amphotericin-b and Diabetes-Mellitus--Type-1

Candida infection is a relatively common hematogenous nosocomial infection in immunocompromised patients. However, renal disease remains unusual. The mode of presentation in the case reported herein was lumbar pain with fever and hydronephrosis of the left kidney due to a fungal bezoar in the renal pelvis. Clinical and biological suspicion of this disease must quickly lead to ultrasound examination to confirm the diagnosis.

Topics: Amphotericin B; Antifungal Agents; Bezoars; Candidiasis; Child; Diabetes Mellitus, Type 1; Diagnosis, Differential; Female; Flank Pain; Humans; Kidney Pelvis; Opportunistic Infections; Ultrasonography

Mucormycosis is an angioinvasive infection caused by ubiquitous filamentous fungi of the order Mucorales. It is a rapidly progressive fatal infection mostly reported in susceptible individuals, such as those with poorly controlled diabetes or those with defects in phagocytic function. Rhinocerebral mucormycosis is the most common type of mucormycosis in diabetic patients. This case report describes a 17-year-old girl with type 1 diabetes mellitus presenting with rhinocerebral mucormycosis. The patient presented with a history of toothache and facial pain with oedema of left half of face, periorbital oedema and depressed conciousness. She had hyperglycaemia with diabetic ketoacidosis and rapidly developed hemiparesis progressing to quadriparesis and died within 3 days of admission. The current report emphasises the importance of having a high index of suspicion when dealing with patients with diabetes presenting with facial pain or cellulitis and prompt initiation of medical therapy along with surgical debridement for control of rhinocerebral mucormycosis.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Disease Progression; Emergency Service, Hospital; Fatal Outcome; Female; Humans; Immunocompromised Host; India; Mucormycosis; Paranasal Sinus Diseases; Risk Assessment; Rural Population; Severity of Illness Index; Toothache

Rhino-orbito-cerebral mucormycosis (ROCM) is a rare, fulminant opportunistic fungal infection that is mostly seen in immunocompromised or diabetic patients. The disease should be recognised and treated immediately. We present here MR imaging findings of two patients with histopathologically proven ROCM. One of the cases had a history of corticosteroid treatment and iatrogenic diabetes mellitus and although amphotericin B was started immediately, the disease progressed and surgical debridement was necessary. The second case was a patient with diabetes mellitus type 1 in whom ROCM had occurred following an abdominal surgery; amphotericin B treatment alone was adequate in this patient.

Topics: Adrenal Cortex Hormones; Amphotericin B; Antifungal Agents; Brain Diseases; Diabetes Complications; Diabetes Mellitus, Type 1; Humans; Iatrogenic Disease; Immunocompromised Host; Male; Middle Aged; Mucormycosis; Nose Diseases; Opportunistic Infections; Orbital Diseases; Purpura, Thrombocytopenic, Idiopathic

Pulmonary mucormycosis is a relatively uncommon but an important opportunistic fungal infection in immunocompromised patients. It may be acquired by inhalation of spores into the lungs. The pathogenic hallmark of mucormycosis is vascular invasion resulting in thrombosis and tissue infarction/necrosis. The diagnosis can be difficult since presentation does not differ from other forms of pneumonia. Risk factors include neutropenia, haematologic malignancies, uncontrolled diabetes mellitus, skin burns and deferoxamine therapy in dialysis patients. Early recognition, control of underlying diseases and medical-surgical aggressive management are warranted to better outcomes. Pulmonary mucormycosis has a high mortality and medical treatment strategy alone has been associated in several studies to greater mortality. We describe a case of pulmonary mucormicosis with favorable evolution only under medical treatment. We reviewed the bibliography.

Topics: Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 1; Humans; Lung Diseases, Fungal; Male; Middle Aged; Mucormycosis

Mucormycosis refers to a group of rapidly progressive infections caused by fungi belonging to the order Mucorales. Infection most often develops in individuals with immunological or metabolic compromise, although patients without underlying abnormalities have been affected. Specific clinical manifestations are associated with various predisposing factors. Rhinocerebral mucormycosis is the most common form and most frequently develops in individuals with poorly controlled diabetes mellitus. The extent of anatomical involvement and clinical course are unpredictable, depending on the intrinsic factors of the host. Over the past 20 years the prognosis for patients with rhinocerebral mucormycosis, once considered to be a uniformly fatal disease, has improved. Coordinated medical and surgical treatment, including rapid diagnosis, the advent of systemic antifungal agents, aggressive surgical debridement, and control of the underlying disease process, have been credited with its successful management. The range of survival rates recorded with the regimen of combined therapies is wide because the number of patients reported is limited and anatomical involvement is diverse. Survival with intracerebral abscess is rare. The authors describe the successful management of a patient who developed a bifrontal fungal abscess during treatment for rhinocerebral mucormycosis associated with ketoacidosis and diabetes mellitus. The patient remains without radiographic or clinical evidence of infection more than 2 years after treatment. The authors review the characteristic clinical, radiographic, and pathological features of previously reported infections and emphasize the importance of early detection and aggressive treatment in the management of this frequently fulminant and fatal disease.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Abscess; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Follow-Up Studies; Humans; Immunocompromised Host; Male; Mucormycosis; Paranasal Sinus Diseases; Prognosis; Risk Factors; Survival Rate; Treatment Outcome

