ABSTRACT
AIMS: 1: Describe the epidemiology and determine risk factors for COVID-19 associated mucormycosis. 2: Elaborate the clinical spectrum of Rhino-Orbital-Cerebral Mucormycosis (ROCM), pattern of neuroaxis involvement and it's radiological correlates. METHODS: Observational study. Consecutive, confirmed cases of mucormycosis (N = 55) were included. A case of mucormycosis was defined as one who had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological examination (HPE). Data pertaining to epidemiology, risk factors, clinico-radiological features were analysed using percentage of total cases. RESULTS: Middle aged, diabetic males with recent COVID-19 infection were most affected. New onset upper jaw toothache was a striking observation in several cases. Among neurological manifestations headache, proptosis, vision loss, extraocular movement restriction; cavernous sinus, meningeal and parenchymal involvement were common. Stroke in ROCM followed a definitive pattern with watershed infarction. CONCLUSIONS: New onset upper jaw toothache and loosening of teeth should prompt an immediate search for mucormycosis in backdrop of diabetic patients with recent COVID-19 disease, aiding earlier diagnosis and treatment initiation. Neuroaxis involvement was characterized by a multitude of features pertaining to involvement of optic nerve, extraocular muscles, meninges, brain parenchyma and internal carotid artery.
Subject(s)
COVID-19/complications , Mucormycosis/epidemiology , Mucormycosis/etiology , Adult , COVID-19/epidemiology , Central Nervous System Fungal Infections/epidemiology , Central Nervous System Fungal Infections/etiology , Eye Infections, Fungal/epidemiology , Eye Infections, Fungal/etiology , Female , Humans , India/epidemiology , Male , Middle Aged , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Nervous System Diseases/microbiology , Orbit/microbiology , Orbital Diseases/epidemiology , Orbital Diseases/microbiology , Prevalence , Rhinitis/epidemiology , Rhinitis/etiology , Rhinitis/microbiology , Risk Factors , SARS-CoV-2/physiology , Socioeconomic FactorsABSTRACT
We present an uncommon case of isolated basal ganglia mucormycosis in a patient without any known cause of immunosuppression, but with a history of drug injection. The patient presented a good clinical and radiological response to antifungal treatment without aggressive surgical debridement (liposomal amphotericin B combined with isavuconazole for 4 weeks followed by isavuconazole as maintenance therapy for 10 months).
Subject(s)
Central Nervous System Fungal Infections/etiology , Mucormycosis/etiology , Substance Abuse, Intravenous/complications , Substance Abuse, Intravenous/microbiology , Amphotericin B/administration & dosage , Central Nervous System Fungal Infections/diagnosis , Central Nervous System Fungal Infections/drug therapy , Central Nervous System Fungal Infections/microbiology , Cocaine , Cocaine-Related Disorders/complications , Cocaine-Related Disorders/drug therapy , Cocaine-Related Disorders/microbiology , Drug Therapy, Combination , Drug Users , Humans , Magnetic Resonance Imaging , Male , Marijuana Abuse/complications , Marijuana Abuse/drug therapy , Marijuana Abuse/microbiology , Middle Aged , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/microbiology , Nitriles/administration & dosage , Pyridines/administration & dosage , Substance Abuse, Intravenous/diagnostic imaging , Substance Abuse, Intravenous/drug therapy , Triazoles/administration & dosageABSTRACT
Cerebral abscess due to pigmented molds is a rare but usually fatal infection occasionally seen in transplant recipients. A 67-year-old man of Iraqi origin underwent a deceased donation renal transplant for renal failure and 2 months later was diagnosed with an abscess in the left posterior frontal lobe of his brain. Subsequent biopsy proved this to be due to the mold Rhinocladiella mackenziei. Further interventions included two operations to aspirate the lesion, voriconazole, then liposomal amphotericin B, then a combination of posaconazole and flucytosine which he continued for over 4 years. He also suffered from right ankle pain and was diagnosed with septic arthritis; R mackenziei was isolated from pus aspirated from the ankle joint. He responded well to the treatment and has had little loss of function, and on CT, the cerebral lesion has stabilized. Beta-D-glucan, initially at very high levels proved useful to monitor response over the 5 years and the latest sample was negative (38 pg/mL). This case is notable for the first disseminated case of this infection, its favorable outcome on a novel antifungal combination and a new approach to monitoring the course of disease.
