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PubMedDate not supplied

Gastrointestinal mucormycosis--an uncommon isolated mucormycosis.

BACKGROUND: Isolated mucormycosis of the gastrointestinal tract is uncommon, with only two case reports from India. OBJECTIVES: To study the clinicopathologic features of gastrointestinal mucormycosis in Indian patients. METHODS: Eight cases of isolated gastrointestinal mucormycosis, seen over six years (1992-97) are reviewed. RESULTS: Five of the patients were premature babies or infants, one was a 12-year-old boy, and two were middle aged. Symptomatology included vomiting, bloody diarrhea, upper gastrointestinal bleeding, abdominal lump and abdominal distention. All the neonates presented with intestinal perforation. The duration of symptoms was ten days or less in six cases. Mucormycosis was not suspected clinically in any patient. In six cases the diagnosis was established antemortem from resection or biopsy material. Only two patients received antifungal therapy and only one patient responded. CONCLUSIONS: Isolated gastrointestinal mucormycosis is not uncommon in India. Early diagnosis may be helpful in reducing the high mortality.

Child↗
PubMed2003

Mucormycosis in systemic lupus erythematosus.

OBJECTIVE: To describe a case of mucormycosis in systemic lupus erythematosus (SLE) and to review other patients reported in the English literature. METHOD: A Medline search for articles about mucormycosis in SLE published between 1970 and 2002 was performed by using the key words "lupus," "mucormycosis," "zygomycosis," "Mucorales," "Rhizopus," and "Mucor." Cases were pooled for analysis, and the mycology, diagnosis, treatment, and outcome of mucormycosis in SLE was reviewed. RESULTS: Eight cases of mucormycosis in SLE were identified (female:male = 7:1). The mean age at the time of infection was 31.8 +/- 7.6 years and the mean duration of SLE was 6.3 +/- 3.9 years. All except 1 patient had active lupus and all were receiving high-dose corticosteroids. Concomitant cytotoxic agents were used in 4 patients. Additional predisposing factors for opportunistic infection included hypocomplementemia, nephrotic syndrome, uremia, leukopenia, and diabetes mellitus. The disseminated form of mucormycosis was the most common presentation and the diagnosis often was made only at autopsy (63%). For cases with positive culture results, Rhizopus was the causative species. In 4 patients, manifestations of the fungal infection mimicked those of active SLE. The overall mortality of mucormycosis was very high (88%) and, in most cases, was probably a function of delayed diagnosis and treatment. The cutaneous form appeared to have the best prognosis with combined medical and surgical treatment. CONCLUSIONS: Mucormycosis is a rare but usually fatal fungal infection in SLE. Judicious use of immunosuppressive agents, a high index of suspicion, early diagnosis, and combination treatment with amphotericin B and surgical debridement may improve the prognosis of this serious infection.

Adult↗
PubMed2005

Genetic identification and detection of human pathogenic Rhizopus species, a major mucormycosis agent, by multiplex PCR based on internal transcribed spacer region of rRNA gene.

BACKGROUND: Mucormycosis is an invasive opportunistic infection caused by fungi belonging to the order Mucorales. Due to the lack of laboratory tests, the diagnosis of mucormycosis is notoriously difficult. Added with its rapid progression as well as the debilitated state of the patients who contract the disease, mortality is extremely high. OBJECTIVE: The goal of this study was to genetically identify human pathogenic Rhizopus species, a major mucormycosis agent, by the internal transcribed spacer (ITS) region of rRNA gene. METHODS: Primers were designed to identify five Rhizopus species known to cause human disease by multiplex PCR. PCR was done not only with test strains and clinical isolates, but also with clinical samples from cutaneous mucormycosis patients. Sporangiospore morphology was observed by scanning electron microscopy to confirm the correlation of phenotypic and genotypic features. RESULTS: Multiplex PCR identified five Rhizopus species including Rhizopus oryzae, where R. azygosporus could only be distinguished from R. microsporus by certain polymorphisms that were present in its sequence. When this multiplex PCR was applied to clinical samples from three mucormycosis patients (paraffin sections from all and sera from one patient), Rhizopus DNA corresponding to the isolated pathogens were specifically detected. CONCLUSION: While fungal DNA detection from clinical samples is a rigorously studied area, this is the first report to genetically identify and detect Rhizopus species from human mucormycosis specimens. This may expand the possibility of this multiplex PCR system not only to identify isolated fungi, but also as a screening method for visceral mucormycosis.

