Rhinocerebrale Mucormykose

2018 ◽  
Vol 97 (08) ◽  
pp. 550-554
Author(s):  
Anke Mertens ◽  
Doreen Barche ◽  
Laszlo Scheinpflug ◽  
Friedrich Gunther Scholz ◽  
Stefan Vielhaber ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Amphotericin B ◽  
Exenteratio Orbitae ◽  
Operative Eingriffe

ZusammenfassungMucormykose ist eine Schimmelpilzinfektion, die insbesondere bei immunsupprimierten Patienten rasch progredient verlaufen kann. Uns wurde eine 47-jährige Patientin mit einer Ptosis links bei sonst unauffälligem augenärztlichen Befund vorgestellt. Die Blutzuckerwerte waren bei Diabetes mellitus deutlich erhöht.Das CT der Nasennebenhöhlen zeigte eine moderate Verlegung des Siebbeins links und in der cMRT erschienen der orbitale Fettkörper und die Augenmuskeln verdickt. Als noch eine Hebungseinschränkung des Bulbus auftrat, erfolgte die Nasennebenhöhlenoperation. Mikrobiologisch wurde dabei eine Mucormykose (Gattung Lichtheimia) gesichert. Die Patientin erblindete links, sodass die Indikation zur Exenteratio orbitae links und Re-Pansinusoperation zur Fokussanierung gestellt wurde. Liposomales Amphotericin B und Posaconazol wurden hochdosiert verabreicht und der Blutzucker wurde streng reguliert. Bei bildmorphologischem Progress waren weitere operative Eingriffe bis zur Duraresektion nötig.Der Verlauf war durch Komplikationen (rezidivierende septische Episoden, Niereninsuffizienz, ein bifrontales Epiduralhämatom sowie multiple zerebrale Mikroinfarkte) erschwert, doch schlussendlich konnte sie nach 8-monatiger Hospitalisation entlassen werden. Eine Epithese wurde angepasst und sie ist seit 24 Monaten (nach Diagnose) rezidivfrei.

scholarly journals Isolates of Cryptococcus Neoformans from Non-HIV and Non-Transplant Hospitalized Patients

2018 ◽  
Vol 1 (2) ◽  
pp. 45
Author(s):  
Yun Xi ◽  
Peng Zhao ◽  
Ling Tao ◽  
Jing Huang ◽  
Youming Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cryptococcus Neoformans ◽  
Amphotericin B ◽  
Drug Susceptibility ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Class A ◽  
Tertiary Hospitals ◽  
Underlying Diseases

A retrospective cross-sectional study for patients with confirmed Cryptococcus neoformans meningitis (CM) in non-HIV-infected and non-transplant hosts in two class-A tertiary hospitals in Guangzhou, China is reported. 181 CM patients were enrolled during the study period, 48% (87/181) of which died. Underlying diseases were risk factor associated with higher mortality, among which diabetes mellitus ranked first for the incidence of CM. The mortality was not related to antifungal drug susceptibility. All strains were considered susceptible to amphotericin B, although interpretative breakpoints for amphotericin B have not yet been established. According to the CLSI guidelines, most of the strains in our study were susceptible to voriconazole, fluconazole, fluorocytosine and dose-dependently susceptible to itraconazle.

scholarly journals Successful Treatment ofSaksenaeasp. Osteomyelitis by Conservative Surgery and Intradiaphyseal Incorporation of Amphotericin B Cement Beads

2018 ◽  
Vol 63 (1) ◽  
Author(s):  
Perrine Parize ◽  
Anne-Claire Mamez ◽  
Dea Garcia-Hermoso ◽  
Valérie Dumaine ◽  
Sylvain Poirée ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Amphotericin B ◽  
Successful Treatment ◽  
Liposomal Amphotericin ◽  
Traumatic Injury ◽  
Conservative Surgery ◽  
Direct Inoculation ◽  
Immunocompetent Patients ◽  
Systemic Antifungal Therapy

ABSTRACTOsteoarticular mucormycosis cases are quite rare and challenging infections that are mostly due to direct inoculation during traumatic injury among immunocompetent patients. Classic management includes a combination of aggressive surgical debridement, which may lead to amputation, and long-term systemic liposomal amphotericin B therapy. This article describes the successful treatment ofSaksenaeasp. osteomyelitis in a patient with diabetes mellitus, using a combination of systemic antifungal therapy and conservative surgery with insertion of amphotericin-impregnated cement beads.

