Cases reported "Mucormycosis"

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1/60. Rhinocerebral mucormycosis in patients with burns: case report and review of the literature.

    mucormycosis is an opportunistic infection most commonly occurring in patients with impaired host defenses or diabetes mellitus. In patients with burns the rhinocerebral form is rare, and mucormycotic infections more commonly involve the cutaneous burn wound. Both forms are associated with a high mortality rate that increases with delays in treatment. The initial management of these types of infections includes vigorous glucose control, correction of acidosis, and the administration of systemic antifungal agents such as amphotericin b. The rhinocerebral form of mucormycosis is extremely virulent and may warrant the use of interstitial and intraventricular antifungal therapy. Despite these measures, the mainstay of treatment for both forms of mucormycosis is the extensive surgical debridement of all infected and necrotic tissue.
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2/60. Successful eradication of mucormycosis occurring in a pulmonary allograft.

    The zygomycetes are saprophytic fungi that rarely cause disease in the normal human host. In immunocompromised individuals, these organisms can cause invasive infections, collectively called mucormycosis. mucormycosis is associated with a high mortality rate, especially in organ transplant recipients. In this report, we describe the first case of successfully treated mucormycosis involving a pulmonary allograft. Treatment consisted of surgical excision of the affected lobe and chest wall and lipid-complex amphotericin b. The lipid complex formulation permitted a prolonged course of therapy that was likely critical to eradication of the infection.
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3/60. Long-term survival of a patient with invasive cranial base rhinocerebral mucormycosis treated with combined endovascular, surgical, and medical therapies: case report.

    OBJECTIVE: Rhinocerebral mucormycosis is a clinical syndrome resulting from an opportunistic infection caused by a fungus of the order mucorales. The prognosis of rhinocerebral mucormycosis, once considered uniformly fatal, remains poor. Even with early diagnosis and aggressive surgical and medical therapy, the mortality rate is high. We present a patient with rhinocerebral mucormycosis involving the paranasal sinuses and cranial base who experienced long-term survival after multimodality treatment. Clinical characteristics of the disease are discussed, and the literature is reviewed. CLINICAL PRESENTATION: A 24-year-old diabetic man presented with invasive rhinocerebral mucormycosis involving the paranasal sinuses, right middle fossa, and right cavernous sinus. INTERVENTION: The patient underwent endovascular sacrifice of the involved carotid artery and radical resection of the cranial base, including exenteration of the cavernous sinus. Reconstruction with a local muscle flap was performed. He continued to receive intravenous and intrathecal administration of antibiotics. CONCLUSION: Long-term survival with invasive rhinocerebral mucormycosis is rare, but possible, with aggressive multimodality treatment, including carotid sacrifice for en bloc resection of the pathology, when indicated.
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4/60. 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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5/60. cunninghamella infection post bone marrow transplant: case report and review of the literature.

    cunninghamella spp., in the class Zygomycete and order mucorales, are unusual opportunistic pathogens that have been identified with increased frequency in immunocompromised patients. Infections with this group of organisms have been seen most frequently in patients with hematologic malignancy. We describe an allogeneic bone marrow recipient who developed fungal pneumonitis and disseminated fungal dermatitis caused by cunninghamella spp. To our knowledge, this is the first reported case of cunninghamella infection in a BMT recipient. The case highlights the mortality associated with opportunistic infections in immunocompromised patients and confirms the risk factors associated with non-candida fungal infections after bone marrow transplantation.
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6/60. Hepatic and small bowel mucormycosis after chemotherapy in a patient with acute lymphocytic leukemia.

    mucormycosis is a rare but invasive opportunistic fungal infection with increased frequency during chemotherapy-induced neutropenia. The clinical infections due to Mucor include rhinocerebral, pulmonary, cutaneous, gastrointestinal and disseminated diseases. The first two are the most common diseases and all entities are associated with a high mortality rate. Still hepatic involvement of Mucor is rarely reported. We experienced a case of hepatic and small bowel mucormycosis in a 56-year-old woman after induction chemotherapy for B-cell acute lymphocytic leukemia. Initial symptoms were a high fever unresponsive to broad spectrum antibiotics and pain in the left lower abdominal quadrant. It was followed by septic shock, deterioration of icterus and progressively elevated transaminase. An abdominal CT demonstrated multiple hypodense lesions with distinct margins in both lobes of liver and pericolic infiltration at small bowel and ascending colon. Diagnosis was confirmed by biopsy of the liver. The histopathology of the liver showed hyphae with the right-angle branching, typical of mucormycosis. The patient was managed with amphotericin b and operative correction of the perforated part of the small bowel was performed. However, the patient expired due to progressive hepatic failure despite corrective surgery and long-term amphotericin b therapy.
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7/60. cunninghamella bertholletiae infection in a bone marrow transplant patient: amphotericin lung penetration, MIC determinations, and review of the literature.

