Rhinocerebral invasive mycosis: occurence in immunocompetent individuals

Hussain, Syed Danish; Salahuddin, Naseem I.; Ahmad, Iftikhar; Salahuddin, I. Salahuddin I.; Jooma, Rasheed

doi:10.1016/0720-048x(95)00644-6

Cited by 73 publications

(42 citation statements)

References 14 publications

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“…Case series of craniocerebral aspergillosis due to A. flavus in immunocompetent hosts have been reported mainly from Pakistan, India, Saudi Arabia, Sudan and other African countries (Rudwan & Sheikh, 1976;Hussain et al, 1995;Panda et al, 1998). Most of these cases occurred as a complication of chronic granulomatous sinusitis, described below.…”

Section: Central Nervous System Infectionmentioning

confidence: 99%

“…flavus is more likely to be recovered from the upper respiratory tract than any other Aspergillus species (Chakrabarti et al, 1992;Hussain et al, 1995;Iwen et al, 1997;Kennedy et al, 1997;Panda et al, 1998). Clinical presentations of Aspergillus rhinosinusitis include acute and chronic invasive, chronic granulomatous and noninvasive syndromes (Hope et al, 2005).…”

Section: Rhinosinusitismentioning

confidence: 99%

“…Most of these cases occurred as a complication of chronic granulomatous sinusitis, described below. These reports have speculated that tropical environmental conditions (hot and dry weather), bad hygiene and poor socioeconomic status are responsible Aspergillus flavus (Rudwan & Sheikh, 1976;Hussain et al, 1995;Panda et al, 1998;Alrajhi et al, 2001).…”

Section: Central Nervous System Infectionmentioning

confidence: 99%

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Aspergillus flavus: human pathogen, allergen and mycotoxin producer

et al. 2007

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Aspergillus infections have grown in importance in the last years. However, most of the studies have focused on Aspergillus fumigatus, the most prevalent species in the genus. In certain locales and hospitals, Aspergillus flavus is more common in air than A. fumigatus, for unclear reasons. After A. fumigatus, A. flavus is the second leading cause of invasive aspergillosis and it is the most common cause of superficial infection. Experimental invasive infections in mice show A. flavus to be 100-fold more virulent than A. fumigatus in terms of inoculum required. Particularly common clinical syndromes associated with A. flavus include chronic granulomatous sinusitis, keratitis, cutaneous aspergillosis, wound infections and osteomyelitis following trauma and inoculation. Outbreaks associated with A. flavus appear to be associated with single or closely related strains, in contrast to those associated with A. fumigatus. In addition, A. flavus produces aflatoxins, the most toxic and potent hepatocarcinogenic natural compounds ever characterized. Accurate species identification within Aspergillus flavus complex remains difficult due to overlapping morphological and biochemical characteristics, and much taxonomic and population genetics work is necessary to better understand the species and related species. The flavus complex currently includes 23 species or varieties, including two sexual species, Petromyces alliaceus and P. albertensis. The genome of the highly related Aspergillus oryzae is completed and available; that of A. flavus in the final stages of annotation. Our understanding of A. flavus lags far behind that of A. fumigatus. Studies of the genomics, taxonomy, population genetics, pathogenicity, allergenicity and antifungal susceptibility of A. flavus are all required.

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Section: Central Nervous System Infectionmentioning

confidence: 99%

Section: Rhinosinusitismentioning

confidence: 99%

Section: Central Nervous System Infectionmentioning

confidence: 99%

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Aspergillus flavus: human pathogen, allergen and mycotoxin producer

et al. 2007

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“…Progressive vision loss and ultimately blindness may result either from involvement of the optic nerve or from arteriolar invasion resulting in infarction (58,109,143,153) or from cavernous sinus thrombosis. Cranial nerves five and seven may also be affected, resulting in ipsilateral loss of facial sensation and ptosis and pupillary dilation (32,118,153).…”

