1/46. mucormycosis of the central airways: CT findings in three patients.Computed tomographic (CT) findings are described in three diabetic patients with central airways mucormycosis. The CT findings of the tracheobronchial mucormycosis include enhancing areas of mural thickening (n = 3), luminal narrowing (n = 3), intramural air (n = 3), low-attenuation nonenhancing bronchial wall thickening (n = 2), and bronchonodal fistula formation (n = 1). These CT features in a diabetic patient should raise a high index of suspicion for tracheobronchial mucormycosis, particularly when typical radiographic features of pulmonary tuberculosis are absent.- - - - - - - - - - ranking = 1keywords = mucormycosis (Clic here for more details about this article) |
2/46. Rhinocerebral mucormycosis diagnosis by aspiration cytology.Rhinocerebral mucormycosis is a rapidly progressing, often fatal fungal infection that occurs commonly in diabetics and immunocompromised individuals. We present 2 cases of rhinocerebral mucormycosis with a paranasal mass. One patient had an intracranial extension. Nasal scrapings and fine-needle aspiration cytology (FNAC) of the paranasal masses showed fungal hyphae morphologically resembling Mucor. Surgical material showed features of mucormycosis. FNAC and scrape smears can give a conclusive diagnosis of mucormycosis, and the patient can be treated with appropriate antifungal therapy and surgical debridement. Preoperative cytology is an effective technique to establish a diagnosis of mucormycosis and obviates the need for a preoperative biopsy.- - - - - - - - - - ranking = 3keywords = mucormycosis (Clic here for more details about this article) |
3/46. mucormycosis manifesting as proptosis and unilateral blindness.A 51-year-old woman presented to the emergency department (ED) of another institution with sudden onset of blindness in the left eye. The patient was found to have no light perception in the left eye and a marked chemosis occurring several days after a fall. She was transferred to the hospital for ophthalmologic evaluation. Upon careful history and physical examination, the diagnosis of rhinocerebral mucormycosis was considered and urgent ophthalmology and otolaryngology consults were obtained. The patient underwent extensive surgical debridement and pharmacologic treatment. The diagnosis was confirmed by pathological specimens. In this case report, the clinical presentation, pathogenesis, diagnostic workup, and ED management of mucormycosis are discussed, highlighting the possible diagnostic and therapeutic pitfalls that are most pertinent to the emergency physician.- - - - - - - - - - ranking = 0.66666666666667keywords = mucormycosis (Clic here for more details about this article) |
4/46. Pulmonary mucormycosis in a diabetic patient.We present the case of a 54 year-old male from Moldavia with diabetes mellitus (type II diabetic), admitted to hospital in January 1999, with ketoacidosis and consolidation of the lower left lobe. The diagnosis of mucormycosis was confirmed by identification of large, nonseptate hyphae of the order mucorales. A strain of rhizopus oryzae (rhizopus arrhizus) was isolated from culture on sabouraud medium. The patient was treated by systemic amphotericin b, associated with surgical debridement (lobectomy).The treatment with amphotericin b was stopped after ten days and the patient was completely asymptomatic and returned to Moldavia. Mucormycoses are rare, and tend to be encountered in individuals with predisposing factors such as malignant blood disorders (immunocompromised patients) or diabetes mellitus. prognosis is poor, resembling infection with aspergillus, despite aggressive treatment as in the present case. The gravity of the condition can be accounted for by the thrombotic and necrosing nature of the fungal invasion of lung vessels.- - - - - - - - - - ranking = 1.6666666666667keywords = mucormycosis (Clic here for more details about this article) |
5/46. Lethal invasive mucormycosis: case report and recommendations for treatment.A case of lethal invasive mucormycosis (IM), a rare fungal infection which predominantly affects immunocompromised patients, is reported in a 73-year-old female patient who presented with a cervical abscess. The patient had asthma treated with steroids and had previously undiagnosed diabetes mellitus. Despite surgical treatment and parenteral antibiotic therapy, there was fatal progression of the condition. The pathogenesis, histological appearances and treatment of mucormycosis are discussed, particularly the importance of urgent histological examination of debrided tissue to distinguish this condition from necrotizing fasciitis (NF) earlier than microbiological culture alone would allow, thus permitting the early introduction of appropriate antifungal therapy.- - - - - - - - - - ranking = 2keywords = mucormycosis (Clic here for more details about this article) |
6/46. 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.- - - - - - - - - - ranking = 0.66666666666667keywords = mucormycosis (Clic here for more details about this article) |
