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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 -
Journal of Clinical Microbiology Feb 2003Apophysomyces elegans was considered a rare but medically important zygomycete. We analyzed the clinical records of eight patients from a single center in whom...
Apophysomyces elegans was considered a rare but medically important zygomycete. We analyzed the clinical records of eight patients from a single center in whom zygomycosis due to A. elegans was diagnosed over a span of 25 months. We also attempted a DNA-based method for rapid identification of the fungi and looked for interstrain polymorphism using microsattelite primers. Three patients had cutaneous and subcutaneous infections, three had isolated renal involvement, one had rhino-orbital tissue infection, and the final patient had a disseminated infection involving the spleen and kidney. Underlying illnesses were found in two patients, one with diabetes mellitus and the other with chronic alcoholism. A history of traumatic implantation was available for three patients. All except two of the patients responded to surgical and/or medical therapy; the diagnosis for the two exceptions was made at the terminal stage of infection. Restriction enzyme (MboI, MspI, HinfI) digestion of the PCR-amplified internal transcribed spacer region helped with the rapid and specific identification of A. elegans. The strains could be divided into two groups according to their patterns, with clustering into one pattern obtained by using microsatellite [(GTG)(5) and (GAC)(5)] PCR fingerprinting. The study highlights the epidemiology, clinical spectrum, and diagnosis of emerging A. elegans infections.
Topics: Adult; Aged; Female; Humans; India; Male; Microsatellite Repeats; Middle Aged; Mucorales; Mucormycosis; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length
PubMed: 12574283
DOI: 10.1128/JCM.41.2.783-788.2003 -
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 -
Microbiology (Reading, England) Sep 2011Most studies on fungal biofilms have focused on Candida in yeasts and Aspergillus in mycelial fungi. To the authors' knowledge, biofilm formation by zygomycetes has not...
Most studies on fungal biofilms have focused on Candida in yeasts and Aspergillus in mycelial fungi. To the authors' knowledge, biofilm formation by zygomycetes has not been reported previously. In this study, the biofilm-forming capacity of Rhizopus oryzae, Lichtheimia corymbifera, Rhizomucor pusillus and Apophysomyces elegans was evaluated. At appropriate seeding spore densities, Rhp. oryzae (10⁵ c.f.u. ml⁻¹, L. corymbifera (10⁴ c.f.u. ml⁻¹) and Rhm. pusillus (10⁴ c.f.u. ml⁻¹) produced highly intertwined, adherent structures on flat-bottomed polystyrene microtitre plates after 24 h at 37 °C. The adhered fungal hyphae were encased in an extracellular matrix, as confirmed by phase-contrast and confocal microscopy. The thickness of Rhp. oryzae, L. corymbifera and Rhm. pusillus biofilms was 109.67±10.02, 242±23.07 and 197±9.0 µm (mean±sd), respectively. Biochemical characterization of the biofilm matrix indicated the presence of glucosamine, constituting 74.54-82.22 % of its dry weight, N-acetylglucosamine, glucose and proteins. Adherence and biofilm formation were not observed in A. elegans. Although A. elegans spores germinated at all three seeding densities tested (1×10⁷, 1×10⁶ and 1×10⁵ c.f.u. ml⁻¹), no significant difference was observed (P>0.05) between the A₄₉₀ of wells inoculated with A. elegans and the cut-off A₄₉₀ for biofilm detection. This study highlights the potential for biofilm formation by at least three medically important species of zygomycetes.
Topics: Biofilms; Cell Adhesion; Hyphae; Kinetics; Microscopy, Confocal; Mucorales
PubMed: 21636650
DOI: 10.1099/mic.0.048504-0 -
Journal of Clinical Microbiology Oct 1985A case of zygomycosis caused by Apophysomyces elegans in a diabetic, obese female is described. The fungus gained entry into the body through injury to the skin,...
A case of zygomycosis caused by Apophysomyces elegans in a diabetic, obese female is described. The fungus gained entry into the body through injury to the skin, penetrating the keratin, epidermis, and dermis. Hyphal angioinvasion was observed. Fungal elements invaded the subcutaneous fat, skeletal muscle fibers, nerves, and large blood vessels, resulting in the spread of the infection. The rapidity with which A. elegans invaded the blood vessels left no choice except amputation of the leg to stop the spread of the infection. This zygomycetous fungus closely resembles Absidia corymbifera. It is distinguished by its prominent campanulate apophyses. In its gross colony characteristics and failure to sporulate on routinely used media it resembles Saksenaea vasiformis.