Mucormycosis with hemipansinusitis and left orbital involvement was observed in a 66-year-old diabetic woman. Diagnosis was confirmed by mycology and pathology examinations. The patient was treated surgically with wide exeresis of necrotic tissue and medically with amphotericin B and insulin. Cure was obtained after three months of treatment at the cost of retraction of the left nostril due to infectious lysis and resection of the nasal infrastructure. The sinus involvement was exceptional compared with reports in the literature. Mucormycosis is an uncommon condition caused by opportunistic infection in immunodepressed subjects. The causal agent is a fungus belonging to the Rhizopus, Absidia or Mucor genera. Prognosis is poor with overall mortality reaching 50%.

Topics: Aged; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Diabetes Mellitus, Type 1; Female; Humans; Insulin; Ketoconazole; Mucormycosis; Nose Diseases; Orbital Diseases; Sphenoid Sinusitis

We report on a case of subcutaneous infection of the arm caused by the coelomycetous fungus Nattrassia mangiferae (formerly Hendersonula toruloidea) in a steroid-dependent diabetic man with chronic obstructive lung disease. The man was a resident of Arizona, where the fungus is known to be endemic on Eucalyptus camaldulensis and on citrus trees. Diagnosis of fungal infection was made by observation of narrow hyphal filaments by histopathology of biopsy specimens and isolation of a fast-growing black mold which demonstrated hyphae and arthroconidia of varying widths typical of the Scytalidium synanamorph (S. dimidiatum). The formation of pycnidia, which at maturity expressed conidia with a central median dark band, allowed for the confirmation of the isolate as N. mangiferae. Remission of the lesions occurred following intravenous therapy with amphotericin B, followed by topical clotrimazole treatment. We use this patient's case report as an opportunity to review the literature on cases of deep infection caused by Scytalidium species, to evaluate the antifungal susceptibilities of a spectrum of Scytalidium isolates, and to review the taxonomy of Scytalidium species isolated from human infections.

Topics: Aged; Amphotericin B; Antifungal Agents; Arm; Dermatomycoses; Diabetes Mellitus, Type 1; Humans; Lung Diseases, Obstructive; Male; Microbial Sensitivity Tests; Mitosporic Fungi; Skin

Pregnant women with respiratory symptoms of pleuritic pain and productive cough should undergo evaluation for coccidioidomycosis. This should include a history of travel or residency in endemic areas and careful assessment for toxic erythema, erythema nodosum, or erythema multiforme. To confirm a diagnosis of this disease, a sputum culture, wet mount, and serological tests should be performed. The risk of dissemination, which is highest in the second and third trimesters, can be estimated by a complement-fixation titer. In disseminated cases aggressive treatment with amphotericin B has improved the previously reported high maternal and neonatal mortality rate. Fortunately, case reports do not indicate that transplacental spread occurs. Reactivation or exacerbation of a chronic low-grade infection during pregnancy may occur in patients treated for prior disseminated disease (32, 34). Interestingly, both of the reported cases of reactivation or exacerbation occurred in insulin-dependent diabetics.

Topics: Adult; Amphotericin B; Coccidioidomycosis; Diabetes Mellitus, Type 1; Erythema Multiforme; Erythema Nodosum; Female; Fetal Death; Humans; Insulin Infusion Systems; Opportunistic Infections; Pregnancy; Pregnancy Complications, Infectious; Pregnancy in Diabetics; Pregnancy Trimester, Second

Topics: Acute Disease; Aged; Amphotericin B; Antifungal Agents; Blindness; Debridement; Diabetes Mellitus, Type 1; Eye Infections, Fungal; Eye Pain; Fatal Outcome; Humans; Intraocular Pressure; Magnetic Resonance Imaging; Male; Mucormycosis; Orbital Diseases; Rhinitis; Slit Lamp Microscopy; Tomography, X-Ray Computed; Visual Acuity

We report the clinical and radiological features as well as outcomes of invasive fungal rhinosinusitis in patients with diabetes from a tertiary care center in North India.. All patients admitted with a diagnosis of invasive fungal rhinosinusitis with pre-existing or newly diagnosed diabetes from 1st January 2008 to 31st December 2015 were included. Hospital records were used to identify clinical features, biochemical investigations and treatment modalities used. The imaging findings were reported at baseline, 30, 60,90 and 120 days of admission and progression of disease was reported as static, worse or improved. The outcomes were sight loss and survival at end of hospital stay.. 22 patients of invasive fungal sinusitis and diabetes were identified. At presentation, 5 had ketoacidosis, all of whom died at the end of hospital stay. Loss of vision in one eye was seen in 70% cases. The survival at end of hospital stay was 72.7% and at six months after end of study period was 57.8%. No patients had radiological improvement at day 30 imaging (including those who subsequently improved).. Radiological improvement is not apparent before two months of therapy. Ketoacidosis is a predictor of mortality in invasive fungal sinusitis with diabetes.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; India; Invasive Fungal Infections; Male; Middle Aged; Mortality; Rhinitis; Sinusitis; Young Adult