7/46. Invasive mucormycosis in benign gastric ulcer.Fungal elements are frequently noted overlying the base of chronic peptic ulcers of the stomach and it has been suggested that the fungi enhance the degree of necrosis and that these cases have protracted disease and deeper ulcers with more perforations. It has also been postulated that the number of fungal elements might be increased in the stomach of patients who are receiving potent medications such as H2-receptor antagonists to reduce gastric acidity, but there have not been adequate control studies, and the deleterious effects from the presence of the fungi in these cases have not been substantiated. We present a very rare case of invasive mucormycosis (phycomycosis) occurring in the base of a chronic gastric ulcer in a 55 years old diabetic male. This case was clinically and radiologically been mistaken for a gastric carcinoma. In addition, the ulcer was complicated by perforation and fungal septicemia with subsequent fatal outcome. The clinical, radiological and histopathological features are described together with a literature review of other reported fungal gastric ulcers.- - - - - - - - - - ranking = 1.6666666666667keywords = mucormycosis (Clic here for more details about this article) |
8/46. Rhinocerebral mucormycosis treated with 32 gram liposomal amphotericin b and incomplete surgery: a case report.BACKGROUND: mucormycosis (or zygomycosis) is the term for infection caused by fungi of the order mucorales. Mucoraceae may produce severe disease in susceptible individuals, notably patients with diabetes and leukemia. Rhinocerebral mucormycosis most commonly manifests itself in the setting of poorly controlled diabetes, especially with ketoacidosis. CASE PRESENTATION: A 31-year-old diabetic man presented to the outpatient clinic with the following signs and symptoms: headache, periorbital pain, swelling and loss of vision in the right eye. On physical examination his right eye was red and swollen. There was periorbital cellulitis and the conjunctiva was edematous. KOH preparation of purulent discharge showed broad, ribbonlike, aseptate hyphae when examined under a fluorescence microscope. Cranial MRI showed involvement of the right orbit, thrombosis in cavernous sinus and infiltrates at ethmoid and maxillary sinuses. mucormycosis was diagnosed based on these findings. amphotericin b (AmBisome(R); 2 mg/kg.d) was initiated after the test doses. Right orbitectomy and right partial maxillectomy were performed; the lesions in ethmoid and maxillary sinuses were removed. The duration of the liposomal amphotericin b therapy was approximately 6 months and the total dose of liposomal amphotericin b used was 32 grams. Liposomal amphotericin b therapy was stopped six months later and oral fluconazole was started. CONCLUSIONS: Although a total surgical debridement of the lesions could not be performed, it is remarkable that regression of the disease could be achieved with medical therapy alone.- - - - - - - - - - ranking = 1.6666666666667keywords = mucormycosis (Clic here for more details about this article) |
9/46. Cutaneous mucormycosis secondary to acquired reactive perforating collagenosis.Acquired reactive perforating collagenosis (ARPC) is a rare perforating disease of the skin. It is characterized by hyperkeratotic papules with transepidermal elimination of degenerated material including collagen and elastic fibers. The disease presents clinically as umbilicated papules with a central adherent keratotic plug. mucormycosis infection, caused by the molds of the class Zygomycetes and order mucorales, generally occurs as an opportunistic infection. It presents most frequently in patients with diabetes mellitus, in patients with leukemia receiving chemotherapy, and in those on sustained immunosuppressive therapy. We describe a patient with type 2 diabetes mellitus and end-stage renal disease requiring hemodialysis in whom extensive cutaneous mucormycosis with secondary spread to the brain, lumbar spine, and breast developed in the setting of ARPC. To our knowledge, this is the first case report of a patient with ARPC who developed extensive cutaneous mucormycosis.- - - - - - - - - - ranking = 2keywords = mucormycosis (Clic here for more details about this article) |
10/46. MR imaging in rhinocerebral and intracranial mucormycosis with CT and pathologic correlation.Three cases of mucormycosis, two in diabetics and one in an intravenous drug abuse patient, are presented. magnetic resonance imaging proved to be useful in all cases, as was computed tomography. In one case, extremely low signal was detected from the fungal mass. It is surmised that this appearance was a result of high concentrations of iron and manganese. The low-signal area simulated air in paranasal sinuses; however, CT displayed a mildly enhancing soft tissue mass and allowed the correct diagnosis to be made. In another patient, pontine infarction was demonstrated by MR. In the third case the MR findings of mucormycosis involving the basal ganglia are shown and correlated with CT. Subsequent imaging studies demonstrated reduction of the mass, corresponding to clinical improvement.- - - - - - - - - - ranking = 2keywords = mucormycosis (Clic here for more details about this article) |
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