A Mucormycosis Case in a Cirrhotic Patient Successfully Treated with Posaconazole and Review of Published Literature

Mucormycosis is an invasive fungal infection associated with a high mortality rate, especially in immunocompromised hosts. Mucormycosis rarely occurs in cirrhotic patients. Here, we report a case of mucormycosis with underlying liver cirrhosis and diabetes mellitus. The patient suffered from maxillary sinusitis and osteomyelitis, and the infection was successfully treated with antifungal agents, surgical debridement, and hyperbaric oxygen therapy. The antifungal treatments used were liposomal amphotericin B, itraconazole, and posaconazole. Although our patient had liver cirrhosis (Child-Pugh classification B), no hepatic decompensation was developed during the treatment course of posaconazole. This is the first report of the safe and effective use of posaconazole for the treatment of mucormycosis in a cirrhotic patient.     

Implementation of a Pan-Genomic Approach to Investigate Holobiont-Infecting Microbe Interaction: A Case Report of a Leukemic Patient with Invasive Mucormycosis

Disease can be conceptualized as the result of interactions between infecting microbe and holobiont, the combination of a host and its microbial communities. It is likely that genomic variation in the host, infecting microbe, and commensal microbiota are key determinants of infectious disease clinical outcomes. However, until recently, simultaneous, multiomic investigation of infecting microbe and holobiont components has rarely been explored. Herein, we characterized the infecting microbe, host, micro- and mycobiomes leading up to infection onset in a leukemia patient that developed invasive mucormycosis. We discovered that the patient was infected with a strain of the recently described Mucor velutinosus species which we determined was hypervirulent in a Drosophila challenge model and has a predisposition for skin dissemination. After completing the infecting M. velutinosus genome and genomes from four other Mucor species, comparative pathogenomics was performed and assisted in identifying 66 M. velutinosus-specific putatively secreted proteins, including multiple novel secreted aspartyl proteinases which may contribute to the unique clinical presentation of skin dissemination. Whole exome sequencing of the patient revealed multiple non-synonymous polymorphisms in genes critical to control of fungal proliferation, such as TLR6 and PTX3. Moreover, the patient had a non-synonymous polymorphism in the NOD2 gene and a missense mutation in FUT2, which have been linked to microbial dysbiosis and microbiome diversity maintenance during physiologic stress, respectively. In concert with host genetic polymorphism data, the micro- and mycobiome analyses revealed that the infection developed amid a dysbiotic microbiome with low α-diversity, dominated by staphylococci. Additionally, longitudinal mycobiome data showed that M. velutinosus DNA was detectable in oral samples preceding disease onset. Our genome-level study of the host-infecting microbe-commensal triad extends the concept of personalized genomic medicine to the holobiont-infecting microbe interface thereby offering novel opportunities for using synergistic genetic methods to increase understanding of infectious diseases pathogenesis and clinical outcomes.     

Cutaneous Mucormycosis by Saksenaea vasiformis: An Unusual Case Report and Review of Literature

Mycopathologia - Saksenaea vasiformis is one of the numerous fungi of the Order Mucorales. Rapid progression and invasion of neighboring tissues are the most characteristic features of S....     

Mucormycosis in Mainland China: A Systematic Review of Case Reports

Mycopathologia - Mucormycosis is a lethal fungal infection with increasing incidence. The epidemiology of mucormycosis in current mainland China has not been fully elucidated. To investigate the...     

Significant Hypercortisolism During Fractionated Radiotherapy in a Patient with a Large Corticotroph Adenoma: A Case Report and Literature Review

ObjectiveWe describe a patient with a large, invasive corticotroph adenoma who developed severe hypercortisolism shortly after starting fractionated radiotherapy.MethodsWe reviewed the patient’s clinical course, along with relevant literature for similar reported cases.ResultsA 29-year-old man was referred for radiotherapy for a residual and recurrent, invasive corticotroph adenoma. Prior to radiotherapy, he had a normal urine free cortisol (UFC) level of 44.7 μg/24 hours, with minimal symptoms. Within 2 weeks of radiotherapy, he developed hypertension, ankle edema, and hypokalemia (potassium level, 2.8 mEq/L), with a markedly elevated UFC level of 9,203 μg/24 hours. His UFC gradually decreased and normalized by the end of radiotherapy. One month later, the patient became adrenal insufficient, with a nondetectable 24-hour UFC. His adrenal function slowly recovered in 3 months. We are aware of only one previous case report of clinically significant hypercortisolism following radiotherapy in Cushing disease.ConclusionRadiotherapy may result in acute severe hypercortisolism in patients with a large corticotroph adenoma. This uncommon, but clinically significant, acute adverse effect of radiotherapy suggests that clinical observation and biochemical monitoring during or soon after radiotherapy may be indicated. (Endocr Pract. 2014;20:e166-e170)     

Vacuum-Assisted Closure and Skin Grafting Combined with Amphotericin B for Successful Treatment of an Immunocompromised Patient with Cutaneous Mucormycosis Caused by Mucor irregularis: A Case Report and Literature Review

Mycopathologia - Cutaneous mucormycosis caused by Mucor irregularis (M. irregularis) is a rare condition that typically occurs in immunocompetent patients. Herein, we describe an immunocompromised...     

