation and early keratoplasty might be required to preserve the ocular globe.- - - - - - - - - - ranking = 1keywords = fungus (Clic here for more details about this article) |
3/30. Subcutaneous phaeohyphomycotic abscess caused by Pleurophomopsis lignicola.A 41-year-old man with a past medical history of diabetes mellitus type II, AIDS (diagnosed 2 years earlier; CD4 count < 10), peripheral neuropathy, and pulmonary tuberculosis of 2 years duration was admitted to the hospital with abnormal liver function tests. There was a chronic hepatitis/cholestasis that had worsened while the patient was undergoing directly observed tuberculosis therapy. On admission, the patient complained of a painful swelling on his right arm. In the posterior aspect of the arm, there was a 3-4-cm subcutaneous mass that was fluctuant, mobile and tender. Incision of the mass released yellowish pus mixed with blood. Direct examination of the pus in KOH mounts and Gram-stained smears revealed subhyaline, septate, branched hyphae. When the pus was cultured on Sabouraud dextrose agar containing chloramphenicol, several velvety, olivaceous grey colonies grew after 7 days at 25 degrees C. When grown on oatmeal agar, the fungus produced subglobose, rostrate pycnidia with phialidic conidiogenous cells, and 1-celled cylindrical conidia. It was identified as Pleurophomopsis lignicola Petrak. This report describes the third known case of subcutaneous infection caused by P. lignicola in an immunocompromized patient.- - - - - - - - - - ranking = 1keywords = fungus (Clic here for more details about this article) |
4/30. A fatal fungus.We report the case of a 66-year-old man who presented with a prodromal type illness and pre-sternal swelling after having coronary artery bypass grafts 4 years earlier. Computed tomography showed that the mass had a retrosternal extension, to join a collection anterior to the right ventricle. Candida famata was isolated from operative specimens and he was treated with aggressive antifungal therapy. We believe that this is the first reported case of mediastinal Candida famata.- - - - - - - - - - ranking = 4keywords = fungus (Clic here for more details about this article) |
5/30. Successful treatment of paecilomyces variotii splenic abscesses: a rare complication in a previously unrecognized chronic granulomatous disease child.A case of splenic abscesses caused by paecilomyces variotii in a 21-month-old child with previously undiagnosed chronic granulomatous disease (CGD) is described. An X-linked form of CGD with deficiency of gp91-phox was diagnosed. The fungal pathogen was isolated from the abscess contents. Cure was achieved by a partial splenectomy and a prolonged fluconazole and flucytosine combination treatment regimen. P. variotii is an emerging fungus in children with CGD. Every effort should be made to recover the possible underlying immunodeficiency in children with paecilomycosis.- - - - - - - - - - ranking = 1keywords = fungus (Clic here for more details about this article) |
6/30. A case of fusariosis in an immunocompromised patient successfully treated with liposomal amphotericin b.Although aspergillosis remains the most common mould infection in patients with haematologic malignancies, disseminated fusarium infection is an emerging problem with a poor prognosis in this patient population. The treatment options are limited due to relative resistance of the fungus to standard antifungals. We present a patient with acute lymphoblastic leukaemia successfully treated with AmBisome for a disseminated fusarium solani infection that did not respond to first line treatment with voriconazole. Despite the fact that he received additional myelosuppressive chemotherapy and underwent two stem cell transplantations from HLA mismatched donors the fusarium infection did not recur during the subsequent phases of neutropenia. The clinical presentation, diagnosis, prognosis and therapeutic options of fusariosis in immunocompromised patients are briefly discussed.- - - - - - - - - - ranking = 1keywords = fungus (Clic here for more details about this article) |
7/30. Splenic microabscesses in the immune-compromised patient.Four immune-compromised children who were receiving antineoplastic chemotherapy (three for leukemia), presented with recurrent episodes of fever and left upper abdominal pain. blood cultures grew enteric gram-negative organisms in three children. Multiple blood cultures were negative for fungus although three patients had mucocutaneous and urinary candidiasis. All remained febrile and symptomatic despite treatment with broad spectrum antibiotics and antifungal chemotherapy. Computed tomography (CT) scans in all patients showed 2- to 10-mm focal defects in the spleen. The larger defects could be seen by ultrasonography but not on the live-spleen nuclear scan. A splenectomy was performed 2 to 4 weeks after the onset of symptoms in each child, and the cut surface of the spleens showed multiple small abscesses. All operative cultures were negative. A histological examination confirmed Candida infection in two patients and aspergillus in one. Necrotizing granulomas strongly suggestive of fungus were seen in the fourth child. The patients defervesced and appeared well within three days. Antifungal therapy was continued. One child remains in remission from acute lymphocytic leukemia; one continues on chemotherapy; and one has recurrent widespread tumor. The patient with aspergillus died following a bone marrow transplantation 6 months after the splenectomy. He had disseminated aspergillosis. An immune-compromised patient with persistent unexplained fever should have a CT scan of the abdomen. The presence of multiple splenic lesions strongly suggests fungal disease. If antifungal therapy does not result in complete resolution of fever and the splenic lesions, a splenectomy is indicated.- - - - - - - - - - ranking = 2keywords = fungus (Clic here for more details about this article) |
8/30. Subcutaneous abscesses caused by Ochroconis gallopavum.A subcutaneous fungus infection that occurred in a patient with an acute myeloblastic leukemia was found to be caused by Ochroconis gallopavum (Dactylaria gallopava). In histological sections dematiaceous, septate hyphae were present. A darkly pigmented fungus was isolated on Sabouraud glucose medium. The mycological features of the causative agent were typical of O. gallopavum. The patient died after 6 months of treatment with antileukemic drugs and 5-fluorocytosine. At autopsy, tissue sections revealed leukemic infiltrates in most of the internal organs but fungal invasion was not detected.- - - - - - - - - - ranking = 2keywords = fungus (Clic here for more details about this article) |
9/30. urinoma and arterial hypertension complicating neonatal renal candidiasis.During antibiotic treatment for E. coli urinary tract infection and meningitis, a male new born developed a candida albicans urinary tract infection with a mycotic kidney abscess and pelvicalyceal fungus balls diagnosed by US investigations and confirmed by radiology. Three weeks later a perirenal urinoma with arterial hypertension developed. After surgical treatment of the urinoma the arterial pressure returned to normal.- - - - - - - - - - ranking = 1keywords = fungus (Clic here for more details about this article) |
10/30. Subcutaneous phaeohyphomycosis caused by Exserohilum rostratum in an immunocompetent host.A healthy, 55-year-old woman developed a subcutaneous abscess and systemic symptoms of nausea, dizziness, and chills following minor trauma to her leg. Histopathologic examination of a skin biopsy specimen revealed golden-brown colored mycelial elements, and culture resulted in growth of a dematiaceous fungus identified as Exserohilum rostratum. Surgical excision of the abscess and concomitant oral therapy with ketoconazole resulted in resolution of symptoms. In previously reported cases of human phaeohyphomycosis caused by Exserohilum and related Bipolaris species in both immunocompromised and immunocompetent hosts, treatment has varied from topical antimicrobial therapy to combined surgery and intravenous antifungal chemotherapy. Our experience leads us to believe that surgical debridement of an accessible focus of infection along with orally administered ketoconazole may provide adequate therapy in an immunocompetent host.- - - - - - - - - - ranking = 1keywords = fungus (Clic here for more details about this article) |
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