Rhizomucor hepatosplenic abscesses in a patient with renal and pancreatic transplantation.

Fungal infections are generally observed in immunosuppressed patients only, with a diagnostic challenge due to non-specific symptoms. For this reason, appropriate management may be delayed. This case report concerns a 36-year-old man with history of pancreas and kidney transplantation. He had chemotherapy for post-transplant B-cell lymphoma and presented with left upper abdominal pain and fever. Multiple investigations led to a final diagnosis of disseminated abdominal mucormycosis with multiple Rhizomucor abscesses in the liver, spleen and kidney transplant. Treatment was antifungal therapy and laparotomy with splenectomy, wedge resection of two fungal abscesses in segments II and IVb, and segmental left colic resection.

Fatal Pulmonary and Cerebellar Zygomycosis due to Rhizomucor pusillus in a Ringed Seal (Pusa hispida).

A 4-year-old captive ringed seal (Pusa hispida) was treated with subcutaneous antibacterial injections for pus exuding wounds in the skin and associated blubber following a bite attack. Three months after the incident, the animal presented nystagmus and died the following day. At necropsy, there was a 25 × 18 × 25 mm well-delineated, opaque nodular mass in the lung, besides the skin ulcers and localized areas of discoloration in the blubber correlating with the bite wound and injection sites. Histopathology of the pulmonary mass demonstrated severe eosinophilic inflammatory infiltration among numerous intralesional fungal hyphae. The hyphae were irregularly branched, broad and aseptate, consistent of zygomycosis. Magnetic resonance imaging was conducted on the head, which was initially frozen intact, revealing diffuse areas of hyperintensity in the cerebellum. Restricted histopathologic examination of the cerebellum showed severe granulomatous inflammation well spread within the neuroparenchyma, associated with abundant intralesional fungal hyphae similar to those appreciated in the pulmonary mass. Molecular analyses of the fungi in the pulmonary and cerebellar tissue identified the etiologic agent in both sites as Rhizomucor pusillus. The likely route of infection is through inhalation of R. pusillus spores or fragmented hyphae from the environment that developed into an initial pulmonary infection, becoming the source of hematogenous dissemination to the cerebellum. The skin and blubber lesions likely contributed to immunosuppression. Zygomycosis is uncommon in pinnipeds, and the present report emphasizes the importance of considering zygomycete dissemination even when the primary focus is highly confined.

Isolated cerebral mucormycosis caused by Rhizomucor pusillus.

A 61-year-old man with relapsing chronic lymphocytic leukaemia, status post allogeneic stem cell transplant and multiple chemotherapy regimens presented to the emergency room after suffering a grand mal seizure. His evaluation revealed a 1.5-2 cm ring-enhancing left temporal lobe brain lesion on the CT scan. This brain lesion was resected and the histopathology revealed an invasive fungal organism resembling mucormycosis. Amplification and sequencing of the 28S ribosomal RNA gene identified the organism as Rhizomucor pusillus The patient was treated with liposomal amphotericin B 5 mg/kg every 24 hours for 4 weeks, and then was transitioned to oral posaconazole. Serial brain imaging at 1 and 3 months, while on therapy, showed significant improvement.

[Pulmonary mucormycosis in a patient with kidney transplant and uncontrolled haemoptysis]. / Mucormicosis pulmonar en un paciente con trasplante renal y hemoptisis incoercible.

BACKGROUND: Pulmonary mucormycosis is a rare opportunistic infection with high mortality that is caused by species of Mucorales. The most common species involved are Rhizopus, Mucor, Lichtheimia, and Rhizomucor. CASE REPORT: A 56 year-old woman presented with a clinical history of diabetes mellitus type 2 and chronic renal disease. She underwent a cadaveric kidney transplantation two years before her admission, for which immunomodulating therapy with thymoglobulin, tacrolimus, mofetil-microphenolate and prednisone was established. The patient suffered a pneumonic process with cough, expectoration, and dyspnoea. The computed tomography scan showed a cavitation in the right upper lobe. With all these findings an invasive broncopulmonary aspergillosis was suspected and the patient began an antifungal treatment with voriconazole without improvement. Rhizomucor pusillus was isolated from a clinical specimen obtained by fine needle aspiration, and its identification was confirmed by PCR. After this finding amphotericin B was administered, but the patient had an uncontrolled haemoptysis and died. CONCLUSIONS: Pulmonary mucormycosis is a rare infection, usually fatal in kidney transplant recipients with anti-rejection therapy. Mucorales species usually produce thrombotic phenomena, associated with necrosis and parenchymal destruction that caused a fatal uncontrolled haemoptysis in our patient. Early diagnosis is important in order to perform any surgical treatment and to administer amphotericin B.

Severe invasive pulmonary zygomycosis by Rhizomucor pusillus and concomitant severe bacterial endocarditis in acute promyelocytic leukaemia.

