Fungal Abscess Research Articles

Multifocal Renal Fungal Abscesses

We report a case of multiple fungal renal abscesses in a 36-year-old woman with a history of diabetes and intravenous substance use disorder. The patient presented with fever and hematuria, and was found to be bacteremic and fungemic. She was initially managed with broad-spectrum antibiotics and antifungals. She remained febrile and imaging on treatment day 14 showed no improvement of the renal abscesses. Thus, a nephrectomy was performed, after which the patient defervesced and follow-up blood cultures were negative. There is a paucity of literature regarding management of multifocal fungal renal abscesses that fail to respond to medical management.

Fungal brain abscess in haematological malignancy: Is good outcome possible?

Fungal brain abscess in haematological malignancy: Is good outcome possible?

Secondary headache due to aspergillus sellar abscess simulating a pituitary neoplasm: case report and review of literature.

Fungal sellar abscess is rare. A 42-year-old man was admitted with 2-month headache characterized by right peri-orbital pain. An intrasellar mass was found to be simulated a pituitary neoplasm after magnetic resonance imaging examination, and operated on via an endoscopic trans-sphenoidal approach. Milk-like pus and a mass of ash black mixed and necrotic material were found and removed. Histopathology revealed numerous aspergillus hyphae. Itraconazole was given on a dosage of 200 mg twice a day orally for 6 weeks. No recurrence was observed during follow-up. Complete surgical resection through endoscopic trans-sphenoidal approach combined with systemic anti-fungal therapy, should be considered as the optimal treatment.

Isolation and Characterization of an Unknown Chrysosporium sp. Producing Subcutaneous Mycosis in an Immunocompromised Patient.

We report a case of subcutaneous fungal abscess over the great toe caused by a keratinophilic fungus, an unknown Chrysosporium sp., in a 60-year-old diabetic female who was treated successfully with oral fluconazole. The fungus was isolated from aspirated pus, and septate hyphae were seen in fine needle aspiration cytology. Ovoid- to club-shaped hyaline one-celled conidia (aleuriconidia) with broad truncated bases were seen, and sequencing of ITS1-5.8S-ITS2 rDNA revealed belonging to the order Onygenales and most closely related to Chrysosporium spp. isolated from a fowl. Of the 65 species within the genus Chrysosporium, very few have been reported as pathogenic.

Usefulness of positron emission tomography in the differentiation between tumor and infectious lesions in pediatric oncology: a case report

BackgroundSometimes, in pediatric oncology, it is difficult to differentiate the relapse of primary tumor from other diagnoses such as post-ischemic lesions or fungal abscess, without performing an organ biopsy. In addition, patients frequently are not under clinical conditions to be biopsied, mainly due to febrile neutropenia. A growing number of studies has focused on the use of Positron emission tomography/computed tomography with 18 Fluorodeoxyglucose ([18F]FDG-PET/CT) to distinguish tumor relapse from infectious lesions in patients with febrile neutropenia.Case presentationThis case report describes a 6 years-old girl with febrile neutropenia during the treatment of neuroblastoma. Blood culture showed Candida sp. Abdominal ultrasonography revealed multiple unspecific hypoechoic areas of variable sizes in spleen, which might be either tumor or Candida-induced abscesses. [18F]FDG-PET/CT was performed to help the diagnosis and revealed small splenic lesions highly suggestive of disseminated candidiasis. Patient was then treated with systemic antifungal agent. After the recovery from febrile neutropenia, a spleen biopsy was performed, confirming the diagnosis of fungal abscess. Due to the small size of lesions, modalities such as ultrasonography, CT and magnetic nuclear resonance were not able in distinguishing tumor relapse from infectious lesions.ConclusionThis case provides an excellent example in which the use of [18F]FDG-PET/CT is valuable in helping to localize potential sites of disseminated fungal infection to be diagnosed within clinical context. [18F]FDG-PET /CT seems to have a role in the evaluation of pediatric patients with febrile neutropenia.