Diagnose und zielgerichtete Therapie der Fournier-Gangrän mit septischem Verlauf: Vorstellung eines Behandlungsalgorithmus, Identifikation von Risikofaktoren, Betrachtung des Mikrobioms und Abgleich mit der Literatur

2021 ◽  
Author(s):  
Aliona Wöhler ◽  
Robert Schwab ◽  
Christoph Güsgen ◽  
Sebastian Schaaf ◽  
Carolin Weitzel ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Sofa Score ◽  
Zielgerichtete Therapie ◽  
Nekrotisierende Fasziitis ◽  
Operative Eingriffe

Zusammenfassung Hintergrund Die Fournier-Gangrän ist eine nekrotisierende Fasziitis Typ I der genitalen und perinealen Regionen, die insbesondere bei schweren Verläufen und systemischer Sepsis mit einer hohen Letalität vergesellschaftet ist. Der Schwerpunkt wurde auf die Evaluation der Risikofaktoren und Komorbiditäten, auf das bakteriologische Spektrum, laborchemische Analysen, Mortalität und den Verlauf nach dem algorithmischen Vorgehen gelegt. Material und Methoden Es wurden 10 Patienten am Bundeswehrzentralkrankenhaus Koblenz im Zeitraum von 2010 bis 2019 mit einer Fournier-Gangrän und Sepsis sowie einer mindestens 48-stündigen Intensivtherapie erfasst und deskriptiv analysiert. Ergebnisse Die Patientenkohorte bestand aus 6 männlichen und 4 weiblichen Patienten mit einem Durchschnittsalter von 62 Jahren (Range 42 – 78 Jahre). Der durchschnittliche Zeitpunkt zwischen Auftreten der Beschwerden und der Krankenhausaufnahme betrug 4 Tage (Range 3 – 5). Die häufigste Genese war ein Bagatelltrauma bei bestehender entgleister Diabeteserkrankung (30%). Diabetes mellitus (60%) und Adipositas (80% mit BMI > 25) waren führende Risikofaktoren. Bei 90% der Patienten bestand eine polymikrobielle Besiedlung. Alle Patienten wiesen eine Multiorgandysfunktion auf und hatten einen SOFA-Score zwischen 3 und 17 Punkten. Die Mortalitätsrate betrug in unserem Patientenkollektiv 40%. Signifikante Unterschiede zwischen überlebenden und verstorbenen Patienten zeigten PCT, INR und aPTT (p < 0,05). Schlussfolgerung Die Fournier-Gangrän ist insbesondere bei septischem Verlauf nach wie vor eine Erkrankung mit hoher Letalitätsrate. Bei foudroyantem Verlauf bedarf es einer unmittelbaren Diagnosestellung sowie eines aggressiven operativen Vorgehens, um die Letalität so gering wie möglich zu halten. Nach initialem radikalem Débridement sowie stabilisierenden intensivmedizinischen Maßnahmen folgen weitere operative Eingriffe. In der postakuten Phase hat sich die Anwendung der Vakuumtherapie zur Defektverkleinerung bewährt.

Invasive Fungal Rhinosinusitis Caused by Curvularia in a Patient With Type 1 Diabetes Mellitus: A Case Report

2020 ◽  
pp. 089719002096619
Author(s):  
Victoria Marinucci ◽  
Elias B. Chahine ◽  
Larry M. Bush
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Sinus Surgery ◽  
Liposomal Amphotericin B ◽  
Fungal Rhinosinusitis ◽  
Invasive Fungal Rhinosinusitis