We describe a severe pulmonary invasive zygomycosis sustained by Rhizomucor pusillus and concomitant bacterial endocarditis in a woman diagnosed with acute promyelocytic leukaemia.

Fungal isolates from a Pu-erh type tea fermentation and their ability to convert tea polyphenols to theabrownins.

The natural microbiota involved in the fermentation influence the quality and taste of fully postfermented teas such as China's Pu-erh tea. Ten microbial isolates representing 6 species were recovered from a solid-state fermentation of a Pu-erh type tea. The isolates were Aspergillus tubingensis, Aspergillus marvanovae, Rhizomucor pusillus, Rhizomucor tauricus, Aspergillus fumigatus, and Candida mogii. With the exception of A. marvanovae and C. mogii, all these microorganisms have been previously reported in solid-state fermentations of native Pu-erh tea. The ability of the isolates for converting the tea polyphenols to bioactive theabrownins in infusions of sun-dried green tea leaves in a submerged fermentation process was subsequently investigated. All isolates except C. mogii TISTR 5938 effectively produced theabrownins in a 4-d fermentation in shake flasks at 40 °C, 250 rpm. A. tubingensis TISTR 3646, A. tubingensis TISTR 3647, A. marvanovae TISTR 3648, and A. fumigatus TISTR 3654 produced theabrownins at particularly high levels of 6.5, 12.4, 11.1, and 8.4 g/L, respectively.

Successful treatment of invasive zygomycosis based on a prompt diagnosis using molecular methods in a patient with acute myelogenous leukemia.

Zygomycosis is a lethal and invasive mold infection that is often associated with hematological malignancies. The keys for successful treatment include making a rapid diagnosis and appropriately administering antifungal agents. We herein report the early diagnosis of a case of zygomycosis in a patient with acute myeloid leukemia using a deoxyribonucleic acid sequence analysis. We successfully performed allogeneic hematopoietic stem cell transplantation with the use of high-dose liposomal amphotericin B and granulocyte transfusion.

Isavuconazole treatment of a patient with disseminated mucormycosis.

We report a patient with relapsed acute myelogenous leukemia after allogeneic stem cell transplantation who developed disseminated mucormycosis due to Rhizomucor pusillus/R. miehei involving lung, brain, and skin. After failing posaconazole and being intolerant to amphotericin, he was treated effectively with isavuconazole for over 6 months despite ongoing treatment for relapsed leukemia.

Pulmonary, rhino-orbital and cutaneous mucormycosis caused by Rhizomucor pusillus in an immunocompromised patient.

The number of patients with haematopoietic malignancies receiving chemotherapy and stem-cell transplantation has increased the incidence of severe opportunistic infections. Systemic fungal infections are of major concern in immunocompromised patients, as these infections are often fatal. We report a case of a patient with acute myeloid leukaemia who developed multiple cutaneous plaques and necrotizing infiltrates in the lungs during chemotherapy. Using real-time PCR on a wax-embedded tissue sample, Rhizomucor pusillus was identified. We provide an overview of the literature on cutaneous mucormycosis and its diagnosis by PCR.

Zygomycosis presenting a major clinical challenge: case report on Rhizomucor pusillus infection in a stem-cell-transplant recipient.

Zygomycoses are opportunistic infections caused by the Mucorales fungi. They are typically seen in immunosuppressed patients. The incidence of zygomycosis cases seems to be increasing. We report on zygomycosis in a pediatric, female stem-cell-transplant recipient. This case report underlines the difficulty of taking care of patients with zygomycosis. In fungal infections of immunosuppressive patients on broad-coverage antibiotics, foci of skin necrosis are unique and typical for zygomycoses, and may be helpful in this challenging diagnosis.

Chronic rhinofacial mucormycosis caused by Mucor irregularis (Rhizomucor variabilis) in India.

In this article, we describe a chronic case of rhinofacial mucormycosis caused by Mucor irregularis, formerly known as Rhizomucor variabilis var. variabilis, a rare mycotic agent in humans. The infection caused progressive destruction of the nasal septum and soft and hard palate, leading to collapse of the nose bridge and an ulcerative gaping hole. The mucoralean mold cultured from a nasal biopsy specimen was determined by multilocus DNA sequence data to be conspecific with M. irregularis.

Duodenal perforation caused by Rhizomucor species in a cat.

UNLABELLED: CLINICAL SUMMARY: A 7-month-old female Persian cat presented with gastrointestinal (GI) necrosis and perforation caused by Rhizomucor species. Unfortunately, the cat died of bacterial peritonitis and sepsis before a definitive diagnosis, based on histopathology and fungal culture, was achieved. PRACTICAL RELEVANCE: This appears to be the first reported case of GI disease caused by Rhizomucor species in a cat. Mucorales infections typically cause acute and rapidly progressive disease. As illustrated by this case, clinicians should be alert to the potentially fatal consequences of an opportunistic Rhizomucor species infection in their feline patients.

