Isolated cerebral mucormycosis caused by<i>Rhizomucor pusillus</i>

Farid, Saira; AbuSaleh, Omar; Liesman, Rachael M.; Sohail, M. Rizwan

doi:10.1136/bcr-2017-221473

Cited by 8 publications

(5 citation statements)

References 12 publications

(5 reference statements)

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“…The most commonly identified species is Rhizopus arrhizus (syn. R. oryzae ), recorded in approximately 37% of cases, with Rhizopus microsporus, Rhizomucor pusillus, Apophysomyces variabilis , and Lichtheimia ramosa being less commonly found [ 57 , 59 , 63 ].…”

Section: Etiological Factors Of Fis-cnsmentioning

confidence: 99%

Neuroinfections caused by fungi

2018

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BackgroundFungal infections of the central nervous system (FIs-CNS) have become significantly more common over the past 2 decades. Invasion of the CNS largely depends on the immune status of the host and the virulence of the fungal strain. Infections with fungi cause a significant morbidity in immunocompromised hosts, and the involvement of the CNS may lead to fatal consequences.MethodsOne hundred and thirty-five articles on fungal neuroinfection in PubMed, Google Scholar, and Cochrane databases were selected for review using the following search words: “fungi and CNS mycoses”, CNS fungal infections”, “fungal brain infections”, " fungal cerebritis”, fungal meningitis”, “diagnostics of fungal infections”, and “treatment of CNS fungal infections”. All were published in English with the majority in the period 2000–2018. This review focuses on the current knowledge of the epidemiology, clinical presentations, diagnosis, and treatment of selected FIs-CNS.ResultsThe FIs-CNS can have various clinical presentations, mainly meningitis, encephalitis, hydrocephalus, cerebral abscesses, and stroke syndromes. The etiologic factors of neuroinfections are yeasts (Cryptococcus neoformans, Candida spp., Trichosporon spp.), moniliaceous moulds (Aspergillus spp., Fusarium spp.), Mucoromycetes (Mucor spp., Rhizopus spp.), dimorphic fungi (Blastomyces dermatitidis, Coccidioides spp., Histoplasma capsulatum), and dematiaceous fungi (Cladophialophora bantiana, Exophiala dermatitidis). Their common route of transmission is inhalation or inoculation from trauma or surgery, with subsequent hematogenous or contiguous spread. As the manifestations of FIs-CNS are often non-specific, their diagnosis is very difficult. A fast identification of the etiological factor of neuroinfection and the application of appropriate therapy are crucial in preventing an often fatal outcome. The choice of effective drug depends on its extent of CNS penetration and spectrum of activity. Pharmaceutical formulations of amphotericin B (AmB) (among others, deoxycholate-AmBd and liposomal L-AmB) have relatively limited distribution in the cerebrospinal fluid (CSF); however, their detectable therapeutic concentrations in the CNS makes them recommended drugs for the treatment of cryptococcal meningoencephalitis (AmBd with flucytosine) and CNS candidiasis (L-AmB) and mucormycosis (L-AmB). Voriconazole, a moderately lipophilic molecule with good CNS penetration, is recommended in the first-line therapy of CNS aspergillosis. Other triazoles, such as posaconazole and itraconazole, with negligible concentrations in the CSF are not considered effective drugs for therapy of CNS fungal neuroinfections. In contrast, clinical data have shown that a novel triazole, isavuconazole, achieved considerable efficacy for the treatment of some fungal neuroinfections. Echinocandins with relatively low or undetectable concentrations in the CSF do not play meaningful role in the treatment of FIs-CNS.ConclusionAlthough the number of fungal species causing CNS mycosis is increasing, only som...

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Section: Etiological Factors Of Fis-cnsmentioning

confidence: 99%

Neuroinfections caused by fungi

2018

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“…Hematological malignancies have also been reported to be rarely associated with isolated cerebral mucormycosis. 8 However, the present case exceptionally failed to show any evidence of intravenous drug abuse or other known cause of immunosuppression, pointing out the importance of clinical suspicion of isolated cerebral mucormycosis in immunocompetent cases. The literature search shows that rarely isolated cerebral mucormycosis may be seen in immunocompetent patients.…”

Section: Discussionmentioning

confidence: 42%

Isolated cerebral mucormycosis masquerading as a tumor in an immunocompetent patient

et al. 2020

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Mucormycosis is an opportunistic fungal disease that commonly presents as cutaneous or rhinocerebral infections associated with immunocompromised states. It may exceptionally present as isolated involvement of the brain with a varied clinical presentation, which may be difficult to diagnose early, leading to increased mortality. Herein, we report the case of a 42-yearold immunocompetent female with left-sided limb weakness and a history of recurrent vomiting and headache for the last two years. Clinically, glioma was suspected, but histopathological examination revealed a few broad aseptate fungal hyphae. As no other organ was involved, the diagnosis of isolated cerebral mucormycosis was rendered. Reporting this case, we show an unusual presentation of a central nervous system mucormycosis masquerading a tumor in an immunocompetent patient. The case also highlights the importance of a careful histopathological examination to avoid missing the presence of occasional fungal hyphae. Ideally, recognition of fungal hyphae in the brain, during intraoperative consultation, can prompt brain tissue culture for definitive diagnosis and early empirical antifungal therapy, which may prove life-saving.

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“…ICM is seldom reported (9,(15)(16)(17)(18)(19), especially in healthy individuals (15,20,21). The special characteristics of the case reported herein are mainly manifested in the following aspects.…”

Section: Discussionmentioning

confidence: 81%

Fatal and Rapid Progressive Isolated Cerebral Mucormycosis Involving the Bilateral Basal Ganglia: A Case Report

et al. 2020

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Isolated cerebral mucormycosis is a clinical type of mucormycosis that is estimated to account for 8% of all mucormycosis cases. The clinical symptoms of isolated cerebral mucormycosis are elusive, and thus conventional techniques often lake sensitivity and specificity. Moreover, cultures are often negative, even when direct microscopy examination is positive. Although histopathology will probably remain the gold standard for the diagnosis of mucormycosis, obtaining a biopsy specimen is not always feasible in most vulnerable populations. Thus, molecular approaches are currently used as an advantageous assistant examination method to improve the early identification of the causative agent and subsequently guide therapy to improve the prognosis of patients. Here, we report a case of isolated cerebral mucormycosis caused by Rhizopus microspores in a healthy young adult that was identified using next-generation sequencing technology.

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Isolated cerebral mucormycosis caused byRhizomucor pusillus

Cited by 8 publications

References 12 publications

Neuroinfections caused by fungi

Neuroinfections caused by fungi

Isolated cerebral mucormycosis masquerading as a tumor in an immunocompetent patient

Fatal and Rapid Progressive Isolated Cerebral Mucormycosis Involving the Bilateral Basal Ganglia: A Case Report

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