Isolated Renal Mucormycosis in Children

Shantou University, Swatow, Guangdong, China
The Journal of Urology (Impact Factor: 4.47). 02/2004; 171(1):387-8. DOI: 10.1097/01.ju.0000100842.96636.a0
Source: PubMed
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    ABSTRACT: Primary renal zygomycosis is a rare fungal infection, and only 45 cases have been reported in the literature. The major etiologic agents of the disease were Mucor spp., Rhizomucor spp., Rhizopus spp. and Absidia spp. Here we report a case of primary renal zygomycosis due to Rhizopus oryzae infection. The patient had systemic lupus erythematosus and was treated with corticosteroids. He had frequent micturition, urodynia and passed amorphous and membranous-looking masses through the urethra several times prior to admission. Histopathological examination of the mass showed numerous broad and nonseptate hyphae. Rhizopus oryzae was isolated from the mass. We also reviewed the clinical features of primary renal zygomycosis in the literature.
    Medical Mycology 09/2006; 44(5):461-6. DOI:10.1080/13693780500338951 · 2.34 Impact Factor
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    ABSTRACT: Objectives Show the contribution of imaging to the diagnosis and follow-up of serious mucormycosis in immunodepressed patientsMaterials and methodsRetrospective analysis of the 5-year radiological data in serious forms of mucormycosis occurring in patients with bone marrow allografts who are in refractory chronic graft-versus-host disease after bone marrow transplantation from 2002 to 2005. The positive diagnosis was bacteriologically and pathologically positive in all cases.ResultsThis study involved three patients with isolated pulmonary involvement and two cases of disseminated mucormycosis. Areas of pulmonary condensations were found in all cases, one of whom had a low-attenuation zone and parenchymal nodules. The kidney, liver, and spleen lesions were clearly limited, hypoechogenic, hypodense, and homogenous with no peripheral contrast material uptake. There was thyroid involvement in the form of hypoechogenic nodules. Rapid growth of the lesions was observed on follow-up CT (n=3) and despite surgical treatment (n=2) and intensive medical management, all cases ended in death.Conclusion Mucormycosis is an integral part of the differential diagnosis of infectious syndromes in immunodepressed patients during the period after bone marrow transplantation. Imaging can assist in the diagnosis but pathological confirmation remains indispensable.
    Journal de Radiologie 10/2006; 88(5):677-683. DOI:10.1016/S0221-0363(07)89875-1 · 0.57 Impact Factor
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    ABSTRACT: Mucormycosis 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%.
    Clinical Microbiology and Infection 11/2006; 12(s7):7 - 23. DOI:10.1111/j.1469-0691.2006.01604.x · 5.77 Impact Factor
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