Basidiobolus Research Articles

Unveiling the Uncommon: Gastrointestinal Basidiobolomycosis of the Colon and its Distinctive Splendore-Hoeppli Phenomenon

Background Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum. Case Presentation A 53-year-old man from Saudi Arabia with a known history of diverticulosis presented with severe abdominal pain and diarrhea. A CT scan revealed circumferential wall thickening of the descending and sigmoid colon with surrounding fat stranding, suggesting a diagnosis of complicated diverticulitis. Additional thick fluid was observed around the affected area. Surgical excision was pursued. A gross examination of two received large bowel segments disclosed marked ulcerated mucosa and wall thickening with exudate-covered serosal surfaces and adhesions. Microscopic examination unveiled significant infiltration by eosinophils, polymorphonuclear leukocytes, and granulomatous inflammation. Thin-walled, broad fungal hyphae of Basidiobolus, surrounded by eosinophilic material, were identified. Granulomas displayed abundant multinucleated giant cells and palisading histiocytes around central necrosis or abscess formation. Thin-walled, broad fungal hyphae of Basidiobolus, with sparse septations, are surrounded by a radiating, intensely eosinophilic cuff (Splendore-Hoeppli phenomenon). These hyphae, visible with hematoxylin and eosin staining, were further highlighted with periodic acid-Schiff and Gomori methenamine silver staining. Discussion Basidiobolomycosis may mimic neoplastic lesions. Histologically, the characteristic features include broad, thin-walled septate hyphae surrounded by eosinophilic material, a finding that is accentuated by the Splendore-Hoeppli phenomenon. Microscopic examination, along with special stains such as periodic acid-Schiff (PAS) and Gomori methenamine silver, is essential for accurate diagnosis. Conclusion Prompt recognition and appropriate antifungal therapy are vital for favorable patient outcomes. This report highlights the distinctive features of Basidiobolomycosis to raise awareness and understanding of this infrequent yet clinically significant fungal infection.

Disseminated Gastrointestinal Basidiobolomycosis: A Case Report with Review of Diagnostic Clues

Introduction. Basidiobolomycosis is a rare fungal infection caused by an environmental saprophyte, Basidiobolus ranarum. It usually presents as a chronic subcutaneous infection; however, few cases of gastrointestinal involvement have been reported. The exact transmission route of gastrointestinal cases is not clear, and diagnosis always requires a high index of suspicion because it tends to mimic other inflammatory and neoplastic conditions. Case Report. A 31‐year‐old immunocompetent woman presented with abdominal pain and an advanced colon mass. She was completely well until about 1.5 years ago, when she underwent bariatric surgery. One year after surgery, chronic abdominal pain developed. A colonoscopy showed an ulcerative lesion in the descending colon, and the biopsy was in favor of ulcerative colitis. Despite immunosuppressive treatment, there was no improvement, and with worsening symptoms, more investigations revealed advanced colon mass with entrapment of the stomach and pancreas. Colonic mucosa biopsy and trucut biopsy of the mass showed just necrosis and acute inflammation; thus, she underwent exploratory laparotomy with colectomy, partial gastrectomy, distal pancreatectomy, and left nephrectomy. On pathologic examination, there was granulomatous inflammation plus the Splendore–Hoeppli phenomenon around fungal hyphae, which was diagnostic for gastrointestinal basidiobolomycosis. Previous pathology slides were reviewed and revealed a tiny focus of basidiobolomycosis. After 6 months of treatment with itraconazole, she is relatively well without any clinical or radiologic abnormalities. Conclusion. Our case highlights the significance of suspicion for basidiobolomycosis in ulcerative and necrotic lesions with increased eosinophils, especially in the presence of abdominal mass and systemic eosinophilia.

