1/9. 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.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/9. Splendore-Hoeppli phenomenon in Pityrosporum folliculitis (pseudoactinomycosis of the skin).actinomyces-like granules showing the Splendore-Hoeppli phenomenon have been demonstrated in histologic material, e.g. uterine curettings, in various conditions unrelated to genuine actinomycotic infection. The exact nature of the granules and the mechanism of their formation is open to speculation. We report two patients with a follicular skin eruption (Pityrosporum folliculitis) where pseudoactinomycotic granules were found in the skin biopsies. To the best of our knowledge, such findings have not previously been reported, but supposedly they are not rare. In order to avoid an incorrect diagnosis of actinomycosis, and unnecessary therapy, it is important to be familiar with the phenomenon.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/9. Disseminated hyalohyphomycosis in a leukemic patient.A 69-year-old man with acute myeloblastic leukemia was admitted to the hospital for induction chemotherapy. A complication caused by a disseminated mycotic infection occurred while the neutropenic patient was maintained on a course of cytotoxic drugs, antibiotics, and corticosteroid therapy. The causal isolate was identified as fusarium solani on the basis of its colonial and microscopic morphology. This fungus developed in the patient's tissue in the form of hyaline, branched, septate hyphae. This case fits the definition of the disease entity known as hyalohyphomycosis. The term hyalohyphomycosis encompasses infections caused by various nondematiaceous opportunistic fungi with a filamentous tissue form. The purpose of this article is to review and discuss the literature on hyalohyphomycosis caused by fusarium species. Combined histopathologic and mycologic findings were evaluated to determine the nature of opportunistic mycotic infections.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/9. Musculoskeletal sporotrichosis.sporotrichosis is a chronic, indolent, fungal infection that rarely involves the musculoskeletal system. The etiologic agent, sporothrix schenckii, is ubiquitous in nature and has been isolated from soil, timber, decaying vegetation, and a variety of foliage. The organism gains entrance to the body through trauma to the skin or, in rare instances, by inhalation. The vast majority of infections in humans is characterized by nodular or ulcerated lesions of the cutaneous tissues and adjacent lymphatics. Osteoarticular involvement may occur either by contiguous spread from a cutaneous focus, through direct inoculation of tissue by the organism, or by hematogenous dissemination. The rarity of musculosketetal sporotrichosis often causes a delay in diagnosis which leads to inappropriate therapy and permanent deformity in some patients. Three cases which show a spectrum of bone and joint involvement are presented.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/9. Infections due to Wangiella dermatitidis in humans: report of the first documented case from the united states and a review of the literature.Wangiella dermatitidis, a normally saprophytic dematiaceous fungus, has rarely been reported as a cause of disease in humans. A review of the worldwide literature yielded eight validly documented cases of W. dermatitidis infections. Reported herein is a subcutaneous knee infection due to W. dermatitidis in a diabetic man with impaired T-cell function and cutaneous anergy. Repeated cultures of the lesion were positive for W. dermatitidis despite therapy with amphotericin b. It is believed that this represents the first well-documented case of infection due to W. dermatitidis in north america, although the fungus has previously been isolated from nature in several states. The current state of knowledge of this organism, based on previously reported cases and isolations from nature, are discussed. No curative medical therapy is known for this infection, but surgical excision seems to be the treatment of choice for circumscribed W. dermatitidis infections.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
6/9. Bacterial pseudomycosis (botryomycosis) in an otherwise normal child.We report what we believe to be the first case in the modern literature of botryomycosis occurring in an otherwise normal 22-month-old child. The term bacterial pseudomycosis is more descriptive of the true nature of the condition and more meaningful to the clinician.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/9. Disseminated Microascus cirrosus infection in pediatric bone marrow transplant recipient.Microascus cirrosus Curzi and its associated anamorphic state, scopulariopsis, were recovered from the cutaneous lesion of a 12-year-old male who had undergone an autologous bone marrow transplantation for acute myelogenous leukemia. Histopathology sections from the biopsied lesion demonstrated septate hyphae consistent with a fungal etiology. Radiographic studies of the lungs subsequent to progression of the lesion revealed a consolidation in the right upper lobe suggesting a primary focus of infection. While M. cirrosus is fairly abundant in nature and widely distributed in stored grains in north america, this is, to our knowledge, the first reported human infection by this species. Salient characteristics for the identification of this dematiaceous ascomycete, M. cirrosus, will be presented.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/9. Primary cutaneous mucormycosis with a Mucor species: is iron overload a factor?A severely debilitated patient showed primary cutaneous mucormycosis with a Mucor species at a tape erosion site. The pathogenic nature and epidemiologic features of this unusual fungal infection are reviewed to emphasize its recognition in the differential diagnosis of ischemic lesions in immunocompromised patients. iron overload may be a risk factor for mucormycosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/9. Cutaneous cryptococcosis and Kaposi's sarcoma occurring in the same lesions in a patient with the acquired immunodeficiency syndrome.A 34-year-old woman presented with a history of fever, malaise and skin lesions. A diagnosis of Kaposi's sarcoma and acquired immunodeficiency syndrome (AIDS) was established, and in addition, the skin lesion which was biopsied also demonstrated cryptococcal infection. Disseminated cryptococcosis was later confirmed and the disease ran a florid course. The co-existence of different diseases within the same lesion is a feature of human immunodeficiency virus (hiv) infection, this being the third documented case of simultaneous Kaposi's sarcoma and cutaneous cryptococcosis occurring at the same site in a patient with AIDS. The nature of this co-existence is discussed with reference to the pathogenesis of Kaposi's sarcoma.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |