Transient Mucor Circinelloides Fungemia

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Nicole Veltri
Prameet Sheth
Nicole Le Saux

Mucormycosis, Filamentous Fungi, IVDU, Opportunistic, Zygomycetes

Abstract

Mucor circinelloides is a filamentous fungus which causes rare but devastating human infection. It is also a known human colonizer and laboratory contaminant which is difficult to grow in blood culture. We present a case of a 48-year old-male presenting with fever, confusion and hemodynamic instability, ultimately drug-related, complicated by transient Mucor circinelloides fungemia. Blood cultures drawn on separate occasions grew Mucor circinelloides following clinical improvement, likely from IVDU versus nasal septal fracture with colonization of nasal turbinates.  No infectious focus was identified. He received 4 days of liposomal amphotericin B and was discharged home after prolonged observation. This case is a reminder that diagnosis of Zygomycetes infection is based on evidence of tissue invasion and that growth in blood cultures should be taken seriously, however is a poor predictor of true infection.


Mucor circinelloides is a filamentous fungus that causes rare but devastating human infections. It is also a known human colonizer and laboratory contaminant which is tough to grow in blood culture. We present a case of a 48-year-old male presenting with fever, confusion, and hemodynamic instability, ultimately drug-related, complicated by transient M. circinelloides fungemia. Blood cultures drawn on separate occasions grew M. circinelloides following clinical improvement, likely from intravenous drug use versus nasal septal fracture with the colonization of nasal turbinates. No infectious focus was identified. He received 4 days of liposomal amphotericin B and was discharged home after prolonged observation. This case is a reminder that diagnosis of Zygomycetes infection is based on evidence of tissue invasion and that its growth in blood cultures should be taken seriously, however, it is a poor predictor of the true infection.


Résumé
Mucor circinelloides est un champignon filamenteux qui provoque des infections rares, mais dévastatrices chez l’humain. Il est également connu pour coloniser l’humain et être un contaminant de laboratoire qui est difficile à faire pousser par hémoculture. Nous présentons le cas d’un homme de 48 ans qui manifeste de la fièvre, une confusion et une instabilité hémodynamique liées au bout du compte à la prise de médicaments et compliquées par une mycose généralisée transitoire causée par M. circinelloides. Des hémocultures effectuées à différentes occasions montrent une croissance de M. circinelloides à la suite d’une amélioration clinique, probablement attribuable à l’administration de médicaments par voie intraveineuse ou à une fracture de la cloison nasale et de la colonisation des cornets nasaux. Aucun foyer d’infection n’a été trouvé. Le patient a reçu de l’amphotéricine liposomale B pendant quatre jours et a reçu son congé de l’hôpital après une période d’observation prolongée. Ce cas rappelle que le diagnostic d’une infection à zygomycètes repose sur des signes d’invasion tissulaire et que leur croissance dans les hémocultures doit être prise au sérieux, car il s’agit d’un mauvais prédicteur de la véritable infection.

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References

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