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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fungi belonging to class Zygomycetes become pathogenic in certain predisposing conditions; principally diabetes mellitus, immunosuppression, trauma or burns. We report a case of a 31-year-old man with acute promyelocytic leukemia who developed infection of the sino-oral cavity, due to Absidia corymbifera during a neutropenic phase following induction chemotherapy. A provisional diagnosis of zygomycosis was made by demonstration of broad aseptate branching filamentous hyphae in the scrapings of the palate, which was subsequently confirmed as A. corymbifera by culture. Surgical debridement could not be done due to the thrombocytopenic status of the patient; instead antifungal therapy with amphotericin B was instituted. However, the patient succumbed to the infection after 15 days of its diagnosis. Although infections with Absidia are infrequent, this case highlights the need for its awareness as a potentially lethal opportunistic fungal infection that can present even with short duration of exposure to the usual risk factors.
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PMID:Sino-oral zygomycosis due to Absidia corymbifera in a patient with acute leukemia. 1555 49

A retrospective review of a five year period (1994-1998) revealed that opportunistic mycoses caused by ubiquitous fungal pathogens are a serious problem in the immunocompromised patient population of Kuwait. Patients with renal transplantation and diabetes mellitus were most susceptible to aspergillosis, cryptococcosis, and zygomycosis, whereas patients with candidemia/hematogenous candidiasis had multiple risk factors. Basidiobolomycosis of the rectum in a Bangladeshi male, cryptococcosis due to Cryptococcus neoformans var. gatti in an AIDS patient,fungal peritonitis due to Absidia corymbifera in a patient on peritoneal dialysis, and endocarditis due to Aspergillus terreus detected by direct microscopic examination and culture of the blood clot are some of the notable cases diagnosed during the period under review. The predominance of Candida species other than C. albicans as bloodstream pathogens is another noteworthy observation. Although outbreaks of C. parapsilosis candidemia in neonatal intensive care units contributed significantly to this shift in favour of non-albicans Candida species, a surveillance strategy comprising of molecular, epidemiologic and antifungal susceptibility studies is warranted. With the proposed expansion of organ and bone marrow transplantation facilities in Kuwait, the incidence of opportunistic fungal infections is likely to increase.
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PMID:Invasive fungal infections in Kuwait: A retrospective study. 1559 75

Six cases of zygomycosis that were diagnosed at Hamad Medical Corporation over an eleven-year period are retrospectively reviewed. All patients had at least one predisposing condition. Renal transplant and diabetes mellitus were the most common predisposing conditions. Sites of involvement were pulmonary in two patients, rhinocerebral two, rhino-orbital, and cutaneous in one each. The clinical features in patients with rhinocerebral and rhino-orbital involvement were very suggestive of the diagnosis, while patients with pulmonary and cutaneous involvement, the disease was not suspected and was only made after the histopathology or culture results were available. Diagnosis was made premortum in all patients. Diagnosis was confirmed by histopathology in three patients and by culture in the other three. Five of the six patients died. Poor outcome correlated with rhinocerebral and pulmonary involvement, while cutaneous disease was associated with favorable outcome. Therapy with amphotericin B, surgical debridement, and correction of the underlying predisposing condition offers the best chance for survival.
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PMID:Zygomycosis in Qatar: a retrospective review of six cases. 1566 67

Zygomycosis refers to diseases caused by filamentous fungi from the class Zygomycetes. These organisms are ubiquitous in nature and can be found in soil as well as in decaying organic matter such as fruit and bread. Risk factors for zygomycosis include uncontrolled diabetes mellitus, hematologic malignancies, corticosteroid therapy, deferoxamine therapy, intravenous drug use, and malnutrition. Clinical manifestations include rhino-orbital-cerebral, pulmonary, cutaneous, disseminated, gastric, and isolated cerebral disease. Isolated involvement of the central nervous system is rare and is most often associated with intravenous drug use. This case report describes isolated cerebral zygomycosis in an intravenous drug user.
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PMID:Fever and headache in an intravenous drug user. 1617 12

Fifty-six patients with cerebral zygomycosis (mucormycosis) were seen during the period 1971-2001 in two tertiary care hospitals located in south India with tropical climate and catering to neurological diseases. Forty-four patients had rhinocerebral and twelve patients had isolated central nervous system (CNS) zygomycosis. Of these, ten were culture proven (Rhizopus oryzae in eight and Mucor in two); 30 were diagnosed as probable and 16 were diagnosed possible; mixed infections were seen in three patients. Diabetes mellitus was the predisposing condition in a majority (31/44) of patients with the rhinocerebral form of zygomycosis. The tissue obtained at biopsy/autopsy in either form showed necrotic/infarcted tissue with neutrophilic infiltration with broad non-septate hyphae showing irregular branching. The outcome was poor despite surgical excision and antifungal therapy. The high concentration of spores in a mouldy environment, the bird population and improper disposal of hospital waste may facilitate healthy hosts presenting with primary CNS disease.
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PMID:Cerebral zygomycosis. 1626 76

Mucormycosis is an uncommon infection caused by fungi of the class Zygomycetes, suborder Mucorales. It occurs predominantly in the immunodeficient host, the most common risk factor being diabetes mellitus. Pulmonary mucormycosis is a disease that is localized in the lungs or mediastinum. It usually presents in a fulminant manner, although a chronic presentation can also occur. We describe two cases of pulmonary mucormycosis in patients with diabetes mellitus, one with an acute and the other with a chronic presentation. A high level of clinical suspicion, combined surgical and medical therapy, and control of patient's underlying immunosuppression are the key to a successful outcome.
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PMID:Pulmonary mucormycosis: two of a kind. 1637 92

