Cunninghamella bertholletiae is a rare cause of pulmonary mucormycosis. We describe a cluster of invasive pulmonary infections caused by C. bertholletiae in 4 immunocompromised patients that occurred during a 2-year period at 1 center. Three of the patients were receiving antifungal prophylaxis with itraconazole. Presenting symptoms were fever unresponsive to antibacterial chemotherapy, hemoptysis, and infiltrates on chest radiograms. Three patients were treated with liposomal amphotericin B. Only 1 patient survived.Invasive fungal infections are serious and often fatal complications in immunocompromised patients. Candida species, Aspergillus species, and Cryptococcus neoformans are the most frequent pathogens of these infections [1,2]. Similar conditions caused by other fungal pathogens such as Trichosporon beigelii, Fusarium species, and Penicillium marneffei have been described, and these pathogens are being isolated with increasing frequency [3,4].Cunninghamella bertholletiae (class Zygomycetes, order Mucorales) is a saprophytic, ubiquitous fungus that is found in soil. It is rarely isolated as an agent of zygomycoses in immunocompromised patients [5]. We reviewed the medical records of 4 immunocompromised patients who developed serious pulmonary infections caused by C. bertholletiae during a 2-year period at the University Hospital in Frankfurt, Germany; we describe this cluster of infections here (table 1). Case ReportsCase 1. A 60-year-old woman in first complete remission of acute lymphoblastic leukemia was admitted to our hospital in November 1998 for consolidation therapy with cytarabine and teniposide (German ALL [acute lymphoblastic leukemia] Study Group protocol) [6]. Eight days after the start of chemotherapy, she developed neutropenia (absolute neutrophil count, !500/mL). She developed fever and abdominal pain 1 day later. CT of the abdomen revealed evidence of appendicitis and cholecystitis. Cholecystectomy and appendectomy were performed the same day. Both diagnoses were confirmed his- topathologically. There was no evidence of invasive fungal infection of the gallbladder or appendix. The bone marrow regenerated after 14 days of neutropenia, and the patient developed mild hemoptysis. The platelet count, prothrombin time, and partial thromboplastin time were normal. A CT scan of the chest showed a homogenous alveolar opacification in the left upper and right lower lobes. Treatment was not started.Follow-up CT performed 7 days later showed decreasing infiltrates, and the patient was discharged from the hospital 4 weeks thereafter in stable condition. Four days later, the patient developed massive hemoptysis and was readmitted. A CT scan of the chest revealed multiple cavities in both lower lobes and left middle and upper lobes. Antifungal therapy with amphotericin B (1 mg/kg/day) was started on the same day. Bronchoscopy was done; this procedure revealed hemorrhage of the right lower lobe and a mass obstructing the left upper bronchus. Analysis of bronchial aspirates (BAs) revealed broad, nonsepta...
The incidence of aspergillosis in kidney transplant recipients is low and most commonly occurs in the early posttransplantation period. We report an unusual case of a 52-year-old female patient with Aspergillus endocarditis as a late complication after kidney transplantation, presumably spread from a necrosis in the gut, associated with previous cytomegalovirus colitis. As complications, the patient experienced septic embolization into the coronary and pulmonary arteries, and an infarction of the right parietal cortex and insula. The patient died as a result of global heart failure after a 10-day course of antimycotic therapy with amphotericin B plus 5-flucytosine during surgical valve replacement.
The recent unfortunate rabies transmissions through solid organ transplants of an infected donor in Germany required the initiation of a vaccination program to protect health care workers (HCWs) with close contact to rabies-infected patients. A systematic follow-up of adverse effects was initiated. Rabies postexposure prophylaxis (PEP) was started in 269 HCWs at four German hospitals. Pre-exposure prophylaxis (PreEP) was administered to 74 HCWs caring for an already diagnosed rabies patient. At each vaccination date, HCWs were interviewed for symptoms possibly representing adverse effects. Adverse effects of PEP and PrePEP were compared. Out of 269 HCWs, 216 were included for the investigation of adverse effects. Of these 216 HCWs, 114 (53%) individuals developed at least one systemic adverse effect. Incidences of tiredness (30.6%), malaise (26.4%), headache (26.9%), dizziness (14.8%), and chills (13.0%) declined in the course of PEP (p < 0.05), whereas incidences of fever (7.4%), paraesthesias (7.9%), arthralgias (1.9%), myalgias (4.2%), nausea (9.3%), diarrheas (2.8%) and vomiting (1.4%) did not. In 11 (5.1%) HCWs PEP was discontinued mostly due to adverse reactions (four suffered strong headaches, two HCWs meningeal irritations, two chills, one paraesthesia, one malaise, and one a rush). Systemic effects of PEP or PreEP did not differ significantly. Despite relatively high incidences of moderate severe adverse reactions rabies PEP is safe. Strong headache, tiredness, dizziness, and paraesthesias are the most important postvaccinal symptoms. Vaccinees suffering from adverse effects of PEP must be strongly encouraged to complete PEP, as it is to date the only protection against fatal rabies.
Introduction: Transradial access (TRA) has become the primary route for coronary angiography (CAG) and percutaneous coronary interventions (PCI). Recently a new puncture site more distally in the area of the anatomical snuffbox has been described. With this multicenter registry, we wish to demonstrate the feasibility and safety of the distal radial access (dRA).Methods: Between December 2018 and May 2019 all patients with a planned CAG or PCI via dRA in three cardiology centers in Germany were entered into this registry. Procedural data, puncture success, crossover rate and complications were registered. Proximal and distal radial artery patency were examined by ultrasound within 48 h. Results: A total of 327 patients were enrolled (mean age: 69 ± 12 years, 69% male gender, 49% PCI), in 5 cases bilateral distal puncture was performed. Puncture success, defined as completed sheath placement was high (N = 316/332, 95%) and the crossover rate was low (27/332, 8%). The rate of proximal radial artery occlusion after 1-48 h was low (2/332 1%), the rate of occlusion at the distal puncture site was also very low (3/332, 1%). Major complications were not encountered. Conclusion: Coronary angiography and interventions via the distal transradial access in the area of the anatomical snuffbox can be performed with a high rate of success and safety. This data suggests a reduced rate of radial artery occlusion compared to previously reported data after cannulation via the standard forearm radial artery puncture site. Randomized studies are needed to further investigate these results. Trial Registration: This study was registered in the German registry for clinical trials: DRKS00017110, retrospectively on 07.May 2019
Due to excellent care in the prehospital phase and in the emergency room the number of patients requiring treatment on the intensive care unit was rather low. The mortality was in the range of other reports.
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