amphotericin-b and Diabetes-Mellitus--Type-2

In many cases of mucormycosis, immediate surgical treatments are necessary because of its fulminant course and destructive characteristics in an immunocompromised patient. However, a chronic indolent type is also observed in a healthy group of people. We experienced rhinomucormycosis in a 56-year-old woman with diabetes who previously had pulmonary mucormycosis. She was treated successfully through endoscopic sinus surgery and nasal irrigation with antifungal agent. Herein, we report the clinical courses and symptoms of this patient with literature review.

Topics: Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 2; Endoscopy; Female; Humans; Lung Diseases, Fungal; Middle Aged; Mucormycosis; Paranasal Sinus Diseases; Therapeutic Irrigation; Tomography, X-Ray Computed

Mucormycosis is a rare fungal infection that affects immunocompromised patients, and the rhinoorbitocerebral presentation is the most common clinical form of the disease, often associated with diabetes mellitusThe treatment is complex and involves amphotericin B and surgery. Studies show increasing success without or with minimal surgeries. The authors present the case of a diabetic woman with a 1-month history of intranasal and right periorbital pain associated with progressive deficit of various cranial nerves, sudden amaurosis and homolateral ptosis. Rhizopus oryzae species was identified in pus in the nasal mucosa. She was treated with antifungal therapy and minimal surgical debridement with success. The authors decided on publication because of the rarity of this entity, alerting for the need of a high suspicion index for the diagnosis, which should be made as early as possible due to the high mortality rate, as well as presenting data about the increasing discussion of therapeutic strategies, with some new approaches that prioritise minimal surgeries.

Topics: Amphotericin B; Central Nervous System Fungal Infections; Debridement; Diabetes Mellitus, Type 2; Female; Humans; Immunocompromised Host; Middle Aged; Mucormycosis; Nose Diseases; Orbital Diseases; Rhizopus; Treatment Outcome; Turbinates

Topics: Aged; Amphotericin B; Antifungal Agents; Caspofungin; Diabetes Mellitus, Type 2; Disease Susceptibility; Drug Resistance, Multiple, Fungal; Drug Therapy, Combination; Echinocandins; Endophthalmitis; Eye Enucleation; Eye Infections, Fungal; Glaucoma; Humans; Hypertension; Intravitreal Injections; Lipopeptides; Male; Phialophora; Pyrimidines; Triazoles; Vitrectomy; Voriconazole

Renal papillary necrosis (RPN) due to Candida is a rare disease with only 19 cases reported over the past 37 years. But the diagnosis in 17 of the 19 cases was not made until a necropsy was carried out. The 2 cases that were diagnosed antemortem had radiographic sonography. A singapore case with candidal RPN was described in detail. Candidal RPN was associated with underlying diseases in all these cases. The disease may be more frequently encountered in the future with the advent of radiographic tools like sonography which was not described prior to 1980. Indeed, patients with underlying diseases who develop persistent candiduria should have radiographic investigation of the urinary tract to detect candidal RPN to that early remedial measures can be carried out.

Topics: Aged; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Diabetes Mellitus, Type 2; Female; Humans; Kidney; Kidney Diseases; Necrosis; Radiography

Seventeen cases of infections due to Cunninghamella species have been reported worldwide in humans, and there have been only three survivors. We report a case of paranasal sinusitis due to Cunninghamella bertholletiae in an elderly patient who had diabetes mellitus and myelodysplasia. After receiving 7 weeks of therapy with deoxycholate amphotericin B (44 mg/kg or a total of 3 g) and rifampin, the patient was cured and did not have to undergo radical surgery.

Topics: Aged; Amphotericin B; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Ethmoid Sinusitis; Humans; Male; Maxillary Sinusitis; Mucorales; Mucormycosis; Myelodysplastic Syndromes; Paranasal Sinuses; Rifampin; Tomography, X-Ray Computed

A 67-year-old obese man (BMI 38.0) with type 2 diabetes mellitus (DM), chronic atrial fibrillation, and chronic lymphocytic leukemia stage II, stable for 8 years after chemotherapy, and a history of smoking presented to the ED with progressive dyspnea and fever due to SARS-CoV-2 infection. He was admitted to a general ward and treated with dexamethasone (6 mg IV once daily) and oxygen. On day 3 of hospital admission, he became progressively hypoxemic and was admitted to the ICU for invasive mechanical ventilation. Dexamethasone treatment was continued, and a single dose of tocilizumab (800 mg) was administered. On day 9 of ICU admission, voriconazole treatment was initiated after tracheal white plaques at bronchoscopy, suggestive of invasive Aspergillus tracheobronchitis, were noticed. However, his medical situation dramatically deteriorated.

