Fungal Infections

September 25, 2009

The role of neutrophils in the development and outcome of zygomycosis in haematological patients.

The role of neutrophils in the development and outcome of zygomycosis in haematological patients.

Pagano L, Valentini CG, Fianchi L, Caira M.
Istituto di Ematologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, I-00168 Rome, Italy.

Zygomycosis constitutes the third leading cause of invasive fungal infections following aspergillosis and candidosis. Patients with haematologic malignancies or haematopoietic stem cell transplantation are particularly susceptible to zygomycosis. Neutropenia represents the most important pathogenic mechanism influencing the onset and outcome of zygomycosis. Neutrophils cause a lesion of the fungal wall with subsequent destruction by macrophages. They also enhance the activity of antifungal drugs against Zygomycetes. Strategies that aim to increase neutrophil count and function, such as granulocyte colony stimulating factor and granulocyte transfusion, could play an important role in the management of this life-threatening infectious complication.

PMID: 19754754 [PubMed – in process]

Zygomycosis and diabetes mellitus.

Zygomycosis and diabetes mellitus.

Clin Microbiol Infect. 2009 Oct;15

Lanternier F, Lortholary O.

Université Paris Descartes, Centre d’Infectiologie Necker-Pasteur, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants malades, Paris, France.

Zygomycoses are severe angio-invasive fungal infections that develop in immunocompromised and diabetic patients. Any episode of sinusitis not responding to short-term antibacterial therapy should evoke the diagnosis of zygomycosis in the latter population, especially in cases of a surrounding necrotic area. Appropriate diagnosis is obtained after careful direct examination of the sample and culture. Current therapy underscores the need to control glycaemia and acidosis in addition for urgent administration of high-dose liposomal amphotericin B in combination with extensive surgery.


Incidence of zygomycosis in transplant recipients.

Incidence of zygomycosis in transplant recipients.

Clin Microbiol Infect. 2009 Oct

Cuenca-Estrella M, Bernal-Martinez L, Isla G, Gomez-Lopez A, Alcazar-Fuoli L, Buitrago MJ.
Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid, Spain.

Recently, a remarkable increase in the incidence of zygomycosis has been reported from institutions in the USA and Europe. The use of voriconazole for the treatment of aspergillosis and, less frequently, the use of echinocandins as empirical treatment for invasive fungal infections are thought to be responsible for the increase. In addition, an increased incidence of this infection has been observed in transplant recipients, including both haematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) patients. There are no global surveys on the prevalence or incidence of zygomycosis, but data from individual institutions and countries show that zygomycosis is an emerging infection. The increased incidence of zygomycosis most probably reflects a greater frequency of predisposing factors, such as higher numbers of patients undergoing HSCT and immunosuppressive chemotherapy. In addition, the emergence of rare pathogens as a result of the rise in the use of antifungal therapy against common species can be postulated. Further, the availability of antifungal agents with activity profiles that are more specific for selected fungi increases the necessity of identifying pathogenic fungi; the frequency of Zygomycetes infections may have been underestimated until now because therapeutic decisions did not depend on the precise identification of pathogenic fungi.


Outbreaks of zygomycosis in hospitals.

Outbreaks of zygomycosis in hospitals.

Clin Microbiol Infect. 2009 Oct

Antoniadou A.
4th Department of Internal Medicine, Athens University Medical School, University General Hospital ATTIKON, Athens, Greece.

Zygomycosis refers to a group of uncommon and frequently fatal mycoses caused by fungi of the class Zygomycetes, the organisms of which are usually found in decaying organic matter. Disease can be transmitted by the inhalation of spores or by direct inoculation on disrupted skin or mucosa. For rare diseases such as zygomycosis, two or more cases occurring in a short time should be investigated as a probable epidemic. Twelve hospital outbreaks and two pseudoepidemics caused by Zygomycetes have been cited in the English literature. The first epidemic was recorded in 1977 and the last in 2008. Outbreaks have been reported in the USA, the UK and elsewhere in Europe. Cases have included cutaneous, disseminated, pulmonary and rhinocerebral disease. Species identified have included Rhizopus arrhizus, Rhizopus rhizopodiformis, Rhizopus microsporus, Rhizopus spp., Absidia corymbifera and Rhizomucor pusillius. Sources of infection have included Elastoplast adhesive bandage rolls, ventilation systems, wooden tongue depressors, karaya (plant-derived adhesive) ostomy bags, and water damage to a linen store and patient shower room. Patients have included cardiosurgery patients, renal transplant recipients, orthopaedic patients, adult leukaemia patients, intensive care unit neonates, immunocompromised haematology patients, and burn unit patients. Although zygomycosis outbreaks in the hospital environment are infrequent, a high index of suspicion should exist if necrotic lesions appear in proximity to a postoperative wound. Direct tissue examination and tissue culture and histopathology must be routinely performed.


September 17, 2009

Clinical presentation of zygomycosis.

Clinical presentation of zygomycosis.

Clin Microbiol Infect. 2009 Oct

Mantadakis E, Samonis G.

Department of Paediatrics, Democritus University of Thrace and General District Hospital of Alexandroupolis, Thrace, Greece.

Zygomycetes are filamentous fungi with a worldwide distribution. This class of fungi encompasses two orders, i.e. the Mucorales and the Entomophthorales. Members of the latter are associated with chronic cutaneous and subcutaneous infections that are limited to the tropics and rarely disseminate to internal organs. The order Mucorales includes several species involved in rhinocerebral, pulmonary, cutaneous, gastrointestinal and other less frequent infections in immunocompetent and immunocompromised individuals, and is characterized by a tendency to disseminate. Portals of entry of zygomycetes are usually the lungs, skin, and gastrointestinal tract. A characteristic property of zygomycetes is their tendency to invade blood vessels and to cause thrombosis-processes that result in subsequent necrosis of involved tissues. Risk factors associated with zygomycosis include prolonged neutropenia and use of corticosteroids, solid organ or haematopoietic stem cell transplantation, AIDS, poorly controlled diabetes mellitus, iron chelation with deferoxamine, burns, wounds, malnutrition, extremes of age, and intravenous drug abuse. Recently, the widespread use of voriconazole for prophylaxis or treatment of aspergillosis in patients with haematological malignancies has been linked with a rise in the numbers of cases of invasive zygomycosis. As the symptoms, clinical signs and imaging findings of these infections are non-specific, a high index of suspicion is required for timely diagnosis. Early diagnosis, correction of the underlying predisposing factors, aggressive surgical debridement of all infected tissues and lengthy administration of antifungals are the only potentially curative options for this rare but emerging invasive fungal infection.



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