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Combined Orofacial Aspergillosis and Mucormycosis: Fatal Complication of a Recurrent Paediatric Glioma—Case Report and Review of Literature

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Abstract

Mucormycosis and aspergillosis are two opportunistic fungal infections, which can evolve into life-threatening complications. They generally affect patients with relevant risk factors such as immunocompromisation or long-term use of antibiotics or corticosteroids. Treatment usually combines medical and surgical approaches, often including extended necrosectomies, although the prognosis of generalized fungal infections is very poor. In this paper, we present the case of a 17-year-old girl affected by combined aspergillosis and mucormycosis, following treatment of a recurrent glioma. The patient was hospitalized for a suspected cellulitis of the right hemi-face, involving frontal maxillary area and the upper airways and was immediately put on intravenous antibiotic therapies; after performing nasal septum and maxillary biopsies, concomitant mucormycosis and aspergillosis were diagnosed and antimycotic therapy with liposomal B-amphotericin was administered. After evaluation by the oral surgeon and otolaryngologist, surgical cranio-facial necrosectomy was suggested, but refused by the parents of the patient. The girl died only few days later, due to a respiratory arrest. Awareness of this pathology with prompt diagnosis and early treatment may improve the outcome of these infections and reduce the mortality.

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References

  1. Elinav H, Zimhony O, Cohen MJ, Marcovich AL, Benenson S. Rhinocerebral mucormycosis in patients without predisposing medical conditions: a review of the literature. Clin Microbiol Infect. 2009;15(7):693–7.

    Article  CAS  PubMed  Google Scholar 

  2. Binder U, Maurer E, Lass-Flörl C. Mucormycosis—from the pathogens to the disease. Clin Microbiol Infect. 2014;. doi:10.1111/1469-0691.12566.

    PubMed  Google Scholar 

  3. Hong HL, Lee YM, Kim T, Lee JY, Chung YS, Kim MN, Kim SH, Choi SH, Kim YS, Woo JH, Lee SO. Risk factors for mortality in patients with invasive mucormycosis. Infect Chemother. 2013;45(3):292–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Garnacho-Montero J, Olaechea P, Alvarez-Lerma F, Alvarez-Rocha L, Blanquer J, Galván B, Rodriguez A, Zaragoza R, Aguado JM, Mensa J, Solé A, Barberán J. Epidemiology, diagnosis and treatment of fungal respiratory infections in the critically ill patient. Rev Esp Quimioter. 2013;26(2):173–88.

    PubMed  Google Scholar 

  5. Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41:634–53.

    Article  PubMed  Google Scholar 

  6. Lanternier F, Dannaoui E, Morizot G, Elie C, Garcia-Hermoso D, Huerre M, Bitar D, Dromer F, Lortholary O, French Mycosis Study Group. A global analysis of mucormycosis in France: the RetroZygo Study (2005–2007). Clin Infect Dis. 2012;54(Suppl 1):S35–43.

    Article  CAS  PubMed  Google Scholar 

  7. Gyotoku H, Izumikawa K, Ikeda H, Takazono T, Morinaga Y, Nakamura S, Imamura Y, Nishino T, Miyazaki T, Kakeya H, Yamamoto Y, Yanagihara K, Yasuoka A, Yaguchi T, Ohno H, Miyzaki Y, Kamei K, Kanda T, Kohno S. A case of bronchial aspergillosis caused by Aspergillus udagawae and its mycological features. Med Mycol. 2012;50(6):631–6.

    Article  CAS  PubMed  Google Scholar 

  8. Kim JG, Park HJ, Park JH, Baek J, Kim HJ, Cha IH, Nam W. Importance of immediate surgical intervention and antifungal treatment for rhinocerebral mucormycosis: a case report. J Korean Assoc Oral Maxillofac Surg. 2013;39(5):246–50.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ardeshirpour F, Bohm LA, Belani KK, Sencer SF, Lander TA, Sidman JD. Surgery for pediatric invasive fungal sinonasal disease. Laryngoscope. 2013;. doi:10.1002/lary.24369.

    PubMed  Google Scholar 

  10. Garner D, Machin K. Investigation and management of an outbreak of mucormycosis in a paediatric oncology unit. J Hosp Infect. 2008;70(1):53–9.

    Article  CAS  PubMed  Google Scholar 

  11. Ryan M, Yeo S, Maguire A, Webb D, O’Marcaigh A, McDermott M, Butler K, O’Meara A. Rhinocerebral zygomycosis in childhood acute lymphoblastic leukaemia. Eur J Pediatr. 2001;160(4):235–8.

