Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Aspergillosis, cryptococcosis and zygomycosis (mucormycosis) are overall the most common systemic mycoses but histoplasmosis is particularly endemic in parts of central USA and other areas worldwide. Orofacial lesions caused by systemic mycoses have rarely been reported in the past though they have been recorded particularly in outdoor workers from geographic areas with a high prevalence of infection and occasionally in immunocompromised individuals. Increasing world-wide travel, and the dramatic increase in numbers of immunocompromised persons, especially those with human immunodeficiency virus (HIV) disease, have been responsible for an increase in reports and other studies of orofacial disease in systemic mycoses and new opportunists are now being recognized. Those in Oral Medicine and Pathology must now be aware of the possibility of a systemic mycosis as the cause of chronic oral ulceration, chronic maxillary sinus infection, or bizarre mouth lesions, especially in patients with HIV disease, lymphoproliferative disorders, or diabetes mellitus, or in those who have been in endemic areas. Diagnosis and management should be undertaken in consultation with a physician with appropriate expertise, as pulmonary and other systemic infection may well be present. This paper reviews the eight main systemic mycoses.
 ...
PMID:Orofacial manifestations of the systemic mycoses. 152 29

Mucormycosis (phycomycosis) is an acute and often fatal infection, mostly seen in diabetics and immunocompromised patients, and seldom in healthy people. Therapy includes aggressive surgical debridement, amphotericin B and control of underlying predisposing condition (diabetes, immunosuppression or immunodeficiency). The rhino-sinuso-orbital presentation is typically observed in insulin-dependent diabetes mellitus with ketoacidosis. This metabolic condition may impair the polymorphonuclear function in a reversible way and this may favour infection by a mucoral. These spores germinate into hyphae, which invade local arteries and arterioles, causing thrombosis, vascular insufficiency and tissue hypoxia and acidosis, conditions which further enhance fungal growth. Hyperbaric oxygen has theoretical value in treating mucormycosis, since it reduces tissue hypoxia caused by the vascular insufficiency. We report an insulin-dependent diabetic patient with rhino-sinuso-orbital mucormycosis, who after being treated with amphotericin B and surgical debridement on two occasions, maintained clinical and tomographic evidence of active infection, and mucoral persistence in the lesion. An aggressive surgical debridement, using microsurgical techniques, was performed. Amphotericin B was increased up to a total dose of 3900 mg. (he had previously received 2900 mg) and hyperbaric oxygen was added as adjunctive treatment. The outcome was successful. There was no evidence of relapse after a 16-month follow-up. This observation would confirm the usefulness of hyperbaric oxygen as adjunctive therapy in mucormycosis.
 ...
PMID:[Adjunctive treatment with hyperbaric oxygen in a patient with rhino-sinuso-orbital mucormycosis]. 192 93

Mucormycosis is an uncommon infection caused by fungi of the order Mucorales. During an 8-year period, mucormycosis was diagnosed in 13 patients from three Madrid hospitals. There were 8 males and 5 females, with ages ranging from 21 to 75 years (mean 45 years). There were several underlying diseases, and 4 patients had more than one. Five had diabetes mellitus, 4 chronic renal failure, 2 acute myeloblastic leukemia, 2 were narcotic abusers and were infected by the human immunodeficiency virus (HIV), 1 had non-Hodgkin's lymphoma, 1 was a carrier of a renal allograft and 1 had systemic necrotizing vasculitis. There were different clinical presentations: rhino-orbital in 3, paranasal in 2, cutaneous in 2, pulmonary in 2, primary cerebral in 2, rhinocerebral in 1, and peritoneal in 1. The diagnosis was made during the first week in 6 patients, in the second week in 4, and it was delayed for more than one month in 2. Fresh examination of clinical samples was carried out in 3 patients and hyphae were visualized in all 3. Cultures were taken in 10 patients and they were positive in 7. All isolates were identified as Rhizopus sp. One patient died within 24 hours without being treated, 12 were treated with amphotericin B and 9 received surgical therapy. Six patients (46%) died. The involvement of central nervous system and the absence of surgical therapy were associated with a poor outcome. These results indicate that mucormycosis can develop in several clinical contexts and has a varying clinical presentation. It is a potentially curable infections when early diagnosed and appropriately treated.
 ...
PMID:[Mucormycosis. The disease spectrum in 13 patients]. 239 7

30 cases of autopsies of patients who died after human renal allografts were studied. The incidence of infection was 60% and the lethal infectious complications amounted to 43%. The most common infectious agents were bacteria, including mycobacterium tuberculosis. In addition, some opportunistic agents, such as Cryptococcus, Aspergillus, mucormycosis, Pneumocystis carinii and cytomegalovirus were also found. All these patients had a history of receiving large dosage of immunosuppressive drugs such as cyclophosphamide, azathioprine, prednisone and dexamethasone after renal allografts. Pathological changes showed marked atrophy of lymphoid tissue and it was compatible with the histologic appearance of immunodeficiency. It is concluded that overuse of immunosuppressive drugs impairs the function of the immune system causing acquired immunodeficiency. Pathological features of lesions caused by the aforementioned infectious agents are also described in this paper.
 ...
PMID:[Pathologic changes of infections in patients after receiving immunosuppressive therapy in renal allografts]. 258 55

A 24-year-old man with an 11-year history of i.v. drug use rapidly developed parkinsonism clinically indistinguishable from MPTP toxicity and Parkinson's disease. Although tests were negative for the human immunodeficiency virus, radiologic evaluation revealed bilateral striatal lesions. Stereotactic biopsy demonstrated septate hyphae consistent with either aspergillosis or mucormycosis. Gradual improvement followed systemic therapy with amphotericin B.
 ...
PMID:Parkinsonism secondary to bilateral striatal fungal abscesses. 281 92

