Term
| Why Worry About Fungal Infections? |
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Definition
• Increase in at-risk populations
– HIV
– Solid organ transplantation – Stem cell transplantation
– Chemotherapeutic regimens
• Improving technology – Catheters
– Drugs |
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Term
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Definition
| Now, there is a wide distribution of fungal infections around the world, but there are a number of them, as you can see, here in North America. Blastomycosis, histoplasmosis, paracoccidioidomycosis, coccidioidomycosis-- you can see there's lots of different fungal infections that we see here in our part of the world. |
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Term
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Definition
The Diseases
• Aspergillosis
• Blastomycosis
• Coccidioidomycosis
• Cryptococcosis
• Histoplasmosis
• Paracoccidioidomycosis
• Penicilliosis
• Sporotrichosis
• Zygomycosis
The Fungi
• Aspergillus fumigatus
• Blastomyces dermatitidis
• Coccidioides immitis
• Cryptococcus neoformans
• Histoplasmosis capsulatum
• Paracoccidioides brasiliensis
• Penicillium marneffei • Sporothrix schenckii • Rhizopus arrhizus |
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Term
Mycotic Infections
• General concepts |
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Definition
– The fungi represent a diverse, heterogeneous group
of eukaryotes.
– Most of these organisms are plant pathogens, and relatively few cause disease in humans.
– In nature, fungi generally grow by secreting enzymes that digest tissues, but some are actually predacious.
– Fungal membranes contain ergosterol rather than cholesterol, and this provides a target for chemotherapy (azole derivatives interfere with ergosterol synthesis).
• Most antifungal antibiotics are relatively toxic to the human host.
– The growth of the fungi generally involves two
phases; vegetative and reproductive.
• In the vegetative phase, the cells are haploid and divide mitotically. Most fungi exist as molds with hyphae, but some fungi exist as unicellular yeast cells. Some fungi can change their morphology and are termed dimorphic.
• In the reproductive phase, fungi may undergo either asexual or sexual reproduction. Asexual reproduction involves the generation of spores; sexual reproduction requires specific cellular structures that are used for taxonomic differentiation. |
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Term
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Definition
| In the reproductive phase, they may undergo either asexual or sexual reproduction. Asexual reproduction involves the generation of spores, whereas sexual reproduction requires specific cellular structures. Here's just a diagram that you can see. There are some spores on both sides, but here's the asexual reproduction with the spore-producing structures. |
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Term
| types of mycotic infections |
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Definition
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Term
| types of tinea infections |
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Definition
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Term
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Definition
| These are what it looks like on the surface of the skin. Tinea versicolor is a little bit different. This is due to an organism called M furfur. Sporothrix-- this is the ulceration you get from Sporothrix schenckii which is the rose handler's disease. And then the tinea. This is the classic presentation for ringworm. |
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Term
| systemic and opportunistic mycotic infections |
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Definition
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Term
Mycotic Infection (cont.)
• Pathogenesis |
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Definition
– Mycotic disease is often a consequence of predisposing
factors including age, stress, or other pathologic conditions (e.g., cancer, diabetes, AIDS).
– Only the dermatophytes (Trichophyton, Microsporum) and Candida are communicable from human to human.
• The other agents are acquired from the environment (plants, soil, etc.).
– Fungi generally cause one of three distinct tissue responses;
• Chronic inflammation (scarring, accumulation of lymphocytes)
• Granulomatous inflammation (collections of modified epithelial cells, lymphocytes)
• Acute suppurative inflammation (vascular congestion, exudation of plasma, accumulation of PMNs)
– Aspergillus produces a toxin called aflatoxin that has a strong association with liver cancer.
– For example, in Thailand, where people generally consume about 25 times more aflatoxin in their diets, the incidence of cancer is about 10-fold greater.
– Systemic mycoses are generally asymptomatic but may have generalized symptoms including low-grade fever, shaking chills, night sweats, malaise, or appetite loss. |
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Term
Mycotic Infection (cont.)
• Host defenses |
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Definition
– Host defenses against the fungi include nonspecific and
specific factors.
• Nonspecific defenses include the skin (lipids, fatty acids, normal flora), internal factors (mucous membranes, ciliated cells, macrophages), blood components, temperature, and genetic and hormonal factors. Both physical and chemical factors and phagocytic defenses play major roles in prevention and control of mycotic disease. |
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Term
Mycotic Infection (cont.)
