amphotericin-b and Diabetes-Mellitus

Mucormycosis is a rare but life-threatening disease with high morbidity and mortality and is difficult to diagnose. Mucormycosis, is a severe but rare fungal infection caused by a group of molds called mucormycetes. Diabetes, use of corticosteroids, metabolic/diabetic acidosis and Covid-19 mediated immunosuppression are reported in more than 70% of cases in mucormycosis patients. Coexisting mucormycosis, Covid-19 along with diabetes mellitus increase the likelihood of mortality. Despite its occurrence since the beginning of the pandemic, there are still unanswered concerns regarding the origin of this fungal infection and mortality rate and/or relation with diabetic patients. In this review, we describe the detailed view of causative pathogens responsible for mucormycosis, diabetes mellitus and Covid-19 association along with the morbidity cases during the latest Covid-19 crisis. In the case of mucormycosis diagnosis, imaging, histopathological confirmation, fungal culture and molecular identification methods should be considered. Once mucormycosis is diagnosed, a combined treating method consisting of antifungals administration like amphotericin B, surgical intervention is needed for the reversal of the underlying condition. Early detection of this potentially life-threatening infection and timely care is needed in lowering mortality rates.

Topics: Amphotericin B; COVID-19; Diabetes Mellitus; Diabetic Ketoacidosis; Humans; Mucormycosis

Patients with diabetes are known as an important high-risk group for cerebral mucormycosis (CM).. We conducted a structured search using PubMed/MEDLINE to collect both case reports and case series case (ie including at least two patients) onto CM in diabetic patient published between 2000 and March 2020.. Forty-five reports of individual cases and eighteen case series articles were included. India accounted for the largest share of reports with 37.7% and 38.8% of individual cases and case series, respectively. Mortality ranged from 0% to 100% in the case series. The overall mortality in the individual cases was 46.3%, and 64.2% of deaths were reported in patients with ketoacidosis diabetes. Facial swelling (53.3%), headache (44.4%), loss of vision (35.5%) and ophthalmoplegia (35.5%) were the most frequently reported clinical symptoms. In all patients except 4 (91.1%), CM was treated surgically; however, in many cases (42%), despite the use of surgery, death occurred. Amphotericin B deoxycholate (AMB) and lipid-based AMB (LAMB) were used as the first lines of treatment for all patients; however, posaconazole, echinocandins, hyperbaric oxygen therapy (HBOT) and deferasirox were used in combination for a number of patients. Posaconazole has been shown to have positive therapeutic effect; however, posaconazole, LAMB and HBOT are not commonly used in low-income and health-challenged countries.. Cerebral mucormycosis is a rapidly progressive infection in diabetic patients and carries immense morbidity despite early diagnosis and treatment. Low-income countries have had the highest number of reports of the disease in recent years, indicating the need to control diabetes in these countries.

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Deoxycholic Acid; Diabetes Complications; Diabetes Mellitus; Drug Combinations; Humans; Mucormycosis; Risk Factors; Triazoles

Topics: Amphotericin B; Antifungal Agents; Brain; Brain Abscess; Diabetes Mellitus; DNA, Fungal; Frontal Sinusitis; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mycoses; Radiography; Schizophyllum

Protothecosis is an opportunistic infection caused by Prototheca, usually called as saprophytes, and is frequently found in natural and living surroundings with low virulence, but may cause chronic infection in immunocompromised individuals. We report a case of cutaneous protothecosis with zopfii var. portoricensis infection in a 66-year-old diabetic woman following hand surgery on middle right finger. Mycology study showed that smooth, creamy white, yeast-like colonies grown after necrotic tissue was cultured on Sabouraud dextrose agar at both 37 and 25°C. The organism was then identified as Prototheca zopfii var. portoricensis by molecular identification and also found from histopathology of the lesion. The lesion got improved with intravenous amphotericin B and itraconazole.

Topics: Aged; Amphotericin B; Diabetes Mellitus; Female; Humans; Itraconazole; Opportunistic Infections; Postoperative Complications; Prototheca; Skin Diseases

To evaluate the efficacy and safety of short-course intravenous amphotericin B followed by sustained release posaconazole tablets for diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis.. This prospective, pragmatic study included adults with diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis. Patients received short (7-14 days) or long (15-28 days) intravenous antifungal therapy (short intravenous antifungal treatment [SHIFT] or long intravenous antifungal treatment [LIFT], respectively) depending on the presence or absence of brain involvement. All patients received step-down posaconazole tablets, debridement, and glycemic control. The primary outcome was the treatment success at week 14, which was determined by assessing survival and the absence of disease progression through clinical evaluation and nasal endoscopy. Log-binomial regression analysis (risk ratio and 95% CI) was performed to assess factors associated with the primary outcome.. Intravenous therapy was administered to 251 participants: SHIFT, 205 (median duration, 13 days); LIFT, 46 (median duration, 22 days). Treatment success at 3 months was 88% (217/248; 95% CI, 83-91%): SHIFT group, 93% (189/203; 89-96%); LIFT group, 62% (28/45; 47-76%). All-cause mortality was 12% (30/251): SHIFT group, 6% (13/205); LIFT group, 37% (17/46). Age (aRR [95% CI]: 1.02 [1.00-1.05]; p 0.027), diabetic ketoacidosis at presentation (2.32 [1.20-4.46]; p 0·012), glycated haemoglobin A1c (1.19 [1.03-1.39]; p 0.019), stroke (3.93 [1.94-7.95]; p 0·0001), and brain involvement (5.67 [3.05-10.54]; p < 0.0001) were independently associated with unsuccessful outcomes.. Short intravenous amphotericin B with step-down posaconazole tablets should be further studied as primary treatment option for diabetes or COVID-19-associated mucormycosis in randomized controlled trials.

