RESUMEN
Mucormycosis is a rare fungal infection caused by fungi of the Mucorales order that occurs in immunocompromised individuals or with loss of skin or mucosa barrier integrity. This report presents four cases of rhinocerebral mucormycosis attended at a third-level hospital in Cali (Colombia) during a period of three years. All patients had different case histories and times of evolution. All four had a previous or de novo diagnosis of type 2 diabetes mellitus, with glycated hemoglobin higher than 10% on admission. We ruled out other possible pathologies that could explain their immunocompromised condition. Mucormycosis diagnosis was made with direct visualization of hyaline coenocytic hyphae on biopsies. The basis of treatment was liposomal amphotericin B and surgical debridement. Two patients presented bacterial coinfection. One asked for voluntary discharge without having completed the treatment, and another one died. The remaining two have attended controls and had an adequate evolution.
La mucormicosis es una infección fúngica poco frecuente causada por hongos del orden Mucorales, la cual se presenta en individuos inmunocomprometidos o con pérdida de la integridad de la barrera de piel o mucosas. Se reportan cuatro casos de mucormicosis rinocerebral atendidos en un hospital de tercer nivel de Cali (Colombia) durante un periodo de tres años. Los cuatro pacientes presentaron diferentes cuadros clínicos y tiempos de evolución. Todos tenían diagnóstico de diabetes mellitus de tipo 2, de novo o previo, con una hemoglobina glucosilada de ingreso mayor del 10 % y en todos se descartaron otras enfermedades que explicaran su compromiso inmunitario. La mucormicosis se diagnosticó por la visualización directa de hifas hialinas sincitiales (coenocytic) en las biopsias tomadas. El pilar del tratamiento fue la anfotericina B liposómica junto con el desbridamiento quirúrgico. Dos pacientes presentaron coinfección bacteriana. De los cuatro, uno firmó su egreso voluntario sin completar el tratamiento y otro falleció. Los dos pacientes restantes han asistido a los controles y han mostrado una adecuada evolución.
Asunto(s)
Anfotericina B , Mucormicosis , Humanos , Mucormicosis/diagnóstico , Masculino , Persona de Mediana Edad , Anfotericina B/uso terapéutico , Femenino , Antifúngicos/uso terapéutico , Diabetes Mellitus Tipo 2/complicaciones , Anciano , Desbridamiento , Huésped InmunocomprometidoRESUMEN
Mucormycosis is a rare life-threatening opportunistic infection, with rhinocerebral mucormycosis (ROCM) being the most common presentation. Trichosporon asahii is an emerging pathogen that often causes fatal infections in patients with underlying hematologic malignancies due to its high drug resistance. We report a rare case of concomitant rhinocerebral mucormycosis and T. asahii fungemia secondary to Pseudomonas aeruginosa sepsis in a patient with neutropenia and acute lymphoblastic leukemia. A boy aged one year and two months was diagnosed with B-cell acute lymphoblastic leukemia on January 10 and underwent three courses of regular chemotherapy. He experienced neutropenia for 154 days and was hospitalized for vomiting, diarrhea and fever for 3 days. The day after hospitalization, Pseudomonas aeruginosa was isolated by blood culture and ceftazidime/avibactam was administered. Extracorporeal Membrane Oxygenation (ECMO) was used to provide continuous extracorporeal respiration and circulation for the patient. On day 8, the patient developed T. asahii fungemia. On day 10, he presented with necrotizing skin caused by Rhizopus delemar. He was treated with liposomal amphotericin B for Rhizopus delemar and voriconazole for T. asahii infection. Unfortunately, his health deteriorated and he died on day 11 due to the rapid progression of the infection and multiple organ failure. The management and treatment of such a complex infection requires a multidisciplinary approach and close monitoring of the patient's condition. Therefore, it is imperative to continue to research and report rare cases such as this to further understand the complexities of mucormycosis and trichosporidiosis coinfection and improve patient outcomes.
