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Objective: In order to manage the antimicrobial treatment of patients with cholangitis/cholecystitis properly, it is very important to predict the potential causative pathogens and their antimicrobial resistance patterns. The aim of this study is to provide data for empirical treatment approaches by identifying the causative agents of biliary tract infections and their antimicrobial susceptibilities, and the risk factors in patients infected with drug-resistant microorganism. Methods: Hospitalized patients with cholangitis/cholecystitis developed primarily or secondary to a biliary tract intervention, and whose bile samples for culture could be obtained, were included in the study during a 9-month period. Bile cultures were incubated in an aerobic environment, and antimicrobial susceptibilities were tested by disk diffusion method. Isolated strains that were resistant to at least two major antimicrobial groups were regarded as "drug-resistant". Risk factors for development of infection with a drug-resistant pathogen were evaluated by univariate analysis. Results: A total of 76 bacteria were isolated from 58 bile samples obtained from patients with biliary tract infections. While 30 (39.5%) bacteria were in the drug-resistant group, patients infected with these agents were found to be 26 (44.8%). All drugresistant strains of Escherichia coli were producing extendedspectrum β-lactamases, and carbapenem resistance was seen among Pseudomonas aeruginosa strains only. Antimicrobial usage during last 3 months before diagnosis (p=0.01) and duration of hospital stay before the infective episode (p=0.03) were found to be risk factors for cholangitis due to drug-resistant agents. Conclusions: In order to guide the empirical treatment of patients with cholangitis/cholecystitis properly, antimicrobial susceptibility patterns of causative agents should be monitored closely and drug-resistant pathogens should be considered in patients with a history of antimicrobial usage during the last 3 months or who have been hospitalized for a long time before the infective episode. closely and drug-resistant pathogens should be considered in patients with a history of antimicrobial usage during the last 3 months or who have been hospitalized for a long time before the infective episode. [ABSTRACT FROM AUTHOR]

Objective: It was aimed to evaluate clinical and laboratory differences and characteristic aspects between cases that were classified in three subgroups as tuberculous spondylodiscitis (TS), pyogenic spondylodiscitis (PS) and brucellar spondylodiscitis (BS). Methods: Adult patients with spondylodiscitis diagnosis were evaluated retrospectively. Patients who had compatible epidemiological data with brusellosis and had Brucella tube agglutination test ≥1/160 or 4-fold increased titer two weeks later were diagnosed as BS. Cases with M. tuberculosis growth in the tissue samples and/or chronic granulomatous inflammation were diagnosed as TS. Cases in which diagnostic evaluation could not be made and clinical response was elicited with antituberculous treatment were also defined as TS. Cases in which pyogenic bacteria were isolated in samples or culture-negative cases that cured with antibiotic treatment were diagnosed as PS. Results: Among 103 patients there were 46 patients in TS, 37 in PS and 20 in BS groups. TS cases were younger (p=0.011) and had longer duration of complaints (p=0.044). Localized warmth and redness were observed more often and leukocyte counts, neutrophil counts, C-reactive protein levels and erythrocyte sedimentation rates were higher in PS (p<0.05). The thoracal involvement was most common in TS (41.3%) and lumbar in PS (67.6%). Sensitivity of determining causative organism was 56.7% for computerized tomography-guided percutaneous biopsy. Abscess formation was most frequent in TS and least in BS. Conclusions: Cervical or thoracal involvement with abscess formation and paravertebral spread in magnetic resonance imaging should be primarily considered as TS. Patients with previous spine surgery, localized warmth and redness on spine, elevated acute phase reactants and lumbar involvement should be considered as PS. [ABSTRACT FROM AUTHOR]