Topics: Adult; Amphotericin B; Antifungal Agents; COVID-19; Diabetes Mellitus; Humans; Mucormycosis; Orbital Diseases; Prospective Studies

Despite the unprecedented surge in the incidence of mucormycosis in the COVID-19 era, the antifungal susceptibility patterns (ASPs) of COVID-19 associated mucormycosis (CAM) isolates have not been investigated so far and it is unclear if the high mortality rate associated with CAM is driven by decreased susceptibility of Mucorales to antifungal drugs.. To describe the clinical, mycological, outcome and in vitro ASPs of CAM cases and their etiologies from Iran.. A prospective study from January 2020 to January 2022 at a referral tertiary hospital in Tehran, Iran was conducted for screening mucormycosis through histopathology and mycological methods. The identity of Mucorales isolates was revealed with ITS-panfungal PCR& sequencing and MALDI-TOF. The AS for amphotericin B, itraconazole, isavuconazole and posaconazole was cleared according to the EUCAST antifungal susceptibility testing protocol.. A total of 150 individuals were diagnosed with CAM. Males constituted 60.7% of the population. The mean age was 54.9 years. Diabetes was the leading risk factor (74.7%). The median interval between diagnosis of COVID-19 and CAM was 31 days. The recovery rate of culture was as low as 41.3% with Rhizopus arrhizus being identified as the dominant (60; 96.7%) agent. Amphotericin B (MIC. Majority of the cases had either diabetes, history of corticosteroid therapy or simultaneously both conditions. Accordingly, close monitoring of blood glucose should be considered. The indications for corticosteroids therapy are recommended to be optimized. Also, an anti Mucorales prophylaxis may be necessitated to be administrated in high risk individuals. Although amphotericin B was the most active agent, a higher rate of resistance to this antifungal was noted here in comparison with earlier studies on mucormycetes from non-CAM cases.

Topics: Amphotericin B; Antifungal Agents; COVID-19; Diabetes Mellitus; Humans; Iran; Male; Middle Aged; Mucorales; Mucormycosis; Prospective Studies; Tertiary Care Centers

Rhinocerebral mucormycosis is extremely fatal, with mortality rates ranging from 85-93% despite the best treatment in immunocompromised patients. We emphasize the importance of early diagnosis, repeated debridement, and aggressive antifungal treatment to reduce mortality.. We report six cases (five male and one female), with a mean age of 51 years who were diagnosed to have mucormycosis from 2017 to 2019. All patients were diabetic. Intracranial involvement and orbital involvement were found in four cases. Facial nerve palsy was seen in two cases, one without any apparent otological involvement. Aggressive serial debridement and amphotericin B was started. Posaconazole was added subsequently to the treatment in two cases. One patient succumbed to the disease five months after discharge. The other five patients are on regular follow-up for a mean duration of 14 months at the end of which two had residual disease which was under control.. Repeated surgical debridement with an early aggressive and combination antifungal therapy can result in good outcomes even in advanced mucormycosis. Concurrent management of the underlying pathology, monitoring of liver and kidney functions, and therapeutic drug monitoring are useful to ensure smooth and effective treatment.

Topics: Amphotericin B; Antifungal Agents; Debridement; Diabetes Mellitus; Female; Humans; Male; Middle Aged; Mucormycosis

The pandemic of coronavirus disease (COVID-19) emerged as a fatal infection, especially in immunocompromised patients. Currently, this infection is managed with systemic corticosteroids. Co-infection of CO-VID-19 with opportunistic fungi is increasingly recognized.. We describe a case of rhino-cerebral mucormycosis 12 days following severe COVID-19 in a diabetic patient.. He received 50 mg amphotericin B and surgical debridement. The patient's symptoms improved following medical and surgical intervention.. Mucormycosis is an uncommon but serious infection that complicates the course of severe COVID-19. Subjects with diabetes mellitus and multiple risk factors may be at a higher risk for developing mucormycosis.

Topics: Amphotericin B; Antifungal Agents; COVID-19; Diabetes Mellitus; Humans; Male; Mucormycosis; Rhizopus

The aim of the study was to report clinical features, contributing factors and outcome of patients with coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM).. A cross-sectional descriptive multicentre study was conducted on patients with biopsy-proven mucormycosis with RT-PCR-confirmed COVID-19 from April to September 2020. Demographics, the time interval between COVID-19 and mucormycosis, underlying systemic diseases, clinical features, course of disease and outcomes were collected and analysed.. Fifteen patients with COVID-19 and rhino-orbital mucormycosis were observed. The median age of patients was 52 years (range 14-71), and 66% were male. The median interval time between COVID-19 disease and diagnosis of mucormycosis was seven (range: 1-37) days. Among all, 13 patients (86%) had diabetes mellitus, while 7 (46.6%) previously received intravenous corticosteroid therapy. Five patients (33%) underwent orbital exenteration, while seven (47%) patients died from mucormycosis. Six patients (40%) received combined antifungal therapy and none that received combined antifungal therapy died.. Clinicians should be aware that mucormycosis may be complication of COVID-19 in high-risk patients. Poor control of diabetes mellitus is an important predisposing factor for CAM. Systematic surveillance for control of diabetes mellitus and educating physician about the early diagnosis of CAM are suggested.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Caspofungin; Coinfection; Comorbidity; COVID-19; COVID-19 Drug Treatment; Cross-Sectional Studies; Diabetes Complications; Diabetes Mellitus; Drug Therapy, Combination; Female; Humans; Iran; Male; Middle Aged; Mucormycosis; Respiratory Distress Syndrome; Triazoles; Young Adult

BACKGROUND Invasive mucormycosis is a rare, life-threatening infection that requires urgent medical management. Here we describe a patient who developed invasive mucormycosis after receiving only a short course of dexamethasone. The purpose is to highlight this atypical presentation of a rare disease. CASE REPORT A 74-year-old woman with a medical history of diabetes mellitus (DM), hypertension, hyperlipidemia, and small cell lung cancer with metastasis to the brain presented to the Emergency Department with altered mental status and a hyperosmolar hyperglycemic state. Three weeks before, she had been diagnosed with DM (hemoglobin A1c [HbA1c] 6.5%) and was started on dexamethasone to treat cerebral edema. On admission, her HbA1c was 10.8%, although she had received only a short course of dexamethasone. Her physical exam was concerning for left eyelid swelling and ophthalmoplegia. Computed tomography of the head and neck revealed signs of left ocular proptosis and invasive rhinomaxillary fungal disease. The patient underwent urgent surgical debridement; subsequent magnetic resonance imaging revealed extensive fungal disease extending into her left inferior frontal lobe. A surgical pathology report was positive for Rhizopus oryzae and Stenotrophomonas maltophilia. Her blood cultures were positive for methicillin-susceptible Staphylococcus aureus. She was treated with antibiotics and amphotericin B. Her clinical course was complicated by hypokalemia. She eventually recovered and was discharged from the hospital. CONCLUSIONS This case highlights an atypical presentation of mucormycosis. Clinicians should remain vigilant for this rare complication of dexamethasone use even when the therapy is given for a short time.

Topics: Aged; Amphotericin B; Dexamethasone; Diabetes Mellitus; Female; Humans; Magnetic Resonance Imaging; Mucormycosis

The authors present their experience about clinical evidences that include patients with an untreated diabetes who developed rhino-orbito-cerebral mucormycosis (ROCM). They were treated with endoscopic sinus surgery and medical treatment with intravenous, intradural therapy, and sinus washes with amphotericin B. The ROCM is a disease with a rapid evolution and an increase in mortality rate, especially if the fungus enters the cranial cavity. Therefore, it would be necessary in all diabetic patients with sinus symptoms, headaches, visual changes, suspect a mucormycosis, and perform a careful radiology assessment and a nasal endoscopy. Often, despite an early diagnosis and rapid treatment for ROCM, it is not possible to stem the disease, which ends with the patient's death.

