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Sunday, June 13, 2010: 4:30 PM
Topic : Invasive mould infection in three immuno-compromised patients
Author : Michelle Wai Kuen LEE, Peter Chi Keung LAI, Chiu Wai KUK
Country : Hong Kong
Two patients, case 1 and 2, suffered from B cell lymphoma and developed abdominal pain and emergency Laparotomy done with bowel perforation found. Excision of affected bowel with ileal stoma performed. Both affected bowel lumen were sent for culture and intestinal mucormycosis was identified due to Rhizopus microsporus invasion. 4-5 days after surgery of both patients, the skin around the laparotomy wound in round shape developed dusky discoloration; the area 2.5 cm around the wounds was indurated and cold on palpation. After 24 hours of incubation of the wound swabs, a hairy colony of mould was seen which showed broad non-septate hyphae with rhizoids directly under the sporangiophores. For the ileal stoma, deep red colour were found 2-3 days after surgery but turned to dusky colour with spontaneous bleeding started from the fourth to five days after the operation. Stomal lumen was inspected and further bowel necrosis was found.
Another patient, case 3, suffered from Aplastic anaemia with chemotherapy done and developed an abscess with necrotic tissue over PICC site. PICC removed immediately and necrotic tissue excised in operation theatre and culture yield fungal element.
Removal of infected material was a key issue in treating fungal infection. All three patients were in poor condition and further operations to remove the infected bowel lumen and necrotic tissue were impossible. All of them were treated with anti-fungal medications, included Meropenem, Caspofungin, Posaconazole but they were not effective. For local wound treatment, there were no wound dressing materials available in the market could treat fungal infected wounds. For wound lotions; such as povidine lotion was tried but there was no improvement. For the patient with aplastic anaemia, local application of anti-fungal ointment was tried but patient passed away later on.
Angioinvasion is a common pathological feature of the patients with immunocompromised diseases. Prevention of infection was not only confined to virus or bacteria, fungus was also a main issue that the healthcare professionals should be alert and further investigation on dressing materials or lotions which can help to control the infection should be evaluated.
Author : Michelle Wai Kuen LEE, Peter Chi Keung LAI, Chiu Wai KUK
Country : Hong Kong
Two patients, case 1 and 2, suffered from B cell lymphoma and developed abdominal pain and emergency Laparotomy done with bowel perforation found. Excision of affected bowel with ileal stoma performed. Both affected bowel lumen were sent for culture and intestinal mucormycosis was identified due to Rhizopus microsporus invasion. 4-5 days after surgery of both patients, the skin around the laparotomy wound in round shape developed dusky discoloration; the area 2.5 cm around the wounds was indurated and cold on palpation. After 24 hours of incubation of the wound swabs, a hairy colony of mould was seen which showed broad non-septate hyphae with rhizoids directly under the sporangiophores. For the ileal stoma, deep red colour were found 2-3 days after surgery but turned to dusky colour with spontaneous bleeding started from the fourth to five days after the operation. Stomal lumen was inspected and further bowel necrosis was found.
Another patient, case 3, suffered from Aplastic anaemia with chemotherapy done and developed an abscess with necrotic tissue over PICC site. PICC removed immediately and necrotic tissue excised in operation theatre and culture yield fungal element.
Removal of infected material was a key issue in treating fungal infection. All three patients were in poor condition and further operations to remove the infected bowel lumen and necrotic tissue were impossible. All of them were treated with anti-fungal medications, included Meropenem, Caspofungin, Posaconazole but they were not effective. For local wound treatment, there were no wound dressing materials available in the market could treat fungal infected wounds. For wound lotions; such as povidine lotion was tried but there was no improvement. For the patient with aplastic anaemia, local application of anti-fungal ointment was tried but patient passed away later on.
Angioinvasion is a common pathological feature of the patients with immunocompromised diseases. Prevention of infection was not only confined to virus or bacteria, fungus was also a main issue that the healthcare professionals should be alert and further investigation on dressing materials or lotions which can help to control the infection should be evaluated.
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