Cases reported "Mucormycosis"

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1/35. zygomycosis due to Apophysomyces elegans: report of 2 cases and review of the literature.

    OBJECTIVE: The zygomycete Apophysomyces elegans is an unusual human pathogen that is being reported with increasing frequency as a cause of infection in previously healthy patients following trauma or after invasive procedures. We report 2 cases of infection caused by this emerging fungal pathogen. methods: Histologic sections of tissue removed from the infected patients and the isolates in culture were examined. Other infections caused by A. elegans that have been reported in the literature were reviewed. RESULTS: Both patients developed infection due to A. elegans after sustaining trauma that required tissue debridement because of tissue necrosis. Histologic examination showed broad, sparsely septate, thin-walled hyphae and angioinvasion with thrombosis. Extensive coagulation necrosis of surrounding tissue was seen. A rapidly growing mold with sporangiophores having funnel-shaped apophyses and pyriform sporangia, characteristic of A. elegans, was isolated from each case. CONCLUSION: Apophysomyces elegans is an opportunistic pathogen that can cause infection in previously healthy patients who suffer an injury to the cutaneous barrier, such as trauma or burns. Infection with this zygomycete should be considered when there is progressive necrosis of a wound in a previously healthy patient. Successful treatment requires tissue debridement and amphotericin b. Histologic examination for early diagnosis and frozen section evaluation of surgical margins are required for optimal therapy.
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2/35. 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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3/35. Post-traumatic course complicated by cutaneous infection with absidia corymbifera.

    Cutaneous mucormycosis is a rare but serious infection in trauma patients. Reported here is the case of a young patient with cutaneous mucormycosis due to absidia corymbifera probably caused by a soil-contaminated wound. Despite daily surgical debridement and amphotericin b therapy, cure could be achieved only by amputation of the lower limb.
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4/35. Disseminated mucormycosis in healthy adults.

    Three patients of disseminated mucormycosis are described. None had predisposing factors. Two of them presented with nonspecific symptoms along with acute renal failure and peritonitis. Third patient had fulminating primary cutaneous mucormycosis which disseminated later. Development of acute renal failure with smooth enlargement of both kidneys in an apparently healthy individual or appearance of mould in a wound should raise the suspicion of mucormycosis. The hallmark of the infection was vascular invasion and thrombosis. Antemortem diagnosis could be made in one patient only. All patients had progressive downhill course despite supportive treatment, antibiotic and amphotericin in-B in one patient.
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5/35. Craniofacial mucormycosis following assault: an unusual presentation of an unusual disease.

    A case of craniofacial mucormycosis following assault is discussed. A female diabetic developed peri-orbital cellulitis adjacent to a scalp wound which progressed to a necrotizing fasciitis. This did not respond to treatment. Subsequently the patient developed a hemiparesis, with CT imaging showing peri-orbital and paranasal sinus inflammatory changes, evidence of cavernous sinus invasion and development of a middle cerebral artery territory infarction. The patient died shortly afterwards. The imaging findings and their relationship to the pathological spread of mucor infection are discussed.
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6/35. Indolent cutaneous mucormycosis with pulmonary dissemination in an asthmatic patient: survival after local debridement and amphotericin b therapy.

    We describe a 68-year-old asthmatic female patient with multiple pulmonary cavities. A preexisting ecthyma on the left lower leg became erythematous and swollen during exacerbation of her asthma which was under treatment with high-dose steroids. Nonseptate broad hyphae were found in her sputum, pus from the wound, and debrided skin tissue. Hematogenous spread of septic emboli from indolent cutaneous mucormycosis to both lungs was the suspected mechanism of dissemination. High-dose steroid therapy may have been the major contributory factor. The patient was successfully treated with local surgical debridement of the wound and intravenous amphotericin b.
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7/35. Successful treatment of mucor infection after liver or pancreas-kidney transplantation.

