1/26. mucormycosis, a threatening opportunistic mycotic infection.mucormycosis is a rare and invasive mycotic opportunistic infection, occurring mostly in predisposed patients, mainly diabetics and immunocompromised individuals. The evolution of this fungal infection is frequently fatal unless aggressive treatment is started, or predisposing factors are handled. Our first patient was a known diabetic who had ketoacidotic coma at admission, complicated with pulmonary mucormycosis, and needed surgical resection followed by antimycotic therapy. The second patient did not survive his severe aplastic anemia (with neutropenia) and hemochromatosis (treated with desferrioxamine), complicated with a systemic rhizopus infection, despite treatment with amphotericin b and granulocyte-colony-stimulating factors.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
2/26. Liposomal amphotericin b and surgery in the successful treatment of invasive pulmonary mucormycosis in a patient with acute T-lymphoblastic leukemia.Pulmonary mucormycosis is a usually fatal opportunistic infection in immunocompromised patients. We describe the first case of an adult patient with hematological malignancy and profound neutropenia to survive a disseminated pulmonary rhizomucor pusillus infection. Early diagnostic procedures combined with high doses of liposomal amphotericin b and surgical resection may have contributed to the successful outcome.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
3/26. Combined medical surgical therapy for pulmonary mucormycosis in a diabetic renal allograft recipient.mucormycosis is a rare opportunistic infection that complicates chronic debilitating diseases and immunosuppressed solid-organ transplant recipients. We present a case of life-threatening pulmonary mucormycosis in a diabetic renal allograft recipient who survived with reasonable renal function. Early recognition of this entity and prompt use of bronchoalveolar lavage (BAL) are critical to the outcome. Antifungal therapy combined with early surgical excision of infected, necrotic tissue appears to be the preferred course of action. Judicious withholding of immunosuppressants until fungemia cleared did not jeopardize allograft function.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
4/26. diagnosis of disseminated zygomycosis using a polymerase chain reaction assay.Invasive pulmonary zygomycosis is an uncommon opportunistic infection in patients with haematological malignancies. Clinical manifestations are in distinguishable from the more frequent invasive aspergillosis. Standard diagnostic methods like culture and microscopy from respiratory secretions have a low diagnostic sensitivity. A case in which proven invasive pulmonary zygomycosis was confirmed using a panfungal polymerase chain reaction assay in blood is presented. Since zygomycosis requires more aggressive treatment than aspergillosis (high-dose amphotericin b and surgical intervention), the polymerase chain reaction assay may improve the outcome of these often fatal infections by guiding the therapeutic approach through an early, non-invasive diagnosis.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
5/26. A novel type of metastatically spreading subcutaneous aspergillosis without epidermal lesions following allogeneic stem cell transplantation.Systemic mycosis is among the most feared opportunistic infections in the immunocompromised host. Difficulty and delay in diagnosis and treatment often result in poor outcomes. In this communication a metastatically spreading form of subcutaneous aspergillosis developed in a patient with a history of allogeneic stem cell transplantation for relapsed Hodgkin's lymphoma. Strikingly, necrotizing cutaneous papules or ulcerating lesions were absent. diagnosis was accomplished after excision of a clinically non-suggestive subcutaneous nodule. Despite prompt initiation of antimycotic therapy the outcome was fatal; dosage of conventional and liposomal amphotericin b was limited due to treatment-related toxicities. This case report describes a novel form of aspergillosis and underlines the need for an aggressive diagnostic approach in severely immunocompromised patients.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
6/26. Immunoparalysis as a cause for invasive aspergillosis?aspergillus infections are among the most feared opportunistic infections in humans. These organisms are ubiquitous in nature; protection against infection is usually provided by anatomical barriers and by the immune system. Tissue invasion by aspergillus is uncommon, occurring primarily in the setting of immunosuppression. The prognosis of invasive aspergillosis is very poor. Although it is widely recognised that critically ill patients in the intensive care Unit (ICU) are at risk for nosocomial infections, it is not generally appreciated that such patients may also be at risk for opportunistic infections usually seen only in immunocompromised patients. This might be explained by a biphasic immunological pattern during sepsis: an early hyperinflammatory phase followed by an anti-inflammatory response, leading to a hypo-inflammatory state, the so-called compensatory anti-inflammatory response syndrome (CARS or immunoparalysis). We describe four patients admitted to our ICU for various reasons, without a history of abnormal immune function, who developed invasive pulmonary aspergillosis. We hypothesise that the occurrence of these opportunistic infections in our patients may have been due to immunoparalysis, and that perhaps all ICU patients with sepsis and multiple organ dysfunction syndrome (MODS) may be at risk for opportunistic infections such as aspergillosis as a result of this syndrome. physicians treating critically ill patients in the ICU should be aware of the CARS/immunoparalysis syndrome and its potential to cause opportunistic infections, even in patients with normal immune function prior to ICU admission.- - - - - - - - - - ranking = 5keywords = opportunistic infection (Clic here for more details about this article) |
