RESUMEN
Rhino-orbital-cerebral mucormycosis (ROCM) is a rare fulminant opportunistic fungal infection that despite relevant treatment has high mortality. We present a case of a 3-year-old girl with acute lymphoblastic leukemia and ROCM, who was treated successfully with excessive surgery, systemic antifungal treatment with amphotericin B (AmB), posaconazole, and terbinafine as well as hyperbaric oxygen. Surgery included, beside extracranial and intracranial removal of infected areas, endoscopic sinus and skull base surgery with local AmB installation and in addition placement of an Ommaya reservoir for 114 intrathecal administrations of AmB. In addition, we review the literature of ROCM in pediatric patients with hematological diseases.
Asunto(s)
Antifúngicos/uso terapéutico , Mucormicosis/tratamiento farmacológico , Mucormicosis/cirugía , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Anfotericina B/administración & dosificación , Anfotericina B/uso terapéutico , Encéfalo/microbiología , Encéfalo/patología , Preescolar , Femenino , Humanos , Oxigenoterapia Hiperbárica , Mucormicosis/patología , Naftalenos/uso terapéutico , Nariz/microbiología , Nariz/patología , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/etiología , Infecciones Oportunistas/cirugía , Órbita/microbiología , Órbita/patología , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Terbinafina , Triazoles/uso terapéuticoRESUMEN
Skin and soft tissue infections are common diseases. The spectrum ranges from slight furuncles to severe necrotizing soft tissue infections. Grampositive bacteria account for 70-80 % of cases as causative organisms. Diagnostics include rapid evaluation of locally limited or diffuse spreading extent of the disease. In complicated skin and soft tissue infections, surgical intervention with debridement and necronectomy is indicated. Necrotizing skin and soft tissue infections call for programmed redebridement. If systemic signs of inflammation are present (fever > 38 degrees C, leukocytosis, CRP elevation) or significant comorbidity exists, application of antibiotics is indicated. The prognosis in operatively treated patients is dependent on the time of surgical intervention.
Asunto(s)
Infecciones Bacterianas/diagnóstico , Enfermedades Cutáneas Bacterianas/cirugía , Infecciones de los Tejidos Blandos/diagnóstico , Absceso/diagnóstico , Absceso/mortalidad , Absceso/cirugía , Antibacterianos/uso terapéutico , Infecciones Bacterianas/mortalidad , Infecciones Bacterianas/cirugía , Proteína C-Reactiva/metabolismo , Terapia Combinada , Cuidados Críticos , Desbridamiento , Erisipela/diagnóstico , Erisipela/mortalidad , Erisipela/cirugía , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/mortalidad , Fascitis Necrotizante/cirugía , Gangrena Gaseosa/diagnóstico , Gangrena Gaseosa/mortalidad , Gangrena Gaseosa/cirugía , Humanos , Oxigenoterapia Hiperbárica , Recuento de Leucocitos , Resistencia a la Meticilina , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/mortalidad , Infecciones Oportunistas/cirugía , Pronóstico , Enfermedades Cutáneas Bacterianas/diagnóstico , Infecciones de los Tejidos Blandos/mortalidad , Infecciones de los Tejidos Blandos/cirugía , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/mortalidad , Infecciones Estafilocócicas/cirugía , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/mortalidad , Infecciones Estreptocócicas/cirugía , Streptococcus pyogenes , Tasa de SupervivenciaRESUMEN
OBJECTIVES/HYPOTHESIS: Objectives were to highlight the importance of surgical therapy in treating invasive polymicrobial infections of the temporal bone, to discuss the importance of antifungal therapy, and to review the differential diagnosis of ear canal granulomatous disorders. STUDY DESIGN: Retrospective case review at a tertiary care medical center. METHODS: A retrospective chart review of all patients diagnosed with invasive polymicrobial temporal bone infections was performed. Four patients were identified. All patients required surgical therapy for definitive management. All patients were followed for at least 1 year or until death. RESULTS: Three of four patients had invasive fungi as pathogens. One patient had an occult squamous cell carcinoma. At the time of writing, one patient was free of disease, two were dead of disease, and one was alive with disease. CONCLUSION: Invasive polymicrobial temporal bone infections can occur in immunocompromised patients and can possibly harbor an occult malignancy. Surgical debridement may be necessary to arrive at a correct diagnosis. Modified radical mastoidectomy with parenteral antibiotic therapy and other adjunctive measures may be necessary for disease resolution.
Asunto(s)
Aspergilosis/cirugía , Infecciones Bacterianas/cirugía , Conducto Auditivo Externo/cirugía , Otitis Externa/cirugía , Hueso Temporal/cirugía , Adulto , Anciano , Antibacterianos , Antifúngicos/administración & dosificación , Aspergilosis/patología , Infecciones Bacterianas/patología , Biopsia , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Quimioterapia Combinada/administración & dosificación , Conducto Auditivo Externo/patología , Neoplasias del Oído/patología , Neoplasias del Oído/cirugía , Femenino , Estudios de Seguimiento , Humanos , Oxigenoterapia Hiperbárica , Cuidados a Largo Plazo , Masculino , Infecciones Oportunistas/patología , Infecciones Oportunistas/cirugía , Otitis Externa/patología , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Hueso Temporal/patología , Tomografía Computarizada por Rayos XRESUMEN
Pseudallescheria boydii and Aspergillus terreus are unusual opportunistic fungal pathogens that are often resistant to chemotherapy with amphotericin B. We report a case of simultaneous invasive pulmonary infection with these organisms occurring in a bone marrow transplant recipient who was successfully treated with the oral azole itraconazole.