In this report, we describe the case of a young, diabetic girl with ketoacidosis who suffered sudden loss of vision of the right eye. The loss of vision was caused by an invasive rhino-orbital-cerebral fungal infection (mucormycosis) with extensive periorbital thrombosis. Despite maximal antifungal and surgical treatment (including exenteration of the right orbit), the clinical situation deteriorated. It was only after overcoming the difficulties of managing her hyperglycaemia that the patient's condition stabilised and her life was saved. Another factor contributing to this girls' survival was the swift diagnosis of mucormycosis, which was made soon after the onset of symptoms. Because of this, treatment could be started almost immediately.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Blindness; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Eye Infections, Fungal; Female; Humans; Medication Adherence; Mucormycosis; Nasal Surgical Procedures; Orbital Diseases; Paranasal Sinus Diseases; Tomography, X-Ray Computed; Treatment Outcome

Onychomycosis is an infection of the nail unit by a fungus. This is a very common infection amongst diabetics. Its occurrence among diabetics in Fako division is unknown. In this study we provide information on the characteristics of onychomycosis in diabetics in Fako division, Cameroon.. A cross-sectional descriptive and analytical hospital-based study was conducted in two diabetic clinics in the Buea and Limbe regional hospitals. We recruited 152 consenting diabetics into the study. Demographic, behavioural, and clinical data of patients were obtained through the use of structured questionnaires. Toenail, finger nail, skin scrapings and nail clippings were collected from participants, KOH mounts were prepared and observed under the microscope and cultured on Sabouraud Dextrose Agar supplemented with chloramphenicol to isolate causative fungi. Identification of isolates was done to species level using the cello tape flag method and slide culture. The presence of a dermatophyte by either microscopy or culture or both methods was considered positive for onychomycosis. Antifungal susceptibility testing was carried out using selected antifungals by the Kirby-Bauer disk diffusion method on Sabouraud Dextrose Agar.. Clinical onychomycosis was found in 77 of the 152 diabetics tested giving a prevalence of 50.7% (95% CI 42.4-58.9) in diabetics in Fako. No socio-demographic or clinical factor studied was significantly associated with onychomycosis. Trichophyton rubrum was the most common isolate (62%). Other isolates included Trichophyton metagraphyte (22%) and Trichophyton tonsurans (16%). Dermatophytes were sensitive to miconazole (66%), amphotericin B (19%) and ketoconazole (14%).. Onychomycosis is common in diabetics in Fako signifying the need for regular screening by either microscopy or culture. Infected nails could be treated with miconazole.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Cameroon; Cross-Sectional Studies; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Drug Resistance, Fungal; Female; Humans; Ketoconazole; Male; Miconazole; Microbial Sensitivity Tests; Middle Aged; Nails; Onychomycosis; Prevalence; Trichophyton

Topics: Amphotericin B; Antifungal Agents; Child; Child, Preschool; Debridement; Deoxycholic Acid; Diabetes Mellitus, Type 1; Drug Combinations; Humans; Mucormycosis; Rhinitis; Sinusitis

Phaeohyphomycosis is a heterogeneous group of opportunistic infections caused by dematiaceous molds, which are distributed worldwide as plant pathogens but rarely cause human diseases. However, due to the growing populations of immunocompromised patients, these fungi are frequently recognized as important human pathogens. We are reporting this very rare, unique case for the first time from Islamabad, Pakistan, describing the association of visceral Phaeohyphomycosis caused by the opportunistic fungus Alternaria alternata, affecting the left kidney, with the immunocompromised state in a young incidentally detected patient with insulin-dependent type I diabetes. The case was diagnosed on the basis of a high index of clinical suspicion, microbial cultures, microscopy, imaging studies and endourological procedures. The patient did not respond well to the highly sensitive Amphotericin B, resulting in loss of the kidney. Therefore, we suggest that clinicians involved in treating immunocompromised patients should have a high degree of clinical suspicion for such opportunistic pathogens to allow timely initiation of the correct diagnostic and therapeutic work-up.

Topics: Alternaria; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 1; Humans; Hydronephrosis; Hypoglycemic Agents; Immunocompromised Host; Insulin; Male; Nephrectomy; Opportunistic Infections; Phaeohyphomycosis; Predictive Value of Tests; Risk Factors; Treatment Outcome; Urinary Tract Infections; Young Adult

Trichosporon asahii is a basidiomycete yeast responsible for white piedra and onychomycosis in the immunocompetent host. In the immunocompromised patients, invasive infections are reported; their diagnosis is difficult and they are associated with high mortality rate. Urinary infection due to Trichosporon Asahi is rare but its incidence increasing. We report the case of a 58 year old diabetic patient. The yeast was isolated from urine samples of three consecutive crops in pure form. The patient improved after antifungal therapy.

