1/38. Cutaneous mucormycosis.The patient, a 59-year-old male, had been diagnosed as having alcoholic hepatopathy 20 years previously. He noticed localized swelling on his left leg after fishing in a river. The patient was diagnosed as having cutaneous mucormycosis upon histological and mycological examination of the skin. Gradual improvement of the symptoms was noted four weeks after administration of itraconazole and fruconazole; these were discontinued after five months.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
2/38. 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.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
3/38. 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.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
4/38. Resolution of rhinocerebral zygomycosis associated with adjuvant administration of granulocyte-macrophage colony-stimulating factor.We successfully treated 3 consecutive patients who had nonneutropenic rhinocerebral zygomycosis, by use of subcutaneous granulocyte-macrophage colony-stimulating factor therapy combined with traditional surgical and medical treatment. All patients are currently free of disease. granulocyte-macrophage colony-stimulating factor should be considered as adjuvant therapy for rhinocerebral zygomycosis; however, optimum dose and length of therapy are unknown.- - - - - - - - - - ranking = 4keywords = administration (Clic here for more details about this article) |
5/38. palate ulcer due to mucormycosis.mucormycosis is caused by fungi of the order mucorales and is one of the most rapidly fatal fungal infections known to man. Rhinocerebral mucormycosis is the most common type and its extension to the orbit and brain is quite usual. Location of mucormycosis on the palate is a rare and late occurrence. A case of deep hard palate ulcer due to sinonasal mucormycosis in a 79-year-old man is reported. He was successfully treated with a combination of surgical debridement and systemic liposomal amphotericin b administration for six weeks. By presenting this case report we would like to point out that mucormycosis should be included in the differential diagnosis of hard palate ulcers.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
6/38. 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.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
7/38. Innovative medical management with resection for successful treatment of pulmonary mucormycosis despite diagnostic delay.We present a case of primary pulmonary mucormycosis infection in a renal transplant recipient diagnosed serendipitously by computed tomography scan. Treatment included discontinuation of immunosuppressive regimen, initiation of antifungal therapy with amphotericin b lipid complex, administration of granulocyte-macrophage colony stimulating factor, surgical excision of the involved lobe, and outpatient treatment with amphotericin b with dialysis. The patient ultimately required transplant nephrectomy as a result of immunosuppression discontinuation.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
8/38. Two cases of disseminated mucormycosis in patients following allogeneic bone marrow transplantation.We describe two cases of disseminated mucormycosis following allogeneic bone marrow transplantation (BMT). Both patients were suffering from chronic graft-ver-sus-host disease (GVHD) and treated with prolonged administration of corticosteroid. In both cases, the initial symptoms were high fever and left flank pain. Involved organs were the spleen, right kidney and the right lung in one case, and the spleen and the brain in the other. The diagnosis was confirmed by pathology after splenectomy. One patient, in whom the immunosuppressants could be discontinued, was treated with prolonged conventional and liposomal amphotericin b and 5-fluorocytosine. The other, in whom the immunosuppressants could not be discontinued due to extensive GVHD, was unresponsive to amphotericin b, and eventually died from the fungal infection. Although mucormycosis, especially the disseminated form thereof is infrequent, it should be considered in high-risk patients because early diagnosis and timely therapy combining antifungal drug or surgery and reduction of immunosuppression appear to improve the prognosis.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
9/38. Rhinocerebral mucormycosis in a boy with recurrent acute lymphoblastic leukemia: long-term survival with systemic antifungal treatment.Rhinocerebral mucormycosis is rare in hematologic malignancies and usually leads to death within weeks. In contrast, chronic rhinocerebral mucormycosis takes a slowly progressive course and has not been reported in hematologic malignancies in children so far. The authors report the long-term survival of a boy with rhinocerebral mucormycosis in a relapse of acute lymphoblastic leukemia after allogeneic cord blood transplantation. The disease started acutely but took a chronic course thereafter. No surgical debridement was performed because of extensive involvement of the sinuses, orbits, and cerebrum. His long-term survival of 15 months is attributed to the long-range administration of liposomal amphotericin b, early neutrophil recovery, and slow progression of the relapsing acute lymphoblastic leukemia.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
10/38. Systemic Apophysomyces elegans after trauma: case report and literature review.We present a case of systemic fungal infection caused by Apophysomyces elegans in a 50-year-old patient who developed a progressive skin lesion after a motor vehicle crash. Histopathological and mycological examination of the surgical sample showed non-septated hyphae characteristic of mucoraceous fungi. Despite extensive surgical debridement, and parenteral administration of amphotericin b, the patient died of multi-organ failure. autopsy findings suggested systemic involvement. The fungi recovered from culture had non-apophyseal and globose sporangi, and branched sporaniophores and was identified as Apophysomyces elegans.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
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