The therapy of rhinocerebral mucormycosis includes aggressive surgical debridement, administration of high-dose amphotericin B, and control of underlying predisposing conditions, especially diabetes and immunosuppression or immunodeficiency. Hyperbaric oxygen suppresses fungal growth in vitro and has theoretical value in treating mucormycosis because it reduces the tissue hypoxia and acidosis that accompany vascular invasion by the fungus. In a retrospective review of patients at Duke University Medical Center with rhinocerebral mucormycosis, six patients were treated with hyperbaric oxygen and seven cases (involving six patients) were treated without hyperbaric oxygen. All patients received surgical debridement and amphotericin B. Two of six patients receiving hyperbaric oxygen therapy died, and four of seven patients not receiving hyperbaric oxygen therapy died. Adverse effects from hyperbaric oxygen were minimal. Because mucormycosis occurs infrequently, this retrospective review involved a small number of patients. Despite this limitation, adjunctive hyperbaric oxygen appears to be a promising clinical modality for the treatment of rhinocerebral mucormycosis and warrants further investigation.
 ...
PMID:Adjunctive hyperbaric oxygen for treatment of rhinocerebral mucormycosis. 339 82

The 15th reported case of isolated renal mucormycosis (infection of the kidney with fungus of the order Mucorales, in the absence of infection elsewhere in the body) is presented. The patient was a 36-year-old human immunodeficiency virus-infected man, actively using iv drugs, who suffered 6 wk of flank pain and fever before diagnosis was made by percutaneous renal biopsy. He received 4 months of amphotericin B treatment, then no therapy for 6 months before dying with no evidence of mucormycosis. Isolated renal mucormycosis should be suspected in those with an underlying immunocompromising illness or history of iv drug use who have persistent flank pain and fever, but sterile urine cultures. Computed tomographic scanning with contrast should then be performed; findings of severe inflammation or bacterial infection, despite an indolent clinical course with sterile or nondiagnostic urine and blood cultures, are suggestive of isolated renal mucormycosis, and renal biopsy under computed tomographic guidance should be performed, despite the potential risk of disseminated infection. Although our patient was treated with amphotericin B alone, nephrectomy with or without amphotericin B therapy appears to be more likely to cure infection and relieve pain and constitutional symptoms.
 ...
PMID:Isolated renal mucormycosis: case report and review. 757 48

We report three cases of zygomycosis (mucormycosis) occurring in three individuals infected with the human immunodeficiency virus (HIV) and review 12 other published cases. We present the only two case reports of disseminated zygomycosis in AIDS patients, and the only AIDS patient with renal zygomycosis to survive without nephrectomy, receiving intravenous (i.v.) amphotericin alone. Coinfection with zygomycosis and HIV is rare, occurs primarily in patients with low CD4+ lymphocyte counts, does not always require the usual predisposing conditions for zygomycosis, and may be the presenting opportunistic infection among HIV-infected persons. Transient episodes of neutropenia occurring within 4 months before presentation may be a risk factor for this disease. Zygomycosis may arise in multiple sites including the basal ganglia, cutaneous tissue, kidney, respiratory tract, and may be disseminated. Occurring more commonly in, but not restricted to, injection drug users, it is significantly associated with sites other than basal ganglia in those patients with advanced HIV disease or AIDS. The presenting symptoms are related to the site of involvement, and the illness may develop insidiously or progress rapidly to a fulminant course. Successful therapy usually consists of surgical debridement and intravenous amphotericin B. Overall mortality in this review is 40%, and is significantly associated with sites of disease inaccessible to surgical debridement.
 ...
PMID:Zygomycosis (mucormycosis) and HIV infection: report of three cases and review. 758 40

We describe three cases of cerebral mucormycosis in intravenous drug users and review 22 previously reported cases. Involvement of the basal ganglia was demonstrated in all but two cases. Seven of the 10 patients tested for antibodies to the human immunodeficiency virus (HIV) were seronegative. Eight of the 25 patients survived and were discharged from the hospital; for 7 of 10 patients, cultures of brain lesions yielded Rhizopus arrhizus. The radiographic findings varied, and in most cases, no or minimal contrast enhancement was seen in the initial computed tomography scans. Although uncommon, the diagnosis of cerebral mucormycosis should be considered when basal ganglia lesions are present in an intravenous drug user, regardless of previous exposure to HIV.
 ...
PMID:Cerebral mucormycosis associated with intravenous drug use: three case reports and review. 858 85

Cerebral mucormycosis (without associated involvement of and invasion from the nasal sinuses and turbinates) is an extremely rare opportunistic infection of the central nervous system. We report the case of an intravenous drug abuser (who was negative for the human immunodeficiency virus) who presented with hemiparesis on the right side, slurred speech, altered mental status, and an unsteady gait. Imaging studies revealed a large left-side basal ganglia lesion. A stereotactic biopsy obtained a tissue sample that revealed wide, nonseptated hyphal fragments with granulomatous inflammation. The patient was treated with 3 gm of amphotericin B during a 5-month period. The patient had no residual neurological dysfunction after treatment. Open surgical resection was not employed. This case suggests that stereotactic biopsy followed by long-term amphotericin B therapy, in lieu of open surgical resection, represents a viable treatment option for this rare disorder.
 ...
PMID:Isolated cerebral mucormycosis: case report and therapeutic considerations. 775 68


1 2 3 4 5 Next >>