AIM： To compare argon laser photocoagulation and intrastromal injection of voriconazole as adjunctive treatment modalities in cases of resistant mycotic corneal ulcers. METHODS： Two groups each of them included 20 c...AIM： To compare argon laser photocoagulation and intrastromal injection of voriconazole as adjunctive treatment modalities in cases of resistant mycotic corneal ulcers. METHODS： Two groups each of them included 20 cases of resistant mycotic corneal ulcers. Both groups treated with local and systemic specific antimicrobial drugs guided with culture and sensitivity results. In one group argon laser photocoagulation was used as an adjunctive therapy to the specific antifungal drugs and in the other group, intrastromal injection of voriconazole was done besides the specific antifungal drugs. The 40 cases included in the study were proven according to culture and sensitivity to be 28 cases with pure fungal results and 12 cases with mixed （fungal and bacterial）. In argon laser group, argon laser irradiation of the corneal ulcer was performed using argon laser 532 nm wavelength （Carl Zeiss LSL 532s AG; Meditec, Inc.） after fluorescein staining. In the other group, voriconazole solution （500 pg/mL） was prepared and injected in the corneal stroma. All cases were followed up for 3mo after healing was achieved. RESULTS： Complete healing of the epithelial defect and resolution of stromal infiltration with no adverse effects were achieved in argon laser group in duration ranged from 2-4wk in 90% of cases. In voriconazole group 4 cases needed amniotic membrane graft due to thinning and 16 cases healed in duration ranged from 2- 6wk （80% of cases）. CONCLUSION： Argon superior to intrastromal treatment of resistant fungal laser photocoagulation is voriconazole injection in corneal ulcers.展开更多
Primary abdominoaortic fistula is an extremely rare cause of upper gastrointestinal(GI)bleeding.The diagnosis is frequently delayed due to the rarity of the disease and low index of suspicion by physicians.A range of ...Primary abdominoaortic fistula is an extremely rare cause of upper gastrointestinal(GI)bleeding.The diagnosis is frequently delayed due to the rarity of the disease and low index of suspicion by physicians.A range of invasive and non-invasive diagnostic tools are available,but helical computer tomography(CT) remains the mainstay.Surgery offers the only hope for survival.This case report presents a 47-year-old male with massive upper GI bleeding.Various diagnostic tests and an exploratory laparotomy failed to identify the diagnosis.Later,a primary aortoduodenal fistula was confirmed by CT scan which necessitated surgical repair of the fistula and a Goretex graft for the abdominal aortic aneurysm.The patient made an uneventful recovery and remained well to the first postoperative visit in the clinic 2 wk after surgery.展开更多
BACKGROUND：Endovascular repair of mycotic aneurysm is an alternative to open repair if the patho-anatomy is suitable. The aortic size above and below the mycotic aneurysm may be small. METHODS： A retrospective revie...BACKGROUND：Endovascular repair of mycotic aneurysm is an alternative to open repair if the patho-anatomy is suitable. The aortic size above and below the mycotic aneurysm may be small. METHODS： A retrospective review was made of prospectively collected departmenta computerised database. RESULTS： Three oriental patients with juxta- and infra-renal mycotic aortic aneurysms with a small aortic diameter of 17 mm to 18 mm underwent successful emergency endovascular treatment using Cook Zenith ELSE stentgraffs. These are ancillary devices aimed at iliac extensions usually. CONCLUSIONS： This is to our knowledge the first case series of Cook Zenith ELSE iliac component endografts for the treatment of aortic mycotic aneurysms with small aortae, and short- and mid-term results are encouraging.展开更多
This case describes a ruptured mycotic aneurysm from Abiotrophia defectiva that led to a subdural hematoma and subsequent herniation. In the current literature, there have been cases highlighting mycotic aneurysms lea...This case describes a ruptured mycotic aneurysm from Abiotrophia defectiva that led to a subdural hematoma and subsequent herniation. In the current literature, there have been cases highlighting mycotic aneurysms leading to subdural hematoma. Several others describe similar topics;however, none were caused by Abiotrophia defectiva, leading to a herniation event. Abiotrophia defectiva, while not common, is an insidious bacterium that is difficult to detect and leads to a poor prognosis. In their paper, Ding et al. described a hematoma formation from a ruptured aneurysm of the distal middle cerebral artery [1]. Similar cases include two instances published by Boukobza et al. [2]. These prior articles and our report summarizes that this diagnosis typically warrants careful evaluation of etiologies and close management of the patient.展开更多
