Cutaneous Rhizopus and Aspergillus infections in five patients with cancer

Khardori, N.

doi:10.1001/archderm.125.7.952

Cited by 17 publications

(9 citation statements)

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“…Traumatic implantation of spores in dirt has been seen in a number of patients (6,9,66,77,93,171,178,207,210,276,280,309,342,350,453). Needlestick exposures have been implicated in zygomycotic infections occurring at the site of medicine injection (77,158,215,361,474), catheter insertion sites (160,234,237,262,332), injection sites for illicit drug use (7,163,189,205,365,401,426,465,476,514), and tattooing (357). Insect bites or stings have also been implicated in disease transmission in cases of cutaneous and subcutaneous zygomycosis (33,152,159,199,203,233,372,494).…”

Section: Modes Of Transmissionmentioning

confidence: 99%

“…rhizopodiformis has been seen in a surgical wound covered by an adhesive ostomy bag (353), both representing iatrogenic transmission. Sporadic cases of transmission by an insect bite (88,152,199,233), intramuscular injection (215), and catheter insertion site infections (234,237) have all been described. Intravenous drug use has also been linked to Rhizopus zygomycosis (163,205,365,401).…”

Section: Rhizopus Speciesmentioning

confidence: 99%

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Zygomycetes in Human Disease

2000

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SUMMARY The Zygomycetes represent relatively uncommon isolates in the clinical laboratory, reflecting either environmental contaminants or, less commonly, a clinical disease called zygomycosis. There are two orders of Zygomycetes containing organisms that cause human disease, the Mucorales and the Entomophthorales. The majority of human illness is caused by the Mucorales. While disease is most commonly linked to Rhizopus spp., other organisms are also associated with human infection, including Mucor, Rhizomucor, Absidia, Apophysomyces, Saksenaea, Cunninghamella, Cokeromyces, and Syncephalastrum spp. Although Mortierella spp. do cause disease in animals, there is no longer sufficient evidence to suggest that they are true human pathogens. The spores from these molds are transmitted by inhalation, via a variety of percutaneous routes, or by ingestion of spores. Human zygomycosis caused by the Mucorales generally occurs in immunocompromised hosts as opportunistic infections. Host risk factors include diabetes mellitus, neutropenia, sustained immunosuppressive therapy, chronic prednisone use, iron chelation therapy, broad-spectrum antibiotic use, severe malnutrition, and primary breakdown in the integrity of the cutaneous barrier such as trauma, surgical wounds, needle sticks, or burns. Zygomycosis occurs only rarely in immunocompetent hosts. The disease manifestations reflect the mode of transmission, with rhinocerebral and pulmonary diseases being the most common manifestations. Cutaneous, gastrointestinal, and allergic diseases are also seen. The Mucorales are associated with angioinvasive disease, often leading to thrombosis, infarction of involved tissues, and tissue destruction mediated by a number of fungal proteases, lipases, and mycotoxins. If the diagnosis is not made early, dissemination often occurs. Therapy, if it is to be effective, must be started early and requires combinations of antifungal drugs, surgical intervention, and reversal of the underlying risk factors. The Entomophthorales are closely related to the Mucorales on the basis of sexual growth by production of zygospores and by the production of coenocytic hyphae. Despite these similarities, the Entomophthorales and Mucorales have dramatically different gross morphologies, asexual reproductive characteristics, and disease manifestations. In comparison to the floccose aerial mycelium of the Mucorales, the Entomophthorales produce a compact, glabrous mycelium. The asexually produced spores of the Entomophthorales may be passively released or actively expelled into the environment. Human disease with these organisms occurs predominantly in tropical regions, with transmission occurring by implantation of spores via minor trauma such as insect bites or by inhalation of spores into the sinuses. Conidiobolus typically infects mucocutaneous sites to produce sinusitis disease, while Basidiobolus infections occur as subcutaneous mycosis of the trunk and extremities. The Entomophthorales are true pathogens, infecting primarily immunocompetent hosts. They generally do not invade blood vessels and rarely disseminate. Occasional cases of disseminated and angioinvasive disease have recently been described, primarily in immunocompromised patients, suggesting a possible emerging role for this organism as an opportunist.

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Section: Modes Of Transmissionmentioning

confidence: 99%

Section: Rhizopus Speciesmentioning

confidence: 99%

Zygomycetes in Human Disease

2000

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“…It is believed that local trauma and macerated skin play the major pathogenic role. 11 This may occur either at the site of the intravenous needle itself, under tape, or under adjoining armboards, both in children 4,[15][16][17]19,21,27 and in adults. 3,12 Such infections may also occur at central venous access sites, 3 or as a result of contaminated elastic bandages used over operative sites.…”

Section: Discussionmentioning

confidence: 99%

“…Published case series of cutaneous mold infections from an individual institution have focused on primarily adult populations. 6,[8][9][10][11][12] In the pediatric population, descriptions of cutaneous mold infections have mainly taken the form of case reports [13][14][15][16][17] or reviews of the literature. 18,19 Although Rowen et al 20 Texas Children's Hospital (TCH) in Houston is a quaternary care hospital and has the largest number of beds of any pediatric hospital in the country.…”

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confidence: 99%

Primary cutaneous opportunistic mold infections in a pediatric population

Katta¹,

Bogle

Levy

2005

Journal of the American Academy of Dermatology

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“…Compromise of skin integrity places patients at risk; catheter exit sites, burns, trauma, surgery, and tattoos have been implicated in this disease. [16][17][18][19][20] Zygomycosis has also been reported in some patients with no identifiable immune defect. 12,21,22 Occupational exposure to sporangiospores has been linked to disease in immunocompetent hosts.…”

mentioning

confidence: 99%

Pulmonary Zygomycosis

Pyrgos

Shoham

Walsh

2008

Semin Respir Crit Care Med

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Zygomycosis has emerged as an increasingly common infection in immunocompromised patients. Although the majority of these cases are community acquired, hospital outbreaks have been described, linked to the use of contaminated products. Risk factors for development of zygomycosis include uncontrolled diabetes mellitus, neutropenia, use of immunosuppressive medications, and iron overload states. Recent studies have shown the central role of iron in the pathogenesis of zygomycosis and the effect of disease states such as ketoacidosis and hyperglycemia on the availability of iron to the Zygomycetes. These organisms most commonly infect the sinuses, lungs, central nervous system, and skin and soft tissues. Diagnosis often involves invasive procedures, including deep tissue biopsy, because radiological studies are not specific for this disease, and other less invasive diagnostic modalities have not yet been proven to be sensitive or specific. Treatment may require a combined medical and surgical approach in these frequently frail patients; yet, even with such aggressive measures the mortality of zygomycosis remains high.

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Cutaneous Rhizopus and Aspergillus infections in five patients with cancer

Cited by 17 publications

References 0 publications

Zygomycetes in Human Disease

Zygomycetes in Human Disease

Primary cutaneous opportunistic mold infections in a pediatric population

Pulmonary Zygomycosis

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