Inhalation Of Fungal Spores Research Articles

Alternaria infectoria causes opportunistic human infections and is a source of allergens leading to respiratory allergies. In this work, we prepared cell wall nanoparticles (CWNPs) as a novel approach to study macrophage immunomodulation by fungal hyphal cell walls. A. infectoria was grown in the presence of caspofungin, an inhibitor of β(1,3)-glucan synthesis; nikkomycin Z, an inhibitor of chitin synthases; and pyroquilon, an inhibitor of dihydroxynaphthalene (DHN)-melanin synthesis. Distinct CWNPs were obtained from these cultures, referred to as casCWNPs, nkCWNPs, and pyrCWNPs, respectively. CWNPs are round-shaped particles with a diameter of 70-200 nm diameter particles that when added to macrophages are taken up by membrane ruffling. CWNPs with no DHN-melanin and more glucan (pyrCWNPs) caused early macrophage activation and lowest viability, with the cells exhibiting ultrastructural modifications such as higher vacuolization and formation of autophagy-like structures. CasCWNPs promoted the highest tumor necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β) increase, also resulting in the release of partially degraded chitin, an aspect never observed in macrophage-like cells and fungi. After 6 h of interaction with CWNPs, only half were viable, except with control CWNPs. Overall, this work indicates that compounds that modify the fungal cell wall led to CWNPs with new properties that may have implications for the effects of drugs during antifungal therapy. CWNPs provide a new tool to study the interaction of hyphal fungal cell wall components with phagocytic cells and enable to show how the modification of cell wall components in A. infectoria can modulate the response by macrophages.IMPORTANCEAlternaria species are ubiquitous environmental fungi to which the human host can continuously be exposed, through the inhalation of fungal spores but also of fragments of hyphae, from desegregated mycelia. These fungi are involved in hypersensitization and severe respiratory allergies, such as asthma, and can cause opportunistic infections in immunodepressed human host leading to severe disease. The first fungal structures to interact with the host cells are the cell wall components, and their modulation leads to differential immune responses. Here, we show that fungal cells grown with cell wall inhibitors led to cell wall nanoparticles with new properties in their interaction with macrophages. With this strategy, we overcame the limitation of in vitro assays interacting with filamentous fungi and showed that the absence of DNH-melanin leads to higher virulence, while caspofungin leads to cells walls that trigger higher hydrolysis of chitin and higher production of cytokines.

Coccidioidomycosis is a disease caused by soil fungi of the genus Coccidioides, divided genetically into Coccidioides immitis (California isolates) and Coccidioides posadasii (isolates outside California). Coccidioidomycosis is transmitted through the inhalation of fungal spores, arthroconidia, which can cause disease in susceptible mammalian hosts, including humans. Coccidioidomycosis is endemic to the western part of the United States of America, including the central valley of California, Arizona, New Mexico, and parts of western Texas. Cases have been reported in other regions in different states, and endemic pockets are present in these states. The incidence of reported cases of coccidioidomycosis has notably increased since it became reportable in 1995. Clinically, the infection ranges from asymptomatic to fatal disease due to pneumonia or disseminated states. The recognition of coccidioidomycosis can be challenging, as it frequently mimics bacterial community-acquired pneumonia. The diagnosis of coccidioidomycosis is frequently dependent on serologic testing, the results of which can take several days or longer to obtain. Coccidioidomycosis continues to present challenges for clinicians, and suspected cases can be easily missed. The challenges of coccidioidomycosis disease, from presentation to diagnosis to treatment, remain a hurdle for clinicians, and further research is needed to address these challenges.

Mucormycosis, an angioinvasive fungal infection, typically originates in the nose and paranasal sinuses following inhalation of fungal spores. It poses a potentially life-threatening risk, primarily caused by opportunistic, saprophytic aerobic fungi of the Zygomycetes subdivision and Mucorales order. Common risk factors associated with mucormycosis include uncontrolled diabetes, hematological disorders, immunosuppression, underlying systemic diseases, and symptoms associated with COVID-19.The infection presents various clinical manifestations, including rhino-orbit-cerebral, pulmonary, gastrointestinal, and mucocutaneous symptoms. We observed two cases of mucormycosis precipitated by classical and atypical risk factors, affecting individuals of different age groups. Despite the differing presentations, a common underlying systemic cause i.e. diabetes ketoacidosis was evident. The diagnosis was confirmed through either histopathological examination or positive culture.Mucormycosis ranks as the third most common invasive fungal infection. Treatment entails rapid diagnosis, correction of risk factors, surgical resection or debridement, and appropriate antifungal therapy.

