Mucormycosis

2020 ◽  
Vol 41 (01) ◽  
pp. 099-114 ◽  
Author(s):  
Gail Reid ◽  
Joseph P. Lynch ◽  
Michael C. Fishbein ◽  
Nina M. Clark
Keyword(s):  
Hematological Malignancies ◽  
Organ Transplant ◽  
Developed Countries ◽  
Underlying Disease ◽  
Diagnostic Value ◽  
Therapeutic Trials ◽  
Contaminated Food ◽  
Common Clinical Presentation ◽  
Disseminated Disease ◽  
Immunocompromised Hosts

AbstractMucormycosis is an infection caused by a group of filamentous molds within the order Mucorales. Infections may result from ingestion of contaminated food, inhalation of spores into the nares or lungs, or inoculation into disrupted skin or wounds. In developed countries, mucormycosis occurs primarily in severely immunocompromised hosts (e.g., those with hematological malignancies, organ transplantation, neutropenia, autoimmune disorders, or other impairments in immunity). Only 6 to 10% of cases occur in subjects with no underlying disease. In contrast, in developing countries, most cases of mucormycosis occur in persons with poorly controlled diabetes mellitus or in immunocompetent subjects following trauma. Mucormycosis exhibits a marked propensity to invade blood vessels, leading to thrombosis, necrosis, and infarction of tissue. Mortality associated with invasive mucormycosis is high (> 30–50%), with 90% mortality associated with disseminated disease. Mortality rates are much lower, though still significant (10–30%), among patients with localized cutaneous disease.The diagnosis of mucormycosis relies upon histopathology and culture. Blood tests are of limited diagnostic value. Even with disseminated disease, blood cultures are usually negative. Mucorales have a distinct histological appearance, with irregular, nonseptate hyphae that branch at right angles. Cultures and/or polymerase chain reaction (PCR) are important to identify the genera.Based on anatomic localization, mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM), (2) pulmonary, (3) cutaneous, (4) gastrointestinal (GI), (5) disseminated, and (6) mucormycosis of uncommon sites. Among diabetics, ROCM is the most common clinical presentation, whereas lung involvement is uncommon. In contrast, among organ transplant recipients or patients with hematological malignancies (HemeM), pulmonary and disseminated diseases are most common. Mucormycosis can progress rapidly, and delay in initiation of treatment by even a few days markedly worsens outcomes.Due to the rarity of mucormycosis, randomized controlled therapeutic trials have not been performed. Lipid formulations of amphotericin B (LFAB) are the mainstay of therapy, but the newer triazoles, posaconazole (POSA) and isavuconazole (ISAV) (the active component of the prodrug isavuconazonium sulfate), may be effective in patients refractory to or intolerant of LFAB. Early surgical debridement or excision plays an important adjunctive role. Additional studies are required to assess the optimal duration of therapy as well as the specific roles of LFAB and the triazoles in the treatment of mucormycosis.

scholarly journals Disease Entities in Mucormycosis

2019 ◽  
Vol 5 (1) ◽  
pp. 23 ◽  
Author(s):  
Alexandra Serris ◽  
François Danion ◽  
Fanny Lanternier
Keyword(s):  
Hematological Malignancy ◽  
Clinical Symptoms ◽  
Underlying Disease ◽  
Severe Form ◽  
Pulmonary Mucormycosis ◽  
Burn Units ◽  
Contaminated Food ◽  
Direct Inoculation ◽  
Cerebral Infections ◽  
Disseminated Disease

Mucormycosis is an emerging life-threatening fungal infection caused by Mucorales. This infection occurs mainly in immunocompromised patients, especially with hematological malignancy, transplantation, or diabetes mellitus. Rhino-orbito-cerebral and pulmonary mucormycosis are the predominant forms. Interestingly, location is associated with the underlying disease as pulmonary mucormycosis is more frequent in hematological malignancy patients whereas rhino-orbito-cerebral mucormycosis is associated with diabetes. Cutaneous mucormycosis results from direct inoculation, mainly after trauma or surgery. Gastro-intestinal mucormycosis occurs after ingestion of contaminated food or with contaminated device and involves the stomach or colon. Disseminated disease is the most severe form and is associated with profound immunosuppression. Uncommon presentations with endocarditis, osteoarticluar or isolated cerebral infections are also described. Finally, health-care associated mucormycosis is a matter of concern in premature newborns and burn units. Clinical symptoms and CT scan findings are not specific, only the early reversed halo sign is associated with pulmonary mucormycosis. Circulating Mucorales DNA detection is a recent promising diagnostic tool that may lead to improving the diagnosis and prompting therapeutic initiation that should include antifungal treatment, correction of the underlying disease and surgery when feasible.