Objective: Identifying the presence and type of carbapenemases is essential to determine the treatment choices for carbapenem-resistant Gram-negative bacilli (CRB). Genotypic characterization of CRB needs technical support and experienced staff and is not an option for most laboratories due to its high cost. For this reason, especially in countries with limited resources, cheap, reliable phenotypic methods are an alternative, do not require experience, and can be easily applied in daily practice. The goal of the study was to evaluate the performance of phenotypic methods for carbapenemase production in CRB and to form a simple algorithm to differentiate carbapenemase types such as blaOXA-48 or blaNDM, which are common in our country. Methods: The study included 16 consecutive carbapenem-resistant, Gram-negative bacteria. Simplified carbapenem inactivation methods (sCIM) and modified Hodge test (MHT) were performed. Genes responsible for carbapenemase production (blaOXA-48, blaNDM, and blaKPC) were detected by real-time polymerase chain reaction. Temocillin resistance and ceftazidime-avibactam disc diffusion test were also applied to define carbapenemase types. Results: The carbapenemase gene was detected in 12 of the 16 strains; sCIM positivity was found in 11, and MHT was positive in 10. Sensitivity for sCIM and MHT were 91.9% and 83.3%, respectively. All Enterobacterales strains were positive for sCIM, and blaOXA-48 was the most common carbapenemase. sCIM false negativity was detected for only one strain. High-level temocillin resistance (MIC >128 μg/mL) was present in all strains with blaOXA-48; it wasn't detected in the strain carrying isolated blaNDM. Conclusion: sCIM positivity was present for all Enterobacterales, which were shown to carry the carbapenemase gene by RT-PCR. Our findings support the usage of sCIM in daily practice to screen for carbapenemase production in CRB. [ABSTRACT FROM AUTHOR]

Objective: Multisystem Inflammatory Syndrome (MIS) is a condition seen in the early post-COVID-19 period and thought to develop with an impaired immune response. It has been usually reported in children but rarely in adults. Here we report the first adult MIS (MIS-A) case series from Turkiye. Material and Methods: Six patients who met the Centers for Disease Control and Prevention’s MIS-A diagnostic criteria were included in the study. The demographic, clinical, laboratory, radiological characteristics and therapy regimes and outcomes of the patients were recorded. Results: All of our cases had a history of mild COVID-19. They presented with fever, severe fatigue and hypotension. Abnormal echocardiography findings were detected in five patients. Only one patient had multiple mucocutaneous findings. Common laboratory features were lymphopenia, markedly increased C-Reaktive Protein, procalcitonin, pro-brain natriuretic peptide (pro-BNP), D-dimer, and ferritin. All patients had positive SARSCoV-2 antibody result. Corticosteroids and/or anakinra were used in five, and intravenous immunoglobulin was used in two patients. Low-molecular-weight heparin (LMWH) was used for all cases. Empirically initiated antibiotic treatments were discontinued after cultures were negative. After anti-inflammatory treatment, the hypotension of the patients resolved, they did not need intensive care follow-up and no mortality was seen in our cases. Conclusions: MIS-A is a severe and mortal condition that causes various clinical pictures and can be confused with sepsis. Anakinra, a recombinant IL-1 receptor antagonist, is a significant agent that can be used in the treatment of MIS-A since it blocks the cytokine cascade at an early stage. The satisfactory responses will be obtained with early diagnosis and anti-inflammatory treatment. In this period when the pandemic is not over yet, it is necessary to increase the awareness of clinicians about MIS-A, which can be fatal. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to compare classical methods and chromogenic media to detect carbapenem-resistant Enterobacteriaceae (CRE) colonization among hospitalized patients and determine the risk factors causing infection in colonized patients. Methods: Between January and August 2017, 100 patients over the age of 18 who were hospitalized in the Reanimation Intensive Care Unit and the Trauma Emergency Intensive Care Unit of a university hospital were examined. From the first day of intensive care unit (ICU) admission, rectal swabs were collected once every week and were tested for the presence of CRE by using the classical method defined by the Centers for Disease Control and Prevention (CDC), ChromID CARBA chromogenic medium, and direct inoculation into MacConkey agar plates. In addition, MIC values for imipenem, ertapenem, meropenem and colistin were determined by using the Etest. Results: Rectal BDE carriage was detected by at least one method in 46 (46%) of 100 patients included in the study. Sensitivity and specificity values of the CDC classical method, direct MacConkey inoculation, and ChromID CARBA medium in the first 24 hours were found as 78%-42%, 87%-80%, and 91%-98%, respectively. Sensitivity and specificity values of these methods after 72 hours were determined as 78%-100%, 87%-100%, and 91%-100%, respectively. Conclusion: We observed that, although the ChromID CARBA method performed better than classical CDC and direct MacConkey inoculation methods, direct MacConkey inoculation can still be employed, especially in areas with limited resources. [ABSTRACT FROM AUTHOR]

