Cases reported "Lung Diseases, Fungal"

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1/35. Combined anti-fungal therapy and surgical resection as treatment of pulmonary zygomycosis in allogeneic bone marrow transplantation.

    Opportunistic fungal infection is a rare but severe complication in allogeneic bone marrow transplant (BMT) recipients. We report a 49-year-old patient who developed pneumonitis after BMT, due to a mucorales fungus (class Zygomycetes), absidia corymbifera. Infections due to mucormycosis are likely to become increasingly recognized even though the occurrence after BMT has only been described sporadically. We postulate that the patient was contaminated before BMT despite no intensive drug treatment or other iatrogenic features, related to his poor living conditions and developed the infection during aplasia. He immediately received i.v. liposomal amphotericin b (AmBisome) and GM-CSF. Because there was no response, the infected area and necrotic tissue were resected. Despite initial clinical and biological improvement and the absence of Mucor on mycological examination post-surgery, the patient died 3 weeks later from bilateral pulmonary infection and multiorgan failure.
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ranking = 1
keywords = zygomycosis
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2/35. Case report. Localized pulmonary zygomycosis without pre-existing immunocompromised status.

    Pulmonary zygomycosis rarely occurs without pre-existing immunocompromised disease. A 72-year-old male was found to have a nodular shadow (3 cm x 4 cm) in the right S8 and S9 on a chest X-ray. Right lower lobectomy was performed and histological examination of the resected material demonstrated pulmonary zygomycosis. hyphae stained positively not only with Grocott-Gomori methenamine silver staining, but also with an anti-rhizopus oryzae polyclonal antibody.
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ranking = 1.5
keywords = zygomycosis
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3/35. Pulmonary rhizopus infection in a diabetic renal transplant recipient.

    Infectious complications after renal transplantation remain a major cause of morbidity and mortality. mucormycosis is a rare infection in renal transplant recipients; however, mortality is exceedingly high. risk factors predisposing to this disease include prolonged neutropenia, diabetes, and patients who are immunosuppressed (Singh N, Gayowski T, Singh J, Yu LV. Invasive gastrointestinal zygomycosis in a liver transplant recipient: case report and review of zygomycosis in solid-organ transplant recipients, Clin Infect Dis 1995: 20: 617). life-threatening infections can occur, as this fungus has the propensity to invade blood vessel endothelium, resulting in hematological dissemination. We report a case of cavitary rhizopus lung infection, 2 months after renal transplantation, where the patient was treated successfully with amphotericin b and surgical resection of the lesions with preservation of his allograft function. In this era of intensified immunosuppression, we may see an increased incidence of mucormycosis in transplant population. Invasive diagnostic work-up is mandatory in case of suspicion; amphotericin b and, in selected cases, surgical resection are the mainstays of therapy.
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ranking = 0.5
keywords = zygomycosis
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4/35. 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.
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ranking = 1.75
keywords = zygomycosis
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5/35. Successful allogeneic stem cell transplant after invasive pulmonary zygomycosis.

    We report the successful outcome of allogeneic stem cell transplant (SCT) in a patient with acute lymphoblastic leukaemia (ALL) and pulmonary zygomycosis diagnosed prior to transplant. The lesion was surgically excised and SCT proceeded with antifungal therapy, granulocyte transfusions and G-CSF support during the period of neutropenia.
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ranking = 1.25
keywords = zygomycosis
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6/35. Cutaneous phycomycosis (mucormycosis) with fatal pulmonary dissemination.

    Phycomycosis of the skin manifested as a spontaneous solitary ulcer of the leg in a patient with uremia. The infection later spread to the lungs and produced fatal pulmonary infarction. Histopathologic study of the lesions revealed broad nonseptate fungal hyphae that had invaded vascular channels, with areas of necrosis and acute inflammation. Primary cutaneous phycomycosis is rare. In the studied cases, dissemination of infection did not occur. The unusual feature of fatal pulmonary dissemination of primary cutaneous phycomycosis as observed in our patient has not been described in the leterature.
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ranking = 3.5595820534871
keywords = phycomycosis
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7/35. Complete resolution of pulmonary rhizopus oryzae infection with itraconazole treatment: more evidence of the utility of azoles for zygomycosis.

    zygomycosis often requires aggressive surgical and antifungal therapy. We report a non-neutropenic patient with myelodysplastic syndrome and iron overload receiving cytotoxic therapy who presented with pulmonary rhizopus oryzae infection. This patient was cured through the use of itraconazole alone and the literature on the utility of azole antifungals for zygomycosis is reviewed.
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ranking = 1.25
keywords = zygomycosis
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8/35. 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.
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ranking = 1
keywords = zygomycosis
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9/35. Lipid-based amphotericin in pulmonary zygomycosis: safety and efficacy of high exposure in a renal allograft recipient.

    zygomycosis is associated with a high mortality in immunosuppressed patients. Treatment typically includes surgical resection and administration of intravenous amphotericin b. Success of treatment may require withdrawal of immunosuppression, with risk of graft loss. We report the successful treatment of invasive pulmonary zygomycosis, following initial surgical resection, using very high doses of lipid-based amphotericin b without withdrawal of immunosuppression. The patient received daily doses up to 10 mg/kg/day (51 g cumulatively) of lipid-based amphotericin b along with a brief course of intrapleural amphotericin. Despite immunosuppression not being withdrawn, the patient's kidney allograft function remained stable. We conclude that high doses of lipid-based amphotericin b can be safe and effective as part of the treatment regimen for pulmonary zygomycosis.
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ranking = 1.5
keywords = zygomycosis
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10/35. Successful treatment of pulmonary zygomycosis with posaconazole in a recipient of a haploidentical donor stem cell transplant.

    We report the clinical course of a patient who developed a rhizopus infection of his right lung and pleural cavity, 11 months after receiving a T-cell-depleted, haploidentical donor peripheral blood stem cell transplant. thoracotomy was performed to remove the pulmonary lesion, but residual disease in the pleural cavity was noted. Treatment with amphotericin b was complicated by the development of severe renal dysfunction, necessitating alternative antifungal therapy. Treatment was initiated with the investigational triazole posaconazole. Despite concurrent treatment with corticosteroids for graft-versus-host disease (GVHD), the patient had a complete response and remains well 4 years later.
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ranking = 1
keywords = zygomycosis
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