Adolescent↗
PubMed2005

Mucormycosis presenting with painful ophthalmoplegia.

Mucormycosis is a rare fungal infection that can involve the sino-orbito-cerebral region. Sino-orbito-cerebral mucormycosis is most common in patients who are immunocompromised or have diabetes mellitus, severe malnutrition or burns. This condition can be fatal if it is not diagnosed early and treated aggressively. This article presents 4 cases of mucormycosis, including 2 with orbital apex syndrome, 1 with cavernous sinus syndrome, and 1 with multiple cranial nerve involvement. All of the patients were presented with painful ophthalmoplegia. The predisposing factors for mucormycosis included diabetes mellitus (three patients) and chronic leukemia (one patient). In all cases, mucormycosis was diagnosed by examining endoscopic sinus drainage material and was treated with surgical debridement and amphotericin B. Two patients with central nervous system involvement died. The others have survived, but still exhibiting various neurologic abnormalities after aggressive treatment. Patients with mucormycosis rarely present with orbital apex syndrome. The possibility of mucormycosis should be investigated in any patient with painful ophthalmoplegia, and prompt otorhinolaryngologic examination is recommended to ensure rapid diagnosis and treatment.

Aged↗
PubMed1995

Successful treatment of invasive thoracopulmonary mucormycosis in a patient with acute lymphoblastic leukemia.

BACKGROUND: Pulmonary mucormycosis associated with hematologic malignancy is an uncommon, but important opportunistic fungal pneumonia that is usually a fatal infection. Only a few survivors of pulmonary mucormycosis have been reported. METHODS: A case report of invasive thoracopulmonary mucormycosis during remission-induction therapy for acute lymphoblastic leukemia and a review of the literature are presented. RESULTS: The fungal lesions extended to both lungs, the left ribs, and intercostal muscles. Percutaneous needle biopsy and immunostaining of the fungal hyphae established the diagnosis of thoracopulmonary mucormycosis. The patient was treated with granulocyte-colony stimulating factor (G-CSF) and intravenous amphotericin B for 9 weeks and the lesions in the right lung disappeared. Left pneumonectomy and partial resection of the chest wall were later performed. The left lung was grossly necrotic and contained a large cavity and bronchopulmonary fistula. Thereafter, antileukemic therapy was resumed and completed without recurrence of mucormycosis or leukemia. CONCLUSIONS: In the management of mucormycosis, the addition of G-CSF to the conventional treatment may substantially improve outcome.

Adolescent↗
PubMed2000

Survival after rhino-orbital-cerebral mucormycosis in an immunocompetent patient.

OBJECTIVE: Rhino-orbital-cerebral mucormycosis is usually associated with a poor prognosis and is almost exclusively seen in immunocompromised patients. We report the third documented case of rhino-orbital-cerebral mucormycosis caused by Apophysomyces elegans (a new genus of the family Mucoraceae first isolated in 1979) in an immunocompetent individual. Orbital exenteration and radical debridement of involved adjacent structures combined with intravenous liposomal amphotericin resulted in patient survival. DESIGN: Interventional case report. METHOD: A 59-year-old immunocompetent white man sustained a high-pressure water jet injury to the right inner canthus while cleaning an air conditioner filter. He later had "orbital cellulitis" develop that did not respond to antibiotics and progressed to orbital infarction. Imaging studies and biopsy results led to a diagnosis of mucormycosis. Tissue culture grew Apophysomyces elegans, a new genus of the family Mucoraceae first isolated in 1979. Orbital exenteration and radical debridement of involved adjacent structures, combined with intravenous liposomal amphotericin, resulted in patient survival. RESULTS: After orbital exenteration and debridement of involved adjacent structures along with intravenous liposomal amphotericin, our patient has remained free from relapse with long-term follow-up. CONCLUSIONS: The agent causing this case of rhino-orbital-cerebral mucormycosis (Apophysomyces elegans) contrasts with the three genera most commonly responsible for mucormycosis (Rhizopus, Mucor, and Absidia) in that infections with this agent tend to occur in warm climates, by means of traumatic inoculation, and in immunocompetent patients. Rhino-orbital-cerebral mucormycosis should be considered in all patients with orbital inflammation associated with multiple cranial nerve palsies and retinal or orbital infarction, regardless of their immunologic status. A team approach to management is recommended for early, appropriate surgery and systemic antifungal agents.

