Subcutaneous mucormycosis caused by Rhizopus oryzae: probable nosocomial acquired infection

Telles Filho, Flávio de Queiroz; Coelho, Affonso; Porto, Edward; Lameira, Rosângela Ferreira; Freitas, Marli Maria; Barboza, Jânio; Ramos, Jorge Luiz Zanette

doi:10.1590/S0036-46651985000400008

Abstracts

The Authors present a case of subcutaneous mucormycosis occurring in a patient with clinical and biochemical evidence of diabetic ketoacidosis. The clinical, mycological and histopathological features are described, emphasizing the relevance of a rapid diagnosis in order to stablish early treatment. The clinical forms of mucormycosis and the main associated conditions are briefly reviewed as well as the most probable conditions which may lead to the enhanced susceptibility to infection in the diabetic patient in ketoacidosis. The recovery of Rhizopus oryzae from the air of the room of the patient suggests a nosocomial infection acquired through contamination of venous puncture site by air borne spores.

Os Autores relatam caso de mucormicose subcutânea em paciente apresentando quadro clínico e laboratorial de ceto-acidose diabética. São descritos os aspectos clínicos, micológicos e histopatológicos, salientando-se a importância da obtenção do diagnóstico rápido para a instituição da terapêutica precoce. São revistas as formas clínicas da mucormicose e as principais condições associadas, bem como os possíveis mecanismos que facilitam a infecção por Mucorales em pacientes com ceto-acidose diabética. O isolamento de R. oryzae do ambiente onde o paciente esteve internado, sugere tratar-se provavelmente de infecção hospitalar adquirida por contaminação venosa através de esporos do fungo.

CASE REPORTS

Subcutaneous mucormycosis caused by Rhizopus oryzae. Probable nosocomial acquired infection (^{^*})

Mucormicose subcutânea causada por Rhizopus oryzae. Provável infecção hospitalar

Flávio de Queiroz Telles Filho^{I, IV}; Affonso Coelho^III; Edward Porto^III; Rosângela Ferreira Lameira^IV; Marli Maria Freitas^V; Jânio Barboza^V; Jorge Luiz Zanette Ramos^V

^IProfessor Auxiliar da Disciplina de Doenças Infecciosas e Parasitarias da U.F.PR

^IIProfessor Titular de Anatomia Patológica da U.F.PR

^IIIMicologista do Instituto de Medicina Tropical de São Paulo

^IVSetor de Micologia Médica do Hospital de Clínicas da U.F.PR

^VMédicos Residentes do Departamento de Clínica Médica da U.F.PR

SUMMARY

The Authors present a case of subcutaneous mucormycosis occurring in a patient with clinical and biochemical evidence of diabetic ketoacidosis. The clinical, mycological and histopathological features are described, emphasizing the relevance of a rapid diagnosis in order to stablish early treatment. The clinical forms of mucormycosis and the main associated conditions are briefly reviewed as well as the most probable conditions which may lead to the enhanced susceptibility to infection in the diabetic patient in ketoacidosis. The recovery of Rhizopus oryzae from the air of the room of the patient suggests a nosocomial infection acquired through contamination of venous puncture site by air borne spores.

RESUMO

Os Autores relatam caso de mucormicose subcutânea em paciente apresentando quadro clínico e laboratorial de ceto-acidose diabética. São descritos os aspectos clínicos, micológicos e histopatológicos, salientando-se a importância da obtenção do diagnóstico rápido para a instituição da terapêutica precoce.

São revistas as formas clínicas da mucormicose e as principais condições associadas, bem como os possíveis mecanismos que facilitam a infecção por Mucorales em pacientes com ceto-acidose diabética.

O isolamento de R. oryzae do ambiente onde o paciente esteve internado, sugere tratar-se provavelmente de infecção hospitalar adquirida por contaminação venosa através de esporos do fungo.

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Recebido para publicaçäo em 14/6/1984.