    BACKGROUND: mucormycosis is a rare and opportunistic infection usually associated with hematologic diseases, diabetes mellitus, renal failure, solid tumors, and organ transplantation. methods: We present five cases of mucor infection after transplantation (three after a series of 750 orthotopic liver transplantation and two after a series of 13 simultaneous pancreas-kidney transplantation in patients with type 1 diabetes) subjected to medical and surgical treatment and analyze the factors related to the development of this infection. RESULTS: The clinical forms were two cutaneous (laparotomy wound or prior surgical drain site), two rhino-maxillary, and one pulmonary. As risk factors for mucormycosis all patients had pre- or posttransplantation diabetes, and showed at least one episode of acute rejection that required aggressive immunosuppression (2-7 g of methylprednisolone; also three patients were treated with antithymocyte globulin [ATG] monoclonal antibody [orthoclone and/or OKT3]). We also found renal failure, acidosis, malnutrition, and candida and cytomegalovirus infections as factors related to mucor infection. Diagnosis of fungal infection was confirmed by exudate or fluid culture in three cases and by biopsy in two. All patients were treated with liposomal amphotericin b (from 3.5 to 5.6 g of total dose) and resection until the surgical margins were free of infection. All patients survived after this severe infection. CONCLUSIONS: With an early diagnosis of mucormycosis by clinical findings, culture, or tissue biopsy, and aggressive treatment consisting of administration of liposomal amphotericin b and surgical resection of all infected tissue, excellent results are achieved.
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8/35. Primary cutaneous mucormycosis: guide to surgical management.

    mucormycosis is the most acute, fulminate, and fatal of all fungal infections in humans. It presents most frequently in immunocompromised patients, but can occur in healthy patients in the presence of often-insignificant trauma. Surgical management of primary cutaneous mucormycosis is almost always required. case reports of surgical treatment for primary cutaneous mucormycosis are reported in the literature; however, the extent of debridement required for cure is unclear and no uniform plan of treatment has been suggested. To date, no clinical guidelines exist to assist the clinician in the surgical management of this disease. This article reviews the literature, reports on two clinical cases, and submits clinical guidelines designed to assist the clinician in the surgical management of primary cutaneous mucormycosis. Because of the infrequent and potentially fatal nature of the diagnosis, a high index of suspicion and a low threshold for wound biopsy must be maintained. Wound cultures are grossly inadequate and should not be relied on for a false sense of security. It is recommended that, for the early diagnosis of cutaneous mucormycosis, chemotherapy and surgical debridement of grossly necrotic tissue be performed at the earliest possible time. The debrided wound is monitored for the resolution of surrounding erythema and induration before definitive reconstruction. In the case of delayed diagnosis and/or advanced or rapidly progressive disease, surgical debridement of all involved tissue, in addition to chemotherapy, is warranted.
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9/35. Primary cutaneous mucormycosis in infants and neonates: case report and review of the literature.

    A case of angioinvasive cutaneous mucormycosis in a premature infant, eventually requiring extracorporeal membrane oxygenation therapy, is described. The fungal infection began at the site of a brachial artery catheter that had been covered with an adhesive dressing in the left antecubital fossa. The infection progressed rapidly over a 5-day period, and a left arm amputation was required. Fungal hyphae were present at the margins of resection. The patient eventually had disseminated mucormycosis and died. A second case of cutaneous mucormycosis in another premature infant also is presented. This infant had the infection at an intravenous catheter site. Rapid initiation of surgical debridement of the wound and amphotericin b therapy resulted in patient survival. Eighteen reported cases of cutaneous mucormycosis in neonates were found and are reviewed. Prematurity, low birth weight, broad-spectrum antibiotics, corticosteroid therapy, and local trauma to the skin site were common risk factors. Only 7 of the 18 patients survived. Therapy consisted of local debridement and intravenous amphotericin b. High index of suspicion, early diagnosis, and rapid institution of therapy can improve survival rate. The key to prevention appears to be appropriate skin care.
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10/35. Primary cutaneous mucormycosis in an immunocompetent host: report of a case.

    Cutaneous mucormycosis is an uncommon disease and it usually affects immunocompromised, diabetic, and trauma patients with contaminated wounds or patients with underlying malignancies. It is very rare to find this disease in immunocompetent, nondiabetic patients. We herein report a case of primary cutaneous mucormycosis in an immunocompetent and nondiabetic patient. Our patient was a 50-year-old veterinary doctor. He was diagnosed to have cutaneous mucormycosis of the anterior abdominal wall, and was treated with multiple debridements of the wound and intravenous amphotericin b therapy. He received a total of 1000 mg of amphotericin b. A high index of clinical suspicion and early institution of therapy in the form of surgical debridements and antifungal drugs are required to achieve a successful outcome.
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