Cutaneous infection by Absidia corymbifera and Syncephalastrum racemosum treated with amphotericin B and surgical debridement

R. Bandettini, E. Mantero, A.M. Tamisani, P. Tuo, R. Ceccarelli, L. Pescetto, L. Ricagni, G. Melioli

Author address: 

Genoa, IT

Abstract: 

Objective: The infections by Absidia spp. and Syncephalastrum spp. are opportunistic invasive diseases in immunocompromized hosts, in patients with underlying disease or with skin lesions. A high mortality is described even when aggressive invasive antifungal therapy and surgical debridement are used. We describe a clinical case of a paediatric patient with cutaneous infection by Absidia corymbifera and Syncephalastrum racemosum. Materials and Methods: A 1-year-old child was hospitalized in February 2005 for Streptococcuspneumoniae septicemia and purpura fulminans followed by severe reliquates like cutaneous necrosis (hands, feet, legs and nose). For this reason in April the patient was treated with multiple escarectomy and multiple grafts of skin and autologous keratinocytes but only the 50% of the treated surface improved. In the half of May some pieces of debrided tissue submitted for microbiological examination resulted positive for Absidia corymbifera and Syncephalastrum racemosum. In this period the patient presented an intermittent fever >38.5°C. The laboratory findings showed leukocytosis with neutrophilia (WBC: 18,000/mmc and neutrophils 79%), CRP > 10 mg/dl and negative blood cultures. In May 26 an antifungal therapy with liposomal amphotericin B (10 mg/kg/day) was started and the debridement of cutaneous infected sites was performed. The antifungal treatment was completed with topical amphotericin B and continued until June 13, 2005. Results: In May 30 the microbiological examinations of the skin biopsies were negative, the fever disappeared and haematochemical tests turned to normal values. The side effects of antifungal therapy were not observed. The cutaneous lesions recovered and from July the patient had not signs and symptoms of fungal infection. Conclusions: Zygomycosis are very severe infections with high mortality despite the use of in vitro effective antifungal therapy. We present a clinical case of successful treatment of cutaneous infection by Absidia corymbifera and Syncephalastrum racemosum with liposomal amphotericin B and topic amphotericin B, associated with surgical debridement. The therapy was well tolerated and the patient recovered without any diffusion of the infection to other sites. We think that the combination of two different approaches, medical and surgical, offers the best chance for survival.
2006

abstract No: 

P1208

Full conference title: 

16th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 16th (2006)