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Journal of Clinical Microbiology Dec 2010Apophysomyces elegans is an emerging pathogen in India. We planned the present study to analyze the clinical pattern of the disease, to perform molecular strain typing,...
Apophysomyces elegans is an emerging pathogen in India. We planned the present study to analyze the clinical pattern of the disease, to perform molecular strain typing, and to determine the in vitro activities of eight antifungal drugs against A. elegans. A total of 16 clinical and two environmental A. elegans isolates were included in the study. The clinical histories of the patients were noted. MICs or minimum effective concentrations (MECs) were determined for antifungal drugs by microdilution testing in accordance with CLSI standard M38-A2 guidelines. Of 16 patients, seven had rhino-cerebral, five had cutaneous, and three had renal zygomycosis. One patient had osteomyelitis. Uncontrolled diabetes was observed in 63% of the patients. Amplified fragment length polymorphism (AFLP) analysis divided the strains into two clearly different clades. The fingerprints of the environmental strains (including the type strain) were clearly different from those of the clinical strains. The MIC50s and MIC90s for amphotericin B, itraconazole, posaconazole, and isavuconazole were 2 and 4, 1 and 2, 0.5 and 1, and 2 and 4 μg/ml, respectively. The strains had high MICs for fluconazole, voriconazole, and echinocandins. The study indicates a possible change in the clinical pattern of zygomycosis due to A. elegans in India. The fungus caused not only cutaneous or subcutaneous infection but also other deep-seated infections, and the disease is commonly associated with uncontrolled diabetes. The AFLP patterns show a clear difference between environmental and clinical strains. Posaconazole is the most active drug against the isolates, followed by itraconazole. The MICs of amphotericin B against A. elegans were higher than those of the other drugs.
Topics: Adolescent; Adult; Aged; Amplified Fragment Length Polymorphism Analysis; Antifungal Agents; Child; Environmental Microbiology; Female; Humans; India; Male; Microbial Sensitivity Tests; Middle Aged; Mucorales; Mucormycosis; Mycological Typing Techniques
PubMed: 20881165
DOI: 10.1128/JCM.01420-10 -
Archives of Pathology & Laboratory... May 1999The zygomycete Apophysomyces elegans is an unusual human pathogen that is being reported with increasing frequency as a cause of infection in previously healthy patients... (Review)
Review
OBJECTIVE
The zygomycete Apophysomyces elegans is an unusual human pathogen that is being reported with increasing frequency as a cause of infection in previously healthy patients following trauma or after invasive procedures. We report 2 cases of infection caused by this emerging fungal pathogen.
METHODS
Histologic sections of tissue removed from the infected patients and the isolates in culture were examined. Other infections caused by A. elegans that have been reported in the literature were reviewed.
RESULTS
Both patients developed infection due to A. elegans after sustaining trauma that required tissue debridement because of tissue necrosis. Histologic examination showed broad, sparsely septate, thin-walled hyphae and angioinvasion with thrombosis. Extensive coagulation necrosis of surrounding tissue was seen. A rapidly growing mold with sporangiophores having funnel-shaped apophyses and pyriform sporangia, characteristic of A. elegans, was isolated from each case.
CONCLUSION
Apophysomyces elegans is an opportunistic pathogen that can cause infection in previously healthy patients who suffer an injury to the cutaneous barrier, such as trauma or burns. Infection with this zygomycete should be considered when there is progressive necrosis of a wound in a previously healthy patient. Successful treatment requires tissue debridement and amphotericin B. Histologic examination for early diagnosis and frozen section evaluation of surgical margins are required for optimal therapy.