Objective:Central nervous system (CNS) infections with the dematiaceous fungus Cladophialophora bantiana (C. bantiana) are extremely rare, with approximately 120 confirmed cases reported as of 2016. C. bantiana is a highly neurotropic and thermotolerant fungus found in soil worldwide. The mode of entry into the CNS remains unknown, but inhalation of fungal spores or subcutaneous trauma have been suggested. Entry of fungal spores can cause cerebral phaeohyphomycosis with the main clinical manifestation of a brain abscess. Symptoms are non-specific and can include headache, fever, hemiparesis, aphasia, visual disturbances, and confusion. C. bantiana cerebral phaeohyphomycosis occurs in both immunocompetent and immunocompromised individuals, with a slightly higher prevalence in immunocompetent males for unknown reasons. Diagnosis is often delayed due to its nonspecific presentation and prevalence in individuals without pre-existing immunological disease. Prognosis is poor, with mortality rates of approximately 70% despite aggressive treatment. Treatment is not standardized but may include several anti-fungal agents and surgical intervention. Case reports documenting the variability seen with cerebral phaeohyphomycosis by C. bantiana can provide valuable insight into this emerging disease. C. bantiana’s neurotropic propensity also warrants cognitive investigation of the disease; however, there are currently limited descriptions of cognitive findings in published case reports of C. bantiana CNS infections.Participants and Methods:Here, we describe a case of a 35-year-old immunocompetent, college educated male with a CNS C. bantiana infection, presumably following a fall while biking in Costa Rica. First symptoms included left sided facial palsy, headache, and hand weakness, prompting extensive diagnostic workup, with diagnosis of C. bantiana infection confirmed 8 months after symptom onset. Initial treatment included anti-fungal agents and steroids, but his course of infection was complicated by infectious vasculitis with posterior circulation infarcts and obstructive hydrocephalus requiring ventriculoperitoneal shunt placement two years following the fungal infection diagnosis. The most recent brain MRI revealed encephalomalacia in global periventricular areas, two small masses, likely representing small fungal phlegmons, and enhancing lesions in the upper cervical spinal canal.Results:The patient reported cognitive changes following the infarcts and shunt placement including difficulties with spatial navigation, following directions, and articulating thoughts. Memory concerns and lapses in judgment were also reported. Results from a neuropsychological evaluation revealed high average baseline intellectual abilities with decrements in visuospatial processing, processing speed, executive functioning, and aspects of memory stemming from his executive dysfunction. At the time, his cognitive profile suggested parietal and frontosubcortical systems disruption meeting criteria for mild cognitive impairment. Two years later, the patient reported continuing cognitive difficulties prompting a follow-up neuropsychological evaluation. Results were similar to his first evaluation, revealing deficits in aspects of visuospatial processing, decreased verbal and visual learning, bradyphrenia and processing speed deficits, and difficulties with visual planning and organization. Minimal anxiety and depression, but increased apathy and executive dysfunction were endorsed on self-report measures.Conclusions:This case report highlights neurological sequela resulting from CNS infection with C. bantiana, -with a course complicated by subsequent strokes, hydrocephalus, and cognitive impairment-, and contributes additional insight into the relatively limited existing reports of an extremely rare but emerging disease.

Background: Mucormycosis is one of the most rapidly progressing and fulminant forms of fungal infection which usually begins in the nose and paranasal sinuses following inhalation of fungal spores.
 Case details:This is a case report of a 65 year old male ,admitted in our hospital with long history of Type 2 diabetes with pain and swelling on right side of nose and signs and symptoms indicating Rhino-Orbital-Cerebral-mucormycosis. 
 Methodology:The level of involvement like nasal cavity, septum, turbinates, sinuses, palate, orbit involvement was noted and the protocol of medical and surgical management was decided in accordance to that. Post surgery KOH mount and HPE report after every debridement,CT and MRI findings were the mainstay.
 Conclusion : We here report a case of mucormycosis in diabetic patient shows aggressive and alarming mortality,which can be reduced by rapid diagnosis, surgical debridment and administration of drugs like amphotericin B.