Amphotericin B↗
PubMed1992

Mucormycosis.

Mucormycosis refers to the disease caused by a growing number of members of the Mucorales. Typically an airborne infection, primary disease is initiated in the upper or lower airways and is associated with the clinical development of sinusitis, rhinocerebral mucormycosis, or pulmonary infection. Dissemination of infection to skin, brain, and other sites is less common, but direct extension of the infection to contiguous sites is common if patients do not receive aggressive surgical and medical therapy. Risk factors for the development of mucormycosis include diabetic ketoacidosis; neutropenia; protein-calorie malnutrition; and iron overload, with or without the concomitant use of deferoxamine. This last association has only recently been recognized and has emerged as a major life-threatening complication for patients who are undergoing hemodialysis. Intravenous drug abusers may inject spores of Mucorales with their drugs and may present with space-occupying lesions of the CNS. The underlying immunologic defects that are responsible for predisposing different populations of patients to the development of mucormycosis are not well understood, and there is no unifying theory to explain why most individuals have innate immunity to this group of fungi. Patients with mucormycosis who are managed aggressively (i.e., those who undergo surgical debridement and who receive therapy with iv amphotericin B) may have increased rates of survival. The role of new azole derivatives in the treatment of mucormycosis is unknown.

Amphotericin B↗
PubMed1992

Mucormycosis in trauma patients.

Cutaneous mucormycosis is a rare but often fatal infection in trauma patients. We retrospectively reviewed a 9-year experience with mucormycosis among injured patients. Eleven patients had biopsy- or culture-proven mucormycosis. Nine patients were victims of blunt trauma, two patients had burns measuring greater than 50% TBSA. No patient was at increased risk because of underlying disease or immunosuppression prior to injury. All 11 patients had open wounds on admission. Four patients died of mucormycosis. All nonsurvivors had phycomycotic gangrenous cellulitis of the head, the trunk, or both. In contrast, survivors had involvement of only the extremities. Because of underlying disease, contaminating wounds, antibiotic use, or immunocompromise secondary to shock and sepsis, trauma patients are at risk of developing mucormycosis. To successfully treat mucormycosis, diagnosis must be prompt and accompanied by aggressive debridement and parenteral administration of amphotericin B.

Adult↗
PubMed1994

Mucormycosis of a median sternotomy wound.

Mucormycosis is an unusual complication of cardiothoracic surgery. The fungi may infect the sternotomy wound causing a progressive gangrene or seed the implanted prosthetic valve or graft resulting in endocarditis or graft failure. There have been six previous reports of mucormycosis following cardiothoracic surgical procedures. Four cases involved prosthetic devices, the remaining two are examples of sternal wound mucormycosis acquired from the use of contaminated elasticized bandages. The first case of sternal wound mucormycosis not associated with elasticized bandages is reported here. The infection occurred in a diabetic patient who had undergone coronary artery bypass surgery and mitral valve replacement. The patient received corticosteroids and broad-spectrum antibiotics at the time of and after operation. The patient developed invasive sternal mucormycosis and died on day 10 after surgery, despite aggressive surgical débridement and amphotericin B therapy. No elasticized bandages were used and the source of the infection was not identified. Previous cases of mucormycosis in cardiothoracic surgery are reviewed and the specific clinical setting in which this fungal disease should be suspected defined.

