Baradkar V P, Mathur M, Taklikar S, Rathi M, Kumar S
Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India.
Indian J Med Microbiol. 2008 Oct-Dec;26(4):385-7. doi: 10.4103/0255-0857.43572.
A 56-year-old female patient presented with history of nasal blockage, nasal bleeding, headache, since one month. On admission the patient developed severe headache, decreased vision of eyes and blindness. Clinical diagnosis of rhino-orbital involvement was confirmed by computerized tomography of the paranasal sinuses. The diagnosis of fungal infection was confirmed by KOH examination, haematoxylin and eosin examination and Gomori's methanamine silver stain of the biopsy material. Diagnosis was confirmed by culture on Sabouraud Dextrose agar, slide culture on Czapek Dox medium and the isolate was identified as Saksenaea vasiformis. The patient was started on intravenous amphotericin B (received only one dose before succumbing), but she did not respond to the treatment, developed hemiparesis, slurred speech, diminished reflexes and ultimately died. The involvement of the brain was confirmed by computerised tomographic scan. We believe this case to be the first case of rhino-orbito-cerebral infection due to Saksenaea vasiformis and that of second case in an immunocompetent patient in the world.
一名56岁女性患者，有鼻塞、鼻出血、头痛病史1个月。入院时患者出现严重头痛、视力下降及失明。鼻窦计算机断层扫描确诊为鼻眶受累。活检材料的氢氧化钾检查、苏木精和伊红检查以及高碘酸-雪夫氏甲胺银染色确诊为真菌感染。在沙氏葡萄糖琼脂上培养、察氏培养基上玻片培养确诊，分离菌鉴定为瓶霉。患者开始静脉注射两性霉素B（仅在死亡前接受一剂），但治疗无效，出现偏瘫、言语不清、反射减弱，最终死亡。计算机断层扫描证实脑部受累。我们认为该病例是世界上首例由瓶霉引起的鼻眶脑感染，也是世界上第二例免疫功能正常患者的此类感染病例。