Asunto(s)
Coinfección , Fungemia , Mucormicosis , Leucemia-Linfoma Linfoblástico de Células Precursoras , Tricosporonosis , Humanos , Masculino , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Fungemia/microbiología , Fungemia/tratamiento farmacológico , Resultado Fatal , Coinfección/microbiología , Tricosporonosis/microbiología , Tricosporonosis/diagnóstico , Tricosporonosis/tratamiento farmacológico , Lactante , Infecciones Oportunistas/microbiología , Infecciones Oportunistas/complicaciones , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/microbiología , Infecciones por Pseudomonas/complicaciones , Antifúngicos/uso terapéutico , BasidiomycotaAsunto(s)
Enfermedades Pulmonares Fúngicas , Mucormicosis , Humanos , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Enfermedades Pulmonares Fúngicas/complicaciones , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Enfermedades Pulmonares Fúngicas/microbiología , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
Rhino-cerebral mucormycosis (RM) is a rare and opportunistic fungal infection observed in immune-compromised patients and metabolic imbalances such as Diabetes Mellitus. RM rapidly infiltrates blood vessels, leading to vascular thrombosis, subsequent tissue necrosis, and high mortality rates (23.6-60%). Due to its fast advancement, RM is a life-threatening condition requiring accurate clinical decisions by the medical and surgical teams. Based on the report of six cases, we emphasize the need for an early diagnosis and starting antifungal pharmacological therapy at the slightest suspicion of RM. Moreover, the restitution of metabolic balance and aggressive surgical debridement are vital steps to control RM, reducing the possibility of fatal outcomes.
Asunto(s)
Desbridamiento , Diagnóstico Precoz , Mucormicosis , Humanos , Mucormicosis/diagnóstico , Mucormicosis/terapia , Mucormicosis/microbiología , Mucormicosis/cirugía , Masculino , Persona de Mediana Edad , Femenino , Desbridamiento/métodos , Antifúngicos/uso terapéutico , Adulto , Anciano , Encefalopatías/diagnóstico , Encefalopatías/microbiología , Encefalopatías/terapia , Encefalopatías/cirugía , Enfermedades Nasales/diagnóstico , Enfermedades Nasales/microbiología , Enfermedades Nasales/terapia , Enfermedades Nasales/cirugíaRESUMEN
Mucormycosis, a group of opportunistic mycoses caused by Mucorales, present a significant threat to immunocompromised patients. In this report, we present the case of a 57-year-old male patient who underwent liver transplant for secondary biliary cirrhosis following inadvertent bile duct injury. Despite initial satisfactory postoperative evolution, the patient developed fever, and imaging revealed a suspicious lesion. Preliminary culture growth suggested a filamentous fungus, leading to initiation of liposomal amphotericin B. However, the lesion progressed, and a surgical debridement was necessary. During surgery, involvement of the liver dome and diaphragm was observed, and a nonanatomical hepatectomy was performed. Despite efforts, the patient's condition deteriorated, ultimately resulting in multiple organ failure and mortality. This case emphasizes the challenging nature of mucormycosis in livertransplant recipients.
Asunto(s)
Antifúngicos , Huésped Inmunocomprometido , Cirrosis Hepática Biliar , Trasplante de Hígado , Mucormicosis , Humanos , Masculino , Mucormicosis/diagnóstico , Mucormicosis/microbiología , Mucormicosis/inmunología , Mucormicosis/tratamiento farmacológico , Mucormicosis/etiología , Persona de Mediana Edad , Trasplante de Hígado/efectos adversos , Antifúngicos/uso terapéutico , Resultado Fatal , Cirrosis Hepática Biliar/cirugía , Cirrosis Hepática Biliar/microbiología , Cirrosis Hepática Biliar/diagnóstico , Resultado del Tratamiento , Infecciones Oportunistas/microbiología , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Desbridamiento , Aloinjertos , Hepatectomía , Anfotericina B/uso terapéutico , Anfotericina B/administración & dosificación , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/microbiologíaRESUMEN
Mucormycosis is an invasive opportunistic fungal infection with high mortality, mainly detected in people with COVID-19, especially those with underlying diseases such as diabetes mellitus. Mucormycosis prevalence is 0.005 to 1.7 cases per million inhabitants, and it has been increasing in countries like India and Pakistan. This mycosis can affect different organs, and clinical manifestations reflect the transmission mechanism. Frequent forms are rhino-orbital-cerebral and pulmonary. This disease should be suspected in patients with necrotic injuries on mucous membranes or skin. We present a case of a patient with diabetes mellitus and diagnosed with oral mucormycosis associated with COVID-19.