Topics: Acute Kidney Injury; Aged; Amphotericin B; Antibodies, Monoclonal, Humanized; Antifungal Agents; Atrial Fibrillation; Bronchoscopy; COVID-19; Dexamethasone; Diabetes Mellitus, Type 2; Fatal Outcome; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Mucormycosis; Nitriles; Obesity; Oxygen Inhalation Therapy; Pulmonary Aspergillosis; Pyridines; Respiration, Artificial; SARS-CoV-2; Smoking; Tomography, X-Ray Computed; Triazoles; Voriconazole

Topics: Amphotericin B; Antifungal Agents; Asymptomatic Infections; COVID-19; Diabetes Mellitus, Type 2; Female; Humans; Middle Aged; Mouth Diseases; Mucormycosis; Palate, Hard; Rhizopus; SARS-CoV-2

We describe an elderly diabetic patient presenting with sudden onset right-sided proptosis and vision loss secondary to rhino-orbital mucormycosis and central retinal vascular occlusion. He underwent orbital exenteration that was complicated by intraoperative cerebrospinal fluid (CSF) leak from lateral orbital wall. The leak was surgically repaired and the patient recovered well. We postulate the cause of the CSF leak to be twofold: necrotic periorbital tissue due to mucormycosis rendering the thin bones susceptible to damage and second, intraoperative manipulation and dissection at the orbital apex with monopolar cautery and instruments. We describe measures taken to successfully repair the CSF leak and the possible precautions that can be taken to avoid it.

Topics: Administration, Intravenous; Amphotericin B; Antifungal Agents; Blepharoptosis; Blindness; Cerebrospinal Fluid Leak; Debridement; Diabetes Mellitus, Type 2; Endoscopy; Humans; Hyphae; Intraoperative Complications; Magnetic Resonance Angiography; Male; Middle Aged; Mucormycosis; Orbit; Orbit Evisceration; Orbital Diseases; Paranasal Sinuses; Retinal Artery Occlusion; Sinusitis; Treatment Outcome

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Bronchoalveolar Lavage Fluid; Diabetes Mellitus, Type 2; Humans; Lung; Male; Tomography, X-Ray Computed

Topics: Amphotericin B; Antifungal Agents; Bronchoalveolar Lavage Fluid; Diabetes Mellitus, Type 2; Humans; Hyphae; Lung; Male; Middle Aged; Mucormycosis; Tomography, X-Ray Computed; Treatment Outcome

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

The small lymphocytic lymphoma is a mature B cell neoplasm with a broad spectrum of clinical presentations. Opportunistic infections that are not related to the treatment, even in advanced stages, have a low incidence rate. There are few case reports in the medical literature of patients who have not received immunosuppressive therapy and present with small lymphocytic lymphoma associated with disseminated histoplasmosis at diagnosis.\ A female 82-year-old patient was admitted due to an intermittent dry cough, asthenia, and adynamia that had persisted for one month. Multiple studies to detect infections and immuno-rheumatic conditions were performed and an extensive cervical, thoracic and peritoneal adenopathic syndrome was diagnosed.\ A flow cytometry and a cervical lymph node biopsy were performed reporting CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg, and CD10neg phenotypes with restriction in the light kappa chain compatible with a small lymphocytic lymphoma.\ Epithelioid granulomas without necrosis were observed in the lymph node histopathology and special colorations showed no microorganisms. The culture from the lymph node was positive for Histoplasma capsulatum. We initiated treatment with amphotericin B and itraconazole with an adequate response. In the absence of compliance with oncology treatment criteria, the patient was managed on a “watch and wait” basis.\ Opportunistic infections could be the initial clinical manifestation in patients with low-grade lymphoproliferative syndromes. This case report shows that they can develop even in the absence of chemotherapy.

Topics: Aged, 80 and over; Alzheimer Disease; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 2; Female; Histoplasma; Histoplasmosis; Humans; Hypertension; Itraconazole; Leukemia, Lymphocytic, Chronic, B-Cell; Lymph Nodes; Opportunistic Infections; Watchful Waiting

Histoplasma capsulatum causes a spectrum of manifestations from asymptomatic to fatal disseminated disease. Disseminated histoplasmosis is mostly seen in endemic areas among immunocompromised patients such as those with AIDS. Here, we present a patient living in a non-endemic area with previously undiagnosed diabetes mellitus, who presented with septic shock and diabetic ketoacidosis (DKA), and was ultimately diagnosed with disseminated histoplasmosis. The patient rapidly recovered on administration of intravenous liposomal amphotericin followed by oral itraconazole. Uncontrolled diabetes may be a risk factor for disseminated or severe histoplasmosis in otherwise immunocompetent patients.