Pediatric lung lesions: a clinicopathological study of 215 cases

To investigate clinical and pathological features of lung lesions in children. Clinical manifestations, radiologic imaging, histopathological features and immunohistochemical results were analyzed in 215 cases of lung lesions in children. A total of 215 cases of lung lesions in children aged 0 day to 13 years (average age of 27.2 months and the median age of 18.0 months) were selected, including 137 male and 78 female patients with a male to female ratio of 1.76:1.00. The incidence of congenital lung disease was higher in patients of less than 1 year old than those of over 1 year old age, and the difference of the two groups was statistically significant (P = 0.004). 142 cases had acquired lung diseases, and 73 cases had congenital bronchopulmonary dysplasia. Lung abscess was the most common lesion seen in 86 cases (40.0%), including 1 case of fungal abscess. Congenital pulmonary airway malformation (CPAM) was the second most common, seen in 44 patients (20.5%), including 20 cases of type 1, 18 cases of type 2 and 6 cases of type 4 CPAM. Pulmonary sequestration was found in 25 cases (11.6%) including 14 cases of intralobar type and 11 cases of extralobar type. Two cases of extralobar pulmonary sequestration showed simultaneous CPAM2 type 2 lesion. Other lesions included tuberculosis (13 cases, 6.0%), emphysema (12 cases, 5.6%), interstitial pneumonia (7 cases, 3.2%), pulmonary hemorrhage (6 cases, 2.8%), bronchogenic cyst (4 cases, 1.9%), bronchiolitis obliterans (2 cases, 0.9%), idiopathic pulmonary hemosiderin deposition disease (2 cases, 0.9%) and 1 cases of lung non-specific changes. 13 cases of neoplastic lesions (6.0%) were found, of which 11 cases were primary tumors (5.1%), including inflammatory myofibroblastic tumor in 5 patients (2.3%), pleuropulmonary blastoma in 5 cases (1 case of type I, 2 type II and 2 type III) and 1 case of mucoepidermoid carcinoma (0.5%) and 2 cases of metastatic tumors (hepatoblastoma and Wilm's tumor, 0.9%). Infectious diseases are the most common lung diseases in children. Congenital bronchopulmonary dysplasia is the most common in children of less than 1 year old. Malignant lesions are rare.

Acute Central Nervous System Complications in Pediatric Acute Lymphoblastic Leukemia

BackgroundThe outcome of childhood acute lymphoblastic leukemia has improved because of intensive chemotherapy and supportive care. The frequency of adverse events has also increased, but the data related to acute central nervous system complications during acute lymphoblastic leukemia treatment are sparse. The purpose of this study is to evaluate these complications and to determine their long term outcome. Patients and MethodsWe retrospectively analyzed the hospital reports of 323 children with de novo acute lymphoblastic leukemia from a 13-year period for acute neurological complications. The central nervous system complications of leukemic involvement, peripheral neuropathy, and post-treatment late-onset encephalopathy, and neurocognitive defects were excluded. ResultsTwenty-three of 323 children (7.1%) suffered from central nervous system complications during acute lymphoblastic leukemia treatment. The majority of these complications (n = 13/23; 56.5%) developed during the induction period. The complications included posterior reversible encephalopathy (n = 6), fungal abscess (n = 5), cerebrovascular lesions (n = 5), syndrome of inappropriate secretion of antidiuretic hormone (n = 4), and methotrexate encephalopathy (n = 3). Three of these 23 children (13%) died of central nervous system complications, one from an intracranial fungal abscess and the others from intracranial thrombosis. Seven of the survivors (n = 7/20; 35%) became epileptic and three of them had also developed mental and motor retardation. ConclusionsAcute central neurological complications are varied and require an urgent approach for proper diagnosis and treatment. Collaboration among the hematologist, radiologist, neurologist, microbiologist, and neurosurgeon is essential to prevent fatal outcome and serious morbidity.