Topics: Diabetes Complications; Female; Humans; Inflammation; Leg Injuries; Middle Aged; Mucorales; Mucormycosis; Muscles; Necrosis; Obesity; Skin; Spores, Fungal; Wound Infection
PubMed: 4077963
DOI: 10.1128/jcm.22.4.522-526.1985 -
American Journal of Transplantation :... Sep 2010Two patients developed renal mucormycosis following transplantation of kidneys from the same donor, a near-drowning victim in a motor vehicle crash. Genotypically,...
Two patients developed renal mucormycosis following transplantation of kidneys from the same donor, a near-drowning victim in a motor vehicle crash. Genotypically, indistinguishable strains of Apophysomyces elegans were recovered from both recipients. We investigated the source of the infection including review of medical records, environmental sampling at possible locations of contamination and query for additional cases at other centers. Histopathology of the explanted kidneys revealed extensive vascular invasion by aseptate, fungal hyphae with relative sparing of the renal capsules suggesting a vascular route of contamination. Disseminated infection in the donor could not be definitively established. A. elegans was not recovered from the same lots of reagents used for organ recovery or environmental samples and no other organ transplant-related cases were identified. This investigation suggests either isolated contamination of the organs during recovery or undiagnosed disseminated donor infection following a near-drowning event. Although no changes to current organ recovery or transplant procedures are recommended, public health officials and transplant physicians should consider the possibility of mucormycosis transmitted via organs in the future, particularly for near-drowning events. Attention to aseptic technique during organ recovery and processing is re-emphasized.
Topics: Accidents, Traffic; Adolescent; Adult; Female; Humans; Kidney; Kidney Transplantation; Male; Medical Futility; Middle Aged; Mucorales; Mucormycosis; Near Drowning; Tissue and Organ Harvesting; Transplantation, Homologous
PubMed: 20883549
DOI: 10.1111/j.1600-6143.2010.03216.x -
Journal of Clinical Microbiology Dec 1994We describe a previously healthy 69-year-old man presenting with osteomyelitis of the humerus due to the zygomycete Apophysomyces elegans. The infection was acquired in... (Review)
Review
We describe a previously healthy 69-year-old man presenting with osteomyelitis of the humerus due to the zygomycete Apophysomyces elegans. The infection was acquired in Aruba, The Netherlands Antilles. The skin provided the most likely portal of entry, although there was no history of a traumatic inoculation. The patient had no history of diabetes, and no underlying immune defects were found. Despite treatment with 7.9 g of amphotericin B, an interthoracoscapular amputation proved necessary to curtail the rapid spread of the fungus in this immunocompetent host.
Topics: Aged; Amphotericin B; Amputation, Surgical; Humans; Humerus; Immunocompromised Host; Male; Mucorales; Mucormycosis; Osteomyelitis
PubMed: 7883908
DOI: 10.1128/jcm.32.12.3078-3081.1994 -
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 -
Journal of Clinical Microbiology Jun 2009Several members of the order Mucorales (subphylum Mucoromycotina) are important agents of severe human infections. The identification of these fungi by using standard... (Comparative Study)
Comparative Study
Several members of the order Mucorales (subphylum Mucoromycotina) are important agents of severe human infections. The identification of these fungi by using standard mycologic methods is often difficult and time consuming. Frequently, the etiological agent in clinical cases is reported either as a Mucor sp., which is not the most frequent genus of zygomycetes, or only as a member of the Mucorales. For this reason, the actual spectrum of species of zygomycetes and their incidences in the clinical setting is not well known. The goals of this study were to compare the results of the molecular identification of an important set of clinical isolates, received in a mycological reference center from different regions of the United States, with those obtained by using the traditional morphological methods and to determine the spectrum of species involved. We tested 190 isolates morphologically identified as zygomycetes by using sequencing of the internal transcribed spacer (ITS) region of the ribosomal DNA. Molecular identification revealed that Rhizopus oryzae represented approximately half (44.7%) of these isolates. The remainder was identified as Rhizopus microsporus (22.1%), Mucor circinelloides (9.5%), Mycocladus corymbifer (formerly Absidia corymbifera) (5.3%), Rhizomucor pusillus (3.7%), Cunninghamella bertholletiae (3.2%), Mucor indicus (2.6%), Cunninghamella echinulata (1%), and Apophysomyces elegans (0.5%). The most common anatomic sites for clinically significant zygomycetes, as determined by isolates sent to the Fungus Testing Laboratory for identification and/or susceptibility testing and included in this study, were the sinuses, lungs, and various cutaneous locations, at 25.8%, 26.8%, and 28%, respectively. These sites represented approximately 80% of the isolates evaluated. A high level of correlation (92.6%) between morphological and molecular identifications was found.
Topics: DNA, Fungal; DNA, Ribosomal Spacer; Fungi; Humans; Microscopy; Molecular Sequence Data; Sequence Analysis, DNA; United States; Zygomycosis
PubMed: 19386856
DOI: 10.1128/JCM.00036-09