La mucormicosis es una infección fúngica oportunista e invasiva, con una elevada tasa de mortalidad. Se ha detectado principalmente en pacientes con COVID-19, especialmente en personas con enfermedades concomitantes como la diabetes mellitus. La prevalencia de las mucormicosis es de 0,005 a 1,7 casos por millón de habitantes y ha ido en aumento en países como India y Pakistán; puede afectar diferentes órganos y su forma clínica refleja el mecanismo de transmisión. Entre las formas frecuentes están la rino-orbital-cerebral y la pulmonar, por ello, debe sospecharse mucormicosis en los pacientes con lesiones necróticas en mucosas o piel. Se presenta el caso de un paciente con antecedentes de diabetes mellitus que fue diagnosticado con mucormicosis oral asociada a la COVID-19.
Asunto(s)
COVID-19 , Mucormicosis , Humanos , Antifúngicos/uso terapéutico , COVID-19/complicaciones , COVID-19/epidemiología , Complicaciones de la Diabetes , Diabetes Mellitus Tipo 2/complicaciones , Enfermedades de la Boca/microbiología , Mucormicosis/complicaciones , Mucormicosis/epidemiología , Mucormicosis/diagnósticoRESUMEN
Mucormycosis is the third most frequent invasive mycosis, following candidiasis and aspergillosis. It is frequently neglected due to its rare occurrence; but recently attend the status of notifiable disease due to its higher incidence in both developed and developing nations. India has received global notice since its estimated instances were greater than the global estimated figures. Mucormycosis has several clinical manifestations, including rhino-orbital-cerebral (ROCM), pulmonary, gastrointestinal, cutaneous, renal, and diffuse Mucormycosis. ROCM is the most frequent clinical manifestation in India, although pulmonary mucormycosis is prevalent worldwide. This review also discusses host defenses, pre disposing risk factors and fungal virulence factors that impair host's ability to prevent fungus invasion and disease establishment. The diagnosis of the disease depends on clinical interventions, histological or microbiological procedures along with molecular methods to obtain timely results. But there are still unmet challenges for rapid diagnosis of the disease. Treatment of the disease is achieved by multimodal approaches such as reversal of underlying predisposing factors, rapid administration of antifungals in optimal doses and surgical procedures to remove infected tissues. Liposomal Amphotericin B, Posaconazole and Isavuconazoles are preferred as the first line of treatment procedures. clinical trials. Different studies have improved the existing drug and under clinical trials while several studies predicted the new potential targets as CotH and Ftr1 as shown in infection and in vitro models. Therefore, current scenario demands a multidisciplinary approach is needed to investigate the prevalence, pathogenesis which is highly important for the advancement of rapid diagnosis and effective treatment.
Asunto(s)
Antifúngicos , Mucormicosis , Enfermedades Raras , Humanos , Mucormicosis/epidemiología , Mucormicosis/microbiología , Mucormicosis/tratamiento farmacológico , Mucormicosis/diagnóstico , Antifúngicos/uso terapéutico , Enfermedades Raras/microbiología , India/epidemiología , Factores de RiesgoRESUMEN
The occurrence of mucormycosis has been observed in individuals with COVID-19. However, there is limited information on the epidemiological factors, presentation, diagnostic certainty, and outcome of this infection in children. PubMed, MEDLINE, Scopus, Embase, Web of Science, LitCovid, and back-references of the identified manuscripts were systematically searched from December 2019 to March 2023. We have identified 14 cases of pediatric mucormycosis in patients with COVID-19. The median age of patients was 10.7 years. Among these cases, 10 were associated with active COVID-19. In 7 cases, the patients had pre-existing diabetes mellitus and concomitant diabetic ketoacidosis. Corticosteroids were administered to treat COVID-19 in 7 of the patients. The most common clinical presentation of the disease was rhino-orbital cerebral mucormycosis. Seven patients died (50%). Given the high mortality rate, clinicians should maintain a high level of clinical suspicion of mucormycosis in pediatric patients with COVID-19.