Objective: Skull base osteomyelitis (SBO) is a rare, life-threatening infection and frequently followed and treated by otolaryngologists previously. In this study, we analyzed the diagnosis, treatment and long-term outcomes of SBO from the perspective of infectious diseases and clinical microbiology (IDCM). Methods: Hospitalized patients with SBO between 2012-2019 were evaluated retrospectively. Epidemiological, clinical, laboratory data of the patients were recorded. The patients who recovered with and without sequelae were compared. Results: The mean age of 16 SBO cases was 66 years, 75% of them were male and 87.5% had diabetes mellitus (DM). Cranial nerve and vascular/dural involvement were present in 75% and 56.3% of them, respectively. The most common isolated microorganism were P. aeruginosa, staphylococci and Candida spp. 81.2%, 43.7%, and 56% of the patients received anti-pseudomonal antibiotics, additional glycopeptide and additional antifungal drugs, respectively. The sequelae rate was 46.7% in a 24-month follow-up. Hypertension (p=0.041), duration of complaints (p=0.003), bilateral involvement of skull base (p=0.001), vascular thrombosis/inflammation or dural involvement (p=0.007), previous surgical intervention (p=0.041) and elevated ESR at the end of treatment (p=0.014) were defined as risk factors for permanent sequelae. There was no in-hospital mortality. Conclusions: SBO mainly affects older male patients with DM and causes significant sequelae in half of them. In the cases unresponsive to anti-pseudomonal agents, the addition of antifungal therapy empirically may provide a clinical response. Permanent sequelae are more common in cases with delayed diagnosis/treatment, bilateral, vascular or dural involvement, and elevated ESR at the end of treatment. ESR can be used to determine the treatment response and duration. The follow-up and treatment of SBO cases by IDCM with the support of experienced surgeons may contribute to the positive clinical results. [ABSTRACT FROM AUTHOR]

[Display omitted] • Tocilizumab, anakinra and prednisolone did not affect the antibody response to SARS-CoV-2. • The antibody response correlated with and could be predicted by involvement on thoracic CT. • The antibody level also correlated with the level of lung involvement on thoracic CT. Disease severity, previous medications and immunosuppressive agents could affect the antibody response against SARS-CoV-2. This study aimed to analyze variables affecting the humoral response to SARS-CoV-2. This prospective cohort study included adult patients who recovered from COVID-19 and were admitted to a COVID-19 follow-up unit. Eight patient groups were defined in accordance with the results of thoracic computed tomography (CT), SARS-CoV-2 PCR test, and tocilizumab or anakinra use during active disease. Anti-S IgG antibodies were determined by ELISA in serum samples. Anti-S positive and negative cases were compared. A total of 518 patients were included in the study. SARS-CoV-2 IgG antibodies were positive in 82.8% of patients. SARS-CoV-2 PCR positivity, extent of lung involvement on CT, and time to antibody testing were independently associated with antibody positivity. Tocilizumab, anakinra or prednisolone use was not a factor affecting the antibody response. The rate of antibody response and sample/CO values among antibody-positive patients showed a linear relationship with the extent of lung involvement on CT. The use of tocilizumab, anakinra and prednisolone for COVID-19 did not affect the antibody response against SARS-CoV-2. The main driver of antibody response among patients with COVID-19 was the extent of pulmonary involvement on CT. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the comorbidities, antiretroviral therapy (ART) switches, and drug side-effects in HIV-infected patients who were followed in the Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University. Methods: This study was designed as a retrospective cohort study. Files of HIV-infected patients admitted to the outpatient clinic between years 2002 and 2018 were evaluated. Among them, 210 patients over 18 years of age, whose HIV/AIDS diagnosis was confirmed with ELISA and Western Blot test, without loss to follow up longer than six months, and using ART for at least 6 months were included in the study. Their demographic and clinical features, laboratory results, initial ART regimen, and its side-effects, reasons for ART switches, and subsequent ART regimen were recorded. Results: 165 (78.5%) out of 210 patients were men, and 45 (21.4%) patients were women. Mean age of the patients was 40.4±12.373. 152 (72.4%) patients identified themselves as heterosexual, and 39 (18.6%) were men who had sex with men. Comorbidities of patients during their follow-up were hyperlipidemia in 42 (20%), hypertension in 22 (10.4%), cardiovascular disease in 13 (6.1%), type 2 diabetes mellitus in 12 (5.7%), renal dysfunction in 9 (3.8%), osteopenia/osteoporosis in 8 (3.8%) patients. Although two most common regimens in the first step therapy were tenofovir disoproxil fumarate/emtricitabine + lopinavir/ritonavir, and tenofovir disoproxil fumarate/ emtricitabine + elvitegravir/cobisistate, the second step therapy was detected as an interchange in the order of these two regimens. ART switch was detected in 71 (33.8%) patients. Leading reasons of ART switch were intolerance/toxicity in 22 (30.9%) patients, and simplification of regimen in 19 (26.7%) patients. Frequency of disorders developed after ART were 5 (2.3%) diabetes mellitus, 4 (1.9%) renal diseases, 5 (2.3%) cardiovascular events, 4 (1.9%) osteopenia, and 4 (1.9%) osteoporosis. Conclusions: HIV infection is controlled with ART and life expectancy is prolonged. Patients must be evaluated carefully for metabolic risk factors in the beginning of the treatment and treatment regimen should be selected by considering these situations. The side-effects such as hyperlipidemia, diabetes mellitus, cardiovascular diseases, bone metabolic disorders, osteopenia ve osteoporosis may also develop during the treatment. Therefore, patients must be closely monitored for the possible side-effects, and physicians must work in cooperation with the related specialties, and ART switch must be performed when required. Klimik Dergisi 2020; 33(3): 241-7. [ABSTRACT FROM AUTHOR]