Invasive fungal rhinosinusitis (IFRS) is a serious illness requiring early diagnosis, surgical debridement, and administration of antifungals. We report a case of an acute IFRS caused by Curvularia in a patient with diabetes mellitus. An 18-year-old female presented to the emergency department with an acute onset of fever, headache, facial discomfort, and a blood glucose reading of 500 mg/dL. The patient was admitted for the management of hyperosmolar hyperglycemia. Her past medical history includes uncontrolled type 1 diabetes mellitus and a recent toothache. A computed tomography scan of the facial maxillary region revealed sinus disease with bony erosion. Empiric therapy with liposomal amphotericin B 400 mg i.v. every 24 hours, piperacillin/tazobactam 4.5 g i.v. every 6 hours and vancomycin 1 g i.v. every 12 hours was started. A functional endoscopic sinus surgery revealed invasive rhinosinusitis and cultures were positive for fungal elements. The patient was discharged on liposomal amphotericin B 400 mg i.v. daily and cefuroxime 500 mg orally twice daily. However, she was readmitted for the management of acute kidney injury and was discharged on itraconazole capsules 200 mg orally twice daily. Sinus cultures grew Curvularia and itraconazole was prescribed for 6 weeks, but the patient discontinued treatment after 3 weeks and had no signs or symptoms of rhinosinusitis when she was last seen in the clinic. The possibility of IFRS should be explored in patients with diabetes and signs and symptoms of rhinosinusitis.

Seltene nuklearmedizinische Untersuchungen: Die Magenfunktionsszintigrafie

2018 ◽  
Vol 41 (02) ◽  
pp. 135-139
Author(s):  
Rainer Linke
Keyword(s):  
Diabetes Mellitus ◽  
Operative Eingriffe ◽  
Übelkeit Und Erbrechen

ZusammenfassungNuklearmedizinische Verfahren erlauben die nicht invasive Erfassung von Organfunktionen des Verdauungstraktes, allerdings wird aufgrund des immer umfangreicher werdenden diagnostischen Spektrums (Atemtest, Ultraschall, Endoskopie, Manometrie, MRT) zunehmend seltener an diese Untersuchungsmethoden gedacht. Dennoch können nuklearmedizinische Verfahren weiterhin einen wichtigen Beitrag in der Diagnostik von Erkrankungen des oberen Gastrointestinaltraktes leisten. So kann szintigrafisch die Magenfunktion visuell und quantitativ erfasst werden. Der Magen hat die Aufgabe, die Nahrung nach der Ösophaguspassage vorübergehend zu speichern und fraktioniert in den Dünndarm zu entleeren. Eine phasische Peristaltik des Magens dient der Durchmischung und Zerkleinerung des Speisebreis. Störungen der Magenfunktion können Beschwerden wie Völlegefühl, Blähungen, epigastrische Schmerzen, Übelkeit und Erbrechen verursachen. Ursächlich für eine Magenfunktionsstörung sind operative Eingriffe (Fundoplikatio, Magenteilresektion), aber auch Stoffwechselerkrankungen (z. B. Diabetes mellitus), Kollagenosen, Gastritiden oder selten auch Tumoren. Zudem müssen auch funktionelle Krankheitsbilder oder Nebenwirkungen von Medikamenten in Betracht gezogen werden. Mit der Magenfunktionsszintigrafie kann das Ausmaß einer Funktionsstörung einfach und schnell erfasst und können Kenntnisse über die Magenentleerung und die peristaltische Aktivität des Magens gewonnen werden. Untersuchungen mit radioaktiv markierten Testspeisen sind physiologisch und nicht invasiv. Je nach zugrundeliegender Erkrankung bzw. Störung finden sich typische Befundkombinationen, die eine differenzial- und artdiagnostische Einordnung ermöglichen.

scholarly journals A Review on Mucormycosis: Disease transmission, Risk factors, Management and Outcomes of Mucormycosis

2021 ◽  
Vol 71 (1) ◽  
Author(s):  
Shivam Bhaskar ◽  
Sunil Kumar ◽  
Surabhi Dwivedi ◽  
Anil Kumar Shrivastava
Keyword(s):  
Diabetes Mellitus ◽  
Amphotericin B ◽  
Disease Transmission ◽  
Death Rate ◽  
Antifungal Treatment ◽  
Transmission Risk ◽  
The People ◽  
Amphotericin B Deoxycholate ◽  
Careful Treatment ◽  
Limited Length