Salmonella, a food-borne pathogen, can cause mild self-limiting gastroenteritis. However, immunocompromised hosts and older adults with complex medical conditions may develop a complicated form of bacteraemia, with a ...Salmonella, a food-borne pathogen, can cause mild self-limiting gastroenteritis. However, immunocompromised hosts and older adults with complex medical conditions may develop a complicated form of bacteraemia, with a high mortality rate involving extra-intestinal foci of infection and mycotic aneurysms. We report the case of a 61-year-old man with poorly controlled diabetes mellitus, hypertension, dyslipidaemia, and congestive heart failure, who presented with unilateral left lower limb swelling, extensive deep vein thrombosis, and concomitant Salmonella bacteraemia. An oral anticoagulant and intravenous antibiotic therapy were initiated. Although the patient remained haemodynamically stable, he complained of constant left lower limb weakness and lower back pain. A computed tomography angiography scan of the thorax and abdomen revealed saccular aneurysms with contained hematoma of the left common iliac artery. The oral anticoagulant was discontinued, and an inferior vena cava filter was inserted as part of the venous thrombosis management. The patient was offered aorto-uni-iliac endovascular aneurysm repair and received intravenous antibiotic therapy, postoperatively, for six weeks. The postoperative blood cultures remained negative, and he was discharged with a course of ciprofloxacin administered orally. However, three months after the surgery, the patient died of recurrent septicaemia. This case illustrates the importance of remaining vigilant for potential endovascular complications of Salmonella bacteraemia, such as mycotic aneurysms and deep vein thrombosis, among high-risk patients. Further, this case highlights the challenges of eliminating Salmonella bacteraemia and its related complications, albeit treating it with both a prolonged course of medical therapy and surgical intervention.展开更多
AIMTo isolate and identify the molds involved in mycotic keratitis; to isolate corresponding species from soil samples; to compare the extracellular enzyme activity indices of the molds isolated from keratitis cases a...AIMTo isolate and identify the molds involved in mycotic keratitis; to isolate corresponding species from soil samples; to compare the extracellular enzyme activity indices of the molds isolated from keratitis cases and the corresponding soil isolates.展开更多
A 68-year-old man who presented with periodic fever and generalized weakness was diagnosed with Enterococcus faecalis bacteraemia from an infected abdominal aneurysm. The aneurysm was new: aortic dilatation was absent...A 68-year-old man who presented with periodic fever and generalized weakness was diagnosed with Enterococcus faecalis bacteraemia from an infected abdominal aneurysm. The aneurysm was new: aortic dilatation was absent a year before. In such patients the diagnosis “microbial aortitis” is more appropriate than “mycotic aneurysm”. We discuss the pathophysiology, epidemiology, prognosis and treatment of this condition.展开更多
Mycotic pseudo-aneurysm is a rare and potentially fatal sequela of bacteraemia. The injury results in a localized, irreversible dilatation due to destruction of the blood vessel wall by infection, usually with an aero...Mycotic pseudo-aneurysm is a rare and potentially fatal sequela of bacteraemia. The injury results in a localized, irreversible dilatation due to destruction of the blood vessel wall by infection, usually with an aerobic bacterium. Anaerobic bacteria are uncommon. We report an unusual case of a 72-year-old Caucasian man who presented with a rapidly progressive mycotic pseudoaneurysm of the right subclavian artery due to an anaerobic Gram-positive coccus Peptoniphilus asaccharolyticus. Despite optimal treatment, combining antibiotics and surgery, mycotic pseudo-aneurysm has a poor prognosis. When surgery is not possible, antibiotics alone with or without the placement of an endovascular stent have been proposed but in such cases, mortality is very significant. Despite the availability of non-invasive imaging techniques, a strong clinical suspicion is essential for early diagnosis of a mycotic aneurysm. Clinicians must be aware of these important aspects of management.展开更多