Colonic basidiobolomycosis masquerading as colon cancer with liver metastasis: A case report and review of literature

AbstractBasidiobolomycosis is a rare subcutaneous fungal infection caused by Basidiobolus ranarum. Gastrointestinal Basidiobolomycosis GIB has been increasingly reported in the literature.We present a case of a 50-year-old male patient who presented by abdominal pain and weight loss. Imaging showed a left colon mass with a small liver lesion. Provisional diagnosis of colon cancer with liver metastasis was made. Endoscopic stenting and biopsy were done, and the results of the biopsy were not conclusive. The condition was complicated by perforation, and emergency laparotomy was done. The diagnosis of colon Basidiobolomycosis was reached from surgical histopathology. Unfortunately, the patient's condition deteriorated post operatively and the patient passed away a few days after surgery.GIB is a rare fungal infection commonly presenting as a colonic neoplastic mass or inflammatory bowel disease. The endoscopy biopsy usually fails to provide definitive diagnosis. Post-operative histopathological examination with or without culture provides a definite diagnosis. Treatment of GIB includes surgical resection with appropriate antifungal therapy which revealed dramatic response in most of the cases. However, delayed diagnosis and treatment lead to dissemination of the disease which is life-threatening condition.

Subcutaneous Basidiobolomycosis: A Rare and Underdiagnosed but Curable Fungal Infection - A Case Report

Basidiobolomycosis is a rare deep fungal infection caused by Basidiobolus ranarum and characterized by the development of swollen erythematous nodular lesions. Several azoles have been shown to be an effective treatment for this condition. Herein, we report a case of basidiobolomycosis that was initially misdiagnosed as a different disease and resolved after itraconazole medication. A 25-year-old man presented with a 2.5-year history of extensive swelling on his right arm, face, and neck. Initially, he was diagnosed with lipoma and scapular tuberculosis; however, no improvements were observed post-surgery and with tuberculosis medication. Histopathological examinations revealed giant cells, aseptate hyphae, and the Splendore-Hoeppli phenomenon. Fungal culture confirmed the isolate to be Basidiobolus ranarum. The patient was given oral itraconazole 200 mg twice daily, and the complete resolution was achieved after 25 months of treatment.

Subcutaneous basidiobolomycosis: An unusual fungus in immuno-competent children, vindicating longer duration of anti-fungal treatment

Subcutaneous Basidiobolomycosis is a rare fungal infection caused by environmental saprophyte Basidiobolus ranarum. The disease is seen among immunocompetent individuals of age 18 months to 80 years, being more common in children. We report a case of Subcutaneous Basidiobolomycosis in a 10-year-old immunocompetent male child from Ahmednagar, Maharashtra who presented with complaints of right gluteal non tender, diffuse swelling, which was gradually progressive involving inner and back of thigh. The overlying skin was hyperpigmented with scaling at places. It was associated with complaints of difficulty in walking and voiding of urine. Patient was prescribed multiple medicines with no records available. All primary investigations were done along with a deep incisional biopsy for histopathology. MRI was suggestive of? lymphangioma? vascular malformation. Histopathology revealed panniculitis with dense collections of eosinophils. Few broad, aseptate fungal hyphae were seen camouflaged within the inflammatory infiltrate, surrounded by Splendore-Hoeppli phenomenon. The patient was treated with oral fluconazole for a period of one year with complete resolution of the symptoms. After one year of follow-up, the patient is clinically well. Clinically, this lesion presented as induration of skin and subcutaneous tissue thus mimicking a soft tissue sarcoma. However, histopathological examination clinched the diagnosis. Fungal infections are common in immuno-suppressed patients, and extremely uncommon in children. Since this is an exceptional rare fungal infection seen in immuno-competent children and young adults, it is often disregarded as a differential diagnosis.

Pediatric Gastrointestinal Basidiobolomycosis: A Retrospective Study from Jazan Province, Saudi Arabia.

Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum, and its incidence is poorly understood due to its rarity. Gastrointestinal Basidiobolomycosis (GIB) is an uncommon presentation with limited reports in Saudi Arabia. This retrospective study aims to describe risk factors, clinical findings, diagnosis, and management of GIB in the pediatric population. We conducted a retrospective analysis of all pediatric patients diagnosed with GIB at a tertiary hospital between 2010 and 2022. Patients were identified based on their diagnosis of GIB. A self-administered questionnaire was distributed to assess risk factors associated with GIB. We analyzed 25 cases of pediatric GIB, with approximately half of the cases (56%) occurring during the COVID-19 pandemic. The mean age of affected patients was 6.6 years, with a male predominance (60%, n=15). About 100% of parents acknowledged gecko existence in their residence, and their children were exposed to insect bites. Poor appetite was reported in all patients, and high counts of eosinophils and erythrocyte sedimentation rate were observed. Thrombocytosis was present in approximately 90% of patients, and 87% had anemia. Abdominal computerized tomography scans and ultrasound-guided biopsies were the most used diagnostic tools, with cases being diagnosed based on histopathological findings and confirmed via fungal culture. Our study provides valuable information on the potential risk factors, clinical features, diagnosis, and management of pediatric GIB in the Jazan region. The observed increase in cases during the COVID-19 pandemic highlights the need for continued surveillance and research to understand better the epidemiology and associated risk factors with this rare fungal infection. These findings emphasize the need for heightened awareness, early detection, and effective prevention strategies to mitigate the impact of pediatric GIB.