Bloodstream Infection of a Cancer Patient by Cystobasidium minutum: A Case Report and Literature Review

Mycopathologia - Emergent fungal infections are uncommon conditions which frequently lead to death. To our knowledge, only a few cases of invasive infection by...     

慢性戊肝重叠急性乙肝患者一例报道并文献复习

目的:探讨慢性戊型病毒性肝炎合并急性乙型病毒性肝炎的发病机制、诊断、治疗及其预后。方法:回顾我院收治的一例慢性戊型病毒性肝炎合并急性乙型病毒性肝炎患者的临床资料,并结合文献探讨戊型病毒性肝炎及乙型病毒性肝炎的发病机制,总结其诊断及治疗经验,并评价其预后。结果:该患者戊肝抗体长期阳性,被诊断为慢性戊型病毒性肝炎,但合并急性乙型病毒性肝炎后,经治疗乙肝表面抗原转阴后戊肝抗体Ig M也阴转。结论:慢性戊型病毒性肝炎合并急性乙型病毒性肝炎患者经治疗后可同时出现乙肝表面抗原转阴,戊肝抗体阴转,预后可较好。     

Isavuconazole in a Successful Combination Treatment of Disseminated Mucormycosis in a Child with Acute Lymphoblastic Leukaemia and Generalized Haemochromatosis: A Case Report and Review of the Literature

Invasive mucormycosis in immunocompromised children is a life-threatening fungal infection. We report a case of a 7-year-old girl treated for acute lymphoblastic leukaemia complicated by disseminated mucormycosis during induction therapy. Microscopic examination of surgically removed lung tissue revealed wide, pauci-septate hyphae suggesting a Mucorales infection. This diagnosis was confirmed immunohistochemically and by PCR analysis followed by a final identification of Cunninghamella sp. The patient was treated successfully with surgical debridement and antifungal combination therapy with amphotericin B, caspofungin and isavuconazole. The use of isavuconazole in a child was not previously reported. Additionally, case reports concerning pulmonary mucormycoses in paediatric population published after 2010 were reviewed. Nineteen out of 26 identified patients suffered from haematological diseases. Reported mortality reached 38.5%. By the fact of rising morbidity, unsatisfactory results of treatment and remaining high mortality of mucormycoses in immunocompromised patients, new therapeutic options are warrant. Isavuconazole, with its broad-spectrum activity, good safety profile and favourable pharmacokinetics, is a promising drug. However, further studies are necessary to confirm positive impact of isavuconazole on mucormycosis treatment in children.

     

Pulmonary Artery Pseudoaneurysm in COVID-19-Associated Pulmonary Mucormycosis: Case Series and Systematic Review of the Literature

Mycopathologia - Literature on COVID-19-associated pulmonary mucormycosis (CAPM) is sparse. Pulmonary artery pseudoaneurysm (PAP) is an uncommon complication of pulmonary mucormycosis (PM), and...     

Fusarium falciforme Infection of Foot in a Patient with Type 2 Diabetes Mellitus: A Case Report and Review of the Literature

Fungal infections of foot in patients with diabetes are not uncommon; however, foot infection due to Fusarium species has been rarely reported. We report here a case of a 50-year-old male with type 2 diabetes who developed multiple spontaneous nodular lesions on right foot without any systemic symptoms and signs for 6 months. The lesions were unresponsive to broad-spectrum antibacterial treatment. Fine needle aspiration cytology of nodular lesions revealed the presence of fungal hyphae, and Fusarium species was isolated from the same sample which was identified as Fusarium solani species complex: Fusarium falciforme. Radiological investigations and blood culture ruled out any dissemination of the disease. The lesions healed after voriconazole therapy for 3 months. No relapse was noted at the end of the next 6-month follow-up. All reported cases of Fusarium infection of foot in patients with diabetes in English and non-English literature since 1970 have been reviewed.     

Tinea Infection with Scutula-like Lesions Caused by Microsporum Gypseum in a SLE Patient: Case Report and Literature Review

Scutula are characteristic lesions of tinea favosa or favus; the most frequently identified causative organism is Trichophyton schoenleinii. Although scutula-like lesions were described in Microsporum gypseum infection, their presence on glabrous skin in a patient with SLE has not been reported previously. We report a case of tinea infection with scutula-like lesions caused by Microsporum gypseum in a SLE patient, who was treated with topical terbinafine cream, and the lesions resolved completely. In addition, we reviewed the reported cases about this rare clinical manifestation caused by Microsporum gypseum in the medical literature.     

First Case of Rhinocerebral Mucormycosis Caused by Lichtheimia ornata,with a Review of Lichtheimia Infections

Mycopathologia - Lichtheimia species are emerging opportunistic fungal pathogens in the Mucorales, causing serious skin and respiratory infections in immunocompromised patients. Established agents...