Disseminated mucormycosis with myocardial involvement in a renal transplant recipient

Nam, Y.; Jung, Jae Hyun; Park, S.S.; Kim, S.J.; Shin, Saeam; Choi, Jong Ho; Kim, M.; Yoon, Hye Eun

doi:10.1111/tid.12452

Cited by 10 publications

(9 citation statements)

References 18 publications

(25 reference statements)

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“…107 Only one case of mucormycosis (Lichtheimia) was identified among 362 heart transplant recipients at a single center from 1995 to 2012. 108 Numerous case reports and small series of mucormycosis in SOTRs including liver, 80,[109][110][111][112][113][114][115] kidney, 107,[116][117][118][119][120][121][122][123][124][125] heart, 108,126,127 and lung recipients [128][129][130][131] have been published.…”

Section: Solid Organ Transplant Recipientsmentioning

confidence: 99%

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Mucormycosis

Reid

Lynch

Fishbein

et al. 2020

Semin Respir Crit Care Med

134

108

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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: Solid Organ Transplant Recipientsmentioning

confidence: 99%

“…Rare sites of involvement include bone and joints, 31,[216][217][218][219][220] heart, 116,221,222 and peritoneum. [90][91][92]223…”

Section: Rare Sites Of Involvementmentioning

confidence: 99%

Mucormycosis

Reid

Lynch

Fishbein

et al. 2020

Semin Respir Crit Care Med

134

108

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“…148 Similarly, only one case of mucormycosis (Lichtheimia) was identified among 362 heart transplant recipients at a single center from 1995 to 2012. 149 Numerous case reports and small series of mucormycosis in SOT recipients including liver, 42,[150][151][152][153][154][155][156] kidney, 148,[157][158][159][160][161][162][163][164][165][166] heart, 149,167,168 and lung 55,[169][170][171] have been published.…”

Section: Organ Transplant Recipientsmentioning

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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“…3 Although cardiac mucormycosis is rare, reported cases have also occurred in the setting of disseminated disease with fatal outcomes. [6][7][8][9] To our knowledge, this is the first report of and side effect profile, but more study is needed. 16 Lastly, the importance of hyperglycemia should not be underestimated and can be particularly challenging with high-dose glucocorticoids and calcineurin inhibitors.…”

Section: Discussionmentioning

confidence: 82%

“…In patients with localized disease, amphotericin B (AmB) combined with surgical resection was associated with better mortality than AmB alone; however, disseminated infection was fatal in all cases . Although cardiac mucormycosis is rare, reported cases have also occurred in the setting of disseminated disease with fatal outcomes …”

Section: Discussionmentioning

confidence: 99%

Disseminated mucormycosis masquerading as rejection early after orthotopic heart transplantation

Margoles

DeNofrio

Patel

et al. 2018

Transplant Infectious Dis

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Mucorales organisms are an uncommon cause of invasive fungal infections after solid organ transplantation but are associated with great morbidity and mortality. We report a fatal case of disseminated Cunninghamella infection early after heart transplantation. The patient developed graft dysfunction and elevated markers of myocyte injury and autopsy revealed fulminant fungal myocarditis. This case highlights the need for a high index of suspicion in immunocompromised patients who are not improving with standard antimicrobial therapy.

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Disseminated mucormycosis with myocardial involvement in a renal transplant recipient

Cited by 10 publications

References 18 publications

Mucormycosis

Mucormycosis

Fungal Infections Complicating Lung Transplantation

Disseminated mucormycosis masquerading as rejection early after orthotopic heart transplantation

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