ABSTRACT
We would like to report a case of invasive Fusariosis involving the native mitral valve and complicated by septic thromboembolism. The patient was a known case of end-stage renal disease on maintenance haemodialysis and did not have any of the known risk factors for invasive Fusariosis like neutropaenia, severe T cell immunodeficiency, postsolid organ transplant recipients, posthaematopoietic stem cell transplant recipients and patients who received cytotoxic and/or high-dose corticosteroid therapy.
Subject(s)
Endocarditis, Bacterial/microbiology , Fusariosis/diagnosis , Fusarium/isolation & purification , Heart Valve Diseases/microbiology , Kidney Failure, Chronic/physiopathology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/diagnosis , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Fatal Outcome , Fusariosis/drug therapy , Fusariosis/physiopathology , Heart Valve Diseases/diagnosis , Heart Valve Diseases/drug therapy , Humans , Kidney Failure, Chronic/immunology , Male , Middle Aged , Mitral Valve/pathology , Renal Dialysis , Staphylococcal Infections/drug therapy , Staphylococcal Infections/physiopathology , Treatment RefusalSubject(s)
Antineoplastic Agents/therapeutic use , Fusariosis/complications , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Opportunistic Infections/complications , Protein Kinase Inhibitors/therapeutic use , Protein-Tyrosine Kinases/antagonists & inhibitors , Pyrazoles/therapeutic use , Pyrimidines/therapeutic use , Adenine/analogs & derivatives , Agammaglobulinaemia Tyrosine Kinase , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Fever/etiology , Fever/prevention & control , Fusariosis/immunology , Fusariosis/microbiology , Fusariosis/physiopathology , Fusarium/drug effects , Fusarium/immunology , Fusarium/isolation & purification , Humans , Immunocompromised Host , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Leukemia, Lymphocytic, Chronic, B-Cell/immunology , Leukemia, Lymphocytic, Chronic, B-Cell/physiopathology , Lymphadenopathy/etiology , Lymphadenopathy/prevention & control , Maintenance Chemotherapy , Male , Middle Aged , Neoplasm Recurrence, Local/complications , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/immunology , Opportunistic Infections/immunology , Opportunistic Infections/microbiology , Opportunistic Infections/physiopathology , Piperidines , Protein-Tyrosine Kinases/metabolism , Remission Induction , Treatment OutcomeABSTRACT
OBJECTIVES: To report the outcomes of therapeutic corneal transplant for managing fungal keratitis that is refractory to medical treatment. MATERIALS AND METHODS: Retrospective data analyses of the medical records was performed on 17 patients who underwent a therapeutic corneal transplant for severe culture-proven fungal keratitis between October 2006 and August 2013. We evaluated demographics, fungal organism type, surgical data, recurrence presentation, disease course, follow-up, and graft status. RESULTS: Mean patient age was 53.2 years (range, 33-81 y). The male/female ratio was 12/5. All patients had positive microscopic evaluation and positive culture results for fungal infection. The most common fungal agent was Fusarium sp. (35%). Nine patients reported a history of injury to the cornea and/or contact with plant material or soil. The mean best-corrected visual acuity at the initial visit was 2.45 logMAR unit (range, 0.52-3.10 logMAR unit). The mean follow-up was 14 months (range, 6-76 mo). Four patients underwent evisceration surgery because of graft lysis or uncontrolled recurrent disease. Recurrence of the fungal infection after corneal transplant was seen in 8 patients (47.05%). The graft rejection rate was 18.18%. At the final visit, 5 grafts were clear, 4 were translucent, and 2 were opaque. There were 2 phthisis bulbi owing to catastrophic disease. The mean final best-corrected visual acuity was 1.64 logMAR unit (range, 0.22-3.10 logMAR unit). CONCLUSIONS: Although therapeutic corneal transplant has a higher incidence of infection recurrence and graft failure, it continues to be an effective treatment for uncontrolled, refractory fungal keratitis cases to save the affected eye.
Subject(s)
Antifungal Agents/therapeutic use , Corneal Transplantation , Eye Infections, Fungal/surgery , Fusariosis/surgery , Keratitis/surgery , Adult , Aged , Aged, 80 and over , Corneal Transplantation/adverse effects , Drug Resistance , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/microbiology , Eye Infections, Fungal/physiopathology , Female , Fusariosis/diagnosis , Fusariosis/microbiology , Fusariosis/physiopathology , Fusarium/isolation & purification , Graft Rejection/etiology , Humans , Keratitis/diagnosis , Keratitis/microbiology , Keratitis/physiopathology , Male , Middle Aged , Recovery of Function , Recurrence , Retrospective Studies , Time Factors , Treatment Outcome , Visual AcuityABSTRACT
Mycetoma is defined as a fungus ball that fills a preexisting lung cavity, most frequently being of tuberculous or sarcoid etiology. The most frequently isolated fungus is the species of Aspergillus, but other fungi such as Fusarium or Zygomycetes can also be present. Most patients lack symptoms. However, presentation may also be with hemoptysis, which can be massive and life-threatening. We describe the case of a 50-year-old man with a history of prior pulmonary tuberculosis, with recurrent episodes of cough and hemoptysis. He was diagnosed to have mycetoma in the left upper lobe cavity. The mycetoma was extracted through bronchoscopy under general anesthesia using a cryoprobe. Treatment was completed with amphotericin B instilled in the cavity and the patient was placed on oral itraconazole. This is the first case report to date in which cryotherapy was used to remove a mycetoma.