Subject(s)
Antifungal Agents/therapeutic use , Brain Abscess/surgery , Central Nervous System Fungal Infections/therapy , Invasive Fungal Infections/therapy , Triazoles/therapeutic use , Aged , Amphotericin B/therapeutic use , Arthritis, Infectious/microbiology , Ascomycota/drug effects , Brain Abscess/microbiology , Central Nervous System Fungal Infections/diagnosis , Central Nervous System Fungal Infections/etiology , Humans , Immunocompromised Host , Invasive Fungal Infections/diagnosis , Invasive Fungal Infections/etiology , Kidney Transplantation/adverse effects , Male , Treatment OutcomeSubject(s)
Amphotericin B/administration & dosage , Central Nervous System Fungal Infections , Hematopoietic Stem Cell Transplantation , Voriconazole/administration & dosage , Adolescent , Adult , Allografts , Central Nervous System Fungal Infections/drug therapy , Central Nervous System Fungal Infections/etiology , Central Nervous System Fungal Infections/mortality , Child , Disease-Free Survival , Female , Hematologic Neoplasms/mortality , Hematologic Neoplasms/therapy , Humans , Male , Middle Aged , Survival RateABSTRACT
OBJECTIVES: In this study, we presented neuroradiologic findings and diagnoses of neurologic complications in a series of heart transplant recipients. MATERIALS AND METHODS: A retrospective review was conducted at Baskent University Hospital. We searched the hospital and radiology databases and identified 109 heart transplant recipients. Thirty-one of these recipients had neuroradiologic evaluations secondary to presentation of neurologic symptoms after heart transplant, with 18 patients evaluated with computed tomography and 22 patients evaluated with magnetic resonance imaging (overlap of imaging-defined groups occurred in 9 recipients). Computed tomography and magnetic resonance imaging studies were retrieved from the Picture Archiving and Communication System, with each type of imaging retrospectively evaluated on consensus by 2 radiologists. RESULTS: Radiopathologic findings related to symptoms were detected in 12 of the 31 study patients. The most common abnormality was posterior reversible leukoencephalopathy syndrome (5 patients, 4.6%). The other abnormalities were ischemic stroke (3 patients, 2.8%), hemorrhagic stroke (1 patient, 0.9%), intracranial abscess (2 patients, 1.8%), and intracranial dissemination of sinusoidal fungal infection and related hemorrhagic infarct (1 patient, 0.9%). The other 19 heart transplant recipients who underwent computed tomography and/or magnetic resonance imaging for neurologic complaints showed no neuroradiologic findings related to neurologic symptoms. CONCLUSIONS: Posterior reversible leukoencephalopathy syndrome and ischemic stroke were the most common neurologic complications in our heart transplant recipients. The other complications were hemorrhagic stroke, intracranial abscess, and intracranial dissemination of sinusoidal fungal infection. Neurologic complications are common in heart transplant recipients and should be identified promptly for early treatment. For the recognition of these complications, computed tomography should be performed for initial evaluation to rule out edema or hemorrhage. However, in the presence of serious neurologic symptoms that cannot be explained by computed tomography, magnetic resonance imaging should be indicated.
Subject(s)
Central Nervous System Diseases/diagnostic imaging , Diffusion Magnetic Resonance Imaging , Heart Transplantation/adverse effects , Neuroimaging , Tomography, X-Ray Computed , Adolescent , Adult , Brain Abscess/diagnostic imaging , Brain Abscess/etiology , Central Nervous System Diseases/etiology , Central Nervous System Fungal Infections/diagnostic imaging , Central Nervous System Fungal Infections/etiology , Child , Databases, Factual , Female , Hemorrhagic Stroke/diagnostic imaging , Hemorrhagic Stroke/etiology , Humans , Ischemic Stroke/diagnostic imaging , Ischemic Stroke/etiology , Male , Middle Aged , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Posterior Leukoencephalopathy Syndrome/etiology , Predictive Value of Tests , Retrospective Studies , Treatment Outcome , Turkey , Young AdultSubject(s)
Central Nervous System Fungal Infections/diagnosis , Central Nervous System Fungal Infections/etiology , Invasive Pulmonary Aspergillosis/diagnosis , Invasive Pulmonary Aspergillosis/etiology , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Pyrazoles/adverse effects , Pyrimidines/adverse effects , Adenine/analogs & derivatives , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biopsy , Blood Culture/methods , Central Nervous System Fungal Infections/drug therapy , Humans , Invasive Pulmonary Aspergillosis/drug therapy , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Neoplasm Recurrence, Local , Piperidines , Pyrazoles/administration & dosage , Pyrazoles/therapeutic use , Pyrimidines/administration & dosage , Pyrimidines/therapeutic use , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Pattern recognition receptors (PRRs), receptors of the innate immune system, are important in interaction with pathogens. Caspase Recruitment Domain-containing protein 9 (CARD9), a member of PRRs, is an intracellular adaptor protein important in fungal defense. CARD9 deficiency causes a rare primary immunodeficiency (PID) characterized by superficial and deep fungal infections. We report a 17year-old female with a homozygous nonsense mutation in CARD9, who presented with severe cerebral fungal infection of the central nervous system. She was also found to have an heterozygous NLRP12 mutation, which may have had add-on effect on the severity of the infection.
