-
Mycoses Dec 2014Mucormycosis remains a devastating invasive fungal infection, with high mortality rates even after active management. The disease is being reported at an alarming... (Review)
Review
Mucormycosis remains a devastating invasive fungal infection, with high mortality rates even after active management. The disease is being reported at an alarming frequency over the past decades from India. Indian mucormycosis has certain unique features. Rhino-orbito-cerebral presentation associated with uncontrolled diabetes is the predominant characteristic. Isolated renal mucormycosis has emerged as a new clinical entity. Apophysomyces elegans and Rhizopus homothallicus are emerging species in this region and uncommon agents such as Mucor irregularis and Thamnostylum lucknowense are also being reported. This review focuses on these distinct features of mucormycosis observed in India.
Topics: Diabetes Complications; Diabetes Mellitus; Humans; Incidence; India; Mucorales; Mucormycosis; Rhizopus; Risk Factors
PubMed: 25187095
DOI: 10.1111/myc.12243 -
The International Journal of Lower... May 2022Primary cutaneous mucormycosis is a consequence of environmental Mucorales spores inoculation at the abraded skin. In a diabetic patient, these spores germinate quickly...
Primary cutaneous mucormycosis is a consequence of environmental Mucorales spores inoculation at the abraded skin. In a diabetic patient, these spores germinate quickly and disseminate hematogenously to the surroundings. Cutaneous mucormycosis is a rare but aggressive, invasive, and life-threatening fungal infection. Its presentation is nonspecific, but it rapidly results in necrosis of underneath tissues. Diagnosis can be readily made by KOH wet mount of excise tissue. However, a prompt diagnosis with multidisciplinary management is a prerequisite for a better outcome. We present a case of fatal cutaneous mucormycosis caused by , in a diabetic patient who succumbed to death despite extensive debridement and antifungal treatment.
PubMed: 35611497
DOI: 10.1177/15347346221103387 -
Mycoses Oct 2016Mucorales are saprobes, ubiquitously distributed and able to infect a heterogeneous population of human hosts. The fungi require robust stress responses to survive in...
Mucorales are saprobes, ubiquitously distributed and able to infect a heterogeneous population of human hosts. The fungi require robust stress responses to survive in human host. We tested the growth of Mucorales in the presence of different abiotic stress. Eight pathogenic species of Mucorales, including Rhizopus arrhizus, Rhizopus microsporus, Rhizomucor pusillus, Apophysomyces elegans, Licthemia corymbifera, Cunninghamella bertholletiae, Syncephalastrum racemosum and Mucor racemosus, were exposed to different stress inducers: osmotic (sodium chloride and d-sorbitol), oxidative (hydrogen peroxide and menadione), pH, cell wall and metal ions (Cu, Zn, Fe and Mg). Wide variation in stress responses was noted: R. arrhizus showed maximum resistance to both osmotic and oxidative stresses, whereas R. pusillus and M. indicus were relatively sensitive. Rhizopus arrhizus and R. microsporus showed maximum resistance to alkaline pH, whereas C. bertholletiae, L. corymbifera, M. racemosus and A. elegans were resistant to acidic pH. Maximum tolerance was noted in R. microsporus to Cu, R. microsporus and R. arrhizus to Fe and C. bertholletiae to Zn. In contrast, L. corymbifera, A. elegans and M. indicus were sensitive to Cu, Zn and Fe respectively. In conclusion, R. arrhizus showed high stress tolerance in comparison to other species of Mucorales, and this could be the possible reason for high pathogenic potential of this fungi.
Topics: Humans; Hydrogen-Ion Concentration; Metals; Mucorales; Osmotic Pressure; Oxidative Stress; Rhizomucor; Rhizopus; Stress, Physiological; Vitamin K 3
PubMed: 27292160
DOI: 10.1111/myc.12512 -
Medicine Nov 2014Data on clinical, mycologic characteristics, and outcome of posttraumatic mucormycosis are scarce and often limited to case reports. From the French nationwide... (Review)
Review
Data on clinical, mycologic characteristics, and outcome of posttraumatic mucormycosis are scarce and often limited to case reports. From the French nationwide "RetroZygo" study, we compared posttraumatic mucormycosis cases with other forms of mucormycosis. We also reviewed reports of posttraumatic mucormycosis in the English-language literature from 1993 to 2013. We included all proven or probable cases for which underlying condition, route of infection, surgical and antifungal treatments, and outcome were detailed. From our cohort, posttraumatic mucormycosis (n = 16) differed significantly from other forms (n = 85) by rarity of underlying disease (31.2% vs 81%, p < 0.0001), frequency of cutaneous localization (87% vs 7%, p < 0.0001), short time before diagnosis (4.5 vs 21 d, p = 0.0002), species involved (Apophysomyces elegans complex and Saksenaea vasiformis), surgical requirement (93.7% vs 47%, p = 0.0006) and better survival (87.5% vs 47.6% at day 90, p = 0.03). We studied 122 cases of posttraumatic mucormycosis through our literature review. Most frequently reported traumas were traffic (37%), domestic accidents (15.1%), or natural disasters (13.4%). Mucormycosis occurred after extensive soft-tissue damage in 47.5% cases, with symptoms occurring a median of 9.5 days after trauma with necrosis being reported in 76.2% cases. Dissemination was found in 9% of patients, and bacterial coinfection in 41%. Nineteen percent of cases occurred in the Middle East or in India where Apophysomyces elegans complex was the predominant species recovered. Awareness of mucormycosis as a cause of posttrauma soft-tissue infection is warranted, especially in cases of soil-contaminated wounds. Survival is higher than in other forms of mucormycosis, but morbidity remains high.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; France; Humans; Male; Middle Aged; Mucorales; Mucormycosis; Wounds and Injuries; Young Adult