Objective: Methicillin-sensitive Staphylococcus aureus (MSSA) is frequent cause of bacteraemias and associated with substantial mortality. We defined risk factors for mortality among patients with either community-acquired (CA) or healthcare-associated (HCA) MSSA bacteraemia with special emphasis on treatment options including cefazolin and other antimicrobials (mainly ampicillin- sulbactam). Material and Method: All adult patients who were hospitalized and whose blood cultures were positive for MSSA between 2009 and 2014 were included. Patients with CA and HCA MSSA bacteraemia were compared. Results: 83% of the 127 patients with MSSA bacteraemia had HCA. The mortality rate of patients was 20.5% and this did not differ between patients with either CA or HCA MSSA bacteraemia. In the multivariate analysis, higher comorbidity index (HR 1.557), presence of metastatic foci (HR 2.883), and requirement for ICU support (HR 16.239) were found as independent risk factors for mortality, and cefazolin use was found to be protective against mortality (HR 0.178). Conclusion: Patients with MSSA bacteraemia should be treated with cefazolin instead of other antimicrobial options, especially in countries where anti-staphylococcal penicillins are not available or in patients who cannot tolerate anti-staphylococcal penicillins, as cefazolin was found to be protective against mortality. [ABSTRACT FROM AUTHOR]

Objective: Recommended combination for the treatment of serious Stenotrophomonas maltophilia infections is ticarcillinclavulanate and co-trimoxazole (SXT). However, first agent is not available in our country, and the second component may be a matter of antimicrobial resistance or intolerance. Therefore, we aimed to evaluate antimicrobial susceptibility testing results of S. maltophilia and in vitro activity of ceftazidime and moxifloxacin as a potential therapeutic alternative. Methods: S. maltophilia strains isolated from clinical samples in Infectious Diseases and Clinical Microbiology Laboratory between 1 October 2007-23 November 2017 were included in the study. Disk diffusion antimicrobial susceptibility test results of the strains were evaluated retrospectively. The in vitro activity of combination of ceftazidime and moxifloxacin against 24 of these strains was investigated by Etest®. Results: During the study period, 649 S. maltophilia strains were isolated from 649 different patients, and 94%, 93%, 92%, 81%, 60%, 55%, 45%, 41%, 38% of the strains were susceptible to tigecycline, moxifloxacin, SXT, ciprofloxacin, cefoperazonesulbactam, ceftazidime, netilmicin, gentamicin and amikacin, respectively. For the 24 strains included in the combination study, the moxifloxacin minimal inhibitory concentration (MIC)50/MIC90 values were defined as 0.064/0.125 µg/mL (MIC range 0.023-4 µg/mL) and ceftazidime MIC50/MIC90 values were defined as 32/256 µg/mL (MIC range 1.5-256 µg/mL). According to the results of fractional inhibitor concentration (FIC) index; ceftazidime and moxifloxacin combination displayed synergism, additivity and indifference for 1 (4%), 18 (75%) and 5 (21%) strains, respectively and there was no antagonism. The FIC50/ FIC90 value is calculated as 0.75/1.01 (FIC range 0.5-1.01). Conclusions: SXT resistance in S. maltophilia strains is below 10%, but it should be closely monitored because of the limited treatment options. Tigecycline and moxifloxacin can be among the treatment alternatives because of their high sensitivity rates similar to SXT. The combination of moxifloxacin plus ceftazidime demonstrated in vitro synergism or additivity against majority of the strains. So, this combination may be used as an alternative for the treatment of patients with S. maltophilia infections if there is resistance or side effects to the antibiotics used as the first option. [ABSTRACT FROM AUTHOR]

