Mucormicosis Rinocerebral asociado a Cetoacidosis diabética / Rhinocerebral Mucormycosis associated to diabetic ketoacidosis

Mucormycosis is an infrequent fungal infection This infection is difficult to diagnose and treat and have a high morbility and mortality and affects immunocompromised patients, especially those patients with decompensated diabetes mellitus. We report the case of a 60 years old diabetic patient with poor metabolic control who was admitted for diabetic ketoacidosis and days later present right periorbital swelling and pain, is diagnosed of mucomycosis and is successfully treated with amphoterin B and surgery.

Cutaneous mucormycosis in advanced HIV disease

ABSTRACT Angionvasive mucormycosis is an emerging fungal disease known to affect mainly diabetics or subjects with profound neutropenia. Infection usually occurs through the inhalation route, but cutaneous inoculation may occur after trauma or burns. However, mucormycosis remains unusual in HIV infection. We report a fatal case of cutaneous mucormycosis due to Rhizopus arrhizus involving the scalp following herpes zoster infection. The patient was a 42-year-old man with advanced AIDS failing on salvage antiretroviral therapy. The fungus was diagnosed on the basis of histopathology and culture. Our case emphasizes the need to consider mucormycosis in the differential diagnosis of necrotic cutaneous lesions in patients with late-stage HIV disease.

Utilização de três métodos imuno-histoquímicos na detecção de aspergilose e zigomicose em animais / Usage of three immunohistochemical methods in the detection of aspergillosis and zygomycosis in animals

Visando a otimização do uso da técnica de imuno-histoquímica (IHQ) na detecção de Aspergillus spp. e zigomicetos (membros da família Mucoraceae), utilizaram-se dois anticorpos monoclonais fungo-específicos em fragmentos de tecidos de animais (fixados em formol e embebidos em parafina) com diagnóstico histomorfológico prévio de aspergilose e zigomicose, os quais foram submetidos a três sistemas de detecção diferentes (dois biotinilados e um não biotinilado). Os dois anticorpos apresentaram alta especificidade e sensibilidade nos tecidos examinados. Não ocorreram reações cruzadas entre os anticorpos utilizados e os agentes etiológicos avaliados (incluindo casos de aspergilose, zigomicose, candidíase e pitiose). No entanto, reações inespecíficas foram observadas nas hifas em alguns casos, as quais puderam ser eliminadas através de um dos métodos de detecção utilizados. Para a aspergilose, o método da estreptavidina-biotina-fosfatase alcalina não apresentou reações inespecíficas nas hifas. Enquanto que nos casos de zigomicoses, as reações inespecíficas não ocorreram no método por polímero (não biotinilado). A técnica de IHQ mostrou-se uma ferramenta muito útil na detecção e confirmação dos casos de aspergilose e zigomicose neste estudo retrospectivo.

Aiming to optimize the usage of the immunohistochemical technique (IHC) in the detection of Aspergillus spp. and zygomycetes (members of the Mucoraceae family), two fungal-specific monoclonal antibodies were used in tissue fragments (formalin-fixed paraffin-embedded), previously diagnosed by histomorphology as aspergillosis and zygomycosis. Tissues were submitted to three different detection systems (two biotinilated and one non biotinilated). Both antibodies showed high specificity and sensitivity in the examined tissues. No cross-reactions were observed between the antibodies used and the agents evaluated (including cases of aspergillosis, zygomycosis, candidiasis and pythiosis). However, nonspecific reactions in hyphae were observed in some cases, but were eliminated by mean of one of the detection systems used. In the aspergillosis cases, with the streptavidin-biotin-alkaline phosphatase method, nonspecific reactions were not observed. In the zygomycosis cases, nonspecific reactions did not occur using a polymer (nonbiotinilated). The IHC technique showed to be a useful tool detecting and confirming aspergillosis and zygomycosis in this retrospective study.

Fatal Pulmonary Mucormycosis Caused by Rhizopus microsporus in a Patient with Diabetes

No abstract available.