Topics: Acute Kidney Injury; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 1; Humans; Immunocompromised Host; Male; Middle Aged; Opportunistic Infections; Trichosporon; Trichosporonosis; Urinary Tract Infections; Urine; Virulence

We present a case report of young man with Type 1 diabetes who developed acute visual loss after initially presenting with diabetic ketoacidosis. The diagnosis of invasive paranasal sinusoidal aspergillosis was made following CT and biopsy. Although uncommon, visual loss is a recognised complication of disseminated aspergillosis and is more likely in immune-compromised patients and those with diabetes. Early investigation with appropriate sinus imaging and involvement of the Ear Nose and Throat team in recommended when patients with diabetes develop acute visual loss in the context of a non-specific infective illness.

Topics: Acute Disease; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Aspergillosis; Biopsy; Blindness; Caspofungin; Diabetes Mellitus, Type 1; Diagnosis, Differential; Echinocandins; Emergency Service, Hospital; Fatal Outcome; Humans; Lipopeptides; Magnetic Resonance Imaging; Male; Meropenem; Middle Aged; Paranasal Sinuses; Thienamycins; Tomography, X-Ray Computed; United Kingdom

Topics: Amphotericin B; Antifungal Agents; Coccidioides; Coccidioidomycosis; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Fluconazole; Humans; Kidney Transplantation; Lip Diseases; Male; Middle Aged; Pancreas Transplantation; Ulcer

The objective of this paper is to review a recent case of rhino-orbital-cerebral mucormycosis that involved the successful treatment of an immunocompromised male patient that took place in a deployed military setting. In this interventional case review, a comprehensive evaluation of predisposing factors, presenting signs and symptoms, diagnostic evaluation, and treatment will be discussed in detail. The patient was a 38-yr-old noncompliant insulin-dependent diabetes mellitus Iraqi man whose initial presentation encompassed nonspecific signs and symptoms consistent with sinusitis. Symptoms progressed rapidly including the development of acute visual loss, unilateral facial edema, fixed dilated right pupil, loss of extraocular movements, and oropharyngeal eschar formation. With this progressive clinical picture, a diagnosis of mucormycosis was made in the absence of histological confirmation due to the nature of the deployed environment. Treatment included hospitalization for combined intervention with intravenous antifungal therapy and a series of surgeries which ultimately resulted in orbital exenteration and preservation of life. Successful treatment was attributed to having a high index of suspicion in the clinical presentation of nonspecific otorhinolaryngological and ophthalmological symptoms superimposed with underlying predisposing immunocompromised host conditions.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Debridement; Diabetes Insipidus, Nephrogenic; Diabetes Mellitus, Type 1; Disease Progression; Eye Infections, Fungal; Humans; Immunocompromised Host; Magnetic Resonance Imaging; Male; Mucormycosis; Nose Diseases; Orbital Diseases; Tomography, X-Ray Computed; Triazoles

Mucormycosis is one of the most rapidly progressing and lethal form of fungal infections in humans which usually begins in the nose and paranasal sinuses. The fungus assaults the arteries, leading to thrombosis that subsequently causes necrosis of hard and soft tissues. The purpose of this article is to describe a rare case of maxillary necrosis due to mucormycosis in a 12-year-old diabetic patient and emphasizes on early diagnosis and timely management of this potentially fatal fungal infection.

Topics: Amphotericin B; Antifungal Agents; Child; Diabetes Mellitus, Type 1; Humans; Infusions, Intravenous; Male; Maxillary Diseases; Maxillary Sinus; Mucormycosis; Paranasal Sinus Diseases

Zygomycosis (mucormycosis) is a rare, highly aggressive opportunistic fungal disease caused by saprophytic fungi, belonging to the division Zygomycota, class Zygomycetes. Patients with immunodeficiency, neutropenia, iron overload, hematological malignancies, as well as diabetics with ketoacidosis are typically affected.. Authors describe the case of an eighteen-year old man with poor compliance suffering from diabetes since the age of nine. He was admitted with ketoacidotic somnolence in severe general condition with unilateral periorbital erythematous edema. Though from nasal exudates gained by the fibero-endoscopic sinus surgery Methicillin-resistant Staphylococcus aureus and Pseudomas aeruginosa was cultured, amphotericin-B was administered as the medical history, clinical picture suggested presence of zygomycosis. An invasive infection caused by Rhizopus oryzae was confirmed by histology and microbiology.. The combination of antifungal therapy, repeated surgical interventions and granulocyte colony-stimulating factor resulted in good clinical response. Four month after discharge he is alive and doing well.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Diabetes Complications; Diabetes Mellitus, Type 1; Diabetic Coma; Granulocyte Colony-Stimulating Factor; Humans; Magnetic Resonance Imaging; Male; Methicillin-Resistant Staphylococcus aureus; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Zygomycosis

Topics: Adult; Amphotericin B; Antifungal Agents; Bronchoscopy; Combined Modality Therapy; Diabetes Mellitus, Type 1; Drainage; Female; Humans; Intraoperative Complications; Mucormycosis; Pneumonia; Pneumothorax; Tracheal Diseases

Fungal sinusitis caused by invasive fungal infections, such as Mucormycosis, occurs predominantly in an immunocompromised patient. However, invasive cranial bone mycoses are rare and are usually associated with host immunodeficiency. They are difficult to diagnose, and in many cases are fatal. Treatment consists of antifungal chemotherapy, radical surgical debridement, and control of the underlying immunological condition. We report a case of Mucormycosis in a patient with type 1 diabetes mellitus. The patient had a history of dental pathology and associated renal dysfunction. The patient was managed by extensive surgical debridement followed by amphotericin B lipid complex injection (Abelcet 5 mg/bw kg/day) as an antifungal agent. Our patient's ocular function was affected. The radical treatment and follow-up by a multidisciplinary team eliminated the mucor-related consequences, however, the patient died because of end-stage renal failure. In conclusion, type 1 diabetes may be associated with invasive fungal sinusitis.