Subject(s)
CARD Signaling Adaptor Proteins/genetics , Central Nervous System Fungal Infections/etiology , Codon, Nonsense , Mycoses/etiology , Adolescent , CARD Signaling Adaptor Proteins/deficiency , Central Nervous System Fungal Infections/genetics , Female , Humans , Intracellular Signaling Peptides and Proteins/genetics , Mycoses/geneticsSubject(s)
Blastomycosis/diagnosis , Central Nervous System Fungal Infections/diagnosis , Lung Diseases, Fungal/diagnosis , Aphasia/etiology , Blastomyces , Blastomycosis/complications , Blastomycosis/diagnostic imaging , Brain/diagnostic imaging , Brain/microbiology , Central Nervous System Fungal Infections/complications , Central Nervous System Fungal Infections/diagnostic imaging , Central Nervous System Fungal Infections/etiology , Confusion/etiology , Emergency Service, Hospital , Humans , Lung Diseases, Fungal/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Neuroimaging , Radiography, ThoracicABSTRACT
Invasive fungal infections are rare in children with acute lymphoblastic leukemia. It compromises the antileukemia therapy should it happen. Central nervous system fungal infections carry high mortality. We here report the case of a 6.5-year-old girl who developed multiple central nervous system fungal abscesses possibly due to Aspergillus infection during induction therapy for acute lymphoblastic leukemia who has been successfully managed without compromising antileukemia therapy. She has been receiving antifungal therapy and maintenance chemotherapy for 20 months from diagnosis. We reviewed literature about the optimal duration of therapy for such children as the reported cases duration ranged between 4 and 24 months.
Subject(s)
Central Nervous System Fungal Infections/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Antifungal Agents/therapeutic use , Antineoplastic Agents/therapeutic use , Aspergillosis/drug therapy , Aspergillosis/etiology , Central Nervous System Fungal Infections/etiology , Child , Female , Humans , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapyABSTRACT
Mucormycosis is a rare and acute fungal infection which is frequently lethal, usually observed in non-controlled diabetic patients. The infection usually begins in the nose but it can invade the lung, the digestive tract, and the skin. Rhinocerebral mucormycosis accounts for 40 to 49% of mucormycosis cases. We report the case of a 44-year-old diabetic man, presenting with rhinocerebral mucormycosis. Our patient was treated by an association of amphotericin B and surgical debridement.
Subject(s)
Central Nervous System Fungal Infections/diagnosis , Diabetes Complications/diagnosis , Invasive Fungal Infections/diagnosis , Mucormycosis/diagnosis , Rhinitis/diagnosis , Tooth Extraction/adverse effects , Adult , Central Nervous System Fungal Infections/etiology , Diabetes Complications/microbiology , Diabetes Mellitus/microbiology , Humans , Immunocompromised Host , Invasive Fungal Infections/etiology , Male , Mucormycosis/etiology , Postoperative Complications/diagnosis , Postoperative Complications/microbiology , Rhinitis/complications , Rhinitis/microbiologyABSTRACT
Central nervous system mucormycosis is an aggressive fungal infection often ending in fatality. The usual circumstance is an immunocompromised individual presenting with rapidly progressive rhinocerebral involvement. An extremely rare variant of central nervous system mucormycosis isolated to the basal ganglia in an immunocompetent intravenous drug user is detailed in this manuscript. The patient was aggressively treated with aspiration of the fungal abscess and long-term intravenous antifungal agents.