References

1. ARTIS, W. M.; FOUNTAIN, J. A.; DECLCHER, H. K. & JONES, H. E. A mechanism of susceptibility to mucormycosis in diabetic ketoacidosis: Transferrin and iron availability. Diabetes 31: 1108-1114, 1983.
2. BAKER, R. D. The epidemiology of mucormycosis. In: AL DOORY, Y. The Epidemiology of Human Micotic Diseases. Springfield, Charles C. Thomas, 1975, 197-209.
3. BATEMAN, C. P.; UMLAND, E. T. & BECKER, L. E. Cutaneous zygomycosis in a patient with lymphoma. J. Am. Acad. Dermatol. 8: 890-894, 1983.
4. BHADURI, S.; KURRLE, E.; VANEK, E. & SPANEL, R. Mucormycosis in the immunocompromised host. Infection 11: 170-172, 1983.
5. BITTENCOURT, A. L.; MELO, C. R.; JALIL, O. A. M. & ANDRADE, Z. A. Basidiobolomicose. Apresentação de um caso. Rev. Inst. Med. trop. São Paulo 19: 208-212, 1977.
6. CHANDLER, A. W.; KAPLAN, W. & AJELLO, L. Histopathology of Mycotic Diseases. London, Wolfe Medical Publications, 1980, 122-127.
7. CHUNTRASAKUL, C. & CHANTARAKUL, N. Mucormycosis in severely burned patients. Report of two cases with extensive destructive lesions. J. Med. Assoc. Thai. 66: 135-138, 1983.
8. ELDER, T. D. & BAKER, R. D. Pulmonary mucormycosis in rabbits with alloxan diabetes. Arch. Path. 61: 159-168, 1956.
9. EVERETT, E. D.; PEARSON, S. & ROGERS, W. Rhizopus surgical wound infection associated with elasticized adhesive tape dressings. Arch. Surg. 114: 738-739, 1979.
10. FEUILHADE, M.; REVUZ, J. & TOURAINE, R. Mucormycose cutannée primitive chez un transplanté renal. Ann. Dermatol. Venerol. 109: 765-766, 1982.
11. GARTENBERG, G.; BOTTONE, E. J.; KEUSCH, G. & WEITZMAN, I. Hospital acquired mucormycosis (Rhizopus rhizopodiformis) of skin and subcutaneous tissue. N. Engl. J. Med. 299: 1115-1118, 1978.
12. GREER, D. L. Agents of zygomycosis (Phycomycosis). In LENETTE, E. H.; BALOWS, A.; HAUSLER, J. R. & TRUANT, J. P. Manual of Clinical Microbiology. (Third/ed.). Whashington, American Society for Microbiology, 1980, 611-619.
13. GUIMARÃES, N. S. & BARRETO, E. R. M. Zigomicose subcutânea. An. Bras. Dermatol. 58: 277-280, 1983.
14. HAMMER, G. S. Mucormycosis in a transplante patient. Am. J. Clin. Path. 64: 389-398, 1975.
15. HAMMOND, D. E. & WINKELMANN, R. K. Cutaneous phycomycosis. Report of three cases with identification of Rhizopus. Arch. Dermatol. 115: 990-992, 1979.
16. JAIN, J. K.; MARKOWITZ, A.; KHILANANI, P. V. & LAUTER, C. B. Localized mucormycosis following intramuscular corticosteroid. Case report and review of the literature. Am. J. Med. Sci. 275: 209-216, 1978.
17. KRICK, J. A. & REMINGTON, J. S. Opportunistic invasive fungal infections in patients with leukaemia and lymphoma. Clin. Haematol. 5: 249-310, 1976.
18. LACAZ, C. da S.; PORTO, E. & MARTINS, J. E. C. Zigomicose. In Micologia Médica. Fungos, Actinomicetos e Algas de Interesse Médico. 7.Ş ed. São Paulo. Sarvier, 1984.
19. MARCHEVSKY, A. M.; BOTTONE, E. J.; GELLER, S. A. & GIGER, D. K. The changing spectrum of a disease, etiology, and diagnosis of mucormycosis. Human Pathol. 11: 457-464, 1980.
20. MEAD, J. H.; LUMPTON, G. P.; DILLAVOU, C. L. & ODOM, R. B. Cutaneous Rhizopus infection. Occurrence as a postoperative complication associated with an elasticited adhesive dressing. J.A.M.A. 242: 272-274, 1979.
21. PEREIRA, V. G.; PEREIRA, M. A. A.; CRUZ, J. O. B. & HARON, E. S Mucormicose rino-orbitária. Relato de um caso. Rev. Hosp. Clin. Fac. Med. Säo Paulo 37: 140-146, 1982.
22. RIPPON, J. W. Mucormycosis. In: Medical Mycology. The patogenic fungi and the pathogenic actinomycetes. (2nd.). Philadelphia, W.B. Saunders, 1982, 615-640.
23. SHELDON, D. L. & JOHNSON, W. C. Cutaneous mucormycosis: Two documented causes of suspected nosocomial cause. J.A.M.A. 241: 1032-1034, 1979.
24. SZEPES, E. & GRÓF, P. Subcutaneous mucormycosis. Mylkosen 25: 503-507, 1982.
25. VELIATH, A. J.; RAO, R.; RADAHKRISHNA, P. & AURORA, A. L. Cutaneous Phycomycosis (Mucormycosis) with fatal pulmonary dissemination. Arch. Dermatol. 112: 509-512, 1976.
26. WHEAT, L. J. Infection and diabetes mellitus. Diahet. Care. 3: 187-191, 1980.
27. WILSON, C. B.; SIBER, G. R. & O'BRIEN, T. F. Phycomicotic gangrenous cellulitis. Arch. Surg. 1l1: 532-538, 1976.