Introduction: The diabetes constitutes the factor risk of mycotic infections. The pathogenic agents depend on the climate, geography and the migration. The objective of this study is to evaluate the prevalence of the ...Introduction: The diabetes constitutes the factor risk of mycotic infections. The pathogenic agents depend on the climate, geography and the migration. The objective of this study is to evaluate the prevalence of the mycotic infections within the hospitalized diabetic patients, to describe their localization and identify the responsible germs. Patients and methods: It is about a descriptive and retrospective study conducted from November 2015 to March 2016 in endocrinology office at CHU Ibn Roch of Casablanca. It was included all diabetic patients hospitalized with whom mycotic infection has been suspected. Results: In total 350 diabetic patients have been hospitalized during the period of research. A mycotic infection has been suspected in 138 patients corresponding to the prevalence of 39.4 percent. The means localizations of mycotic infections were feet (intertrigos: 38.4%), onychomycosis (29%), vulvovaginal (21.7%) and mouth (oral candidiasis: 13.3%). The most frequent pathogenic agents were dermatophytes (Trichophyton rubrum: 61%, Trichophyton mentagrophytes: 6.3%) and Candida albicans (23.1%). The direct test and the culture were negative in 7.3%. Conclusion: One-third of the diabetic patients showed a mycotic infection. The feet, constitute the predilection localization of mycotic infections in the diabetic. The dermatophytes and Candida albicans constitute the most frequent pathogenic agents found in our study.展开更多
We present a case of leaking mycotic aneurysm of abdominal aorta complicated by infective endocarditis in a young boy of 14 years age. This boy with history of rheumatic heart disease with vegetations on mitral valve ...We present a case of leaking mycotic aneurysm of abdominal aorta complicated by infective endocarditis in a young boy of 14 years age. This boy with history of rheumatic heart disease with vegetations on mitral valve and severe mitral regurgitation landed up in complications of infective endocarditis like femoral artery thrombo embolism followed by an abdominal aortic aneurysm with contained rupture. This case was successfully managed addressing two problems i.e. valve and aneurysm repair in single sitting.展开更多
Mycotic or infected aneurysms are focal vascular dilatations from inflammation or infection that results in weakening of the blood vessel wall. It poses a high risk of complications such as aneurysm rupture, uncontrol...Mycotic or infected aneurysms are focal vascular dilatations from inflammation or infection that results in weakening of the blood vessel wall. It poses a high risk of complications such as aneurysm rupture, uncontrolled sepsis and extensive periaortic infection. Symptoms are frequently minimal during the early stages and a high index of suspicion is essential to make the diagnosis. They are more likely to expand rapidly and rupture without surgical intervention. We report a case of a middle-aged man presented with 3-week history of fever, abdominal pain and low back pain. Initially presented as acute pyelonephritis with subsequent findings of liver abscess, right epididymoorchitis and left infrarenal mycotic aneurysm, which rapidly increased in size and underwent successful endovascular surgery.展开更多
Objective:To investigate clinical,pathological and mycological findings in canaries,in which pox lesions and Aspergillus fumigatus(A.fumigatus)infection were observed simultaneously.Methods:This study was performed on...Objective:To investigate clinical,pathological and mycological findings in canaries,in which pox lesions and Aspergillus fumigatus(A.fumigatus)infection were observed simultaneously.Methods:This study was performed on a breeding colony(about 100 canaries)affected by fatal wasting disease.Necropsy was undertaken on 10 severely affected canaries,and gross lesions were recorded.Samples from internal organs displaying lesions were obtained for histopathological evaluation.Tracheal