Basidiobolomycosis: a case of a rare fungal infection misdiagnosed as adenocarcinoma of the colon

Background: Basidiobolomycosis is a rare infection caused by the fungus Basidiobolus ranarum. Since 1887, B. ranarum has been identified as an unusual fungus. It is a saprophytic fungus found in soil, decaying fruits and vegetables, and the digestive tracts of amphibians, fish, reptiles, and insectivorous bats. Since its discovery in 1964, this unusual and rare fungal infection has only been reported 71 times in the literature, and few cases were reported in Saudi Arabia. Case Presentation: A 62-year-old female Burmese with a 2-month history of nausea, vomiting, diarrhea, and chronic abdominal pain, accompanied by weight loss, loss of appetite, and lower limb myopathy was pre sented. This myopathy was so severe that it rendered her bedridden, thereby diminishing her quality of life. No hemoptysis or bleeding per rectum was seen. Past surgical and medical history were unremarkable. No med ications or allergies were reported. Regarding her social history, she was married and a housewife with low socioeconomic status, and a significant language barrier. The patient was successfully diagnosed and properly treated. Conclusion: Basidiobolomycosis is an emerging fungal pathogen. It usually causes subcutaneous infection, transmitted via traumatic inoculation. Gastrointestinal basidiobolomycosis is rare; it is associated with mass or inflammatory lesions in the gastrointestinal tract.

Effect of pediatric gastrointestinal basidiobolomycosis on parents' psychological outcomes and wellbeing

Background: The Jazan region experienced an outbreak of gastrointestinal basidiobolomycosis, a rare, unusual, fungal infection that resides in the colon, liver, stomach, and small intestines. The fungus basidiobolus ranarum is responsible for this infection. This study aimed to determine the effects of pediatric gastrointestinal basidiobolomycosis on parents' psychological outcomes and sleep quality. Methods: This study retrospectively assessed the effect of pediatric gastrointestinal basidiobolomycosis on parents' wellbeing. A case series design was employed in this study, which targeted parents living in the Jazan region whose children were diagnosed with gastrointestinal basidiobolomycosis. Results: The parents reported higher levels of stress, anxiety, and depression. Some also reported a decrease in sleep quality. Residency location affects parental fear, anxiety, or stress. Conclusion: The study highlighted the need for psychological support for parents whose children were diagnosed with gastrointestinal basidiobolomycosis.

Gastrointestinal Basidiobolomycosis (GIB) in Jeddah, Saudi Arabia

Basidiobolomycosis is a well known, but rare and under diagnosed condition. It is adeep-seated fungal infection caused by the organism Basidiobolusranarum a worldwide environmental saprophyte belonging to the Entomophthorales order of the class zygomycetes1,2 and is found in soil, decaying plants,and gastrointestinal tracts of amphibians, reptiles, horses, dogs and bats. It has been found to be of higher incidence in males (a male to female ratio of 11:1) and is seen in different age groups, the mean age being 37 years2. Eidam first isolated Basidiobolusranarum in 18863,9. Unlike other fungi, Basidiobolus Ranarum, can cause significant disease in the immune-competent hosts4.