– Nonspecific and specific factors |
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Definition
• Specific defenses include both humoral and cell-mediated.
• The role of humoral defenses is somewhat controversial, since certain antibodies are not protective.
• It is possible that high titers of certain antibodies actually suppress the cell-mediated defenses.
• Some antibodies may be protective (e.g., antitoxins or opsonins).
• Generally, the cell-mediated defenses are probably more important.
• Acquired resistance is usually T-cell-mediated, and persons with compromised cell-mediated defenses generally show more disseminated disease. |
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Term
Mycotic Infection (cont.)
• Epidemiology |
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Definition
– Dermatophytes may be communicated from person to
person by combs, towels, and so on.
• These infections include ringworm, athlete's foot, jock itch, and so on.
• Candida is a member of the normal vaginal flora; candidiasis is often associated with diabetes.
– In some cases of mycosis, occupation seems an important contributor.
• Sporothrix is normally found in woody plants; hence, agricultural workers acquire disease more often.
• Histoplasma is often found in bird or bat excreta; hence spelunkers (cavers) or persons involved in community cleanup may acquire. |
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Term
Mycotic Infection (cont.)
– Most of the systemic diseases are geographically distributed. |
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Definition
• Histoplasmosis and blastomycosis predominate in the Ohio and Mississippi River valleys.
• Paracoccidioidomycosis is found primarily in Brazil.
• Coccidioidomycosis predominates in the Southwestern United States.
• Cryptococcosis has a worldwide distribution. |
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Term
Mycotic Infection (cont.) • Diagnosis
– Clinical: |
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Definition
• For the dermatophytes, appearance of the lesions
is usually diagnostic.
• For systemic mycoses, the epidemiology and symptomology are useful clues. |
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Term
Mycotic Infection (cont.)
– Laboratory: |
|
Definition
• Treatment of skin scrapings with 10% potassium
hydroxide can reveal hyphae or spores.
• Most fungi can be grown on Sabouraud's dextrose agar, but they are often very difficult to speciate.
• Some fungi show a yellow fluorescence under 365 nm ultraviolet light.
• Skin testing for a delayed hypersensitivity response is useful for epidemiologic purposes but often not for diagnosis. |
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Term
| Mycotic Infection (cont.) • Control |
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Definition
– Sanitary:
• Control by sanitary means is difficult, but the incidence of communicable disease can be reduced by good hygiene. |
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Term
Mycotic Infection (cont.)
– Chemotherapeutic: |
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Definition
• Many antifungals are available, but some are very toxic
to the host and must be used with caution.
• Topical powders and creams often contain tolnaftate or
azole derivatives (miconazole, clotrimazole, econazole) and are useful against superficial dermatophytes.
• Hair or nail disease may be treated with oral griseofulvin, but it is rather toxic.
• Sporotrichosis may be treated using potassium iodide or amphotericin B (oral).
• Systemic infections are generally treated by amphotericin B, 5-flourocytosine, miconazole, or ketoconazole. |
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Term
|
Definition
• General
– Most common opportunistic fungal infection
– Normal flora in GI and GU tract
– Due to Candida albicans
• Clinical
– Oropharyngeal – Vulvovaginitis – Cutaneous
– Disseminated • Endocarditis
© Richard Usatine, M.D. Used with permission
• Candidemia |
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Term
|
Definition
| – White plaques on buccal mucosa – Erythematous base |
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Term
|
Definition
| – Women in child-bearing years – Pruritus, curd-like discharge |
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Term
| Cutaneous candida infectrion |
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Definition
– Intertriginous areas
– Erythematous lesions with distinct borders and
satellite lesions |
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Term
| disseminated candida infection |
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Definition
| – Hepatosplenic infection in leukemic patients |
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Term
|
Definition
• Diagnosis
– KOH prep – Culture
• Treatment
– Mucocutaneous • Clotrimazole
• Fluconazole in AIDS – Vulvovaginitis
• Miconazole, clotrimazole – Disseminated
• Fluconazole, amphotericin B |
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Term
|
Definition
• Are180specieswithinthegenusAspergillus
– Most common is Aspergillus fumigatus |
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Term
| aspergillosis disease states |
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Definition
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Term
|
Definition
• Allergicbronchopulmonaryaspergillosis
– Type I and II hypersensitivity to A. fumigatus growing in the airway mucosa
– Occurs frequently in cystic fibrosis and bronchial asthma
– Manifests as asthma with fleeting pulmonary infiltrates • Represent recurrent inflammation • Can lead to proximal bronchiectasis and lung fibrosis
• Allergic bronchopulmonary aspergillosis
– Diagnostic criteria
• History of asthma
• Recurrent pulmonary infiltrates
• Productive sputum with mucous plugs or brown specks
• Allergicbronchopulmonaryaspergillosis – Labs
• Isolation of Aspergillus
• Eosinophilia
• Central bronchiectasis on CT scan
• Immunologic responses
– Skin reactivity, precipitating antibodies, Aspergillus- specific IgE
– Treatment
• Corticosteroids
• Antifungal drugs – Itraconazole |
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Term
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Definition
So the first one is this allergic bronchopulmonary aspergillosis. This is the type I and type II hypersensitivity reaction as it's growing in the airway mucosa. Frequently, you see this in people who have bronchial asthma and even more frequently see it in patients who have cystic fibrosis. It manifests as asthma with fleeting pulmonary infiltrates. So they look like asthma. They sound like asthma. On X-ray, you'll see these infiltrates that kind of come and go.