Topics: Aged; Amphotericin B; Antifungal Agents; Diabetes Complications; Diabetes Mellitus; Endoscopy; Humans; Male; Middle Aged; Mucormycosis; Orbital Diseases; Paranasal Sinus Diseases

Osteoarticular mucormycosis cases are quite rare and challenging infections that are mostly due to direct inoculation during traumatic injury among immunocompetent patients. Classic management includes a combination of aggressive surgical debridement, which may lead to amputation, and long-term systemic liposomal amphotericin B therapy. This article describes the successful treatment of

Topics: Amphotericin B; Antifungal Agents; Debridement; Diabetes Complications; Diabetes Mellitus; Drug Carriers; Humans; Male; Middle Aged; Mucorales; Mucormycosis; Osteomyelitis

Mucormycosis is a rare but fulminant opportunistic fungal infection, which occurs most often in diabetic and immunocompromised patients. Dental extractions may create a portal of entry for the fungal infection. The mucormycosis may be the original cause of the pain and can be misdiagnosed as dental pain. In this paper, two cases of mucormycosis are reported after dental extractions and successfully treated with amphotericin B (case #1) and combined with posaconazole (case #2). The two cases we describe exemplify the fulminant mucormycosis of maxillary sinuses after dental extraction inpatients with uncontrolled diabetic support the findings that this predisposing condition created a suitable environment for the Mucorales growth. These case reports emphasize early recognition and urgent treatment of mucormycosis is necessary to prevent the spread of infection Therefore, dental surgeons and healthcare practitioners should become familiar with mucormycosis.

Topics: Adult; Amphotericin B; Antifungal Agents; Diabetes Complications; Diabetes Mellitus; Female; Humans; Immunocompromised Host; Male; Maxillary Sinus; Middle Aged; Mucorales; Mucormycosis; Opportunistic Infections; Sinusitis; Tooth Extraction; Treatment Outcome; Triazoles

Mucormycosis is a devastating infection caused by Mucoralean fungi (Mucormycotina, Mucorales). Data concerning the global epidemiology of mucormycosis are scarce and little is known about the characteristics of mucormycosis in Iran. In this study, we aimed to understand the distribution of this infection in Iran retrospectively and to ascertain whether the patterns of infection are associated with specific host factors or not. A total of 208 cases were included in this study occurring during 2008-2014 and were validated according to (EORTC/MSG) criteria. A rising trend as significant increase from 9.7% in 2008 to 23.7% in 2014 was observed. The majority of patients were female (51.4%) with median age of 50 and the infections were seen mostly in autumn season (39.4%). Diabetes mellitus (75.4%) was the most common underlying condition and sinus involvement (86%) was the mostly affected site of infection. Amphotericin B (AmB) was the drug of choice for the majority of cases. Sixty four isolates did not show any growth in the lab and only 21 cases were evaluated by ITS sequencing, among them; Rhizopus arrhizus var. arrhizus was the dominant species. Considering the high mortality rate of mucormycosis, early and accurate diagnosis, with the aid of molecular methods may provide accurate treatments and improve the survival rate. Therefore, increased monitoring and awareness of this life-threatening disease is critical.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Diabetes Complications; Diabetes Mellitus; DNA, Ribosomal Spacer; Female; Host-Pathogen Interactions; Humans; Iran; Male; Middle Aged; Mucorales; Mucormycosis; Paranasal Sinuses; Retrospective Studies; Rhizopus; Seasons

Mucormycosis (MCM) is a rare fungal infection affecting people with impaired immunity. Data related to MCM from Lebanon are scarce. The aim of this study is to shed light on the epidemiology, incidence, and outcome of patients with MCM hospitalized at a tertiary care center in Lebanon.. We conducted a retrospective chart review between Jan 1, 2008 and Jan 10, 2018. All patients with proven or probable MCM were included.. A total of 20 patients were included. Their median age was 49 years and the majority were males. Comorbidities included mainly hematologic malignancy and diabetes mellitus. Most common sites of involvement were rhino-orbital and pulmonary, respectively. The number of MCM cases/10.000 hospital admissions increased significantly between 2008 and 2017 (0.47 vs. 1.18; P < 0.05). A liposomal amphotericin B formulation alone or in combination with other antifungals was used as a first line agent in all patients. All-cause mortality was 60%; however, death was attributed to MCM in 20% of cases.. The incidence of MCM has significantly increased over the past 10 years at our institution, most likely due to the increasing patient population at risk. Understanding the epidemiology of MCM in our setting would help guide antifungal therapy.

Topics: Amphotericin B; Diabetes Mellitus; Fungicides, Industrial; Hematologic Neoplasms; Incidence; Lebanon; Mucormycosis; Retrospective Studies; Tertiary Care Centers; Treatment Outcome

Mucormycosis is a highly lethal fungal infection especially in immunocompromised individuals.. In order to review the epidemiology, diagnosis, and treatment of mucormycosis in renal transplant recipients we searched publications of mucormycosis cases in renal transplant recipients in PUBMED database up to December 2015.. A total of 174 cases in renal transplant recipients were included in this review. Most of the cases (76%) were male. Major underlying diseases were diabetes mellitus (43.1%). Rhinocerebral was the most common site of infection (33.3%). Rhizopus species was the most frequent fungus (59.1%) in patients with pathogen identified to species level. The mortality rates of disseminated mucormycosis (76.0%) and graft renal (55.6%) were higher than infection in other sites. The overall survival in patients received surgical debridement combined with amphotericin B/posaconazole (70.2%) was higher than those who received antifungal therapy alone (32.4%), surgery alone (36.4%) or without therapy (0%) (p < 0.001). The overall survivals in patients receiving posaconazole and lipid amphoterincin B were higher than that receiving deoxycholate formulation (92.3% and 73.4% vs 47.4%).. Mucormycosis is a severe infection in renal transplant recipients. Surgical debridement combined with antifungals, especially liposomal amphotericin B and posaconazole, can significantly improve patient's overall survival.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Child; Debridement; Deoxycholic Acid; Diabetes Mellitus; Female; Humans; Immunocompromised Host; Kidney Transplantation; Male; Middle Aged; Mucormycosis; Rhizopus; Transplant Recipients; Triazoles; Young Adult

