Class Zygomycetes Research Articles

A rare pulmonary zygomycosis manifested as chronic mediastinitis and bronchial perforation

To the Editors: Zygomycosis is an emerging infection caused by fungi of class Zygomycetes, order Mucorales. It occurs mostly in diabetic and immunocompromised patients, but occasionally occurs in immunocompetent individuals [1]. After rhinocerebral zygomycosis, pulmonary zygomycosis, which carries a high mortality rate, is the second most common presentation [1]. Common manifestations of pulmonary zygomycosis mainly include different types of pulmonary infiltrates [2], and other rare manifestations such as endobronchial mass lesions or mediastinitis. However, in the literature, bronchial perforation caused by zygomycetes has not been previously documented. This report presents the case of a diabetic patient infected with Rhizopus sp., which resulted in chronic mediastinitis and bronchial perforation. A 76-yr-old, Chinese, never-smoking female with uncontrolled type 2 diabetes experienced a productive cough for 6 months prior to admission. This patient denied having fever, breathlessness, night sweating or body weight loss. Physical examination revealed a moderately nourished female without respiratory distress or fever. Upon admission, laboratory studies revealed a haemoglobin level of 10.5 g·dL−1, white blood cell count 5.4×103 cells per μL (53.3% neutrophils, 28.3% lymphocytes, 6% monocytes and 12% eosinophils), platelet count 355×103 cells per μL, creatinine 0.9 mg·dL−1, C-reactive protein 1.7 mg·dL−1, fasting glucose level 311 mg·dL−1 and glycated haemoglobin 14.7%. The chest radiograph on admission revealed partial atelectasis of the …

Gastrointestinal Basidiobolomycosis Mimicking Colon Cancer in a Sudanese Patient

Basidiobolomycosisis a rare disease caused by the fungus Basidiobolus ranarum. The incidence Rate of Gastrointestinal Basidiobolomycosis is approximately 1 in 45,333,334 or 0.00% in every 5 people in USA), member of the class Zygomycetes found worldwide (1).Basidiobolomycosis is usually a subcutaneous infection but rarely gastrointestinal1. This fungus is found mainly in the soil and on decaying vegetations2. It has been isolated from the banks of tropical rivers in West Africa, and has also been found in association with some insects2. The fungus is known to be present in the gastrointestinal tracts of reptiles, amphibians, and some bat species3. Definitive diagnosis requires culture and serological testing may be helpful. The fungal morphology and the Splendore-Hoeppli phenomenon are characteristic histological features. Basidiobolomycosis is treated with surgical resection and itracanzole 200mg BD for three months or Amphotericin B 5mg /kg iv/24 hrs4. Keywords : Zygomycetes, vegetations, subcutaneous infection.

Mucormycosis and Myiasis in Uncontrolled Diabetes: A Double Whammy

Mucormycosis is a rare, often fatal opportunistic fungal infection that is caused by an aerobic saprophytic fungus belonging to the order mucorales and class zygomycetes. Myiasis is caused by the members of the Diptera fly family that lay eggs or larvae on food, necrotic tissue, open wounds, and unbroken skin or mucosa. We report a rare case of mucormycosis coexisting with oral myiasis in a 50-year-old woman with uncontrolled diabetes mellitus.

Rhinocerebral zygomycosis in a diabetic patient

Rhinocerebral zygomycosis is the most frequent form of fungal infection caused by members of the Zygomycetes class. A fatal case of rhinocerebral zygomycosis caused by Rhizopus (oryzae) arrhizus with histopathological and mycological diagnosis is reported in a diabetic patient.

Rapidly progressive cutaneous Rhizopus microsporus infection presenting as Fournier's gangrene in a patient with acute myelogenous leukemia

Members of the genus Rhizopus within the class Zygomycetes can cause devastating opportunistic infections. Cutaneous disease arising from direct inoculation of fungal spores has the potential to disseminate widely. Here, we describe a dramatic case of cutaneous Rhizopus infection involving the penis in a patient with acute myelogenous leukemia. Despite aggressive surgical debridement, systemic antifungal therapy, and donor lymphocyte infusion, the infection was ultimately fatal. This case illustrates the unique diagnostic and therapeutic challenges in the clinical management of cutaneous Rhizopus infection.