Subject(s)
Basal Ganglia/pathology , Central Nervous System Fungal Infections/etiology , Immunoglobulins, Intravenous/adverse effects , Adult , Antifungal Agents/therapeutic use , Basal Ganglia/diagnostic imaging , Central Nervous System Fungal Infections/diagnostic imaging , Central Nervous System Fungal Infections/therapy , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/drug therapy , Female , Humans , Hypertension/complications , Hypertension/drug therapy , Immunocompromised Host , Magnetic Resonance Spectroscopy , Neurosurgical Procedures/methods , Pregnancy , Rhizopus/pathogenicity , Tomography, X-Ray ComputedABSTRACT
Disseminated infection by Hormographiella aspergillata is extremely rare and small intestine involvement has not been reported previously. A 51-year-old man with myelodysplastic syndrome developed pneumonia after cord blood cell transplantation. Fungal growth from the biopsied lung was identified as H. aspergillata by morphology and the gene analysis. Although antifungal agents including voriconazole and liposomal amphotericin B were administered, he died of disseminated H. aspergillata infection. We review the literature and discuss the treatment and prognosis.
Subject(s)
Agaricales/pathogenicity , Antifungal Agents/therapeutic use , Hematopoietic Stem Cell Transplantation/adverse effects , Immunosuppression Therapy/adverse effects , Invasive Fungal Infections/microbiology , Rare Diseases/microbiology , Agaricales/genetics , Agaricales/isolation & purification , Antifungal Agents/administration & dosage , Brain/diagnostic imaging , Brain/pathology , Central Nervous System Fungal Infections/blood , Central Nervous System Fungal Infections/drug therapy , Central Nervous System Fungal Infections/etiology , Central Nervous System Fungal Infections/pathology , DNA, Fungal , Graft vs Host Disease/prevention & control , Humans , Immunosuppression Therapy/methods , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/therapeutic use , Intestinal Diseases/blood , Intestinal Diseases/drug therapy , Intestinal Diseases/etiology , Intestinal Diseases/pathology , Intestine, Small/pathology , Invasive Fungal Infections/blood , Invasive Fungal Infections/drug therapy , Lung Diseases, Fungal/blood , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/etiology , Lung Diseases, Fungal/pathology , Magnetic Resonance Imaging , Male , Middle Aged , Myelodysplastic Syndromes/surgery , Neutropenia/drug therapy , Neutropenia/etiology , Neutropenia/microbiology , Rare Diseases/blood , Rare Diseases/drug therapy , Sequence Analysis, DNA , Tomography, X-Ray Computed , Transplantation Conditioning/adverse effects , Transplantation Conditioning/methods , Transplantation, Homologous/adverse effectsABSTRACT
Many victims of the tsunami that occurred following the Great East Japan Earthquake on March 11, 2011 developed systemic disorders owing to aspiration pneumonia. Herein, we report a case of tsunami lung wherein Scedosporium aurantiacum was detected in the respiratory tract. A magnetic resonance image of the patient's head confirmed multiple brain abscesses and lateral right ventricle enlargement. In this case report, we describe a potential refractory multidrug-resistant infection following a tsunami disaster.
Subject(s)
Brain Abscess/diagnosis , Brain Abscess/etiology , Central Nervous System Fungal Infections/etiology , Delayed Diagnosis , Near Drowning/complications , Scedosporium , Survivors , Tsunamis , Aged , Amphotericin B/administration & dosage , Antifungal Agents/administration & dosage , Brain Abscess/drug therapy , Brain Abscess/therapy , Central Nervous System Fungal Infections/diagnosis , Central Nervous System Fungal Infections/drug therapy , Female , Humans , Japan , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/etiology , Lung Diseases, Fungal/therapy , Magnetic Resonance Imaging , Pyrimidines/administration & dosage , Scedosporium/isolation & purification , Tomography, X-Ray Computed , Triazoles/administration & dosage , VoriconazoleABSTRACT
Mucormycosis, caused by mucorales, is an acute, rapidly progressive infection associated with high mortality. Rhino-orbitocerebral infection is the most common variant and is generally seen in association with immune deficiency syndromes. Prompt medical treatment of this infection and debridement decreases the mortality rate. We describe a 47-year-old man with crescentic glomerulonephritis on maintenance prednisolone therapy. He had earlier received steroid and cyclophosphamide pulse therapies. Renal functions improved following immunosuppressive treatment. In the third month of maintenance therapy, he presented to us with left-sided facial swelling and bloody nasal discharge. He had high blood sugar and acidic blood pH (ketoacidosis), probably due to steroid therapy. Magnetic resonance imaging of the head and sinuses showed inflammation and mass in the ethmoid sinus and nose with partial septal destruction, proptosis, global destruction of the left eye, brain infarction and carotid artery obliteration. Endoscopic biopsy of the sinuses revealed severe tissue necrosis. Samples of nasal discharge and biopsy tissue showed aseptate hyphae on light microscopy and culture, compatible with Rhizopus. The patient was treated with amphotericin B and multiple wound debridements along with ethmoidectomy and enucleation of the left eye. He was discharged in good general condition but with mild right hemiparesis. On follow-up examination at one year, there were no signs of fungal infection or renal dysfunction.