Topics: Adult; Amphotericin B; Antifungal Agents; Delayed Diagnosis; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Histoplasma; Histoplasmosis; Humans; Immunocompetence; Male; Tomography, X-Ray Computed; Travel; 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; Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Blepharoptosis; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 2; Diagnosis, Differential; Ethmoid Sinusitis; Humans; Immunocompromised Host; Male; Maxillary Sinusitis; Nasal Mucosa; Orbit; Osteolysis; Paranasal Sinus Neoplasms; Radiography

Topics: Amphotericin B; Antifungal Agents; Combined Modality Therapy; Diabetes Mellitus, Type 2; Female; Humans; Lung Diseases, Fungal; Middle Aged; Mucormycosis; Pneumonectomy; Rhizopus

Topics: Amphotericin B; Antifungal Agents; Biopsy; Brain Diseases; Deoxycholic Acid; Diabetes Mellitus, Type 2; Drug Combinations; Eye; Eye Diseases; Fatal Outcome; Female; Humans; Kidney Failure, Chronic; Magnetic Resonance Imaging; Middle Aged; Mucormycosis; Multiple Organ Failure; Paranasal Sinuses; Temporal Lobe

Mucormycosis are the fungal infections caused by emerging ubiquitous filamentous fungi classified as zygometes and order as mucorales. They occur mainly in immunosuppressed patients and diabetics. The onset of hemoptysis, in this context, may rapidly become life-threatening.. We report the case of a man of 83 years, Caribbean with a history of non-insulindependent diabetes and HTLV1 seropositive. At admission he presented with fever, cough and cachexia. Chest X-ray revealed a snapshot of excavation within alveolar consolidation. Endoscopy showed a mucopurulent plug obstructing lingula. The histological appearance of bronchial biopsies was in favor of mucormycosis. A combined treatment with liposomal amphotericin B and posaconasole was implemented, but the occurrence of abundant hemoptysis led us to make a left upper lobectomy. Finally, the outcome was favorable and the patient was discharged after hospitalization of 56 days.. A medicosurgical treatment during mucormycosis complicating bronchopulmonary hemoptysis not controlled by medical treatment alone seems to offer an effective therapeutic strategy.

Topics: Aged, 80 and over; Amphotericin B; Combined Modality Therapy; Diabetes Mellitus, Type 2; Hemoptysis; Humans; Lung Diseases, Fungal; Male; Mucormycosis; Opportunistic Infections; Pneumonectomy; Triazoles

Topics: Amphotericin B; Antifungal Agents; Cellulitis; Diabetes Mellitus, Type 2; Female; Hand Dermatoses; Histoplasma; Histoplasmosis; Humans; Hypothyroidism; Immunocompromised Host; Immunosuppressive Agents; Itraconazole; Middle Aged; Panniculitis; Pemphigus

A 43 year-old diabetic woman, who suffered chronic cough and brown expectoration, is presented in this clinical problem. X-ray exam and CT thorax scan showed a cavitary lung lesion, located at the upper field of the left lung. This lesion had 5 cm in diameter, with a thick wall and a spherical shadow inside. The diagnosis of chronic cavitary pulmonary coccidioidomycosis was based on the isolation of Coccidioides sp. from cultures of expectoration and bronchoalveolar lavage, and the detection of specific antibodies in immunodiffusion test and counterimmunoelectrophoresis with coccidiodin. Her diabetes was not well controlled. She was treated with intravenous amphotericin B and oral itraconazole, with good clinical response; after four months of treatment the patient abandoned clinical controls. We suppose that the patient presented a coccidioidal fungus ball, inside a chronic cavitary lesion due to pulmonary coccidiodomycosis. She came from an endemic zone of coccidioidomycosis in the Northwest of the Argentine Republic (Catamarca Province).

Topics: Adult; Amphotericin B; Antifungal Agents; Argentina; Bronchoalveolar Lavage Fluid; Coccidioides; Coccidioidin; Coccidioidomycosis; Cough; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Dyspnea; Endemic Diseases; Female; Humans; Itraconazole; Lung Diseases, Fungal; Sputum; Tomography, X-Ray Computed

Fungal rhinosinusitis is being recognized and reported with increasing frequency over the last two decades worldwide. Intracranial extension is the most dreaded complication of fungal sinusitis with high mortality rates. We report a case of chronic rhinosinusitis in a 55-year-old diabetic male, caused by Fusarium species. The patient was diagnosed as a case of chronic left maxillary sinusitis with cavernous sinus thrombosis. The sinus lavage showed fungal elements on direct microscopic examination and culture revealed growth of Fusarium species within 4 days of incubation. Conservative therapy with IV amphotericin B resulted in favorable outcome of the patient. This is an extremely rare case where cavernous sinus thrombosis occurred as a complication secondary to Fusarium species rhinosinusitis.