Topics: Child; Dermatomycoses; Humans; Male; Middle Aged; Mucormycosis; Phycomyces
PubMed: 10235495
DOI: 10.5858/1999-123-0386-ZDTAE -
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 -
Journal of Clinical Microbiology Mar 2006Rhino-orbitocerebral mucormycosis (ROCM) caused by more common zygomycetes (e.g., Mucor) is known to cause rapidly fatal infections in immunocompromised patients.... (Review)
Review
Rhino-orbitocerebral mucormycosis (ROCM) caused by more common zygomycetes (e.g., Mucor) is known to cause rapidly fatal infections in immunocompromised patients. Apophysomyces elegans is an emerging zygomycete that has been reported to cause invasive cutaneous and rhino-orbitocerebral infections in immunocompetent individuals. Limited data exist describing the syndrome of ROCM caused by A. elegans. We describe a recent case and performed a comprehensive literature review to delineate the clinical characteristics of ROCM caused by A. elegans. Our case is a 50-year-old man with diabetes mellitus who presented with facial pain and right eye proptosis. Endoscopic sinus sampling revealed A. elegans. He was treated with liposomal amphotericin B and multiple debridements, with no disease on 1.5-year follow-up examination. Seven cases were identified on literature review, including the present case. Most patients (86%) were male, with a mean age of 40 years. Most patients (71%) did not have predisposing medical conditions. Three patients had predisposing head trauma. All presented with facial and/or periorbital pain. All had magnetic resonance imaging or computed tomography of the head showing intraorbital and/or sinus inflammation. Diagnosis was confirmed by histopathology and deep tissue culture in all cases. All patients required eye exenteration and extensive surgical debridement, in addition to intravenous amphotericin B. Six of the seven patients (86%) recovered. ROCM caused by A. elegans is rarely reported in the literature. Most such infections occurred in immunocompetent patients, often after facial trauma. Survival in ROCM caused by A. elegans is favorable in reported cases, with prompt surgical debridement and antifungal therapy.
Topics: Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Mucorales; Mucormycosis; Nose Diseases; Orbit Evisceration; Orbital Diseases
PubMed: 16517873
DOI: 10.1128/JCM.44.3.892-898.2006 -
Journal of Clinical Microbiology Sep 1988Apophysomyces elegans and Saksenaea vasiformis are notorious for their failure to sporulate on routine media. Agar blocks, permeated with the mycelia of A. elegans and...
Apophysomyces elegans and Saksenaea vasiformis are notorious for their failure to sporulate on routine media. Agar blocks, permeated with the mycelia of A. elegans and S. vasiformis, were cut aseptically from 7-day-old colonies grown on Sabouraud dextrose agar and transferred to plates containing 20 ml of sterile distilled water supplemented with 0.2 ml of 10% filter-sterilized yeast extract solution. When the plates were incubated at 37 degrees C, all 5 isolates of A. elegans and all 10 isolates of S. vasiformis produced abundant, characteristic sporangia within 7 to 10 days. The method is simple to use and yields consistent results.
Topics: Culture Media; Humans; Mucorales; Spores, Fungal
PubMed: 3183029
DOI: 10.1128/jcm.26.9.1861-1863.1988 -
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 -
Clinical Microbiology and Infection :... Oct 2009Aspergillosis and candidosis remain the most prevalent opportunistic fungal infections in immunocompromised patients, but diseases caused by the Zygomycetes have become... (Review)
Review
Aspergillosis and candidosis remain the most prevalent opportunistic fungal infections in immunocompromised patients, but diseases caused by the Zygomycetes have become of increasing importance. Exposure to antimycotic drugs with no activity against zygomycetes may be a new risk factor and an explanation for the increasing incidence of zygomycosis. The latter infection occurs only rarely in immunocompetent hosts, but in recent years Apophysomyces elegans has been described in many subtropical countries as an emerging pathogen causing mostly cutaneous infections after traumatic inoculation.
Topics: Antifungal Agents; Communicable Diseases, Emerging; Humans; Incidence; Wounds and Injuries; Zygomycosis
PubMed: 19754750
DOI: 10.1111/j.1469-0691.2009.02973.x -
The Indian Journal of Surgery Dec 2012Cutaneous zygomycosis remains underdiagnosed despite being frequently encountered. Delay in the diagnosis contributes to delay in treatment, and a resultant high... (Review)
Review
Cutaneous zygomycosis remains underdiagnosed despite being frequently encountered. Delay in the diagnosis contributes to delay in treatment, and a resultant high morbidity and mortality. A retrospective analysis of the reported cases of cutaneous zygomycosis from India was made using various search engines and cross-referencing from available manuscripts. A total of 42 publications from India on the topic were identified, since the first reported case of primary cutaneous zygomycosis by Veliath et al. (1976). There are 130 described cases of cutaneous zygomycosis with an overall mortality of 35 %. The commonest zygomycete identified was Apophysomyces elegans, and the commonest predisposing factor was breach of the skin. Surprisingly, diabetes was reported only in 36 cases (27.69 %). It is important to be aware of this unusual but fatal infection in order to manage it properly and have a good outcome.
