Cases reported "Zygomycosis"

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1/16. Disseminated zygomycosis due to rhizopus schipperae after heatstroke.

    A 21-year-old woman suffered heatstroke and developed diarrhea while trekking across south texas. The heatstroke was complicated by seizures, rhabdomyolysis, pneumonia, renal failure, and disseminated intravascular coagulation. The patient's stool and blood cultures grew campylobacter jejuni. The patient subsequently developed paranasal and gastrointestinal zygomycosis and required surgical debridement and a prolonged course of amphotericin b. The zygomycete cultured was rhizopus schipperae. This is only the second isolate of R. schipperae that has been described. R. schipperae is characterized by the production of clusters of up to 10 sporangiophores arising from simple but well-developed rhizoids. These asexual reproductive propagules are produced on Czapek Dox agar but are absent on routine mycology media, where only chlamydospores are observed. Despite multiorgan failure, bacteremia, and disseminated zygomycosis, the patient survived and had a good neurological outcome. Heatstroke has not been previously described as a risk factor for the development of disseminated zygomycosis.
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2/16. Basidiobolus ranarum as an etiologic agent of gastrointestinal zygomycosis.

    Basidiobolus ranarum is a known cause of subcutaneous zygomycosis. Recently, its etiologic role in gastrointestinal infections has been increasingly recognized. While the clinical presentation of the subcutaneous disease is quite characteristic and the disease is easy to diagnose, gastrointestinal basidiobolomycosis poses diagnostic difficulties; its clinical presentation is nonspecific, there are no identifiable risk factors, and all age groups are susceptible. The case of gastrointestinal basidiobolomycosis described in the present report occurred in a 41-year-old Indian male who had a history of repair of a left inguinal hernia 2 years earlier and who is native to the southern part of india, where the subcutaneous form of the disease is indigenous. Diagnosis is based on the isolation of B. ranarum from cultures of urine and demonstration of broad, sparsely septate hyphal elements in histopathologic sections of the colon, with characteristic eosinophilic infiltration and the Splendore-Hoeppli phenomenon. The titers of both immunoglobulin g (IgG) and IgM antibodies to locally produced antigen of the fungus were elevated. The patient failed to respond to 8 weeks of amphotericin b therapy, and the isolate was later found to be resistant to amphotericin b, itraconazole, fluconazole, and flucytosine but susceptible to ketoconazole and miconazole. One other noteworthy feature of the fungus was that the patient's serum showed raised levels of Th2-type cytokines (interleukins 4 and 10) and tumor necrosis factor alpha. The present report underscores the need to consider gastrointestinal basidiobolomycosis in the differential diagnosis of inflammatory bowel diseases and suggests that, perhaps, more time should be invested in developing standardized serologic reagents that can be used as part of a less invasive means of diagnosis of the disease.
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3/16. 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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4/16. Primary cutaneous zygomycosis due to mucor circinelloides.

    A 62-year-old woman with myelodysplastic syndrome presented with a 4-week history of a large indurated ulcer with a black eschar on the forearm following trauma. On biopsy a diagnosis of zygomycosis was made as broad, sparsely septate, thin-walled hyphae were seen in the deep dermis and subcutaneous fat. The zygomycete fungus mucor circinelloides was cultured from tissue. Further investigation confirmed that the infection was localized to the skin. The 6 x 4 cm lesion was excised and the defect closed with a neurovascular island flap. No other treatment was undertaken. The patient died 6 months later from her haematological disease without recurrence of the fungal infection.
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5/16. Orofacial conidiobolomycosis due to conidiobolus incongruus.

    We report here a patient of orofacial conidiobolomycosis presenting with classical centrofacial distribution described typically for conidiobolus coronatus infection. The culture, however, showed C. incongruus. The mode of infection and its possible correlation with patient's occupation is also discussed.
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6/16. Concurrent subcutaneous and visceral basidiobolomycosis in a renal transplant patient.

    Basidiobolomycosis is a chronic inflammatory disease that occurs exclusively in healthy individuals. Clinically, the infection is generally restricted to subcutaneous tissue; however, the disease has been documented to emerge in visceral organs but seldom spreads to cause disseminated infection. We describe the first culture-confirmed case of systemic Basidiobolus ranarum infection in an immunosuppressed patient. A 55-year-old female renal transplant recipient developed chronic hard nonpitting oedema of the right lower extremity and abdominal wall concurrent with the infection from the same organism involving the uterus, urinary bladder and intra-abdominal lymph nodes. The patient responded successfully, both clinically and radiographically, to medical therapy without surgical resection. The treatment regimen consisted of potassium iodide and trimethoprim/sulfamethoxazole for 3 months, and the patient remains clear of symptoms after 10 months' follow-up.
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7/16. Cutaneous zygomycosis following attempted radial artery cannulation.

