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Vol. 14. Núm. S2.
Páginas 181-192 (diciembre 2010)
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Vol. 14. Núm. S2.
Páginas 181-192 (diciembre 2010)
Open Access
Zigomicosis
Zygomycosis
Visitas
25813
Gerson Arias León, Javier Garzón Herazo
Autor para correspondencia
garzonjavier@yahoo.com

Correspondencia: Javier Garzón. Dirección electrónica.
Facultad de Medicina. Universidad Nacional de Colombia
Este artículo ha recibido

Under a Creative Commons license
Información del artículo
Resumen

Las zigomicosis son infecciones fúngicas graves e inusuales, causadas por hongos ubicuos pertenecientes a la clase Zigomicetos, los cuales están subdivididos en dos órdenes: Mucorales y Entomoftorales. Las infecciones causadas por los Mucorales se caracterizan por su rápida evolución, con destrucción tisular e invasión de vasos sanguíneos. Se presentan en hospederos con factores de riesgo definidos, entre los que se incluyen alteraciones funcionales o cuantitativas de los neutrófilos, acidosis metabólica o aumento en los niveles séricos de hierro. Sus manifestaciones clínicas se dividen en rinocerebral, pulmonar, cutánea, gastrointestinal y diseminada. El principal mecanismo de infección es la vía inhalatoria, seguida por la mecánica por lesiones dérmicas. Tienen un curso clínico agresivo y a su vez inespecífico que usualmente pone en peligro la vida del paciente, por lo que se debe tener un alto índice de sospecha en aquellas personas con cuadro clínico sugestivo y factores de riesgo, para iniciar tratamiento agresivo temprano con antifúngicos y cirugía.

Palabras claves:
Zigomicosis
Diagnóstico
fisiopatología
Terapia
Abstract

Zygomycosis are severe and uncommon fungal infections caused by ubiquitous fungi members of the class zygomicetes, which are subdivided into two orders: Mucorales and Entomophtorales. Infections due to Mucorales are characterized by a rapid evolution along with a wide tissue destruction and direct invasion of blood vessels. These diseases are seen in individuals with clearly defined risk factors such as quantitative or qualitative neutrophil defects, metabolic acidosis, or elevated iron serum levels. The clinical forms of these diseases are divided into new categories: Rhinocerebral, pulmonary, cutaneous, gastrointestinal, and disseminated infections. The main mechanism of infection is by inhalation, but it is also possible to acquire the infection by direct inoculation into the dermis. The clinical course is aggressive but unspecified and usually threatens patients’ survival; therefore, we must have a high index of suspicion in those cases with a suggestive clinical scenario and risk factors in order to perform a timely and aggressive intervention with antifungal therapy and surgery.