PubMed: 24293901
DOI: 10.1007/s12262-012-0429-4 -
Clinical Microbiology Reviews Apr 2011Rhizopus, Mucor, and Lichtheimia (formerly Absidia) species are the most common members of the order Mucorales that cause mucormycosis, accounting for 70 to 80% of all... (Review)
Review
Rhizopus, Mucor, and Lichtheimia (formerly Absidia) species are the most common members of the order Mucorales that cause mucormycosis, accounting for 70 to 80% of all cases. In contrast, Cunninghamella, Apophysomyces, Saksenaea, Rhizomucor, Cokeromyces, Actinomucor, and Syncephalastrum species individually are responsible for fewer than 1 to 5% of reported cases of mucormycosis. In this review, we provide an overview of the epidemiology, clinical manifestations, diagnosis of, treatment of, and prognosis for unusual Mucormycetes infections (non-Rhizopus, -Mucor, and -Lichtheimia species). The infections caused by these less frequent members of the order Mucorales frequently differ in their epidemiology, geographic distribution, and disease manifestations. Cunninghamella bertholletiae and Rhizomucor pusillus affect primarily immunocompromised hosts, mostly resulting from spore inhalation, causing pulmonary and disseminated infections with high mortality rates. R. pusillus infections are nosocomial or health care related in a large proportion of cases. While Apophysomyces elegans and Saksenaea vasiformis are occasionally responsible for infections in immunocompromised individuals, most cases are encountered in immunocompetent individuals as a result of trauma, leading to soft tissue infections with relatively low mortality rates. Increased knowledge of the epidemiology and clinical presentations of these unusual Mucormycetes infections may improve early diagnosis and treatment.
Topics: Antifungal Agents; Fungi; Humans; Mucormycosis; Prognosis; Treatment Outcome
PubMed: 21482731
DOI: 10.1128/CMR.00056-10 -
Nihon Ishinkin Gakkai Zasshi = Japanese... 2008In recent years fungi have been flourishing in immunocompromised patients of tertiary care centers. The data on the burden of opportunistic mycoses in India is not clear... (Review)
Review
In recent years fungi have been flourishing in immunocompromised patients of tertiary care centers. The data on the burden of opportunistic mycoses in India is not clear though the climate in this country is well suited for a wide variety of fungal infections. There are very few good diagnostic mycology laboratories and clinicians are still not aware of the emerging trends. Within the limited data available, an increased incidence of invasive candidiasis, aspergillosis, and zygomycosis are reported. The emergence of fungal rhinosinusitis, penicilliosis marneffei and zygomycosis due to Apophysomyces elegans is unique in the Indian scenario. Invasive candidiasis is the most common opportunistic mycosis. The global change in spectrum of Candida species is also observed in India; however, the higher prevalence of candidemia due to Candida tropicalis instead of C. glabrata or C. parapsilosis is interesting. Invasive aspergillosis is the second contender. Though due to difficulty in antemortem diagnosis the exact prevalence of this disease is not known, high prevalence is expected in Indian hospitals where construction activities continue in the hospital vicinity without a proper impervious barrier. The other opportunistic mycosis, invasive zygomycosis is an important concern as the world's highest number of cases of this disease is reported from India. The infection is commonly observed in patients with uncontrolled diabetes mellitus. Though antiretroviral therapy in AIDS patients has been introduced in most Indian hospitals, no decline in the incidence of cryptococcosis and penicilliosis has yet been observed. Thus there is need of good diagnostic mycology laboratories, rapid diagnosis, and refinement of antifungal strategies in India.
Topics: Humans; India; Mycoses; Opportunistic Infections
PubMed: 18689964
DOI: 10.3314/jjmm.49.165