Mucormycose rhino-cérébrale à Rhizopus oryzae : à propos d’un cas

Summary Mucormycosis infections are rare in France, and are caused by fungi of the class Zygomycetes, order Mucorales. The prognosis of these emergent pathologies remains severe. We report a case of a 44-year-old man, who has been admitted to the Emergency Care Unit, for a fly-away acute sinusitis resistant to antibiotic treatment. Biological parameters revealed a diabetic ketoacidosis. On day 2 after admission, ocular dysfunctions happened. An ethmoido-oculo-cerebral lesion was revealed by a cerebral MRI, suggesting a mucormycosis infection. Isolation of Rhizopus orizae was performed by a surgical histologic biopsy. Mucormycosis agents of are ubiquitary. Rhino-cerebral lesions are the most common clinical manifestations. Diabetic ketoacidosis and hematologic malignancies are respectively the two higher risk factors of mucormycosis development. This angioinvasive fungal infection induces more than a 50 % rate mortality despite the first surgical-line therapy. To conclude, a global therapeutic care and a complete knowledge of this varied clinical fungi infection must be controlled. The actual incidence of diabetes is increased, thus a mucormycosis infection must be evoked in non-responsive head and neck infections.

Sequence of oral manifestations in rhino-maxillary mucormycosis

Mucormycosis, caused by saprophytic fungi of the order Mucorales of the class Zygomycetes, is a rare opportunistic fungal infection, which has a rapidly progressive and fulminant course with fatal outcome. These fungi are ubiquitous, found in soil, bread molds, decaying fruits and vegetables. The most common form of mucormycosis is rhinocerebral and is usually seen in uncontrolled diabetes mellitus or in immunocompromised patients. This fungus invades the arteries, leading to thrombosis that subsequently causes necrosis of hard and soft tissues. We report a case of palatal perforation by rhino-maxillary mucormycosis in an immunocompromised patient. The aim of this article is to draw attention to the clinical presentation and pathogenesis of mucormycosis and to emphasize the need for high degree of suspicion in its diagnosis and management.

Successful Treatment of Cutaneous Zygomycosis With Intravenous Amphotericin B Followed by Oral Posaconazole in a Multivisceral Transplant Recipient

Successful Treatment of Cutaneous Zygomycosis With Intravenous Amphotericin B Followed by Oral Posaconazole in a Multivisceral Transplant Recipient

Case of a diabetic man cured from rhinocerebral zygomycosis

Zygomycosis (mucormycosis) is a rare, highly aggressive opportunistic fungal disease caused by saprophytic fungi, belonging to the division Zygomycota, class Zygomycetes. Patients with immunodeficiency, neutropenia, iron overload, hematological malignancies, as well as diabetics with ketoacidosis are typically affected. Authors describe the case of an eighteen-year old man with poor compliance suffering from diabetes since the age of nine. He was admitted with ketoacidotic somnolence in severe general condition with unilateral periorbital erythematous edema. Though from nasal exudates gained by the fibero-endoscopic sinus surgery Methicillin-resistant Staphylococcus aureus and Pseudomas aeruginosa was cultured, amphotericin-B was administered as the medical history, clinical picture suggested presence of zygomycosis. An invasive infection caused by Rhizopus oryzae was confirmed by histology and microbiology. The combination of antifungal therapy, repeated surgical interventions and granulocyte colony-stimulating factor resulted in good clinical response. Four month after discharge he is alive and doing well.

Meningoencephalitis caused by a zygomycete fungus (Basidiobolus) associated with septic shock in an immunocompetent patient: 1-year follow-up after treatment

Zygomycosis is an infection caused by opportunistic fungi of the Zygomycetes class, specifically those from the Mucorales and Entomophthorales orders. It is an uncommon disease, mainly restricted to immunocompromised patients. We report a case of a 73-year-old male patient with a history of fever (39 degrees C) lasting for 1 day, accompanied by shivering, trembling, and intense asthenia. The patient was admitted to the intensive care unit with complex partial seizures, and submitted to orotracheal intubation and mechanical ventilation under sedation with midazolam. The electroencephalogram showed evidence of non-convulsive status epilepticus. There is no fast specific laboratory test that permits confirmation of invasive fungal disease. Unless the physician suspects this condition, the disease may progress rapidly while the patient is treated with broad-spectrum antibiotics. Differential diagnosis between fungal and bacterial infection is often difficult. The clinical presentation is sometimes atypical, and etiological investigation is not always successful. In the present case, the histopathological examination of the biopsy obtained from the right temporal lobe indicated the presence of irregular, round, thick-walled fungi forming papillae and elongated structures of irregular diameter, with no septa, indicative of zygomycete (Basidiobolus). Treatment with liposomal amphotericin B and fluconazole was initiated after diagnosis of meningoencephalitis by zygomycete, with a successful outcome.