To improve the understanding of diabetic combined pulmonary mucormycosis.. The clinical data of twelve patients diagnosed as diabetic combined pulmonary mucormycosis were analyzed by the clinical manifestations, imaging features, diagnosis, treatment and prognosis of this disease. Patients from January 1999 to June 2015 in our hospital had poor blood glucose control and varying degrees of diabetic chronic complications with an on average of diabetes 8.6 ± 3.5 years. The clinical symptoms of diabetic combined pulmonary mucormycosis included different degrees of fever, cough, sputum and dyspnea. The numbers of white blood cells and neutrophils were significantly elevated in patients, and Mucor had been checked in sputum culture for three times. In addition, although the liver and kidney functions were normal, the patients had hypoxemia and decreased diffusion capacity, lung capacity and carbon dioxide binding force. Imaging manifestations revealed small patchy shadows with nodular shadows and pneumonia in the lung of the patients. Twelve patients took oral hypoglycemic drugs for improving glucose combined with subcutaneous injection of insulin. One patient with intravenous injection of fluconazole was died of respiratory failure at 1 week. There were two of seven cases with amphotericin B liposome died of haemoptysis and respiratory failure, respectively, and the other five were cured. Moreover, four cases who took more than two drugs were cured.. Diabetic with pulmonary mucormycosis is a rare but fatal fungal infection disease. Diagnosis and treatment early are essential to improve the prognosis of the patients.

Topics: Adult; Amphotericin B; Antifungal Agents; Diabetes Complications; Diabetes Mellitus; Female; Fluconazole; Humans; Hypoglycemic Agents; Hypoxia; Insulin; Lung Diseases, Fungal; Male; Middle Aged; Mucor; Mucormycosis; Respiratory Function Tests

Opportunistic infections have been reported infrequently in primary HIV infection. We report a case of cryptococcemia in primary HIV infection. To our knowledge there has not been such a case reported. Our case highlights the need for clinicians to be wary of other opportunistic infections, including cryptococcosis, in primary HIV infection.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Diabetes Mellitus; Fluconazole; Hepatitis B; HIV Infections; Humans; Liver Function Tests; Male; Syphilis; Treatment Outcome

No comprehensive reports have been published on epidemiological status of Rhinocerebral zygomycosis infections and its outcome in our population, Hence, the current study came to address epidemiological characteristics as well as clinical outcome of patients with Rhinocerebral zygomycosis infection referred to a referral hospital in Iran.. This retrospective study was performed at the Rasoul-e-Akram hospital, an 800-bed tertiary care teaching hospital in Tehran, Iran. The pathology recorded charts were reviewed to identify all cases of Rhinocerebral zygomycosis from patients admitted between April 2007 and March 2014. A diagnosis of Rhinocerebral zygomycosis was based on histopathological assessments.. Sixty four patients with Rhinocerebral zygomycosis were assessed. The mean age of the patients was 46.07 ± 22.59 years and 51.6% were female. Among those, 67.2% were diabetic, 26.6% were hypertensive and 29.7% had history of cancer. Different sinuses were infected in 73.4% of the patients. Out of all the patients 26.6% underwent surgical procedures and 17.2% were controlled medically. Extensive debridement was carried out in 40.6%. Neutropenia (<1500 cell/ µl) was revealed in 12.5%. In-hospital mortality rate was 35.9% and prolonged hospital stay (> 14 days) was found in 60.9%. According to the Multivariable logistic regression analysis, the main predictors of in-hospital mortality included female gender, advanced age, the presence of sinus infection, and neutropenia, while higher dosages of amphotericin administered had a protective role in preventing early mortality. In a similar Multivariate model, history of cancer could predict prolonged hospital stay, whereas using higher dose of amphotericin could lead to shortening length of hospital stay.. There is no difference in demographic characteristics between our patients with Rhinocerebral zygomycosis and other nations. The presence of diabetes mellitus is closely associated with the presence of this infection. Sinus involvement is very common in those with Rhinocerebral zygomycosis leading to high mortality and morbidity. Besides female gender, advanced age, and presence of neutropenia was a major risk factor for increasing early mortality. The use of higher doses of antifungal treatment such as amphotericin can prevent both mortality and prolonged hospital stay. The cancer patients may need longer hospital stay because of needing comprehensive in-hospital treatment.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Brain Diseases; Child; Child, Preschool; Debridement; Diabetes Mellitus; Dose-Response Relationship, Drug; Female; Hospital Mortality; Humans; Iran; Length of Stay; Logistic Models; Male; Middle Aged; Nose Diseases; Retrospective Studies; Risk Factors; Young Adult; Zygomycosis

Mucormycosis has emerged as a rare but frequently fatal invasive fungal disease. Current knowledge on paediatric mucormycosis is based on case reports and small series reported over several decades. Contemporary data on a large cohort of patients is lacking.. Two large international registries (Zygomyco.net and FungiScope™) were searched for mucormycosis cases in ≤19 year-old patients. Cases enrolled between 2005 and 2014 were extracted, and dual entries in the two databases merged. Epidemiology, clinical characteristics, diagnostic procedures, therapeutic management and final outcome were recorded and analysed with SPSS v.12.. Sixty-three unique cases (44 proven and 19 probable) were enrolled from 15 countries (54 in European and 9 in non-European countries). Median age was 13 years [Interquartile Range (IQR) 7.7] with a slight predominance (54.1 %) of females. Underlying conditions were haematological malignancies (46 %), other malignancies (6.3 %), haematopoietic stem cell transplantation (15.9 %), solid organ transplantation, trauma/surgery and diabetes mellitus (4.8 % each) and a variety of other diseases (7.9 %); in 9.5%, no underlying medical condition was found. Neutropenia was recorded in 46 % of the patients. The main sites of infection were lungs (19 %), skin and soft tissues (19 %), paranasal sinus/sino-orbital region (15.8 %) and rhino-cerebral region (7.9 %). Disseminated infection was present in 38.1 %. Mucormycosis diagnosis was based on several combinations of methods; culture combined with histology was performed in 31 cases (49.2 %). Fungal isolates included Rhizopus spp. (39.7 %), Lichtheimia spp. (17.5 %), Mucor spp. (12.7 %), Cunninghamella bertholletiae (6.3 %) and unspecified (23.8 %). Treatment comprised amphotericin B (AmB) monotherapy in 31.7 % or AmB in combination with other antifungals in 47.7 % of the cases, while 14.3 % received no antifungals. Surgery alone was performed in 6.3 %, and combined with antifungal therapy in 47.6 %. Crude mortality at last contact of follow-up was 33.3 %. In regression analysis, disseminated disease and prior haematopoietic stem cell transplantation were associated with increased odds of death, whereas the combination of systemic antifungal therapy with surgery was associated with improved survival.. Paediatric mucormycosis mainly affects children with malignancies, presents as pulmonary, soft tissue, paranasal sinus or disseminated disease and is highly lethal. Outcome is improved when active antifungal therapy and surgery are combined.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Child; Diabetes Mellitus; Europe; Female; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Humans; Lung Diseases, Fungal; Male; Mucormycosis; Neutropenia; Prospective Studies; Registries; Rhizopus; Treatment Outcome