This represents recurrent inflammation, can lead to bronchiectasis and lung fibrosis. Bronchiectasis is where you get recurrent infections in the lung and then the lung gets destroyed. And when it tries to rebuild, which it tries to do, it just doesn't build itself in a normal format.
It's sort of like you've got this nice, tarred road, and in the winter, you start running snow plows over it. And hunks of tar fall away. People come by and try to patch it, but it's never as smooth and as nice as it was when it was first laid down. That's bronchiectasis in the lungs.
It does have distinct criteria. You have to have a history of asthma. You have to have these recurrent pulmonary infiltrates and productive sputum with these mucus plugs or brown specks. They will actually cough up these plugs that take on the shape, these mucus plugs that take on the shape of the airway that it was in. |
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Term
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Definition
Now, the other one is a saprophytic invasive disease. This is aspergillomus or a fungal ball. Often occurs when preexisting lung lesions become infected with aspergillus. So they've already had something else and now aspergillus gets in it. This includes tuberculosis. This includes sarcoidosis. This even includes patients who have emphysema.
As a mass of hyphae-- they are a mass of hyphae protected within a matrix of this fibrin and cellular debris. Typically, unilateral, typically in the upper lobes, and they can go elsewhere. I've actually seen patients with aspergillomus or these fungal balls in their heart. I took care of a gentleman once years ago who actually had it in his left ventricle of his heart.
You can get infection of previously normal lung tissue, this chronic necrotizing aspergillosis. We usually see this in patients with immune suppression. All of these, the main things to try to treat these is with surgical resection. You need to get that kind of tumor out, this aspergilloma out, this mass out of the lung. Just giving them antifungal agents will never do the trick. |
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Term
| Saprophytic Invasive Disease |
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Definition
• Aspergillomas, or “fungus balls”
• Occur when pre-existing lung
lesions become infected with
Aspergillus
– Lesions include tuberculosis, sarcoidosis, bullous emphysema or other cavitary lung lesion
• Are a mass of hyphae protected within a matrix of fibrin and cellular debris
• Typically located unilateral in upper lobes
• Infection in previously normal lung
– Chronic necrotizing aspergillosis • Not called aspergillomas
– Noted in patients with immune suppression
• Diabetes, COPD, neutropenia, AIDS, corticosteroids
– Therapy
• Surgical resection |
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Term
|
Definition
• Canbeallergic,saprophytic,orinvasive
– Allergic noted in patients with history of atopy
– Allergic inflammation to the live mold with the sinus cavity
– Signs include edema, obstruction, polyposis
– May have bony erosion of ethmoid sinus
– Treatment
• Drainage, corticosteroids, surgical/endoscopic removal |
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Term
| Invasive Pulmonary Aspergillosis |
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Definition
• Prominent cause of infectious morbidity and mortality in patients with hematologic malignancies and transplants
• Symptoms
– Fever, hemoptysis, cough, or pleuritic chest pain, neurologic symptoms (seizures, hemiparesis, and stupor)
• Radiology
– Pulmonary nodules, infiltrates, cavitating lesions
– Halo sign
• Laboratory
– Culture respiratory tract
– ELISA detection of galactomannan or beta-D-glucan
– Isolation in blood is uncommon
• Treatment(IDSAGuidelines,2008)
– Voriconazole • Recommended as primary treatment
– High dose amphotericin B
– Itraconazole • Accepted alternative therapy |
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Term
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Definition
You can get invasive pulmonary aspergillosis. This is a prominent cause of infectious mortality and morbidity in patients who are post-transplant or who have hematological malignancies. They present with fever, hemoptysis, cough, pleuritic chest pain. You see these pulmonary nodules or infiltrates in these cavitary lesions.