P177 A Psittacine bite and subcutaneous Zygomycosis in immune competent: Case with therapeutic challenge

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectivesPrimary objective: To document a case of subcutaneous zygomycosis following a Psittacine bite in an immune-competent in India.Secondary objective: To follow-up the case till microbiological and clinical cure.MethodA case report entry prospectively carried out during 1.5 years of hospital visit of the patient with subcutaneous zygomycosis. This had ethical approval and patient consent obtained. A detailed account of case progression from date of first hospital admission to final cure was noted. A 56-year-old female from Vidisha in Madhya Pradesh India, apparently well 2 years back following a wild parrot bite on her back, causing an initial ulcer on infrascapular area gradually spreading bilaterally visited outpatient department of AIIMS, Bhopal. With prominent weight loss and non-healing ulcer; asymptomatic initially, ruptured spontaneously formed sinuses with exudate. Nodules and spontaneous rupture of nodule were mentioned. Provisional clinical differential diagnoses were nocardiosis, deep fungal infection, and Phagedenic ulcer. Tissue biopsy sent for microbiological and histopathological evaluation showed broad pauciseptate hyphae with right angle branching and bulging on direct microscopy suggesting subcutaneous zygomycosis. Histopathology H&E, and PAS showed similar morphology. A second sample sent was exudate from infrascapular region and showed broad pauciseptate hyphae with buildings on KOH mount. The patient was treated and discharged with some relief. Noncompliance to prescribed antifungal led to progression and horizontal spread forming plaque within months. A saturated solution of potassium iodide (SSKI) and itraconazole started. Lesions improved. The patient was again non-compliant and the lesions increased in size. The patient was reviewed again for the exacerbation and worsening. Around Day 10; SDA with chloramphenicol showed whitish growth with satellite colonies and LPCB showed broad quasi-septate hyaline hyphae, sporangia elongated, and beak with rounded zygospores suggesting Basidiobolus species. The patient received itraconazole, SSKI, and terbinafine. Species confirmation as Basidiobolus ranarum from PGIMER Chandigarh Mycology Reference center India was done.ResultsAfter 1.5 years, clinical improvement and final biopsy showed no growth and microscopy negative. The patient is on regular follow-up.ConclusionThis study highlights the traumatic implantation and zoonotic potential of fungal species. Clinical suspicion of fungal etiology and timely mycology laboratory diagnostic support is key to address such cases.

P487 Basidiobolus omanensis, an emerging pathogen to watch out for?

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Introduction Basidiobolus species can be found in amphibian, reptile, lizard, insectivorous bat, and soil, as well as decaying vegetables, and fruits. Basidiobolus species infect both adults and children, with the majority of cases reported from the Middle East, including Oman. Basidiobolomycosis is a chronic subcutaneous infection of the trunk and limbs that typically manifests as subcutaneous or gastrointestinal lesions with only a few cases of systemic involvement. Basidiobolus haptosporus, B. heterosporus, B. magnus, B. meristosporus, B. microsporus, B. omanensis and B. ranarum are the seven species in the genus Basidiobolus. Four of these species have been linked to gastrointestinal infections in humans. Basidiobolus ranarum is the most commonly reported species from humans, followed by B. omanensis. We recently described B. omanensis as a novel species from a patient in Oman. It was isolated from a boy with type 1 diabetes who died as a result of basidiobolmycosis complications. Four more fatal human cases have been documented since then (unpublished data), but little is known about its role as a pathogen in humans.ObjectiveThe goal of this paper is to present four cases of basidiobolomycosis caused by B. omanensis in young children and adults, each with unique diagnostic and treatment challenges.MethodsWe collected four cases of basidiobolomycosis caused by B. omanensis from various tertiary hospitals in Oman. All identifications were based on ribosomal DNA gene sequencing of the internal transcribed spacers (ITS) and partial large subunit (LSU). The CLSI method was used for testing the antifungal drug susceptibility in vitro.ResultsWe present four new cases of Basidiobolus infection in humans (two from children and two from adults). The underlying condition, site of infection, clinical presentation, treatment, and outcomes are all summarized in Table 1. Basidiobolus omanensis strains isolated from these cases were molecularly identified using (ITS and LSU) gene sequencing. The minimum inhibitory concentration (MIC) for amphotericin B (AMB) is 1 µg/ml, isavuconazole (ISC) is 4 µg/ml, itraconazole (ITC), posaconazole (PSC), and voriconazole (VRC) is > 16 µg/ml respectively. These were the first cases of the fungus B. omanensis ever diagnosed globally at various hospitals in Oman. All of the cases presented diagnostic and treatment challenges. Despite the atypical nature of the disease, clinical response was obtained following surgical excision and antifungal treatment, and the mortality rate among the four cases was 50%.ConclusionThis new species may cause problems with identification and antifungal susceptibility, which is why clinicians should be aware of infections with uncommon mould species and consider DNA sequencing for confirmation. Any fungus can cause infection in an immunocompromised host and should never be dismissed as a contaminant out of hand.