(*

) Hospital de Clínicas da Faculdade de Medicina da Universidade Federal do Paraná, Curitiba, PR, Brasil

Publication Dates

Publication in this collection
29 Oct 2012
Date of issue
Aug 1985

History

Received
14 June 1984

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

[1] 1. ARTIS, W. M.; FOUNTAIN, J. A.; DECLCHER, H. K. & JONES, H. E. A mechanism of susceptibility to mucormycosis in diabetic ketoacidosis: Transferrin and iron availability. Diabetes 31: 1108-1114, 1983.

[2] 2. BAKER, R. D. The epidemiology of mucormycosis. In: AL DOORY, Y. The Epidemiology of Human Micotic Diseases. Springfield, Charles C. Thomas, 1975, 197-209.

[3] 3. BATEMAN, C. P.; UMLAND, E. T. & BECKER, L. E. Cutaneous zygomycosis in a patient with lymphoma. J. Am. Acad. Dermatol. 8: 890-894, 1983.

[4] 4. BHADURI, S.; KURRLE, E.; VANEK, E. & SPANEL, R. Mucormycosis in the immunocompromised host. Infection 11: 170-172, 1983.

[5] 5. BITTENCOURT, A. L.; MELO, C. R.; JALIL, O. A. M. & ANDRADE, Z. A. Basidiobolomicose. Apresentação de um caso. Rev. Inst. Med. trop. São Paulo 19: 208-212, 1977.

[6] 6. CHANDLER, A. W.; KAPLAN, W. & AJELLO, L. Histopathology of Mycotic Diseases. London, Wolfe Medical Publications, 1980, 122-127.

[7] 7. CHUNTRASAKUL, C. & CHANTARAKUL, N. Mucormycosis in severely burned patients. Report of two cases with extensive destructive lesions. J. Med. Assoc. Thai. 66: 135-138, 1983.

[8] 8. ELDER, T. D. & BAKER, R. D. Pulmonary mucormycosis in rabbits with alloxan diabetes. Arch. Path. 61: 159-168, 1956.

[9] 9. EVERETT, E. D.; PEARSON, S. & ROGERS, W. Rhizopus surgical wound infection associated with elasticized adhesive tape dressings. Arch. Surg. 114: 738-739, 1979.

[10] 10. FEUILHADE, M.; REVUZ, J. & TOURAINE, R. Mucormycose cutannée primitive chez un transplanté renal. Ann. Dermatol. Venerol. 109: 765-766, 1982.