And they get this classic thing called the halo sign, and you can see the arrows here pointing to this halo sign. So you've got the area, and then so there's the one area and then there's the halo around it. |
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Term
|
Definition
• Due to Blastomyces
dermatitidis
– A dimorphic fungus
• Endemic in south central and north central United States
• Natural habitat is soil and decaying wood
– Growth from the soil is difficult
• Acquired through inhalation of conidia of the mold form
• Clinical manifestations
– Range from asymptomatic and ARDS
– Fever, night sweats, fatigue, productive cough, dyspnea
• Skin lesions
– Well-circumscribed nonpainful papules, nodules, or plaques, verrucous with punctate microabscesses in the center |
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Term
|
Definition
blastomycosis
And then the clinical manifestations range from anywhere from asymptomatic to full blown ARDS with fever, night sweats, fatigue, cough, dyspnea. It also can lead to some skin infections. These nonpainful papules, nodules, and plaques. They often have these little microabscesses inside the center. Classic photos of them there. |
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Term
|
Definition
Blastomycosis (cont.)
• Chestx-ray
– Masslike lesion must common
– Multiple nodules, lobar infiltrates, cavitary lesions
– Mediastinal lymphadenopathy uncommon
X-ray can show a mass-like lesion, multiple nodules, lobar infiltrates. Really, the way to make this diagnosis isn't through chest X-ray but it's through culture. |
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Term
Blastomycosis (cont.)
• Diagnosis |
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Definition
– Culture
• DNA probe to confirm culture growth
– Standard serology not indicated
– Urinary antigen enzyme immunoassay
• Studies pending
– Tissue biopsy |
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Term
Blastomycosis (cont.)
• Treatment(IDSAGuidelines,2008) |
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Definition
– Pulmonary/disseminated/CNS • Amphotericin B
• Itraconazole
– Immunosuppressed
• Amphotericin B
• Itraconazole – Lifetime suppression maybe needed |
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Term
|
Definition
• Duetothedimorphic fungi Coccidioides immitis or posadasii
– C. immitis: isolated in California
– C. posadasii: isolated outside California
• Soil-dwellingfungi
• Mostcasesare asymptomatic |
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Term
Coccidioidomycosis (cont.)
• Primaryinfection |
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Definition
• Typically asymptomatic • Symptomatic
• 1−3 weeks after inhalation
• Resembles community- acquired pneumonia
• Fever, cough, pulmonary infiltrates
• Outcomes
• Uneventful healing
• Coccidioima
• Progressive or persistent pneumonia
• Chronic pulmonary |
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Term
|
Definition
Coccidioidomycosis
. After inhalation, they may actually develop what looks like a community-acquired pneumonia with fever, cough. The real kicker for this is going to be they look like a pneumonia, but they came from or live in the area where this is really rampant So this is one you think about when you're practicing in Southern California, Arizona, New Mexico, through western Texas
You can have uneventful healing. A lot of people get exposed to this, they get infected, and they don't even know it. It can go and farm these masses and lesions. It can cause a progressive pneumonia and even chronic pulmonary infections.
It can disseminate, may invade the pleural space, the heart, the brain, the bones, the joint.\ |
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Term
Coccidioidomycosis (cont.)
• Disseminated |
|
Definition
– May occur locally or hematogenously
– May invade pleural space, pericardium, CNS, bone, and joint |
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Term
| Coccidioidomycosis diagnosis and treatment |
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Definition
• Diagnosis – Culture
– Serology/ELISA
• Treatment
– Amphotericin B – Ketoconazole – Fluconazole |
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Term
|
Definition
• Infectionduetotwo organisms:
– Cryptococcus neoformans – Cryptococcus gattii
• Environmentalreservoir
– C. neoformans: pigeon guano • Occurs worldwide
– C. gattii: tropical and subtropical trees • Northern Australia, Papua New Guinea, Vancouver Island |
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Term
Cryptococcosis (cont.)