Objective: We aimed to find the incidence and risk factors of hematologic adverse effects of piperacillin-tazobactam (TZP). Materials and Methods: Adult patients who used TZP for more than 10 days were included in the study. Results: The incidence of leukopenia, neutropenia, and eosinophilia in 110 TZP therapy episodes was found to be 16.3%, 10%, and 10%, respectively. Lower Charlson Comorbidity Index score, lower initial leukocyte count, combination of TZP with another antibiotic, and total duration of TZP therapy were found to be independent risk factors for leukopenia, while initial higher eosinophil count (IHEC) and usage of TZP for >20 days were independent risk factors for neutropenia and IHEC and total duration of TZP therapy were independent risk factors for eosinophilia. Conclusion: Longer duration of therapy, combination with other antibiotics, younger age with fewer comorbidities, and IHEC could result in hematologic adverse effects in patients treated with TZP. Patients with IHEC may be more prone to allergic reactions, so immunological mechanisms may facilitate the development of hematological adverse effects of TZP. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to compare the efficacy of catheter lock solutions of novel antibiotics with anticoagulants against methicillin-resistant Staphylococcus aureus (MRSA) embedded in biofilm. Methods: Biofilm was formed in vitro on silicone Hickman catheter segments by 10 MRSA isolates. Catheter segments were exposed to 2 mg/ml vancomycin, teicoplanin, daptomycin, linezolid, tigecycline, and rifampin solutions for 24 hours. To evaluate the antimicrobial activities of antibiotics against MRSA, bacterial colonies were counted after catheters were vortexed in 0.9% saline. Additionally, as in antibiotic lock therapy, catheter segments were exposed to combination of vancomycin, teicoplanin, daptomycin, linezolid, and tigecycline with 1000 IU/ ml heparin daily four hours for consecutive five days. Antimicrobial efficacy was assessed daily. Results: After 24 hours of exposure, the most effective antibiotic was detected as daptomycin on the Hickman catheter segments. Both daptomycin and tigecycline decreased significantly the bacterial colony counts on the third day of 4-hour daily exposures (all p values were <0.01). There was no significant difference between these two antibiotics (p=0.993). Conclusions: Both daptomycin and tigecycline are promising antimicrobial agents that can be used in antibiotic lock solution for the treatment of central line-associated bloodstream infections due to MRSA. This study provides encouraging data which should be validated in clinical settings. [ABSTRACT FROM AUTHOR]

A case of infective endocarditis (IE) presented with fatigue, lowgrade fever, painful nodular lesions and intracranial haemorrhage and diagnosed after 16 months is reported. A 35-year-old woman without any previous disease was investigated at different medical departments during these 16 months. Despite the detection of an underlying valvular heart disease by echocardiography, the patient was thought to have vasculitis because of absence of vegetations and presence of autoantibodies including rheumatoid factor, perinuclear and cytoplasmic antineutrophil cytoplasmic antibodies. IE was suspected because of multiple cerebral mycotic aneurysms revealed in magnetic resonance imaging, and subsequent blood cultures yielded Gram-positive diphtheroid rods after three days of incubation. Although the organism was identified as Listeria sp. by biochemical identification tests, 16S rRNA analysis revealed that it was Streptococcus mutans. It is concluded that several autoantibodies could be positive in IE cases and vegetation could not be seen by echocardiography and S. mutans could be seen as diphtheroids in blood cultures. [ABSTRACT FROM AUTHOR]