To portray the study of disease transmission, the board and result of people with Mucormycosis; and to assess the danger factors related with mortality. We led a planned observational examination including continuous people with demonstrated Mucormycosis across 12 focuses from India. The segment profile, microbiology, inclining elements, the board and 90-day mortality were recorded; hazard factors for mortality were broke down. We included 465 patients. Rhino-orbital mucormycosis was the most well-known (315/465, 67.7%) show followed by aspiratory (62/465, 13.3%), cutaneous (49/465, 10.5%), and others. The inclining factors included diabetes mellitus (342/465, 73.5%), harm (42/465, 9.0%), relocate (36/465, 7.7%), and others. Rhizopus species (231/290, 79.7%) were the most well-known followed by Apophysomyces variabilis (23/290, 7.9%), and a few uncommon Mucorales. Careful treatment was acted in 62.2% (289/465) of the members. Amphotericin B was the essential treatment in 81.9% (381/465), and posaconazole was utilized as mix treatment in 53 (11.4%) people. Antifungal treatment was unseemly in 7.6% (30/394) of the people. The 90-day death rate was 52% (242/465). On multivariate examination, dispersed and rhino-orbital (with cerebral augmentation) mucormycosis, more limited span of manifestations, more limited length of antifungal treatment, and talent with amphotericin B deoxycholate (versus liposomal) were autonomous danger components of mortality. A joined clinical and careful the executives was related with a superior endurance. Diabetes mellitus was the prevailing inclining factor in all types of mucormycosis. Consolidated careful and clinical administration was related with better results. A few holes surfaced in the administration of mucormycosis. The more extraordinary Mucorales recognized in the investigation warrant further assessment.

scholarly journals Mucormycosis: Effect of Comorbidities and Repeated Debridement on the Outcome

2019 ◽  
Vol 27 (1) ◽  
pp. 8-14
Author(s):  
Harshavardhan N Reddy ◽  
Sanjay B Patil ◽  
Chandrakiran Channegowda ◽  
Aiswarya Muralidharan
Keyword(s):  
Diabetes Mellitus ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B ◽  
Invasive Infection ◽  
Comorbid Conditions ◽  
Tissue Necrosis ◽  
Immunocompromised Hosts ◽  
Vessel Thrombosis

Introduction: Mucormycosis is an aggressive, invasive infection caused by ubiquitous filamentous fungibelonging to the subphylum Mucormycotina, order Mucorales. Mucormycosis most commonly affects immunocompromised hosts, but are rarely reported in immunocompetent hosts as well. The most common reported sites of invasive mucormycosis have been the sinuses (39%), lungs (24%), and skin (19%). The hallmark of mucormycosis is angioinvasion resulting in vessel thrombosis and hence, tissue necrosis.   Materials and Methods: Ambispective study of 20 cases with mucormycosis seen and treated in our hospital between 2009 and 2015 and followed up to 2017 to compare the prognosis of the cases of repeated debridement with that of single debridement and effect of comorbidities in the outcome of patients mortality .   Results: Out of 20 patients 19 (95%) received Liposomal Amphotericin B. 11 (55%) were male and 9 (45%) were female. All the 7 (35%) who underwent repeated debridement survived. Out of 13 (65%) patients who underwent single debridement, 5 (25%) did not survive. 2 (10%) patients were lost for follow up. The survival amongst the patients undergoing multiple debridement and single debridement was statistically significant (p=0.042) Conclusion: The chances of survival are better in cases with better controlled comorbid conditions like diabetes mellitus. Repeated debridement with Liposomal Amphotericin B is the most effective mode of management.