Disseminated zygomycosis heralded by a subtle cutaneous finding.

BACKGROUND: Zygomycosis is the preferred name for the angiotropic infection produced by the Zygomycete class of fungi. Although healthy individuals may be affected, the majority of patients diagnosed with zygomycosis have diabetes, malignancy, or have had solid organ or bone marrow transplantation. Unlike other filamentous fungi that tend to disseminate hematogenously to skin, cutaneous zygomycosis most commonly arises via direct inoculation. Cutaneous lesions of zygomycosis are characteristically hemorrhagic, ulcerated or necrotic plaques. Histology typically demonstrates angioinvasion with associated necrosis. CASE: We present a case of a neutropenic patient who presented with disseminated zygomycosis heralded by a clinically non-specific erythematous macule that showed non-specific, mild, inflammatory changes on histological examination. Tissue culture was performed at the time of initial evaluation and was consistent with zygomycosis. Rhizomucor was subsequently confirmed by PCR. The patient was diagnosed with disseminated zygomycosis, treatment was promptly initiated, and the patient recovered completely. Our case represents an atypical clinical and histological presentation of disseminated zygomycosis and highlights the value of performing tissue culture of non-distinctive cutaneous lesions, especially in the setting of severely immunocompromised states.

Combined antifungal therapy, iron chelation and surgical resection as treatment of hepatic zygomycosis in a patient with haematological malignancy.

We describe the case of a 19-year-old boy with acute leukaemia who developed primary hepatic zygomycosis. The patient presented with febrile neutropenia and severe abdominal tenderness. Despite the administration of antibiotics and liposomal Amphotericin-B (L-AmB), the CT scan demonstrated an increase in the size of liver lesions. A wide surgical resection was carried out and liver specimens demonstrated a branching, filamentous fungus that was identified as Rhizomucor pusillus by both phenotypic and molecular methods. The patient was treated with L-AmB combined with posaconazole, and deferasirox was subsequently added given the potential synergistic effect of this iron chelator in combination with L-AmB. Three months after surgical intervention, an allogeneic stem-cell transplantation was successfully carried out. The present case confirms that an early surgical management combined with antifungal agents is crucial to optimise the outcome of patients with zygomycosis and the use of deferasirox is a promising alternative.

Rhizomucor variabilis var. regularior and Hormographiella aspergillata infections in a leukemic bone marrow transplant recipient with refractory neutropenia.

Rhizomucor variabilis and Hormographiella aspergillata rarely cause human infections. This report details a fatal case of a 14-year-old female with leukemia posthematopoietic cell transplant and relapse with refractory pancytopenia. The patient first developed an R. variabilis var. regularior palate infection and later developed a cutaneous H. aspergillata infection while on posaconazole and caspofungin therapy.

Outbreaks of zygomycosis in hospitals.

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.

Mucormycosis of the bronchial anastomosis: a case of successful medical treatment and historic review.

Rhizomucor is a genus of zygomycetes that can cause pulmonary mucormycosis. In the immunocompromised host, mucormycosis was fatal until advances in anti-fungal therapy were combined with surgery. Although uncommon, fungal infection at the bronchial anastomosis is associated with a significant risk of morbidity and mortality after lung transplantation. Our patient is a middle-aged woman with end-stage chronic obstructive pulmonary disease who received a bilateral lung transplant. After discharge, she developed increasing dyspnea. Bronchoscopy revealed stenosis and Rhizomucor at the right anastomosis. Repeated endobronchial debridement, systemic lipid-soluble amphotericin, and inhaled amphotericin successfully resolved the infection. The residual stenosis was treated with a self-expandable metal stent. At 3 months, the patient continues on inhaled amphotericin suppression therapy without sequelae. Anastomosis mucormycosis is a grave complication after lung transplantation. Without combination therapy of surgery and anti-fungal drugs, mortality has been exceedingly high. We present a case wherein endobronchial debridement and anti-fungal therapy were successful without surgery.

Successful treatment of disseminated mucormycosis with a combination of liposomal amphotericin B and posaconazole in a patient with acute myeloid leukaemia.

The combination of resection of infected tissue and antifungal therapy is the treatment of choice in mucormycosis. In disseminated mucormycosis, where surgery is impossible, the mortality is almost 90%. We report the first case of disseminated mucormycosis that was cured with a combination therapy of liposomal amphotericin B and posaconazole without surgical intervention.

Molecular identification of Rhizomucor pusillus as a cause of sinus-orbital zygomycosis in a patient with acute myelogenous leukemia.

Sinus-orbital zygomycosis caused by Rhizomucor pusillus in a patient with acute myelogenous leukemia is described. Identification was achieved by sequencing of the internal transcribed spacer (ITS) regions of the rRNA gene and by expression of zygospores in mating. This report highlights the value of ITS sequencing as a diagnostic tool for the identification of R. pusillus and expands the understanding of infection types caused by this zygomycete.