Section: Epidemiology and Disease Manifestationsmentioning

confidence: 99%

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

2005

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Mucormycosis is a life-threatening fungal infection that occurs in immunocompromised patients. These infections are becoming increasingly common, yet survival remains very poor. A greater understanding of the pathogenesis of the disease may lead to future therapies. For example, it is now clear that iron metabolism plays a central role in regulating mucormycosis infections and that deferoxamine predisposes patients to mucormycosis by inappropriately supplying the fungus with iron. These findings raise the possibility that iron chelator therapy may be useful to treat the infection as long as the chelator does not inappropriately supply the fungus with iron. Recent data support the concept that high-dose liposomal amphotericin is the preferred monotherapy for mucormycosis. However, several novel therapeutic strategies are available. These options include combination therapy using lipid-based amphotericin with an echinocandin or with an azole (largely itraconazole or posaconazole) or with all three. The underlying principles of therapy for this disease remain rapid diagnosis, reversal of underlying predisposition, and urgent surgical debridement

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“…The standard therapy for invasive zygomycosis consists of reversal of the underlying predisposing factors, widespread surgical debridement, and aggressive antifungal medication (2,6,13). Unfortunately, despite disfiguring surgical debridement and aggressive therapy with amphotericin B, the overall mortality of zygomycosis remains Ͼ50% (13), and it approaches 100% in patients with disseminated disease (5). Clearly, new strategies to treat zygomycosis are urgently needed.…”

mentioning

confidence: 99%

Rhizopus oryzae Adheres to, Is Phagocytosed by, and Damages Endothelial Cells In Vitro

et al. 2005

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Rhizopus oryzae is the most common cause of zygomycosis, a life-threatening infection that usually occurs in immunocompromised patients. A characteristic hallmark of zygomycosis is angioinvasion by the fungus, resulting in thrombosis and subsequent tissue necrosis. Interactions between R. oryzae and vascular endothelial cells are therefore likely of central importance to the organism's pathogenetic strategy. We studied the ability of R. oryzae to adhere to and damage human umbilical vein endothelial cells (HUVECs) in vitro. We report that R. oryzae spores and germ tubes adhere to HUVECs, whereas only spores adhere to subendothelial matrix proteins. Additionally, R. oryzae damages endothelial cells. This endothelial cell damage requires direct contact and subsequent phagocytosis of the fungus. Surprisingly, R. oryzae viability was not required for damage, but phagocytosis was required for dead R. oryzae to cause damage. These results elucidate the nature of R. oryzae-endothelial cell interactions, which are likely central to the angioinvasion and tissue necrosis seen during zygomycotic infections. The fact that dead R. oryzae damage human endothelial cells may, in part, explain the lack of efficacy of fungicidal agents during clinical disease.Rhizopus oryzae is the organism most frequently isolated from patients with zygomycosis (6, 12), a highly destructive and lethal infection in immunocompromised hosts (2, 6, 9, 13). The standard therapy for invasive zygomycosis consists of reversal of the underlying predisposing factors, widespread surgical debridement, and aggressive antifungal medication (2, 6, 13). Unfortunately, despite disfiguring surgical debridement and aggressive therapy with amphotericin B, the overall mortality of zygomycosis remains Ͼ50% (13), and it approaches 100% in patients with disseminated disease (5). Clearly, new strategies to treat zygomycosis are urgently needed.A hallmark of mucormycosis infections is the virtually uniform presence of extensive angioinvasion with resultant vessel thrombosis and tissue necrosis (2,6,9,13). This angioinvasive character is associated with the ability of the organism to spread through viable tissue and to hematogenously disseminate to other target organs. Furthermore, since antifungal agents are carried to the site of infection in the vasculature, adequate blood supply is necessary to deliver these agents to R. oryzae in vivo. Therefore, ischemic necrosis as a result of R. oryzae-mediated angioinvasion is likely an important mechanism by which the fungus survives therapy with fungicidal agents, such as amphotericin B. For these reasons, damage of and penetration through endothelial cells lining blood vessels is likely a critical step in R. oryzae's pathogenetic strategy.We therefore studied the interaction between R. oryzae and endothelial cells. We find that damage to endothelial cells from R. oryzae is dependent upon its adherence to and phagocytosis by endothelial cells. Surprisingly, R. oryzae does not need to be viable to cause endothelial cell damage. ...

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Rhinocerebral invasive mycosis: occurence in immunocompetent individuals

Cited by 73 publications

References 14 publications

Aspergillus flavus: human pathogen, allergen and mycotoxin producer

Aspergillus flavus: human pathogen, allergen and mycotoxin producer

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

Rhizopus oryzae Adheres to, Is Phagocytosed by, and Damages Endothelial Cells In Vitro

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