Adenovirus: Epidemiology, Global Spread of Novel Types, and Approach to Treatment

2021 ◽  
Vol 42 (06) ◽  
pp. 800-821
Author(s):  
Joseph P. Lynch ◽  
Adriana E. Kajon
Keyword(s):  
Hemorrhagic Cystitis ◽  
Organ Transplant ◽  
Clinical Manifestations ◽  
The United States ◽  
Healthy Children ◽  
Drug Of Choice ◽  
Therapeutic Trials ◽  
Military Recruits ◽  
Tissue Tropisms ◽  
Disseminated Disease

AbstractAdenoviruses (AdVs) are DNA viruses that typically cause mild infections involving the upper or lower respiratory tract, gastrointestinal tract, or conjunctiva. Rare manifestations of AdV infections include hemorrhagic cystitis, hepatitis, hemorrhagic colitis, pancreatitis, nephritis, or meningoencephalitis. AdV infections are more common in young children, due to lack of humoral immunity. Epidemics of AdV infection may occur in healthy children or adults in closed or crowded settings (particularly military recruits). The vast majority of cases are self-limited. However, the clinical spectrum is broad and fatalities may occur. Dissemination is more likely in patients with impaired immunity (e.g., organ transplant recipients, human immunodeficiency virus infection). Fatality rates for untreated severe AdV pneumonia or disseminated disease may exceed 50%. More than 100 genotypes and 52 serotypes of AdV have been identified and classified into seven species designated HAdV-A through -G. Different types display different tissue tropisms that correlate with clinical manifestations of infection. The predominant types circulating at a given time differ among countries or regions, and change over time. Transmission of novel strains between countries or across continents and replacement of dominant viruses by new strains may occur. Treatment of AdV infections is controversial, as prospective, randomized therapeutic trials have not been done. Cidofovir has been the drug of choice for severe AdV infections, but not all patients require treatment. Live oral vaccines are highly efficacious in reducing the risk of respiratory AdV infection and are in routine use in the military in the United States but currently are not available to civilians.

scholarly journals Breaking the mold: a brief review on the diagnostic and treatment approaches of mucormycosis

2021 ◽  
Author(s):  
Aroop Mohanty ◽  
Pratima Gupta ◽  
Saurabh Varshney ◽  
Ankita Kabi ◽  
Sumeet Angral
Keyword(s):  
Hematological Malignancies ◽  
Indian Subcontinent ◽  
Organ Transplant ◽  
Complete Removal ◽  
Integrated Approach ◽  
Underlying Disease ◽  
Solid Organ ◽  
Susceptible Population ◽  
Uncontrolled Diabetes ◽  
Causative Agents

<p class="abstract">Mucormycosis is a severe emerging angioinvasive fungal infection that occurs predominantly in immunocompromised individuals. The incidence of this disease seems to be increasing in recent years with the emergence of new causative agents and rise of the susceptible population. The present COVID-19 pandemic has seen an un-precented increase in the number of mucormycosis cases all over the world. It has emerged as one of the most common complication of COVID-19 leading to severe morality. Uncontrolled diabetes has been postulated to be the most common underlying disease in developing countries and hematological malignancies in case of the high-income countries. Besides diabetes, chronic renal failure and tuberculosis have also been predisposed in the Indian subcontinent. Rhino-cerebral form is mostly seen in diabetics whereas the pulmonary type is the most common presentation in patients with hematological malignancies and solid organ transplant. Diagnosis and treatment of this rapidly progressive disease is equally challenging. Microscopy and culture are the cornerstone for the diagnosis, but if assisted by imaging and molecular assays, it plays an important role in the correct and early identification of the causative agent. Successful management of mucormycosis is based on an integrated approach, including reversal or discontinuation of underlying risk factors, early administration of antifungal agents, and complete removal of infected tissue and use of various adjunctive therapies.</p>

scholarly journals Herpes Zoster in Solid Organ Transplantation: Incidence and Risk Factors