Objective: Appropriate and prompt treatment of infections in patients with neutropenia influences the morbidity and mortality. For this purpose, information about etiological agents is of great importance. The objective of this study is to detect the organisms isolated from blood cultures, their antimicrobial susceptibilities, and patient characteristics in patients with haematological malignancy during their febrile neutropenic episodes. Methods: Febrile neutropenic patients with hematologic malignancies were evaluated retrospectively. The automated BacT/ALERT® 3D (bioMérieux, France) system was used for blood cultures. Antimicrobial susceptibility testing was performed as recommended by the Clinical Laboratory Standards Institute using disk diffusion method. Infections causing bacteremia were defined as primary bloodstream infections, urinary tract infections, soft tissue infections, nosocomial pneumonia, and catheter-related bloodstream infections. Results: 45 bacteremic episodes in 37 cancer patients with febrile neutropenia were evaluated in this study. Overall, 73% of the episodes were caused by Gram-negative bacili, and 27% by Gram-positive coci. The isolates were Escherichia coli (34%) Klebsiella pneumoniae (30%), coagulase-negative staphylococci (16%), Staphylococcus aureus (11%), Enterobacter spp. (4%), Serratia spp. (2%), and other Gram-negative enteric bacilli (2%) in order of frequency. Causative agents showed the highest rate of antimicrobial resistance to ciprofloxacin and piperacillin-tazobactam. The lowest rate of antimicrobial resistance were observed to amikacin and carbapenems. Conclusions: The most frequent isolates were E. coli and K. pneumoniae, and the most frequent infection was urinary tract infection in patients with febrile neutropenia. Therefore, a particular consideration has to be given to the uropathogens and their antimicrobial susceptibilities in empirical treatment. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to follow critically ill patients prospectively in intensive care units (ICUs) to determine risk factors for mortality and outcome associated with nosocomial bacteraemia (NB). Subjects and Methods: A case-control study of 176 patients was conducted to identify the risk factors for mortality of NB in ICU patients. The study was performed in emergency, surgical and general surgical ICUs with 23 beds during a 15-month period. A total of 1,450 patients were admitted to the ICUs during the study period. The USA Center for Disease Control and Prevention definitions were used to diagnose nosocomial infections. Nosocomial bacteraemia was defined as the isolation of one or more organisms from blood cultures taken at least 48 h after admission, which were not related to a problem present on admission. An assessment of whether the isolated organisms represented true bacteraemia rather than contamination was made by clinical or laboratory evidence of infection. Results: A total of 214 bacteraemia episodes were found in the 176 patients (64 female, 112 male; 51.3 ± 21.3 years old), 90 of whom died and 86 survived. The bacteraemia rate was 12.1%. The most common etiological agents of bacteraemia were Klebsiella pneumoniae: 46 (21.5%), methicillin-resistant Staphylococcus aureus: 46 (21.5%), Pseudomonas aeruginosa: 32 (14.9%), and Escherichia coli: 20 (9.3%). Multivariate analysis showed that the requirement of mechanical ventilation for more than 7 days (p < 0.001), total parenteral nutrition (p = 0.034), inotropic drug (p < 0.001), and increased creatinine level (p = 0.034) were independent risk factors for mortality of NB in ICUs. Conclusions: Nosocomial infections caused by Gram-negative bacteria continue to be one of the major sources of morbidity and mortality. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Mucormycosis (or zygomycosis) is the term for infection caused by fungi of the order Mucorales. Mucoraceae may produce severe disease in susceptible individuals, notably patients with diabetes and leukemia. Rhinocerebral mucormycosis most commonly manifests itself in the setting of poorly controlled diabetes, especially with ketoacidosis. Case Presentation: A 31-year-old diabetic man presented to the outpatient clinic with the following signs and symptoms: headache, periorbital pain, swelling and loss of vision in the right eye. On physical examination his right eye was red and swollen. There was periorbital cellulitis and the conjunctiva was edematous. KOH preparation of purulent discharge showed broad, ribbonlike, aseptate hyphae when examined under a fluorescence microscope. Cranial MRI showed involvement of the right orbit, thrombosis in cavernous sinus and infiltrates at ethmoid and maxillary sinuses. Mucormycosis was diagnosed based on these findings. Amphotericin B (AmBisome®; 2 mg/kg.d) was initiated after the test doses. Right orbitectomy and right partial maxillectomy were performed; the lesions in ethmoid and maxillary sinuses were removed. The duration of the liposomal amphotericin B therapy was approximately 6 months and the total dose of liposomal amphotericin B used was 32 grams. Liposomal amphotericin B therapy was stopped six months later and oral fluconazole was started. Conclusions: Although a total surgical debridement of the lesions could not be performed, it is remarkable that regression of the disease could be achieved with medical therapy alone. [ABSTRACT FROM AUTHOR]

Rothia mucilaginosa, previously known as Stomatococcus mucilaginosus, is a Gram-positive coccus and belongs to the family Micrococcaceae. It is considered as normal flora of oropharynx and upper respiratory tract, and rarely causes pneumonia. In this report, we present a case of nosocomial pneumonia caused by R. mucilaginosa, in a patient who recently had neoadjuvant chemotherapy and radiotherapy for lung cancer. [ABSTRACT FROM AUTHOR]