Problem/ConditionCoccidioidomycosis, histoplasmosis, and blastomycosis are underdiagnosed fungal diseases that often mimic bacterial or viral pneumonia and can cause disseminated disease and death. These diseases are caused by inhalation of fungal spores that have distinct geographic niches in the environment (e.g., soil or dust), and distribution is highly susceptible to climate changes such as expanding arid regions for coccidioidomycosis, the northward expansion of histoplasmosis, and areas like New York reporting cases of blastomycosis previously thought to be nonendemic. The national incidence of coccidioidomycosis, histoplasmosis, and blastomycosis is poorly characterized.Reporting Period2019.Description of SystemThe National Notifiable Diseases Surveillance System (NNDSS) tracks cases of coccidioidomycosis, a nationally notifiable condition reported to CDC by 26 states and the District of Columbia. Neither histoplasmosis nor blastomycosis is a nationally notifiable condition; however, histoplasmosis is voluntarily reported in 13 states and blastomycosis in five states. Health departments classify cases based on the definitions established by the Council of State and Territorial Epidemiologists.ResultsIn 2019, a total of 20,061 confirmed coccidioidomycosis, 1,124 confirmed and probable histoplasmosis, and 240 confirmed and probable blastomycosis cases were reported to CDC. Arizona and California reported 97% of coccidioidomycosis cases, and Minnesota and Wisconsin reported 75% of blastomycosis cases. Illinois reported the greatest percentage (26%) of histoplasmosis cases. All three diseases were more common among males, and the proportion for blastomycosis (70%) was substantially higher than for histoplasmosis (56%) or coccidioidomycosis (52%). Coccidioidomycosis incidence was approximately four times higher for non-Hispanic American Indian or Alaska Native (AI/AN) persons (17.3 per 100,000 population) and almost three times higher for Hispanic or Latino persons (11.2) compared with non-Hispanic White (White) persons (4.1). Histoplasmosis incidence was similar across racial and ethnic categories (range: 0.9–1.3). Blastomycosis incidence was approximately six times as high among AI/AN persons (4.5) and approximately twice as high among non-Hispanic Asian and Native Hawaiian or other Pacific Islander persons (1.6) compared with White persons (0.7). More than one half of histoplasmosis (54%) and blastomycosis (65%) patients were hospitalized, and 5% of histoplasmosis and 9% of blastomycosis patients died. States in which coccidioidomycosis is not known to be endemic had more cases in spring (March, April, and May) than during other seasons, whereas the number of cases peaked slightly in autumn (September, October, and November) for histoplasmosis and in winter (December, January, and February) for blastomycosis.InterpretationCoccidioidomycosis, histoplasmosis, and blastomycosis are diseases occurring in geographical niches within the United States. These diseases cause substantial illness, with approximately 20,000 coccidioidomycosis cases reported in 2019. Although substantially fewer histoplasmosis and blastomycosis cases were reported, surveillance was much more limited and underdiagnosis was likely, as evidenced by high hospitalization and death rates. This suggests that persons with milder symptoms might not seek medical evaluation and the symptoms self-resolve or the illnesses are misdiagnosed as other, more common respiratory diseases.Public Health ActionImproved surveillance is necessary to better characterize coccidioidomycosis severity and to improve detection of histoplasmosis and blastomycosis. These findings might guide improvements in testing practices that enable timely diagnosis and treatment of fungal diseases. Clinicians and health care professionals should consider coccidioidomycosis, histoplasmosis, and blastomycosis in patients with community-acquired pneumonia or other acute infections of the lower respiratory tract who live in or have traveled to areas where the causative fungi are known to be present in the environment. Culturally appropriate tailored educational messages might help improve diagnosis and treatment. Public health response to these three diseases is hindered because information gathered from states’ routine surveillance does not include data on populations at risk and sources of exposure. Broader surveillance that includes expansion to other states, and more detail about potential exposures and relevant host factors can describe epidemiologic trends, populations at risk, and disease prevention strategies.