PubMed: 25500709
DOI: 10.1097/MD.0000000000000221 -
Survey of Ophthalmology 2017Apophysomyces is a rare fungal organism causing rhino-orbito-cerebral mycotic infections with high morbidity and mortality, typically in immunocompetent individuals.... (Review)
Review
Apophysomyces is a rare fungal organism causing rhino-orbito-cerebral mycotic infections with high morbidity and mortality, typically in immunocompetent individuals. Several cases of Apophysomyces elegans orbital disease have been reported. Herein, we report a case of Apophysomyces variabilis infection involving the orbit, sinuses, and calvarium in an immunocompetent 74-year-old woman, with a review of the literature. Unlike prior cases of A. elegans classic rhino-orbito-cerebral infection, our case included diffuse calvarial lytic lesions and overlying soft tissue nodules, but without parenchymal intracranial involvement. There was radiographic and clinical evidence of infarction of the orbital contents and cavernous sinus thrombosis. Anastomoses between the superior orbital (ophthalmic) vein and diploic veins of the calvarium are believed to be primarily responsible for the unusual mode of spread on the extradural surface of the brain. Although the patient stabilized without definitive surgical intervention, her disease slowly and intermittently progressed for over a year after presentation, requiring multiple courses of antifungal treatment.
Topics: Aged; Antifungal Agents; Debridement; Disease Management; Eye Infections, Fungal; Female; Global Health; Humans; Immunocompromised Host; Morbidity; Mucorales; Mucormycosis; Ophthalmologic Surgical Procedures; Orbital Diseases
PubMed: 27256687
DOI: 10.1016/j.survophthal.2016.05.006 -
Medical Mycology Case Reports Dec 2018Mucorales infections typically occur in immunocompromised hosts. We describe a case of disseminated post-traumatic Apophysomyces elegans in an immunocompetent patient...
Mucorales infections typically occur in immunocompromised hosts. We describe a case of disseminated post-traumatic Apophysomyces elegans in an immunocompetent patient status-post soil inoculation. Fungi introduced at a deep arm laceration leads to neurovascular invasion and dissemination prior to amputation and systemic treatment. We specify strict post-traumatic wound surveillance protocol and roles of novel tissue tests to improve time to diagnosis and prognosis of frequently fatal post-traumatic Mucorales infections.
PubMed: 30225186
DOI: 10.1016/j.mmcr.2018.08.002 -
Revista Iberoamericana de Micologia 2015The mucoralean fungi are emerging causative agents of primary cutaneous infections presenting in the form of necrotizing fasciitis.
BACKGROUND
The mucoralean fungi are emerging causative agents of primary cutaneous infections presenting in the form of necrotizing fasciitis.
AIMS
The aim of this study was to investigate a series of suspected necrotizing fasciitis cases by Apophysomyces species over one-year period in a northern Indian hospital.
METHODS
The clinical details of those patients suspected to suffer from fungal necrotizing fasciitis were recorded. Skin biopsies from local wounds were microscopically examined and fungal culturing was carried out on standard media. The histopathology was evaluated using conventional methods and special stains. Apophysomyces isolates were identified by their morphology and by molecular sequencing of the internal transcribed spacer (ITS) region of the ribosomal genes. Antifungal susceptibility testing was carried out following EUCAST guidelines and treatment progress was monitored.
RESULTS
Seven patients were found to be suffering from necrotizing fasciitis caused by Apophysomyces spp. Six isolates were identified as Apophysomyces variabilis and one as Apophysomyces elegans. Five patients had previously received intramuscular injections in the affected area. Three patients recovered, two died and the other two left treatment against medical advice and are presumed to have died due to their terminal illnesses. Posaconazole and terbinafine were found to be the most active compounds against A. variabilis, while the isolate of A. elegans was resistant to all antifungals tested.
CONCLUSIONS
Apophysomyces is confirmed as an aggressive fungus able to cause fatal infections. All clinicians, microbiologists and pathologists need to be aware of these emerging mycoses as well as of the risks involved in medical practices, which may provoke serious fungal infections such as those produced by Apophysomyces.
