amphotericin-b and Fasciitis--Necrotizing

Primary cutaneous mucormycosis is an unusual mycotic infection associated to immunosupression. We present a 34 year-old woman with HIV infection with a necrotic primary mucormycosis of the skin associated to a venous catheter. She was treated with amphotericin B and surgical debridement.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Catheterization; Combined Modality Therapy; Debridement; Drug Therapy, Combination; Fasciitis, Necrotizing; Female; Forearm; Humans; Klebsiella Infections; Mucormycosis; Occlusive Dressings; Pneumonia, Pneumocystis; Skin Ulcer

We describe a case of progressive cutaneous mucormycosis, which caused gangrenous necrotizing fasciitis, in an immunocompetent neonate from Oman. Extensive wound contamination and a favorable environment for the growth of Mucorales were the predisposing factors. Early aggressive management including frequent wound debridement, targeted pharmacotherapy with liposomal amphotericin B and supportive care is pivotal for improved outcomes.

Topics: Amphotericin B; Antifungal Agents; Debridement; Fasciitis, Necrotizing; Female; Gangrene; Humans; Infant, Newborn; Mucormycosis; Streptococcus agalactiae; Treatment Outcome

Necrotizing fasciitis is a life-threatening, rapidly progressing infection of fascia and subcutaneous cellular tissue typically caused by mixed aerobic and anaerobic bacteria. We present a case report of an immunocompromised 4-year-old female with necrotizing fasciitis from a rare fungal organism, Mucor indicus. The patient underwent multiple debridements and was treated for 10 months, first on liposomal amphotericin B (2 months) then posaconazole (8 months). Mucor indicus is a rarely described pathogen with only nine other cases described. Identification of this organism remains a challenge, and the need for further understanding of risk factors and organism susceptibility testing to help guide treatment is crucial.

Topics: Amphotericin B; Bone Marrow Transplantation; Child, Preschool; Debridement; Fasciitis, Necrotizing; Female; Humans; Immunocompromised Host; Magnetic Resonance Imaging; Mucor; Risk Factors; Treatment Outcome; Triazoles

Phaeohyphomycosis is an infrequent infection in human beings. However, in recent years, its prevalence has augmented in immunosuppressed patients (mostly in solid organ transplanted patients). Infection can be mucocutaneous or disseminated. In the former, the fungus inoculation occurs mainly through traumatism. Lesions may be polymorphic and asymptomatic, isolated or multiple, and are usually localized in exposed areas of the limbs and head. Treatment is not standardized. When possible, surgical resection of the lesion is combined with systemic antifungals.. We communicate three phaeohyphomycosis cases with cutaneous compromise.. The cases we present show diverse clinical characteristics and varied severity and evolution.. It is important for dermatologists to recognize this cutaneous fungus infection because the diagnosis using microscopic examination and mycological culture depends on the clinical suspicion.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Fasciitis, Necrotizing; Fatal Outcome; Female; Humans; Immunocompromised Host; Itraconazole; Lung Diseases; Male; Middle Aged; Phaeohyphomycosis

Cutaneous mucormycosis, an uncommon disease caused by Mucorales, predominantly occurs in immunocompromised host. The present case is a primary cutaneous mucormycosis due to Mucor indicus in an immunocompetent individual. It is with the features of necrotizing fasciitis over the right pretibial area. We are presenting this case owing to its rarity and the successful treatment with amphotericin B and skin grafting.

Topics: Amphotericin B; Antifungal Agents; Fasciitis, Necrotizing; Humans; Male; Middle Aged; Mucor; Mucormycosis; Postoperative Complications; Skin Transplantation

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

A 50-year-old man, who had received an ABO-incompatible living related preemptive renal transplantation 1 year before, presented with painful lesions on both lower extremities and fever. At first, bacterial cellulitis was suspected and antibiotic therapy was initiated, but it was not effective. The serum cryptococcal antigen titer was 1:4,098, and pathologic examination of debrided tissue and wound pus culture revealed cryptococcal necrotizing fasciitis. Liposomal amphotericin B and fluconazole were started, and repeated debridement and skin grafting were performed. Because his graft function deteriorated because of antibody-mediated rejection and polyoma viral nephropathy, hemodialysis was induced on day 9 of hospitalization. During the treatment, he suffered repeated urinary tract infections, which were treated with antibiotics, and cytomegalovirus retinopathy, which was treated with ganciclovir. His cryptococcal necrotizing fasciitis was successfully cured by the combination of antimicrobial treatment and surgical procedures. He could walk with a cane and was discharged on day 298 of hospitalization. Cryptococcal necrotizing fasciitis in renal transplant recipients is so rare that only 14 cases have been reported. The mortality is not very high, but the prognosis of the patient is complicated by worsening of the cryptococcal infection of the central nervous system (CNS). Early detection and treatment to prevent spreading to other sites, especially the CNS or disseminated disease, is very important in cases of cryptococcal necrotizing fasciitis.