• Epidemiology |
|
Definition
– High risk of infection in HIV-infected patients • Due to reduction in T-cell function
– Immunosuppressed patients
• Lung disease, liver disease, immunosuppressive drugs, transplant, autoimmune disease, malignancies |
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Term
| Cryptococcosis clinical manifestations |
|
Definition
– Central nervous system
• Neck stiffness, headache, fever, altered mental status
– Pulmonary
• Dry cough, chest tightness, fever |
|
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Term
|
Definition
– Positive antigen titer
– Culture
– Positive India ink staining
– Bronchial alveolar lavage |
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Term
Cryptococcosis (cont.)
• Treatment |
|
Definition
– Nonmeningeal
• Mild to moderate disease
– Fluconazole
• Severe disease
– Amphotericin B plus flucytosine
– Meningoencephalitis • Induction therapy
– Amphotericin B plus flucytosine • Consolidation therapy
– Fluconazole
• Maintenance therapy
– Fluconazole or itraconazole
– Meningoencephalitis, HIV negative/non-transplant • Induction therapy
– Amphotericin B plus flucytosine
• Consolidation therapy – Fluconazole
• Maintenance therapy – Fluconazole |
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Term
Cryptococcosis (cont.)
– Transplant recipients treatment |
|
Definition
• Induction therapy
– Amphotericin B plus flucytosine
• Consolidation therapy – Fluconazole
• Maintenance therapy – Fluconazole |
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Term
Histoplasmosis
• Clinicalpresentation and more info |
|
Definition
– Depend on number of microconidia inhaled and immune status of host
– Vary from asymptomatic or mild nonspecific respiratory illness
– Severe, life-threatening pneumonia
• High fever, dyspnea, nonproductive cough, chest pain
– Disseminated infection
• Immunosuppressed patients, use of TNF antagonists
• Due to the dimorphic fungus
Histoplasma capsulatum
• Most frequent in Ohio and Mississippi River valleys
– Found in soil rich in bird and bat droppings
• Pathology
– Aerosolized microconidia (mold form) are inhaled, phagocytized by alveolar macrophages where they convert to yeast form and spread to lymph nodes
– May become latent and reactive later |
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Term
Histoplasmosis (cont.)
• Diagnosis |
|
Definition
– Chest x-ray
• Diffuse reticulonodular infiltrates and hilar lymphadenopathy in acute disease
• Pulmonary nodules or cavitary lesions also noted
– Cavitary lesion in elderly with COPD
– Miliary pattern
– Culture or special stains
– Serology: antibody assays
– Antigen detection in the urine |
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Term
|
Definition
Histoplasmosis
Chest X-ray can show these diffuse reticulonodular infiltrates or hilar lymphadenopathy. It also can present with these miliary patterns, as you can see here. Once again, it looks like somebody just threw white little beads at this chest X-ray. And you can see them throughout this chest X-ray. That miliary pattern can also be seen in tuberculosis, we've talked about that before. |
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Term
Histoplasmosis (cont.)
• Treatment(IDSAGuidelines,2007) |
|
Definition
– Mild to moderate disease • Itraconazole
– Severe disease
• Amphotericin B
• Methylprednisolone
– Prophylaxis
• Itraconazole |
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Term
|
Definition
• CausedbytheorganismParacoccidioides
brasiliensis
• VerycommoninLatinAmerica
– Distribution ranges from Mexico to Argentina • Brazil accounts for 80% of cases
• Rareinchildren
– Common in males age 30−50 |
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Term
Paracoccidioidomycosis (cont.)
• Diseasepatterns |
|
Definition
– Subacute
• Juvenile form
• Reticuloendothelial system is involved, minimal lung involvement
– Chronic
• Lungs predominantly affected
• Present with cough, night sweats, fever, weight loss
• Mucosal and cutaneous involvement also noted |
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Term
Paracoccidioidomycosis (cont.)
• Diagnosis |
|
Definition
– Chest x-ray
• Bilateral patchy infiltrates or nodular infiltrates with cavities
• No hilar adenopathy
– Histology
• Note budding yeast
– Steering wheel or Mickey Mouse appearance
– Culture
– Immunodiffusion serology testing |
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Term
Paracoccidioidomycosis (cont.)