Topics: Amphotericin B; Cavernous Sinus Thrombosis; Cefotaxime; Chronic Disease; Diabetes Mellitus, Type 2; Diplopia; Disease Susceptibility; Fusariosis; Fusarium; Headache; Humans; Insulin; Magnetic Resonance Imaging; Male; Maxillary Sinusitis; Middle Aged; Photophobia; Rhinitis; Vomiting

Rhinocerebral mucormycosis (RCM) is a rare, fulminating opportunistic fungal infection caused by a fungus of order Mucorales. These fungi are ubiquitus, subsisting on decaying vegetation and diverse organic material. Although fungi and spores of Mucorales show minimal intrinsic pathogenicity towards normal person, they can initiate aggressive and fulminating infection in immunocompromised host. Since RCM occurs infrequently, it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation.. We present a patient with classical presentation of RCM involving paranasal sinuses, orbit, and cranial base who was treated by combination of aggressive surgical and medical therapy.. The purpose of this paper is to draw attention to the clinical presentation and pathogenesis of RCM and to emphasize need for high index of suspicion in diagnosis and treatment.

Topics: Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Fatal Outcome; Female; Humans; Infusions, Intravenous; Lip Diseases; Maxilla; Middle Aged; Mouth Diseases; Mucormycosis; Nose; Nose Diseases; Opportunistic Infections; Orbital Diseases; Paranasal Sinus Diseases; Tomography, X-Ray Computed

Cerebral mucormycosis without systemic foci of involvement is a rare life-threatening fungal infection that is reported to be more common in intravenous drug abusers. We present a case of isolated cerebral mucormycosis in a diabetic patient diagnosed through excision and biopsy and treated with combination of surgery and amphotericin with posaconazole.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Brain Diseases; Combined Modality Therapy; Diabetes Mellitus, Type 2; Diagnosis, Differential; Drug Therapy, Combination; Endoscopy; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mucormycosis; Tomography, X-Ray Computed; Triazoles

Mucormycosis is an opportunist, often lethal fungal infection which occurs in immunocompromised patients. We present our experience in 14 patients with this condition.. A retrospective chart review was conducted for 14 patients treated for rhinocerebral mucormycosis.. Nine patients had diabetes mellitus and six had a haematological malignancy. Nine patients had cutaneous and/or palatal necrosis. Eleven patients were treated with amphotericin B and five with liposomal amphotericin B. Endoscopic sinus surgery was performed in five patients with disease limited to the sinonasal cavity; nine patients underwent more extensive surgery. Five patients with disease limited to the sinonasal cavity survived, while nine patients with widely disseminated disease died. Five of the nine diabetic patients died, as did five of the six patients with haematological malignancy.. Patients with rhinocerebral mucormycosis spreading outside the sinonasal cavity have a poor prognosis.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Child; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Female; Humans; Immunocompromised Host; Magnetic Resonance Imaging; Male; Middle Aged; Mucormycosis; Nose Diseases; Orbital Diseases; Palate; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

A case of a 38-year-old male farmer with a brain abscess caused by Cladophialophora bantiana is described. He had a 2 year history of non-insulin-dependent diabetes and myelodysplastic syndrome. A cranial computed tomography scan demonstrated a hypodense ring lesion with peripheral oedema and a midline shift in the left frontal lobe. A darkly pigmented mould was isolated from the brain abscess. The isolate was identified as C. bantiana based on its morphological features and DNA sequence analysis. The patient was unresponsive to burr hole aspiration and irrigation, as well as liposomal amphotericin B infusion, and died after discharge from the hospital. This is believed to be the first case of a cerebral abscess due to C. bantiana in China.

Topics: Adult; Amphotericin B; Antifungal Agents; Ascomycota; Brain Abscess; Central Nervous System Fungal Infections; China; Cladosporium; Diabetes Mellitus, Type 2; Fatal Outcome; Humans; Male; Molecular Sequence Data; Myelodysplastic Syndromes

Intracranial fungal masses are uncommon diseases, but their incidence is increasing, most often due to the prolonged survival of patients with different immunodeficiencies. The management of patients with intracranial fungal masses included stereotactic biopsy for diagnosis, partial or radical surgery excision and prolonged antifungal therapy.. We report the case of a 51-year-old diabetic man with a history of psoas abscess due to Candida albicans 1 year before the onset of neurological symptoms, including headache and generalized tonoclonic seizures.. Magnetic resonance imaging showed a single lesion located in the right parietal lobe with mass effect, surrounding edema and enhancement after injection of gadolinium. The material was purulent.. Direct microscopic examination showed hyaline, branched and septate hyphae compatible with fungal elements.. Fungal infections, especially due to Candida species, should be considered in diabetic patients with parenchymal brain abscesses. Radical excision followed by prolonged antifungal therapy based on fluconazole or amphotericin B is necessary to improve the prognosis of this type of patients.