Asunto(s)
COVID-19 , Mucormicosis , Humanos , Mucormicosis/complicaciones , Mucormicosis/epidemiología , Mucormicosis/diagnóstico , COVID-19/complicaciones , Niño , Adolescente , Preescolar , Femenino , Masculino , Cetoacidosis Diabética/complicacionesRESUMEN
BACKGROUND: Fungal infections, during or as a consequence of SARS-CoV-2 infection, associated with uncontrolled diabetes mellitus and indiscriminate use of corticosteroids have been reported. In the jaw, mostly mucormycosis has been diagnosed in hospitals. METHODS: A retrospective, cross-sectional, descriptive study of the clinical, imaging, and histopathologic characteristics of maxillary invasive fungal infection in post-COVID-19 patients diagnosed in a private non-hospital oral pathology service in Mexico during 2020-2022 was conducted. RESULTS: We found 20 cases of maxillary invasive fungal infections in post-COVID-19 patients, 75% including a diagnosis of mucormycosis and 25% diagnosed as probable aspergillosis. The most common signs and symptoms were exposed necrotic bone followed by tooth mobility, discharge, and pain. On imaging, unilateral maxillary sinus involvement was observed in 6 cases (30%), and bilateral maxillary sinus involvement was observed in 3 cases (15%). CONCLUSIONS: It is essential to consider the association of osteonecrosis of the jaw in post-COVID-19 patients, with aspergillosis, not only mucormycosis, for early diagnosis and appropriate treatment.
Asunto(s)
Aspergilosis , COVID-19 , Mucormicosis , Osteonecrosis , Humanos , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Mucormicosis/epidemiología , México/epidemiología , Estudios Transversales , Estudios Retrospectivos , COVID-19/complicaciones , COVID-19/epidemiología , SARS-CoV-2 , Aspergilosis/diagnóstico , Aspergilosis/epidemiología , Aspergilosis/etiologíaRESUMEN
Hypercalcemia is a vital laboratory marker because it can show underlying severe diseases like cancer and infections. Of all the causes of hypercalcemia, primary hyperparathyroidism, and malignancies are the most common, but granulomatous diseases, such as certain fungal infections, can also be the cause. Here we describe the case of a 29-year-old woman, an insulin-dependent diabetic, found unconscious and tachypneic at home. In the emergency room, the medical team diagnosed diabetic ketoacidosis (DKA) and acute kidney injury (AKI). During hospitalization, despite resolving acidemia, persistent hypercalcemia attracted attention. Laboratory tests showed decreased parathyroid hormone (PTH) levels, confirming non-PTH-dependent hypercalcemia. Computed tomography (CT) of the chest and abdomen demonstrated no alterations, but an upper digestive endoscopy revealed an ulcerated and infiltrative lesion in the stomach. A biopsy showed a granulomatous infiltrate due to mucormycosis infection. The patient received liposomal amphotericin B for 30 days and isavuconazonium for two months. Serum calcium levels improved during treatment. Inquiry of the etiology of hypercalcemia should begin with the PTH assay; high levels are consistent with hyperparathyroidism; low levels, with calcium or vitamin D intoxication, malignancies, prolonged immobilization, and granulomatous diseases. In the latter cases, the overproduction of 1-alpha-hydroxylase by the granulomatous tissue increases the conversion of 25(OH)vitamin D into 1-25(OH)vitamin D, which causes the intestinal absorption of calcium. We have described the first hypercalcemia related to mucormycosis infection in a young diabetic patient, although case presentations associate other fungal infections with elevated serum calcium.
