1/14. Pulmonary rhizopus infection in a diabetic renal transplant recipient.Infectious complications after renal transplantation remain a major cause of morbidity and mortality. mucormycosis is a rare infection in renal transplant recipients; however, mortality is exceedingly high. risk factors predisposing to this disease include prolonged neutropenia, diabetes, and patients who are immunosuppressed (Singh N, Gayowski T, Singh J, Yu LV. Invasive gastrointestinal zygomycosis in a liver transplant recipient: case report and review of zygomycosis in solid-organ transplant recipients, Clin Infect Dis 1995: 20: 617). life-threatening infections can occur, as this fungus has the propensity to invade blood vessel endothelium, resulting in hematological dissemination. We report a case of cavitary rhizopus lung infection, 2 months after renal transplantation, where the patient was treated successfully with amphotericin b and surgical resection of the lesions with preservation of his allograft function. In this era of intensified immunosuppression, we may see an increased incidence of mucormycosis in transplant population. Invasive diagnostic work-up is mandatory in case of suspicion; amphotericin b and, in selected cases, surgical resection are the mainstays of therapy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/14. Complications of corticosteroid therapy in presumptive temporal arteritis.Two elderly patients presented with symptoms suggestive of occult temporal arteritis. Both were treated with high doses of corticosteroids although subsequent biopsies of the arteries did not show evidence of arteritis. After 5 months of corticosteroid therapy, the first patient died of Gram-negative bacterial pneumonia and cystitis and disseminated intravascular coagulation. The second patient, six days after the biopsy, died of pneumococcal meningitis which had presumably spread from a focus about the left optic nerve. In the first patient, necropsy studies showed that the loss of vision appeared to be due to arteriosclerosis of the nutrient vessels of the optic nerve while in the second patient, the visual symptoms appeared to be due to a localized optic perineuritis. Corticosteroid therapy in elderly patients carries a high morbidity, as is illustrated by the first case and may mask unsuspected underlying disease processes, as presumably occurred in the second. We discuss the importance of obtaining a biopsy diagnostic of temporal arteritis in order to justify the continuation of corticosteroid therapy and the significance of a negative biopsy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/14. Floating aortic thrombus in systemic aspergillosis and detection by transesophageal echocardiography.After immunosuppressive treatment for a colitis ulcerosa, a 49-yr-old man developed signs of systemic aspergillosis with subsequent septic shock and encephalitis. For recurrent signs of thromboembolism, transesophageal echocardiography was performed and revealed a large floating thrombus of the aortic arch. Despite appropriate antibiotic treatment, the patient died a few days later suffering from adult respiratory distress syndrome. The appearance of aortic thrombi concomitant to systemic fungal infection rarely has been reported. The present case is the first report of in vivo detection of large vessel involvement in systemic aspergillosis by transesophageal echocardiography. In our opinion, transesophageal echocardiography is the method of choice for bedside diagnosis of this rare complication in critically ill patients.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/14. Case Report. Disseminated aspergillosis complicating pregnancy.We report a case of disseminated aspergillosis in a hitherto healthy 24-year-old woman during her 24th week of pregnancy. Relevant findings at autopsy revealed innumerable septate, dichotomously branched (45 degrees ) hyphae compatible with aspergillus in lung and liver tissues. Cerebral histology showed cerebral vessels occluded by hyphae causing cerebral infarction. There was no evidence of invasive aspergillosis in the placenta and fetal tissues. aspergillus sp. was confirmed by amplification of a specific 357-base-pair amplicon from a paraffin block containing lung tissue. This case illustrates a previously uncharacterized spectrum of disseminated aspergillosis, indicating the need for a heightened awareness that aspergillus species are opportunistic agents for invasive and disseminated infection in pregnancy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/14. Rhinoorbital mucormycosis secondary to rhizopus oryzae: a case report and literature review.mucormycosis is a form of fulminant invasive fungal infection of the sinonasal tract that often extends to the orbit, brain, palate, and skin. It is caused by members of the order mucorales, and it is considered to be the most fatal fungal infection known to man because it is rapidly disseminated by the blood vessels. It is most commonly associated with diabetic ketoacidosis, hematologic malignancies, acquired immunodeficiency syndrome, and immunosuppressive therapy. This rare opportunistic infection exists in many forms, the most common of which is rhinocerebral mucormycosis. Treatment includes aggressive surgical debridement of the necrotic tissue combined with systemic antifungal