Diagnosis Of Pulmonary Mucormycosis Research Articles

Performance of Mucorales spp. qPCR in bronchoalveolar lavage fluid for the diagnosis of pulmonary mucormycosis.

To estimate the diagnostic performance of Mucorales polymerase chain reaction (PCR) in Bronchoalveolar lavage fluid (BALF) in routine practice. This was a single-center retrospective study including all consecutive patients>18 years who underwent Mucorales PCR assay in BALF between January 2021 and May 2022. Index testing was prospectively performed using the MycoGENIE Aspergillus spp.-Mucorales spp. PCR. The reference was the diagnosis of pulmonary mucormycosis by the Adjudication Committee. Mucorales PCR in BALF was performed for 938 patients and was positive for 21 of 938 (2.2%). Eleven pulmonary mucormycosis (including one disseminated) were diagnosed. Among them, one (9.1%) was classified as proven mucormycosis, three (27.3%) as probable, and seven (63.6%) as possible according to the EORTC/MSGERC 2019 criteria. The main host factor was hematological malignancy (10 of 11, 90.9%). Mucorales PCR was positive in serum for eight patients (72.7%). Three patients had positive PCR in BALF, but negative in serum. The mean cycle threshold value was significantly lower in mucormycosis than false-positive cases. Sensitivity was 72.7% (95% confidence interval [CI], 43.4-90.3%), and specificity was 98.6% (95% CI, 97.6-99.2%). The positive and negative predictive values were 38.1% (95% CI, 20.8-59.1%) and 99.7% (95% CI, 99.1-99.9%), respectively. Mucorales PCR in BALF showed good diagnostic performance for mucormycosis, particularly in combination with serum PCR. A positive result should be interpreted with caution, given the possibility of carriage in the airway. However, its high negative predictive value and specificity suggest the utility of Mucorales PCR in BALF in the diagnosis of pulmonary mucormycosis.

Pulmonary mucormycosis in post-pulmonary tuberculosis as an emerging risk factor: A rare case report

Pulmonary mucormycosis is an uncommon pulmonary fungal disease, which is commonly seen in immunocompromised individuals. It is caused by fungi of class Zygomycetes. It constitutes the third most common invasive fungal infection following aspergillosis and candidiasis. Risk factors include patients with hematological malignancies, diabetes mellitus, and immunocompromised states. It is difficult to diagnose early due to non-specific clinical presentation and delay in treatment associated with greater mortality. As we know that Tuberculosis and HIV are highly prevalent in country like India. Post pulmonary tuberculosis is emerging as a risk factor for Pulmonary mucormycosis in the developing countries like India. Patients with non-resolving pneumonia are generally misdiagnosed as Pulmonary tuberculosis. The diagnosis of Pulmonary Mucormycosis is based upon demonstration of fungal hyphae in the clinical specimen. We highlight the importance of clinical suspicion in these cases for early diagnosis and early treatment initiation can reverse morbidity and mortality associated with Pulmonary Mucormycosis. We report 2 cases of Pulmonary mucormycosis present in post-pulmonary tuberculosis patients.

How could hypoglycemia-inducing glycogen storage disease lead to hyperglycemia-induced mucormycosis?

Mucormycosis is an increasingly frequent, difficult to diagnose, difficult to treat, often fatal infection, especially in patients with hyperglycemia from uncontrolled diabetes. Type I (von Gierke) glycogen storage disease is due to inherited deficiency of enzymes in glycogen metabolism, which causes hypoglycemia. This report is the case of a patient with von Gierke disease and a missed diagnosis of pulmonary mucormycosis. This report illustrates the importance of having a high index of suspicion for mucormycosis in the appropriate clinical context.