    Infections caused by cunninghamella bertholletiae, an opportunistic fungal organism, have an extremely high mortality rate. A fatal case of C. bertholletiae fungal pneumonia occurred in a man who had received an allogeneic bone marrow transplant. Aggressive debridement and high-dose liposomal amphotericin b failed to eradicate the infection. Right lung tissue samples obtained during lobectomy were assayed for amphotericin b concentrations by high-performance liquid chromatography, and minimum inhibitory concentration (MIC) determinations of amphotericin b against C. bertholletiae were determined by the macrobroth dilution method. The MIC for the isolate of C. bertholletiae was 4 microg/ml. amphotericin b lung concentrations averaged 9.5 microg/ml (range 3.7-13.8 microg/ml), with a corresponding serum trough concentration of 0.9 microg/ml. To our knowledge, this is the first reported case of amphotericin b concentrations measured at the site of infection in a patient with a pulmonary cunninghamella infection, together with a corresponding MIC of the organism. The patient's death, which occurred despite aggressive debridement and high amphotericin b lung concentrations, highlights the need for novel strategies to treat infections caused by invasive molds such as C. bertholletiae.
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8/60. Treatment of invasive fungal sinusitis with liposomal amphotericin b: a report of four cases.

    Invasive fungal sinusitis increasingly causes significant morbidity and mortality in immunocompromised patients. It is difficult to treat. Despite standard treatment by surgical debridement and intravenous amphotericin b, morbidity and mortality remain high. Conventional amphotericin b is the standard drug but its use is limited by dose-related nephrotoxicity and infusion-related acute toxicity. Liposomal amphotericin b has proven to be as effective as conventional amphotericin b with less nephrotoxicity and infusion reaction. We report four cases of invasive fungal sinusitis who were treated with liposomal amphotericin b after having severe side effects from conventional amphotericin b. There were two cases of mucormycosis and two cases of aspergillosis. All patients had diabetes millitus. One patient had systemic lupus erythematosus and another was receiving immunosuppressive drugs after kidney transplantation. All cases needed multiple operations for sinus surgery. Two cases had acute reaction to amphotericin b infusion, one had active lupus nephritis with renal insufficiency, and one was considered treatment failure from amphotericin b. The patients received liposomal amphotericin b at the total doses of 4.55-8.85 g. Two cases of mucormycosis were considered to be successfully treated. In cases of aspergillosis, one was considered improved and another one with immunocompromised status died with active disease. From our experience, surgery is the main treatment for patients with invasive fungal sinusitis and liposomal amphotericin b is an effective alternative drug for adjuvant medical treatment. However, the degree of immunosuppression of the patients, the extension of fungal sinusitis and perhaps the species of fungus are important factors determining the clinical response.
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9/60. Fatal rhino-orbito-cerebral mucormycosis in an apparently normal host: case report and literature review.

    Fungal infections of the central nervous system (CNS) are fortunately rare but remain challenging problems occurring mostly in immunocompromised individuals, with protean manifestations, unpredictable course and unfavorable outcome in many cases despite aggressive neurosurgical intervention and recent antifungal drugs. Rhino-orbito-cerebral mucormycosis is a potentially lethal opportunistic fungal infection with rapid progression and high mortality. Its pathogenic nature becomes evident when the patient's general resistance is compromised. We present a case of an invasive rhino-orbito-cerebral mucormycosis in an apparently normal adult who initially developed mild paranasal sinusitis and later developed status epilepticus and despite an aggressive management died. Interesting clinical, neuroimaging and histological findings are described, and the possibility of fatal mucormycosis in an apparently normal host is highlighted.
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10/60. diabetic ketoacidosis and rhino-orbital mucormycosis.

    mucormycosis often develops in immunocompromised patients, particularly in patients with diabetic ketoacidosis. Unless early diagnosis and treatment is established mucormycosis leads rapidly to death. A 38-year-old woman was admitted to the hospital with a severe diabetic ketoacidosis. Her clinical status improved in 4 days as a result of aggressive medical treatment. She has complained left cheek pain on the 10th day and had a swelling of her left cheek, facial edema, a black eschar on the palate and nasal cavity in association with visual disturbance and total ophthalmology in a short time. CT scan revealed left orbital cellulitis and pansinusitis. Excessive surgical treatment was performed and liposomal amphotericin-B, 4 mg/(kg day) was applied. Extensive fungal invasion of the orbit and the sinuses was demonstrated in the pathological species and rhizomucor species were yielded with culture. Repeated superficial debridement was also performed. After 10 weeks, she was discharged with suggestion of insulin treatment and liposomal amphotericin-B with progressively decreasing doses. At the 13th month following the presentation, the patient was free of disease as confirmed by serial imaging and under good glycaemic control with insulin treatment. Although mucormycosis is a fatal infection, early diagnosis and aggressive treatment may decrease mortality.
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