Recurrent pulmonary mucormycosis after lobectomy in a non-smoking patient without predisposing risk factors

Pulmonary mucormycosis is a very rare clinical condition in patients without underlying risk factors. A limited number of cases have been reported in predominantly elderly patients; history of smoking appears to be a common feature. A case of non-smoking male who developed pulmonary mucormycosis with the longest reported follow-up is presented. In addition, this is also the first reported case with disease recurrence after lobectomy (two years) in an immunocompetent host. Treatment with an additional lobectomy and amphotericin B was successful in this patient.

Mucormicosis cutánea en un paciente inmunocomprometido / Cutaneous mucormycosis in an immunocompromised patient

Mucormycosis is an increasingly emerging life-threatening infection and is an important cause of morbidity and mortality in patients with leukemia. We present the case of a 4-year-old boy with an acute lymphoblastic leukemia complicated by severe and prolonged neutropenia during induction chemotherapy, who developed cutaneous mucormycosis of the elbow. Direct microscopy with KOH and the histopathologic observation of the skin revealed fungal hyphae without septations. The cultures were positive for Rhizopus microsporus var oligosporus. The patient was treated succefully with amphotericin B during 40 days, surgical debridement and dermoepidermic graft. Early recognition and prompt intervention with combined medical and surgical treatment may improve the outcome. The most common management strategy in survivors involves a combination of antifungal therapy with amphotericin B and surgical debridement.

La mucormicosis es una enfermedad emergente grave, producida por hongos saprófitos del orden Mucorales, que afecta fundamentalmente a pacientes inmunocom-prometidos. La forma cutánea se origina por inoculación de esporas dentro de la dermis con el subsecuente desarrollo de una lesión tipo ectima, generalmente única y de evolución rápidamente progresiva, por las características angioinvasoras del hongo, que determina amplias zonas de infartos y necrosis en los tejidos. Presentamos el caso de un paciente con cuatro años de edad, con diagnóstico de leucemia linfoblástica aguda, en quimioterapia de inducción, que cursó con neutropenia profunda y prolongada, presentando una lesión cutánea en el codo compatible con ectima gangrenoso. Recibió tratamiento antimicrobiano y antifúngico, asociado a un aseo quirúrgico. El cultivo para hongos demostró crecimiento de Rhizopus microsporus var oligosporus, y la histología concluyó presencia de hifas no septadas. El estudio de extensión descartó compromiso óseo, sinusal y cerebral. Completó 40 días de terapia antifúngica con anfotericina B deoxicolato, evolucionando satisfactoriamente. Posteriormente requirió injerto dermo-epidérmico. Si bien esta patología es infrecuente, debemos sospecharla en pacientes con neoplasias hematológicas, para establecer un diagnóstico etiológico oportuno, ya que el tratamiento contempla el desbridamiento quirúrgico precoz asociado a antifúngicos sistémicos, siendo de elección anfotericina B.

Rhinocerebral zygomycosis in a diabetic patient / Zigomicose rinocerebral em paciente diabética

Rhinocerebral zygomycosis is the most frequent form of fungal infection caused by members of the Zygomycetes class. A fatal case of rhinocerebral zygomycosis caused by Rhizopus (oryzae) arrhizus with histopathological and mycological diagnosis is reported in a diabetic patient.

Zigomicose rinocerebral é a forma mais frequente das infecções fúngicas causadas por membros da classe Zygomicetes. É relatado um caso fatal de zigomicose rinocerebral por Rhizopus (oryzae) arrhizus com diagnóstico histopatológico e micológico, em paciente diabética.

A rare case of mucormycosis of median sternotomy wound caused by Rhizopus arrhizus.

We describe a case of mucormycosis of median sternotomy wound caused by Rhizopus arrhizus . The patient, a known diabetic and a case of coronary artery disease underwent coronary artery bypass surgery. In the postoperative period, patient developed infection of the median sternotomy wound, from which R. arrhizus was isolated on culture. Patient succumbed in spite of being treated with surgical debridement and amphotericin B. To the best of our knowledge, this is the first reported case of mucormycosis of median sternotomy wound from India.

Pulmonary zygomycosis in a diabetic patient.