Aspergillus is a group of conidial fungi, isolated from soil and litter, cause serious diseases in humans and animals. This ubiquitous fungus is prevalent in the air and inhalation of fungal spores is common. Fungal diseases from Aspergillus became a major health problem and are difficult to manage because they tend to be chronic and invasive, hard to diagnose and difficult to exterminate with antifungal drugs. Although, immune responses play vital roles in monitoring the fate of fungal infections and regulation of the immune responses against fungal infections might be an effective approach for controlling and reducing the pathological damages. Recent studies have shown that microRNAs (miRNAs) are assembly of regulators which modulates the immune responses during fungal infections through diversified cellular mechanisms. These small non-coding RNA sequences regulate gene expression, mostly at the post-transcriptional level and have emerged as the controller of gene expression of at least 30% human genes. Therefore, miRNAs might be considered as one of the potential goals in immunotherapy for fungal infections. The objective of this review is to explore the role of miRNAs in host recognition processes and understanding the modulation of regulatory pathways in response to Aspergillus exposure.

Cryptococcus neoformans is a fungal pathogen that causes life-threatening meningoencephalitis in lymphopenic patients. Pulmonary macrophages comprise the first line of host defense upon inhalation of fungal spores by aiding in clearance but can also potentially serve as a niche for their dissemination. Given that macrophages play a key role in the outcome of a cryptococcal infection, it is crucial to understand factors that mediate phagocytosis of C.neoformans. Since lipid rafts (high-order plasma membrane domains enriched in cholesterol and sphingomyelin [SM]) have been implicated in facilitating phagocytosis, we evaluated whether these ordered domains govern macrophages' ability to phagocytose C.neoformans. We found that cholesterol or SM depletion resulted in significantly deficient immunoglobulin G (IgG)-mediated phagocytosis of fungus. Moreover, repletion of macrophage cells with a raft-promoting sterol (7-dehydrocholesterol) rescued this phagocytic deficiency, whereas a raft-inhibiting sterol (coprostanol) significantly decreased IgG-mediated phagocytosis of C.neoformans. Using a photoswitchable SM (AzoSM), we observed that the raft-promoting conformation (trans-AzoSM) resulted in efficient phagocytosis, whereas the raft-inhibiting conformation (cis-AzoSM) significantly but reversibly blunted phagocytosis. We observed that the effect on phagocytosis may be facilitated by Fcγ receptor (FcγR) function, whereby IgG immune complexes crosslink to FcγRIII, resulting in tyrosine phosphorylation of FcR γ-subunit (FcRγ), an important accessory protein in the FcγR signaling cascade. Correspondingly, cholesterol or SM depletion resulted in decreased FcRγ phosphorylation. Repletion with 7-dehydrocholesterol restored phosphorylation, whereas repletion with coprostanol showed FcRγ phosphorylation comparable to unstimulated cells. Together, these data suggest that lipid rafts are critical for facilitating FcγRIII-mediated phagocytosis of C.neoformans.

The focus of attention of authoritative international organizations, such as the World Health Organization, the Food and Agriculture United Nations, is the problem of contamination by fungal microflora of feed and the formation of secondary metabolites (mycotoxins) and a number of micromycetes. Contaminant fungi are mainly represented by saprophytic species with disease-causing potential. Entering the body of an animal, fungi can cause invasive lesions of the gastrointestinal tract (mucoromycosis), infection by inhalation of fungal spores, followed by the development of respiratory mycoses (aspergillosis). Almost all types of molds are capable of synthesizing mycotoxins. Some types of fungi (Penicillium) form antibiotics as secondary metabolites, which, when ingested, can disrupt the composition of the microflora of the gastrointestinal tract. The article presents the results of studies on the identification of mycoses in mustelids of cell content. To determine the species composition of pathogenic fungi, most often found in mustelids in fur farms of the Russian Federation, microbiological studies were carried out using selective culture media and a MicroTax microbiological analyzer. As a result of laboratory research, it was found that among the isolated material from the internal organs, pathogenic fungi of the genera Fusarium, Aspergillus, Mucor, Candida are most often found. Microbiological examination of animal feed (porridge, grain grinding, fish feed) revealed identical pathogens. As a result of setting a bioassay on rabbits and white mice, the pathogenicity of the isolated fungi was determined. A laboratory study was carried out to study the effect of the isolated mushrooms and their metabolic products on the weasel organism.