An Uncommon Case of Systemic Mucormycosis Associated with Spinal Cord Infarction in a Recently Diagnosed Diabetic

Mucormycosis is a relatively rare, opportunistic, invasive infection caused by various members of the Phycomycetes class [from Greek phyko- seaweed; having a plant body], an extensive taxonomy introduced in 1956 to enlarge the class of Zygomycetes. These filamentous fungi have a worldwide distribution and are capable of rapid growth and thermotolerance of human body temperature. Infection typically occurs in seriously compromised patients (i.e. diabetic ketoacidosis, hematologic malignancies, immunosuppressive disorders, end-stage renal disease, solid-organ or bone-marrow transplantation) and can be acute or fulminant, as well as indolent and chronic. In this paper we describe a case of cutaneous mucormycosis that occurred in a 54-year-old diabetic woman and evolved into a disseminated form, leading to an uncommon spinal cord infarction and consequent paraparesis. Our case suggests the importance of suspecting a mucormycosis infection in patients with decompensated diabetes mellitus, even without ketoacidosis.

Zygomycetes Infections in Pediatric HematologyOncology Patients

Fungi from the Zygomycetes class are increasingly recognized causes of infection in immunosuppressed children, but no comprehensive literature review and few case series have been published on the topic. A case series of 6 pediatric oncology patients with Zygomycetes infections cared for at our institution was constructed, and a concurrent search of the English language literature for Zygomycetes infections in children with oncologic disorders was undertaken. Our case series described 6 patients (5 male) between the ages of 2.5 and 19.5 years. One patient was diagnosed with rhinocerebral disease, 2 with rhinosinusitis, 2 with pulmonary involvement, and 1 with a gastrointestinal presentation. Five patients survived. Our literature review identified 82 cases from 61 studies. The mean subject age was 10.8 years (1.4 to 21.0 y). About 92.7% of all patients suffered from some form of leukemia, with 70.7% suffering from acute lymphoblastic leukemia. Overall, 58.5% of reported patients survived, with individuals with disseminated disease showing the worst prognosis (68.2% mortality) and those with cutaneous disease the best (14.3% mortality). Survival is increasingly reported in the literature, perhaps as a result of improved diagnostic capabilities, increased physician awareness and increased reliance on adjunctive surgical therapy.

Emerging & Rare Fungal Infections in Solid Organ Transplant Recipients

Emerging & Rare Fungal Infections in Solid Organ Transplant Recipients

In vitro interaction between suramin and fluvastatin against clinically important Zygomycetes

The in vitro antifungal activity of suramin and its combinations with fluvastatin was investigated in this study. Several species belonging to the class Zygomycetes are considered agents of opportunistic human or animal infections. In the present work, 15 fungal isolates representing eight clinically important genera (Absidia, Micromucor, Mortierella, Mucor, Rhizomucor, Rhizopus, Saksenaea and Syncephalastrum) were investigated. The efficiency with which fluvastatin inhibited growth in the presence of suramin (100 microg ml(-1)) was studied. The investigated compounds acted synergistically and additively on the growth when a strain was resistant to suramin and sensitive to fluvastatin; at the same time, antagonistic interactions were detected when strains were sensitive to both agents. In these cases, the growth inhibition effect of suramin was dominant.

Hard palate perforation in acute lymphoblastic leukemia due to mucormycosis — a case report

Palatal perforation can occur due to trauma, infection and malignancy. Mucormycosis is a rare opportunistic fungal infection caused by an organism of class zygomycetes. Rhinocerebral mucormycosis is the most common type of mucormycosis that typically starts in maxillary antrum in immunocompromised patients. Invasion of surrounding structures leads to necrotizing ulcer of the hard palate and ultimately leads to perforation. Here, we report a case of perforation of the hard palate due to mucormycosis in a eight years child having acute lymphoblastic leukemia (ALL), who was on prolonged chemotherapy and corticosteroid therapy. This case is being reported for its rarity. The aim of presenting this case report is to emphasize that the infection due to mucomycosis should be included in the differential diagnosis of hard palate perforation in ALL patients who are immunocompromised.