Tubo-Ovarian Abscess Caused by Candida Albicans in an Obese Patient.

Tubo-ovarian abscess (TOA) arises in most cases from pelvic infection. Appropriate treatment includes use of antimicrobials and, especially in patients with increased BMI, drainage of the contents. A 44-year-old morbidly obese woman (BMI 72) had a persistent TOA despite receiving antibiotic treatment for four months. She had no history of diabetes, and denied being sexually active. Imaging demonstrated a pelvic abscess of 14.9 × 8.9 × 11.1 cm. Successful percutaneous drainage was performed yielding purulent material which grew Candida albicans. The patient recovered after drainage of the abscess and the addition of fluconazole to her antimicrobials. She had no apparent risk factor for acquiring such an opportunistic infection, other than her morbid obesity. Because morbid obesity may confer a relative immunodeficiency, morbidly obese patients may develop unusual infections such as opportunistic fungal abscesses.

Neonatal liver abscesses due to Candida infection in a preterm infant, secondary to malpositioned umbilical lines – a rare entity

Neonatal liver abscess is an uncommon seen condition in neonatology and it holds a very high neonatal mortality because of difficulty in diagnosis and treatment. Till today, only few instances are reported that too are mainly in preterm. Its diagnosis requires a high index of suspicion. Fungal hepatic abscess is very rare and in medical literature very few case reports are there in the medical literature. Here, we report a case of Candida albicans liver abscess in a preterm neonate, secondary to malpositioned umbilical lines that presented with respiratory difficulty and other clinical features of sepsis that was managed medically and discharged successfully.

Targeting zinc homeostasis to combat Aspergillus fumigatus infections.

Aspergillus fumigatus is able to invade and grow in the lungs of immunosuppressed individuals and causes invasive pulmonary aspergillosis. The concentration of free zinc in living tissues is much lower than that required for optimal fungal growth in vitro because most of it is tightly bound to proteins. To obtain efficiently zinc from a living host A. fumigatus uses the zinc transporters ZrfA, ZrfB, and ZrfC. The ZafA transcriptional regulator induces the expression of all these transporters and is essential for virulence. Thus, ZafA could be targeted therapeutically to inhibit fungal growth. The ZrfC transporter plays the major role in zinc acquisition from the host whereas ZrfA and ZrfB rather have a supplementary role to that of ZrfC. In addition, only ZrfC enables A. fumigatus to overcome the inhibitory effect of calprotectin, which is an antimicrobial Zn/Mn-chelating protein synthesized and released by neutrophils within the fungal abscesses of immunosuppressed non-leucopenic animals. Hence, fungal survival in these animals would be undermined upon blocking therapeutically the function of ZrfC. Therefore, both ZafA and ZrfC have emerged as promising targets for the discovery of new antifungals to treat Aspergillus infections.

Fungal septal abscess complicating maxillary sinus fungus balls in an immunocompetent host.

Background:Fungal infections of the nasal cavity can be destructive entities that are typically seen in immunocompromised hosts. We present a case of a localized fungal abscess of the nasal septum in an immunocompetent host after endoscopic treatment of maxillary sinus fungus balls.Method:A 51-year-old woman with a history of asthma and recent treatment with oral steroids presented with bilateral maxillary sinus mycetomas. She underwent endoscopic sinus surgery. The postoperative course was complicated by an asthma flare, which required oral steroids. The patient returned with nasal obstruction, and results of a physical examination were consistent with a nasal septal abscess. Drainage was attempted, and cultures showed fungal elements. The abscess reaccumulated, and the patient was referred to our institution. Operative drainage was performed with placement of a catheter in the septal abscess cavity. Forty-eight hours of amphotericin irrigations were performed through this site. The patient was started on oral antifungal therapy. Results of an immune workup, including testing for human immunodeficiency virus and assessing immunoglobulin levels, were negative. Final fungal cultures grew Scedosporium apiospermum sensitive to voriconazole. The patient completed therapy without further recurrence. Follow-up at 6 months demonstrated no further recurrence of her fungal septal infection.Conclusion:Sinonasal fungal infections rarely occur in immunocompetent hosts. The septum may have been seeded during the endoscopic sinus surgery. The use of oral steroids may have been a risk factor for the development of an aggressive nasal septal fungal abscess in this patient. This is the first reported case of a nasal septal abscess in an otherwise immunocompetent host with S. apiospermum.

