Cutaneous mucormycosis in advanced HIV disease

Moreira, José; Ridolfi, Felipe; Almeida‐Paes, Rodrigo; Varon, Andréa G.; Lamas, Cristiane da Cruz

doi:10.1016/j.bjid.2016.06.004

Cited by 9 publications

(9 citation statements)

References 19 publications

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“…Several conditions have been associated with the development of mucormycosis (►Table 1), including: poorly controlled DM 1,15,20,[62][63][64][65][66][67] ; HemeM with neutropenia 61,65,[68][69][70][71][72] ; HSCT 48,[73][74][75][76][77] ; SOTRs 19,52,63,75,[78][79][80][81][82] ; immunosuppression or chemotherapy 23,59,83 ; autoimmune or rheumatic disorders 59,84 ; human immunodeficiency virus infection 14,[85][86][87][88] ; peritoneal dialysis [89][90][91][92] ; iron overload states 37,38,93 ; malnutrition 23 ; trauma 67 ; burns…”

Section: Risk Factors For Mucormycosismentioning

confidence: 99%

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Mucormycosis

Reid

Lynch

Fishbein

et al. 2020

Semin Respir Crit Care Med

131

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Mucormycosis is an infection caused by a group of filamentous molds within the order Mucorales. Infections may result from ingestion of contaminated food, inhalation of spores into the nares or lungs, or inoculation into disrupted skin or wounds. In developed countries, mucormycosis occurs primarily in severely immunocompromised hosts (e.g., those with hematological malignancies, organ transplantation, neutropenia, autoimmune disorders, or other impairments in immunity). Only 6 to 10% of cases occur in subjects with no underlying disease. In contrast, in developing countries, most cases of mucormycosis occur in persons with poorly controlled diabetes mellitus or in immunocompetent subjects following trauma. Mucormycosis exhibits a marked propensity to invade blood vessels, leading to thrombosis, necrosis, and infarction of tissue. Mortality associated with invasive mucormycosis is high (> 30–50%), with 90% mortality associated with disseminated disease. Mortality rates are much lower, though still significant (10–30%), among patients with localized cutaneous disease.The diagnosis of mucormycosis relies upon histopathology and culture. Blood tests are of limited diagnostic value. Even with disseminated disease, blood cultures are usually negative. Mucorales have a distinct histological appearance, with irregular, nonseptate hyphae that branch at right angles. Cultures and/or polymerase chain reaction (PCR) are important to identify the genera.Based on anatomic localization, mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM), (2) pulmonary, (3) cutaneous, (4) gastrointestinal (GI), (5) disseminated, and (6) mucormycosis of uncommon sites. Among diabetics, ROCM is the most common clinical presentation, whereas lung involvement is uncommon. In contrast, among organ transplant recipients or patients with hematological malignancies (HemeM), pulmonary and disseminated diseases are most common. Mucormycosis can progress rapidly, and delay in initiation of treatment by even a few days markedly worsens outcomes.Due to the rarity of mucormycosis, randomized controlled therapeutic trials have not been performed. Lipid formulations of amphotericin B (LFAB) are the mainstay of therapy, but the newer triazoles, posaconazole (POSA) and isavuconazole (ISAV) (the active component of the prodrug isavuconazonium sulfate), may be effective in patients refractory to or intolerant of LFAB. Early surgical debridement or excision plays an important adjunctive role. Additional studies are required to assess the optimal duration of therapy as well as the specific roles of LFAB and the triazoles in the treatment of mucormycosis.

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Section: Risk Factors For Mucormycosismentioning

confidence: 99%

“…uncommon sites1,3,85,86 (►Table 2). Roden et al reviewed 929 cases of mucormycosis; the most common sites of involvement were: sinuses (39%); lungs (24%); disseminated (23%); and skin and soft tissue infection (SSTI) (19%).…”

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confidence: 99%

Mucormycosis

Reid

Lynch

Fishbein

et al. 2020

Semin Respir Crit Care Med

131

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“…107,112,115 Based on anatomic localization, mucormycosis can be classified as one of six forms: 110 (1) rhino-orbital-cerebral, 39,124,147 (2) pulmonary, 38,125,136 (3) cutaneous, 170,179,180 (4) gastrointestinal, 181,182 (5) disseminated, 32,38,107,112 and (6) uncommon sites. 110,121,133,134 In a review of 929 cases of mucormycosis, most common sites of involvement were sinuses (39%), pulmonary (24%), skin/soft tissue infection (SSTI) (19%), and disseminated (23%). 112 Among 154 patients with malignancy, 92 (60%) had pulmonary disease and only 6 (4%) had rhinocerebral disease.…”

Section: Clinical Features Of Mucormycosismentioning

confidence: 99%

Fungal Infections Complicating Lung Transplantation

Clark

Weigt

Fishbein³

et al. 2018

Semin Respir Crit Care Med

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Lung transplantation is an increasingly utilized modality for treating advanced lung disease. However, lung transplant recipients (LTRs) experience high rates of infection-related mortality and, compared with other solid organ transplant recipients, are at increased risk of infectious complications given the intensity of immunosuppression employed, the presence of airway abnormalities after surgery and exposure of the allograft to the environment. Fungal infections, particularly mold infections, are problematic after transplantation as they are often associated with limited treatment options and poor outcomes. We describe the non- fungal infections occurring in LTRs, including their epidemiology, clinical features, and treatment.

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“…Other less reported findings were alopecia, cellulitis, hyperkeratotic plaque and pruritus. 14,19,20 Of the 8 cases presenting with isolated cerebral mucormycosis, 7 were in association with IVDU. Three cases were known to have injected an illegal drug (i.e.…”

Section: Clinical Categoriesmentioning

confidence: 99%

“…4 Finally, one patient presented with multiples episodes of moderate to severe neutropenia before and during hospital admission. 19 Surgery, alone or as part of antifungal therapy, was performed in 27 cases (40.3%). The most common surgical procedures performed were elective nephrectomy (n Z 8, 29.6%), sinus surgery (n Z 6, 22.2%) and skin debridement consisting of local excision of necrotic areas (n Z 5, 18.5%).…”

Section: Managementmentioning

confidence: 99%