Peritoneal dialysis-associated peritonitis due to fungi of the class Zygomycetes occurs very rarely. A case of fungal continuous ambulatory peritoneal dialysis peritonitis due to Cunninghamella bertholletiae is reported in a 39-year-old Aboriginal woman with end-stage renal failure and diabetes mellitus. This isolate was found to be resistant in vitro to amphotericin B, 5-fluorocytosine, fluconazole, itraconazole, ketoconazole and voriconazole. However, this patient was successfully treated with voriconazole and removal of the Tenckhoff dialysis catheter. Zygomycoses are an emerging threat among immunocompromised patients, including those with chronic renal failure. Zygomycosis due to C. bertholletiae is frequently fatal and is often non-responsive to systemic antifungal therapy. This is believed to be the first reported case of C. bertholletiae causing peritonitis in humans and one of the minority of cases involving this organism with a successful outcome.
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PMID:Peritonitis due to Cunninghamella bertholletiae in a patient undergoing continuous ambulatory peritoneal dialysis. 1638 39

Acute alloxan diabetic rabbits were used in a survey of the potential ability of Absidia, Cunninghamella, Mucor, Rhizopus, Syncephalastrum, and Thamnidium species to cause cerebral zygomycosis (phycomycosis, mucormycosis). Specifically, the correlation of thermotolerance with potential pathogenicity was studied. The test organisms fell into two groups: those able to grow well at 39 C on Sabouraud dextrose agar and those unable to grow at that temperature. Isolates unable to grow at 39 C were not pathogenic. The nonpathogens were C. elegans, M. jansenni, R. reflexus, R. stolonifer, and T. elegans. Two isolates of S. racemosum and one isolate of A. corymbifera, although able to grow well at 39 C in vitro, did not invade the brain or lungs of acutely diabetic rabbits. Three species of Rhizopus, R. chinensis, R. microsporus, and R. oligosporus, all of which grew at 39 C and which had not been previously known to cause cerebral zygomycosis, were as pathogenic as the only two previously implicated disease agents, R. arrhizus and R. oryzae. Studies were also carried out to determine whether animals inoculated with spores of selected zygomycetes many hours prior to the onset of acute diabetes would develop cerebral zygomycosis. Approximately 50% of the rabbits that became acutely diabetic 72 to 90 hr after receiving R. oryzae spores by nasal instillation succumbed to cerebral zygomycosis. Our study indicates that several members of the genus Rhizopus that grow well at 39 C or higher, other than R. arrhizus and R. oryzae, are potential etiological agents of cerebral zygomycosis.
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PMID:Experimental cerebral zygomycosis in alloxan-diabetic rabbits I. Relationship of temperature tolerance of selected zygomycetes to pathogenicity. 1655 53

Invasive fungal infections are major medical complications in immunocompromised patients. The recent rise in the incidence of cancer and the increased use of newer medical treatment modalities, including organ transplantations, have resulted in growing numbers of highly immunosuppressed individuals. Although aspergillosis and candidiasis are among the most common invasive mycoses in such patients, there is evidence that the incidence of infectious diseases caused by Zygomycetes has risen significantly over the past decade. Patients with diabetes, malignancies, solid organ or bone marrow transplants, or iron overload and those receiving immunosuppressive agents, deferoxamine therapy, or broad-spectrum antimicrobial drugs are at highest risk for zygomycosis. This review details the emergence and importance of zygomycosis in current clinical practice and its manifestations and management. The etiologic species, pathogenesis and risk factors for zygomycosis are reviewed and updated. The clinical spectrum of zygomycosis is now broader, and it can be difficult to distinguish between mucormycosis and enthomophthoramycosis, both of which can manifest as disease ranging from a superficial infection to an angioinvasive infection with high mortality. Finally, the three-part treatment strategy (antifungal drugs, surgery, control of underlying diseases) is reviewed. Lipid formulations of amphotericin B are the antifungal agents of choice for treatment of zygomycosis. A novel antifungal triazole, posaconazole, has been developed and may become approved for treatment of zygomycosis. The clinical experience with adjunctive treatments like colony-stimulating factors, interferon-gamma, and hyperbaric oxygen therapy is still limited.
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PMID:Zygomycosis: the re-emerging fungal infection. 1656 97

Zygomycosis is an emerging infection worldwide. A study was conducted to understand its spectrum in the Indian scenario. All patients diagnosed for invasive zygomycosis at a tertiary care center in north India from 2000-2004, were retrospectively analyzed. A total of 178 cases (mean average of 35.6 cases/year) of zygomycosis were diagnosed. Rhino-orbito-cerebral type (54.5%) was the commonest presentation followed by cutaneous (14.6%), disseminated (9.0%), and gastrointestinal (8.4%) zygomycosis. Renal and pulmonary zygomycosis were seen in 6.7% patients each. Uncontrolled diabetes mellitus (in 73.6% of cases) was the significant risk factor in all types (Odds Ratio 1.5-8.0) except renal zygomycosis. Breach of skin was the risk factor in 46.2% patients with cutaneous zygomycosis. However, no risk factor could be detected in 11.8% patients. Antemortem diagnosis was possible in 83.7% cases. The commonest (61.5%) isolate was Rhizopus oryzae followed by Apophysomyces elegans in 27% patients. Combination of debridement surgery and amphotericin B therapy was significantly better in survival of the patients (P<0.005) than amphotericin B alone (79.6% vs. 51.7% survival). Thus, a rising trend of invasive zygomycosis was observed in patients with uncontrolled diabetes mellitus in India. Consistent diagnosis of renal zygomycosis in apparently healthy hosts and the emergence of A. elegans in India demand further study.
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PMID:The rising trend of invasive zygomycosis in patients with uncontrolled diabetes mellitus. 1677 27


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