Keywords:
Zygomycosis
Diagnosis
Physiopatholoy
Therapy
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Referencias
[1.]
M. Richardson, P. Koukila-Kähkölä.
Rhizopus, Rhizomucor, Absidia and other agents of systemic and subcutaneous zygomycoses.
Manual of Clinical Microbiology, 9th, pp. 1839-1856
[2.]
W. Winn, S. Allen, W. Janda, E. Koneman, G. Procop, P. Schrenckenberger, et al.
Procedimientos de laboratorio para la identificación presuntiva de aislamientos de hongos.
Diagnóstico Microbiológico. Texto y atlas color, 6a, pp. 1118-1121
[3.]
D. Kontoyiannis.
Agents of Mucormycosis and Entomophtoramycosis Mandell Douglas Benett’ principles practice of infectious diseases.
7th, Elsevier, (2010),
[4.]
M. Richardson.
The ecology of the Zygomycetes and its impacto on enviromental exposure.
Clin Microbiol Infect, 15 (2009), pp. 2-9
[5.]
G.N. Pongas, R.E. Lewis, G. Samoni, D. Kontoyiannis.
Voriconazoleassociated zygomycosis: a significant consequence of evolving antifungal prophylaxis and immunosupression practices?.
Clin Microbiol Infect, 15 (2009), pp. 93-97
[6.]
A.S. Symeonidis.
The role of iron andi ron chelators in zygomycosis.
Clin Microbiol Infect, 15 (2009), pp. 26-32
[7.]
O.A. Cornely, J.J. Vehreschild, M. Rüping.
Current experience in treating invasive zygomycosis with posaconazole.
Clin Microbiol Infect, 15 (2009), pp. 77-81
[8.]
T. Rogers.
Treatment of zygomycosis: current and new options.
J Antimicrob Chemother, 61 (2008), pp. i35-i39
[9.]
J. Hiemenz, A. Groll, T. Walsh.
Infections caused by uncommon fungi in patients undergoing hematopoietic stem cell or solid organ transplanation.
Transplant Infections, 3th,
[10.]
Corina E. Gonzale, Michael G. Rinaldi, Alan M. Sugar. Zygomycosis. Infect Dis Clin N Am 16 (2002) 895-914.
[11.]
Dimitrios P. Kontoyiannis MD, ScD, FIDSA, Russell E. Lewis PharmD.
Invasive Zygomycosis: Update on Pathogenesis Clinical Manifestations, and Management.
Infect Dis Clin N Am, 20 (2006), pp. 581-607
[12.]
J.P. Bouchara, N.A. Oumeziane, J.C. Lissitzky.
Attachment of spores of the human pathogenic fungus Rhizopus oryzae to extracellular matrix components.
Eur J Cell Biol, 70 (1996), pp. 76-83
[13.]
B. Spellberg, J. Edwards Jr., A. Ibrahim.
Novel perspectives on mucormycosis: pathophysiology, presentation, and management.
Clin Microbiol Rev, 18 (2005), pp. 556-569
[14.]
R.D. Diamond, R.A. Clark.
Damage to Aspergillus fumigatus and Rhizopus oryzae hyphae by oxydative and nonoxidative microbicidal products of human neutrophils in vitro.
Infect Immunol, 38 (1982), pp. 487-495
[15.]
D.P. Kontoyiannis, M.S. Lionakis, R.E. Lewis, et al.
Zygomycosis in a tertiary- care cancer center in the era of Aspergillus-active antifungal therapy: a case-control observational study of 27 recent cases.
J Infect Dis, 191 (2005), pp. 1350-1360
[16.]
R.Y.W. Chinn, R.D. Diamond.
Generation of chemotactic factors by Rhizopus oryzae in the presence and absence of serum: relationship to hyphal damage mediated by human neutrophils and effects of hyperglycemia and ketoacidosis.
Infect Immunol, 38 (1982), pp. 1123-1129
[17.]
D.A. Baldwin, D.M. De Sousa, R.M. Von Wandruszka.
The effect of pH on the kinetics of iron release from human transferrin.
Biochim Biophys Acta, 719 (1982), pp. 140-146
[18.]
I. Nyilasi, T. Papp, M. Tako, E. Nagy, C. Vagvolgyi.
Iron gathering of opportunistic pathogenic fungi. A mini review.
Acta Microbiol Immunol Hung, 52 (2005), pp. 185-197
[19.]
J.R. Boelaert, M. de Locht, J. Van Cutsem, V. Kerrels, B. Cantinieaux, A. Verdonck, et al.
Mucormycosis during deferoxamine therapy is a siderophore mediated infection: in vitro and in vivo animal studies.