    A 70-year-old man was seen in a hospital consultation for evaluation of cellulitis of the left arm. The patient had multiple medical problems, including advanced liver disease due to alcohol, diabetes mellitus, congestive heart failure, atrial fibrillation, chronic renal in sufficiency, and hypopituitarism requiring steroid replacement. Most recently, he was admitted to the intensive care unit, where he required intubation and mechanical ventilation support following respiratory failure secondary to pneumonia. At that time, an attempt was also made to place an arterial line in the left radial artery. The patient had multiple areas of ecchymosis on both arms. A large bulla was found on the lateral aspect of the left wrist several days after the attempted arterial line placement. Subsequently, the lesion drained serosanguineous fluid, and, during the next 2 days, it ulcerated with necrosis extending around the wrist and to the elbow. He was started on ampicillin/sulbactam and clindamycin for presumed necrotizing fasciitis. The surgical service performed a very limited debridement,which was partially limited by his coagulopathy from liver disease. The initial tissue culture was positive only for enterococcus faecium.At the time of the consultation, his temperature was 95' F (35 degrees C), pulse 82 bpm, respirations 16 BPM, and blood pressure 101/56 mmHg. He was awake but not oriented or responsive. His cardiopulmonary exam was unremarkable. Abdominal exam disclosed ascites. His extremities were all grossly edematous with multiple ecchymoses. His left forearm had a circumferential area of ecchymosis and necrosis with macerated margins, sparing only the lateral ulnar epicondyle, and involving deeper structures of subcutaneous fat and muscle(Figures 1-2 showing evolution of the lesion in a period of 1 week). Small tissue clippings were taken from the edge of the lesion and placed on culture plates. By the next morning, the patient's tissue culture grew a mold, later identified as rhizopus. amphotericin b was initiated. Surgical intervention (wide debridement with potential conversion to amputation of the left arm) was considered to offer little benefit in view of the patient's multiple and severe comorbidities and his poor prognosis. amphotericin b was then stopped; the patient died within a week from his multiple medical complications. The family refused an autopsy.
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8/16. zygomycosis due to conidiobolus coronatus in west Bengal.

    zygomycosis of upper respiratory tract, caused by conidiobolus coronatus, in eight Bengalee males and one female is described. The clinical syndrome of the cases included initial coryza, epistaxis, intranasal tumor, nasal obstruction, broadening of bridge of nose with swelling of paranasal sinuses, dorsum of nose, alae nasi, cheek and glabella in all or majority of the cases. In addition upper lip or both lips and pharynx were involved in some cases. Swellings were fixed to the skin in seven cases and to the deeper tissues in five cases. The fungus was demonstrated by direct microscopy in the nasal mucosa, and was isolated in culture. The isolates produced conidia, replicative conidia and villose conidia but not multiplicative conidia. The disease was cured with KI and/or ketoconazole/fluconazole. The cases described here constitute the first report on zygomycosis due to C. coronatus from North-eastern india.
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9/16. Failure of voriconazole to cure disseminated zygomycosis in an immunocompromised child.

    Voriconazole is increasingly used as a first-line agent for empirical antifungal therapy of prolonged febrile neutropenia in paediatric cancer patients. We describe the case of a 9-year-old patient with stage IV burkitt lymphoma, who developed pulmonary and splenic zygomycosis while receiving voriconazole for persistent febrile neutropenia. The causative agent, absidia corymbifera, was identified by broad-range fungal PCR in a lung biopsy sample. The patient was successfully treated with a combination of partial resection of the left upper lobe and antifungal therapy with high-dose liposomal amphotericin b followed by oral itraconazole as demonstrated by resolving pulmonary infiltrates on serial high resolution CT scans. CONCLUSION: This case emphasises that the lack of in vitro activity of voriconazole against zygomycetes is clinically relevant. Failure of voriconazole in suspected fungal infection should be investigated for the possibility of zygomycosis. Broad-range polymerase chain reaction may be able to identify the causative organism when cultures remain sterile.
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10/16. Successful treatment of extensive basidiobolomycosis with oral itraconazole in a child.

    BACKGROUND: Basidiobolomycosis is a rare chronic subcutaneous infection caused by Basidiobolus ranarum, which is usually treated with potassium iodide. Extensive deforming lesions in children can occur owing to lack of early diagnosis and/or inappropriate treatment. CASE REPORT: An 8-year-old girl child presented to us with extensive deforming plaque-like lesions over the left thigh and leg with multiple ulcerations of 1 year's duration. Histopathology was suggestive of subcutaneous zygomycosis with Splendore Hoeppli phenomenon. Microscopic examination of the tissue showed branching, sparsely septate fungal hyphae on a 10%KOH mount, and culture yielded Basidiobolus ranarum. The patient was initially treated with potassium iodide for 6 weeks to which only a poor response was observed. itraconazole therapy resulted in rapid regression of the lesions and complete resolution after 15 weeks of therapy. She continues to be disease-free at 1 year of follow up. CONCLUSIONS: This case report highlights that in an older child even longstanding extensive basidiobolomycosis can be safely treated with itraconazole. Surgery is not usually necessary in these patients.
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