Adolescent↗
PubMed1996

Mucormycosis. Adjunctive therapy with hydrogen peroxide.

Mucormycosis is a devastating fungal disease affecting mainly diabetic and immunosuppressed patients and frequently causing death. Mucor rhizopus, the opportunistic fungus, has been controlled via radical extirpation and intravenous Amphotericin B. Hyperbaric oxygen also has been used. The authors present two interesting patients: 1) A diabetic female with rhinoorbital mucormycosis post total maxillectomy with recurrent mucormycosis and 2) A diabetic female with acute myelogenous leukemia and sphenoid sinus mucormycosis post functional endoscopic sinus surgery with residual mucormycosis. Both patients were receiving Amphotericin B without improvement. Both fungal infections were apparently eradicated with 1/2 strength topical hydrogen peroxide soaks. It appears the hydrogen peroxide destroys mucor and supporting host tissue by oxidation. The authors propose adding 1/2 strength topical hydrogen peroxide soaks to the list of possible adjunctive treatments of mucormycosis.

Aged↗
PubMed2026

Rapid and reliable diagnosis of mucormycosis using colorimetric loop-mediated isothermal amplification.

Current diagnostic approaches for mucormycosis are often limited by low sensitivity and prolonged turnaround times, which result in delayed treatment and poor clinical outcomes. We developed a novel diagnostic method utilizing a colorimetric loop-mediated isothermal amplification (LAMP) assay for the rapid and sensitive detection of mucormycosis. The assay incorporates specifically designed primers capable of detecting as low as 0.001 picograms (pg) of spiked genomic DNA from Mucorales fungi. This LAMP assay demonstrated a high sensitivity of 98% and a 100% specificity of detecting fungal ribosomal DNA (rDNA) in bronchoalveolar lavage (BAL) samples collected from mice infected with Mucorales fungi (n = 48) or from an uninfected control group (n = 15). To align the assay with clinical antifungal therapy, a subset of infected mice was treated with either liposomal amphotericin B (LAMB) or a combination of LAMB and a humanized monoclonal antibody (VX-01) targeting the Mucorales-specific surface protein CotH3. Consistent with the treatment efficacy, the LAMP assay detected significantly lower fungal burdens in BAL samples from mice receiving the combination therapy compared to those treated with LAMB alone or placebo. Further validation was conducted using BAL samples from patients diagnosed with mucormycosis (n = 24) or aspergillosis (n = 17). The assay demonstrated a sensitivity of 79% and a specificity of 94%. These findings highlight the diagnostic potential of this LAMP-based assay as a point-of-care. Its high sensitivity, specificity, and rapid turnaround time position this assay as a promising tool for early and accurate detection of mucormycosis, with the potential to improve patient management and clinical outcomes.IMPORTANCEMucormycosis is a rapidly progressive and fatal fungal infection. Timely diagnosis is critical for effective treatment, yet current diagnostic tools are slow, insensitive, or require complex laboratory procedures. In this study, we developed and validated a colorimetric loop-mediated isothermal amplification (LAMP) assay that enables rapid and reliable detection of Mucorales DNA directly from bronchoalveolar lavage (BAL) specimens. The assay demonstrated high sensitivity and specificity in both experimental mouse models and clinical samples, producing results within 1 h without the need for sophisticated equipment. This simple, robust, and cost-effective molecular diagnostic tool holds great potential for early detection of mucormycosis, facilitating prompt antifungal therapy and improving patient survival.

Mucormycosis↗
PubMed2000

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.

Amphotericin B↗
PubMed2005

A case of mucormycosis limited to the parotid gland.

