Bilobectomy and Amphotericin B in a Case of Endobronchial Mucormycosis

Ramírez, Tania Rosa Escalona; Álvarez-Sala, R; Prados, Concepción; M, Nistal; Casillas, M.

doi:10.1055/s-2000-6898

Cited by 5 publications

(7 citation statements)

References 3 publications

(7 reference statements)

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“…Most healthy individuals with low-inoculum exposure remain asymptomatic for a considerable period of time. However, patients who inhale a large inoculum often develop a severe and potentially fatal diffuse pulmonary infection [67,68,69,70,71]. Lungs are the most common site of Mucor infection, which may then spread to contiguous structures such as the mediastinum and heart.…”

Section: Discussionmentioning

confidence: 99%

“…Consistent with this, the most common underlying condition was diabetes mellitus (n = 20, 65%) in EB mucormycosis. Hematologic malignancies, prolonged neutropenia, treatment with corticosteroids or deferoxamine, bronchogenic cancer, renal transplantation and acquired immunodeficiency syndrome were other reported risk factors [6,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73]. Consistent with this, 7 patients (23%) were reported to be immunocompromised hosts; including diabetic patients, the number increased to 25 (81%), reflecting the opportunistic behavior of this organism.…”

Section: Discussionmentioning

confidence: 99%

“…Reviewing the English literature, we recognized that the most common agents causing EBFI are Aspergillus spp. [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45], Coccidioides immitis [46] , agents of zygomycosis [6,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73], Candida spp. [6, 34,74,75,76], Cryptococcus neoformans [77,78,79,80,81,82,83,84,85,86,87,88], and Histoplasma capsulatum [89,…”

Section: Introductionmentioning

confidence: 99%

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Endobronchial Fungal Disease: An Under-Recognized Entity

Karnak

Avery²,

Gildea

et al. 2006

Respiration

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Most fungi enter the human body via inhalation; however, endobronchial fungal infection (EBFI) seems to be a rare manifestation compared to pulmonary or systemic disease. This presentation seems to be related to environmental factors as well as to the host status. With the increasing popularity of flexible bronchoscopy, it is being recognized with a higher frequency. Bronchoscopic findings in EBFI vary from mild mucosal inflammation to central airway obstruction. We searched English literature related to the topic and found 228 total cases of EBFI: Aspergillus species (121), Coccidioides immitis (38), Zygomycetes (31), Candida species (14) Cryptococcus neoformans (13), and Histoplasma capsulatum (11). We have also included a single case of endobronchial Pseudallescheria boydii infection in a lung transplant recipient that has not been reported previously. Most patients were immunocompromised, exhibited systemic manifestations of the primary infection, and responded to appropriate therapy. EBFI should be included in the differential diagnosis of any form of airway lesions in immunocompromised patients, especially among residents from the endemic areas.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endobronchial Fungal Disease: An Under-Recognized Entity

Karnak

Avery²,

Gildea

et al. 2006

Respiration

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“…Mucormycosis usually occurs in the at-risk population alongside other common diseases, e.g., cytomegalovirus infection, bacterial infection or even other fungal diseases [202,203,[205][206][207]. Endobronchial or tracheal lesions are common [197,[208][209][210][211][212][213][214][215], and vascular involvement of great vessels may be a cause of fatal haemoptysis [216][217][218][219][220][221][222][223][224]. Symptoms may appear after near-drowning episodes [225], and the differential diagnosis of necrotising pneumonia or lung abscesses should be considered [204].…”

Section: R E S P I R a T O R Y M A N I F E S T A T I O N Smentioning

confidence: 99%

Mucormycosis: an emerging disease?