Topics: Amphotericin B; Antifungal Agents; Brain Abscess; Candida albicans; Candidiasis; Combined Modality Therapy; Craniotomy; Deoxycholic Acid; Diabetes Mellitus, Type 2; Drug Combinations; Drug Therapy, Combination; Fluconazole; Humans; Hyphae; Magnetic Resonance Imaging; Male; Mannitol; Middle Aged; Parietal Lobe; Psoas Abscess

Zygomycosis and aspergillosis are two serious opportunistic fungal infections that are commonly seen in immunocompromised patients. Since both these fungi invade vessels of the arterial system, an early and rapid diagnosis by direct examination of KOH mounts of the relevant clinical sample can confirm the diagnosis. Here, we present an unusual case of a diabetic patient who presented with nasal blockade and bleeding for 2 months, along with occasional haemoptysis for 15 days. On investigation, the patient was diagnosed with a case of rhinocerebral zygomycosis and was treated with amphotericin B (1 mg kg(-1) day(-1)), which was subsequently replaced with liposomal amphotericin B (2 mg kg(-1) day(-1)). However, the patient did not completely respond to therapy as haemoptysis continued. Further investigations revealed the presence of Aspergillus flavus in respiratory specimens. Thus, a final diagnosis of rhinocerebral zygomycosis with pulmonary aspergillosis in a non-HIV-infected patient was made, but due to infection of two vital sites by these fungi, the patient could not be saved.

Topics: Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 2; Female; HIV Infections; Humans; India; Middle Aged; Paranasal Sinus Diseases; Pulmonary Aspergillosis; Zygomycosis

Rhinocerebral mucormycosis is an invasive fungal sinusitis with a high mortality rate, especially in immunocompromised patients. A 70-year-old woman, with uncontrolled type 2 diabetes mellitus, presented with a one-month history of non-specific headaches associated with progressive swelling of her left eye. Computed tomography of the brain and orbits showed the extensive involvement of bilateral intranasal sinuses, orbits, extraocular muscle and soft tissues. The diagnosis of invasive mucormycosis was confirmed from a tissue biopsy taken from the internasal septum. Despite the extensive mucormycosis invasion, she was successfully treated with intranasal and systemic amphotericin B and minimal adjunctive intranasal sphenoidotomy.

Topics: Aged; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 2; Female; Humans; Mucormycosis; Nose Diseases; Orbital Diseases; Sinusitis

Zygomycosis is an opportunistic fungal infection mainly affecting patients with diabetes mellitus, immunodeficiency, and malignancies. The majority of cases in which it has been reported as a posttransplantation complication have been after renal or liver transplantation. There are few instances of rhino-sinusitis and orbital mucormycosis complicating heart transplantation.. A 38-year-old diabetic man who had undergone heart transplantation returned to the transplantation follow-up clinic 20 days after a successful operation with unilateral periorbital swelling, nasal discharge, and multiple cranial nerve dysfunctions. Multidisciplinary investigations resulted in detection of mucormycosis in the paranasal sinuses and the orbital space, as well as a thrombosis of the cavernous sinus. Surgical ablation of the infected parts, along with antifungal treatment and adjustment of immunosuppressive maintenance, restricted extension of the craniofacial involvement. Allograft function remained undisturbed.. Early detection of opportunistic infections in transplant recipients plays a big role in preventing dissemination. Fungal infections, including zygomycosis, should be considered for recipients, especially those with risk factors, such as diabetes, who present with local unusual manifestations. Sinonasal and orbital mucormycosis, if diagnosed in timely fashion, can be managed to reduce mortality. Although devastation of one-side facial and ophthalmic structures was inevitable in this case, the overall outcome was acceptable.

