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Medical Mycology Jun 2020Apophysomyces elegans species complex is an important cause of cutaneous mucormycosis in India. However, majority of those cases are reported as case reports only. We...
Apophysomyces elegans species complex is an important cause of cutaneous mucormycosis in India. However, majority of those cases are reported as case reports only. We desired to analyze our patients with Apophysomyces infection reported over 25 years (1992-2017) to understand the epidemiology, management, and outcome of the disease. During the study period 24 cases were reported, and the majority (95.8%) of them presented with necrotizing fasciitis following accidental/surgical/iatrogenic trauma. One patient presented with continuous ambulatory peritoneal dialysis (CAPD) related peritonitis. Healthcare related Apophysomyces infection was noted in 29.2% patients. In addition to trauma, comorbidities were noted in 37.5% patients (type 2diabetes mellitus-6, chronic alcoholism-2, and chronic kidney disease-1). Of the 24 isolates, 11 isolates starting from year 2014 were identified as Apophysomyces variabilis by molecular methods. Majority (95.8%) of the patients were managed surgically with or without amphotericin B deoxycholate therapy, while one patient was treated with amphotericin B deoxycholate alone. Among 24 patients, seven (29.1%) recovered, six (25%) patients could not afford antifungal management and left the hospital against medical advice, and 11 (45.9%) patients died.The present case series highlights that necrotizing fasciitis caused by A. variabilis is prevalent in India, and the disease may be healthcare related. Although diagnosis is not difficult, awareness among surgeons is still limited about the infection, leading to a delay in sending samples to the mycology laboratory. Apophysomyces infection must be considered in the differential diagnosis in apatient with progressive necrosis of a wound who is not responding to antibacterial therapy.
Topics: Adolescent; Adult; Aged; Antifungal Agents; Comorbidity; Fasciitis, Necrotizing; Female; Humans; India; Male; Middle Aged; Mucorales; Mucormycosis; Retrospective Studies; Tertiary Care Centers; Young Adult
PubMed: 31342074
DOI: 10.1093/mmy/myz081 -
Medicine Jul 2016Mucormycosis is a rare, aggressive, and life-threatening infection that is caused by organisms belonging to the order Mucorales. It is usually acquired through direct... (Review)
Review
BACKGROUND
Mucormycosis is a rare, aggressive, and life-threatening infection that is caused by organisms belonging to the order Mucorales. It is usually acquired through direct means and virtually always affects immunocompromised patients with the port of entry reflecting the site of infection, in this case, cutaneous. Unlike other mucormycoses, patients affected by Apophysomyces elegans (A elegans) are known to be immunocompetent. This locally aggressive disease penetrates through different tissue plains invading adjacent muscles, fascia, and even bone causing extensive morbidity and may prove fatal if treated inadequately. Cutaneous mucormycosis is associated with disruption of cutaneous barriers such as trauma. However, rarely, it may be iatrogenic. No cases have been previously reported postcosmetic surgery, especially one that is so commonly performed, lipofilling.
CASE REPORT
The patient is a, previously healthy, 41-year-old middle-eastern female who was admitted to the plastic surgery department 17 days after undergoing cosmetic surgery. She suffered from extensive tissue inflammation and necrosis in both gluteal regions. Following admission, she was initially started on empirical antimicrobial therapy which was changed to an antifungal agent, voriconazole, when preliminary microbiological results showed filamentous fungi. This was discontinued and liposomal amphotericin B was commenced when further mycological analysis identified A elegans. Furthermore, she underwent a total of 10 sessions of extensive debridement to the extent that portions of the sacrum and left femoral head became exposed. Her clinical status and wounds improved with the appropriate management and she remained an inpatient for 62 days. Subsequently, she had defects in both gluteal regions which required reconstructive surgery.
CONCLUSION
A elegans is an uncommon cause of iatrogenic cutaneous mucormycosis. A high index of clinical suspicion is required, especially in the absence of clinical improvement despite conventional methods of treatment, so that early diagnosis can be reached and the appropriate management instigated promptly in order to mitigate morbidity and mortality. Reversal of predisposing risk factors, regular extensive surgical debridement, and antifungal therapy remain the cornerstones of therapy for this life-threatening condition.