Cutaneous zygomycosis: A possible postoperative complication in immunocompetent individuals

Fungi in the class of zygomycetes usually produce serious infections in diabetics and immunocompromised hosts. Cutaneous zygomycosis is a less common form, with an unpredictable extent of anatomical involvement and clinical course. Here, we report two cases of primary cutaneous zygomycosis as postoperative complications in otherwise healthy females. Zygomycosis was suspected and specimens from the surgical debridement were examined by microbiological and histopathological studies for confirming the clinical diagnosis. Rapid diagnosis, liposomal amphotericin B, and proper debridement of affected tissue are necessary to avoid a fatal outcome.

Isolation and identification ofRhizomucor pusillusfrom pleural zygomycosis in an immunocompetent patient

Zygomycosis is usually an invasive mycotic disease caused by fungi in the class Zygomycetes. It often occurs in immunocompromised patients, but sporadic cases without apparent immune impairment have been described. This report presents the first case of pleural zygomycosis caused by Rhizomucor pusillus, an uncommon pathogen of human infection. A 19-year-old man was found to have pleuritis several days after a drainage catheter was implanted to cure a pneumothorax caused by a ruptured bulla. Local pneumonectomy to resect the ruptured bulla and vacuuming of the pleural fluid was performed. Rhizomucor pusillus was cultured from the pleural fluid and irregular broad sparsely septate hyphae, consistent with zygomycetes, were histologically detected in the thickened pleura of the resected bulla. The catheter was suspected of having been contaminated with the fungus, but no evidence could be obtained. His fungal pleuritis subsided without any antifungal medical therapy and his immunocompetence seemed to contribute to limiting the infection.

Post-traumatic Lethal Form of Primary Cutaneous Zygomycosis in a Healthy Young Patient and Review of the Literature

Abstract Zygomycosis is an invasive disease caused by fungi in of the class Zygomycetes. Primary cutaneous zygomycosis is uncommon. We report a case of post-traumatic most lethal form of cutaneous zygomycosis (gangrenous cellulitis), which closely resembles necrotizing fasciitis in a young healthy male patient with polytrauma. Multiple surgical debridements, skin grafting, and intravenous antifungal therapy were necessary to ultimately eradicate the infection. The early diagnosis by tissue culture and histopathology study is mandatory to successfully treat this condition.

Primary cutaneous mucormycosis in a lung transplant recipient: case report and concise review of the literature

Mucormycosis (zygomycosis) is an invasive, opportunistic fungal infection caused by organisms of the class Zygomycetes. Immunocompromised individuals, including both solid organ and hematopoietic stem cell transplant recipients, are preferentially affected. Among solid organ transplant (SOT) recipients, the sinuses, with or without involvement of the orbits and cerebrum, are the most common sites of disease, although the pulmonary allograft appears to be targeted following lung transplantation. Here, we describe the unique case of a lung transplant recipient who developed multifocal cutaneous mucormycosis without involvement of the pulmonary allograft, and review the published literature regarding incidence, treatment, and prognosis of primary cutaneous mucormycosis following SOT.

Post-traumatic infection of the lower limb caused by rare Enterobacteriaceae and Mucorales in a young healthy male

Enterobacter amnigenus and Leclercia adecarboxylata are gram-negative aerobic bacilli of the family Enterobacteriaceae that have been isolated from water and, rarely, from various clinical specimens. Absidia is a filamentous fungus of the class Zygomycetes that is ubiquitous in nature and can cause infection, primarily in immunocompromised hosts. Here, we describe an infection of the left lower limb caused by E. amnigenus and L. adecarboxylata with subsequent isolation of Absidia spp. in a patient with multiple traumatic injuries after a major motor vehicle accident. The severity of the clinical picture made amputation necessary, despite aggressive anti-infective therapy with both antibacterial and antifungal agents. Prompt diagnosis and management are mandatory in order to minimize morbidity and even mortality, and reduce the social and economic cost.