Argon laser photocoagulation versus intrastromal voriconazole injection in treatment of mycotic keratitis

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.

Deadly case of Pasteurella multocida aortitis and mycotic aneurysm following a cat bite

Animal bites are frequently encountered in the emergency department(ED). Aortitis leading to mycotic abdominal aortic aneurysm is a rare and potentially deadly complication of Pasteurella multocida(P. multocida) following an animal bite. We present the case of a 68-year-old male who presented to the ED after falling at home. He complained of weakness and abdominal pain. He was in septic shock and was treated empirically with broad-spectrum antibiotics and intravenous fluids. He reported previous antibiotic treatment of a cellulitis secondary to a cat bite injury to his right thumb four weeks prior. Abdominal ultrasound and subsequent computed tomography scan revealed a leaking mycotic abdominal aneurysm that was surgically repaired. Blood cultures and aortic wall tissue cultures grew P. multocida. Given how common animal bite presentations are in the ED, this case highlights the need to consider aortitis and mycotic abdominal aortic aneurysm in an unwell patient with an animal bite.

Mycotic Aneurysm of Infrarenal Aorta: A Case Report and Review of Literature

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.

Mycotic Infections in Diabetic Patients in Casablanca

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.

Mycotic Aneurysm from Abiotrophia Defectiva Causing Subdural Hematoma with Herniation

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.

Peptostreptococcus Mycotic Pseudo-Aneurysm

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.

Leaking Mycotic Aneurysm of Abdominal Aorta in a 14-Year-Old Boy with Infective Endocarditis and Severe Mitral Regurgitation—A Rare Case Report

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.

An Unusual Case of Deep Vein Thrombosis and Mycotic Aneurysms Secondary to Salmonella Bacteraemia

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.

A Rare Cause of Hemiparesis: Intracranial Mycotic Aneurysm—A Case Report, and Review of the Literature

Background: The intracranial mycotic aneurysm is known to be a rare complication of infective endocarditis and it is more clinically challenging to get this diagnosis right when it happened to be in a patient without a past medical history of heart diseases. We report a documented case of mycotic aneurysm revealed by isolated left hemiparesis and our management with the collaboration of the cardiology department. Case Description: A 48-year-old male patient with a history of teeth loss, a chronic smoker presented with sudden heaviness in the left upper and lower limbs. No fever. Physical examination revealed a left hemiparesis of 3/5 on the muscle tone scale without the stiffness of the neck. The CT-Scan and the MRI conclude of subarachnoid and cerebral hemorrhage with right temporal hematoma being most probably a vascular malformation. The cerebral arteriography concluded of a right Sylvian mycotic distal aneurysm in the M4 segment. Transesophageal echocardiography was performed and concluded of infectious endocarditis with mitral and aortic valvular disease grade II. Positive blood culture for staphylococcus coagulase-negative. The patient was managed with antibiotic therapy and clinically stable after 28 days. He was then transferred to the cardiology department for follow-up. Six (6) months later a CT-angiography was done for a check-up and shows no further changes in the aneurysm. The patient underwent surgery, two (2) months later, for clipping the aneurysm because the aneurysm did not regress in size. The aneurysm was then excluded with an eventless post-operative period, confirmed by controlled cerebral arteriography. The patient was discharged five (5) days later and he is doing well. Conclusion: Mycotic aneurysm is a rare consequence of infective endocarditis. The distal sites of the middle cerebral artery are commonly found, and conservative treatment with a long course of antibiotics like amoxicillin 12 g/24h for 6 weeks or direct surgical clipping or excision can manage it.

Surgical management of ruptured mycotic aortic aneurysm induced by Klebsiella pneumoniae

To the Editor:A 63-year-old male patient was referred from a local clinic for diffuse abdominal pain for 1 day and ruptured abdominal aortic aneurysm (rAAA) in computed tomography (CT).He denied any medical history of hypertension,diabetes mellitus,hepatitis or pneumonia.The patient’s blood pressure was 100/70 mmHg with a pulse rate of 105 beats/min and a body temperature of 37.1℃.The Abdomen was mildly distended with diffuse pain and tenderness.

Primary aortoduodenal fistula:A case report

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.

In vitro and comparative study on the extracellular enzyme activity of molds isolated from keratomycosis and soil

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.

Clinical and pathological findings of concurrent poxvirus lesions and aspergillosis infection in canaries

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.

Spectrum of fungal keratitis: clinicopathologic study of 44 cases

AIM: To determine the causative agents of fungal keratitis and study the predisposing factors over a period of ten years in a single tertiary care hospital. ·METHODS: A retrospective analysis of fungal corneal ulcers was done from 2003-2012. Patients’ clinical data were noted from the file records. Correlation of histopathological diagnosis was done with the report on fungal culture. · RESULTS: Mycotic keratitis was established in 44 cases by a positive fungal culture. Direct microscopic examination of potassium hydroxide(KOH) mounts revealed fungal elements in 39 cases while 40 cases showed fungus on Gram stained smears. Males(54.55%) were more commonly affected than the females(45.45%). The age ranged from 18 to 82 years. Most common age group to be involved was 41-60 years. Predisposing risk factors were seen in 34(77.27%) cases. Most common findings on clinical examination were anterior chamber reaction and conjunctival injection seen in all the cases. Other common findings were stromal infiltration and hypopyon seen in 20(45.45%) and 18(40.91%) cases respectively. On histopathological examination the fungus was typed,as aspergillus in 34 cases while no definite typing was possible in 10 cases. The predominant isolate was aspergillus flavus(59.09%) followed by fusarium(15.91%). Mixed fungal and bacterial infection was seen in 3(6.82%) cases. ·CONCLUSION: Although culture is the gold standard for definitive diagnosis of fungal keratitis,direct microscopic examination of corneal scrapings or histomorphological evaluation of biopsies allow a rapidpreliminary diagnosis. Early administration of antifungal treatment helps in preventing dreadful complications.

Microbial Aortitis with Aneurysm Formation

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.

A palpable tender abdominal mass in a patient with endocarditis on antibiotics for 5 weeks

Mycotic aneurysms are a rare finding in the post-antibiotic era but must still be considered as a cause of abdominal pain in a patient with endocarditis. We present a case of a 47-year-old man with a history of IV drug use and a prior episode of endocarditis who developed a mycotic aneurysm while hospitalized on IV antibiotic therapy for aortic valve endocarditis. Due to their life-threatening character and often lack of evident clinical picture, mycotic aneurysms should still remain in high suspicion for a patient with abdominal pain in the setting of endocarditis.