Mucormycosis is an uncommon opportunistic fungal infection caused by Zygomycetes. It usually affects immunocompromised, diabetic and trauma patients with infected wounds. We report a case of disseminated infection secondary to facial cutaneous mucormycosis caused by Saksenaea vasiformis in a diabetic patient who had a farming accident causing him severe head injury. The patient was treated with a combination of surgical debridement and antifungal therapy with liposomal amphotericin B, but he had a slow and fatal outcome. In cases of tissue necrosis following trauma involving wound contact with soil (i.e., potential fungal contamination), testing for the presence of Zygomycetes fungi such as S. vasiformis in both immunocompetent and immunocompromised patients is crucial. The reason is that this infection usually has a rapid progression and may be fatal if appropriate treatment is not administered.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Craniocerebral Trauma; Dermatomycoses; Diabetes Complications; Diabetes Mellitus; Humans; Immunocompromised Host; Male; Middle Aged; Molecular Sequence Data; Mucorales; Mucormycosis; Sepsis

Acute kidney injury (AKI) following admission to hospital is associated with increased mortality, morbidity and length of stay. Factors that predispose patients to AKI frequently co-exist. The precise description of their representation in unselected admissions could help define mechanistic inter-relationships and optimise risk stratification strategies. Our aim was therefore to define precisely, using electronically available data, the variables that are associated with AKI.. A cohort study of 112,987 emergency admissions to an urban academic medical centre between 2006 and 2010 was performed. Post-admission AKI was defined using KDIGO aligned, proportionate changes in serum creatinine, denominated by the first measured. AKI correlated with co-morbidities, medications received and the C-reactive protein concentration (CRP).. The relationship between post-admission AKI and putative risk factors was defined in univariate and multivariate analyses. Inclusion of CRP in multivariate analyses significantly reduced the strength of association between some co-variables such as radiological contrast and gentamicin administration but not others.. The effect of CRP in these analyses supports the role of systemic inflammation in susceptibility to post-admission AKI. It accounts for the greater part of univariate associations between AKI and some nephrotoxic agents, placing the risk attributable to their use in context. Quantification of the systemic inflammatory response may have utility in AKI risk stratification, integrating various determinants of susceptibility.

Topics: Academic Medical Centers; Acute Kidney Injury; Adult; Aged; Aged, 80 and over; Amphotericin B; C-Reactive Protein; Comorbidity; Creatinine; Diabetes Mellitus; Emergencies; Female; Gentamicins; Hospitalization; Hospitals, Urban; Humans; Hypertension; Inflammation; Male; Middle Aged; Risk Assessment; Risk Factors

Necrotizing fasciitis is an uncommon, rapidly progressive soft-tissue infection that is associated with a high incidence of morbidity and mortality. It is usually caused by bacteria and rarely caused by or complicated by a fungus. We report 3 cases of necrotizing fasciitis of the head and neck in patients with uncontrolled diabetes. Fungi were isolated in all 3 cases. In 1 fatal case, the invasive zygomycete Apophysomyces elegans was isolated. Keys to the management of this condition are (1) early isolation of the causative organism by fungal smear and culture, (2) adequate control of diabetes, (3) maintenance of electrolyte balance, and (4) controlled aggressive surgical debridement at an early stage. We emphasize the importance of fungal smears and cultures in the management of this rapidly spreading infection.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Debridement; Diabetes Complications; Diabetes Mellitus; Fasciitis, Necrotizing; Head; Humans; Male; Middle Aged; Mucormycosis; Neck

Opportunistic fungi are dispersed as airborne, ground and decaying matter. The second most frequent extra-pulmonary disease by Aspergillus is in the central nervous system.. The case subject was 55 years old, male, mulatto, and an assistant surveyor residing in Teresina, Piauí. He presented with headache, seizures, confusion, fever and left hemiparesis upon hospitalization in 2006 at Hospital São Marcos. Five years previously, he was diagnosed with diabetes mellitus, and 17 months previously he had acne margined by hyperpigmented areas and was diagnosed with leprosy. Laboratory tests indicated leukocytosis and magnetic resonance imaging showed an infarction in the right cerebral hemisphere. Cerebrospinal fluid examination showed 120 cells/mm(3) and was alcohol-resistant bacilli negative. Trans-sphenoidal surgery with biopsy showed inflammation was caused by infection with Aspergillus fumigatus. We initiated use of parenteral amphotericin B, but his condition worsened. He underwent another surgery to implant a reservoir of Ommaya-Hickmann, a subcutaneous catheter. We started liposomal amphotericin B 5 mg/kg in the reservoir on alternate days. He was discharged with a prescription of tegretol and fluconazole.. This report has scientific interest because of the occurrence of angioinvasive cerebral aspergillosis in a diabetic patient, which is rarely reported. In conclusion, we suggest a definitive diagnosis of cerebral aspergillosis should not postpone quick effective treatment.

Topics: Amphotericin B; Anticonvulsants; Antifungal Agents; Aspergillus fumigatus; Biopsy; Carbamazepine; Cerebrum; Diabetes Mellitus; Fluconazole; Humans; Leprosy, Lepromatous; Magnetic Resonance Imaging; Male; Middle Aged; Neuroaspergillosis; Predictive Value of Tests; Seizures; Treatment Outcome

This study investigated the susceptibility of 198 clinical isolates of Candida species against caspofungin, amphotericin B, itraconazole, and fluconazole.. Suspensions of the microorganisms were spread on Roswell Park Memorial Institute (RPMI) agar plates. Etest strips were placed on the plates, and the minimal inhibitory concentration (MIC) was read after incubation (48 h at 37 °C). Data were analyzed by a factorial analysis of variance and a 2 × 2 post hoc test (α = .05).. C glabrata showed the highest MIC values (P < .001) against caspofungin, itraconazole, and fluconazole. For amphotericin B, the MIC values of C tropicalis and C glabrata (P = .0521) were higher than those of C albicans (P < .001). Itraconazole was the least effective antifungal; 93.3% of the C glabrata isolates, 3.3% of the C albicans, and 1.3% of the C tropicalis were resistant. All microorganisms were susceptible to caspofungin and amphotericin B.. Caspofungin and amphotericin B should be recommended as an effective alternative for the management of oral Candida infections when treatment with topical or other systemic drugs has definitely failed.