Subject(s)
Brain Diseases/etiology , Central Nervous System Fungal Infections/etiology , Glomerulonephritis/complications , Mucormycosis/etiology , Nose Diseases/etiology , Orbital Diseases/etiology , Humans , Male , Middle AgedABSTRACT
Fungal infections caused by zygomycetes are important and potentially life threatening infections. These opportunistic moulds have been increasingly implicated in human disease and are most frequently seen in immune compromised patients. We report a case of disseminated infection with Mycocladus corymbifera involving the brain, lungs, kidneys and skin in a 16-year-old patient with acute lymphoblastic leukaemia. The skin lesions played a significant role in the diagnosis of mucormycosis. These infections have an exceedingly high mortality rate and early recognition of cutaneous lesions is essential to successful management.
Subject(s)
Absidia , Central Nervous System Fungal Infections/diagnosis , Dermatomycoses/diagnosis , Zygomycosis/diagnosis , Adolescent , Central Nervous System Fungal Infections/etiology , Central Nervous System Fungal Infections/therapy , Dermatomycoses/etiology , Dermatomycoses/therapy , Female , Humans , Zygomycosis/etiology , Zygomycosis/therapyABSTRACT
Infections are an uncommon but very important etiology of myelitis as a correct diagnosis would allow for timely treatment and recovery. The term "myelitis" is generally used to describe an inflammatory pathologic process affecting the spinal cord and causing an interruption of the ascending and descending pathways, and, therefore, partial or complete loss of function. The onset may be acute or subacute, and the etiology may be cumbersome to determine. This article will review the most recently published literature regarding the infectious agents causing myelitis with an emphasis on diagnosis and treatment.
Subject(s)
Central Nervous System Bacterial Infections/diagnosis , Central Nervous System Fungal Infections/diagnosis , Central Nervous System Parasitic Infections/diagnosis , Central Nervous System Viral Diseases/diagnosis , Myelitis/diagnosis , Central Nervous System Bacterial Infections/drug therapy , Central Nervous System Bacterial Infections/etiology , Central Nervous System Fungal Infections/drug therapy , Central Nervous System Fungal Infections/etiology , Central Nervous System Parasitic Infections/drug therapy , Central Nervous System Parasitic Infections/etiology , Central Nervous System Viral Diseases/drug therapy , Central Nervous System Viral Diseases/etiology , Diagnosis, Differential , Humans , Myelitis/drug therapy , Myelitis/etiologySubject(s)
Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications , Leukemia, Myeloid, Acute/complications , Mucormycosis/diagnosis , Myelodysplastic Syndromes/complications , Blast Crisis , Central Nervous System Fungal Infections/diagnosis , Central Nervous System Fungal Infections/drug therapy , Central Nervous System Fungal Infections/etiology , Colonic Diseases/diagnosis , Colonic Diseases/drug therapy , Colonic Diseases/etiology , Fatal Outcome , Female , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/etiology , Male , Middle Aged , Mucormycosis/drug therapy , Mucormycosis/etiology , Treatment OutcomeSubject(s)
Autonomic Nerve Block/adverse effects , Brain Abscess/etiology , Celiac Plexus , Central Nervous System Fungal Infections/etiology , Cladosporium , Endosonography/adverse effects , Brain Abscess/diagnosis , Brain Abscess/therapy , Central Nervous System Fungal Infections/diagnosis , Central Nervous System Fungal Infections/therapy , Humans , Male , Middle AgedABSTRACT
A 36-year-old African American female with a 14-year history of allergic fungal sinusitis (AFS) presented with progressive worsening headache, fevers, proptosis, and a large frontal lobe brain mass. After excisional biopsy, the non-invasive, dematiaceous mold, Bipolaris australiensis, was identified. We review the epidemiology, etiology, pathophysiology, and clinical presentations of fungal sinusitis, as well as the complex management and multifaceted therapeutic modalities of AFS.