Background and Aim:Aspergillus flavus causes human and animal diseases through either inhalation of fungal spores or ingestion of mycotoxins as aflatoxins produced in human and animal feed as secondary metabolites. This study was aimed to detect the incidence of A. flavus and its aflatoxins in human sputum and milk powder samples and explore the efficacy of pure propolis (PP) and propolis nanoemulsion (PNE) as natural decontaminants against fungal growth and its released aflatoxins.Materials and Methods:A. flavus was isolated by mycological culture and identified macroscopically and microscopically. Coconut agar medium and thin-layer chromatography (TLC) were used to qualitatively detect aflatoxins in the isolated strains. Toxins were extracted from toxigenic strains by the fast extraction technique. The quantitative detection of toxin types was explored by high-performance liquid chromatography (HPLC). PNE was prepared by a novel method using natural components and characterized by Fourier-transform infrared spectroscopy, Zetasizer, and transmission electron microscopy. The effects of PP and PNE on A. flavus growth and its toxin were determined by the well-diffusion method and HPLC.Results:The mycological culture showed that 30.9% and 29.2% of sputum and milk powder samples were positive for A. flavus, respectively. TLC confirmed the production of 61.8% and 63.2% aflatoxin by the isolated strains in sputum and milk powder, respectively. PP and PNE showed antifungal activity on A. flavus growth with mean±standard error (SE) inhibition zones of 27.55±3.98 and 39.133±5.32 mm, respectively. HPLC revealed positive contamination of toxin extracts with AFB1, AFB2, and AFG2 at 0.57±0.026, 0.28±0.043, and 0.1±0.05 mg/L, respectively. After treatment with PP and PNE, a significant decrease in AFB1, AFB2, and AFG2 concentrations was observed.Conclusion:This study suggested using propolis and its nanoformulation as antifungal and antitoxins in human medicine and the food industry to increase the food safety level and stop food spoilage.

: Facial ulcers may be the manifestation of a wide variety of disorders with infective, inflammatory, granulomatous, or malignant etiopathogenesis, leading to challenges in differential diagnosis and management. Mucormycosis is an angio-invasive, rapidly spreading, and potentially fatal fungal infection beginning from the nose and paranasal sinuses after the inhalation of fungal spores, manifesting with cutaneous necrotic eschar. The rhinomaxillary region is the commonest site involved, particularly in immunocompromised individuals. Mucormycosis incidence in people with coronavirus disease 2019 (COVID-19) is on the rise, especially in India during the second wave. Diabetes mellitus is an independent risk factor for severe COVID-19 infection, as well as for mucormycosis. We report an elderly gentleman with uncontrolled diabetes, treated for the COVID-19 infection, who presented with an ulcer over the left nasal ala. This case report highlights the importance of high-index suspicion and prompt and aggressive multidisciplinary management of mucormycosis, as a life-saving measure.

Mucormycosis is a fulminant opportunistic fungus that primarily affects immunocompromised persons. Inhalation of fungal spores causes infection in the nose and paranasal sinuses. The fungus infiltrates the arteries, causing thrombosis and necrosis of the hard and soft tissues of maxillary region. We present a case of mucormycosis-induced maxillary necrosis in a diabetic patient and patient was on amphotericin B for past few days. Early diagnosis and prompt surgical approach like maxillectomy was performed can reduce the mortality and morbidity of this lethal fungal infection.