    Article  CAS  PubMed  Google Scholar 

  12. Ketenci I, Unlü Y, Kaya H, Somdaş MA, Kontaş O, Oztürk M, Vural A. Rhinocerebral mucormycosis: experience in 14 patients. J Laryngol Otol. 2011;125(8):e3.

    Article  CAS  PubMed  Google Scholar 

  13. Prabhu RM, Patel R. Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment. Clin Microbiol Infect. 2004;10(Suppl 1):31–47.

    Article  PubMed  Google Scholar 

  14. Han SB, Kim SK, Lee JW, Yoon JS, Chung NG, Cho B, Jeong DC, Kang JH, Kim HK, Lee DG, Lee HS, Im SA. Serum galactomannan index for early prediction of mortality in immunocompromised children with invasive pulmonary aspergillosis. BMC Infect Dis. 2015;15(1):271.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G. Invasive fungal infections in the ICU: how to approach, how to treat. Molecules. 2014;19(1):1085–119.

    Article  CAS  PubMed  Google Scholar 

  16. Liu M, Spellberg B, Phan QT, Fu Y, Fu Y, Lee AS, Edwards JE Jr, Filler SG, Ibrahim AS. The endothelial cell receptor GRP78 is required for mucormycosis pathogenesis in diabetic mice. J Clin Invest. 2010;120(6):1914–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Rudagi BM, Halli R, Kalburge J, Joshi M, Munde A, Saluja H. Management of maxillary aspergillosis in a patient with diabetic mellitus followed by prosthetic rehabilitation. J Maxillofac Oral Surg. 2010;9(3):297–301.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Abbasi S, Shenep JL, Hughes WT, et al. Aspergillosis in children with cancer: a 34-year experience. Clin Infect Dis. 1999;29:1210–9.

    Article  CAS  PubMed  Google Scholar 

  19. Hohl TM, Feldmesser M. Aspergillus fumigatus: principles of pathogenesis and host defense. Eukaryot Cell. 2007;6(11):1953–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Zhao CS, Zhao SY, Liu G, Xi-Wei X. Risk factors of invasive fungal infections in patients admitted to non- hematological oncology department and pediatric intensive care unit. Zhonghua Er Ke Za Zhi. 2013;51(8):598–601.

    PubMed  Google Scholar 

  21. Gamaletsou MN, Sipsas NV, Roilides E, Walsh TJ. Rhino–orbital–cerebral mucormycosis. Curr Infect Dis Rep. 2012;14(4):423–34.

    Article  PubMed  Google Scholar 

  22. Fukuda T, Boeckh M, Carter RA, et al. Risks and outcomes of invasive fungal infections in recipients of allogeneic hematopoietic stem cell transplants after nonmyeloablative conditioning. Blood. 2003;102:827–33.

    Article  CAS  PubMed  Google Scholar 

  23. Camara-Lemarroy CR, González-Moreno EI, Rodríguez-Gutiérrez R, Rendón-Ramírez EJ, Ayala-Cortés AS, Fraga-Hernández ML, García-Labastida L, Galarza-Delgado DÁ. Clinical features and outcome of mucormycosis. Interdiscip Perspect Infect Dis. 2014;2014:562610. doi:10.1155/2014/562610.

    PubMed  PubMed Central  Google Scholar 

  24. Siddiqui AA, Shah AA, Bashir SH. Craniocerebral aspergillosis of sinonasal origin in immunocompetent patients: clinical spectrum and outcome in 25 cases. Neurosurgery. 2004;55(3):602–11 discussion 611–613.

    Article  PubMed  Google Scholar 

  25. Ingley AP, Parikh SL, DelGaudio JM. Orbital and cranial nerve presentations and sequelae are hallmarks of invasive fungal sinusitis caused by Mucor in contrast to Aspergillus. Am J Rhinol. 2008;22(2):155–8. doi:10.2500/ajr.2008.22.3141.