swap samples of internal organs of the all infected animals with lesions at necropsy were cultured in Sabouraud Dextrose Agar for mycological examination.Results:At necropsy,caseous foci were determined in the lungs,on the air sacs,liver,spleen,heart.Swelling of the eyelids,diffuse hemorrhages in the subcutaneous tissue with small papular lesions of the skin were other typical necropsy findings.Histopathologically,pathognomonic eosinophilic intracytoplasmic inclusion bodies,which called Bollinger bodies,in both skin cells and vacuolated air way epithelial cells confirmed canary pox infection.Moreover,histopathological examination of the white-yellowish caseous foci revealed necrotic granulomatous reaction consisting of macrophages,heterophil leukocytes and giant cells encapsulated with a fibrous tissue.After the culture of the tissue samples,the formation of bluish green colonies confirmed A.fumigatus infection.Conclusions:Canary pox has been known as the disease that can result in high losses in a short time,as a re-emerging disease that has not been present during recent years in canary flocks in Iran.So,the current paper provides useful information to prevent misdiagnosed of canary pox disease which can cause secondary mycotic infection.展开更多
文摘AIM： To compare argon laser photocoagulation and intrastromal injection of voriconazole as adjunctive treatment modalities in cases of resistant mycotic corneal ulcers. METHODS： Two groups each of them included 20 cases of resistant mycotic corneal ulcers. Both groups treated with local and systemic specific antimicrobial drugs guided with culture and sensitivity results. In one group argon laser photocoagulation was used as an adjunctive therapy to the specific antifungal drugs and in the other group, intrastromal injection of voriconazole was done besides the specific antifungal drugs. The 40 cases included in the study were proven according to culture and sensitivity to be 28 cases with pure fungal results and 12 cases with mixed （fungal and bacterial）. In argon laser group, argon laser irradiation of the corneal ulcer was performed using argon laser 532 nm wavelength （Carl Zeiss LSL 532s AG; Meditec, Inc.） after fluorescein staining. In the other group, voriconazole solution （500 pg/mL） was prepared and injected in the corneal stroma. All cases were followed up for 3mo after healing was achieved. RESULTS： Complete healing of the epithelial defect and resolution of stromal infiltration with no adverse effects were achieved in argon laser group in duration ranged from 2-4wk in 90% of cases. In voriconazole group 4 cases needed amniotic membrane graft due to thinning and 16 cases healed in duration ranged from 2- 6wk （80% of cases）. CONCLUSION： Argon superior to intrastromal treatment of resistant fungal laser photocoagulation is voriconazole injection in corneal ulcers.
文摘Primary abdominoaortic fistula is an extremely rare cause of upper gastrointestinal(GI)bleeding.The diagnosis is frequently delayed due to the rarity of the disease and low index of suspicion by physicians.A range of invasive and non-invasive diagnostic tools are available,but helical computer tomography(CT) remains the mainstay.Surgery offers the only hope for survival.This case report presents a 47-year-old male with massive upper GI bleeding.Various diagnostic tests and an exploratory laparotomy failed to identify the diagnosis.Later,a primary aortoduodenal fistula was confirmed by CT scan which necessitated surgical repair of the fistula and a Goretex graft for the abdominal aortic aneurysm.The patient made an uneventful recovery and remained well to the first postoperative visit in the clinic 2 wk after surgery.
文摘BACKGROUND：Endovascular repair of mycotic aneurysm is an alternative to open repair if the patho-anatomy is suitable. The aortic size above and below the mycotic aneurysm may be small. METHODS： A retrospective review was made of prospectively collected departmenta computerised database. RESULTS： Three oriental patients with juxta- and infra-renal mycotic aortic aneurysms with a small aortic diameter of 17 mm to 18 mm underwent successful emergency endovascular treatment using Cook Zenith ELSE stentgraffs. These are ancillary devices aimed at iliac extensions usually. CONCLUSIONS： This is to our knowledge the first case series of Cook Zenith ELSE iliac component endografts for the treatment of aortic mycotic aneurysms with small aortae, and short- and mid-term results are encouraging.
