Primary phycomycosis of the brain in heroin addicts

Kasantikul, Vira; Shuangshoti, Samruay; Taecholarn, Chopeow

doi:10.1016/0090-3019(87)90232-1

Cited by 23 publications

(5 citation statements)

References 11 publications

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“…Treatment with deferoxamine in patients with iron and aluminium overload has been associated with mucormycosis, although the introduction of erythropoietin has significantly decreased the use of deferoxamine, and therefore this factor is becoming progressively less frequent in current cases of mucormycosis [1,11,37,40,64–82]. Mucormycosis is very infrequent in immunocompetent patients, those without risk‐factors, HIV‐infected patients, intravenous drug users and patients with solid‐organ tumors [33,37,41,83–125].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Mucormycosis: an emerging disease?

Bouza

Muñóz

Guinea

2006

Clinical Microbiology and Infection

134

127

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A B S T R A C TMucormycosis is the third invasive mycosis in order of importance after candidiasis and aspergillosis and is caused by fungi of the class Zygomycetes. The most important species in order of frequency is Rhizopus arrhizus (oryzae). Identification of the agents responsible for mucormycosis is based on macroscopic and microscopic morphological criteria, carbohydrate assimilation and the maximum temperature compatible with its growth. The incidence of mucormycosis is approximately 1.7 cases per 1000 000 inhabitants per year, and the main risk-factors for the development of mucormycosis are ketoacidosis (diabetic or other), iatrogenic immunosuppression, use of corticosteroids or deferoxamine, disruption of mucocutaneous barriers by catheters and other devices, and exposure to bandages contaminated by these fungi. Mucorales invade deep tissues via inhalation of airborne spores, percutaneous inoculation or ingestion. They colonise a high number of patients but do not cause invasion. Mucormycosis most commonly manifests in the sinuses (39%), lungs (24%), skin (19%), brain (9%), and gastrointestinal tract (7%), in the form of disseminated disease (6%), and in other sites (6%). Clinical diagnosis of mucormycosis is difficult, and is often made at a late stage of the disease or post-mortem. Confirmation of the clinical form requires the combination of symptoms compatible with histological invasion of tissues. The probable diagnosis of mucormycosis requires the combination of various clinical data and the isolation in culture of the fungus from clinical samples. Treatment of mucormycosis requires a rapid diagnosis, correction of predisposing factors, surgical resection, debridement and appropriate antifungal therapy. Liposomal amphotericin B is the therapy of choice for this condition. Itraconazole is considered to be inappropriate and there is evidence of its failure in patients suffering from mucormycosis. Voriconazole is not active in vitro against Mucorales, and failed when used in vivo. Posaconazole and ravuconazole have good activity in vitro. The overall rate of mortality of mucormycosis is approximately 40%.

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Section: Clinical Manifestationsmentioning

confidence: 99%

Mucormycosis: an emerging disease?

Bouza

Muñóz

Guinea

2006

Clinical Microbiology and Infection

134

127

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Section: Discussionmentioning

confidence: 99%

“…The existing three case reports of obstructive hydrocephalus secondary to mucormycosis in an immunocompetent patient all were reported in the 1980s before the advent of MRI. [24][25][26] One case did diagnose focal obstructive pathology on ventriculography, 24 one was not specified as communicating or obstructive hydrocephalus, 26 and only one of the three cases was diagnosed and appropriately treated before death. 25 Regarding obstructive hydrocephalus secondary to infection, the majority of the literature describes a bacterial etiology including gram-negative rods 32 or tuberculosis basal meningitis 33,34 or is opaquely nonspecific with regard to the nuances of fungal infectious hydrocephalus.…”

Section: Observationsmentioning

confidence: 99%

“… 16–20 Among those, the vast majority had a focal mass lesion or radiographic infectious sequelae on magnetic resonance imaging (MRI). 3 , 8 , 17 , 19 , 21–23 Only three to date have reported obstructive hydrocephalus secondary to mucormycosis without an evident infectious process on neuroimaging, although all occurred in the 1980s before the advent of MRI 24–26 and only one was diagnosed and appropriately treated before death. 25 …”

mentioning

confidence: 99%

“…[16][17][18][19][20] Among those, the vast majority had a focal mass lesion or radiographic infectious sequelae on magnetic resonance imaging (MRI). 3,8,17,19,[21][22][23] Only three to date have reported obstructive hydrocephalus secondary to mucormycosis without an evident infectious process on neuroimaging, although all occurred in the 1980s before the advent of MRI [24][25][26] and only one was diagnosed and appropriately treated before death. 25 Here, we present our experience with a rare case of adult obstructive hydrocephalus caused by Rhizopus infection in an immunocompetent patient, with the obstruction and infection both diagnosed only at the time of surgery.…”

mentioning

confidence: 99%

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Immunocompetent isolated cerebral mucormycosis presenting with obstructive hydrocephalus: illustrative case

Nguyen,

Freeman,

Ung

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Isolated cerebral mucormycosis is rare in immunocompetent adults and is only sparsely reported to be associated with obstructive hydrocephalus. OBSERVATIONS Here, the authors report a case of obstructive hydrocephalus secondary to central nervous system mucormycosis without other systems or rhino-orbital involvement and its technical surgical management. A 23-year-old, incarcerated, immunocompetent patient with history of intravenous (IV) drug use presented with syncope. Although clinical and radiographic findings failed to elucidate an infectious pathology, endoscopy revealed an obstructive mass lesion at the level of the third ventricle, which, on microbiological testing, was confirmed to be Rhizopus fungal ventriculitis. Perioperative cerebrospinal fluid diversion, endoscopic third ventriculostomy, endoscopic biopsy technique, patient outcomes, and the literature are reviewed here. The patient received intrathecal and IV amphotericin B followed by a course of oral antifungal treatment and currently remains in remission. LESSONS The patient’s unique presentation and diagnosis of isolated cerebral mucormycosis reveal this pathogen as a cause of ventriculitis and obstructive hydrocephalus in immunocompetent adult patients, even in the absence of infectious sequelae on neuroimaging.

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Systemic Zygomycosis

Ellis

2010

Topley &Amp; Wilson's Microbiology and Microbial Infections

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Primary phycomycosis of the brain in heroin addicts

Cited by 23 publications

References 11 publications

Mucormycosis: an emerging disease?

Mucormycosis: an emerging disease?

Immunocompetent isolated cerebral mucormycosis presenting with obstructive hydrocephalus: illustrative case

Systemic Zygomycosis

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