    Article  PubMed  Google Scholar 

  26. Cornely OA, Arikan-Akdagli S, Dannaoui E, Groll AH, Lagrou K, Chakrabarti A, Lanternier F, Pagano L, Skiada A, Akova M, Arendrup MC, Boekhout T, Chowdhary A, Cuenca-Estrella M, Freiberger T, Guinea J, Guarro J, de Hoog S, Hope W, Johnson E, Kathuria S, Lackner M, Lass-Flörl C, Lortholary O, Meis JF, Meletiadis J, Muñoz P, Richardson M, Roilides E, Tortorano AM, Ullmann AJ, van Diepeningen A, Verweij P, Petrikkos G. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect. 2014;. doi:10.1111/1469-0691.12371.

    Google Scholar 

  27. Barton RC. Laboratory diagnosis of invasive aspergillosis: from diagnosis to prediction of outcome. Scientifica. 2013;2013:459405.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ambasta A, Carson J, Church DL. The use of biomarkers and molecular methods for the earlier diagnosis of invasive aspergillosis in immunocompromised patients. Med Mycol. 2015;53(6):531–57. doi:10.1093/mmy/myv026.

    Article  PubMed  Google Scholar 

  29. Fisher BT, Zaoutis TE, Park JR, Bleakley M, Englund JA, Kane C, Arceci RJ, Guinan E, Smith FO, Luan X, Marr KA. Galactomannan antigen testing for diagnosis of invasive aspergillosis in pediatric hematology patients. J Pediatric Infect Dis Soc. 2012;1(2):103–11.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Robin C, Alanio A, Cordonnier C. Mucormycosis: a new concern in the transplant ward? Curr Opin Hematol. 2014;21(6):482–90.

    Article  CAS  PubMed  Google Scholar 

  31. Gamaletsou MN, Rammaert B, Bueno MA, Moriyama B, Sipsas NV, Kontoyiannis DP, Roilides E, Zeller V, Prinapori R, Taj-Aldeen SJ, Brause B, Lortholary O, Walsh TJ. Aspergillus osteomyelitis: epidemiology, clinical manifestations, management, and outcome. J Infect. 2013;. doi:10.1016/j.jinf.2013.12.008.

    PubMed  PubMed Central  Google Scholar 

  32. Kim JH, Williams K. Posaconazole salvage treatment for invasive fungal infection. Mycopathologia. 2014;178(3–4):259–65. doi:10.1007/s11046-014-9792-y.

    Article  PubMed  Google Scholar 

  33. Chrenková V, Hubáček P, Weinbergerová B, Sedláček P, Keslová P, Kabíčková E, Pavlíčková K, Srámková L, Snajdauf J, Bébrová E, Nyč O, Starý J, Hamal P. Invasive mucormycosis in pediatric hematology patients-single-center experience from 2005–2010. Klin Mikrobiol Infekc Lek. 2012;18(4):102–8.

    PubMed  Google Scholar 

  34. Katragkou A, Walsh TJ, Roilides E. Why is mucormycosis more difficult to cure than more common mycoses? Clin Microbiol Infect. 2014;20(Suppl 6):74–81. doi:10.1111/1469-0691.12466.

    Article  PubMed  Google Scholar 

  35. Bitterman H. Hyperbaric oxygen for invasive fungal infections. Isr Med Assoc J. 2007;9(5):387–8.

    PubMed  Google Scholar 

  36. Almannai M, Imran H, Estrada B, Siddiqui AH. Successful treatment of rhino–orbital mucormycosis with posaconazole and hyperbaric oxygen therapy. Pediatr Hematol Oncol. 2013;30(3):184–6.

    Article  PubMed  Google Scholar 

  37. Dodémont M, Hites M, Bailly B, Trepant AL, De Mendonça R, Denis O, Jacobs F, Montesinos I. When you can’t see the wood for the trees. Mucor circinelloides: a rare case of primary cutaneous zygomycosis. J Mycol Med. 2015;25(2):151–4. doi:10.1016/j.mycmed.2015.02.043.

    Article  PubMed  Google Scholar 

  38. Klimko NN, Khostelidi SN, Volkova AG, Popova MO, Bogomolova TS, Zuborovskaya LS, Kolbin AS, Medvedeva NV, Zuzgin IS, Simkin SM, Vasilyeva NV, Afanasiev BV. Mucormycosis in haematological patients: case report and results of prospective study in Saint Petersburg, Russia. Mycoses. 2014;57(Suppl 3):91–6. doi:10.1111/myc.12247.

    Article  PubMed  Google Scholar 

  39. Davoudi S, Anderlini P, Fuller GN, Kontoyiannis DP. A long-term survivor of disseminated Aspergillus and mucorales infection: an instructive case. Mycopathologia. 2014;178(5–6):465–70. doi:10.1007/s11046-014-9785-x.

