InvasiveAspergillusStomatitis in Patients with Acute Leukemia: Report of 12 Cases

Abstract

An 8-year retrospective analysis of invasive Aspergillus stomatitis in neutropenic patients with acute leukemia was performed to characterize the epidemiology and clinical features of the infection. Twelve cases of invasive Aspergillus stomatitis were identified with both clinicohistological and microbiological evidence, and the majority of cases were caused by Aspergillus flavus (10 [83%] of 12 patients). The infection was strongly suspected when a neutropenic patient developed persistent fever without a known source, symptoms of gingival pain and facial swelling, and a solitary ulcerating lesion of mucogingiva covered with a gray necrotic pseudomembrane. Aspergillus stomatitis was diagnosed a median 23 days after admission. In all 12 patients, the diagnosis was made during the period of neutropenia. Ten patients (83%) were treated with amphotericin B and surgery and survived with recovery of neutrophils. Two patients died, and disseminated aspergillosis was identified in 1 patient.

Combined mucormycosis and aspergillosis of the oro-sinonasal region in a patient affected by Castleman disease

“…Delayed diagnosis or inappropriate treatment may result in massive tissue destruction and possible extension into the cranial base and/or vault and orbit, via the blood flow, and determine blindness, lethargy, seizure and eventually death [2]. Aspergillosis very rarely arises in healthy individuals and more commonly affects insulin-dependent diabetics with poorly controlled disease, immune-compromised patients [18,28] or leukaemic patients [10,16]. Non-invasive aspergillosis of the maxillary sinus may be associated with extrusion of root canal cements into the sinus, and it has been suggested that zinc oxide-based endodontic materials might promote the infection, as zinc may act as a growth factor for Aspergillus [20].…”

“…Aspergillosis usually occurs in immune-suppressed or debilitated individuals [31], such as patients with neutropenia [17], leukaemia [10,16,18,30], acquired immunodeficiency syndrome [23,27], cancer [25], treated with corticosteroids or with otherwise imbalanced macrophagic functions [24]. In such instances, inhaled spores [22] invade blood vessels, causing thrombosis and infarction and can erode through the facial planes, cartilagine and bone [2].…”

Molecular characterisation of cyp51A and cyp51B genes coding for P450 14α-lanosterol demethylases A (CYP51Ap) and B (CYP51Bp) from voriconazole-resistant laboratory isolates of Aspergillus flavus

“…Recent studies have reported that non-fumigatus Aspergillus spp. [3][4][5][6], including Aspergillus flavus [7,8], are emerging as predominant pathogens in various transplant and cancer centres in the USA and around the world [9][10][11][12][13][14]. Although voriconazole (VCZ) [15,16], the drug of choice for treatment of invasive aspergillosis, has been in use only for the past 3 years, breakthrough infections with Aspergillus and Candida spp.…”

“…Although voriconazole (VCZ) [15,16], the drug of choice for treatment of invasive aspergillosis, has been in use only for the past 3 years, breakthrough infections with Aspergillus and Candida spp. as well as clinical isolates of A. fumigatus showing reduced susceptibility to VCZ therapy [14] have been reported. Mortality, despite therapy, remains high, and drug resistance might partly account for treatment failures.…”

Diagnosis and management of Candida and other fungal infections of the head and neck

“…Aspergillus and other filamentous fungi are uncommon causes of isolated oral lesions and occur almost exclusively in profoundly neutropenic patients [45], similar to invasive aspergillosis at other anatomic sites [46]. Treatment is systemic amphotericin B, and prognosis depends on correction of the underlying immunosuppression, particularly neutrophil recovery.…”