Asunto(s)
Diabetes Mellitus , Hipercalcemia , Mucormicosis , Neoplasias , Femenino , Humanos , Adulto , Hipercalcemia/complicaciones , Hipercalcemia/diagnóstico , Calcio , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Vitamina D , Hormona Paratiroidea , Neoplasias/complicacionesRESUMEN
La mucormicosis, es una patología de baja preva- lencia, rápidamente progresiva y de alta mortalidad que engloba un amplio espectro de infecciones del tipo opor- tunistas, causada por hongos de la familia Mucoraceae, Lichtheimiaceae, Thamnidiaceae, Cunninghamellaceae, Syncephalastraceae y Radiomycetaeae. Actualmente es la tercera causa de infección fúngica invasiva, posterior a la candidiasis y aspergilosos, siendo su presentación clínica más frecuente la rinocerebral de origen paranasal, cuyo síntoma característico es la rinosinusitis aguda bacteriana con proyección a los dientes antrales, de rápido avance y fatalidad. En esta revisión se emplearon resultados extraídos ma- nualmente de artículos indexados en las bases de datos MED- LINE y EBSCO a raíz de la búsqueda de los términos mu- cormycosis, oral surgery y patient care management con el objetivo de entregar una visión actualizada de la literatura, respecto al diagnóstico y tratamiento de la mucormicosis de cabeza y cuello (AU)
Mucormycosis is a low-prevalence, rapidly progres- sive and high-mortality pathology that encompasses a wide spectrum of opportunistic infections caused by fungi of the Mucoraceae, Lichtheimiaceae, Thamnidiaceae, Cunningha- mellaceae, Syncephalastraceae, and Radiomycetaeae. It is currently the third cause of invasive fungal infection, after candidiasis and aspergillosis, with its most frequent clinical presentation being rhinocerebral of paranasal origin, whose characteristic symptom is acute bacterial rhinosinusitis with projection to the antral teeth, with rapid progression and fatality. In this review, manually extracted results from articles indexed in the MEDLINE and EBSCO databases were used following the search for the terms mucormycosis, oral sur- gery and patient care management with the aim of providing an updated view of the literature regarding the diagnosis and treatment of mucormycosis of the head and neck
Asunto(s)
Humanos , Mucormicosis/cirugía , Mucormicosis/diagnóstico , Mucormicosis/terapia , Signos y Síntomas , Biopsia/métodos , Factores de Riesgo , Bases de Datos Bibliográficas , Desbridamiento/métodos , Neoplasias de Cabeza y Cuello , Antibacterianos/uso terapéutico , Mucormicosis/microbiología , Mucormicosis/epidemiología , Antifúngicos/uso terapéuticoRESUMEN
COVID-19 disease is associated with a significant number of opportunistic infections, including invasive fungal infections such as mucormycosis. The prevalence of the latter is rare, estimated to be between 0.005 and 1.7 per million inhabitants. Risk factors include hematological diseases, Diabetes Mellitus with poor metabolic control, solid organ transplantation, neutropenia, and prolonged administration of systemic corticosteroids. We report two males aged 60 and 75 years with pulmonary and tracheobronchial invasive mucormycosis, respectively. Both patients had a deficient metabolic control of their diabetes as a predisposing risk factor added to severe COVID-19 infection. High suspicion and early diagnosis are essential for prompt treatment, especially considering the associated high morbidity and mortality of this fungal infection.
Asunto(s)
COVID-19 , Diabetes Mellitus , Mucormicosis , Infecciones Oportunistas , Humanos , Masculino , COVID-19/complicaciones , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/complicaciones , Factores de Riesgo , Persona de Mediana Edad , AncianoRESUMEN
Rhinocerebral and pulmonary mucormycosis are the main manifestations of mucormycosis; however, disseminated pulmonary associated with renal mucormycosis is rarely reported. In this paper, we report a rare fatal case of disseminated pulmonary and renal mucormycosis caused by Rhizopus microsporus in a 50-year-old man with poorly controlled hypertension, type 2 diabetes, and prolonged use of corticosteroids for the treatment of his reiterative gouty arthritis. In this patient, the use of corticosteroids and poorly controlled diabetes were considered underlying risk factor for his disseminated mucormycosis, along with acute renal dysfunction, suggesting the need for clinical suspicion of disseminated pulmonary and renal mucormycosis in hospitalized patients with poorly controlled diabetes and immunocompromised host.