Topics: Amphotericin B; Cryptococcosis; Drug Therapy, Combination; Fasciitis, Necrotizing; Fluconazole; Humans; Kidney Transplantation; Male; Middle Aged

A 28-year-old man undergoing treatment for hemophagocytic syndrome developed Paecilomyces lilacinus infection in skin ulcers on the face and in the tracheotomy stoma. While his bone marrow was suppressed by chemotherapy with dexamethasone, cyclosporin and etoposide for hemophagocytic syndrome, dental infection led to subacute necrotizing fasciitis caused by Pseudomonas aeruginosa on the right side of the face, resulting in a large area of soft tissue defects. Etoposide was discontinued, and prophylactic treatment with itraconazole was initiated. The ulcers resulting from necrotizing fasciitis were treated conservatively using trafermin and alprostadil alfadex ointment 0.003 %, and near-complete re-epithelialization occurred, except on the right lower eyelid, right buccal mucosa and perioral area. However, 6 weeks later, pustules/crusts started to form and break down repeatedly, leading to expansion of tissue defects on the face. Direct microscopic examination revealed fungal elements, and fungal culture identified Paecilomyces lilacinus suspicious twice some other day. Based on DNA extraction from the isolated fungus, this fungal strain was identified as Paecilomyces lilacinus. Cyclosporin and itraconazole were discontinued, and treatment with liposomal amphotericin B and a tapering dose of steroids was initiated. Cure was achieved in approximately 2.5 months after treatment initiation, and no relapse has been observed. The most important factor that ultimately contributed to the resolution of fungal infection might have been release of immunosuppression by discontinuing cyclosporin and tapering steroids.

Topics: Adult; Amphotericin B; Antifungal Agents; Cyclosporine; Dexamethasone; Face; Fasciitis, Necrotizing; Humans; Immune Tolerance; Lymphohistiocytosis, Hemophagocytic; Male; Mycoses; Paecilomyces; Pseudomonas aeruginosa; Pseudomonas Infections; Skin Ulcer; Surgical Stomas; Tracheotomy; Treatment Outcome

Cutaneous mucormycosis (zygomycosis), with subcutaneous spreading and dissemination, in immunocompetent patients is an uncommon disease caused by species belonging to the fungal genera Apophysomyces, Rhizopus and Saksenaea, among others.. A case of necrotising fasciitis by Saksenaea vasiformis in an immunocompetent woman is described. The infection was acquired through a car accident resulting in multiple injuries affecting mainly her right arm. After the surgical reduction of fractures, skin lesions worsened and led to necrosis. The patient quickly developed a severe necrotising fasciitis with negative cultures at first. Despite the extensive surgical debridement and the aggressive antifungal treatment, the patient died. The histopathological study showed a fungal infection due to a fungus belonging to the Mucorales order, which was confirmed by culturing the clinical sample on Sabouraud agar, and identifying the species by cultures on Czapek-Dox agar, and sequencing of the ITS region of the ribosomal DNA.. This case confirm the presence of this fungus in Spain, the value of histopathology for the mucormycosis diagnosis, as well as the need to perform special cultures to facilitate their isolation and identification to the species level by the combined use of Czapek-Dox agar and sequencing of the ITS region.

Topics: Accidents, Traffic; Amphotericin B; Antifungal Agents; Arm Injuries; Bacterial Infections; Coinfection; Combined Modality Therapy; Fasciitis, Necrotizing; Fatal Outcome; Female; Fractures, Open; Humans; Immunocompetence; Middle Aged; Mucorales; Mucormycosis; Multiple Trauma; Mycology; Radius Fractures; Shock, Septic; Wound Infection

Primary cutaneous mucormycosis is uncommon and is extremely rare in immunocompetent young individuals. Here we report a case of necrotising fasciitis due to mucormycosis in an immunocompetent young individual following minor trauma. Mucormycosis must be suspected in any wound that is worsening despite appropriate treatment even in immunocompetent individuals.

