François Lersy1, Julie Royer-Leblond2, Benoit Lhermitte3, Agathe Chammas1, Francis Schneider4, Yves Hansmann5, Nicolas Lefebvre5, Julie Denis6, Marcela Sabou6,7, François Lafitte8, François Cotton9,10, Marie-Paule Boncoeur-Martel11,12,13,14, Thomas Tourdias15,16, Jean-Pierre Pruvo17,18, Jean-Philippe Cottier19, Raoul Herbrecht20, Stéphane Kremer21,22. 1. Service d'imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière 67200, Strasbourg, France. 2. Service de Radiologie, Centre Hospitalier de Haguenau, Haguenau, France. 3. Department of Pathology, Hautepierre University Hospital, 1 avenue Molière, 67200, Strasbourg, France. 4. Service de Médecine-Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. 5. Service de Maladies Infectieuses, NHC, CHU de Strasbourg, Strasbourg, France. 6. CHU de Strasbourg, Laboratoire de Parasitologie Et de Mycologie Médicale, Plateau Technique de Microbiologie, 1 rue Koeberlé, 67000, Strasbourg, France. 7. Université de Strasbourg, Institut de Parasitologie Et de Pathologie Tropicale, DIHP-UR 7292, Fédération de Médecine Translationnelle, 3 rue Koeberlé, 67000, Strasbourg, France. 8. Radiology Department, Rothschild Foundation in Paris, Paris, France. 9. Service de Radiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France. 10. Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Pierre-Bénite, F-69495, Lyon, France. 11. INSERM, U1094, Neuroépidémiologie Tropicale, Limoges, France. 12. Univ. Limoges, U1094, Neuroépidémiologie Tropicale, Institut D'Epidémiologie Et de Neurologie Tropicale, GEIST, Limoges, France. 13. IRD, Unité Associée, Neuroépidémiologie Tropicale, Limoges, France. 14. Service de Neuroradiologie, CHU Limoges, Limoges, France. 15. CHU de Bordeaux, Neuro imagerie diagnostique et thérapeutique, 33000, Bordeaux, France. 16. Univ. Bordeaux, INSERM U1215, Neurocentre Magendie, 33000, Bordeaux, France. 17. Inserm U 1172, CHU de Lille, University of Lille, Lille, France. 18. Department of Neuroradiology, CHU de Lille, University of Lille, Lille, France. 19. Service de Radiologie, CHU Tours, Tours, France. 20. Department of Hematology, Institut de Cancérologie Strasbourg.Europe (ICANS) and Université de Strasbourg, Inserm UMR-S1113/IRFAC, Strasbourg, France. 21. Service d'imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière 67200, Strasbourg, France. stephane.kremer@chru-strasbourg.fr. 22. Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France. stephane.kremer@chru-strasbourg.fr.
Abstract
INTRODUCTION: Mucormycosis are infections caused by molds of the order Mucorales. These opportunistic infections are rare, difficult to diagnose, and have a poor prognosis. We aimed to describe common radiographic patterns that may help to diagnose cerebral mucormycosis and search for histopathological correlations with imaging data. METHODS: We studied the radiological findings (CT and MRI) of 18 patients with cerebral mucormycosis and four patients' histopathological findings. RESULTS: All patients were immunocompromised and/or diabetic. The type of lesions depended on the infection's dissemination pathway. Hematogenous dissemination lesions were most frequently abscesses (59 lesions), cortical, cortical-subcortical, or in the basal ganglia, with a halo aspect on DWI for lesions larger than 1.6 cm. Only seven lesions were enhanced after contrast injection, with different presentations depending on patients' immune status. Ischemia and hemorrhagic areas were also seen. Vascular lesions were represented by stenosis and thrombosis. Direct posterior extension lesions were bi-fronto basal hypodensities on CT and restricted diffusion without enhancement on MRI. A particular extension, perineural spread, was seen along the trigeminal nerve. Histopathological analysis found endovascular lesions with destruction of vessel walls by Mucorales, microbleeds around vessels, as well as acute and chronic inflammation. CONCLUSIONS: MRI is the critical exam for cerebral mucormycosis. Weak ring enhancement and reduced halo diffusion suggest the diagnosis of fungal infections. Involvement of the frontal lobes should raise suspicion of mucormycosis (along with aspergillosis). The perineural spread can be considered a more specific extension pathway of mucormycosis.