    Article  PubMed  Google Scholar 

  40. Henn A, Mellon G, Benoît H, Roos-Weil D, Jauréguiberry S, Mordant P, Fekkar A, Caumes E. Disseminated cryptococcosis, invasive aspergillosis, and mucormycosis in a patient treated with alemtuzumab for chronic lymphocytic leukaemia. Scand J Infect Dis. 2014;46(3):231–4. doi:10.3109/00365548.2013.866269.

    Article  PubMed  Google Scholar 

  41. Montagna MT, Lovero G, Coretti C, Martinelli D, Delia M, De Giglio O, Caira M, Puntillo F, D’Antonio D, Venditti M, Sambri V, Di Bernardo F, Barbui A, Lo Cascio G, Concia E, Mikulska M, Viscoli C, Maximova N, Candoni A, Oliveri S, Lombardi G, Pitzurra L, Sanguinetti M, Masciari R, Santantonio T, Andreoni S, Barchiesi F, Pecile P, Farina C, Viale P, Specchia G, Caggiano G, Pagano L. SIMIFF study: Italian fungal registry of mold infections in hematological and non-hematological patients. Infection. 2014;42(1):141–51. doi:10.1007/s15010-013-0539-3.

    Article  CAS  PubMed  Google Scholar 

  42. Vidovic A, Arsic-Arsenijevic V, Tomin D, Djunic I, Jakovic R, Loncar Z, Barac A. Proven invasive pulmonary mucormycosis successfully treated with amphotericin B and surgery in patient with acute myeloblastic leukemia: a case report. J Med Case Rep. 2013;7:263. doi:10.1186/1752-1947-7-263.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Cateau E, Randriamalala E, Elsendoorn A, Giot JP, du Sorbier CM, Rodier MH. Fatal-mixed cutaneous zygomycosis–aspergillosis: a case report. Mycopathologia. 2013;176(5–6):423–7. doi:10.1007/s11046-013-9706-4.

    Article  PubMed  Google Scholar 

  44. Mahadevaiah AH, Rajagopalan N, Patil M, Shivaprasad C. Coinfection of pulmonary mucormycosis and aspergillosis presenting as bilateral vocal cord palsy. BMJ Case Rep. 2013;. doi:10.1136/bcr-2013-009615.

    PubMed  PubMed Central  Google Scholar 

  45. Imai Y, Adachi Y, Kimura T, Nakano C, Shimizu T, Shi M, Okigaki M, Shimo T, Kaneko K, Ikehara S. An autopsy case of pulmonary fissure induced by zygomycosis. Int J Gen Med. 2013;6:575–9. doi:10.2147/IJGM.S44701.

    PubMed  PubMed Central  Google Scholar 

  46. Asimakopoulos P, Supriya M, Kealey S, Vernham GA. A case-based discussion on a patient with non-otogenic fungal skull base osteomyelitis: pitfalls in diagnosis. J Laryngol Otol. 2013;127(8):817–21. doi:10.1017/S002221511300145X.

    Article  CAS  PubMed  Google Scholar 

  47. Bergantim R, Rios E, Trigo F, Guimarães JE. Invasive coinfection with Aspergillus and Mucor in a patient with acute myeloid leukemia. Clin Drug Investig. 2013;33(Suppl 1):S51–5. doi:10.1007/s40261-012-0022-4.

    Article  PubMed  Google Scholar 

  48. Webb BJ, Blair JE, Kusne S, Scott RL, Steidley DE, Arabia FA, Vikram HR. Concurrent pulmonary Aspergillus fumigatus and mucor infection in a cardiac transplant recipient: a case report. Transplant Proc. 2013;45(2):792–7. doi:10.1016/j.transproceed.2012.03.056.

    Article  CAS  PubMed  Google Scholar 

  49. Pacheco P, Ventura AS, Branco T, Gonçalves L, Carvalho C. Clinical experience in invasive fungal infections. Clin Drug Investig. 2013;33(Suppl 1):S23–6. doi:10.1007/s40261-012-0017-1.

    Article  PubMed  Google Scholar 

  50. Weng TF, Ho MW, Lin HC, Lu MY, Peng CT, Wu KH. Successful treatment of disseminated mixed invasive fungal infection after hematopoietic stem cell transplantation for severe aplastic anemia. Pediatr Transplant. 2012;16(2):E35–8. doi:10.1111/j.1399-3046.2010.01406.x.

