Disseminated Zygomycosis: Report of Four Cases and Review

Ingram, Christopher W.; Sennesh, Joel; Cooper, James N.; Perfect, John R.

doi:10.1093/clinids/11.5.741

Cited by 145 publications

(79 citation statements)

References 113 publications

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“…They were all treated with steroids and two of them developed steroid-induced diabetes mellitus after BMT. Although none of our patients had been splenectomized, Ingram et al 5 have described previous splenectomy as a co-risk factor. The role of iron overload as another possible co-risk factor has seldom been evalu-ated in this population.…”

Section: Discussionmentioning

confidence: 64%

“…The clinico-radiological features are virtually indistinguishable from other invasive filamentous mycoses and result from hyphal angio-invasion leading to thrombosis and infarction of surrounding tissue and extensive hemorrhage. [1][2][3][4][5][6] Underlying medical conditions and risk factors may influence the portal of entry and hence the presenting clinical syndrome. The rhinocerebral form is classically seen in poorly controlled diabetes, especially with ketoacidosis, while invasive pulmonary disease is most frequently diagnosed in neutropenic patients.…”

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confidence: 99%

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Mucormycosis in allogeneic bone marrow transplant recipients: report of five cases and review of the role of iron overload in the pathogenesis

Maertens

Demuynck

Verbeken

et al. 1999

Bone Marrow Transplant

200

156

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Summary:In a 10-year consecutive series of 263 allogeneic bone marrow transplant recipients, we identified five cases (1.9%) of invasive mucormycosis. Only one infection occurred within the first 100 days after transplantation, while the remainder complicated the late post-transplant course (median day of diagnosis: 343). Sites of infection were considered 'non-classical' and included pulmonary, cutaneous and gastric involvement. No case of fungal dissemination was observed. Mucormycosis was the primary cause of death in three of the five patients. Corticosteroid-treated graft-versus-host disease, either acute or chronic, or severe neutropenia were present in all cases. However, compared with a matched control population, the most striking finding was the demonstration of severe iron overload in each of the mucormycosis patients. The mean level of serum ferritin, transferrin saturation and number of transfused units of red cells (2029 g/l, 92% and 52 units, respectively) in the study group is significantly higher compared with the control group (P Ͻ 0.05). The difference with other risk groups for mucormycosis, including deferoxamine-treated dialysis patients and acidotic diabetics, was analyzed in view of the possible pathogenic role of iron. Although these infections are often fatal, limited disease may have a better prognosis if diagnosed early and treated aggressively.

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Section: Discussionmentioning

confidence: 64%

mentioning

confidence: 99%

Mucormycosis in allogeneic bone marrow transplant recipients: report of five cases and review of the role of iron overload in the pathogenesis

Maertens

Demuynck

Verbeken

et al. 1999

Bone Marrow Transplant

200

156

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“…Despite antifungal therapy, mortality remains very high, particularly in the pulmonary and disseminated forms of the disease (21,26,42). Amphotericin B is the drug of choice for treatment, but its use is limited by its narrow therapeutic index (14).…”

mentioning

confidence: 99%

“…The overall mortality of localized pulmonary zygomycosis is 65% (42), and it is Ͼ95% in disseminated forms of the disease (21,42). Combination therapy is commonly used for difficult-to-treat bacterial and some fungal infections and could be a useful strategy in zygomycosis.…”