Topics: Adult; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Diagnosis, Differential; Humans; Male; Mucormycosis; Sinusitis; Tomography, X-Ray Computed

Mucormycosis is a rare, devastating, fungal infection, which disproportionately affects non-controlled diabetic patients, notably during ketoacidosis. It can be manifested in rhinocerebral, but also pulmonary and disseminated forms.. Four consecutive diabetic patients who were admitted to the Farhat Hached Hospital, Sousse, Tunisia, between January 2001 and November 2002, are presented. Three patients exhibited ketoacidosis and one renal failure with hyperosmolarity. Infection was limited to the sinuses in two cases, to lower respiratory tract in one case, and was probably disseminated in one case. Diagnosis was confirmed by mycological and histological findings in all cases. Systemic Amphotericin B was associated with surgical debridement of the lesions in patients with rhinocerebral involvement.. Despite aggressive therapy, mortality was high (3 out of 4 patients). Mucormycosis remains a severe, frequently fatal disease in diabetic patients.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Debridement; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Fatal Outcome; Female; Humans; Mucormycosis

To describe the presentation and outcome of rhino-orbital-cerebral mucormycosis (ROCM) in adolescents with type 1 diabetes mellitus (T1DM).. The medical records of six patients of T1DM with ROCM admitted between October 2001 to January 2004 were analysed.. The mean (+/- SD) age and duration of DM of these patients were 16.1+/-3.0 years and 26.3 +/- 24.9 months respectively. Four patients had ROCM at presentation, while two developed it during their hospital stay when recovering from diabetic ketoacidosis. Proptosis (100%) and ptosis (100%) were the most common symptoms, and ophthalmoplegia (85%) and vision loss (85%) were the most common signs. Maxillary sinus (85%) was the commonest paranasal sinus to be involved. All patients received amphotericin B and had appropriate surgery except one. Four patients survived. Patients who had altered sensorium, facial necrosis, palatal perforation and cerebral involvement at presentation had poor outcome.. High index of suspicion of ROCM in T1DM and combined approach with amphotericin B and appropriate surgery is rewarding.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Cerebral Infarction; Child; Diabetes Mellitus, Type 1; Fatal Outcome; Humans; Mucormycosis; Nose Diseases; Patient Compliance; Prognosis; Retrospective Studies

We report a case of Candida glabrata perinephric abscess in a patient with diabetes mellitus who recently underwent ureteropelvic surgery for lithiasic urinary tract obstruction. Surgical drainage and amphotericin B treatment led to resolution of the infection. C. glabrata urinary infection has become more prevalent over the last decade in immunocompromised patients. Drainage is indicated for development of a fungal abscess in the perinephric area. Most authors recommend administration of an antifungal adjuvant treatment.

Topics: Abscess; Aged; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Candida; Candidiasis; Combined Modality Therapy; Diabetes Mellitus, Type 1; Drainage; Escherichia coli Infections; Female; Humans; Hypertension; Immunocompromised Host; Kidney Diseases; Postoperative Complications; Risk Factors; Serotyping; Urinary Calculi; Urinary Tract Infections

Topics: Adult; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Fatal Outcome; Humans; Lung Diseases, Fungal; Male; Mucormycosis; Respiratory Distress Syndrome

Mucormycosis is a rare opportunistic infection but a fulminant disease. We report the 4 first cases of rhinocerebral mucormycosis diagnosed in Sfax region (Tunisia). They occurred in insulin dependent diabetes and developed varying clinical manifestations from facial cellulites to ocular and cerebral extension. The diagnosis of mucormycosis was not initially evoked, but confirmed tardively by anatomopathologic and mycologic examinations. The evolution was favourable in 2 cases by administration of amphotericine B associated with extensive surgical debridement and correction of the diabetes. Two patients had a fatal outcome. This infection has a severe prognosis and necessitates early diagnosis.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Diabetes Mellitus, Type 1; Eye Diseases; Fatal Outcome; Female; Humans; Male; Middle Aged; Mucormycosis; Nose Diseases; Prognosis; Tunisia

We report a case of mucormycosis in a 48 year-old diabetic woman. She presented with nasosinusal ulcer accompanied by panophthalmitis in the left eye and central retinal artery occlusion in the right eye. Left eye enucleation was performed and the diagnosis of mucormycosis was made on histopathologic examination displaying fungal micro-organisms in the optic nerve and in the retina. The patient died of stress ulcer hemorrhage. Mucormycoses are rare and severe diseases affecting immunocompromised hosts, especially diabetic patients during ketoacidosis. The treatment includes surgical debridement and amphotericin B but prognosis remains severe.