    Article  PubMed  Google Scholar 

  51. Bourke P, Castro P, Rabagliati R, Beltran C, Verdejo H, Winter JL, Bourge RC. Zygomycosis over-infection during voriconazole therapy for aspergillosis in a heart transplant patient, successfully treated with liposomal amphotericin and posaconazole. Transpl Infect Dis. 2012;14(5):E56–9. doi:10.1111/j.1399-3062.2012.00772.x.

    Article  CAS  PubMed  Google Scholar 

  52. Suwan Y, Punyawattanaporn A, Preechawai P. Rhino-orbital fungal infection: two cases report. J Med Assoc Thail. 2012;95(5):739–42.

    Google Scholar 

  53. Radowsky JS, Strawn AA, Sherwood J, Braden A, Liston W. Invasive mucormycosis and aspergillosis in a healthy 22-year-old battle casualty: case report. Surg Infect (Larchmt). 2011;12(5):397–400. doi:10.1089/sur.2010.065.

    Article  Google Scholar 

  54. Leithauser M, Kahl C, Aepinus C, Prall F, Maruschke M, Riemer H, Wolff D, Jost K, Hilgendorf I, Freund M, Junghanss C. Invasive zygomycosis in patients with graft-versushost disease after allogeneic stem cell transplantation. Transpl Infect Dis. 2010;12(3):251–7. doi:10.1111/j.1399-3062.2009.00480.x.

    Article  CAS  PubMed  Google Scholar 

  55. Hofman V, Dhouibi A, Butori C, Padovani B, Gari-Toussaint M, Garcia-Hermoso D, Baumann M, Vénissac N, Cathomas G, Hofman P. Usefulness of molecular biology performed with formaldehyde-fixed paraffin embedded tissue for the diagnosis of combined pulmonary invasive mucormycosis and aspergillosis in an immunocompromised patient. Diagn Pathol. 2010;5:1. doi:10.1186/1746-1596-5-1.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Lipový B, Rihová H, Hanslianová M, Kocmanová I, Zaloudíková Z, Kaloudová Y, Suchánek I, Mager R, Krupicová H, Slezák M, Datko M, Brychta P, Sevcíková A. Unsuccessful therapy of combined mycotic infection in a severely burned patient: a case study. Acta Chir Plast. 2009;51(3–4):83–4.

    PubMed  Google Scholar 

  57. Sharifipour F, Rezaeetalab F, Naghibi M. Pulmonary fungal infections in kidney transplant recipients: an 8-year study. Transplant Proc. 2009;41(5):1654–6. doi:10.1016/j.transproceed.2009.02.072.

    Article  CAS  PubMed  Google Scholar 

  58. Malhotra S, Duggal S, Bhatia NK, Sharma N, Hans C. Rhinocerebral zygomycosis with pulmonary aspergillosis in a non-HIV-infected patient: an unusual case report from India. J Med Microbiol. 2009;58(Pt 1):146–50. doi:10.1099/jmm.0.005272-0.

    Article  PubMed  Google Scholar 

  59. Itoh Y, Segawa H, Kito K, Hodohara K, Ishigaki H, Sugihara H, Fujiyama Y, Ogasawara K. Lipoid pneumonia with chronic myelomonocytic leukemia. Pathol Res Pract. 2009;205(2):143–7. doi:10.1016/j.prp.2008.07.013.

    Article  PubMed  Google Scholar 

  60. Chua JL, Cullen JF. Fungal pan-sinusitis with severe visual loss in uncontrolled diabetes. Ann Acad Med Singap. 2008;37(11):964–7.

    PubMed  Google Scholar 

  61. Kishel JJ, Sivik J. Breakthrough invasive fungal infection in an immunocompromised host while on posaconazole prophylaxis: an omission in patient counseling and follow-up. J Oncol Pharm Pract. 2008;14(4):189–93. doi:10.1177/1078155208094123.

    Article  PubMed  Google Scholar 

  62. Zhan HX, Lv Y, Zhang Y, Liu C, Wang B, Jiang YY, Liu XM. Hepatic and renal artery rupture due to Aspergillus and Mucor mixed infection after combined liver and kidney transplantation: a case report. Transplant Proc. 2008;40(5):1771–3. doi:10.1016/j.transproceed.2007.10.013.