We report a case of pulmonary zygomycosis in an adult male diabetic patient who presented with fever and altered sensorium initially and later developed streaky haemoptysis. Bronchoscopy showed picture of necrotizing pneumonia. Sputum was negative for fungal elements on admission but later bronchial wash and repeat sputum samples were positive by microscopy and culture showed growth of Rhizopus species. Immediately the patient was put on amphotericin B but had a bout of massive haemoptysis and succumbed. A high index of suspicion is needed for an early diagnosis and aggressive treatment of this infection in view of the high mortality rate.

Panophthalmitis due to rhizopus in an AIDS patient: a clinicopathological study.

Various opportunistic infections in the eye have been reported earlier in AIDS. We report a case of panophthalmitis in an AIDS patient where the eviscerated tissue on histopathologic and microbiologic examination showed the fungus Rhizopus.

Variación anual de la microflora en la ciudad de San Juan y en hogares de pacientes con patología respiratoria IgE dependiente / Annual mycoareological variation in San Juan city, Argentine Republic, and in houses of IgE dependent respiratory pathology patients

El objetivo del estudio fue establecer la variación anual de la microflora en la ciudad de San Juan y en hogares de pacientes con patología respiratoria IgE dependiente. San Juan es una provincia del oeste de la República Argentina, con escasísimas precipitaciones pluviales anuales (menos de 10 mm), con un promedio de humedad relativa ambiente de 46 por ciento (min.: 36 por ciento y máx.: 55 por ciento) y una temperatura promedio de 17,6ºC (min.: 7,8ºC y máx.: 26,5ºC). Para poder conocer el desarrollo de hongos y definir mejor la correlación existente entre ellos y las enfermedades alérgicas respiratorias, estudiamos durante un período anual (julio 1994-junio 1995) la presencia de seis géneros de hongos: Alternaria, Cladosporium, Penicillium, Aspergillus, Mucor y Rhizopus, en el ambiente exterior de la ciudad de San Juan, y en el domicilio de nueve (9) niños con enfermedad respiratoria (rinitis y/o asma), con Prick Test positivo para todos los hongos en estudio. Se controló la reactividad sanguínea de estos pacientes a los mismos géneros de hongos por IgE RAST. La flora micológica fue estudiada por el método gravimétrico, exponiendo mensualmente cápsulas de Petri (diámetro: 10 cm) en medio ambiente externo y en los domicilios (4 cápsulas por domicilio), con medios de cultivo de Sabouraud y Czapek-Dox (Lab. Merck). Los Prick Test se realizaron con antígenos Allergon AB (Lab. Welt), y las IgE RAST (Allerex Labs. Inc - USA). El hongo que se desarrolló con más frecuencia en los domicilios estudiados fue el Penicillium (40,63 por ciento), seguido por Rhizopus (17,24 por ciento), Aspergillus (14,09 por ciento), Mucor (11,28 por ciento), Cladosporium (4,81 por ciento), Alternaria (4,75 por ciento), y otros (7,0 por ciento). Aunque en distinto porcentaje, la distribución de hongos en ambientes externos sigue una curva muy similar a las halladas en los domicilios: Penicillium (17,86 por ciento), Rhizopus (12,76 por ciento), Aspergillus (11,13 por ciento), Mucor (9,97 por ciento), Alternaria (8,12 por ciento), Cladosporium (6,03 por ciento) y otros (1,39 por ciento). La mayor concentración de hongos se alcanzó en octubre para domicilios y en noviembre-diciembre para ambiente exterior. La mejor correlación entre el Prick Test y el RAST se obtuvo para Alternaria y Aspergillus (87 por ciento), seguidos por Cladosporium (75 por ciento), Penicillium (62 por ciento), Rhizopus (50 por ciento), y Mucor (37 por ciento). No encontramos correlación directa entre la respuestas de los pacientes y la concentración de hongos en el período de estudio, confirmando lo esperado de acuerdo con las diferentes potencias alergénicas de cada género

Hongos del maiz de interés en pre y post-cosecha en el norte de Italia: microcomunidades asociadas a raíces y hojas / Pre and post harvest fungi of interest in norther Italy: microcommunities associated to roots and leaves