INTRODUCTION: Mucormycosis are infections caused by molds of the order Mucorales. These opportunistic infections are rare, difficult to diagnose, and have a poor prognosis. We aimed to describe common radiographic patterns that may help to diagnose cerebral mucormycosis and search for histopathological correlations with imaging data. METHODS: We studied the radiological findings (CT and MRI) of 18 patients with cerebral mucormycosis and four patients' histopathological findings. RESULTS: All patients were immunocompromised and/or diabetic. The type of lesions depended on the infection's dissemination pathway. Hematogenous dissemination lesions were most frequently abscesses (59 lesions), cortical, cortical-subcortical, or in the basal ganglia, with a halo aspect on DWI for lesions larger than 1.6 cm. Only seven lesions were enhanced after contrast injection, with different presentations depending on patients' immune status. Ischemia and hemorrhagic areas were also seen. Vascular lesions were represented by stenosis and thrombosis. Direct posterior extension lesions were bi-fronto basal hypodensities on CT and restricted diffusion without enhancement on MRI. A particular extension, perineural spread, was seen along the trigeminal nerve. Histopathological analysis found endovascular lesions with destruction of vessel walls by Mucorales, microbleeds around vessels, as well as acute and chronic inflammation. CONCLUSIONS: MRI is the critical exam for cerebral mucormycosis. Weak ring enhancement and reduced halo diffusion suggest the diagnosis of fungal infections. Involvement of the frontal lobes should raise suspicion of mucormycosis (along with aspergillosis). The perineural spread can be considered a more specific extension pathway of mucormycosis.
Authors: F Lanternier; S Poiree; C Elie; D Garcia-Hermoso; P Bakouboula; K Sitbon; R Herbrecht; M Wolff; P Ribaud; O Lortholary Journal: J Antimicrob Chemother Date: 2015-08-27 Impact factor: 5.790
Authors: A Skiada; L Pagano; A Groll; S Zimmerli; B Dupont; K Lagrou; C Lass-Florl; E Bouza; N Klimko; P Gaustad; M Richardson; P Hamal; M Akova; J F Meis; J-L Rodriguez-Tudela; E Roilides; A Mitrousia-Ziouva; G Petrikkos Journal: Clin Microbiol Infect Date: 2011-07-01 Impact factor: 8.067
Authors: Francisco M Marty; Luis Ostrosky-Zeichner; Oliver A Cornely; Kathleen M Mullane; John R Perfect; George R Thompson; George J Alangaden; Janice M Brown; David N Fredricks; Werner J Heinz; Raoul Herbrecht; Nikolai Klimko; Galina Klyasova; Johan A Maertens; Sameer R Melinkeri; Ilana Oren; Peter G Pappas; Zdeněk Ráčil; Galia Rahav; Rodrigo Santos; Stefan Schwartz; J Janne Vehreschild; Jo-Anne H Young; Ploenchan Chetchotisakd; Sutep Jaruratanasirikul; Souha S Kanj; Marc Engelhardt; Achim Kaufhold; Masanori Ito; Misun Lee; Carolyn Sasse; Rochelle M Maher; Bernhardt Zeiher; Maria J G T Vehreschild Journal: Lancet Infect Dis Date: 2016-03-09 Impact factor: 25.071
Authors: M J G T Rüping; W J Heinz; A J Kindo; V Rickerts; C Lass-Flörl; C Beisel; R Herbrecht; Y Roth; G Silling; A J Ullmann; K Borchert; G Egerer; J Maertens; G Maschmeyer; A Simon; M Wattad; G Fischer; J J Vehreschild; O A Cornely Journal: J Antimicrob Chemother Date: 2009-12-11 Impact factor: 5.790