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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 -
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 -
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 -
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 -
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 -
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 -
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 -
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 -
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 -
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