P053 Invasive Mucormycosis (Zygomycosis) -Pre-Covid Era and Covid Era: a retrospective study at a tertiary care centre, chennai

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PMObjectivesTo compare the prevalence and clinical presentation of Mucormycosis in pre-COVID era (January 2017-December 2019) and COVID era (January 2020-till date).To compare the AFST pattern of the zygomycetes causing Mucormycosis in pre-COVID era and COVID era.MethodsThis is a retrospective, hospital-based descriptive study. This study included patients admitted during the pre-COVID and COVID era at a tertiary care center, Chennai. The cases were categorized into two: (1) possible mucormycosis cases which included direct microscopy [Potassium hydroxide (KOH) and histopathological examination] positives and (2) confirmed cases which included direct microscopy and culture positives. Direct microscopic examinations like KOH wet mount and histopathological examination (H and E stain and special stains) were performed. Samples were cultured on Sabourauds dextrose agar and identification was done by analyzing the microscopic morphology using lactophenol cotton blue mount. AFST was performed for culture positive isolates with amphotericin B, itraconazole, posaconazole, voriconazole and isavuconazole by microbroth dilution method according to CLSI M38-A2.ResultsDuring the Pre-COVID era, out of the 365 samples received in the laboratory, 35 were possible mucormycosis cases. Only 17 were confirmed cases, out of which 16 grew Rhizopus oryzae and 1 grew Apophysomyces elegans. During the COVID era, among 886 samples received in the laboratory, 143 were possible mucormycosis cases, and 31 were confirmed cases that grew Rhizopus oryzae (26), Rhizomucor pusillus (2), Mucor sp (2), and Basidiobolus ranarum (1). Though the risk factors were common during the pre-COVID and COVID era, additional risk factors like steroid therapy (19.2%), and COVID infection (28.7%) were seen during the COVID era. Though clinical presentations were common during both pre-COVID and COVID era, additional complications like epistaxis (0.57%), orbital cellulitis (32.7%), and loss of smell (8.04%) were seen during COVID era. The prevalence of complications was more during COVID era compared to pre-COVID era. Treatment received during the pre-COVID era was only amphotericin B, whereas during the COVID era majority of the patients received posaconazole (74.5%) followed by liposomal amphotericin B (25.5%). The antifungal susceptibility test showed the following mean minimum inhibitory concentration (MIC) values: amphotericin B (1.8 μg/ml), itraconazole (3.6 μg/ml), posaconazole (0.31 μg/ml), and voriconazole (1.61 μg/ml) during the pre-COVID era while the mean MIC values during the COVID era had the following variations: amphotericin B (0.97 μg/mL), itraconazole (13.6 μg/ml), Posaconazole (13.4 μg/ml), voriconazole (14.5 μg/ml), and isavuconazole (1.10 μg/ml).ConclusionHigh incidence of Mucormycosis during the COVID-19 era may be related to common risk factors of COVID and mucormycosis. Though most of the risk factors and clinical presentations were similar during the pre-COVID and COVID era, serious complications like loss of vision and the percentage of complications were more during COVID era which may be attributed to the increased invasiveness of Zygomycetes during COVID infection. The high mean MIC value of amphotericin B during pre-COVID era and higher mean MIC value of posaconazole during COVID era may be contributed to the higher usage of these antifungals. Usage of the antifungal agents is the main contributor toward the resistance. Newer azole like isavuconazole which had a low mean MIC in our study, can be considered as a good therapeutic option for the future management of resistant infections. Hence timely management of the patients with an appropriate antifungal agent by performing AFST will help in the reduction of resistance in the future.