Mediante técnicas de lavado y esterilización superficial, se analizó mensualmente en la zona norte de Italia, la variación estacional de la micota de raíces, hojas y semillas (éstas últimas, sólo previo a su siembra), durante el ciclo vegetativo de 3 cultivares de maíz (aida, hawaiano, hibisco). La mayor cantidad de aislamientos con ambas metodología y en todos los sustratos sembrados en PDA y agar agua, correspondió al cultivo aida. Los taxa más frecuente en raíz, fueron: fusarium, oxysporum, rhizopus stolonifer, trichoderma viride, alternaria alternata, pyrenochaeta terrestris, ramichloridium sp., penicillium spp. y epicoccum purpurascens. En hoja, en cambio, se observó un orden y presencia diferentes. Como modelos de variación estacional, se seleccionaron los integrantes de los 8 taxa o grupos de taxa más frecuentes en raíz y hoja: (alternaria, epicoccum, fusarium, pyrenochaeta-phoma spp., rhizopus, trichoderma, drechslera-bipolaris spp. y penicillium spp.), donde solo los tres últimos presentaron variaciones de magnitud. F. oxysporum, fue dominante en todos los sustratos (80 por ciento), mientras f. moniliforme (gibberella fujikuroi) fue escaso, salvo en las hojas (14 por ciento). En las semillas de los 3 cultivares, las especies frecuentes fueron: f. oxysporum, penicillium spp., c. cladosporioides y f. moniliforme, mientras el mayor número de aislamientos se detectó en aida. A pesar de las buenas condiciones de manejo y al uso de agrotóxicos, se detectó: ustilago zeae, diplodia zeae maydis, bipolaris maydis, botrytis cinerea, f. moniliforme (gibberella fujikuroi), macrophomina phaseolina y pyrenochaeta terrestris). Entre las especies toxicogénicas a. flavus, se aisló sólo en la rizósfera, mientras debe considerarse en post-cosecha la frecuencia constante de los géneros alternaria, fusarium y penicillium

Airborne fungi isolated from Natal, State of Rio Grande do Norte-Brazil

A flora fúngica anemófila foi estudada em natal, Estado do Rio Grande do Norte, Brasil, durante um ano, em cinco pontos da cidade, através da exposiçäo de 120 placas de Petri, contendo o meio agar-Sabouraud. Foram isolados 31 gêneros. Destes, os mais frequentes foram: Aspergillus (78 por cento); Penicillium (60 por cento); Fusarium (42 por cento); Cladosporium (21 por cento); Curvularia (19 por cento); Rhizopus (17 por cento) e Rhodotorula (13 por cento). Estes gêneros aprareceram em todos os locais de coleta. Neurospora e Drechslera foram isolados em Natal com frequência relativa superior à de outras cidades brasileiras. O gênero Cladosporium foi mais frequente no veräo. Näo foi observada diferença significativa entre o número de gêneros, número de colônias de fungos esporulados e näo esporulados, nos cinco locais de coleta. Como tem sido sugerido por outros autores, estes dados indicariam uma poluiçäo homogênia entre os bairros de Natal e seria de baixo nível, pois Natal näo é uma cidade industrializada

Cutaneous mucormycosis in a normal boy

A case of generalized cutaneous mucormycosis is reported in a healthy young boy. He had multiple nodular lesions on his thigh, leg, neck, and chest. Direct examination, culture of the discharges of lesions, and biopsy specimen obtained from the thigh lesion were negative for fungal elements. Histologic examination of the autopsy specimen revealed broad, non-septate hyphae and in culture, Rhizopus sp. were isolated. The diagnosis was made too late for appropriate therapeutic intervention. This is the first report of mucormycosis in a healthy person in Iran

Micosis oportunistas de senos paranasales: manifestaciones cutáneo-mucosas / Mycoses opportunist of nasal sinuses: manifestations cutaneous-mucosas