Successful Treatment of Pulmonary Cunninghamella Bertholletiae Infection With Liposomal Amphotericin and Posaconazole in an Elderly Male With Psoriatic Arthritis on Immunosupression

SESSION TITLE: Unusual Pulmonary Infections SESSION TYPE: Global Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Cunninghamella bertholletiae is a species of zygomycetous fungi in the order Mucorales. It is a saprophytic and ubiquitous fungus found mainly in soil.It is an opportunistic fungal infection seen predominantly in immunocompromised patients,people with leukemia and uncontrolled diabetes causing extremely high mortality rate. Cunninghamella bertholletiae infections are often highly invasive, and can be difficult to treat making prompt and accurate diagnosis of this pathogen an important medical concern.Disseminated infections have also been seen in renal and hepatic transplant patients.Infection usually occurs through traumatic introductions into the body (i.e. through a wound). CASE PRESENTATION: 68 year old male patient came with complaints of high grade fever, cough and shortness of breath grade ΙΙ of 10 days duration.Patient had history of psoriatic arthritis for 3 years and was on multi-drug immunosuppression including corticosteroids,methotrexate,leflunomide.He had type 2 diabetes mellitus of 20 years duration.Lung infection was suspected and immunosuppressive therapy was stopped.Patient had hyoxia and required oxygen support, initially 5L/min later increased to 15L/min.He was put on broad spectrum antibiotics including Meropenem,Clarithromycin .CT chest showed B/L extensive subpleural and peribronchovascular ground glass attenuation with septal thickening and areas of consolidation. Bronchoscopy was performed, BAL for fungal stain showed plenty aseptate, branching broad hyphae suggestive of zygomycetes infection. Liposomal amphotericin was started in the dose of 5mg/kg/day. Patient was closely monitored in ICU over the next 10 days in view of persistent hypoxia,tachycardia,tachypnoea and worsening of chest X-ray shadows.He also received intermittent NIV support through face mask.Syrup Posaconazole was added to the regimen after 3 days of starting amphotericin as he continued to have high grade fever.Bronchial wash was negative for bacterial culture,but fungal culture grew Cunninghamella bertholletiae.After 1 week, patient was slowly weaned off from NIV support and required lesser oxygen.Antifungals were continued, he was shifted out of ICU after 14 days with minimal oxygen support.Patient showed significant clinical and radiological improvement and was closely monitored with renal and electrolyte parameters for potential complications of Amphotericin therapy. DISCUSSION: Mucormycosis is manifested by a variety of syndromes in humans, particularly in patients receiving glucocorticoids[1] and those with diabetes mellitus [2].Devastating rhino-orbital-cerebral and pulmonary infections are the most common syndromes caused by these fungi.Pulmonary mucormycosis is a rapidly progressive infection that occurs after inhalation of spores into the bronchioles and alveoli. The diagnosis of pulmonary mucormycosis is difficult since the presentation does not differ from pneumonia due to other angioinvasive molds. Chest radiographs or CT scans may demonstrate focal consolidation, masses, pleural effusions, or multiple nodules [3] but are nonspecific.Dedicated team of pulmonologists and microbiologists with aggressive search for the causative agent and prompt initiation of antifungals is required. CONCLUSIONS: Invasive fungal infections should be suspected in immunocompromised patients and aggresive search for the causative organism should be employed at the earliest.If sputum is non-representative,bronchoscopy and BAL should be done early in the course of the disease,as later on, severe hypoxia might hinder any invasive procedures,increasing the risk of respiratory failure during bronchoscopy. Multidisciplinary approach in consultation with pulmonologist, microbiologist, intensivist. nephrologist is the key in managing these patients. Lastly, due to exhausting hospital stay and economic burden due to expensive anti-fungal drugs,they are prone to anxiety/depression.An empathetic approach and day-to-day counselling of relatives played a significant role in our patient management. Reference #1: Kontoyiannis DP, Wessel VC, Bodey GP, Rolston KV. Zygomycosis in the 1990s in a tertiary-care cancer center. Clin Infect Dis 2000; 30:851. Reference #2: Kauffman CA, Malani AN. Zygomycosis: an emerging fungal infection with new options for management. Curr Infect Dis Rep 2007; 9:435. Reference #3: Chamilos G, Marom EM, Lewis RE, et al. Predictors of pulmonary zygomycosis versus invasive pulmonary aspergillosis in patients with cancer. Clin Infect Dis 2005; 41:60. DISCLOSURE: The following authors have nothing to disclose: Yashwant K O, Vijay Salla, Annapurna Mydavolu, Latha Sarma No Product/Research Disclosure Information