Pediatric intussusception due to basidiobolomycosis: a case report and literature review

BackgroundPediatric gastrointestinal basidiobolomycosis is an unusual fungal infection caused by Basidiobolus ranarum, an environmental saprophyte found worldwide. Typically, basidiobolomycosis presents as a subcutaneous infection or soft tissue tumor-like lesion, and rarely involves the gastrointestinal tract. Gastrointestinal basidiobolomycosis is most common in young infants. It has no definitive clinical presentation, and almost all cases are misdiagnosed during the initial presentation.Case presentationWe report the case of a 4-year-old Saudi boy who presented to the emergency department with abdominal pain, nausea, vomiting, and weight loss. Ultrasonography revealed a target sign. Based on the ultrasonography findings, surgery was performed, which revealed the presence of intussusception. Eventually, the patient was diagnosed with intussusception secondary to intra-abdominal basidiobolomycosis based on the histological findings. The patient was readmitted and intravenous voriconazole therapy was initiated. One week after the second admission, the patient developed abdominal pain, nausea, vomiting, inability to hold down food, and constipation. Computed tomography of the abdomen was suggestive of small bowel obstruction, which was managed conservatively. The patient responded well and was subsequently discharged with a prescription of oral voriconazole.ConclusionsThis case reveals that gastrointestinal basidiobolomycosis can cause intussusception. This report will inform clinicians of the importance of considering gastrointestinal basidiobolomycosis in the differential diagnosis of chronic abdominal pain in children, even in the absence of fever or a clinically obvious abdominal mass, especially in countries such as Saudi Arabia, where cases have been reported.

Subcutaneous Zygomycosis

Subcutaneous zygomycosis is a rare deep fungal infection caused by a group of fungus belonging to the order Entomophtharales. It is a saprophytic fungus and the predominant species causing the infection includes Basidiobolus ranarum and Conidiobolus coronatus. We, hereby, report a case of a 17-month-old female child who presented with a painless, solitary, woody hard enlarging mass which was disfiguring the left side of the face for 6 months. After our complete workup, a diagnosis of subcutaneous zygomycosis was made. The patient was managed on syrup Itraconazole and potassium iodide drops. The patient responded to the trreatment remarkably. We would like to present our take on workup and treatment of a solitary painless enlarging mass on the face in a child.

Three interesting fungal species associated with the Asian House Gecko in Kunming, China

A dead Asian House Gecko, infected with multiple species of fungi, was found floating in a jug of water inside a building in Kunming, China. The dead gecko was taken to the mycology laboratory at the Kunming Institute of Botany, Chinese Academy of Sciences and different fungal species were isolated. Phylogenetic analyses were carried out on the resultant isolates based on multiple gene sequences (ITS, LSU, mtSSU, rpb1, rpb2, tub2, Bloc, CAL, CHS-1, GAPDH, tef1-α). In addition to the phylogenetic analyses, morphological characteristics were also used to describe the fungal taxa. The entomopathogenic fungus Basidiobolus ranarum was isolated from the gecko’s inflamed right forelimb, while Beauveria bassiana was isolated from the gecko’s forehead. In addition, the neck skin yielded a common and important plant pathogen Colletotrichum jianxiense. Full descriptions, color plates of macro and micro structures of fungal taxa, and phylogenetic trees to show the placements of fungal taxa are provided. These findings represent either new host records or new country records for the three fungal species.

Subcutaneous Mycosis in Hospitals: Study of 3 Cases at The National University Hospital Centre Hubert Koutoukou Maga in Cotonou (Benin)

Introduction: Deep subcutaneous mycosis results from the involvement of subcutaneous tissue by microscopic fungi. Few studies have been conducted on these diseases in Benin. Patients and methods: This was a retrospective descriptive study that included all cases of subcutaneous mycosis recorded in the Dermatology-Venerology Department of the CNHU-HKM from 2009 to 2020. Results: 3 cases of deep subcutaneous mycosis were recorded in 12 years, including two cases of basidiobolomycosis and one case of fungal mycetoma. The cases of basidiobolomycosis were observed in two girls aged 7 and 8 years whose lesions were located on the right buttock, in the form of indurated placards, adherent to the superficial plane, measuring respectively 10cm by 5cm and 14cm by 7cm. Mycological examination of the biopsy specimens isolated Basidiobolus ranarum. The only case of fungal mycetoma was observed in a 39-year-old man, in the form of a nodular placard measuring 14cm by 12cm, polyfistulised, inflammatory and squamous-crusty with an irregular border that had been evolving for 15 years. Mycological examination of the pus revealed the presence of black grains and the identification of Madurella mycetomatis. Treatment with Ketoconazole was initiated in all three patients but the evolution could not be appreciated. Conclusion : Subcutaneous mycosis is rare in Cotonou, but probably underestimated. Keywords: Subcutaneous Mycosis; Mycetoma; Basidiobolomycosis; Benin

Immunological Cross-Reactivity of Proteins Extracted from the Oomycete Pythium insidiosum and the Fungus Basidiobolus ranarum Compromises the Detection Specificity of Immunodiagnostic Assays for Pythiosis.