therapy. In this case report, we describe the successful management of rhinoorbital mucormycosis, a subtype of the rhinocerebral variety, secondary to rhizopus oryzae that developed in a patient with lymphoma. We review the diagnostic work-up and discuss the literature with respect to the presentation, pathophysiology, management, and outcome of the disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/14. Isolated renal mucormycosis: an unusual cause of acute renal infarction in a boy with aplastic anaemia.mucormycosis is an opportunistic fungal infection occurring most often in immunocompromised patients. The most common clinical presentation of infection with the fungus is rhinocerebral, followed by primary pulmonary, disseminated, gastrointestinal and cutaneous manifestations. Renal involvement in disseminated mucormycosis is well described, however, there are only few case reports describing the isolated renal mucormycosis in literature. We present an unusual case of renal mucormycosis in a patient of aplastic anaemia who presented with right flank pain and, on imaging, was found to have renal infarction and thrombosis of renal vessels. Histopathology revealed fungal hyphae infiltrating the entire kidney, renal vessels and perinephric space.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
7/14. Endobronchial zygomycosis.Pulmonary zygomycosis is an uncommon opportunistic fungal infection. Diabetics have a tendency to develop major airway lesions. This can lead to invasion of the airway wall and hilar vessels with infarction and severe haemoptysis. Aggressive early surgery appears to offer the best chance of recovery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/14. The agent of bacillary angiomatosis. An approach to the identification of uncultured pathogens.BACKGROUND. Bacillary angiomatosis is an infectious disease causing proliferation of small blood vessels in the skin and visceral organs of patients with human immunodeficiency virus infection and other immunocompromised hosts. The agent is often visualized in tissue sections of lesions with Warthin-Starry staining, but the bacillus has not been successfully cultured or identified. This bacillus may also cause cat scratch disease. methods. In attempting to identify this organism, we used the polymerase chain reaction. We used oligonucleotide primers complementary to the 16S ribosomal rna genes of eubacteria to amplify 16S ribosomal gene fragments directly from tissue samples of bacillary angiomatosis. The dna sequence of these fragments was determined and analyzed for phylogenetic relatedness to other known organisms. Normal tissues were studied in parallel. RESULTS. Tissue from three unrelated patients with bacillary angiomatosis yielded a unique 16S gene sequence. A sequence obtained from a fourth patient with bacillary angiomatosis differed from the sequence found in the other three patients at only 4 of 241 base positions. No related 16S gene fragment was detected in the normal tissues. These 16S sequences associated with bacillary angiomatosis belong to a previously uncharacterized microorganism, most closely related to Rochalimaea quintana. CONCLUSIONS. The cause of bacillary angiomatosis is a previously uncharacterized rickettsia-like organism, closely related to R. quintana. This method for the identification of an uncultured pathogen may be applicable to other infectious diseases of unknown cause.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/14. Disseminated cutaneous fusarium infection with vascular invasion in a leukemic patient.A 61-year-old male with leukemia manifested multiple cutaneous nodules on his whole body surface, subcutaneous nodules on his arms and a tongue tumor. Septate hyphae were observed microscopically in scrapings from the surfaces of the cutaneous lesions. fusarium solani and F. anthophilum were isolated from scrapings from the several skin lesions. Histological examination revealed the presence of numerous septate hyphae in the lumina of vessels in the dermis. The fungal elements in the cutaneous tissues were suggested to be fusarium by an immunoperoxidase method using a genus-specific anti-fusarium antibody. Although no evidence of fungal infection was found in other organs by clinical examinations, F. solani and/or F. anthophilum were considered to have undergone hematogenous dissemination, because of the presence of thrombi containing abundant fungal elements in the skin lesion. The present case is a case of disseminated cutaneous fusarium infection, in which fungal elements in skin tissue sections were immunohistochemically regarded as fusarium, though fungus cultures from biopsied specimens were negative.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/14. myocardial infarction caused by cardiac disease in disseminated zygomycosis.A case of disseminated zygomycosis is described, in which myocardial infarction rather than coincident coronary or heart disease was seen at necropsy. As zygomycosis is an opportunistic fungal infection, which tends to invade blood vessels, thereby causing thrombosis and infarction, it is surprising that cardiac disease is unusual and that premortem evidence of such disease has only rarely been reported.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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