Topics: Adult; Antifungal Agents; Communicable Diseases, Emerging; Cross Infection; DNA, Fungal; DNA, Ribosomal Spacer; Debridement; Dermatomycoses; Diabetes Complications; Fasciitis, Necrotizing; Female; Humans; India; Injections, Intramuscular; Male; Middle Aged; Mucorales; Mucormycosis; Mycological Typing Techniques; Opportunistic Infections; Prospective Studies; Ribotyping; Survival Analysis; Wound Infection
PubMed: 25576377
DOI: 10.1016/j.riam.2014.06.005 -
Eye (London, England) Sep 2020To report the spectrum of fungal infections involving the orbit encountered in an Australian subtropical population with respect to presentation, host risk factors,...
BACKGROUND/OBJECTIVES
To report the spectrum of fungal infections involving the orbit encountered in an Australian subtropical population with respect to presentation, host risk factors, involved pathogens, treatment and outcomes.
SUBJECTS/METHODS
A retrospective chart review was performed on all adult patients with orbital mycosis treated by the senior author (TJS) from 1986 to 2017 in a tertiary setting.
RESULTS
Thirty cases of fungal infection involving the orbit were included in this case series. Of these, 26 patients had invasive disease and four patients had non-invasive disease. Causative organisms included mucormycosis (16), aspergillus (8) and other fungi (7). Common risk factors included haematological disorders or malignancy, neutropenia, corticosteroid use and diabetes mellitus. Mucormycosis in three immunocompetent patients was caused by Apophysomyces elegans. Orbital apex syndrome was observed in approximately one third of patients at initial ophthalmological assessment. Amphotericin B was used in most cases of mucormycosis, while there was a more varied spectrum of anti-fungal use in other fungal infections. Seven patients with mucormycosis proceeded to orbital exenteration with a survival rate of 43%. No patients with other orbital fungal infections were exenterated.
CONCLUSIONS
Orbital mycoses are not only opportunistic but true pathogenic infections. While initial symptoms may be varied, the development of orbital apex syndrome should raise suspicion for this condition, regardless of patient immune status or age. Survival and visual outcomes are often poor with invasive disease. Multidisciplinary team management with early orbital specialist involvement is essential.
Topics: Adult; Antifungal Agents; Australia; Eye Infections, Fungal; Humans; Mucorales; Mycoses; Orbital Diseases; Retrospective Studies
PubMed: 31822858
DOI: 10.1038/s41433-019-0733-3 -
Mycoses Apr 2019Limited data exist for epidemiology and outcomes of various agents causing mucormycosis in various clinical settings from developing countries like India.
BACKGROUND
Limited data exist for epidemiology and outcomes of various agents causing mucormycosis in various clinical settings from developing countries like India.
OBJECTIVES
To study the epidemiology and outcomes of various agents causing mucormycosis in different clinical settings in a tertiary care hospital from South India.
PATIENTS AND METHODS
We reviewed details of 184 consecutive patients with culture-proven mucormycosis with consistent clinical syndrome and supporting features from September 2005 to September 2015.
RESULTS
The mean age of patients was 50.42 years; 70.97% were male. Unlike developed countries, R microsporus (29/184; 15.7%) and Apophysomyces elegans (20/184; 10.8%) also evolved as important pathogens in addition to R arrhizus in our setting. Paranasal sinuses (136/184; 73.9%) followed by musculoskeletal system (28/184; 15.2%) were the common areas of involvement. Apophysomyces elegans typically produced skin and musculoskeletal disease in immune-competent individuals with trauma (12/20; 60%) and caused significantly lower mortality (P = 0.03). R microsporus was more common in patients with haematological conditions (25% vs 15.7%) and was less frequently a cause for sinusitis than R arrhizus (27.58% vs 10.9%). The overall mortality was 30.97%. Combination therapy with surgery and antifungals offered the best chance for cure.
CONCLUSIONS
Agents causing mucormycosis may have unique clinical and epidemiological characteristics.
Topics: Adult; Age Distribution; Aged; Aged, 80 and over; Antifungal Agents; Child; Debridement; Drug Therapy, Combination; Female; Hematologic Neoplasms; Humans; India; Male; Middle Aged; Mucorales; Mucormycosis; Sex Distribution; Survival Analysis; Tertiary Care Centers; Treatment Outcome; Wound Infection; Wounds and Injuries
PubMed: 30685896
DOI: 10.1111/myc.12897 -
The Aging Male : the Official Journal... Dec 2020Mucor is an angioinvasive fungus that was reported mainly in immunocompromised patients. It usually presents as rhino-orbital, pulmonary, gastrointestinal, and...
Mucor is an angioinvasive fungus that was reported mainly in immunocompromised patients. It usually presents as rhino-orbital, pulmonary, gastrointestinal, and disseminated disease. Isolated renal mucormycosis is an extremely rare infection in immunocompetent patients and is associated with high fatality rate. Early diagnosis, prompt antifungal treatment, and surgery give the patient the best chance for cure and survival. We describe herein a case of renal zygomycosis caused by ) in an immunocompetent host. To the best of our knowledge, this is the first case of renal to be reported from Qatar and the Middle East.
Topics: Antifungal Agents; Humans; Male; Mucorales; Mucormycosis
PubMed: 30879364
DOI: 10.1080/13685538.2019.1586871