Fungal brain abscesses (aspergillosis/mucormycosis) in two immunosuppressed patients

Epstein, Nancy E.; Hollingsworth, Renee; Black, Karen; Farmer, Peter

doi:10.1016/0090-3019(91)90006-u

Cited by 46 publications

(32 citation statements)

References 9 publications

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“…Further, it has been used as a single treatment for CMD pain. 26 In this study, observable sign and symptoms of CMD measured by craniomandibular index (CMI) significantly decreased during the 6 weeks of splint therapy supported by physiotherapy and TENS in 25 patients (83%). Other 5 patients (16%) had probably more advanced problems of TM joint and muscles and need for a prolonged treatment with other modalities.…”

Section: The Journal Of Craniofacial Surgery / Volume 17 Number 3 Mamentioning

confidence: 70%

“…1 It is also responsible for infections of the upper respiratory tract 3 and maxillofacial district. Several new cases have been reported in immunocompetent patients 5,7,8,26 affected by DM, leukemia, vascular and kidney diseases, liver cirrhosis, nose-pharyngeal cancer, 4 and tumors of the central nervous system, with a death rate of 70%. 3 Recent reports of aspergillosis have been linked with drug abuse.…”

Section: Discussionmentioning

confidence: 99%

“…Treacy (1999) claims that subjects exposed to TENS receive a slight rhythmic, electrical impulse through the nerves that control the muscles of facial expression and chewing. 26 The rhythmic pulsing increases blood flow to the tense muscles, helping them to relax and lengthen, and ridding them of toxic substances. TENS has usually been used as pain reliever or as a tool to relax the jaw before splint adjustment.…”

Section: The Journal Of Craniofacial Surgery / Volume 17 Number 3 Mamentioning

confidence: 99%

“…In this case, the infection involved the paranasal sinuses,turbinates, and palate and orbital region; usually the lesions are not self-limiting and can be responsible for extensive degenerations. 30 Cerebral abscesses can be a result of serious aspergillosis 26 and mucormycosis infections. 14,28,30 The developmentof brain abscess is an ominous sign of active systemic infection by fungal hyphae, in which a chronic invasion is characterized by a prolonged clinical course with slow disease progression across mucosa and bone or other contiguousstructures such as the orbit and brain.…”

Section: Brief Clinical Notes / Pellacchia Et Almentioning

confidence: 99%

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Rotating Distraction Osteogenesis in a Child with Secondary Craniosyntostosis

Chung¹,

Yoon²

2006

Journal of Craniofacial Surgery

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The purpose of the treatment of mandibular fractures is to restore proper dental occlusion and stable temporomandibular joint movement, as well as the reduction of the displaced fracture. Consideration must be given to the selection of the most appropriate surgical and rehabilitation methods in such patients. Typical surgical methods for the treatment of mandibular fractures include the arch bar method or plating at the location of the fracture combined with fixing the mandible to the maxilla using the arch bar method. However arch bars and circumdental wires, which require teeth for fixation, damage teeth and periodontal tissue, and tend to be uncomfortable for patients during the fixation period. Moreover, daily maintenance of oral hygiene is difficult for patients with an arch bar. Surgeons are also exposed to the risk of blood-transmitted diseases through skin punctures by wires when affixing these devices. For these reasons, we chose to study the potential of the MMFS method, which is thought to lessen all of the following problems: tissue damage, operating time, patient discomfort, and possible exposure to percutaneous infectious disease due to puncture of gloves and skin by the wires. We demonstrated the utility of the MMFS method in the present study.T he restoration of proper dental occlusion is important in the treatment of a mandibular fracture. The arch bar method is generally used to treat such fractures at present. However, both teeth and periodontal tissue are damaged by penetration of and ligation with the more than 10 wires required by this procedure. The operating team is also placed at considerable risk due to the potential for the ends of the wires to puncture gloves and/or fingers. We analyzed the potential for use of a treatment in which screws are inserted into the maxilla and mandible, and are then ligated with wires to fix both the maxilla and mandible in place and avoid the aforementi1d problems. Fifteen patients with mandibular fractures were treated with maxillomandibular fixation screws (the MMFS method) at the Izunagaoka Hospital of Juntendo University from April, 2000 to December, 2001. Proper dental occlusion was achieved in all patients treated using the MMFS method, and normal temporomandibular joint function was restored after rehabilitation. However, paresthesia occurred around the symphysis menti of the mandible in 33.3% of the patients. The MMFS method proved to be a reliable surgical method for the treatment of mandibular fractures. It not only restores proper dental occlusion and natural temporomandibular joint function, but it also offers the advantages of increased ease of oral and dental hygienic maintenance as well as decreased dental damage, operating time and risk of puncturing gloves and skin. PATIENTS AND METHODSA retrospective chart review was conducted on 15 patients with mandibular fractures treated by the MMFS method at the Izunagaoka Hospital of Juntendo University from April, 2000 to December, 2001. The mean age of the 15 patients was 23.3 years. T...