Topics: Adult; Amphotericin B; Antifungal Agents; Blood Transfusion; Brain; Cardiomyopathy, Dilated; Diabetes Mellitus, Type 2; Erythema; Female; Heart Transplantation; Humans; Magnetic Resonance Imaging; Male; Mucormycosis; Rhinitis; Risk Factors; Tissue Donors; Tomography, X-Ray Computed; Treatment Outcome; Zygomycosis

A 47-year-old man with newly diagnosed acute myeloblastic leukemia and non-insulin-dependent diabetes mellitus developed Trichosporon asahii fungemia while receiving caspofungin as empirical antifungal therapy. The diagnosis was based on repeated isolation of T. asahii in culture of blood for three times. Despite treatment with amphotericin B and voriconazole, the patient died. The in vitro antifungal susceptibilities of the T. asahii isolates were only available after the patient died. In vitro antifungal susceptibility tests showed high caspofungin and amphotericin B minimal inhibitory concentrations (MICs) value for this Trichosporon strain (MICs, 16 microg/ml, and>32 microg/ml, respectively). Fluconazole, itraconazole, and voriconazole exhibited low MICs in vitro (MICs, 4 microg/ml, 0.5 microg/ml, and

Topics: Amphotericin B; Antifungal Agents; Caspofungin; Diabetes Mellitus, Type 2; Drug Resistance, Multiple, Fungal; Echinocandins; Fatal Outcome; Fungemia; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Lipopeptides; Male; Microbial Sensitivity Tests; Middle Aged; Neutropenia; Trichosporon

Descending mediastinitis occurs as a complication of oropharyngeal or cervical infections and its delayed diagnosis and treatment are associated with high mortality. A rare case of an odontogenic infection in a diabetic patient, complicated by Candida parapsilosis and Candida krusei parapharyngeal space infection, descending mediastinitis and aspiration pneumonia is described. Isolate identification was based on colonial and microscopic morphological characteristics and carbohydrate assimilation test results. The patient was successfully treated with surgical drainage and debridement, broad spectrum antibacterials and liposomal amphotericin B followed by prolonged oral voriconazole therapy.

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Diabetes Mellitus, Type 2; Female; Humans; Mediastinitis; Opportunistic Infections; Pyrimidines; Triazoles; Voriconazole

This is a case of mucormycosis complicated by necrotizing fasciitis in a renal transplant recipient on immunosuppressive therapy treated with posaconazole. Mucormycosis occurs most commonly as an opportunistic infection in the immunocompromised host. This patient, with predisposing risk factors for infection, including diabetes mellitus status post cadaveric renal transplantation on immunosuppressive therapy, is the first reported case of successful treatment of Mucor involving an extremity which was neither fatal nor required extremity amputation.

Topics: Alcaligenes; Amphotericin B; Amputation, Surgical; Antifungal Agents; Cefazolin; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Drug Combinations; Drug Resistance, Multiple, Fungal; Escherichia coli Infections; Fatal Outcome; Fluconazole; Gangrene; Graft Rejection; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Leg; Leg Ulcer; Male; Middle Aged; Mucor; Mucormycosis; Penicillanic Acid; Phosphatidylcholines; Phosphatidylglycerols; Piperacillin; Postoperative Complications; Pyrimidines; Renal Dialysis; Reoperation; Sepsis; Skin Transplantation; Tazobactam; Triazoles; Voriconazole

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

Multifocal cutaneous leishmaniasis (MCL) is an extremely rare disease in South Europe, and it mainly affects immunosuppressed patients. We report a case of MCL in an immunocompetent patient affected by type II diabetes mellitus that clinically presented with three large ulcers on the legs with a non-linear distribution and several months later with an erythematous-crusty lesion on the left cheek. Diagnosis of leishmaniasis due to Leishmania infantum was formulated by PCR analysis. Given the diffuse and wide lesions, the unresponsiveness to previous local and systemic treatments, a parenteral i.v. therapy with liposomal amphotericin B at a dosage of 3mg/kg/day for 5 days was started and then repeated on the 14th and 21st days, leading to a clear improvement in the clinical picture. The different clinical expression and the evolution of leishmaniasis depend on both the parasite subtype and the host's immunity status. L. infantum manifests with an atypical clinical feature more frequently than other species. The differential diagnosis for multiple ulcers must include several skin diseases, such as cutaneous TBC, bacterial ulcers, traumatic ulcers, deep mycoses, and sarcoidosis. However, an MCL should always be considered in subjects coming from endemic areas. In our case, the multifocality, the size of the lesions and the unresponsiveness to other treatment indicate a short course treatment with liposomal B amphotericin that proved to be a suitable alternative to traditional drugs used in MCL.

