1/43. Mohs micrographic surgery for fungal soft tissue infections.BACKGROUND: Invasive fungal infections of the integument are relatively rare. In the immunocompromised patient, however, they may show an extremely aggressive biological behavior despite high dosed topical or systemic antifungal therapy. As the fungal tissue invasion usually reaches well beyond the area of clinical necrosis or other visible changes, standard surgical excision often proves to be inadequate, resulting in the need for repeated relatively wide excisions with the resulting substantial loss of initially healthy tissues. OBJECTIVE: To present the use of mohs surgery as a safe and effective treatment modality for invasive fungal infections in a patient with a zygomycetes infection of his scalp. RESULTS: The micrographic excision of the highly aggressive fungal infection, the acute postoperative course, and the delayed reconstruction with a split-thickness skin graft were all well tolerated without complications. CONCLUSION: Mohs micrographic excision deserves serious consideration in the treatment of aggressive localized fungal infections.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/43. Gastrointestinal zygomycotic infection caused by Basidiobolus ranarum: case report and review.Basidiobolus species are filamentous fungi belonging to the order entomophthorales. Unlike other zygomycetes, Basidiobolus species have been mainly associated with a tropical form of subcutaneous zygomycosis in otherwise healthy individuals. Visceral disease caused by this pathogen is rare, but cases of gastrointestinal infection with Basidiobolus ranarum have been reported worldwide. In many of these reports, the inflammatory disease of the colon has been confused with Crohn's disease. We report the third case of B. ranarum gastrointestinal infection in the united states, which was initially treated as inflammatory bowel disease.- - - - - - - - - - ranking = 0.66666666666667keywords = infection (Clic here for more details about this article) |
3/43. Gastrointestinal basidiobolomycosis. Morphologic findings in a cluster of six cases.We describe the histopathologic features of 6 cases of gastrointestinal basidiobolomycosis examined at 4 Phoenix, AZ, area hospitals during the last 4 years. Resected stomach and intestinal specimens were characterized by marked mural thickening with fibrosis, prominent tissue eosinophil infiltration and palisading granulomatous inflammation around pale fungal hyphae. In 2 cases, there was colonic perforation. Basidiobolus ranarum hyphae (associated with spore-like spherules in 4 cases) were identified within tissue sections; the irregularly branched, thin-walled, occasionally septated hyphae were typically surrounded by a thick eosinophilic cuff (Splendore-Hoeppli phenomenon). Although the histologic features of B ranarum are well described in the skin and subcutaneous tissue, gastrointestinal involvement has presented considerable diagnostic difficulty. Before the occurrence of this cluster of cases, intra-abdominal B ranarum infection has been reported only rarely.- - - - - - - - - - ranking = 0.11111111111111keywords = infection (Clic here for more details about this article) |
4/43. Therapeutic experience with fluconazole in the treatment of fungal infections in diabetic patients.diabetes mellitus is associated with a higher incidence of certain infections, including fungal infections like rhinocerebral zygomycosis (RCZ) and cutaneous candidosis. As the pathophysiology of increased susceptibility to infection of diabetic patients is very complex, a general therapeutic approach is not existing yet. Appropriate diabetes control remains as the best preventive measure. Nevertheless, effective drug therapy is very often required. fluconazole has proven efficacy in prophylaxis, treatment and suppressive therapy of both systemic and superficial fungal infections, especially in candidosis and cryptococcosis. Therefore it is used routinely against fungal infections in diabetes (FID). Clinical efficacy of fluconazole against cutaneous candidosis, oropharyngeal candidosis (OPC) and vulvovaginal candidosis (VVC) has been confirmed in more than 100 studies, involving more than 10,000 patients (pts). The overall success rate is 90%, with a mean dosage of 100-200 mg/d. In severe cases, e.g. in OPC in late-stage AIDS pts or in recurrent VVC, higher dosages of up to 800 mg/d may be required. In the treatment of RCZ, therapeutic experience with fluconazole is limited. Four diabetic pts have been treated with dosages of 200-300 mg/d and all of them recovered. Nevertheless, treatment of RCZ should include surgical debridement combined with aggressive antifungal therapy. In conclusion, proven efficacy and the excellent safety profile justify the routine use of fluconazole in the treatment of FID.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
5/43. Entomophthoromycosis of the nose and paranasal sinus.A case of entomophthoromycosis of the nose and paranasal sinus is presented. To our knowledge, this is the youngest patient reported with this infection. Though the clinical picture mimicked a malignancy, histopathology clinched the diagnosis of entomophthoromycosis. The lesions resolved completely with oral potassium iodide.- - - - - - - - - - ranking = 0.11111111111111keywords = infection (Clic here for more details about this article) |
6/43. Gastric zygomycosis diagnosed by brushing cytology.A 66-yr-old man with a history of squamous cell carcinoma and small cell carcinoma of the lung presented with nausea, vomiting, and abdominal pain. After passing black stools, he underwent upper endoscopy which showed gastric ulceration. A gastric brushing was performed which showed numerous nonseptate, ribbon-like hyphae with right-angle branching. The cytologic features permitted a diagnosis of a zygomycotic infection which was confirmed by histologic examination. Despite appropriate antifungal therapy, the patient expired. To the best of our knowledge, this is the first case of gastric zygomycosis diagnosed by brushing cytology. We believe that gastric brushing cytology allows for rapid diagnosis of zygomycotic mycoses, due to the distinctive morphology of these organisms; however, histologic examination is still required for assessment of invasion.- - - - - - - - - - ranking = 0.11111111111111keywords = infection (Clic here for more details about this article) |
7/43. Gastrointestinal basidiobolomycosis in arizona: clinical and epidemiological characteristics and review of the literature.Gastrointestinal basidiobolomycosis (GIB) is an unusual fungal infection that is rarely reported in the medical literature. From April 1994 through May 1999, 7 cases of GIB occurred in arizona, 4 from December 1998 through May 1999. We reviewed the clinical characteristics of the patients and conducted a case-control study to generate hypotheses about potential risk factors. All patients had histopathologic signs characteristic of basidiobolomycosis. Five patients were male (median age, 52 years; range, 37--59 years) and had a history of diabetes mellitus (in 3 patients), peptic ulcer disease (in 2), or pica (in 1). All patients underwent partial or complete surgical resection of the infected portions of their gastrointestinal tracts, and all received itraconazole postoperatively for a median of 10 months (range, 3--19 months). Potential risk factors included prior ranitidine use and longer residence in arizona. GIB is a newly emerging infection that causes substantial morbidity and diagnostic confusion. Further studies are needed to better define its risk factors and treatment.- - - - - - - - - - ranking = 0.22222222222222keywords = infection (Clic here for more details about this article) |
8/43. 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.- - - - - - - - - - ranking = 0.11111111111111keywords = infection (Clic here for more details about this article) |
9/43. Rhinophycomycosis.Rhinophycomycosis, a subcutaneous fungal infection, is less uncommon than many other frequently cited granulomatous lesions of the paranasal sinuses. Four illustrative cases are presented with their characteristic clinical, radiological and histopathological features. The initial origin of the swelling was always in the region of the nasal vestibule and ala. The therapeutic response to potassium iodide, ketaconazole and fluconazole was dramatic and sustained.- - - - - - - - - - ranking = 0.11111111111111keywords = infection (Clic here for more details about this article) |
10/43. 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.- - - - - - - - - - ranking = 0.22222222222222keywords = infection (Clic here for more details about this article) |
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