Cutaneous infarction. Manifestation of disseminated mucormycosis

Kramer, Barnett S.

doi:10.1001/archderm.113.8.1075

Cited by 37 publications

(29 citation statements)

References 7 publications

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“…18 It is a rare disease, often found in the patients with a weakened immune system and can often lead to a fatal outcome. 18 It occurs most often in patients with hematological malignancies, [19][20][21][22][23][24][25][26] and diabetes mellitus. 27 Zygomycosis presents a major clinical challenge, both during diagnosis and patient treatment.…”

Section: Discussionmentioning

confidence: 99%

Identification of fungal pathogens in a patient with acute myelogenic leukemia using a pathogen detection array technology

Banerjee

Peck

Feldman

et al. 2015

Cancer Biology & Therapy

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Invasive zygomycosis in immunocompromised patients results in a high mortality rate, and early identification is crucial to optimize therapy and to reduce morbidity. However, diagnosing specific species of zygomycetes fungi possess challenge in the clinical laboratories. A need for a rapid and sensitive diagnostic tool for early recognition of a zygomycetes fungus in clinical samples to the species level will lead to prompt and accurate therapy and the PathoChip provides one such platform. We utilized a pathogen array technology referred to as PathoChip, comprised of oligonucleotide probes that can detect all the sequenced viruses as well as known pathogenic bacteria, fungi and parasites and family-specific conserved probes, thus providing a means for detecting previously uncharacterized members of a family. We rapidly identified a zygomycetous fungus, Rhizomucor pusillus, an otherwise challenge for the clinical laboratories, predominantly in a patient with acute myelogenous leukemia. This report highlights the value of PathoChip as a diagnostic tool to identify micro-organisms to the species level, especially for those difficult to identify in most clinical laboratories. It will also help clinicians to obtain a critical snapshot of the infection profile of a patient to plan treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Identification of fungal pathogens in a patient with acute myelogenic leukemia using a pathogen detection array technology

Banerjee

Peck

Feldman

et al. 2015

Cancer Biology & Therapy

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“…Sporadic literature reports have shown this species to be mostly associated with patients who are severely immunocompromised, especially those patients undergoing therapy for leukemia or those who have uncontrolled diabetes (17,25). Infection types include primary cutaneous disease with or without dissemination (14,18,21,31), primary pulmonary disease with or without dissemination (3,7,15,17,23,25), and sinusitis with or without orbital participation or involvement of the brain (1,5,6). In all cases, the identification of Rhizomucor species was based on morphological observations, with biochemical tests used in some cases.…”

Section: Discussionmentioning

confidence: 99%

Molecular Identification of Rhizomucor pusillus as a Cause of Sinus-Orbital Zygomycosis in a Patient with Acute Myelogenous Leukemia

et al. 2005

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Sinus-orbital zygomycosis caused by Rhizomucor pusillus in a patient with acute myelogenous leukemia is described. Identification was achieved by sequencing of the internal transcribed spacer (ITS) regions of the rRNA gene and by expression of zygospores in mating. This report highlights the value of ITS sequencing as a diagnostic tool for the identification of R. pusillus and expands the understanding of infection types caused by this zygomycete. CASE REPORTA 62-year-old male Native American rancher from Nebraska was diagnosed with acute myelogenous leukemia. He was treated with standard induction and consolidation chemotherapy followed by a low-intensity related allogeneic peripheral stem cell transplant. The patient received fluconazole prophylaxis and was placed on granulocyte-macrophage colony-stimulating factor (GM-CSF) on the day of transplant. On day 8 posttransplant (PT) the patient had an absolute neutrophil count of 300 cells per mm 3 and complained of nasal congestion. A nasal washing was positive for parainfluenza virus, but cultures for bacteria and fungi were negative. A computed tomography scan of the sinuses showed pansinusitis. On day 9 PT, the absolute neutrophil count was 1,380 cells per mm 3 , at which time GM-CSF was discontinued. Over the next 4 days, the sinusitis symptoms continued with the development of right-sided periorbital edema. On day 13 PT a magnetic resonance image confirmed pansinusitis with diffuse mucosal thickening and bilateral proptosis. Broad-spectrum antibiotics were initiated. The patient was subsequently taken to the operating room for a bilateral total ethmoidectomy and sphenoidectomy; culture and histopathological exam of tissue were negative for pathogens. Amphotericin B (AMB) lipid complex (Abelcet; Enzon Pharmaceuticals, Bridgewater, NJ) was started at 5 mg per kg for presumed fungal sinusitis. Over the next 3 days, the patient had fever spikes to 39.5°C, and on day 16 PT he developed complete loss of vision in the right eye with orbital fixation. On day 18 PT, the patient underwent a bilateral total ethmoidectomy, bilateral maxillary and sphenoid debridement, and a right orbitotomy. The pathological exam of the sphenoid and ethmoid tissues reported "fibrovascular changes and acute inflammation with necrosis containing broad and irregularly shaped non-septate hyphae." Based on diagnosis of an invasive mold infection, the AMB lipid complex was increased to 7.5 mg per kg, AMB nasal irrigation was also initiated, and GM-CSF was restarted. Fungal cultures from the sinus biopsy material plated onto Sabouraud dextrose agar (Remel, Lenexa, Kansas) incubated at 30°C grew a mold within 4 days that was morphologically identified as a Mucor species. Sinus tissue extract and a subculture of the isolate were subsequently submitted to the Molecular Mycology Laboratory at the University of Nebraska Medical Center (UNMC) for further evaluation. DNA extracted from both the sinus tissue and the culture isolate was tested using a molecular assay targeting the internal transcribed s...

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“…Cutaneous disease caused by this fungus is acquired by two mechanisms. Disease may result from direct traumatic implantation of spores into subcutaneous tissues (398,504) or may occur as a manifestation of disseminated infection (249).…”

Section: Mucor Speciesmentioning

confidence: 99%

“…Most of the remaining cases have been associated with profound neutropenia. Although most of these cases were seen in patients with leukemia (29,113,249,298,398,417,434,499), Rhizomucor infections have also been seen associated with neutropenia caused by aplastic anemia (174) and myelofibrosis (153). Treatment with steroids probably contributed to disease risk for a number of patients (29,174,249,257,398,417,434,499,504).…”

Section: Mucor Speciesmentioning

confidence: 99%