    Article  CAS  PubMed  Google Scholar 

  63. Clauss H, Samuel R. Simultaneous mold infections in an orthotopic heart transplant recipient. Transpl Infect Dis. 2008;10(5):343–5. doi:10.1111/j.1399-3062.2007.00299.x.

    Article  CAS  PubMed  Google Scholar 

  64. Ergene U, Ozbalci D, Baykal B, Metin Ciris I, Yariktas M. Aplastic anemia, mucormycosis and aspergillosis in infectious mononucleosis: success is possible. Transfus Apher Sci. 2007;37(2):125–9.

    Article  PubMed  Google Scholar 

  65. Virk RS, Arora P. Chronic sinonasal aspergillosis with associated mucormycosis. Ear Nose Throat J. 2007;86(1):22.

    PubMed  Google Scholar 

  66. Barr A, Nolan M, Grant W, Costello C, Petrou MA. Rhinoorbital and pulmonary zygomycosis post pulmonary aspergilloma in a patient with chronic lymphocytic leukaemia. Acta Biomed. 2006;77(Suppl 4):13–8.

    PubMed  Google Scholar 

  67. Pellacchia V, Terenzi V, Moricca LM, Buonaccorsi S, Indrizzi E, Fini G. Brain abscess by mycotic and bacterial infection in a diabetic patient: clinical report and review of literature. J Craniofac Surg. 2006;17(3):578–84 Review.

    Article  PubMed  Google Scholar 

  68. Alfano C, Chiummariello S, Dessy LA, Bistoni G, Scuderi N. Combined mucormycosis and Aspergillosis of the rhinocerebral region. In Vivo. 2006;20(2):311–5.

    PubMed  Google Scholar 

  69. Lador N, Polacheck I, Gural A, Sanatski E, Garfunkel A. A trifungal infection of the mandible: case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(4):451–6.

    Article  PubMed  Google Scholar 

  70. Rickerts V, Just-Nübling G, Konrad F, Kern J, Lambrecht E, Böhme A, Jacobi V, Bialek R. Diagnosis of invasive aspergillosis and mucormycosis in immunocompromised patients by seminested PCR assay of tissue samples. Eur J Clin Microbiol Infect Dis. 2006;25(1):8–13.

    Article  CAS  PubMed  Google Scholar 

  71. McLintock LA, Gibson BE, Jones BL. Mixed pulmonary fungal infection with Aspergillus fumigatus and Absidia corymbifera in a patient with relapsed acute myeloid leukaemia. Br J Haematol. 2005;128(6):737.

    Article  PubMed  Google Scholar 

  72. van Dam AP, Pruijm MT, Harinck BI, Gelinck LB, Kuijper EJ. Pneumonia involving Aspergillus and Rhizopus spp. after a near-drowning incident with subsequent Nocardia cyriacigeorgici and N. farcinica coinfection as a late complication. Eur J Clin Microbiol Infect Dis. 2005;24(1):61–4.

    Article  PubMed  Google Scholar 

  73. Maiorano E, Favia G, Capodiferro S, Montagna MT, Lo Muzio L. Combined mucormycosis and aspergillosis of the oro-sinonasal region in a patient affected by Castleman disease. Virchows Arch. 2005;446(1):28–33.

    Article  PubMed  Google Scholar 

  74. Blin N, Morineau N, Gaillard F, Morin O, Milpied N, Harousseau JL, Moreau P. Disseminated mucormycosis associated with invasive pulmonary aspergillosis in a patient treated for post-transplant high-grade non-Hodgkin’s lymphoma. Leuk Lymphoma. 2004;45(10):2161–3.

    Article  PubMed  Google Scholar 

  75. Verma A, Williams S, Trifilio S, Zembower T, Mehta J. Successful treatment of concomitant pulmonary zygomycosis and aspergillosis with a combination of amphotericin B lipid complex, caspofungin, and voriconazole in a patient on immunosuppression for chronic graft-versus-host disease. Bone Marrow Transplant. 2004;33(10):1065–6.

    Article  CAS  PubMed  Google Scholar 

  76. Welsch MJ, Moon CM, Elston DM, Vogel P. Invasive synergistic fungal infection after motor vehicle collision. Cutis. 2003;71(3):201–4.

    PubMed  Google Scholar 

  77. Benoit D, Peleman R, Claeys G, Hertveldt K, Vandewoude K. Mixed community-acquired fungal infection in an apparently healthy patient. Eur J Clin Microbiol Infect Dis. 2000;19(8):642–3.