Topics: Amphotericin B; Antifungal Agents; Brazil; Candida; Candidiasis, Oral; Caspofungin; Diabetes Mellitus; Drug Resistance, Fungal; Echinocandins; Fluconazole; Humans; Itraconazole; Lipopeptides; Microbial Sensitivity Tests; Stomatitis, Denture

Mucormycosis is a deadly invasive fungal infection whose characteristics are only partially understood.. Data on mucormycosis obtained in France between 2005 and 2007 from 2 notification systems were merged. The 2008 European Organisation for Research and Treatment of Cancer/Mycoses Study Group definition criteria were applied and risk factors for death were analyzed by hazard ratios (HRs) calculated from the Cox proportional hazards regression model.. A total of 101 cases (60 proven, 41 probable), mostly in men (58%) >50 years (mean age, 50.7 ± 19.9) were recorded. Hematological malignancies represented 50% (median time for occurrence, 8.8 months after disease onset), diabetes 23%, and trauma 18% of cases. Sites of infection were lungs (28%; 79% in hematology patients), rhinocerebral (25%; 64% in diabetic patients), skin (20%), and disseminated (18%). Median time between first symptoms and diagnosis was 2 weeks. The main fungal species were Rhizopus oryzae (32%) and Lichtheimia species (29%). In cases where the causative species was identified, R. oryzae was present in 85% of rhinocerebral forms compared with only 17% of nonrhinocerebral forms (P < .001). Treatment consisted of surgery in 59% and antifungals in 87% of cases (liposomal amphotericin B in 61%). Ninety-day survival was 56%; it was reduced in cases of dissemination compared with rhinocerebral (HR, 5.38 [2.0-14.1]; P < .001), pulmonary (HR, 2.2 [1.0-4.7]; P = .04), or skin localization (HR, 5.73 [1.9-17.5]; P = .002); survival was reduced in cases of hematological malignancies compared with diabetes mellitus (HR, 2.3 [1.0-5.2]; P < .05) or trauma (HR, 6.9 [1.6-28.6], P = .008) and if ≥2 underlying conditions (HR, 5.9 [1.8-19.0]; P = .004). Mucormycosis localization remained the only independent factor associated with survival.. This 3-year study performed in one country shows the diverse clinical presentation of mucormycosis with a high prevalence of primary skin infection following trauma and a prognosis significantly influenced by localization.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Cerebellar Diseases; Child; Data Collection; Dermatomycoses; Diabetes Mellitus; Female; France; Hematologic Neoplasms; Humans; Lung; Male; Middle Aged; Mucormycosis; Prognosis; Proportional Hazards Models; Retrospective Studies; Rhizopus; Risk Factors; Survival Analysis; Treatment Outcome; Wounds and Injuries; Young Adult

We describe a 24-year-old man with type 1 diabetes mellitus and a cavitary lesion in the right upper lobe, caused by a zygomycete. Surgical resection plus liposomal amphotericin B therapy was successful. We discuss predisposing condition, clinical findings, diagnosis, and treatment of pulmonary zygomycosis.

Topics: Amphotericin B; Antifungal Agents; Comorbidity; Diabetes Mellitus; Humans; Immunocompromised Host; Liposomes; Lung Diseases, Fungal; Male; Young Adult; Zygomycosis

A rare case of an invasive cutaneous infection by Geotrichum candidum in an 80-year-old male patient with diabetes mellitus is reported. The primary site of infection manifested after trauma as an ulcerative lesion on the distal phalanx of the midfinger and extended throughout the right hand. Histological examination showed fungal invasion in the deep dermis without vascular involvement and G. candidum was grown in cultures from the biopsy material. Angiography revealed severe obstructive disease of the right brachial artery and its branches. Treatment, after susceptibility testing of the isolated strain, consisted of sequential administration of intravenous liposomal amphotericin B with oral voriconazole followed by liposomal amphotericin B, resulting in substantial improvement of the infection.

Topics: Aged, 80 and over; Amphotericin B; Antifungal Agents; Diabetes Mellitus; Geotrichosis; Geotrichum; Humans; Male; Pyrimidines; Triazoles; Voriconazole

Mucormycosis causes mortality in at least 50% of cases despite current first-line therapies. Clinical and animal data indicate that the presence of elevated available serum iron predisposes the host to mucormycosis. Here we demonstrate that deferasirox, an iron chelator recently approved for use in humans by the US FDA, is a highly effective treatment for mucormycosis. Deferasirox effectively chelated iron from Rhizopus oryzae and demonstrated cidal activity in vitro against 28 of 29 clinical isolates of Mucorales at concentrations well below clinically achievable serum levels. When administered to diabetic ketoacidotic or neutropenic mice with mucormycosis, deferasirox significantly improved survival and decreased tissue fungal burden, with an efficacy similar to that of liposomal amphotericin B. Deferasirox treatment also enhanced the host inflammatory response to mucormycosis. Most importantly, deferasirox synergistically improved survival and reduced tissue fungal burden when combined with liposomal amphotericin B. These data support clinical investigation of adjunctive deferasirox therapy to improve the poor outcomes of mucormycosis with current therapy. As iron availability is integral to the pathogenesis of other infections (e.g., tuberculosis, malaria), broader investigation of deferasirox as an antiinfective treatment is warranted.

Topics: Amphotericin B; Animals; Benzoates; Deferasirox; Diabetes Mellitus; Drug Therapy, Combination; Iron; Iron Chelating Agents; Liposomes; Male; Mice; Mice, Inbred BALB C; Mucorales; Mucormycosis; Survival Rate; Th1 Cells; Th2 Cells; Triazoles

Ramichloridium mackenziei is a dematiaceous fungus that usually causes cerebral phaeohyphomycosis. We describe the aspiration cytology findings of a case of cerebral abscess caused by R. mackenziei in a 66-yr-old Saudi woman who had a long standing history of diabetes mellitus and a recent diagnosis of systemic lupus erythematosus. She was on long-term corticosteroid therapy. The patient developed rapidly progressive multiple brain abscesses and died despite aspiration of the abscess and administration of intravenous amphotericin B lipid complex and voriconazole.

