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Rhino-oculo-cerebral aspergillus and mucor co-infections in an immunocompromised patient with type 2 diabetes mellitus Rit

Several workers reported an increased susceptibility to hepatitis B virus (HBV) in immunosuppressed patients. This study clarified the prevalence of the opportunistic parasites among a group of immunocompromised patients selected from Al Azhar University Hospitals. Data were analyzed with multivariable logistic regression. Debridement of an staphylococceal infected hematoma through a single left lateral gluteus incision, and primary closure was performed. Statistical analysis included the Fisher exact test to verify any association between histopathology and the cause of immunocompromise; a logistic regression was used to predict the risk of death for specific histological findings for each of the independent variables in the model. The highest group affected with the opportunistic parasites was the group of patients under corticosteroid therapy (31.7%), followed by patients suffering from renal failure (28.8%) and malignancy (25.7%), while the least group affected were the diabetic patients (8%). Furthermore, Okamoto et al.

It is seen particularly in immunocompromised patients. Because the agents of mucormycosis are common in the environment, they are relatively frequent contaminants in the clinical microbiology laboratory; all humans have ample exposure to these fungi during day-to-day activities. It has generally been thought to be associated with individuals with AIDS. (3). A 42-year-old man presented with a severe cough over a period of 2 months. After proper control of blood sugar and hypertension, exploration of maxillary sinus was done by modified Caldwell-Luc operation and the tissue was collected. In addition to three blood culture sets collected from three different sites at an interval of half an hour, aseptically collected urine and sputum samples were sent for microbiological examinations.

CMV infection can be prevented by averting immunodeficiency infections, providing suitable treatment and medical care after an organ transplant, or when a body immunity system is weakened by other illnesses. After a one-month symptom-free period the patient presented with throbbing left-sided headache, pain and tenderness over the left maxillary sinus area and blocked left nostril. CT scan showed a large heterogeneous diffuse soft-tissue mass involving both the maxillary antrums and part of the nasopharynx with left orbital proptosis [Figure 2]. Sellar and parasellar regions were normal. She was unable to articulate with pulse oximetry showing sPO2 of 80%. X-ray of the adjoining area showed soft opacity with erosion of superior, middle and inferior margin of the left maxillary antrum. The pathogenesis is unclear, but cytokines and growth factors may play a role.

Blood urea and creatinine levels were 57 mg/dl and 3.6 mg/dl respectively. Urine dipstick analysis identified the presence of ketones and blood gas analysis revealed metabolic acidosis. According to Stern et al [22] and Jackman et al, [23] clotrimazole ear drops is the most effective antifungal agent. Further culture of collected material identified the species as Aspergillus flavus. Material from the left wall of the middle turbinate of the left nasal cavity also revealed growth of Aspergillus flavus [Figure 3]. Intravenous infusion of Voriconazole was started and continued for seven days without much improvement of clinical condition. Chemoprophylaxis may be recommended primarily in the context of traveling to regions where malaria is endemic.

Histopathological staining showed broad nonseptate hyphae of Mucor [Figure 4]. Clinical characteristics of 22 patients with pulmonary cryptococcosis are summarized in Table 1. He tolerated Amphotericin B very poorly and ultimately after 17 days of therapy the patient expired. Aspergillosis is a well-known fungal infection most commonly caused by A. fumigatus. Invasive aspergillosis of the ROC region may spread to the adjoining regions appearing as yellow or black necrotic ulcers. [6] If diagnosis and therapeutic interventions are delayed it may result in massive tissue destruction and, eventually death.

Aspergillosis most commonly affects patients with poorly controlled diabetes with immunodeficiency, like that of our case.

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