文摘This case describes a ruptured mycotic aneurysm from Abiotrophia defectiva that led to a subdural hematoma and subsequent herniation. In the current literature, there have been cases highlighting mycotic aneurysms leading to subdural hematoma. Several others describe similar topics;however, none were caused by Abiotrophia defectiva, leading to a herniation event. Abiotrophia defectiva, while not common, is an insidious bacterium that is difficult to detect and leads to a poor prognosis. In their paper, Ding et al. described a hematoma formation from a ruptured aneurysm of the distal middle cerebral artery [1]. Similar cases include two instances published by Boukobza et al. [2]. These prior articles and our report summarizes that this diagnosis typically warrants careful evaluation of etiologies and close management of the patient.
文摘Salmonella, a food-borne pathogen, can cause mild self-limiting gastroenteritis. However, immunocompromised hosts and older adults with complex medical conditions may develop a complicated form of bacteraemia, with a high mortality rate involving extra-intestinal foci of infection and mycotic aneurysms. We report the case of a 61-year-old man with poorly controlled diabetes mellitus, hypertension, dyslipidaemia, and congestive heart failure, who presented with unilateral left lower limb swelling, extensive deep vein thrombosis, and concomitant Salmonella bacteraemia. An oral anticoagulant and intravenous antibiotic therapy were initiated. Although the patient remained haemodynamically stable, he complained of constant left lower limb weakness and lower back pain. A computed tomography angiography scan of the thorax and abdomen revealed saccular aneurysms with contained hematoma of the left common iliac artery. The oral anticoagulant was discontinued, and an inferior vena cava filter was inserted as part of the venous thrombosis management. The patient was offered aorto-uni-iliac endovascular aneurysm repair and received intravenous antibiotic therapy, postoperatively, for six weeks. The postoperative blood cultures remained negative, and he was discharged with a course of ciprofloxacin administered orally. However, three months after the surgery, the patient died of recurrent septicaemia. This case illustrates the importance of remaining vigilant for potential endovascular complications of Salmonella bacteraemia, such as mycotic aneurysms and deep vein thrombosis, among high-risk patients. Further, this case highlights the challenges of eliminating Salmonella bacteraemia and its related complications, albeit treating it with both a prolonged course of medical therapy and surgical intervention.
基金Partially supported by the University Grants Commission(UGC),Bahadur Shah Zafar Marg,New Delhi-110 002,India[F.No.42-469/2013(SR)]
文摘AIMTo isolate and identify the molds involved in mycotic keratitis; to isolate corresponding species from soil samples; to compare the extracellular enzyme activity indices of the molds isolated from keratitis cases and the corresponding soil isolates.
文摘A 68-year-old man who presented with periodic fever and generalized weakness was diagnosed with Enterococcus faecalis bacteraemia from an infected abdominal aneurysm. The aneurysm was new: aortic dilatation was absent a year before. In such patients the diagnosis “microbial aortitis” is more appropriate than “mycotic aneurysm”. We discuss the pathophysiology, epidemiology, prognosis and treatment of this condition.
文摘Mycotic pseudo-aneurysm is a rare and potentially fatal sequela of bacteraemia. The injury results in a localized, irreversible dilatation due to destruction of the blood vessel wall by infection, usually with an aerobic bacterium. Anaerobic bacteria are uncommon. We report an unusual case of a 72-year-old Caucasian man who presented with a rapidly progressive mycotic pseudoaneurysm of the right subclavian artery due to an anaerobic Gram-positive coccus Peptoniphilus asaccharolyticus. Despite optimal treatment, combining antibiotics and surgery, mycotic pseudo-aneurysm has a poor prognosis. When surgery is not possible, antibiotics alone with or without the placement of an endovascular stent have been proposed but in such cases, mortality is very significant. Despite the availability of non-invasive imaging techniques, a strong clinical suspicion is essential for early diagnosis of a mycotic aneurysm. Clinicians must be aware of these important aspects of management.
