ZYGOMYCOSIS IN IMMUNOCOMPROMISED NON-HAEMATOLOGICAL PATIENTS
<span style="font-size: 12pt;" lang="EN-US"><span style="font-family: Calibri;"><p class="MsoNormal" style="text-align: justify; line-height: normal; margin: 0cm 0cm 6pt; mso-layout-grid-align: none;"><...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
PAGEPress Publications
2011-01-01
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| Series: | Mediterranean Journal of Hematology and Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.mjhid.org/article/view/7840 |
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| Summary: | <span style="font-size: 12pt;" lang="EN-US"><span style="font-family: Calibri;"><p class="MsoNormal" style="text-align: justify; line-height: normal; margin: 0cm 0cm 6pt; mso-layout-grid-align: none;"><p class="MsoNormal" style="text-align: justify;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: AdvTT3713a231; color: #141314;" lang="EN-US">Zygomycoses are rare emerging diseases with a high fatality rate.<span style="mso-spacerun: yes;"> </span>The most important risk factors include neutropenia or functional neutropenia, diabetic ketoacidosis, iron overload, major trauma, prolonged use of corticosteroids, illicit intravenous drug use, neonatal prematurity, malnourishment, and pre-exposure to antifungal agents with no activity against zygomycetes, such as voriconazole and caspofungin.</span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: AdvTT3713a231; color: #141314;" lang="EN-US">A high index of suspicion is crucial </span><span style="font-size: 12.0pt; line-height: 115%;" lang="EN-US">for the diagnosis, as prompt and appropriate management can</span><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: AdvTT3713a231; color: #141314;" lang="EN-US"> </span><span style="font-size: 12.0pt; line-height: 115%;" lang="EN-US">considerably reduce morbidity and mortality. Suspicion index can be increased through recognition of the differential patterns of clinical presentation. In the <span style="mso-bidi-font-weight: bold;">non</span><strong style="mso-bidi-font-weight: normal;">-</strong> haematological <span style="mso-bidi-font-weight: bold;">immunocompromised </span>patients, zygomycosis can manifest in various clinical forms, depending on the underlying condition: mostly as rhino-orbital or rhino-cerebral in diabetes patients, pulmonary infection in patients with malignancy or solid organ transplantation, disseminated infection in iron overloaded or deferoxamine treated patients, cerebral - with no sinus involvement - in ID users, gastrointestinal in premature infants or malnourishment, and cutaneous after direct inoculation in immunocompetent individuals with trauma or burns.</span></p> <p class="MsoNormal" style="margin-bottom: 6.0pt; text-align: justify; mso-pagination: none;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: AdvPSPAL-R; mso-ansi-language: EN-GB;" lang="EN-GB">Treating a patient’s underlying medical condition and reducing immunosuppression are essential to therapy. </span><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-ansi-language: EN-GB;" lang="EN-GB">Rapid correction of metabolic abnormalities is mandatory in cases such as uncontrolled diabetes and corticosteroids or other immunosuppressive drugs should be discontinued where feasible. AmphotericinB or its newer and less toxic lipid formulations are the drugs of choice regarding antifungal chemotherapy, while extensive surgical debridemend is essential to reduce infected and necrotic tissue. A high number of cases could be prevented through measures including diabetes control programmes and proper pre- and post-surgical hygiene. </span></p></p></span></span> |
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| ISSN: | 2035-3006 |