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      Mucormicosis cutánea primaria por Rhizopus arrhizus en un paciente inmunocomprometido. A propósito de un caso Translated title: Primary cutaneous mucormycosis due to Rhizopus arrhizus in an immunocompromised patient. About a case report

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          Abstract

          Resumen La mucormicosis corresponde a una enfermedad fúngica invasora potencialmente mortal y que presenta una incidencia en aumento, principalmente en pacientes inmunocomprometidos onco-hematológicos y receptores de trasplante de células progenitoras hematopoyéticas. La forma cutánea primaria es una de sus presentaciones clínicas. Comunicamos el caso de un paciente de 21 años, con diagnóstico de leucemia linfoblástica aguda, que desarrolló una mucormicosis cutánea primaria causada por Rhizopus arrhizus, confirmada por métodos moleculares e histología, y que evolucionó en forma favorable tras una resección quirúrgica amplia y terapia antifúngica con anfotericina B liposomal e isavuconazol.

          Translated abstract

          Abstract Mucormycosis corresponds to a potentially fatal invasive fungal disease that has an increasing incidence, mainly in immunocompromised onco-hematological patients and stem-cell transplant recipients. Skin involvement being one of its clinical presentations. We report the case of a 21-year-old patient, diagnosed with acute lymphoblastic leukemia, who developed primary cutaneous mucormycosis caused by Rhizopus arrhizus, confirmed by molecular methods and histology, and who evolved favorably after a large surgical resection and antifungal therapy based on to liposomal amphotericin B and isavuconazole.

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          Most cited references30

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          Epidemiology and outcome of zygomycosis: a review of 929 reported cases.

          Zygomycosis is an increasingly emerging life-threatening infection. There is no single comprehensive literature review that describes the epidemiology and outcome of this disease. We reviewed reports of zygomycosis in the English-language literature since 1885 and analyzed 929 eligible cases. We included in the database only those cases for which the underlying condition, the pattern of infection, the surgical and antifungal treatments, and survival were described. The mean age of patients was 38.8 years; 65% were male. The prevalence and overall mortality were 36% and 44%, respectively, for diabetes; 19% and 35%, respectively, for no underlying condition; and 17% and 66%, respectively, for malignancy. The most common types of infection were sinus (39%), pulmonary (24%), and cutaneous (19%). Dissemination developed in 23% of cases. Mortality varied with the site of infection: 96% of patients with disseminated disease died, 85% with gastrointestinal infection died, and 76% with pulmonary infection died. The majority of patients with malignancy (92 [60%] of 154) had pulmonary disease, whereas the majority of patients with diabetes (222 [66%] of 337) had sinus disease. Rhinocerebral disease was seen more frequently in patients with diabetes (145 [33%] of 337), compared with patients with malignancy (6 [4%] of 154). Hematogenous dissemination to skin was rare; however, 78 (44%) of 176 cutaneous infections were complicated by deep extension or dissemination. Survival was 3% (8 of 241 patients) for cases that were not treated, 61% (324 of 532) for cases treated with amphotericin B deoxycholate, 57% (51 of 90) for cases treated with surgery alone, and 70% (328 of 470) for cases treated with antifungal therapy and surgery. By multivariate analysis, infection due to Cunninghamella species and disseminated disease were independently associated with increased rates of death (odds ratios, 2.78 and 11.2, respectively). Outcome from zygomycosis varies as a function of the underlying condition, site of infection, and use of antifungal therapy.
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            The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports

            The epidemiology of mucormycosis in the era of modern diagnostics is relatively under-explored.
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              Global Epidemiology of Mucormycosis

              Mucormycosis is an angio-invasive fungal infection, associated with high morbidity and mortality. A change in the epidemiology of mucormycosis has been observed in recent years with the rise in incidence, new causative agents and susceptible population. The rise has been perceived globally, but it is very high in the Asian continent. Though diabetes mellitus overshadow all other risk factors in Asia, post-tuberculosis and chronic renal failure have emerged as new risk groups. The rhino-cerebral form of mucormycosis is most commonly seen in patients with diabetes mellitus, whereas, pulmonary mucormycosis in patients with haematological malignancy and transplant recipients. In immunocompetent hosts, cutaneous mucormycosis is commonly seen following trauma. The intriguing clinical entity, isolated renal mucormycosis in immunocompetent patients is only reported from China and India. A new clinical entity, indolent mucormycosis in nasal sinuses, is recently recognized. The causative agents of mucormycosis vary across different geographic locations. Though Rhizopus arrhizus is the most common agent isolated worldwide, Apophysomyces variabilis is predominant in Asia and Lichtheimia species in Europe. The new causative agents, Rhizopus homothallicus, Mucor irregularis, and Thamnostylum lucknowense are reported from Asia. In conclusion, with the change in epidemiology of mucormycosis country-wise studies are warranted to estimate disease burden in different risk groups, analyse the clinical disease pattern and identify the new etiological agents.
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                Author and article information

                Journal
                rci
                Revista chilena de infectología
                Rev. chil. infectol.
                Sociedad Chilena de Infectología (Santiago, , Chile )
                0716-1018
                August 2024
                : 41
                : 4
                : 539-546
                Affiliations
                [1] Santiago de Chile orgnameHospital del Salvador orgdiv1Servicio de Medicina orgdiv2Unidad de Infectología Chile
                [2] Santiago de Chile orgnameUniversidad de Chile orgdiv1Facultad de Medicina orgdiv2Depto. Medicina Interna Oriente Chile
                [3] Santiago de Chile orgnameHospital del Salvador orgdiv1Unidad de Anatomía Patológica Chile
                Article
                S0716-10182024000400539 S0716-1018(24)04100400539
                10.4067/s0716-10182024000400140
                660faee0-c581-4bb8-8d5f-6678b527c86c

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 26 March 2024
                : 12 July 2024
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 8
                Product

                SciELO Chile

                Categories
                CASOS CLINICOS

                mucorales,mucormicosis cutánea,anfotericina B liposomal,isavuconazol,Mucorales,cutaneous mucormycosis,Rhizopus arrhizus,amphotericin B,isavuconazole

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