文摘Introduction: The diabetes constitutes the factor risk of mycotic infections. The pathogenic agents depend on the climate, geography and the migration. The objective of this study is to evaluate the prevalence of the mycotic infections within the hospitalized diabetic patients, to describe their localization and identify the responsible germs. Patients and methods: It is about a descriptive and retrospective study conducted from November 2015 to March 2016 in endocrinology office at CHU Ibn Roch of Casablanca. It was included all diabetic patients hospitalized with whom mycotic infection has been suspected. Results: In total 350 diabetic patients have been hospitalized during the period of research. A mycotic infection has been suspected in 138 patients corresponding to the prevalence of 39.4 percent. The means localizations of mycotic infections were feet (intertrigos: 38.4%), onychomycosis (29%), vulvovaginal (21.7%) and mouth (oral candidiasis: 13.3%). The most frequent pathogenic agents were dermatophytes (Trichophyton rubrum: 61%, Trichophyton mentagrophytes: 6.3%) and Candida albicans (23.1%). The direct test and the culture were negative in 7.3%. Conclusion: One-third of the diabetic patients showed a mycotic infection. The feet, constitute the predilection localization of mycotic infections in the diabetic. The dermatophytes and Candida albicans constitute the most frequent pathogenic agents found in our study.
文摘We present a case of leaking mycotic aneurysm of abdominal aorta complicated by infective endocarditis in a young boy of 14 years age. This boy with history of rheumatic heart disease with vegetations on mitral valve and severe mitral regurgitation landed up in complications of infective endocarditis like femoral artery thrombo embolism followed by an abdominal aortic aneurysm with contained rupture. This case was successfully managed addressing two problems i.e. valve and aneurysm repair in single sitting.
文摘Mycotic or infected aneurysms are focal vascular dilatations from inflammation or infection that results in weakening of the blood vessel wall. It poses a high risk of complications such as aneurysm rupture, uncontrolled sepsis and extensive periaortic infection. Symptoms are frequently minimal during the early stages and a high index of suspicion is essential to make the diagnosis. They are more likely to expand rapidly and rupture without surgical intervention. We report a case of a middle-aged man presented with 3-week history of fever, abdominal pain and low back pain. Initially presented as acute pyelonephritis with subsequent findings of liver abscess, right epididymoorchitis and left infrarenal mycotic aneurysm, which rapidly increased in size and underwent successful endovascular surgery.
基金Supported by a grant for Scientific Research from Vice Chancellorof Research of Shahid Bahonar University of Kerman.Iran(Grant No.MP/342/41)
文摘Objective:To investigate clinical,pathological and mycological findings in canaries,in which pox lesions and Aspergillus fumigatus(A.fumigatus)infection were observed simultaneously.Methods:This study was performed on a breeding colony(about 100 canaries)affected by fatal wasting disease.Necropsy was undertaken on 10 severely affected canaries,and gross lesions were recorded.Samples from internal organs displaying lesions were obtained for histopathological evaluation.Tracheal swap samples of internal organs of the all infected animals with lesions at necropsy were cultured in Sabouraud Dextrose Agar for mycological examination.Results:At necropsy,caseous foci were determined in the lungs,on the air sacs,liver,spleen,heart.Swelling of the eyelids,diffuse hemorrhages in the subcutaneous tissue with small papular lesions of the skin were other typical necropsy findings.Histopathologically,pathognomonic eosinophilic intracytoplasmic inclusion bodies,which called Bollinger bodies,in both skin cells and vacuolated air way epithelial cells confirmed canary pox infection.Moreover,histopathological examination of the white-yellowish caseous foci revealed necrotic granulomatous reaction consisting of macrophages,heterophil leukocytes and giant cells encapsulated with a fibrous tissue.After the culture of the tissue samples,the formation of bluish green colonies confirmed A.fumigatus infection.Conclusions:Canary pox has been known as the disease that can result in high losses in a short time,as a re-emerging disease that has not been present during recent years in canary flocks in Iran.So,the current paper provides useful information to prevent misdiagnosed of canary pox disease which can cause secondary mycotic infection.