BACKGROUND: Mucormycosis is a rare fungal infection commonly affecting structures in the head and neck such as air sinuses, orbits, and the brain. Common predisposing factors include diabetes and immunosuppression. To date, only one case of mucormycosis involving the parotid gland has been reported, and this infection was associated with a fatal outcome. METHODS: We report a case of parotid gland mucormycosis in a 45-year-old woman with type 2 diabetes, who was successfully treated with a superficial parotidectomy and intravenous amphotericin B. RESULTS: After initial surgical and antifungal therapy, the patient was left with a residual facial nerve palsy for which multiple sling procedures were performed. She is currently alive and well 6 years after the diagnosis of mucormycosis. CONCLUSIONS: Mucormycosis of the parotid gland is a rare form of this often-fatal infection. In this case, infection remained isolated to the parotid gland and was diagnosed soon after presentation. The patient most likely survived because of the early diagnosis, successful surgical removal of all infected tissue, use of intravenous amphotericin therapy, and the aggressive management of comorbidities such as her diabetes.

Amphotericin B↗
PubMed1994

Pulmonary mucormycosis: results of medical and surgical therapy.

Mucormycosis is an opportunistic fungal infection that commonly begins by invading the respiratory tract. The purpose of the present study was to define the clinical presentation of pulmonary mucormycosis and to evaluate current treatment regimens. Thirty patients treated at our institution and 225 cases reported in the literature were reviewed. For the combined groups, the mean age at presentation was 41 +/- 21 years and associated medical conditions included leukemia or lymphoma (37%), diabetes mellitus (32%), chronic renal failure (18%), history of organ transplantation (7.6%), or a known solid tumor (5.6%). The in-hospital mortality was 65% for patients with isolated pulmonary mucormycosis, 96% for those with disseminated disease, and 80% overall. The mortality in patients treated surgically was 11%, significantly lower than the 68% mortality in those treated medically (p = 0.0004). The most common causes of death were fungal sepsis (42%), respiratory insufficiency (27%), and hemoptysis (13%). Pulmonary mucormycosis has a high mortality; however, antifungal agents appear to improve survival. In addition, surgical resection may provide additional benefit to patients with pulmonary mucormycosis confined to one lung.

Adolescent↗
PubMed1994

Mucormycosis (zygomycosis): is there news for the clinician?

New data on mucormycosis (zygomycosis), relevant to the clinician, are analysed. Several clinical associations of this fungal infection have recently emerged: the association with therapy with the metal chelator desferrioxamine (mainly in dialysis patients), the rarity of mucormycosis in AIDS patients and its sporadic occurrence after bone marrow transplantation. New imaging techniques should be used serially in the case of rhinocerebral mucormycosis in order to evaluate the extent of the lesions and to guide potential surgery. Surgical debridement significantly improves the prognosis of rhinocerebral mucormycosis. Finally, results of the use of liposomal amphotericin B in a few patients with rhinocerebral mucormycosis are reviewed.

AIDS-Related Opportunistic Infections↗
PubMed2003

Mohs micrographic surgery as an alternative treatment method for cutaneous mucormycosis.

BACKGROUND: Mucormycosis is an invasive fungal disease that most commonly occurs in immunocompromised patients. Early angioinvasion and dissemination can lead to the rapid demise of the patient. The growing number of organ transplant patients on pharmacologic immunosuppression has increased the risk for this opportunistic mycosis. Traditional therapy has included aggressive debridement and resection as well as antifungal medications. OBJECTIVE: To demonstrate that the margin control and tissue-sparing technique of Mohs micrographic surgery can effectively eradicate mucormycosis infection and decrease morbidity. METHODS: Case presentation of a 64-year-old transplant patient presenting with biopsy-proven cutaneous mucormycosis treated with Mohs micrographic surgery. Margin control was confirmed by a rapid Gomori methenamine silver stain. RESULTS: There has been no recurrence at 1-year follow-up with full preservation of extremity function. CONCLUSION: The use of the Mohs technique combined with rapid Gomori methenamine silver staining for mucormycosis can be an effective tissue-sparing method for local control of this fungal infection. Mohs micrographic surgery should be considered for the cutaneous manifestations of mucormycosis.

Dermatomycoses↗