J Clin Invest, 91 (1993), pp. 1979-1986
[20.]
G.A. Verpooten, P.C. D’Haese, J.R. Boelaert, I. Becaus, L.V. Lamberts, M.E. De Broe.
Pharmacokinetics of aluminoxamine and ferrioxamine and dose finding of desferrioxamine in haemodialysis patients.
Nephrol Dial Transplant, 7 (1992), pp. 931-938
[21.]
H.C. Pillsbury, N.D. Fischer.
Rhynocerebral mucormycosis.
Arch. Otolaryngol, 103 (1977), pp. 600-604
[22.]
R.A. Yohai, J.D. Bullock, A.A. Aziz, R.J. Markert.
Survival factors in rhinoorbital- cerebral mucormycosis.
Surv Ophthalmol, 39 (1994), pp. 3-22
[23.]
M.R. Terk, D.J. Underwood, C.S. Zee, P.M. Colletti.
MR imaging in rhinocerebral and intracranial mucormycosis with CT and pathological correlation.
Magn Reson Imaging, 10 (1992), pp. 81-87
[24.]
H.P. McAdams, M. Rosado de Christenson, D.C. Strollo, E.F. Patz Jr..
Pulmonary mucormycosis: radiologic findings in 32 cases.
AJR Am J Roentgenol, 168 (1997), pp. 1541-1548
[25.]
J.A. Ribes, C.L. Vanover-Sams, D.J. Baker.
Zygomycetes in human disease.
Clin Microbiol Rev, 13 (2000), pp. 236-301
[26.]
C. Chamilos, E.M. Marom, R.E. Lewis, M.S. Lionakis, D.P. Kontoyiannis.
Predictors of Pulmonary Zygomycosis versus Invasive Pulmonary Aspergillosis in Patients with Cancer.
Clinical Infectious Diseases, 41 (2005), pp. 60-66
[27.]
M.H. Branton, S.C. Johnson, J.D. Brooke, J.A. Hasbargen.
Peritonitis due to Rhizopus in a patient undergoing continuous ambulatory peritoneal dialysis.
Rev Infect Dis, 13 (1991), pp. 19-21
[28.]
J.R. Schwartz, M.G. Nagle, R.C. Elkins, J.A. Mohr.
Mucormycosis of the trachea: an unusual cause of acute upper airway obstruction.
Chest, 81 (1982), pp. 653-654
[29.]
B.A. Connor, R.J. Anderson, J.W. Smith.
Mucor mediastinitis.
Chest, 75 (1979), pp. 525-526
[30.]
N. Lussier, M. Laverdière, K. Weiss, L. Poirier, E. Schick.
Primary renal mucormycosis.
Urology, 52 (1998), pp. 900-903
[31.]
E. Pastor, E. Real, E. Grau.
Splenic mucormycosis.
Haematologica, 84 (1999), pp. 375
[32.]
R.M. Echols, D.S. Selinger, C. Hallowell, J.S. Goodwin, M.H. Duncan, A.H. Cushing.
Rhizopus osteomyelitis. A case report and review.
Am J Med, 66 (1979), pp. 141-145
[33.]
C.H. Bosken, A.H. Szporn, J. Kleinerman.
Superior vena cava syndrome due to mucormycosis in a patient with lymphoma.
Mt Sinai J Med, 54 (1987), pp. 508-511
[34.]
C. Lass-Florl.
Zygomycosis: conventional laboratory diagnosis.
Clin Microbiol Infect, 15 (2009), pp. 60-65
[35.]
E. Dannaoui.
Molecular tools for identification of Zygomycetes and the diagnosis of zygomycosis.
Clin Microbiol Infect, 15 (2009), pp. 66-70
[36.]
C. Reed, R. Bryant, A.S. Ibrahim.
Combination polyene- caspofungin treatment of Rhino-Orbital-Cerebral Mucormycosis.
Clin Infect Dis, 47 (2008), pp. 364-371
[37.]
A.S. Ibrahim, T. Gebermariam, Y. Fu.
The iron chelator defesirox protects mice form mucormycosis through iron starvation.
J Clin Invest, 117 (2007), pp. 2649-2657
[38.]
C. Reed, A. Ibrahim, J.E. Edwards Jr., I. Walot, B. Spellberg.
Deferasirox, an iron-chelating agent, as salvage therapy for rhinocerebral mucormycosis.
Antimicrob Agents Chemother, 53 (2009), pp. 3122-3125
[39.]
D. Rapidis.
Orbitomaxillary mucormycosis (zygomycosis) and the surgical treatment: perspectivas from a maxillofacial surgeon.
Clin Microbiol Infect, 15 (2009), pp. 98-102
[40.]
A. Alastruey-Izquierdo, M.V. Castelli, I. Cuesta, O. Zaragoza, A. Monzón, E. Mellado, et al.
In vitro activiy of antifungals against Zygomycetes.
Clin Microbiol Infect, 15 (2009), pp. 71-76
Copyright © 2010. Asociación Colombiana de Infectología (ACIN)
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