Choanephora infundibulifera Rhinosinusitis in Man with Acute Lymphoblastic Leukemia, Tennessee, USA.

Choanephora infundibulifera is a member of the Mucorales order of fungi. The species is associated with plants as a saprophyte or parasite and may be responsible for spoilage or disease but is an uncommon cause of human infection. We describe C. infundibulifera rhinosinusitis in a young man with leukemia in Tennessee, USA.

Disseminated Acanthamoeba infection in a heart transplant recipient treated successfully with a miltefosine-containing regimen: Case report and review of the literature.

Disseminated acanthamoebiasis is a rare, often fatal, infection most commonly affecting immunocompromised patients. We report a case involving sinuses, skin, and bone in a 60-year-old woman 5 months after heart transplantation. She improved with a combination of flucytosine, fluconazole, miltefosine, and decreased immunosuppression. To our knowledge, this is the first case of successfully treated disseminated acanthamoebiasis in a heart transplant recipient and only the second successful use of miltefosine for this infection among solid organ transplant recipients. Acanthamoeba infection should be considered in transplant recipients with evidence of skin, central nervous system, and sinus infections that are unresponsive to antibiotics. Miltefosine may represent an effective component of a multidrug therapeutic regimen for the treatment of this amoebic infection.

Successful Treatment of Sinusitis by Acanthamoeba in a Pediatric Patient After Allogeneic Stem Cell Transplantation.

Acanthamoeba infections are rare and mostly occur in immunocompromised patients. Most of the reported cases after stem cell transplantation have been diagnosed postmortem. We present the case of a 3-year-old boy with chronic graft versus host disease post hematopoietic transplantation, who was successfully treated for Acanthamoeba.

Aspergilosis sinusal no invasiva por Aspergillus parasiticus en niño inmunocomprometido / Non invasive sinusal aspergillosis by Aspergillus parasiticus in an immunecompromised child

El presente trabajo tiene la finalidad de exponer un caso clínico de un niño inmunosuprimido con antecedentes de hospitalización previa, a los 6 años de edad con múltiples síntomas y signos (poliadenopatías, desnutrición, sepsis en cavidad bucal y foco pulmonar, además de pancitopenia). Permaneció en terapia intermedia durante 38 días, cumpliendo varios esquemas antibióticos sin buena respuesta a los mismos. Fue derivado al Hospital Ricardo Gutiérrez (Buenos Aires) desconociéndose la terapéutica seguida en esa oportunidad. Cinco años después (2007) es ingresado nuevamente a nuestro hospital por cuadro de epistaxis cefaléa, compromiso del estado general y neutropenia febril, por lo que se inicia tratamiento antibiótico, además de estudio con mielograma confirmándose el diagnóstico de leucemia linfocítica aguda. Cinco días después de su ingreso expulsa espontáneamente, desde las fosas nasales material granulomatoso el cual fue enviado a estudio micológico (examen directo y cultivo), detectándose alta presencia de Aspergillus parasiticus en ambos exámenes, lo cual fue ratificado por histopatología como una aspergilosis sinusal no invasiva. El paciente fue remitido a la Sala de Inmunodeprimidos donde recibió tratamiento intravenoso con 350 mg/día de anfotericina B-complejo lipídico y terapia específica para LLA. Presentó una evolución tórpida y al 12º día el paciente falleció por su mal estado general y progresión terminal de su enfermedad de base.

This present paper is meant to reveal the clinical case of an immunesuppressed boy having been previously in a hospital, when he was 6, showing multiple symptoms and signs (polyadenopaties, malnutrition, buccal sepsis and pulmonary focus, in addition to pancitopia). He stayed under intermediate therapy for 38 day being submitted to varied antibiotic schemes, though yielding no satisfactory responses to them. Later on he was derived to the Hospital Ricardo Gutiérrez (Buenos Aires), yet therapeutics used at that place being unknown. Five years later (2007), he is admitted again in our hospital because of cephalea epistaxis, a compromised health condition and fevered neutropenia, so he is given an antibiotic treatment in addition to a mielographic studyyet it is confirmed the diagnosis of an acute lymphocytic leukemia. Five days after his admittance, he discharges granulomatous matter from his nasal cavities which was sent for a mycological study. Direct exam and culture, detecting high presence of Aspergillus parasiticus on both exams which was ratified by histopathology as a non invasive sinusal aspergillosis. The patient was sent to the Immunedepressed Ward where he received intravenous treatment with 350mg/day anfotericina Blipidic complex and a specific therapy for LLA. He had a torpid evolution and on the 12nd day the patient died as a result of his very bad health condition as well as the terminal progression of his base disease.

Successful treatment of Acanthamoeba rhinosinusitis in a patient with AIDS.

Acanthamoeba infection is a rare, difficult-to-treat, and often fatal, opportunistic parasitic infection in immunocompromised hosts, such as patients infected with HIV. We describe an aggressive nasal and sinus infection by Acanthamoeba spp. in a person with AIDS. The resolution of this Acanthamoeba infection was secondary to a multidisciplinary treatment approach involving a combination of surgery as well as high-dose amphotericin B plus 5-fluorocytosine. In the era of the HIV/AIDS pandemic, the present report underscores the need for early identification and prompt aggressive treatment to ensure successful management of this rare but potentially fatal opportunistic infection.

Disseminated acanthamoebiasis presenting as lobular panniculitis with necrotizing vasculitis in a patient with AIDS.

BACKGROUND: Disseminated acanthamoebiasis is a rare entity, almost exclusively occurring in the immunocompromised host. METHODS: We report an unusual case of a 35-year-old female with recurrent sinusitis and multiple skin nodules demonstrating a necrotizing panniculitis, shown to be due to disseminated acanthamoebiasis. RESULTS: Histologic sections showed a neutrophilic lobular panniculitis with 20- to 30-microm trophozoites consistent with Acanthamoeba species. CONCLUSIONS: A review the literature shows that the histopathological presentation of acanthamoebiasis often eludes initial diagnostic attempts and that central nervous system (CNS) involvement is frequent and ultimately fatal. When amoebiasis is suspected, knowledge of the trophozoite and cyst forms may be helpful in distinguishing Acanthamoeba species from Entamoeba histolytica.

Microsporidium-associated sinusitis.

Two cases of biopsy-proven Microsporidium-associated chronic sinusitis in HIV-seropositive patients are presented. Spores of Septata intestinalis were identified by light microscopy and confirmed by electron microscopy in each case. Both patients displayed severe deficiencies of nasal mucosa CD4-positive cells, demonstrated by immunohistochemical methods. Only two other cases of Septata intestinalis-associated sinusitis have been reported previously. Our observations agree with the theory that functional defects in local mucosal immunity may partially explain the acquisition of opportunistic mucosal infections in many HIV-seropositive patients.