Topics: Aged; Amphotericin B; Antifungal Agents; Ascomycota; Biopsy, Needle; Brain Abscess; Central Nervous System Fungal Infections; Combined Modality Therapy; Diabetes Complications; Diabetes Mellitus; Fatal Outcome; Female; Humans; Lupus Erythematosus, Systemic; Pyrimidines; Triazoles; Voriconazole

Rhinocerebral mucormycosis is a rapidly progressive and often fatal infection frequently seen in patients with uncontrolled diabetes mellitus and hematologic malignancies. The disease is difficult to diagnose because it often masquerades as bacterial sinusitis. The current report describes a 69-year-old white woman with diabetes mellitus who was prescribed high-dose prednisone therapy for chronic obstructive pulmonary disease. Two weeks after treatment initiation, she presented to the hospital with facial edema on the right side, mouth pain, and general weakness. No black eschars on the nasal mucosae or palates were present on admission. Although bacterial etiology was initially suspected, surgery and tissue samples revealed the presence of rhinocerebral mucormycosis. The patient died at 6 days postadmission despite aggressive medical and surgical intervention. The current report discusses the risk factors associated with rhinocerebral mucormycosis as well as the necessity of early diagnosis and treatment to improve patient outcomes.

Topics: Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Comorbidity; Diabetes Mellitus; Disease Progression; Edema; Fatal Outcome; Female; Glucocorticoids; Humans; Immunocompromised Host; Kidney Failure, Chronic; Mucormycosis; Prednisone; Pulmonary Disease, Chronic Obstructive; Risk Factors; Sinusitis

A 56 years male diabetic patient presented with recurrent left upper lobe pneumonia. Fiberoptic bronchoscopy revealed extraluminal compression of left main bronchus with an endobronchial mass obstructing the left upper lobe orifice. The lesion resembled bronchial adenoma. However histological examination revealed mucormycosis. Timely diagnosis followed by medical intervention with intravenous Amphotericin B, coupled with proper management of diabetes, ablated the tumor. Relevant literature on the subject is reviewed.

Topics: Amphotericin B; Antifungal Agents; Bronchoscopy; Diabetes Mellitus; Humans; Injections, Intravenous; Lung Diseases, Fungal; Male; Middle Aged; Mucormycosis; Pneumonia

Rhinocerebral mucormycosis is an aggressive fungal disease that involves the nose, paranasal sinuses, orbit and central nervous system. It may rapidly be fatal. This infection usually occurs secondary to immune suppression, diabetic ketoacidosis, and prolonged use of antibiotics, steroids, and cytotoxic drugs. Management of the condition consists of treatment of the underlying disease and surgical debridement combined with intravenous amphotericin B. This paper presents two patients with rhinocerebral mucormycosis, both suffering from diabetes. Complete recovery was achieved in one patient with surgical debridement of necrotic tissue combined with systemic antifungal treatment, whereas in the other, the disease was complicated with subarachnoid hemorrhage and the patient died on the third day of treatment.

Topics: Aged; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Diabetes Mellitus; Diagnosis, Differential; Fatal Outcome; Female; Humans; Male; Middle Aged; Mucormycosis; Nose Diseases; Tomography, X-Ray Computed

A case of disseminated cryptococcosis caused by Cryptococcus neoformans var. grubii is presented in a male diabetic who had AIDS. The diagnosis was based upon the isolation and identification of the aetiological agent from a lymph-node biopsy, cerebrospinal fluid and sputum. The isolate formed spherical, encapsulated yeast cells, produced cherry-brown colonies on niger-seed agar, grew on canavanine-glycine-bromothymol blue (CGB) medium, changing its colour from greenish yellow to blue, and hydrolysed urea weakly in the presence of 100 microM EDTA. The strain was unable to assimilate D-proline and, serologically, it was untypable. The identity of the isolate as C. neoformans var. grubii, serotype A, possessing a mating-type allele A alpha, was confirmed by crossing with standard laboratory test strains and by performing PCR with the mating-type alpha allele-specific primer of the STE12 gene and with serotype (A and D)- and mating type (a and alpha)-specific primers of the STE20 gene. To the best of our knowledge, this is the first report of disseminated cryptococcosis in an AIDS patient caused by a canavanine-resistant strain of C. neoformans var. grubii, serotype A, possessing mating type allele A alpha; the strain is probably a hybrid. The report suggests that, in the absence of a clear-cut serotyping result, a positive CGB reaction alone is not sufficient for intervarietal discrimination and additional confirmatory evidence is required.

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Canavanine; Cryptococcosis; Cryptococcus neoformans; Diabetes Mellitus; Drug Resistance, Fungal; Fatal Outcome; Fluconazole; Humans; Male; Middle Aged

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Brain Abscess; Caspofungin; Combined Modality Therapy; Contraindications; Craniotomy; Diabetes Complications; Diabetes Mellitus; Drug Hypersensitivity; Echinocandins; Female; Follow-Up Studies; Humans; Lipopeptides; Magnetic Resonance Imaging; Peptides; Peptides, Cyclic; Risk Assessment; Treatment Outcome

Topics: Adult; Amphotericin B; Antifungal Agents; Diabetes Complications; Diabetes Mellitus; Diagnosis, Differential; Female; HIV Infections; Humans; Lung Diseases, Fungal; Mucormycosis

Leukaemic patients with advanced disease and severe fungal infections as well as older patients with substantial co-morbidity are usually excluded from conventional allotransplantation because of increased morbidity and mortality. We approached allogeneic transplantation in four patients with a median age of 62 years (one chronic myeloid leukaemia in blast crisis, one high-risk acute myeloid leukaemia (AML) in first complete remission (CR1), one AML in 2nd relapse, one AML in CR2 with pre-existing fungal lung infections (two aspergillus, two mucor) and additional co-morbidity (diabetes n = 2, aortic aneurysm n = 1, arterial sclerosis n = 2) by combining non-myeloablative conditioning with an intensified supportive care regimen, including amphotericin B and 4-12 (median 9) prophylactic granulocyte transfusions from granulocyte colony-stimulating factor (G-CSF)-stimulated volunteer donors. G-CSF was also given to patients until neutrophil recovery. All four patients recovered to a neutrophil count of 0.5 x 109/l after a median of 11.5 d (range 11-13 d). Prophylactic granulocyte transfusions also reduced the need for platelet transfusions and minimized mucositis. All patients were discharged at a median of 25 d (range 18-59 d) and are alive and well after a median follow-up of > 390 d (range 336-417 d) without evidence of leukaemia. Regression of the fungal lesions was documented in three patients, with a slight progression detected by computerized tomography scan of the chest in one patient. We conclude that pulmonary fungal infections are not a contraindication for allogeneic stem cell transplantation, if non-myeloablative conditioning regimens are used in combination with granulocyte transfusions, intravenous amphotericin B and G-CSF.

