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Query: UMLS:C0023418 (leukemia)
 93,477 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fungal infections are increasingly being reported in patients with acute leukaemia on intensive induction chemotherapy protocols. The common fungi seen are candida, aspergillus and mucormycosis. We have seen 3 cases of mucormycosis over the last 4 years. All 3 patients had acute leukaemia-two had acute lymphoblastic and one acute myeloid leukaemia. All patients were in neutropenic phase after induction chemotherapy. Features suggestive of fungal infection were fever and development or progression of pulmonary infiltrates despite antibiotic therapy. Repeated body fluid cultures were negative in two patients. In the first patient, the diagnosis was confirmed after biopsy of a palatal mass; he was treated successfully with amphotericin-B. In two patients the diagnosis was confirmed at autopsy. A high degree of suspicion in febrile, neutropenic cancer patients on chemotherapy and early administration of amphotericin-B may improve the outcome. With dissemination, the prognosis is poor.
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PMID:Phycomycosis infection in acute leukaemia. 208 86

Mucormycosis (synonymous with phycomycosis and zygomycosis) is a devastating fungal infection which usually involves patients with diabetes mellitus, often complicated by ketoacidosis, and malignant neoplasms, commonly leukemia and lymphoma. Clinical manifestations include rhinocerebral, pulmonary, disseminated, isolated cerebral, gastrointestinal and cutaneous disease. Common to all forms of mucormycosis is vascular invasion with production of necrotic tissue. The diagnosis is achieved by demonstrating broad, non-septate hyphae with right-angle branching in a tissue biopsy specimen. Successful treatment consists of early diagnosis, intensive systemic antifungal therapy with amphotericin B, aggressive surgical debridement and control of the underlying disease. In our experience with mucormycosis at Huntsville Hospital, the patients were immuno- compromised and the infection was restricted to the lung. Despite use of amphotericin B in all patients, the only one who survived underwent surgical section of infected tissue.
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PMID:Mucormycosis: a community hospital perspective. 223 27

Rhinocerebral mucormycosis is a rare and fatal deep fungus infection occurring in debilitated patients. Its reports have been recently increased because of the increase of such conditions as uncontrolled diabetics, leukemia, and cancer. A 60-year-old male suffering from continuous headache and fever was diagnosed as meningitis, and repeated culture of cerebrospinal fluid was negative. Antibiotic therapy was ineffective. CT scan revealed brain abscess in the right frontal lobe and bone defect over the right posterior ethmoidal sinuses. Both maxillary and ethmoidal sinuses were operated on 38 years ago. The patient was suspected to have rhinologic brain abscess. We intended to remove the source of infection in the right posterior ethmoidal sinuses beneath the base of the skull and to repair the defect of dura mater. The operation was tried on the 6th hospital day. There was a cyst in the posterior ethmoidal sinuses and an intact denuded dura mater over the cyst. The causative organism was not detected by smear test, bacteriological and fungal culture. He relapsed into lethargy, and died on the 21st hospital day due to the vast cerebral infarction. Autopsy revealed rhinocerebral mucormycosis. The literature on this disease was also reviewed and discussed.
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PMID:[Phinocerebral mucormycosis--report of a case]. 229 52

A multicenter clinical study of fluconazole was conducted at 41 hospital sites in Japan. Fluconazole was administered orally or intravenously at daily doses of 50 to 400 mg to 199 patients with deep-seated mycoses. Clinical efficacy was evaluable in 125 of these patients. Most cases were complicated with serious underlying diseases such as cancer, leukemia, or AIDS. Clinical cures were achieved in 56 (87.5%) of 64 cases of candidiasis, in 11 (68.8%) of 16 cases of cryptococcosis, in 19 (44.2%) of 43 cases of aspergillosis, and in one case each (100%) of mucormycosis and fungemia due to an unspecified yeast. Eradication rates of causative fungi were 87.9% in Candida spp., 62.5% in Cryptococcus neoformans, and 52.2% in Aspergillus spp. Side effects were observed in 13 cases, with an incidence rate of 6.5%. In most cases fluconazole was well tolerated. Changes in laboratory test values due to the drug were reported in 35 patients with an incidence rate of 17.6%. The changes were minor and transient; primarily increases in liver enzyme. Fluconazole is a useful antifungal agent for the treatment of systemic deep-seated mycoses.
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PMID:A clinical study of fluconazole for the treatment of deep mycoses. 255 41

Nineteen cases of intracranial abscesses secondary to infection of the midface are reported. The most common underlying cause was bacterial sinusitis. Other etiologic factors included mucormycosis following steroid therapy, Wegener's granulomatosis, nasal dermoid cyst and sinus tract, tooth abscesses, aspergillosis following chemotherapy for leukemia, squamous cell carcinoma of the frontal sinus, infected methylmethacrylate plate for a prior skull fracture, and a case of gauze packing left in the sinus following surgery. Anaerobic organisms were the predominant cause of the abscesses. The most dangerous intracranial complication was subdural abscess, which occurred in seven patients in this series. Three of them died. Four cases of frontal and parietal lobe abscesses were treated with systemic antibiotics only. This approach has not been well emphasized in our literature. Steroid therapy should not be used for the treatment of sinus and orbital infections. It can result in dreadful complications. The overall mortality rate in this series was 21% (4 of 19), despite aggressive treatment and close cooperation between the neurosurgeon, otolaryngologist, and other specialists. Early diagnosis and adequate treatment are paramount.
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PMID:Intracranial abscesses secondary to nasal, sinus, and orbital infections in adults and children. 257 80

