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Query: UMLS:C0027947 (neutropenia)
 17,527 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe the case of a 19-year-old boy with acute leukaemia who developed primary hepatic zygomycosis. The patient presented with febrile neutropenia and severe abdominal tenderness. Despite the administration of antibiotics and liposomal Amphotericin-B (L-AmB), the CT scan demonstrated an increase in the size of liver lesions. A wide surgical resection was carried out and liver specimens demonstrated a branching, filamentous fungus that was identified as Rhizomucor pusillus by both phenotypic and molecular methods. The patient was treated with L-AmB combined with posaconazole, and deferasirox was subsequently added given the potential synergistic effect of this iron chelator in combination with L-AmB. Three months after surgical intervention, an allogeneic stem-cell transplantation was successfully carried out. The present case confirms that an early surgical management combined with antifungal agents is crucial to optimise the outcome of patients with zygomycosis and the use of deferasirox is a promising alternative.
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PMID:Combined antifungal therapy, iron chelation and surgical resection as treatment of hepatic zygomycosis in a patient with haematological malignancy. 1930 58

Infection is a major cause of death in patients with aplastic anemia (AA). There are differences between the immunocompromised state of a patient with AA and the patient who is neutropenic due to chemotherapy and this leads to a difference in the infections that they incur. Prolonged neutropenia is one of the largest risk factors for the development of infections with the invasive mycoses and bacteria. Recovery from neutropenia is directly related to survival, and supportive care plays a large role in protection while the patient is in a neutropenic state. The most common invasive mycoses include the Aspergillus species, Zygomycetes, Candida spp., and Fusarium spp. Bacterial infections that are seen in patients with AA include gram-positive coagulase-negative Staphylococcus species, Enterococcus, Staphylococus aureus, Clostridium spp., Micrococcus, alpha-hemolytic streptococci, Listeria monocytogenes, and Bacillus cereus. Gram-negative infections including gram-negative bacilli, Escherichia coli, Salmonella, Bacteroides fragilis, Klebsiella oxytoca, Klebsiella pneumonia, Aeromonas hydrophilia, Pseudomonas aeruginosa, and Vibrio vulnificus. Viral infections are much less common but include those that belong to the Herpesviridae family, community-acquired respiratory viral infection, and the viral hepatitides A, B, and C. Evidence of the parasite Strongyloides stercoralis has also been documented. This review discusses the major invasive fungal infections, bacterial pathogens, parasites, and viral infections that are found in patients with AA who are treated with immunosuppressive therapy. The specific immune impairment and current treatment parameters for each of these classes of infection will also be discussed.
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PMID:Infections in patients with aplastic anemia. 1954 79

Caspofungin is the first echinocandin to be approved for the treatment of fungal infections in pediatric patients. The antifungal properties of caspofungin result from interference with fungal cell-wall integrity. In vitro, caspofungin is fungicidal against Candida spp. and fungistatic against Aspergillus spp., but has little or no fungicidal or fungistatic activity against Cryptococcus neoformans, the Zygomycetes, Fusarium spp., or Trichosporon beigelii. Caspofungin was effective as empirical antifungal therapy in pediatric patients with persistent fever and neutropenia. Almost half (46%) of caspofungin recipients and one-third (32%) of liposomal amphotericin B recipients achieved an overall favorable response in a randomized, double-blind trial. Caspofungin was also effective in pediatric patients with fungal infections (invasive candidiasis, invasive aspergillosis refractory to or intolerant of standard antifungal agents, or esophageal candidiasis). Positive responses to treatment were seen in 30 of 37 patients with invasive candidiasis, 5 of 10 patients with invasive aspergillosis, and in the one patient with esophageal candidiasis, in a noncomparative, open-label trial. Caspofungin was generally well tolerated in the clinical trials in pediatric patients with febrile neutropenia requiring empirical antifungal treatment, or with fungal infections. Few caspofungin recipients reported serious drug-related adverse events or discontinued treatment as a result of drug-related adverse events.
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PMID:Caspofungin: in pediatric patients with fungal infections. 1956 10

Zygomycetes are filamentous fungi with a worldwide distribution. This class of fungi encompasses two orders, i.e. the Mucorales and the Entomophthorales. Members of the latter are associated with chronic cutaneous and subcutaneous infections that are limited to the tropics and rarely disseminate to internal organs. The order Mucorales includes several species involved in rhinocerebral, pulmonary, cutaneous, gastrointestinal and other less frequent infections in immunocompetent and immunocompromised individuals, and is characterized by a tendency to disseminate. Portals of entry of zygomycetes are usually the lungs, skin, and gastrointestinal tract. A characteristic property of zygomycetes is their tendency to invade blood vessels and to cause thrombosis-processes that result in subsequent necrosis of involved tissues. Risk factors associated with zygomycosis include prolonged neutropenia and use of corticosteroids, solid organ or haematopoietic stem cell transplantation, AIDS, poorly controlled diabetes mellitus, iron chelation with deferoxamine, burns, wounds, malnutrition, extremes of age, and intravenous drug abuse. Recently, the widespread use of voriconazole for prophylaxis or treatment of aspergillosis in patients with haematological malignancies has been linked with a rise in the numbers of cases of invasive zygomycosis. As the symptoms, clinical signs and imaging findings of these infections are non-specific, a high index of suspicion is required for timely diagnosis. Early diagnosis, correction of the underlying predisposing factors, aggressive surgical debridement of all infected tissues and lengthy administration of antifungals are the only potentially curative options for this rare but emerging invasive fungal infection.
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PMID:Clinical presentation of zygomycosis. 1975 51