Diagnosis and treatment of pulmonary mucormycosis: A case report

Pulmonary mucormycosis, a relatively rare pulmonary fungal disease, is difficult to diagnose and lacks effective treatment. The present study reports the case of a 64-year-old patient who was treated successfully for pulmonary mucormycosis in Xuan Wu Hospital. The patient presented with low-grade fever and a productive cough that persisted for 1 month with no evident cause, and also suffered from diabetes mellitus. Prior antibiotic treatment with levofloxacin had been ineffective. Culture of mucus obtained by bronchoscopy resulted in a diagnosis of pulmonary mucormycosis. The patient received a cumulative dose of 1,355 mg amphotericin B over 2 months and presented a full recovery.

Green herring syndrome: bacterial infection in patients with mucormycosis cavitary lung disease.

Mucormycosis is a life-threatening fungal disease in patients with hematological malignancies. The diagnosis of pulmonary mucormycosis is particularly challenging. We describe 3 mucormycosis cases with an uncommon presentation in patients whose cavitary lung disease was attributed to well documented bacterial infection, although evolution and reassessment established mucormycosis as the underlying disease.

Reverse halo sign on chest imaging in a renal transplant recipient

Without proper treatment, the mortality of pulmonary mucormycosis is nearly 100%. Although the diagnosis is often made histologically, it can be suspected when patients have a reverse halo sign on computed tomography (CT) of the chest, along with the right clinical findings. We describe the case of a woman 7 months post renal transplant who presented with fevers, malaise, and chest pain. Her chest CT revealed a round, focal area of ground-glass attenuation surrounded by a complete rim of consolidation in the left upper lobe, consistent with the reverse halo sign. Pulmonary mucormycosis was diagnosed by transbronchial lung biopsy. She was successfully treated with combined medical and surgical therapies. In the context of this case, we provide a brief review of the diagnosis of pulmonary mucormycosis, with a focus on radiographic and pathologic findings.

Une opacité pulmonaire excavée chez un diabétique

Mucormycosis or zygomycosis is a group of infections caused by filamentous fungi of the mucorales order belonging to the zygomycetes family. They generally appear in patients with uncontrolled diabetes or immunodepression, especially neutropenic immunodepression. Incidence has increased with progress in immunosuppressive therapy and chemotherapy and the absence of the use of antifungal prophylactic agents effective against mucors. We report the case of a diabetic patient presenting with an excavated opacity in the right lung which failed to improve after receiving non-specific antibiotic treatment. Direct examination of the bronchial washing specimen led to the diagnosis of pulmonary mucormycosis. Prognosis depends mainly on early diagnosis, enabling appropriate treatment with amphotericin B. Mortality remains high, around 80%; diagnosis is commonly established post-mortem.

The Role of BAL in the Diagnosis of Pulmonary Mucormycosis

Five patients with pulmonary mucormycosis diagnosed during life are described. All had underlying predisposing conditions: either posttransplant or hematologic malignancies. In all cases, the diagnosis was made using fiberoptic bronchoscopy. In three patients, BAL was diagnostic. In two of these patients, the diagnosis was made by identifying the typical hyphae of mucormycosis in the BAL fluid alone. Transbronchial biopsy was diagnostic in three patients. Treatment was based on IV antifungal chemotherapy together with surgical removal of involved lung tissue whenever feasible. The clinical outcome of these patients was dismal and was determined primarily by the underlying condition.

Case Report: Pulmonary Mucormycosis (Phycomycosis) in a Chicken

SUMMARY Diagnosis of pulmonary mucormycosis in a 9-week-old male chicken, presented for slaughter in good condition, was based on histologic demonstration of the characteristic fungus organism in caseous granulomas. The organism causing these caseous lesions was differentiated from the causative agent of aspergillosis, which is the most common mycotic lung disease in chickens.