Topics: Adult; Buttocks; Cosmetic Techniques; Dermatomycoses; Female; Humans; Mucormycosis; Postoperative Complications
PubMed: 27399143
DOI: 10.1097/MD.0000000000004185 -
Case Reports in Infectious Diseases 2018We describe a case of disseminated mucormycosis () diagnosed on autopsy, in a man who had been working in construction with undiagnosed neutropenia from hairy-cell...
We describe a case of disseminated mucormycosis () diagnosed on autopsy, in a man who had been working in construction with undiagnosed neutropenia from hairy-cell leukemia, which is rarely associated with invasive mold infections. Galactomannan values in both blood and bronchoalveolar lavage were strongly positive. There is an unmet need for accurate noninvasive fungal diagnostic tests. Detailed history, including occupational exposures, can be more informative than laboratory workup.
PubMed: 30675405
DOI: 10.1155/2018/4294013 -
Apophysomyces elegans: a novel cause of endogenous endophthalmitis in an immunocompetent individual.International Ophthalmology Dec 2014A 20-year-old male presented with sudden onset redness, pain, and decreased vision in his left eye. Best-corrected visual acuity in the left eye was noted to be...
A 20-year-old male presented with sudden onset redness, pain, and decreased vision in his left eye. Best-corrected visual acuity in the left eye was noted to be perception of light positive with inaccurate projection. On clinical examination, he was diagnosed to have left eye endogenous endophthalmitis. Smear and culture of vitreous biopsy were positive for Apophysomyces elegans, a fungus known to cause extensive soft tissue infections systemically characteristically in immunocompetent individual. The patient was treated aggressively with topical, systemic, and intravitreal antifungals but had a poor visual and anatomical outcome. This is a first known report of endogenous endophthalmitis due to Apophysomyces elegans.
Topics: Antifungal Agents; Endophthalmitis; Eye Infections, Fungal; Humans; Immunocompetence; Male; Mucormycosis; Treatment Outcome; Young Adult
PubMed: 25183462
DOI: 10.1007/s10792-014-9999-4 -
Medical Mycology Apr 2015Mucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi of the Order Mucorales and class of Mucormycetes. We conducted a...
Mucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi of the Order Mucorales and class of Mucormycetes. We conducted a prospective study of 38 patients who were diagnosed as having mucormycosis in a tertiary care hospital during January 2010 to June 2011. The cases were analyzed regarding the site of involvement, underlying disease and species of fungi isolated, antifungal susceptibility pattern of the isolates, and outcome of therapy. The mean age of the patients was 40.43 years, with 72% male. Rhino-orbital mucormycosis (61.5%) was the most common presentation followed by cutaneous manifestations (31%), gastrointestinal symptoms (5%), and pulmonary (2.5%). Diabetes mellitus (56%) was the significant risk factor in rhino-orbito-cerebral presentation (OR = 7.55, P = 0.001). Among 23 culture isolates, Rhizopus arrhizus (37.5%) was the most common, followed by Apophysomyces variabilis (29.2%), Lichtheimia ramosa (16.7%), Rhizopus microsporus (4.2%), Rhizomucor pusillus (4.2%), and Apophysomyces elegans (4.2%). Rhizopus arrhizus was most commonly isolated from rhino-orbito-cerebral mucormycosis and Apophysomyces species were generally obtained from cutaneous mucormycosis. In vitro antifungal susceptibility showed that 16 isolates were sensitive to amphotericin B (MIC less than 1 μg/ml), while in contrast, all isolates were found to be resistant to voriconazole (MIC- 0.25 to >8), fluconazole (MIC > 32), flucytosine (MIC > 32). Treatment regimens included antifungal therapy, reversal of underlying predisposing risk factors, and surgical debridement. Combination of surgery and medical treatment with amphotericin B was significantly better (OR = 0.2, P < 0.04) than amphotericin B alone (61.5% vs. 10.3% patient survival). The awareness of fungal diseases amongst clinicians is required to decrease the fatal outcome of disease.
Topics: Adult; Antifungal Agents; Child; Debridement; Female; Humans; India; Male; Microbial Sensitivity Tests; Mucorales; Mucormycosis; Prospective Studies; Risk Factors; Survival Analysis; Tertiary Care Centers; Treatment Outcome
PubMed: 25587084
DOI: 10.1093/mmy/myu086 -
Journal of Clinical and Diagnostic... Aug 2015Mucormycosis, an angioinvasive infection is caused by the ubiquitous filamentous fungi of the order Mucorales and class Mucormycetes. Reports of this disease are on the...