Bouza

Muñóz

Guinea

2006

Clinical Microbiology and Infection

133

127

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A B S T R A C TMucormycosis is the third invasive mycosis in order of importance after candidiasis and aspergillosis and is caused by fungi of the class Zygomycetes. The most important species in order of frequency is Rhizopus arrhizus (oryzae). Identification of the agents responsible for mucormycosis is based on macroscopic and microscopic morphological criteria, carbohydrate assimilation and the maximum temperature compatible with its growth. The incidence of mucormycosis is approximately 1.7 cases per 1000 000 inhabitants per year, and the main risk-factors for the development of mucormycosis are ketoacidosis (diabetic or other), iatrogenic immunosuppression, use of corticosteroids or deferoxamine, disruption of mucocutaneous barriers by catheters and other devices, and exposure to bandages contaminated by these fungi. Mucorales invade deep tissues via inhalation of airborne spores, percutaneous inoculation or ingestion. They colonise a high number of patients but do not cause invasion. Mucormycosis most commonly manifests in the sinuses (39%), lungs (24%), skin (19%), brain (9%), and gastrointestinal tract (7%), in the form of disseminated disease (6%), and in other sites (6%). Clinical diagnosis of mucormycosis is difficult, and is often made at a late stage of the disease or post-mortem. Confirmation of the clinical form requires the combination of symptoms compatible with histological invasion of tissues. The probable diagnosis of mucormycosis requires the combination of various clinical data and the isolation in culture of the fungus from clinical samples. Treatment of mucormycosis requires a rapid diagnosis, correction of predisposing factors, surgical resection, debridement and appropriate antifungal therapy. Liposomal amphotericin B is the therapy of choice for this condition. Itraconazole is considered to be inappropriate and there is evidence of its failure in patients suffering from mucormycosis. Voriconazole is not active in vitro against Mucorales, and failed when used in vivo. Posaconazole and ravuconazole have good activity in vitro. The overall rate of mortality of mucormycosis is approximately 40%.

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“…Mucor and Rhizopus are the most commonly reported pathogens of mucormycosis. The endoscopic appearance most commonly seen are mucoid plugs, yellowish or whitish in color, endobronchial mass or polypoid lesions, white cheese like masses, plaques, and areas of necrosis (18,46,59,(74)(75)(76)(77)(78). In patients with airway cryptococcal infections, the bronchoscopic appearance has been reported as whitish or yellowish masses, mucous plugs, red or white thrush-like plaques, mucosal granularity, white granulation tissue, elevated ulcerated lesions, and polypoid masses ( Figure 2) (6,44,64,(79)(80)(81).…”

Section: Bronchoscopic Findings In Fungal Caoimentioning

confidence: 99%

Infections causing central airway obstruction: role of bronchoscopy in diagnosis and management

Keshishyan¹,

DeLorenzo²,

Hammoud³

et al. 2017

J. Thorac. Dis.

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Central airway obstructive infections (CAOI) are challenging medical conditions that may represent an advanced and complicated process of ongoing infections. The epidemiology of CAOI is unknown as well as the pathophysiology and the mechanism of development. This is due to sparse data in the literature that consists mainly of case reports and retrospective case series. CAOI can be caused by fungal, bacterial, parasitic and viral infections. Most patients with CAOI can be diagnosed clinically and with chest imaging, which demonstrate obstruction of the central airways. However, bronchoscopy is commonly used to confirm and obtain a specific diagnosis to guide specific therapy. In recent years, interventional pulmonology (IP) is becoming widely available and offer a minimally invasive approach for the management of central airway diseases such as cancers, benign strictures, and other conditions. Various bronchoscopic modalities are used to treat central airway obstruction (CAO), such as mechanical debulking, endobronchial laser therapy, electrocautery, argon plasma coagulation, cryotherapy, and airway stenting. In patients with CAOI, the role of therapeutic bronchoscopy is not clearly defined, but many isolated reports in the literature described bronchoscopic intervention in combination with medical therapy as the initial management approach. In this paper, we present cases of CAOI that underwent bronchoscopic intervention as part of their management. We described the infectious etiology, locations, bronchoscopic findings and bronchoscopic modalities for airway management.

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Bilobectomy and Amphotericin B in a Case of Endobronchial Mucormycosis

Cited by 5 publications

References 3 publications

Endobronchial Fungal Disease: An Under-Recognized Entity

Endobronchial Fungal Disease: An Under-Recognized Entity

Mucormycosis: an emerging disease?

Infections causing central airway obstruction: role of bronchoscopy in diagnosis and management

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