Successful Treatment of Prosthetic Aortic Valve Mucormycosis

Sánchez‐Recalde, Ángel; Merino, José Luís; Domı́nguez, Francisco; Maté, I; Larrea, Jose Luis; Sobrino, José A.

doi:10.1378/chest.116.6.1818

Cited by 30 publications

(17 citation statements)

References 6 publications

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“…Mucormycosis is a rare cause of prosthetic valve endocarditis [63,130,131]. Native valve endocarditis with C. bertholletiae and S. vasiformis has been reported [12,132].…”

Section: Miscellaneousmentioning

confidence: 99%

Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment

Prabhu

Patel

2004

Clinical Microbiology and Infection

489

422

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The class Zygomycetes is divided into two orders, Mucorales and Entomophthorales. These two orders produce dramatically different infections. Genera from the order Mucorales (Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Cunninghamella and Saksenaea) cause an angioinvasive infection called mucormycosis. Mucormycosis presents with rhino-orbito-cerebral, pulmonary, disseminated, cutaneous, or gastrointestinal involvement. Immunocompromising states such as haematological malignancy, bone marrow or peripheral blood stem cell transplantation, neutropenia, solid organ transplantation, diabetes mellitus with or without ketoacidosis, corticosteroids, and deferoxamine therapy for iron overload predispose patients to infection. Mucormycosis in immunocompetent hosts is rare, and is often related to trauma. Mortality rates can approach 100% depending on the patient's underlying disease and form of mucormycosis. Early diagnosis, along with treatment of the underlying medical condition, surgery, and an amphotericin B product are needed for a successful outcome. Genera from the order Entomophthorales produce a chronic subcutaneous infection called entomophthoramycosis in immunocompetent patients. This infection occurs in tropical and subtropical climates. The genus Basidiobolus typically produces a chronic subcutaneous infection of the thigh, buttock, and/or trunk. Rarely, it has been reported to involve the gastrointestinal tract. The genus Conidiobolus causes a chronic infection of the nasal submucosa and subcutaneous tissue of the nose and face. This paper will review the clinical manifestations, diagnosis and treatment of mucormycosis and entomophthoramycosis.

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“…Mucormycosis is a rare cause of prosthetic valve endocarditis [63,130,131]. Native valve endocarditis with C. bertholletiae and S. vasiformis has been reported [12,132].…”

Section: Miscellaneousmentioning

confidence: 99%

Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment

Prabhu

Patel

2004

Clinical Microbiology and Infection

489

422

View full text Add to dashboard Cite

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“…Mucormycosis may be the cause of endocarditis in natural [162,[278][279][280] or prosthetic valves [281] and has been reported to cause invasion and obstruction of the great vessels [162]. The clinical manifestations are extremely rare and the rate of mortality is very high [58,[281][282][283].…”

Section: O T H E R C L I N I C a L M A N I F E S T A T I O N Smentioning

confidence: 99%

Mucormycosis: an emerging disease?

Bouza

Muñóz

Guinea

2006

Clinical Microbiology and Infection

133

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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“…The overall mortality in this patient group was 89% (41 of 46 cases). In the five patients who survived zygomycosis with cardiac involvement, zygomycosis was restricted to the heart, all went through invasive diagnostic procedures and intensive treatment including the combination of surgery and antifungal therapy [25, 29, 34, 36, 40]. The pathogenesis is not clear in our patient.…”

Section: Discussionmentioning

confidence: 91%

Acute Cardiac Failure due to Intra-Atrial Mass Caused by Zygomycetes in an Immunocompromised Paediatric Patient

Glind

Gidding

Verlaat

et al. 2010

Case Reports in Medicine

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Cardiac zygomycosis can be a critical condition with sudden onset of severe congestive heart failure followed by severe hemodynamic deterioration. We report a fatal course of disseminated fungal infection with a massive intra-atrial thrombosis caused by a zygomycete, in a five year old boy treated for acute lymphoblastic leukaemia. In addition, we discuss the literature concerning infections caused by zygomycetes involving the heart. Prognosis is poor. A high index of suspicion and an aggressive diagnostic and therapeutic approach with the prompt start of preemptive antifungal therapy are key factors to improve outcome.

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Successful Treatment of Prosthetic Aortic Valve Mucormycosis

Cited by 30 publications

References 6 publications

Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment

Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment

Mucormycosis: an emerging disease?

Acute Cardiac Failure due to Intra-Atrial Mass Caused by Zygomycetes in an Immunocompromised Paediatric Patient

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