Melioidosis is an infection of humans and animals caused by a gram-negative motile bacillus, Pseudomonas pseudomallei. Forty-nine patients with melioidosis complicating diabetes mellitus, collagen vascular disorders, leukemia/lymphoma, and other hematologic malignancies are described. Twenty-nine of these patients had disseminated/septicemic infection, two developed toxic shock syndrome, and one with AIDS experienced recrudescent melioidosis. Patients with disseminated melioidosis often have a variety of defects in cellular immunity both in vitro and in vivo. In humans with recrudescent melioidosis, cellular immunity can be transferred by a transfer factor and by levamisole, a cellular immunopotentiating agent. The results of the treatment of our patients with disseminated/septicemic melioidosis with antimicrobial agents in combination have been successful. In recent years, four cases of fungal arteritis due to Pythium species and one case of keratitis due to Pythium were seen. Almost all patients with fungal arteritis had thalassemia; all presented with pain in the lower extremities and gangrenous lesions of the toes. Pythium species, an aquatic Phycomycetes, was identified in these cases as a human pathogen on the basis of clinical features, pathologic findings, and--of greatest importance--the isolation of the etiologic fungi. These five cases with remarkably similar presentations exhibited certain similarities with and differences from cases of mucormycosis, entomophthoromycosis, and peniciliosis.
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PMID:Tropical disease in the immunocompromised host: melioidosis and pythiosis. 260 81

Cerebral mucormycosis is a rare disorder caused by several genera of the family Mucoraceae. The genera Rhizopus, Absidia, and Mucor are the predominant pathogenic groups. Disease caused by these organisms usually complicates an underlying chronic illness, such as diabetes mellitus or malignancy. Cerebral involvement usually occurs from an ascending infection from the paranasal sinuses via the orbit and is usually associated with poorly controlled diabetes. The pulmonary system is the most common site of infection in patients with leukemia. Isolated cerebral mucormycosis not associated with head trauma or intravenous drug abuse is a rare disorder. We report what we believe to be the first successfully treated case of isolated cerebral mucormycosis in a patient with acute lymphocytic leukemia in remission.
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PMID:Survival after isolated cerebral mucormycosis. 278 63

Mucormycosis is an opportunistic invasive infection caused by fungi of the order Mucorales. Rhizopus, Absidia, and Mucor are the most commonly encountered genera. Disease is characterized by vascular invasion, thrombosis, and tissue necrosis. Rhinocerebral disease is the most common manifestation but pulmonary, cutaneous, gastrointestinal, and widely disseminated forms have been reported. Pulmonary and disseminated disease are usually seen in neutropenic patients with leukemia or lymphoma. Both present as fever and unexplained pulmonary infiltrates unresponsive to antibacterials and corticosteroids. Disease is usually fulminant and has a high mortality rate. Diagnosis is most commonly made at autopsy. A single case of disseminated disease is reported that is unusual in its subacute course and its occurrence in an otherwise healthy non-neutropenic diabetic male.
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PMID:Subacute disseminated mucormycosis in a diabetic male. 280 59

A twelve year old boy with acute lymphoblastic leukemia was treated with combination chemotherapy. Two weeks later a cellulitis of the left upper and lower eyelid appeared, followed by a rapidly increasing, deep necrotic inflammation of the periorbital area leading to proptosis. Mucormycosis was identified by histology and microbiology. The spreading inflammatory process was arrested by amphotericin B in a total dose of 1.2 g combined with a drainage of the necrotic tissue of the paranasal sinus, left orbit and bifrontal cerebral abscess. The patient is still in complete continuous remission four years later but a large defect of the nasal, maxillary and orbital area remains. This case demonstrates that the usual fatal outcome of mucormycosis in leukemia is curable with amphotericin B and aggressive surgery.
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PMID:[Rhinocerebral mucormycosis as a complication of cytostatic therapy]. 346 78

A young woman with acute myelocytic leukemia developed acute lower gastrointestinal bleeding immediately after a first remission induction of her leukemia. After the site of bleeding was located in the descending colon, a necrotic bleeding ulcer was resected. Histologic examination of the ulcer established the diagnosis of gastrointestinal mucormycosis. Treatment with amphotericin B was administered because of the high risk of dissemination. The patient has been followed for 9 months with no evidence of relapse of infection. Survival after gastrointestinal mucormycosis in acute leukemia has not previously been reported in the English language literature. Success in managing mucormycosis depends on the adherence to the recommended principles of early aggressive diagnostic measures, excisional surgery, amphotericin B therapy, and control of the underlying predisposing condition.
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PMID:Survival after intestinal mucormycosis in acute myelogenous leukemia. 349 Sep 2


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