amphotericin-b and Gangrene

Cutaneous mucormycosis is a rare opportunistic infection caused by zygomycetes that can be rapidly fatal if unrecognized. We describe the clinical, histopathological, fungal and molecular features of a case of gangrenous cutaneous mucormycosis. The patient presented with great necrosis on his right forearm at the site of detained intravenous cannula needle. He had type II diabetes and chronic renal insufficiency. KOH mount of black eschar showed many broad, aseptate fungal hyphae with right-angle branching. PAS staining of the tissue sample revealed similar broad hyphae in the dermis and cutis. Fungal culture and ITS sequence analysis identified this fungus as Rhizopus oryzae. As no organ involvement was detected, the patient was diagnosed with primary cutaneous mucormycosis. Considering the poor state of the patient, complete excision of the infectious tissue was performed without skin graft instead of amputation. At the same time, intravenous liposomal amphotericin B was given, starting from a small dosage and increased to a total dosage amount of 5.45 g. The wound recovered well with granulation. We emphasize that early recognition and prompt therapy including the control of the primary diseases were important. In this article, we also reviewed the features of primary cutaneous mucormycosis reported in China over the last 20 years.

Topics: Administration, Intravenous; Amphotericin B; Antifungal Agents; Catheter-Related Infections; China; Debridement; Dermatomycoses; Diabetes Complications; DNA, Fungal; DNA, Ribosomal Spacer; Forearm; Gangrene; Histocytochemistry; Humans; Male; Microbiological Techniques; Middle Aged; Molecular Sequence Data; Mucormycosis; Rhizopus; Sequence Analysis, DNA

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

Topics: Aged, 80 and over; Amphotericin B; Amputation, Surgical; Animals; Antifungal Agents; Bites and Stings; Gangrene; Humans; Male; Mucorales; Mucormycosis; Passeriformes

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

Topics: Administration, Oral; Adult; Amphotericin B; Antifungal Agents; Blood Vessels; Diabetes Complications; Fatal Outcome; Gangrene; Hand; Humans; Injections, Intravenous; Itraconazole; Male; Microscopy; Middle Aged; Necrosis; Soft Tissue Infections; Thorax; Thrombosis; Zygomycosis

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

Gangrenous cholecystitis occurred in an immunodepressed patient with generalized neoplasia. Evolution was rapid and severe. Emergency cholecystectomy and systemic treatment with Anphotherycin were life-saving.

Topics: Adult; Amphotericin B; Candidiasis; Cholecystectomy; Cholecystitis; Combined Modality Therapy; Emergencies; Gallbladder; Gangrene; Humans; Male; Postoperative Complications; Ultrasonography

Cutaneous mucormycosis in a renal transplant recipient resulted in gangrenous cellulitis of the neck at an internal jugular cannula site. This nosocomial process was due to a histologically confirmed infection, and cultures revealed Mucor sp. The patient died despite surgical debridement and amphotericin B therapy. Cutaneous mucormycosis is a relatively rare entity with only 12 cases previously reported. In renal transplant patients only nine cases of renal transplant patients only nine cases of mucormycosis have been reported and only one was cutaneous. Also, this case reported is the second originating at an intravenous cannula site; the first recorded patient was diabetic.

Topics: Amphotericin B; Cellulitis; Debridement; Dermatomycoses; Gangrene; Humans; Kidney Transplantation; Male; Middle Aged; Mucormycosis; Neck; Postoperative Complications; Transplantation, Homologous

Progressive gangrenous cellulitis due to Rhizopus arrhizus following colostomy destroyed the entire abdominal wall of a young woman and caused her death. A similar infection in an 11-year-old kidney transplant recipient was diagnosed more promptly and treated successfully with extensive debridement and amphotericin B. Nine similar cases found in the literature were reviewed. All 11 patients appeared to have had prior tissue injury at the original site of infection, and seven had diabetes mellitus. The disease was initially misdiagnosed in most of the patients, progressed rapidly in eight, and was fatal in four. Phycomycotic gangrenous cellulitis should be included in the differential diagnosis of progressive necrotizing lesions of the skin, especially in diabetic patients, but it can be identified promptly only by histologic examination of the infected tissue. Urgent radical excision and amphotericin therapy are recommended.

Topics: Abdominal Muscles; Adult; Amphotericin B; Biopsy; Cellulitis; Child; Colostomy; Diagnosis, Differential; Female; Gangrene; Humans; Immunosuppressive Agents; Kidney Transplantation; Postoperative Complications; Rhizopus; Transplantation, Homologous

A patient suffering from Candida endocarditis presented with a gangrenous foot. In addition to arterial embolism, occult mycotic aneurysms were found by arteriography. Clinical cure was achieved with a combination of chemotherapy and valvular débridement, but viable Candida persisted in an easily removable embolus. Occult peripheral vascular lesions may be a continuing source of Candida sepsis in some patients.

Topics: Adult; Amphotericin B; Aneurysm, Infected; Aortography; Arterial Occlusive Diseases; Arteritis; Candidiasis; Drug Therapy, Combination; Endocarditis; Female; Flucytosine; Gangrene; Humans; Mitral Valve Insufficiency

Cellulitis of the scrotum and penis is caused, in the majority of instances, by a beta hemolytic streptococci without a discernible portal of entry. Clostridium, occasionally, will result in this disease as a manifestation of a perirectal abscess. In either instance, fluid accumulates rapidly in the closed space between Colles' and Buck's fascia, producing intense swelling of the scrotum. If this compartment is not immediately decompressed by linear incisions, devascularization of the scrotal and penile skin will often occur, resulting in gangrene. Immediate treatment of the bacterial infection with penicillin also is essential. If gangrene does develop, radical debridement of the necrotic tissue as well as a wide margin of adjacent inflamed skin must be undertaken. Continual monitoring of the microflora of the debrided would is essential for the selection of the appropriate antibiotic against any secondary intruders. Coverage of the granulating would is accomplished when the would bacterial count is below 10-5 per gram of tissue.

Topics: Amphotericin B; Anti-Bacterial Agents; Antistreptolysin; Candida albicans; Candidiasis; Cellulitis; Debridement; Gangrene; Genital Diseases, Male; Humans; Immunity; Male; Middle Aged; Penile Diseases; Scrotum; Skin Diseases; Skin Transplantation; Streptococcal Infections; Transplantation, Autologous

Topics: Amphotericin B; Amputation, Surgical; Diabetes Complications; Gangrene; Hand; Humans; Male; Mucormycosis; Rhizopus

Topics: Amphotericin B; Carotid Artery Diseases; Cranial Sinuses; Eye Manifestations; Gangrene; Geriatrics; Humans; Mucormycosis; Nose; Nystatin; Ophthalmoplegia; Orbit; Paranasal Sinuses; Sinus Thrombosis, Intracranial; Sinusitis