Se presentan nueve pacientes con sinusitis fúngica, en el período de 1986-1988. Se aislaron los siguientes agentes etiológicos: Aspergillus flavus (n=3), Alternaria alternata (n=3), Acremonium falciforme (n=1), Rhizopus sp. (n=1), y Cladosporium bantianum (n=1). En individuos inmunocomprometidos (n=8) se observó necrosis de cornetes, tumefacción, edema, obstrucción nasal y rinorrea. En algunos casos estas lesiones progresaron con compromiso de la pared nasal, senos paranasales y cavidad craneal. La mayoría de estos pacientes padecían leucemia mieloide aguda (LMA) y se encontraban en período de neutropenia crítica, asociada a tratamientos quimioterapéuticos. En uno de los pacientes no se detectaron alteraciones inmunológicas. La lesión fue localizada, no invasiva, con congestión nasal y rinorrea. El tratamiento fue anfotericina B en todos los casos, hasta completar 1 g de dosis total. Se comprobó la cura clínica y micológica en cinco de los pacientes, los cuatro restantes fallecieron sin recuperar valores normales de neutrófilos, o corregir su enfermedad de base.

Rhinocerebral mucormycosis associated with diabetic ketoacidosis.

Rhinocerebral mucormycosis with hemiparesis occurred in a young woman who was not a known diabetic. Rhyzopus species grew from the initial nasal biopsy. The patient was treated with amphotericin B, in addition to control of diabetic ketoacidosis. Surgical intervention was not done. The patient died on the fourth day of hospitalisation.

Mucormicose (zigomicose) rino cerebral: apresentaçäo de dois casos com sobrevida / Mucomycosis (zygomycosis) rhinocerebral: report of two cases with prognosis

Säo relatados dois casos de mucormicose rinocerebral em jovens diabéticos. Num paciente, a micose teve curso arrastado e apesar do envolvimento sino-órbito-cerebral, a sintomatologia refletiu apenas o comprometimento órbito-ocular. No outro paciente, a doença teve curso agudo nasal e palatina, seios paranasais, tecidos periorbitários, olho e nervos cranianos, porém sem acometimento cerebral. Houve sobrevida de ambos os pacientes, porém, em apenas um deles o diagnóstico foi completo pelo isolamento do agente

Rhinocerebral mucormycosis: a report of eleven cases.

Rhinocerebral mucormycosis (RCM) is a rare, fulminant fungal infection that usually occurs in diabetic or immunocompromised patients. The mortality rate has been reduced recently with the advent of amphotericin B combined with aggressive surgery. Eleven RCM patients have been treated over the past five years at Srinagarind Hospital. Eight had underlying diabetes, five had renal failure and three of them had both. In eight patients, the diagnosis was established by KOH preparation before histological confirmation. Only two cases revealed positive cultures for Rhizopus spp and Cunninghamella spp. All patients underwent surgical treatments (extensive debridement, 8 cases; sphenoidectomy, 7 cases; ethmoidectomy 8 cases; maxillectomy 5 cases and orbital exenteration, 6 cases). Amphotericin B was administered to all patients as soon as the diagnosis of RCM was made. Only three patients survived. Early diagnosis and cooperation among ophthalmologist, otolaryngologist and physician are the most important factors for the survival of patients with mucormycosis.

Zigomicosis rinocerebral: manifestaciones cutáneo-mucosas / Rhinocerebral zygomycosis: mucocutaneous manifestations

Paciente, sexo masculino, 49 años de edad, con antecedentes de tabaquismo, alcoholismo crónico, hepatopatía y diabetes metacorticoidea. Previo episodio de cetoacidosis diabética es internado, presentando rinorrea acuosa de fosa nasal izquierda, parestesia fronto-orbitaria, ptosis palpebral con exoftalmía y ceguera unilaterales izquierdas. En paladar duro del mismo lado, se observa una úlcera de gran tamaño cubierta por tejido necrótico secretante y de olor fétido. La tomografía computada evidencia una masa ocupante en cavidad sinusal y maxilar iszquierda. En el examen micológico de tejido de paladar se observan abundantes filamentos, gruesos, no tabicados con características de un Mucoral. Los cultivos en Sabouraud permiten identificar el agente causal como Rhizopus sp. Inicia tratamiento con Anfotericina B, completando 225 mg dosis total hasta su fallecimiento