7/26. pneumonia and mesenteric lymphadenopathy caused by disseminated penicillium marneffei infection in a cadaveric renal transplant recipient.A38-year-old cadaveric kidney transplant recipient presented with fever, pneumonia, and mesenteric lymphadenopathy 9 months after transplant. blood culture, bone marrow culture, and fine-needle aspiration cytology of mesenteric lymph nodes confirmed the diagnosis of disseminated penicillium marneffei infection. He recovered after receiving parenteral amphotericin b followed by oral itraconazole therapy. P. marneffei infection is a dimorphic fungal opportunistic infection endemic in Southeast asia, southern china, taiwan, and hong kong. It has been well reported in human immunodeficiency virus (hiv)-positive patients in the endemic areas, and also in other immunocompromised patients. This diagnosis must be considered for all febrile transplant recipients who have the relevant clinical features and travel history to Southeast asia. Prompt treatment with anti-fungal therapy improves the survival and outcome of these patients.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
8/26. Pulmonary pseudallescheria boydii infection with cutaneous zygomycosis after near drowning.pseudallescheria boydii is a ubiquitously occurring fungus. While rarely causing opportunistic infection in humans, it is the most common cause of fungal pneumonia in cases of near drowning, and is associated with high mortality. P. boydii typically causes cutaneous mycetomas but may invade the lungs or brain. P. boydii infections are difficult to treat due to amphotericin b resistance and frequent need for surgical resection. Zygomycetous infections, often referred to as "mucormycoses," usually occur in immunocompromised hosts, trauma or burn victims. Like P. boydii, these organisms are found on decaying vegetation and in soil. Zygomycetous infections generally require debridement and prolonged amphotericin b. We report a case of P. boydii pneumonia with a simultaneous brain lesion and cutaneous mucormycosis in a near drowning patient. The pneumonia responded to treatment with voriconazole and the brain lesion resolved without surgery. The cutaneous mucormycosis responded to surgery and amphotericin b. This is the first documented case of simultaneous invasive P. boydii and cutaneous mucormycosis successfully treated with dual systemic antifungal therapy and resection.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
9/26. lung infection due to opportunistic fungus, Phialemonium obovatum, in a bone marrow transplant recipient: an emerging infection with fungemia and crohn disease-like involvement of the gastrointestinal tract.We report the first case of Phialemonium obovatum fungemia with subsequent caseating granulomatas in the lung and crohn disease-like involvement of the gastrointestinal tract in a bone marrow transplant recipient. This phaeoid fungus has been rarely described as an opportunistic infection in immunosuppressed patients. The patient was diagnosed with chronic myelogenous leukemia and underwent subsequent peripheral bone marrow transplant. After 6 months, he developed graft-versus-host disease of the skin and liver with fever and severe diarrhea. Fecal bacterial cultures and cytomegalovirus serologies were negative. Computed tomographic scan showed a peripheral pulmonary mass. A lung wedge biopsy of the lesion showed septate branching hyphae (4-5 microm in diameter) with terminal globular structures (10 microm in diameter). The hyphae were similar in width to that of an aspergillus species but had a more moniliform appearance. blood cultures grew a pure culture of P. obovatum. He was treated with amphotericin b and itraconazole for 6 months without remission of the diarrhea. Biopsies of the stomach, colon, and rectum showed granulomatous inflammation with marked crypt distortion simulating crohn disease. In retrospect, the fungus was found to be resistant to both of the aforementioned drugs and susceptible to voriconazole and posaconazole. The gastrointestinal findings raise the possibility of further dissemination of a partially treated Phialemonium infection.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
10/26. Cytologic diagnosis of pulmonary nocardiosis: a report of 3 cases.BACKGROUND: Nocardiosis is an uncommon infection and presents as an opportunistic infection in an immunocompromised host. Pulmonary infection by nocardia may be difficult to diagnose based on clinical and radiologic features, as these are not specific. sputum examination, bronchoalveolar lavage and transthoracic ultrasound/computed tomography-guided fine needle aspiration cytology offer a simple means of procuring material for diagnostic evaluation. Very few articles have described the morphologic appearance of this uncommon pathogen in cytologic material. CASES: Three cases occurred in patients with an underlying immunocompromised state. Patient 1 was on steroid therapy for nephrotic syndrome, patient 2 was on immunosuppressant therapy after renal transplantation, and patient 3 was hiv positive. A diagnosis of pulmonary nocardiosis was suspected on Papanicolaou stain. Modified Ziehl-Neelsen stain and silver methanamine stains were useful in confirming the diagnosis. CONCLUSION: A high index of suspicion for nocardiosis must be maintained while assessing cytologic material in immunosuppressed individuals as it may be masked by the intense inflammatory exudate associated with this infection. A meticulous search may reveal the presence of delicate, thin, faintly stained, branching filaments of nocardia on routine Papanicolaou stain. Special stains and culture studies are useful in confirming the diagnosis.- - - - - - - - - - ranking = 1keywords = opportunistic infection (Clic here for more details about this article) |
| | Next -> |