Pulmonary Zygomycosis
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Chakrabarti et al. J Clin Microbiol, 2010, 48(5): 1965-1969 Pulmonary Zygomycosis 47-year-old male • Type II diabetes mellitus for 13 years • Developed diabetic neuropathy and end-stage renal disease • Renal transplantation and immunosuppression One month post-transplant • Fever, chills, pleuritic chest pain • Chest x-ray = cavitary lesion in right upper lobe • Sputum examinations negative for acid-fast bacilli • ATT initiated
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Pulmonary Zygomycosis. 47-year-old male Type II diabetes mellitus for 13 years Developed diabetic neuropathy and end-stage renal disease Renal transplantation and immunosuppression One month post-transplant Fever, chills, pleuritic chest pain - PowerPoint PPT Presentation
Transcript of Pulmonary Zygomycosis
Zygomycosis (AKA Mucormycosis, Phycomycosis) Rhizopus spp.
Chakrabarti et al. J Clin Microbiol, 2010, 48(5): 1965-1969Pulmonary Zygomycosis47-year-old maleType II diabetes mellitus for 13 yearsDeveloped diabetic neuropathy and end-stage renal diseaseRenal transplantation and immunosuppressionOne month post-transplantFever, chills, pleuritic chest painChest x-ray = cavitary lesion in right upper lobeSputum examinations negative for acid-fast bacilliATT initiated Pulmonary ZygomycosisATT failedBlood sugar153 226 mg/dlInsulin therapyFine needle aspirate of lesionDirect microscopy = no fungal elementsFungal cultures were negative at 4 weeksNo improvement at 20 daysOpen-lung biopsy of lesion, no mass noted
Chakrabarti et al. J Clin Microbiol, 2010, 48(5): 1965-1969Pulmonary ZygomycosisPeriodic acid-Schiff stain revealed acute inflammatory infiltrates and ribbon-like hyphae
Chakrabarti et al. J Clin Microbiol, 2010, 48(5): 1965-1969Pulmonary ZygomycosisCulture of the biopsy:Fast growing, floccose whit colony turning grayishIsolate identified as Rhizopus spp.
Chakrabarti et al. J Clin Microbiol, 2010, 48(5): 1965-1969ZygomycosisEpidemiology: UbiquitousUsually Rhizopus spp.Others: Mucor, Absidia, Rhizomucor, and Cunninghamella
Virulence factors and pathogenesis:Tissue necrosis suggests tissue destructive enzymesDebilitated and immunocompromisedespecially diabetic ketoacidosisleukemias and lymphomasZygomycosisClinical Manifestation:Route inhalationIncubation - ??? Forms of infections:Rhinocerebral zygomycosis oropharyngeal, periorbitalparanasal sinus eye, brainRisk factor = metabolic acidosisPrimary cutaneous zygomycosis (contaminated bandages)Disseminated fulminant and fatal, very poor prognosisCutaneous zygomycosis
Zygomycosis Clinical Manifestations
Zygomycosis Clinical Manifestations
Zygomycosis Clinical ManifestationsZygomycosis Lab DiagnosisLaboratory Diagnosis:Monomorphic ,true mould
In tissue:Try to get tissue for direct preps!!Aseptate hyphae that branch at RIGHT angles, rare septations are possible (may see sporangial fruiting bodies)In culture: Several etiologies are differentiated by sporangiaRhizopus spp.- Aseptate hyphae; sporangiophore arises from rhizoids, huge sporangia (100-300 um), filled with sporangiospores.
Rhizopus from a colony
Zygomycosis
Zygomycosis13
ZygomycosisZygomycosis - TreatmentTreatment:Invasive disease is very difficult to treat/controlAmphotericin B plus supplement abxSurgical debridementImmune reconstitution
Posiconazole appears to be active against most species
Pulmonary ZygomycosisFor our patient:Liposomal Amphotericin B was administeredStriking improvement both clinical and radiologicalNo relapse at 5 months
Classical presentation of a susceptible diabetic hostLocalized, primary pulmonary zygomycosisChakrabarti et al. J Clin Microbiol, 2010, 48(5): 1965-1969