Asunto(s)
Diabetes Mellitus Tipo 2 , Mucormicosis , Masculino , Humanos , Persona de Mediana Edad , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Rhizopus , Huésped Inmunocomprometido , CorticoesteroidesRESUMEN
Los estudios sobre la infección fúngica invasiva (IFI) por Mucor spp. en pacientes pediátricos con patología hematooncológica, son de baja solidez científica, lo que dificulta conocer en profundidad sus características y evolución. Con el objetivo de analizar la evolución fatal de esos pacientes, se llevó a cabo esta revisión sistemática (RS). Material y métodos: La búsqueda bibliográfica se realizó con fecha 23 de marzo de 2023, en las principales bases de datos (Medline (a través de Pubmed), Embase (a través de Embase-Elsevier), The Cochrane Library (a través de Wiley), Cinahl (a través de Ebsco HOST), SCI-EXPANDED, SciELO (a través de la WOS) y Scopus (a través de Scopus-Elsevier), libre (mediante el motor Google) y revisando las citas de los artículos incluidos. Resultados: Se rescataron 1393 artículos, de los cuales se descartaron 1386 por diversas razones. Mediante el análisis de los textos completos, finalmente se incluyeron 7 estudios. Todos los estudios eran series de casos (nivel 4). La mediana de la frecuencia de muerte observada fue de 36,6% (Q1 20% - Q347%). Conclusiones: Esta RS mostró en niños con patología hemato-oncológica, que la mortalidad por IFI por Mucor spp. alcanzó a casi un tercio de los pacientes (AU)
Studies on invasive fungal infection (IFI) by Mucor spp. in pediatric patients with cancer have a low level of evidence, which makes it difficult to elucidate its characteristics and progression. To analyze the fatal outcome of these patients, this systematic review (SR) was conducted. Material and methods: A literature search was carried out on March 23, 2023, in the following main databases (Medline (via Pubmed), Embase (via Embase-Elsevier), The Cochrane Library (via Wiley), Cinahl (via Ebsco HOST), SCI-EXPANDED, SciELO (via the WOS) and Scopus (via Scopus-Elsevier). Additionally, a complementary search was carried out using free search engines (such as Google) and by reviewing the references of the included articles. Results: A total of 1393 articles were retrieved, of which 1386 were excluded for various reasons. After a thorough analysis of the full-text articles, 7 studies were ultimately included in the review. All studies were case series (level 4). The median observed death rate was 36.6% (IQR, 20% - 47%). Conclusions: This SR showed that in children with hematological-oncological disease, mortality due to IFI by Mucor spp. affected almost one third of the patients (AU)
Asunto(s)
Humanos , Niño , Adolescente , Infecciones Oportunistas/microbiología , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/mortalidad , Neoplasias Hematológicas/terapia , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Mucormicosis/diagnóstico , Mucormicosis/tratamiento farmacológico , Antifúngicos/uso terapéutico , Factores de Riesgo , Huésped Inmunocomprometido , Mucor , NeutropeniaRESUMEN
Background: Mucormycosis is a rare infection caused by ubiquitous fungi of the Mucorales order that mainly affects immunocompromised patients. These fungi have an important tropism for blood vessels that allows them to spread rapidly and cause thromboembolic events. Case report: We present a case of an 8-year-old male patient diagnosed with acute lymphoblastic leukemia treated with chemotherapy. He presented icteric syndrome, hepato-splenomegaly, and data of intestinal obstruction. Although he underwent intestinal resection, he did not improve and died. The autopsy identified disseminated mucormycosis involving the brain, lungs, esophagus, small intestine, colon, and pancreas. Conclusions: Hematological neoplastic diseases and their treatment are important risk factors for developing infections by opportunistic microorganisms such as mucormycosis. Early diagnosis and adequate treatment are essential due to their intrinsic difficulty and the high mortality rate of these cases.
Introducción: La mucormicosis es una infección poco frecuente causada por hongos ubicuos del orden de los Mucorales que afecta principalmente a pacientes inmunocomprometidos. Estos hongos poseen un importante tropismo por vasos sanguíneos que les permite diseminarse rápidamente y provocar lesiones trombo-embólicas. Caso clínico: Se presenta el caso de un paciente de sexo masculino de 8 años con diagnóstico de leucemia linfoblástica aguda tratada con quimioterapia. Presentó síndrome ictérico, hepato esplenomegalia y datos de obstrucción intestinal. A pesar de que fue sometido a resección intestinal, no presentó mejoría y falleció. En la autopsia se identificó mucormicosis diseminada con afección de cerebro, pulmones, esófago, intestino delgado, colon y páncreas. Conclusiones: Las enfermedades neoplásicas hematológicas y su tratamiento son importantes factores de riesgo para el desarrollo de infecciones por microorganismos oportunistas como la mucormicosis. El diagnóstico temprano y adecuado tratamiento son importantes debido a la dificultad intrínseca de los mismos y la alta tasa de mortalidad de estos casos.