Topics: Adult; Amphotericin B; Antifungal Agents; Dermatomycoses; Fasciitis, Necrotizing; Humans; Immunocompetence; Male; Mucormycosis; Rhizomucor; Treatment Outcome

Topics: Adult; Amphotericin B; Antifungal Agents; Fasciitis, Necrotizing; Female; Humans; Injections, Intramuscular; Mucorales; Zygomycosis

Necrotising fasciitis (NF) is an extremely rare skin and soft tissue infection with extensive necrosis of the subcutaneous tissue and underlying fascia, which usually affects the limbs and trunk. It rarely affects the head and neck region because of the excellent blood supply in this region. We report a case of NF initially misdiagnosed as a traumatic pre-septal cellulitis following self-puncture of a hordeolum externum (stye) and its resistance to aggressive antibiotic therapy resulting in the loss of the lower eyelid.

Topics: Adult; Amphotericin B; Antitubercular Agents; Blepharoplasty; Combined Modality Therapy; Debridement; Drug Therapy, Combination; Early Diagnosis; Eyelid Diseases; Eyelids; Fasciitis, Necrotizing; Humans; Male; Orbital Diseases

Topics: Amphotericin B; Antifungal Agents; Debridement; Fasciitis, Necrotizing; Humans; Male; Middle Aged; Mucorales; Mucormycosis; Skin Transplantation; Wound Infection

Topics: Amphotericin B; Antifungal Agents; Combined Modality Therapy; Cryptococcosis; Debridement; Fasciitis, Necrotizing; Fatal Outcome; Humans; Male; Middle Aged; Soft Tissue Infections; Subcutaneous Tissue; Thigh

To report a pediatric case of posttraumatic fungal fasciitis treated successfully with a combination including posaconazole.. Case report.. Pediatric critical care unit at Antwerp University Hospital.. A 12-yr-old female polytrauma patient, suffering from extensive skin and muscle injuries, developed fasciitis. Two fungi (Mucor and Trichosporon species) were isolated. The necrotic tissues were aggressively excised, hyperbaric oxygen therapy was applied, and oral posaconazole was added to the initial amphotericin B treatment. The patient made an excellent recovery.. A combination of a high index of suspicion, early aggressive surgery, hyperbaric oxygen, and the association of amphotericin B and posaconazole led to a successful outcome in a case of fungal necrotizing fasciitis. After decades of disappointing amphotericin B treatment in spite of acceptable in vitro activity, the combination with the new triazole posaconazole seems promising.

Topics: Amphotericin B; Antifungal Agents; Child; Drug Therapy, Combination; Fasciitis, Necrotizing; Female; Humans; Mucormycosis; Mycoses; Triazoles; Trichosporon

Cryptococcal necrotizing fasciitis that is localized to the lower extremities is very rare.. We describe a case of a renal transplant recipient who presented with necrotizing fasciitis of the legs caused by Cryptococcus neoformans, a fungus that is rarely associated with this disease.. This is a case report with literature review.. The patient was hospitalized, and the site of infection was debrided to the level of the periosteum. Cultures and histopathologic examination of biopsy material revealed an invasive deep-seated infection with a fungal organism that was consistent with C. neoformans. After 21 days on parenteral amphotericin B (Ambisome; Er-Kim Pharmaceuticals) treatment, the patient was switched to oral itraconazole (Itraspor; Janssen-Cilag Pharmaceuticals) 200 mg/day. He was discharged after 30 days of hospitalization with his wounds completely healed. He continued on oral fluconazole for a total course of 6 weeks.. Systemic fungal infections continue to be an important cause of morbidity and mortality in transplant recipients. The insidious nature and atypical manifestations of these infections often delay diagnosis and therapy. In immunosuppressed patients, persistent fever that does not respond to antibacterial therapy should alert the physician to the possibility of fungal infection.

Topics: Amphotericin B; Antifungal Agents; Combined Modality Therapy; Cryptococcosis; Debridement; Fasciitis, Necrotizing; Humans; Immunocompromised Host; Kidney Transplantation; Leg; Male; Middle Aged; Skin Transplantation; Treatment Outcome; Triazoles

A case of lethal invasive mucormycosis (IM), a rare fungal infection which predominantly affects immunocompromised patients, is reported in a 73-year-old female patient who presented with a cervical abscess. The patient had asthma treated with steroids and had previously undiagnosed diabetes mellitus. Despite surgical treatment and parenteral antibiotic therapy, there was fatal progression of the condition. The pathogenesis, histological appearances and treatment of mucormycosis are discussed, particularly the importance of urgent histological examination of debrided tissue to distinguish this condition from necrotizing fasciitis (NF) earlier than microbiological culture alone would allow, thus permitting the early introduction of appropriate antifungal therapy.

Topics: Abscess; Absidia; Aged; Amphotericin B; Antifungal Agents; Asthma; Dermatomycoses; Diabetes Complications; Diagnosis, Differential; Drug Therapy, Combination; Fasciitis, Necrotizing; Fatal Outcome; Female; Humans; Immunocompromised Host; Mucormycosis; Neck