Hemispheric multiple fungal brain abscesses due to Scedosporium apiospermum following surgery

We report an interesting and rare case of hemispheric multiple brain abscesses due to Scedosporium apiospermum which developed following neurosurgery and mimicked hemiconvulsion hemiplegia epilepsy syndrome on initial scans. Interestingly all the abscesses were only on the right side of cerebral hemisphere which later on spread to the other side. All the lesions had hemorrhagic walls seen as hypointensities on susceptibility weighted imaging. The patient succumbed to this fatal fungal brain infection.

Amphotericin B LIPOMER for Enhanced Splenic Delivery

Amphotericin B (Amb) is a broad-spectrum polyene macrolide antibiotic which has been a drug of choice for fatal conditions like fungal splenic abscess. Hence a drug delivery system with splenotropic potencial might be of great significance for further therapeutic effectiveness. Present manuscript proposes development of Irregular shaped polymer lipid hybrid nanostructures (LIPOMER) of Amb with enhanced splenic uptake. Amb LIPOMER (~400 nm) was prepared using poly(methylvinylether-co-maleic anhydride) [Gantrez® AN119] and glyceryl monosterarate (GMS) as matrix material. Conditions for preparation of formulation were optimized using 23 factorial design and effect of the concentration of excipients on the particle size and entrapment efficiency was evaluated. Optimized formulation was further characterized using Transmission electron microscopy (TEM), X-ray diffraction (XRD), differential scanning calorimetry (DSC) and Fourier transformed infrared spectroscopy (FTIR) techniques. Amb LIPOMER exhibited acceptable haemolysis when assessed for In-vitro hemolytic potential in comparison to Fungisome TM. The high splenic uptake of Amb LIPOMER was verified using gamma scintigraphic technique in small animal model. Results of our study indicated that LIPOMER system can be a smart drug delivery platform for Amb to eradicate splenic infections effectively. Keywords: Amphotericin B, enhanced splenic uptake, LIPOMER, nano-system, scintigraphy, splenic abscess.

Fungal brain abscess: report of three cases and review of literature

Fungal brain abscess is an unusual but serious complication associated with immunosuppression. The aim of this study is to review our experience, to determine the factors related to the outcome, the pathogenesis and clinical presentation, and to improve the therapeutic strategy for this disease, and also include a review of the relevant literature.We reviewed three cases of fungal brain abscess in patients who were immunocompromised. The three patients included two males and one female. Their ages ranged from 35 to 53 years (mean, 43.3 years). The mean duration of symptoms before diagnosis of brain abscess was 19 days. The diagnostic of brain abscess were performed in all three cases by histopathology and direct preparation, culture techniques and CT scan or magnetic resonance imaging. Patients were presenting with mild dizziness and unsteady gait, headache, and focal or generalized seizure.We isolated two cases of Aspergillus fumigatus and one Candida albicans from cerebral abscess. All patients had predisposing factor to fungal infections. The outcome in our patients was poor, with an overall mortality of 2:3 of patients. Blood and urine culture were negative for fungi in all patients. Early diagnosis, aggressive surgical procedures, and antimicrobial therapy for fungal brain abscess may reduce morbidity and mortality.