2021 ◽  
Vol 12 ◽  
Author(s):  
Marcia M. L. Kho ◽  
Stefan Roest ◽  
Dominique M. Bovée ◽  
Herold J. Metselaar ◽  
Rogier A. S. Hoek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Herpes Zoster ◽  
Multivariable Analysis ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Clinical Signs ◽  
Significant Risk ◽  
Solid Organ ◽  
Disseminated Disease ◽  
Cmv Prophylaxis

BackgroundStudies on herpes zoster (HZ) incidence in solid organ transplant (SOT) recipients report widely varying numbers. We investigated HZ incidence, severity, and risk factors in recipients of four different SOTs, with a follow-up time of 6–14 years.MethodsRecords of 1,033 transplant recipients after first heart (HTx: n = 211), lung (LuTx: n = 121), liver (LiTx: n = 258) and kidney (KTx: n = 443) transplantation between 2000 and 2014 were analyzed for VZV-PCR, clinical signs of HZ, and complications.ResultsHZ was diagnosed in 108 of 1,033 patients (10.5%): 36 HTx, 17 LuTx, 15 LiTx, and 40 KTx recipients. Overall HZ incidence rate after HTx (30.7 cases/1,000 person–years (PY)), LuTx (38.8 cases/1,000 PY), LiTx (22.7 cases/1,000 PY) and KTx (14.5 cases/1,000 PY) was significantly higher than in the general 50–70 year population. Multivariable analysis demonstrated age ≥50 years at transplantation (p = 0.038, RR 1.536), type of organ transplant (overall p = 0.002; LuTx p = 0.393; RR 1.314; LiTx p = 0.011, RR 0.444; KTx p = 0.034, RR 0.575), CMV prophylaxis (p = 0.043, RR 0.631) and type of anti-rejection therapy (overall p = 0.020; methylprednisolone p = 0.008, RR 0.475; r-ATG p = 0.64, RR1.194) as significant risk factors. Complications occurred in 33 of 108 (31%) patients (39% of HTx, 47% of LuTx, 20% of LiTx, 20% of KTx): post-herpetic neuralgia, disseminated disease, and cranial nerve involvement.ConclusionHZ incidence and severity in SOT recipients are most pronounced after heart and lung transplantation, in older patients, and when CMV prophylaxis is lacking.

Phaeohyphomycosis

2020 ◽  
Vol 41 (01) ◽  
pp. 131-140 ◽  
Author(s):  
Jonathan T. Arcobello ◽  
Sanjay G. Revankar
Keyword(s):  
Fungal Infections ◽  
Case Reports ◽  
Invasive Disease ◽  
Molecular Techniques ◽  
Diagnostic Tools ◽  
Dematiaceous Fungi ◽  
Serious Disease ◽  
Cerebral Infection ◽  
Disseminated Disease ◽  
Immunocompromised Hosts

AbstractPhaeohyphomycosis refers to infections due to a large group of heterogenous organisms called “dematiaceous” or “melanized” fungi. These fungi are distinguished by the predominance of melanin in their cell walls, which likely acts as a virulence factor. Virtually, everyone is exposed to dematiaceous fungi through inhalation, as they are ubiquitous in the environment, although the development of infection is extremely uncommon. Invasive disease is rare but remains important due to the ability to cause serious disease in immunocompetent and immunocompromised hosts, unlike other fungal infections such as aspergillosis. A large variety of invasive manifestations can be caused by these organisms, including deep local infections, pulmonary infection, cerebral infection, and disseminated disease, which is associated with high mortality. While advances in molecular techniques are promising, they have still not replaced histology and culture as the primary diagnostic tools. Therapy is not standardized and is based primarily on clinical experience from descriptive case reports.

scholarly journals Entamoeba Histolytica: Updates in Clinical Manifestation, Pathogenesis, and Vaccine Development

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Micaella Kantor ◽  
Anarella Abrantes ◽  
Andrea Estevez ◽  
Alan Schiller ◽  
Jose Torrent ◽  
...  
Keyword(s):  
Immune Response ◽  
Entamoeba Histolytica ◽  
Clinical Manifestation ◽  
Vaccine Development ◽  
Current Knowledge ◽  
Developed Countries ◽  
Narrative Review ◽  
Amoebic Colitis ◽  
Causes Of Mortality ◽  
Disseminated Disease