• Treatment |
|
Definition
– Amphotericin B
– Itraconazole
– Trimethoprim-sulfamethoxazole |
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Term
|
Definition
• Due to the thermally dimorphic
Penicillium marneffei
– Originally isolated in bamboo rats
• Limited to tropical Asia, especially Thailand, southern China, northwestern India, Taiwan, and Vietnam
• Increase prevalence with HIV
• Inhale airborne conidia with conversion to yeast phase in lung macrophages |
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Term
Penicilliosis (cont.)
• Clinicalmanifestations |
|
Definition
– Cutaneous lesions
– Generalized lymphadenopathy |
|
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Term
|
Definition
| – Reticulonodular and diffuse alveolar infiltrates |
|
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Term
|
Definition
– Amphotericin B
– Itraconazole
• Fluconazole is not effective |
|
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Term
|
Definition
• Duetothedimorphic organism Sporothrix schenckii
• Infectionduetoexposureto soil, moss, hay, or decaying material with trauma to the skin leading to direct inoculation
– Can also be spread by exposure to infected animals (cats)
-looks like little trees
[image] |
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Term
Sporotrichosis (cont.)
• Pathogenesis |
|
Definition
– Conidia in mold phase are inoculated into the skin and then converts to a yeast in the body
– Then spread along lymphatics
– Can disseminate to bone, lungs, meninges in patients with
• Alcoholism, diabetes, COPD, HIV |
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Term
Sporotrichosis (cont.)
• Clinical manifestations |
|
Definition
– Primarily a cutaneous disease
– Papule develops within days of
inoculation
– Ulcerates and nodules develop
proximal due to lymphatic distribution
– Pulmonary disease rare but can occur in patients with COPD or alcoholism
• Fever, night sweats, weight loss, fatigue, dyspnea, productive cough, hemoptysis
• Bilateral nodular or cavitary lesions on chest x-ray |
|
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Term
Sporotrichosis (cont.)
• Diagnosis |
|
Definition
– Culture
– Serology not helpful |
|
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Term
|
Definition
– Amphotericin B for severe pulmonary, bone, or meningeal infection
• Followed by itraconazole
– Itraconazole for mild cutaneous disease
– Surgery |
|
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Term
|
Definition
• Due to the organisms – Rhizopus arrhizus
– Mucor species
• Found in decaying vegetation and soil
– Distribution is worldwide
• Risk factors for infection include
– Diabetes mellitus with acidosis, corticosteroid therapy, transplant, iron overload, AIDS, neutropenia
• Less common, 500 cases per year in United States
[image] |
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|
Term
Mucormycosis/Zygomycosis (cont.)
• Sitesofinfection: |
|
Definition
– Rhino-orbital-cerebral – Respiratory
– Gastrointestinal
– Cutaneous
– Widespread
– Mixed |
|
|
Term
| Rhino-Orbital-Cerebral Infection Mucormycosis/Zygomycosis |
|
Definition
• Most common site of infection
– Most common in diabetic patients in acidosis
• Initial symptoms
– Sinusitis or periorbital cellulitis
– Facial pain and numbness, blurry vision, soft tissue swelling
– Fever variable
• If untreated spreads to ethmoid sinus to the orbit with lose of EOM function and proptosis
• Cranial nerve findings indicate a grave prognosis |
|
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Term
| Pulmonary Mucormycosis/Zygomycosis |
|
Definition
• Appearsmostcommonlyinleukemicpatients receiving chemotherapy or stem cell transplants
• Developsasaresultofinhalationor hematogenous/lymphatic spread
• Symptomsincludefever,cough,pleuriticchest pain, effusions |
|
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Term
| Cutaneous Mucormycosis/Zygomycosis |
|
Definition
• Musthavedisruptionofnormalprotective cutaneous barrier
– To not penetrate intact skin
• Typicallyduetotrauma
• Isveryinvasiveandpenetratesalllayersintothe bone |
|
|
Term
Mucormycosis/Zygomycosis
• Laboratory |
|
Definition
– CT/MRI scan
• Sinus mucosal thickening or thickening of extraocular muscles
– Chest x-ray
• Nonspecific: lobar consolidation, isolated masses, nodules, and cavitation
– Biopsy
– Cultures are unreliable
– Galactomannan test is negative |
|
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Term
Mucormycosis/Zygomycosis (cont.)
• Treatment |
|
Definition
– Urgent surgical treatment
• Required due to extensive tissue necrosis
– Antifungals
• Amphotericin B • Itraconazole
• Note:Starttherapybeforediagnosisis confirmed if suspicion is high |
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Term
|
Definition
|
|