mentioning

confidence: 99%

In Vitro Susceptibilities of Zygomycetes to Combinations of Antimicrobial Agents

Dannaoui

Afeltra

Meis

et al. 2002

Antimicrob Agents Chemother

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Combinations of antimicrobial agents were tested against 35 strains of zygomycetes. The interaction between amphotericin B and rifampin was synergistic or additive. Flucytosine alone was inactive and, upon combination with amphotericin B, synergy was not achieved. The combination of amphotericin B with terbinafine was synergistic for 20% of strains, and the interaction between terbinafine and voriconazole was synergistic for 44% of strains. Antagonism was not observed.Zygomycosis is an aggressive infection occurring mostly in patients with diabetic ketoacidosis or neutropenia or in patients receiving corticosteroids (35). Despite antifungal therapy, mortality remains very high, particularly in the pulmonary and disseminated forms of the disease (21,26,42). Amphotericin B is the drug of choice for treatment, but its use is limited by its narrow therapeutic index (14). Few studies have been carried out to test antifungal combinations against zygomycetes in vitro (5, 41) or in animal models of zygomycosis (40). Combination of amphotericin B with rifampin has proven to be synergistic in vitro against yeasts (4,8,13,27), dimorphic fungi (25, 36), Aspergillus (19, 24), and Rhizopus (5). Nevertheless, in animal models of fungal infections, results for this combination have been conflicting (10,16). Interaction between amphotericin B and flucytosine has been shown to be additive or synergistic against yeasts in vitro and in vivo in animal models as well as in patients (34). With Aspergillus, indifferent-to-synergistic and in some instances antagonistic interactions have been reported for this combination (7,19). Terbinafine is a sterol biosynthesis inhibitor that is primarily used for superficial mycoses, but its current applications are extending (33). Although the potential of this antifungal for zygomycosis is unknown, terbinafine exhibits low MICs against some zygomycete isolates (22). Combination of amphotericin B with terbinafine displayed synergistic interaction in Candida albicans (2) and in Aspergillus spp. (38), and this combination has been used successfully in patients for the treatment of aspergillosis (39) and zygomycosis (12,31). Synergy between terbinafine and azoles has also been demonstrated in yeasts (2, 3, 15) and in filamentous fungi (28,38,43). The combination of terbinafine with voriconazole has rarely been investigated (38,43).The aim of this study was to investigate the in vitro interactions of amphotericin B with rifampin, flucytosine, and terbinafine as well as the interaction of terbinafine with voriconazole against zygomycetes.A total of 35 isolates were tested. These comprised 15 Rhizopus spp. (8 R. oryzae and 7 R. microsporus) isolates, 10 Absidia corymbifera isolates, 6 Mucor spp. (3 M. hiemalis, 1 M. circinelloides, 1 M. racemosus, and 1 M. rouxii) isolates, 3 Rhizomucor spp. (2 R. pusillus and 1 R. miehei) isolates, and 1 Cunninghamella bertholletiae isolate. Candida krusei ATCC 6258 and Candida parapsilosis ATCC 22019 were included to ensure quality control. The drugs that were tested ...

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“…It occurs mainly in those patients with diabetes mellitus and ketoacidosis, haematological malignancies, solid organ transplant recipients and in those who are on high dose steroids. [8][9][10][11][12][13] The commonest risk factor for the development of mucormycosis was diabetes. In a metaanalysis, 36% of the patients had diabetes as the risk factor for mucor.…”

Section: Discussionmentioning

confidence: 99%

Rhinocerebral mucormycosis: a case series

Walikar

Patil

Madraki

et al. 2017

Int J Otorhinolaryngol Head Neck Surg

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Background: The study is aimed to evaluate the role played by predisposing conditions like diabetes mellitus and precipitating factors like renal failure are discussed briefly here.Methods: The prospective study of treatment of rhinocerebral mucormycosis on dialysis for renal failure without control subjects was evaluated. Subjects were patients with uncontrolled diabetes with renal failure presenting with rhinocerebral mucormycosis. Complete blood count, renal function tests, CT scan of paranasal sinuses and brain, nasal endoscopy and biopsy was done in all the 10 patients. Results: Seven patients were on long term dialysis except one patient who was on dialysis for the first time. Amphotericin was started for all 10 patients. Seven patients who were on long term dialysis did not recover from mucormycosis and succumbed to death (70% patients showed 30.71±17.18 days prognosis). Three patients (30% patients), who were not on dialysis and had a lesser degree of renal failure, responded to aggressive antifungal and surgical debridement treatment, and recovered from infection.Conclusions: Mucormycosis in patients on dialysis is fatal. Improvement in renal function is a favourable prognostic factor for the successful treatment of mucormycosis.

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Disseminated Zygomycosis: Report of Four Cases and Review

Cited by 145 publications

References 113 publications

Mucormycosis in allogeneic bone marrow transplant recipients: report of five cases and review of the role of iron overload in the pathogenesis

Mucormycosis in allogeneic bone marrow transplant recipients: report of five cases and review of the role of iron overload in the pathogenesis

In Vitro Susceptibilities of Zygomycetes to Combinations of Antimicrobial Agents

Rhinocerebral mucormycosis: a case series

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