Asunto(s)
Mucormicosis , Leucemia-Linfoma Linfoblástico de Células Precursoras , Masculino , Humanos , Niño , Mucormicosis/diagnóstico , Mucormicosis/tratamiento farmacológico , Autopsia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicacionesRESUMEN
BACKGROUND: A variety of bacterial and fungal co-infections may be attributed to the coronavirus disease 2019 (COVID-19), particularly in people who already have a medical condition such diabetes mellitus or those who received large dosages of steroids. CASE REPORT: We described a 52-year-old diabetic man who was receiving high doses of dexamethasone and antibiotics while receiving ambulatory care for COVID-19 pneumonia. His anterior rhinoscopy revealed a necrotic scab, and a sample confirmed Mucor spp. He underwent surgery and was given amphotericin as a result of the severity of the condition, palpebral ptosis, and right ocular palsy he was experiencing. The patien Ìs progression was satisfactory. CONCLUSIONS: pre-existing diabetes mellitus, previous steroid and antimicrobial use, as well as SARS-CoV-2 infection are some of the risk factors associated with Mucor spp. infection. Prompt detection of mucormycosis is important in the management of these affected patients.
ANTECEDENTES: A la enfermedad por coronavirus (COVID-19) se le han atribuido diversas coinfecciones bacterianas y fúngicas, especialmente en sujetos con enfermedades preexistentes (diabetes mellitus) o en quienes han recibido altas dosis de corticosteroides. REPORTE DE CASO: Paciente masculino de 52 años, con antecedente de diabetes mellitus, quien recibió altas dosis de dexametasona y antibióticos mientras recibía atención ambulatoria por neumonía secundaria a COVID-19. La rinoscopia anterior reveló una costra necrótica, y una muestra de exudado confirmó la coexistencia de Mucor spp. Debido a la complicación del cuadro clínico, ptosis palpebral y parálisis ocular derecha, se le administró anfotericina B y fue intervenido quirúrgicamente. La evolución del paciente fue satisfactoria. CONCLUSIONES: La diabetes mellitus preexistente, el consumo de corticosteroides y antimicrobianos, además de la infección por SARS-CoV-2 son factores de riesgo asociados con la infección por Mucor spp. Es importante la detección oportuna de mucormicosis en el tratamiento de estos pacientes.
Asunto(s)
COVID-19 , Mucormicosis , Masculino , Humanos , Persona de Mediana Edad , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , COVID-19/complicaciones , SARS-CoV-2 , NarizRESUMEN
Mucormycosis is rarely described in Platyrrhines. Herein, we describe the pathologic and molecular features of a gastric and hepatic infection by Mucor indicus in a marmoset (Callithrix sp.).
Asunto(s)
Callithrix , Mucormicosis , Animales , Mucor , Mucormicosis/diagnóstico , Mucormicosis/veterinariaRESUMEN
BACKGROUND: Mucormycosis is a severe invasive fungal disease. During the coronavirus disease 2019 (COVID-19) pandemic, outbreaks have been reported worldwide, but epidemiological studies are still scarce in Brazil. METHODS: We conducted a time-series cohort hospitalization study (2010-2021) in southeastern Brazil. RESULTS: There were 311 cases (85 during the pandemic), with significant (P < 0.05) involvement of patients older than 40 years (84%), white patients (78%), rhinocerebral site (63%), and São Paulo State residents (84%). CONCLUSIONS: Mucormycosis hospitalizations were highly prevalent. Further studies are needed to assess the burden of COVID-19 on mucormycosis in Brazil.
Asunto(s)
COVID-19 , Mucormicosis , Humanos , COVID-19/epidemiología , Mucormicosis/diagnóstico , Mucormicosis/epidemiología , Pandemias , Brasil/epidemiología , Factores de Tiempo , HospitalizaciónRESUMEN
COVID-19 disease is associated with a significant number of opportunistic infections, including invasive fungal infections such as mucormycosis. The prevalence of the latter is rare, estimated to be between 0.005 and 1.7 per million inhabitants. Risk factors include hematological diseases, Diabetes Mellitus with poor metabolic control, solid organ transplantation, neutropenia, and prolonged administration of systemic corticosteroids. We report two males aged 60 and 75 years with pulmonary and tracheobronchial invasive mucormycosis, respectively. Both patients had a deficient metabolic control of their diabetes as a predisposing risk factor added to severe COVID-19 infection. High suspicion and early diagnosis are essential for prompt treatment, especially considering the associated high morbidity and mortality of this fungal infection.