Topics: Amphotericin B; Antifungal Agents; Debridement; Diabetes Mellitus, Type 1; Eye Enucleation; Eye Infections, Fungal; Fatal Outcome; Female; Humans; Middle Aged; Mucorales; Mucormycosis; Optic Nerve; Retina

A 24-year-old female diabetic patient was hospitalized because of ketoacidosis and a necrotic wound on the hand. Debridement and antibiotic therapy failed to halt the process. After demonstration of Mucor in cultures from the wound, the patient underwent extensive surgery and amphotericin B was administered. When the necrotic process continued despite these measures, adjunctive hyperbaric oxygen (100% O2 at 2.5 ATA for 90 minutes) was administered daily for a total of 21 treatment sessions. She gradually improved, and at 2 months follow-up most of the wound had healed. Although the mortality rate of cutaneous/soft-tissue zygomycosis is markedly lower than that of the rhinocerebral form, morbidity is still considerably high. Successful use of hyperbaric oxygen has been reported in rhinocerebral zygomycosis, and it may have been of benefit in this high-risk patient by preventing local and systemic spreading of the fungus. This report is the first case of the use of hyperbaric oxygen for cutaneous/soft-tissue zygomycosis. It is suggested that hyperbaric oxygen be considered for this indication in diabetic patients as an adjunct to surgery and amphotericin B.

Topics: Adult; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Female; Fingers; Humans; Mucormycosis; Opportunistic Infections; Soft Tissue Infections

Mucormycosis is a rare opportunistic infection caused by ubiquitous fungi typically found in soil, spoiled foods, bread, and dust. The acute infection most commonly is rhinocerebral and is associated with metabolic acidosis. Mucormycosis spreads quickly and can progress from the paranasal area to the brain in a few days. In the case presented, a young diabetic woman had diabetic ketoacidosis and classic signs and symptoms of mucormycosis. Even after aggressive and appropriate treatment with surgical debridement and IV administration of amphotericin B, the fungus invaded the central nervous system. This article discusses current methods of treating mucormycosis and important critical care nursing considerations for patients who have the infection.

Topics: Adult; Amphotericin B; Antifungal Agents; Debridement; Diabetes Mellitus, Type 1; Fatal Outcome; Female; Humans; Magnetic Resonance Imaging; Mucormycosis

We describe a case of noninvasive sinusitis caused by Paecilomyces lilacinus in a patient with diabetes mellitus. Cure was achieved by endoscopic drainage and aspiration of the fungal mass. We discuss the difficulty in and clinical importance of distinguishing Paecilomyces from Aspergillus.

Topics: Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 1; Female; Humans; Itraconazole; Middle Aged; Mycoses; Paecilomyces; Sphenoid Sinusitis

Mucormycosis usually occurs in immunocompromised patients or in patients with diabetes mellitus. Pathogens are moulds of the mucorales species. The diagnosis is made by histological examination of biopsies. A 39 year-old patient with insulin-dependent diabetes mellitus was admitted with a tentative diagnosis of a tumour of the maxilla. After diagnosis of hyphae of the mucorales species, the patient's diabetes was stabilised and he was treated over 17 weeks with amphotericin B (40 mg per day) and made a good recovery. A 58 year-old insulin-dependent patient with ethmoidali and sphenoidali sinusitis did not respond to antibiotic therapy. Mucormycosis was diagnosed by means of biopsy. Although treatment with amphotericin B was started, the patient died after 3 weeks due to multiple organ failure.

Topics: Adult; Amphotericin B; Antifungal Agents; Biopsy; Combined Modality Therapy; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Fatal Outcome; Humans; Male; Middle Aged; Mucormycosis; Opportunistic Infections; Paranasal Sinuses; Sinusitis