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Section: The Journal Of Craniofacial Surgery / Volume 17 Number 3 Mamentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: The Journal Of Craniofacial Surgery / Volume 17 Number 3 Mamentioning

confidence: 99%

Section: Brief Clinical Notes / Pellacchia Et Almentioning

confidence: 99%

See 2 more Smart Citations

Rotating Distraction Osteogenesis in a Child with Secondary Craniosyntostosis

Chung¹,

Yoon²

2006

Journal of Craniofacial Surgery

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“…A extensão direta da órbita para o lobo frontal pode rapidamente provocar trombose do seio cavern o s o . A destruição óssea, infiltração re t ro-orbitária e form a ç ã o de abscessos podem ser evidentes 12 . Os vasos cerebrais podem ficar ocluídos pelo A s p e rg i l l u s e com infarto cerebral.…”

Section: Discussionunclassified

Aspergilose cerebral em paciente imunocompetente

Filho

Pedroso²,

Giannetti³

et al. 2005

Arq. Neuro-Psiquiatr.

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RESUMO -Descrevemos um caso raro de aspergilose cerebral, como complicação de ciru rgia para aneurisma c e rebral, em paciente imunocompetente, e com sucesso no tratamento. A paciente, de 40 anos, havia sido submetida a craniotomia para clipagem de aneurisma da artéria pericalosa. Após cinco meses, no sitio cir ú rgico, surgiram múltiplos abscessos por Aspergillus sp. Foram necessárias duas craniotomias para a re t i r a d a da massa fúngica e uso de anfotericina B. Após 14 anos de acompanhamento, a evolução mostra re s o l u ç ã o da aspergilose, sem seqüela. O tratamento do abscesso cerebral por Aspergilus exige acompanhamento clínico contínuo, repetidas drenagens cirúrgicas intracranianas e o uso de anfotericina B no tratamento medicamentoso.PALAVRAS-CHAVE: aspergilose, abscesso cerebral, micose oportunística. Cerebral Aspergillus abscess in immunocompetent patientABSTRACT -We re p o rt an unusual case of brain aspergillosis with multiple re c u rrent abscess in a 40 yearsold immunocompetent woman, with good therapeutical outcome. The patient presented a subaracnoid h e m o rhage caused by a ru p t u red pericalosal art e ry aneurysm and was submitted to a craniotomy for aneurysm surg e ry. Five months later, she developed multiple Aspergillus cerebral abscess. Two craniotomies and amphotericin B became necessary during treatment. Fourteen years later, she is asymptomatic. Tre a t m e n t of brain aspergillosis abscess implied the combination of both surgical and drug therapy with amphotericin B .

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Brain Abscess in Solid Organ Transplant Recipients Receiving Cyclosporine-Based Immunosuppression

Selby

Ramirez²,

Singh³

et al. 1997

Arch Surg

125

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Objective-To determine the incidence, clinical presentation, and outcome and confounding factors associated with the development of a brain abscess in solid organ transplant recipients.Design-A 14-year retrospective survey.Setting-A single, multiorgan, academic transplantation center.Patients-A total of 2380 liver transplant recipients, 1650 kidney transplant recipients, and 598 heart, heart-lung, or lung transplant recipients of all ages (pediatric and adult) were included. All patients were given cyclosporine-based immunosuppression during this period.Main Outcome Measure-A brain abscess was determined to be present if there was histological and/or microbiological confirmation of a brain lesion seen by a computed tomographic scan. A brain abscess was considered suspicious if radiographic findings were seen in the clinical setting of neurologic symptoms and fever without histological or microbiological confirmation.Results-A brain abscess developed in a total of 28 patients (0.61%) of the total study population. The frequency of brain abscess according to organ type was as follows: 0.63%, liver; 0.36%, kidney; and 1.17%, heart and heart-lung. The overall mortality was 86%. Complicating factors associated with fungal (Candida and Aspergillus sp) abscess formation included major subsequent operations, retransplantations, antirejection therapy, associated bacteremia or viremia, and multiorgan failure. The lung was the primary site of dissemination in 18 patients. Low-dose prophylactic amphotericin was ineffective in preventing a fungal brain abscess in 10 high-risk patients. Because of the ineffective therapy and the deadly nature of established fungal abscesses, full-dose antifungal therapy and reduced immunosuppression were warranted on identification of a high-risk clinical setting. Nonfungal abscesses (Nocardia and Toxoplasma sp) occurred in healthy graft recipients long after transplantation. The existing medical therapy is usually effective in these patients, provided that rapid tissue diagnosis is established. Conclusion-The epidemiological features of brain abscess formation after solid organ transplantation suggest 2 populations of patients exist that differ in timing, clinical setting, and response to therapy. For the chronically immunosuppressed outpatient, an established abscess should be empirically treated with sulfonamides until tissue diagnosis is confirmed. On the other hand, the acutely immunosuppressed posttransplant recipient, with defined risk factors, should receive full-dose therapy with amphotericin B and concomitantly lowered immunosuppression.

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Fungal brain abscesses (aspergillosis/mucormycosis) in two immunosuppressed patients

Cited by 46 publications

References 9 publications

Rotating Distraction Osteogenesis in a Child with Secondary Craniosyntostosis

Rotating Distraction Osteogenesis in a Child with Secondary Craniosyntostosis

Aspergilose cerebral em paciente imunocompetente

Brain Abscess in Solid Organ Transplant Recipients Receiving Cyclosporine-Based Immunosuppression

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