Pythiosis, a life-threatening disease caused by Pythium insidiosum, has been increasingly diagnosed worldwide. A recently developed immunochromatographic test (ICT) enables the rapid diagnosis of pythiosis. During the 3-year clinical implementation of ICT in Thailand, we collected the laboratory reports of 38 animals with suspected pythiosis and detected ICT false-positive results in three horses and a dog with basidiobolomycosis. P. insidiosum and Basidiobolus ranarum cause infections with indistinguishable clinical and microscopic features. This study investigated cross-reactive antibodies by probing P. insidiosum and B. ranarum crude extracts and cell-free synthesized I06 protein (encoded in P. insidiosum genome, not other fungi) against a panel of pythiosis, basidiobolomycosis, rabbit anti-I06 peptide, and control sera by Western blot analyses. ICT false-positive results occurred from the cross-reactivity of anti-B. ranarum antibodies to the 15, 50, 60, and 120 kDa proteins of P. insidiosum, not double infections caused by both pathogens. Notably, ICT could help to screen pythiosis, and the positive test requires confirmation by culture or molecular method. The detection specificity of ICT requires improvement. The crude extract containing multispecies antigens needs replacement with a refined P. insidiosum-specific protein. We proposed that the 55 kDa I06 protein is an excellent candidate for developing a more specific serodiagnostic test for pythiosis.

Primary Basidiobolomycosis of the Cecum in Immunocompetent Patients: Two Case Reports

Colonic basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum. Primary cecal basidiobolomycosis is an exceptionally rare condition. The study describes two cases of primary basidiobolomycosis of the cecum in immunocompetent male and female patients (one each). The patients presented with fever, abdominal pain, weight loss, eosinophilia, and high erythrocyte sedimentation rates. Computed tomography revealed wall thickening and mass lesions involving the cecum, suggesting malignancy. Right hemicolectomies were performed to relieve the intestinal obstruction. On microscopy, there were destructive, transmural eosinophil-rich pyogranulomatous reactions with thin-walled, pauci-septated fungal elements surrounded by Splendore-Hoeppli bodies. The patients received antifungal drugs, with no evidence of dissemination or recurrence on follow-up. Primary cecal basidiobolomycosis in immunocompetent hosts is a rare occurrence. It oftentimes clinically masquerades malignant neoplasms and therefore its identification mandates its inclusion in the differential diagnosis of a colonic mass, equally both on the part of the clinicians and pathologists.

A Rare Case of Basidiobolomycosis that has an Excellent Response with Itraconazole: Case Report

Background: Basidiobolomycosis caused by Basidiobolus ranarum is a rare fungal infection of the subcutaneous tissues in immunocompetent patients. Primary physicians often misdiagnose the condition because its slow, painless, relentless growth, absence of response to antibiotics and anti-inflammatory drugs and unfamiliarity with these lesions. Case: A 23 years-old men was consulted from pulmonary department with progressive painless, nontender multiple nodules and swelling over his back, chest and arm in the last 1,5 year ago which was initially misdiagnosed as cutaneous tuberculosis. Extensive investigation performed with excision biopsy and culture examination revealed the presence of Basidiobolus ranarum. After initiating antifungal therapy with itraconazole, the patient’s clinical condition improved significantly. Conclusion: Basidiobolomycosis is a potentially curable disease, but the possibility of misdiagnosed is high. Early diagnosis and awarenessis of this entity are very important. There was dramatic improvement after 4 weeks of oral itraconazole 400 mg daily and complete resolution of the lession occurred after 12 weeks of the treatment.

Challenging Presentations of Seven Cases of Gastrointestinal Basidiobolomycosis in Sudan: Clinical Features, Histology, Imaging, and Recommendations.

s Basidiobolomycosis is a fungal infection caused by Basidiobolus ranarum which affects the skin and subcutaneous tissue and rarely the gastrointestinal tract. We report seven cases of gastrointestinal basidiobolomycosis with interesting clinical, radiological, and histological presentations. To our knowledge, this is the first case series of abdominal basidiobolomycosis to be reported from Sudan.