Intra-abdominal infections account for 15 percent of technical failures after pancreatic transplantation. Although some data are available about intra-abdominal bacterial infections, no study has analyzed the incidence, treatment, and outcome of intra-abdominal fungal infections.. We retrospectively studied 445 consecutive pancreatic transplantations--45 percent were simultaneous pancreatic and renal, 24 percent pancreatic after renal, and 31 percent pancreatic transplantations alone--in patients with Type I diabetes mellitus. Donors were cadavers in 92 percent and living relatives in 8 percent. Primary transplantations were done in 80 percent and retransplantation in 20 percent. Of these 445 pancreatic transplantations, 90 percent were bladder-drained, 9 percent enteric-drained, and 1 percent duct-injected. Only symptomatic patients with documented culture-positive intra-abdominal fungal infections were included.. Intra-abdominal fungal infections occurred after pancreatic transplantation in 41 (9.2 percent) of 445 patients. Donor age, but not recipient age, was a significant risk factor. The rate of infections was higher for enteric-drained (21 percent) than for bladder-drained (10 percent) transplantations; for organs donated by living relatives (16 percent) than for those from cadavers (9 percent); and for pancreatic after renal (12 percent) and simultaneous pancreatic-renal (11 percent) than for pancreatic-only (5 percent) recipients. The rate of intra-abdominal fungal infections was 6 percent for recipients who were given antifungal prophylaxis (fluconazole, 400 mg/day for seven days after transplantation) compared with 10 percent for those without prophylaxis. The one-year graft survival rate for recipients with infection was 17 percent compared with 65 percent for those without (p = 0.0001); the survival rate was 70 percent compared with 92 percent for patients with and without infection, respectively (p = 0.0007). In 22 percent of recipients, the infection resolved and graft function persisted; in 58 percent, the infection resolved after transplant pancreatectomy; and in 20 percent, death occurred despite transplant pancreatectomy. Recipients with sole fungal or fungal and bacterial infection (n = 41) were 50 percent less likely to recover with a functioning graft and had a risk of death that was three times higher (p < or = 0.05) than those with sole bacterial infection (n = 48).. Intra-abdominal fungal infections after pancreatic transplants are associated with high morbidity and mortality rates, significantly higher than for sole bacterial infections. In addition to aggressive treatment, including transplant pancreatectomy and reduction of immunosuppression, efforts must be made toward better prevention of intra-abdominal fungal infections.

Topics: Adult; Age Factors; Amphotericin B; Antifungal Agents; Bacterial Infections; Candidiasis; Diabetes Mellitus, Type 1; Female; Fluconazole; Graft Survival; Humans; Immunosuppressive Agents; Incidence; Kidney Transplantation; Male; Pancreas Transplantation; Postoperative Complications; Reoperation; Retrospective Studies; Risk Factors; Tissue Donors; Treatment Outcome

Topics: Amphotericin B; Arthritis, Infectious; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 1; Diagnosis, Differential; Disease Susceptibility; Humans; Knee Joint; Lumbar Vertebrae; Male; Middle Aged; Mycetoma; Occupational Exposure; Osteomyelitis; Pseudallescheria; Rheumatic Diseases; Soil Microbiology; Spondylitis

Topics: Amphotericin B; Diabetes Mellitus, Type 1; Drug Carriers; Humans; Liposomes; Liver Cirrhosis; Male; Meningitis, Cryptococcal; Middle Aged

Topics: Adult; Amphotericin B; Coccidioidomycosis; Diabetes Mellitus, Type 1; Humans; Lung Diseases, Fungal; Male; Pleural Effusion

Mucormycosis (phycomycosis) is an acute and often fatal infection, mostly seen in diabetics and immunocompromised patients, and seldom in healthy people. Therapy includes aggressive surgical debridement, amphotericin B and control of underlying predisposing condition (diabetes, immunosuppression or immunodeficiency). The rhino-sinuso-orbital presentation is typically observed in insulin-dependent diabetes mellitus with ketoacidosis. This metabolic condition may impair the polymorphonuclear function in a reversible way and this may favour infection by a mucoral. These spores germinate into hyphae, which invade local arteries and arterioles, causing thrombosis, vascular insufficiency and tissue hypoxia and acidosis, conditions which further enhance fungal growth. Hyperbaric oxygen has theoretical value in treating mucormycosis, since it reduces tissue hypoxia caused by the vascular insufficiency. We report an insulin-dependent diabetic patient with rhino-sinuso-orbital mucormycosis, who after being treated with amphotericin B and surgical debridement on two occasions, maintained clinical and tomographic evidence of active infection, and mucoral persistence in the lesion. An aggressive surgical debridement, using microsurgical techniques, was performed. Amphotericin B was increased up to a total dose of 3900 mg. (he had previously received 2900 mg) and hyperbaric oxygen was added as adjunctive treatment. The outcome was successful. There was no evidence of relapse after a 16-month follow-up. This observation would confirm the usefulness of hyperbaric oxygen as adjunctive therapy in mucormycosis.

Topics: Adult; Amphotericin B; Brain Diseases; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 1; Follow-Up Studies; Humans; Hyperbaric Oxygenation; Male; Mucormycosis; Nose Diseases

We describe the second reported case of peritonitis caused by the alga Prototheca wickerhamii in a patient on continuous ambulatory peritoneal dialysis (CAPD). This organism, which grows slowly on agar media, is recognised as a race cause of other infections. The condition is clinically similar to cases of fungal peritonitis, but there are important differences, particularly when choosing the best treatment.

Topics: Amphotericin B; Diabetes Mellitus, Type 1; Fluconazole; Flucytosine; Humans; Infections; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Prototheca

Topics: Adult; Amphotericin B; Blastomyces; Blastomycosis; Diabetes Mellitus, Type 1; HIV Infections; Homosexuality; Humans; Lung Diseases, Fungal; Male; Opportunistic Infections

Facial mucormycosis is a rare fungal infection which spreads rapidly and has a severe prognosis. It mainly affects insulin-dependent diabetics and immunodeficient subjects. We report about a case of mucormycosis of the facial structures in a diabetic patient, and lay particular stress on the diagnosis difficulties, on treatment and on evolution, which led to healing, leaving an extensive bony sequestrum which preserved the contents of the orbits.