Topics: Aminoglycosides; Amphotericin B; Animals; Anti-Bacterial Agents; Antiprotozoal Agents; Diabetes Mellitus, Type 2; Glucocorticoids; Humans; Immunocompetence; Leishmania infantum; Leishmaniasis, Cutaneous; Male; Middle Aged; Treatment Failure; Treatment Outcome

Mucormycosis is a rare fungal infection commonly affecting structures in the head and neck such as air sinuses, orbits, and the brain. Common predisposing factors include diabetes and immunosuppression. To date, only one case of mucormycosis involving the parotid gland has been reported, and this infection was associated with a fatal outcome.. We report a case of parotid gland mucormycosis in a 45-year-old woman with type 2 diabetes, who was successfully treated with a superficial parotidectomy and intravenous amphotericin B.. After initial surgical and antifungal therapy, the patient was left with a residual facial nerve palsy for which multiple sling procedures were performed. She is currently alive and well 6 years after the diagnosis of mucormycosis.. Mucormycosis of the parotid gland is a rare form of this often-fatal infection. In this case, infection remained isolated to the parotid gland and was diagnosed soon after presentation. The patient most likely survived because of the early diagnosis, successful surgical removal of all infected tissue, use of intravenous amphotericin therapy, and the aggressive management of comorbidities such as her diabetes.

Topics: Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 2; Facial Paralysis; Female; Humans; Middle Aged; Mucormycosis; Parotid Gland

Topics: Amphotericin B; Antifungal Agents; Black People; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Female; Genetic Predisposition to Disease; Humans; Infusions, Intravenous; Liposomes; Middle Aged; Mucormycosis; Remission Induction; Rhizopus; Sinusitis

The zygomycetes are a class of fungi that can cause a variety of infections in humans. Rhinocerebral mucormycosis is a rare disease and usually affects diabetic or immunosuppressed patients. The disease progresses rapidly and is usually fatal despite aggressive surgical and medical therapy. We report the management of two cases of rhino-sinusal and orbital mucormycosis in diabetic patients on treatment with corticosteroids, and mild renal impairment, successfully treated with a combination of aggressive surgical debridement and liposomal amphotericin B.

Topics: Acute Kidney Injury; Aged; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 2; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Mucormycosis; Orbital Diseases; Paranasal Sinus Diseases; Risk Assessment; Tomography, X-Ray Computed; Treatment Outcome

Rhinocerebral mucormycosis is a rare, fulminating opportunistic fungal infection caused by a fungus of the order mucorales. These fungi are ubiquitous, subsisting on decaying vegetation and diverse organic material. Although the fungi and spores of mucorales show minimal intrinsic pathogenicity towards normal persons, they can initiate aggressive and fulminating infection in the immune compromised host. Because rhinocerebral mucormycosis occurs infrequently it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation. We present a patient with classical presentation of rhinocerebral mucormycosis involving the paranasal sinuses, the orbit and cranial base who, was treated by a combination of aggressive surgical and medical therapy and subsequently had surgical repair of the oral defect. The purpose of this presentation is to draw attention to the clinical presentation and pathogenesis of rhinocerebral mucormycosis and to emphasise the need for high index of suspicion in its diagnosis and management.

Topics: Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 2; Diagnosis, Differential; Facial Paralysis; Hemiplegia; Humans; Kenya; Male; Middle Aged; Mucormycosis; Nose Diseases; Opportunistic Infections; Orbital Diseases; Paranasal Sinus Diseases; Rare Diseases; Skull Base; Treatment Outcome

Malignant otitis externa caused by fungal infections is rare. A review of the literature showed only 9 cases, and the causative fungus in all cases was Aspergillus. This article reports an unusual case caused by Malassezia sympodialis.. A 53-year-old man with non-insulin dependent diabetes presented with malignant otitis externa. He deteriorated despite treatment with intravenous antipseudomonal therapy and surgical debridement. Microbiologic tests revealed M. sympodialis. He responded rapidly to intravenous amphotericin.. Systemic human infections caused by M. sympodialis have not been reported. M. furfur systemic infection is rare and has been associated lipid hyperalimentation by means of a central catheter. Only 1 other case of M. fungemia without these associated risk factors has been reported.. The first case of malignant otitis externa caused by M. sympodialis is presented. It highlights the difficulty of initial biologic diagnosis and the need for lipid-enriched media to grow this fastidious organism.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Diabetes Mellitus, Type 2; Follow-Up Studies; Humans; Malassezia; Male; Middle Aged; Otitis Externa; Tomography, X-Ray Computed; Treatment Outcome

Topics: Aged; Amphotericin B; Anticoagulants; Brain Diseases; Debridement; Diabetes Mellitus, Type 2; Humans; Male; Mucormycosis; Paranasal Sinus Diseases; Warfarin

A case of liver and brain mucormycosis in a 73-y-old diabetic patient is described. The patient presented with fever and a moderate, tender hepatomegaly and a C/T scan examination of the abdomen and brain showed multiple hepatic and cerebral nodular lesions. The largest of the liver lesions was aspirated and broad hyphae of mucor were demonstrated in the purulent material obtained. The patient was treated successfully (for 40 d) with intravenous liposomal amphotericin B and then with itraconazole for 3 months. To our knowledge, this is the first case of a diabetic patient with both liver and brain mucormycosis who has been treated successfully.