“Mucormycosis” The Emerging Global Threat – A Complete Review

2021 ◽  
Vol 8 (6) ◽  
pp. 193-198
Author(s):  
A R Shabaraya ◽  
Nypunya K
Keyword(s):  
Diabetes Mellitus ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Solid Organ Transplantation ◽  
Secondary Prophylaxis ◽  
Liposomal Amphotericin B ◽  
High Dose ◽  
Solid Organ ◽  
Life Threatening ◽  
Global Threat

Mucormycosis is a life-threatening invasive fungal infection that affects people who are immunocompromised (haematological malignancies, solid organ transplantation, diabetes mellitus). Pulmonary, rhinocerebral, cutaneous, and disseminated infections are the most common. Controlling mucormycosis requires reversing the underlying problems. Treatment for mucormycosis also includes quick and vigorous surgery. Extensive surgical debridement of necrotic tissues is required. Finally, an antifungal treatment is required. High-dose liposomal amphotericin B (5 mg/kg/day) is the first-line treatment for mucormycosis. Antifungal chemotherapy has no set length; instead, it is determined by the remission of all related symptoms and results (usually 6-8 weeks). Posaconazole maintenance therapy/secondary prophylaxis should be recommended in patients who have a persistently weakened immune system. Keywords: Mucormycosis, Diabetes mellitus, Liposomal Amphotericin B.

scholarly journals A Case of Obstructing Candida Glabrata Bladder Mucus Treated with Intravesicular Amphotericin - B

2021 ◽  
Vol 6 (10) ◽  
pp. 720-724
Author(s):  
Dr. Nicholas Gaeto, PGY 2, ◽  
Dr. Glenn Goodwin, PGY 2, D.O. ◽  
Mara Seat, OMS III
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Medical History ◽  
Amphotericin B ◽  
Enterococcus Faecalis ◽  
Candida Glabrata ◽  
Past Medical History ◽  
Emphysematous Cystitis ◽  
History Of ◽  
Repeat Imaging

A 51-year-old female with a past medical history of poorly controlled diabetes mellitus presented to the emergency department with signs of emphysematous cystitis and pyelonephritis with associated Enterococcus faecalis bacteremia and Candida Glabrata (C.Glabrata) fungemia. She was treated with micafungin and amoxicillin with improvement in her symptoms. During her course she underwent repeat imaging which showed improvement in her cystitis and no obstruction in her bladder. She was discharged on home IV micafungin. She returned to the emergency department the next day with acute urinary obstruction and was found to have a completely obstructing mucus ball in her bladder. This was removed cystoscopically and surgical cultures grew C. glabrata. She was successfully treated with intra-vesicular amphotericin B and was discharged.

scholarly journals Review on mucormycosis in the oro-facial region: an overview

2021 ◽  
Vol 8 (10) ◽  
pp. 5060
Author(s):  
Yogashree Sonawane ◽  
Ankeeta Ahire ◽  
Ananya Saha
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Amphotericin B ◽  
Clinical Manifestation ◽  
Clinical Manifestations ◽  
Predisposing Factor ◽  
Facial Region ◽  
Drug Of Choice ◽  
Orofacial Region

The study aims to identify the clinical manifestation of mucormycosis in the oro-facial region to distinguish the role of meticulous intraoral examination for early and timely diagnosis based on the review of reported cases, to propose the role of diabetes mellitus as a predisposing risk factor for mucormycosis in the oro-facial region, to propose the association of traumatic incidents like tooth extraction as a risk factor for mucormycosis in immune-compromised individuals and to perceive the use of amphotericin-B in its treatment. A systematic review was conducted on an electronic database, Google Scholar to analyze the existing data for the clinical manifestation of mucormycosis in the orofacial region. Out of the existing literature on this topic for various timelines, a period of 10 years from 2011 to 2021 was selected for the study. The sample size was calculated taking into consideration the 99.99% confidence interval. The data was extracted from these relevant articles in Microsoft Excel, showing remarkable conclusions. Mucormycosis does not show stereotypical clinical manifestations and thus the diagnosis of mucormycosis has to be confirmed through culture studies and histopathological or radiological ways. Diabetes Mellitus serves as a predisposing factor for mucormycosis in the oro-facial region other than the COVID-19 infection and immune-compromised conditions. Amphotericin-B was a drug of choice for the treatment of mucormycosis by many practitioners. The only hindrance to its usage being its nephrotoxicity.

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