Topics: Amphotericin B; Aspergillosis; Bone Diseases; Diabetes Mellitus, Type 1; Drainage; Facial Bones; Humans; Male; Middle Aged; Mucormycosis; Paranasal Sinuses; Tomography, X-Ray Computed

Mucormycosis is infrequently encountered in the pediatric population in any of its forms (nasopharyngeal, disseminated, pulmonary, or cutaneous) and generally is associated with the immunocompromised host. We present an adolescent with poorly controlled diabetes mellitus who developed a progressive skin lesion 3 weeks after a motor vehicle accident. Rhizopus species was isolated from the lesion, and the biopsy revealed a fungal vasculopathy. Control of her diabetes, aggressive surgical intervention and a 10-day course of antifungal therapy (amphotericin B) resulted in a favorable outcome. This article illustrates the importance of considering cutaneous fungal infections, especially those in the class zygomycetes, in the diabetic patient with unusual, severe or persistent skin lesions. Early recognition is essential in order to avoid morbidity and mortality from this unusual opportunistic infection.

Topics: Accidents, Traffic; Adolescent; Amphotericin B; Combined Modality Therapy; Dermatomycoses; Diabetes Mellitus, Type 1; Female; Humans; Mucormycosis; Rhizopus; Skin Transplantation; Wound Infection

A 25-year-old man with juvenile onset diabetes presented with rhinoorbital mucormycosis. He was treated aggressively with orbital extirpation and amphotericin B. Six months later, he presented with posterior fossa extension of the mucormycosis.

Topics: Adult; Amphotericin B; Brain Diseases; Cranial Fossa, Posterior; Diabetes Mellitus, Type 1; Humans; Male; Mucormycosis

The authors report the case of 5 1/2 year-old boy with insulin-dependent diabetes mellitus revealed during the induction therapy of an acute leukemia of the mixed type, and who presented with an unusual type of pulmonary fungal infection: mucormycosis. It had a favourable outcome with surgical excision preceded and followed by amphotericin B treatment.

Topics: Acute Disease; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Child, Preschool; Diabetes Mellitus, Type 1; Humans; Leukemia; Male; Mucormycosis; Postoperative Care; Remission Induction

An alcoholic man with uncontrolled diabetes mellitus had right conjunctivitis, facial numbness, and periorbital edema progressing to bilateral visual loss, and left ptosis in association with a large necrotic palatal ulcer due to zygomycosis. The infection progressed to bilateral retinal vein engorgement; left-sided ophthalmoplegia, fixed dilated pupil, and absent corneal reflex; and right-sided ophthalmoplegia, ptosis, and facial nerve paralysis. Work-up revealed disease of both ethmoid sinuses and the right maxillary sinus, with bilateral thromboses of the cavernous sinuses. An aggressive combined therapeutic attack (three Caldwell-Luc procedures, exploration of orbit walls, control of diabetes, systemic and local amphotericin therapy) led to survival with a three-year follow-up thus far.

Topics: Amphotericin B; Brain Diseases; Cavernous Sinus; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 1; Fungi; Humans; Male; Middle Aged; Mucormycosis; Nose Diseases; Orbital Diseases; Sinus Thrombosis, Intracranial

We report a new case of cutaneous mucormycosis in a diabetic woman. The major favouring circumstances are found in this patient: ketoacidosis diabetes, use of bandages, local corticosteroid applications, renal insufficiency. The diagnosis, rarely made on the clinical aspect, is based on the histological and mycological data. A trial of treatment by ketoconazole has been carried out, but without success. The usual treatment by intravenous amphotericine B has been successful.

Topics: Amphotericin B; Bandages; Casts, Surgical; Dermatomycoses; Diabetes Mellitus, Type 1; Female; Humans; Ketoconazole; Middle Aged; Mucormycosis

Topics: Adolescent; Amphotericin B; Diabetes Mellitus, Type 1; Humans; Male; Mucormycosis

Fifty-two diabetic patients who underwent pulmonary surgery for coccidioiodmycosis were evaluated by a retrospective study which included classification by stage of disease, status of insulin dependency, and reaction to coccidioidin skin test. The insulin-dependent diabetic patient had a fourfold increase in the incidence of more severe (progressive) disease. Perioperative therapy with amphotericin B may be of value in the adult surgical candidate with progressive disease but is not necessary or desirable in the juvenile diabetic patient. Coccidioidomycosis is a disease of relative immunocompromise, and a negative skin test should herald such compromise and support a decision for surgery. Such surgery in the progressive stages should be totally extirpative. The presence of inadequately resected disease may adversely affect subsequent immunologic resistance of the host.

Topics: Adult; Age Factors; Amphotericin B; Coccidioidomycosis; Diabetes Complications; Diabetes Mellitus, Type 1; Female; Humans; Lung Diseases, Fungal; Male; Middle Aged; Pneumonectomy; Skin Tests

Topics: Abscess; Adolescent; Adult; Amphotericin B; Candida; Candidiasis; Diabetes Mellitus, Type 1; Female; Humans; Kidney Diseases; Male; Middle Aged; Perinephritis; Urine; Urography