    Article  CAS  PubMed  Google Scholar 

  78. Wilson AP, Wright S, Bellingan G. Disseminated fungal infection following falciparum malaria. J Infect. 2000;40(2):202–4.

    Article  CAS  PubMed  Google Scholar 

  79. Viscoli C, Dodi F, Pellicci E, Ardizzone G, Soro O, Ceppa P, Nigro A, Rizzo F, Valente U. Staphylococcus aureus bacteraemia, Absidia corymbifera infection and probable pulmonary aspergillosis in a recipient of orthotopic liver transplantation for end stage liver disease secondary to hepatitis C. J Infect. 1997;34(3):281–3.

    Article  CAS  PubMed  Google Scholar 

  80. Grahame-Clarke CN, Roberts CM, Empey DW. Chronic necrotizing pulmonary aspergillosis and pulmonary phycomycosis in cystic fibrosis. Respir Med. 1994;88(6):465–8.

    Article  CAS  PubMed  Google Scholar 

  81. Johnson AS, Ranson M, Scarffe JH, Morgenstern GR, Shaw AJ, Oppenheim BA. Cutaneous infection with Rhizopus oryzae and Aspergillus niger following bone marrow transplantation. J Hosp Infect. 1993;25(4):293–6.

    Article  CAS  PubMed  Google Scholar 

  82. Diamond HJ, Phelps RG, Gordon ML, Lambroza E, Namdari H, Bottone EJ. Combined Aspergillus and zygomycotic (Rhizopus) infection in a patient with acquired immunodeficiency syndrome. Presentation as inflammatory tinea capitis. J Am Acad Dermatol. 1992;26(6):1017–8.

    Article  CAS  PubMed  Google Scholar 

  83. Vallaeys JH, Praet MM, Roels HJ, Van Marck E, Kaufman L. The Budd–Chiari syndrome caused by a zygomycete. A new pathogenesis of hepatic vein thrombosis. Arch Pathol Lab Med. 1989;113(10):1171–4.

    CAS  PubMed  Google Scholar 

  84. Severo LC, Guindani C, Geyer GR. Chronic sinusitis caused by zygomycosis and aspergillosis. Eur J Clin Microbiol Infect Dis. 1989;8(4):317–8.

    Article  CAS  PubMed  Google Scholar 

  85. Allan BT, Patton D, Ramsey NK, Day DL. Pulmonary fungal infections after bone marrow transplantation. Pediatr Radiol. 1988;18(2):118–22.

    Article  CAS  PubMed  Google Scholar 

  86. Reyes CV, Rippon JW. Localized oxalosis associated with simultaneous Aspergillus and Mucor infection in diabetic foot gangrene. Hum Pathol. 1984;15(1):89–91.

    Article  CAS  PubMed  Google Scholar 

  87. Scheld WM, Royston D, Harding SA, Hess CE, Sande MA. Simultaneous disseminated aspergillosis and zygomycosis in a leukemic patient. South Med J. 1979;72(10):1325–8.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell’Ospitale 2, 34125, Trieste, Italy

    Maddalena Chermetz, Margherita Gobbo, Katia Rupel, Giulia Ottaviani, Roberto Di Lenarda & Matteo Biasotto

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Cattinara Hospital, Strada di Fiume 447, 34149, Trieste, Italy

    Giancarlo Tirelli

  3. UCO Pathological Anatomy and Histopathology Unit, Cattinara Hospital, Strada di Fiume 447, 34149, Trieste, Italy

    Rossana Bussani

  4. Infectious Diseases Unit, University Hospital, Trieste, Italy

    Roberto Luzzati

Authors
  1. Maddalena Chermetz
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  2. Margherita Gobbo
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  3. Katia Rupel
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  4. Giulia Ottaviani
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  5. Giancarlo Tirelli
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  6. Rossana Bussani
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  7. Roberto Luzzati
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  8. Roberto Di Lenarda
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  9. Matteo Biasotto
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Correspondence to Matteo Biasotto.

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Chermetz, M., Gobbo, M., Rupel, K. et al. Combined Orofacial Aspergillosis and Mucormycosis: Fatal Complication of a Recurrent Paediatric Glioma—Case Report and Review of Literature. Mycopathologia 181, 723–733 (2016). https://doi.org/10.1007/s11046-016-0021-8

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  • DOI: https://doi.org/10.1007/s11046-016-0021-8

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