Topics: Acute Disease; Amphotericin B; Antifungal Agents; Aortic Aneurysm; Arteriosclerosis; Aspergillosis, Allergic Bronchopulmonary; Bone Marrow Transplantation; Cell Count; Diabetes Complications; Diabetes Mellitus; Granulocyte Colony-Stimulating Factor; Humans; Leukemia; Leukemia, Myeloid; Leukemia, Myeloid, Chronic-Phase; Lung Diseases, Fungal; Male; Middle Aged; Neutrophils; Platelet Count; Recurrence; Remission Induction; Tomography, X-Ray Computed; Transplantation, Homologous; Treatment Outcome

Invasive fungal sinusitis increasingly causes significant morbidity and mortality in immunocompromised patients. It is difficult to treat. Despite standard treatment by surgical debridement and intravenous amphotericin B, morbidity and mortality remain high. Conventional amphotericin B is the standard drug but its use is limited by dose-related nephrotoxicity and infusion-related acute toxicity. Liposomal amphotericin B has proven to be as effective as conventional amphotericin B with less nephrotoxicity and infusion reaction. We report four cases of invasive fungal sinusitis who were treated with liposomal amphotericin B after having severe side effects from conventional amphotericin B. There were two cases of mucormycosis and two cases of aspergillosis. All patients had diabetes millitus. One patient had systemic lupus erythematosus and another was receiving immunosuppressive drugs after kidney transplantation. All cases needed multiple operations for sinus surgery. Two cases had acute reaction to amphotericin B infusion, one had active lupus nephritis with renal insufficiency, and one was considered treatment failure from amphotericin B. The patients received liposomal amphotericin B at the total doses of 4.55-8.85 g. Two cases of mucormycosis were considered to be successfully treated. In cases of aspergillosis, one was considered improved and another one with immunocompromised status died with active disease. From our experience, surgery is the main treatment for patients with invasive fungal sinusitis and liposomal amphotericin B is an effective alternative drug for adjuvant medical treatment. However, the degree of immunosuppression of the patients, the extension of fungal sinusitis and perhaps the species of fungus are important factors determining the clinical response.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Diabetes Complications; Diabetes Mellitus; Female; Humans; Immunocompromised Host; Liposomes; Male; Middle Aged; Mucormycosis; Sinusitis

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Cryptococcus neoformans; Diabetes Complications; Diabetes Mellitus; Female; Fluconazole; Hodgkin Disease; Humans; Male; Meningitis, Cryptococcal; Treatment Outcome

The authors describe a rare case of rhinocerebral mucormycosis. This is an acute, suppurative mycosis with poor prognosis. It has a particular affinity for rhinocerebral tissue and less frequently affects pulmonary tissue. Mucormycosis affects immunosuppressed patients and more than 75% of the cases involve patients suffering from acidosis, especially diabetic ketoacidosis. One characteristic feature is that the blood vessels are flooded causing thromboses, infarction and emboli. The disease is spread through the blood vessels or by expansion. The first clinical symptoms can be confused with an early stage of acute sinusitis with mucosanguineous rhinorrhea, facial tumescence and pain. In 50% of the cases there is rhinocerebral and orbital involvement. If the disease remains untreated it can prove fatal in 10 to 14 days. Effective treatment relies on an early diagnosis and prompt administration of intravenous amphotericin B as well as avulsion of the necrotic areas. To date only 200 cases of this severe pathology have been described. The present work is an attempt to throw further light on this disorder.

Topics: Adult; Amphotericin B; Diabetes Mellitus; Female; Humans; Mucormycosis; Necrosis; Nose

Rhinocerebral mucormycosis is a fulminating, devastating fungal disease, usually associated with debilitating diseases such as diabetes mellitus, leukaemia and immunosuppressive conditions. Ten patients with this rare disease have been treated over the past 14 years at the Beilinson Medical Centre. Nine patients had an underlying debilitating disease and one patient had latent diabetes mellitus which was diagnosed only after presentation of mucormycosis. Only two of the 10 patients survived. Early aggressive surgical debridement, together with amphotericin B and correction of underlying metabolic acidosis were found to be important factors associated with survival.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Diabetes Complications; Diabetes Mellitus; Female; Humans; Injections, Intravenous; Male; Middle Aged; Mucormycosis; Nasal Septum; Necrosis; Photomicrography; Tomography, X-Ray Computed; Turbinates

Topics: Adrenal Cortex Hormones; Adult; Amphotericin B; Diabetes Complications; Diabetes Mellitus; Drug Carriers; Humans; Iatrogenic Disease; Liposomes; Male; Maxillary Sinusitis; Mucormycosis; Orbital Diseases

Topics: Adult; Aged; Amphotericin B; Chromatography, High Pressure Liquid; Diabetes Mellitus; Humans; Methanol; Middle Aged; Mycoses; Urinary Tract Infections

A 51-year-old, ketoacidotic diabetic with the rare neurological complications of rhinocerebral mucormycosis is reported. The clinical presentation was characterized by initial severe frontal headache, rapid visual loss with complete external ophthalmoplegia and intracranial spread by invasive fungal growth. Its course and fungostatic therapy with amphotericin B and ketoconazole are described and the literature reviewed.

Topics: Acidosis; Amphotericin B; Diabetes Complications; Diabetes Mellitus; Humans; Ketoconazole; Ketone Bodies; Male; Middle Aged; Mucormycosis; Paranasal Sinus Diseases; Tomography, X-Ray Computed

Topics: Adult; Amphotericin B; Blastomycosis; Dermatomycoses; Diabetes Mellitus; Humans; Male

Topics: Adult; Amphotericin B; Azathioprine; Diabetes Mellitus; Fungi; Humans; Kidney Transplantation; Male; Mucormycosis; Nose; Nose Diseases; Time Factors; Transplantation, Homologous

Topics: Adolescent; Adult; Amphotericin B; Diabetes Complications; Diabetes Mellitus; Diet, Diabetic; Female; Humans; Insulin; Mucormycosis; Mucous Membrane; Rhizopus; Sinusitis

Topics: Adenoma; Adrenal Gland Neoplasms; Amphotericin B; Candidiasis; Cushing Syndrome; Diabetes Mellitus; Endocarditis; Female; Humans; Hydrocortisone; Hypertension; Infant

Topics: Amphotericin B; Biopsy; Diabetes Mellitus; Humans; Mouth; Mouth Mucosa; Mucormycosis; Mucous Membrane; Palate; Pathology; Zygomycosis

Topics: Amphotericin B; Anti-Bacterial Agents; Atropine; Chloramphenicol; Cornea; Corneal Ulcer; Diabetes Mellitus; Eye Injuries; Fusarium; Glaucoma; Humans; Mycoses; Ointments; Ophthalmic Solutions; Ophthalmology; Penicillins; Streptomycin; Toxicology; Ulcer

Topics: Amphotericin B; Cryptococcosis; Diabetes Mellitus; Humans; Meningoencephalitis