Zygomycosis constitutes the third leading cause of invasive fungal infections following aspergillosis and candidosis. Patients with haematologic malignancies or haematopoietic stem cell transplantation are particularly susceptible to zygomycosis. Neutropenia represents the most important pathogenic mechanism influencing the onset and outcome of zygomycosis. Neutrophils cause a lesion of the fungal wall with subsequent destruction by macrophages. They also enhance the activity of antifungal drugs against Zygomycetes. Strategies that aim to increase neutrophil count and function, such as granulocyte colony stimulating factor and granulocyte transfusion, could play an important role in the management of this life-threatening infectious complication.
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PMID:The role of neutrophils in the development and outcome of zygomycosis in haematological patients. 1975 54

Rhinocerebral or rhino-orbitocerebral (mucormycosis) zygomycosis (ROCZ) usually occurs among patients with poorly controlled diabetes mellitus (especially those with ketoacidosis), solid malignancies, iron overload or extensive burns, in patients undergoing treatment with glucocorticosteroid agents, or in patients with neutropenia related to haematologic malignancies. The disease process starts with inhalation of the fungus into the paranasal sinuses. The fungus may spread to invade the palate, sphenoid sinus, cavernous sinus, orbits or cranially to invade the brain. Pain and swelling precede oral ulceration and the resulting tissue necrosis can result in palatal perforation. Infection can sometimes extend from the sinuses into the mouth and produce painful, necrotic ulcerations of the hard palate. If untreated, infection usually spreads from the ethmoid sinus to the orbit, resulting in the loss of extraocular muscle function and proptosis. Surgical treatment includes the resection of involved tissues of the face, including skin and muscle, any skin of the nose that is involved, maxillary and ethmoid sinuses, necrotic tissue of the temporal area and infratemporal fossa, and orbital exenteration. The keys to successful therapy include suspicion of the diagnosis and early recognition of the signs and symptoms, correction of underlying medical disorders such as ketoacidosis, and aggressive medical and surgical intervention.
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PMID:Orbitomaxillary mucormycosis (zygomycosis) and the surgical approach to treatment: perspectives from a maxillofacial surgeon. 1975 67

We report the clinical and pathological findings of an unusual invasive fungal infection in a 13-year-old girl with T-NHL. The diagnosis of disseminated Zygomycosis was made four days after onset of clinical symptoms. Risk factors for Zygomycosis were prolonged neutropenia, corticosteroids, and steroid induced diabetes mellitus.
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PMID:Zygomycosis in a 13 year old girl with T-NHL. 1989 Jul 92

Invasive Zygomycetes infection complicating prolonged neutropenia is associated with high mortality in the absence of immune recovery. We report a patient who developed disseminated zygomycosis due to Rhizopus microsporus during induction chemotherapy for acute myeloid leukemia. Rescue allogeneic hematopoietic stem cell transplantation (allo-HSCT) was performed as her only chance of cure of this infection and to treat refractory leukemia. Posaconazole combined with liposomal amphotericin B contained the zygomycosis during prolonged neutropenia due to allo-HSCT followed by intense immunosuppression for grade IV acute graft-versus-host disease. Surgical removal of all infected sites after immune recovery, with prolonged posaconazole treatment, ultimately cured the infection. New combination antifungal therapies might sufficiently control disseminated zygomycosis to allow allo-HSCT to be performed, assuring life-saving immune recovery. Surgery appears to be necessary for definite cure of these infections.
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PMID:Disseminated Rhizopus microsporus infection cured by salvage allogeneic hematopoietic stem cell transplantation, antifungal combination therapy, and surgical resection. 2016 67

Zygomycosis (mucormycosis) is a rare but highly invasive infection caused by fungi belonging to the order Mucorales, which includes the genera Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Saksenaea, Cunninghamella, Cokeromyces and Syncephalastrum. This type of infection is usually associated with hematologic diseases, diabetic ketoacidosis and organ transplantation. The most common form of presentation is rhinocerebral mucormycosis, with or without pulmonary involvement. Pulmonary zygomycosis is more common in patients with profound, prolonged neutropenia and can present as segmental or lobar infiltrates, isolated nodules, cavitary lesions, hemorrhage or infarction. The clinical and radiological manifestations are often indistinguishable from those associated with invasive aspergillosis. This article describes the general characteristics of pulmonary zygomycosis, emphasizing laboratory diagnosis, and illustrates the morphology of some lesions.
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PMID:Chapter 7: zygomycosis. 2020 16

Candidiasis and aspergillosis are the most frequent mycosis in patients with febrile neutropenia. Other infections caused by emergent yeast-like organisms, such as hyalohyphomycosis, Fusarium disease and scedosporiosis, phaeohyphomycosis (caused by pigmented mycelia) and zygomycosis are becoming more frequent. The management of documented fungal infections should consider several aspects, such as clinical patterns, the patient's clinical condition, the species involved, in vitro sensitivity and the suitable treatment duration, apart from the selection of the drug and suggested regimen. Though new drugs have been developed, the therapeutic armory is still very limited. Combined treatments are promising, but their use is not yet standardized.
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PMID:[Specific antifungal treatment in patients with neutropenia and fever: current status of the fungicidal activity of caspofungin]. 2049 Mar 79


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