Topics: Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Diabetes Mellitus, Type 2; Female; Humans; Liver Diseases; Mucormycosis; Opportunistic Infections

Lung mucormycosis is a rare fungal infection that has been described mainly in oncologic and diabetic patients. We here report the case of an endobronchial lesion caused by this fungus in an immunocompetent person. Prompt diagnosis, and therapy with Amphotericin B and surgery, permitted the complete resolution.

Topics: Aged; Amphotericin B; Antifungal Agents; Biopsy; Bronchial Diseases; Bronchoscopy; Combined Modality Therapy; Diabetes Mellitus, Type 2; Diagnosis, Differential; Humans; Immunocompromised Host; Male; Mucormycosis; Pneumonectomy; Pulmonary Atelectasis; Tomography, X-Ray Computed

Topics: Aged; Amphotericin B; Cellulitis; Diabetes Mellitus, Type 2; Gangrene; Humans; Male; Mucormycosis

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

Four patients with cryptococcal meningitis were treated with amphotericin B colloidal dispersion because of nephrotoxicity from prior treatment with conventional amphotericin B. The limited experience presented here suggests that amphotericin B colloidal dispersion is efficacious for the treatment of cryptococcal meningitis, despite being undetectable in cerebrospinal fluid, and offers a potential therapeutic alternative for patients who cannot tolerate conventional amphotericin B.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Colloids; Diabetes Mellitus, Type 2; Heart Transplantation; Humans; Liver Diseases; Male; Meningitis, Cryptococcal; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Suspensions

The case is reported of a 70-year-old man with decompensated non-acidotic type-2 diabetes mellitus and with rhinocerebral mucormycosis, manifested by inflammatory infiltration of the left nasal, paranasal, maxillary, and orbital bone structures with left ophthalmoplegia. The patient was cured after amphotericin B treatment (total dose 2.7 g) and 30 sessions of hyperbaric oxygen (2.8 atmospheres). Cure was confirmed by follow-up over more than 2 years. It is concluded that rhinocerebral mucormycosis must be treated, in addition to control of predisposing factors, and especially by restoring endocrine-metabolic balance, by adequate surgical revision, with specific high-dose amphotericin B treatment and adjunctive hyperbaric oxygen. Further studies are desirable in order to define the advantages of these therapeutic measures.

Topics: Aged; Amphotericin B; Brain Diseases; Diabetes Mellitus, Type 2; Follow-Up Studies; Humans; Male; Mucormycosis; Nose Diseases; Time Factors; Tomography, X-Ray Computed

Topics: Amphotericin B; Candidiasis; Diabetes Mellitus, Type 2; Female; Humans; Hypertension, Malignant; Middle Aged; Nitroprusside; Urinary Bladder Diseases

Topics: Amphotericin B; Diabetes Mellitus, Type 2; Edema; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Mucormycosis; Orbital Diseases

A 69-year-old man with a history of diabetes and episodic lymphocytopenia underwent pacemaker implantation for complete heart block. Despite prophylactic antibiotics, pocket irrigation, and strict sterile technique, a fungal (Candida albicans) pacemaker site infection developed that required pacemaker explanation and systemic amphotericin B therapy. After 3 days of temporary pacing, a second pulse generator was implanted on the opposite side. At 2-year follow-up, he has had no recurrence of pacemaker infection. This report underscores the predilection of diabetics for infections, and in particular, their susceptibility to Candida albicans.

Topics: Aged; Amphotericin B; Candidiasis; Diabetes Mellitus, Type 2; Follow-Up Studies; Heart Block; Humans; Male; Pacemaker, Artificial; Surgical Wound Infection

We have presented a case of a stable diabetic outpatient who had an acute illness that proved to be Torulopsis glabrata fungemia responsive to amphotericin B therapy. Her only apparent additional predisposition was a nonobstructing renal calculus. Fungemia with this organism in an outpatient is most unusual. T glabrata should be an additional consideration in outpatient as well as inpatient illnesses, especially in diabetic women.

Topics: Amphotericin B; Candidiasis; Diabetes Mellitus, Type 2; Female; Humans; Kidney Calculi; Middle Aged; Opportunistic Infections