Entamoeba histolyticais the responsible parasite of amoebiasis and remains one of the top three parasitic causes of mortality worldwide. With increased travel and emigration to developed countries, infection is becoming more common in nonendemic areas. Although the majority of individuals infected withE. histolyticaremain asymptomatic, some present with amoebic colitis and disseminated disease. As more is learned about its pathogenesis and the host’s immune response, the potential for developing a vaccine holds promise. This narrative review outlines the current knowledge regardingE. histolyticaandE. disparand insight in the development of a vaccine.

scholarly journals Prospective study of strongyloidosis in patients with hematologic malignancies

1997 ◽  
Vol 30 (5) ◽  
pp. 355-357 ◽  
Author(s):  
Carlos Graeff-Teixeira ◽  
Cristina S.M. Leite ◽  
Cristina L. Sperhacke ◽  
Katia Fassina ◽  
Simone M.G. Petry ◽  
...  
Keyword(s):  
Prospective Study ◽  
Hematological Malignancies ◽  
Severe Disease ◽  
Strongyloides Stercoralis ◽  
Hematologic Malignancies ◽  
Porto Alegre ◽  
Stool Samples ◽  
A Prospective Study ◽  
Disseminated Disease ◽  
Baermann Method

Immunocompromised individuals infected with Strongyloides stercoralis may develop severe hyperinfection or disseminated disease with high mortality. Patients with hematological malignancies are at risk because of immunodepression produced either by the disease or its treatment. A prospective study was undertaken at the Hospital de Clínicas de Porto Alegre, from July 1994 to July 1995. Seventy-two (HIV negative), had 3 stool samples collected at different days and had not received recent anti-helmintic therapy. Larvae, isolated in a modified Baermann method, were found in 6 patients, with a resultant prevalence of 8.3%. No complicated strongyloidosis was documented. The positive result for S. stercoralis larvae was significantly associated (p < 0.001) with eosinophilia. Knowledge of prevalence figures and incidence of severe disease is important to adequate guidelines for empirical treatment besides the rigorous search for strongyloidosis in patients with hematological malignancies.

scholarly journals REALIS: Postgenomic Analysis ofListeria monocytogenes

2002 ◽  
Vol 3 (1) ◽  
pp. 32-34 ◽  
Author(s):  
Uwe Kärst ◽  
The REALIS Consortium
Keyword(s):  
Listeria Monocytogenes ◽  
Opportunistic Infections ◽  
External Environment ◽  
Low Ph ◽  
Health Care Managers ◽  
Food Borne ◽  
Contaminated Food ◽  
Oflisteria Monocytogenes ◽  
Immunocompromised Hosts ◽  
Host Tissues

Listeria monocytogenesis a remarkably successful food-borne pathogen. It is capable a) of surviving and proliferating under conditions that exist within the food chain, such as at low temperatures, high salt and low pH and b) of colonizing animal host tissues after ingestion of contaminated food, causing opportunistic infections mainly, but not exclusively, in immunocompromised hosts. The ultimate goals of REALIS are two fold: Firstly, it aims to completely decipher all genes required for survival in and adaptation ofListeria monocytogenesto two very different environments, ie., the infected host and the external environment. Secondly, using genomics and postgenomic tools, REALIS seeks to precisely address fundamental questions regarding evolutionary relationships between pathogenic and non-pathogenic Listeria and to define qualities of particularly successful clonal pathovariants in causing disease. This project will provide both industry and health care managers with rational approaches to curbing food-borne contamination, minimising risks of infection and providing novel pharmacological approaches for halting the fulminant course of infection.

scholarly journals Scedosporiosis in a Combined Kidney and Liver Transplant Recipient: A Case Report of Possible Transmission from a Near-Drowning Donor

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Rachael Leek ◽  
Erika Aldag ◽  
Iram Nadeem ◽  
Vikraman Gunabushanam ◽  
Ajay Sahajpal ◽  
...  
Keyword(s):  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Near Drowning ◽  
Saprobic Fungi ◽  
Increased Risk ◽  
Serious Infections ◽  
Solid Organ Transplant Recipients ◽  
Immunocompromised Hosts

Scedosporium spp. are saprobic fungi that cause serious infections in immunocompromised hosts and in near-drowning victims. Solid organ transplant recipients are at increased risk of scedosporiosis as they require aggressive immunosuppression to prevent allograft rejection. We present a case of disseminated Scedosporium apiospermum infection occurring in the recipient of a combined kidney and liver transplantation whose organs were donated by a near-drowning victim and review the literature of scedosporiosis in solid organ transplantation.

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