[11] 11. GARTENBERG, G.; BOTTONE, E. J.; KEUSCH, G. & WEITZMAN, I. Hospital acquired mucormycosis (Rhizopus rhizopodiformis) of skin and subcutaneous tissue. N. Engl. J. Med. 299: 1115-1118, 1978.

[12] 12. GREER, D. L. Agents of zygomycosis (Phycomycosis). In LENETTE, E. H.; BALOWS, A.; HAUSLER, J. R. & TRUANT, J. P. Manual of Clinical Microbiology. (Third/ed.). Whashington, American Society for Microbiology, 1980, 611-619.

[13] 13. GUIMARÃES, N. S. & BARRETO, E. R. M. Zigomicose subcutânea. An. Bras. Dermatol. 58: 277-280, 1983.

[14] 14. HAMMER, G. S. Mucormycosis in a transplante patient. Am. J. Clin. Path. 64: 389-398, 1975.

[15] 15. HAMMOND, D. E. & WINKELMANN, R. K. Cutaneous phycomycosis. Report of three cases with identification of Rhizopus. Arch. Dermatol. 115: 990-992, 1979.

[16] 16. JAIN, J. K.; MARKOWITZ, A.; KHILANANI, P. V. & LAUTER, C. B. Localized mucormycosis following intramuscular corticosteroid. Case report and review of the literature. Am. J. Med. Sci. 275: 209-216, 1978.

[17] 17. KRICK, J. A. & REMINGTON, J. S. Opportunistic invasive fungal infections in patients with leukaemia and lymphoma. Clin. Haematol. 5: 249-310, 1976.

[18] 18. LACAZ, C. da S.; PORTO, E. & MARTINS, J. E. C. Zigomicose. In Micologia Médica. Fungos, Actinomicetos e Algas de Interesse Médico. 7.Ş ed. São Paulo. Sarvier, 1984.

[19] 19. MARCHEVSKY, A. M.; BOTTONE, E. J.; GELLER, S. A. & GIGER, D. K. The changing spectrum of a disease, etiology, and diagnosis of mucormycosis. Human Pathol. 11: 457-464, 1980.

[20] 20. MEAD, J. H.; LUMPTON, G. P.; DILLAVOU, C. L. & ODOM, R. B. Cutaneous Rhizopus infection. Occurrence as a postoperative complication associated with an elasticited adhesive dressing. J.A.M.A. 242: 272-274, 1979.

[21] 21. PEREIRA, V. G.; PEREIRA, M. A. A.; CRUZ, J. O. B. & HARON, E. S Mucormicose rino-orbitária. Relato de um caso. Rev. Hosp. Clin. Fac. Med. Säo Paulo 37: 140-146, 1982.

[22] 22. RIPPON, J. W. Mucormycosis. In: Medical Mycology. The patogenic fungi and the pathogenic actinomycetes. (2nd.). Philadelphia, W.B. Saunders, 1982, 615-640.

[23] 23. SHELDON, D. L. & JOHNSON, W. C. Cutaneous mucormycosis: Two documented causes of suspected nosocomial cause. J.A.M.A. 241: 1032-1034, 1979.

[24] 24. SZEPES, E. & GRÓF, P. Subcutaneous mucormycosis. Mylkosen 25: 503-507, 1982.

[25] 25. VELIATH, A. J.; RAO, R.; RADAHKRISHNA, P. & AURORA, A. L. Cutaneous Phycomycosis (Mucormycosis) with fatal pulmonary dissemination. Arch. Dermatol. 112: 509-512, 1976.

[26] 26. WHEAT, L. J. Infection and diabetes mellitus. Diahet. Care. 3: 187-191, 1980.

[27] 27. WILSON, C. B.; SIBER, G. R. & O'BRIEN, T. F. Phycomicotic gangrenous cellulitis. Arch. Surg. 1l1: 532-538, 1976.

Subcutaneous mucormycosis caused by Rhizopus oryzae: probable nosocomial acquired infection

Mucormicose subcutânea causada por Rhizopus oryzae: provável infecção hospitalar

Abstracts

References

Publication Dates

History