Mucormycosis, an angioinvasive infection is caused by the ubiquitous filamentous fungi of the order Mucorales and class Mucormycetes. Reports of this disease are on the rise over the past few decades. Rhino-oculo-Cerebral presentation associated with uncontrolled diabetes is the predominant characteristic of this entity. We report here a case of rhinooculocerebral mucormycosis (ROCM) due to Apophysomyces elegans (A. elegans) in a 45-year-old diabetic lady with background illness of hypothyroidism and polyradiculoneuropathy. Though this condition is usually managed with surgical debridement of the affected tissue and medical therapy with Amphotericin B, the isolate recovered in our case was found to be resistant to Amphotericin B.
PubMed: 26435947
DOI: 10.7860/JCDR/2015/13929.6272 -
Mycoses Dec 2014Mucormycosis is a highly aggressive disease which is usually fatal in immunocompromised patients. The species of mucormycetes show significant differences in...
Mucormycosis is a highly aggressive disease which is usually fatal in immunocompromised patients. The species of mucormycetes show significant differences in susceptibility to amphotericin B, azoles and terbinafine. The precise species level identification for this fungal group could be achieved by internal transcribed-spacer (ITS) region sequencing. Herein, we present the largest series of antifungal susceptibility data of molecularly characterised isolates of mucormycetes reported so far from India. Eighty isolates originating from 71 patients comprised 50 (62.5%) from pulmonary cases, 15 (19%) from rhino-orbital-cerebral, 13 (16.2%) from cutaneous and 2 (2.5%) from disseminated mucormycosis. ITS and D1/D2 regions sequencing of the isolates identified, Rhizopus arrhizus var. delemar (n = 25), R. arrhizus var. arrhizus (n = 15), R. microsporus (n = 17), R. stolonifer (n = 3), Syncephalastrum racemosum (n = 11), Apophysomyces elegans (n = 2), A. variabilis (n = 2), Lichtheimia ramosa (n = 3) and Mucor circinelloides f. lusitanicus (n = 2). Amplified fragment length polymorphism analysis was done to genotype Rhizopus isolates and revealed 5 clusters of R. arrhizus, which were well separated from R. microsporus. Amphotericin B was the most potent antifungal followed by posaconazole, itraconazole and isavuconazole. Etest and CLSI MICs of amphotericin B showed 87% agreement. Overall, the commonest underlying condition was uncontrolled diabetes mellitus. Records of 54 patients revealed fatalities in 28 cases.
Topics: Amphotericin B; Amplified Fragment Length Polymorphism Analysis; Antifungal Agents; DNA, Fungal; Drug Resistance, Fungal; Humans; India; Itraconazole; Microbial Sensitivity Tests; Mucor; Mucorales; Mucormycosis; Mycological Typing Techniques; Nitriles; Pyridines; Rhizopus; Sequence Analysis, DNA; Specimen Handling; Triazoles
PubMed: 25250768
DOI: 10.1111/myc.12234 -
Medical Mycology Case Reports Oct 2014Skin and soft tissue fungal infections with Apophysomyces elegans, Fusarium solani, Cladophialophora bantiana have been reported in survivors from 2004 Indian ocean...
Skin and soft tissue fungal infections with Apophysomyces elegans, Fusarium solani, Cladophialophora bantiana have been reported in survivors from 2004 Indian ocean Tsunami. We report the first case of primary cutaneous cryptococcosis caused by Cryptococcus gattii VGII in a Tsunami survivor from Thailand.
PubMed: 25379396
DOI: 10.1016/j.mmcr.2014.08.005 -
The Journal of the Association of... Feb 2016Malignant otitIs externa (skull base osteomyelitis) is predominantly caused by bacteria while fungal etiology is rare. We report a middle aged diabetic gentleman who...
Malignant otitIs externa (skull base osteomyelitis) is predominantly caused by bacteria while fungal etiology is rare. We report a middle aged diabetic gentleman who succumbed to invasive skull base infection due to Apophysomyces elegans a fungus belonging to Zygomycetes which causes only skin and soft tissue infections. Mortality and invasive infections due to this genus is rarely reported, especially in the ear.
Topics: Antifungal Agents; Fungi; Humans; Magnetic Resonance Imaging; Male; Mastoidectomy; Middle Aged; Osteomyelitis; Otitis Externa; Skull Base; Treatment Outcome
PubMed: 27730788
DOI: No ID Found