Fungal brain abscess – Typical MRI features

ObjectiveTo evaluate the diagnostic value of magnetic resonance imaging (MRI) in brain abscess induced by fungal infection of the central nervous system. MethodsWe analyzed an immune-compromised patient with various neurological symptoms. Imaging studies included T2, T1, post-contrast T1 and diffusion weighted imaging (DWI). The patient had typical imaging features of fungal brain abscess which was later confirmed by histo-pathology. ResultsThe fungal abscess showed irregular walls with intracavitary projections. The abscess showed peripheral ring enhancement with non enhancement of the intra-cavitatory projections. The periphery of the abscess showed susceptibility artifact, thus indicating towards its fungal composition. In the fungal abscesses, the wall and projections showed low ADC; however, the cavity itself showed high ADC. ConclusionMRI-DWI and contrast enhanced MRI changes can improve the early diagnosis of brain abscess & distinguish the fungal brain abscess from pyogenic & tubercular abscesses.

Experience in the treatment of nasal septum fungal abscess

患者 男，62岁，因发热伴乏力10d于2013年8月19日入住感染科，诊断考虑为结核性脑膜脑炎，入院后行诊断性抗结核治疗后体温逐渐恢复正常，住院期间因挖鼻后双侧鼻塞5d而行鼻窦CT（图1）检查，CT见鼻中隔向左偏曲，前下部低密度肿块，囊肿或脓肿可能，于2013年10月17日请我科会诊。

PC.54 A rare presentation of Malassezia fungaemia with liver abscess in preterm neonate

We present a 24 week old male infant weighing 758 gram with significant surfactant deficient respirtory distress. He was extubated on day 19 and remained on BIPAP until he was...

The Global Burden of Skin Disease in 2010: An Analysis of the Prevalence and Impact of Skin Conditions

The Global Burden of Disease (GBD) Study 2010 estimated the GBD attributable to 15 categories of skin disease from 1990 to 2010 for 187 countries. For each of the following diseases, we performed systematic literature reviews and analyzed resulting data: eczema, psoriasis, acne vulgaris, pruritus, alopecia areata, decubitus ulcer, urticaria, scabies, fungal skin diseases, impetigo, abscess, and other bacterial skin diseases, cellulitis, viral warts, molluscum contagiosum, and non-melanoma skin cancer. We used disability estimates to determine nonfatal burden. Three skin conditions, fungal skin diseases, other skin and subcutaneous diseases, and acne were in the top 10 most prevalent diseases worldwide in 2010, and eight fell into the top 50; these additional five skin problems were pruritus, eczema, impetigo, scabies, and molluscum contagiosum. Collectively, skin conditions ranged from the 2nd to 11th leading cause of years lived with disability at the country level. At the global level, skin conditions were the fourth leading cause of nonfatal disease burden. Using more data than has been used previously, the burden due to these diseases is enormous in both high- and low-income countries. These results argue strongly to include skin disease prevention and treatment in future global health strategies as a matter of urgency.

Use of external ventriculostomy and intrathecal anti-fungal treatment in cerebral mucormycotic abscess

Mucormycosis is an invasive fungal infection associated with a high mortality. Cerebral mucor abscesses can result secondary to rhinocerebral or hematogenous spread. Amphotericin B, posaconazole, and aggressive surgical resection are the hallmarks of treatment. While amphotericin is typically administered intravenously, less is known about the use of intrathecal amphotericin B. We describe a 42-year-old man who developed a cerebellar mucor abscess after undergoing hematopoietic stem cell transplant for the treatment of myelodysplastic syndrome. In the post-operative period he was admitted to the neurocritical care unit and received liposomal amphotericin B intravenously and through an external ventricular drain. This patient demonstrates that utilization of an external ventricular drain for intrathecal antifungal therapy in the post-operative period may warrant further study in patients with difficult to treat intracranial fungal abscesses.

Mycotic aneurysm and fungal spinal abscess due to tainted steroid injection

A 42-year-old female with Ehlers–Danlos received tainted Solumedrol injection into her lumbar spine. Two weeks later, the patient presented to the emergency room at an outside institution with head...