<p class="abstract">Rhinofacial entomophthoromycosis or conidiobolomycosis is a rare subcutaneous mycosis seen in immunocompetent people and shows significant male preponderance. It is caused by a saprophytic fungus ‘conidiobolus coronatus’ or rarely conidiobolus incogruus. The mode of transmission is probably inhalation of fungal spores, which implant in nasal mucosa and cause an orofacial granulomatosis. It is reported mainly in tropical and subtropical countries. The infection is frequently underreported since it requires high level of clinical suspicion. Histopathology and fungal culture are the diagnostic modalities. No single antifungal drug has been found to give consistent results against this infection. Here we present a case of rhinofacial entomophthoromycosis (conidiobolomycosis) in an adult male with a disfiguring lesion over the dorsum of nose. The patient was started on itraconazole initially. Following no response to the treatment, he was administered potassium iodide solution. The patient was observed to have symptomatic improvement, but was lost to follow up. </p><p class="abstract"> </p>

BackgroundThere has been a rapid rise in the number of COVID-19-associated rhino-orbital mucormycosis (CAROM) cases especially in South Asian countries, to an extent that it has been considered an epidemic among the COVID-19 patients in India. As of May 13, 2021, 101 CAROM cases have been reported, of which 82 cases were from India and 19 from the rest of the world. On the other hand, pulmonary mucormycosis associated with COVID-19 has a much lesser reported incidence of only 7% of the total COVID-19-associated mucormycosis cases (Singh AK, Singh R, Joshi SR, Misra A, Diab Metab Syndr: Clin Res Rev, 2021). This case report attempts to familiarize the health care professionals and radiologists with the imaging findings that should alarm for follow-up and treatment in the lines of CAROM.Case presentationRhino-orbital mucormycosis (ROM) is a manifestation of mucormycosis that is thought to be acquired by inhalation of fungal spores into the paranasal sinuses. Here, we describe a 55-year-old male, post COVID-19 status with long standing diabetes who received steroids and ventilator therapy for the management of the viral infection. Post discharge from the COVID-19 isolation ICU, the patient complained of grayish discharge from the right nostril and was readmitted to the hospital for the nasal discharge. After thorough radiological and pathological investigation, the patient was diagnosed with CAROM and managed.ConclusionUncontrolled diabetes and imprudent use of steroids are both contributing factors in the increased number of CAROM cases. Our report emphasizes on the radiological aspect of CAROM and reinforces the importance of follow-up imaging in post COVID-19 infection cases with a strong suspicion of opportunistic infections.

Histoplasmosis, a highly infectious fungal disease of public health concern, is caused by Histoplasma capsulatum var. capsulatum, a dimorphic fungus that occurs in mycelial and yeast form. The respiratory tract is recognized as the primary site of H. capsulatum var.capsulatum and the infection is acquired by inhalation of fungal spores from the saprobic environment. Disease can occur in sporadic as well as in epidemic form causing morbidity and mortality in susceptible individuals. Sporadic cases of histoplasmosis are reported from over 60 countries of the world including India. In USA, 25,000 cases of histoplasmosis are diagnosed every year. Certain groups of people who are associated with the soil related activities are at greater risk for developing the severe forms of disease. The fungus has the potential to infect every organ of the body including the skin, lung, brain, eye, adrenal gland, heart, liver, spleen, nose, gastrointestinal tract etc. The infection remains asymptomatic in over 90% of cases. The clinical presentation is varied and the affected person shows fever, headache, dry cough, dyspnea, chest pain, profuse sweating, lymphadenopathy, lesions in the mouth and skin etc. histoplasmosis in immune compromised patients, especially suffering from AIDS has poor prognosis. Mycological, immunological, and molecular techniques are employed to confirm an unequivocal diagnosis of disease. However, the isolation of H. capsulatum var. capsulatum from the clinical specimens still considered the gold standard of diagnosis. Antifungal drugs like liposomal amphotericin B and itraconazole are recommended for the management of disease. The disseminated histoplasmosis can be fatal if left untreated. It is imperative that immune compromised persons must avoid visiting the heavily contaminated sites that are inhabited by bats excreta and avian droppings

Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei in an immunocompetent patient: A case report and review of literature

Mucormycosis is a fatal, opportunistic deep fungal infection caused by genera Rhizopus, and compromised systemic health of the patient predisposes to this condition. Rhino maxillary or rhino nasal form of mucormycosis begins after the inhalation of fungal spores and invasion into the nasal mucosa, and spreads to the paranasal sinuses. This infection can also extend into orbits and intracranium causing fatal rhino orbito-cerebral mucormycosis. Hence early intervention is very significant in terms of prognosis. The aim of current paper is to report a case of rhinomaxillary mucormycosis involving palate, nasal and maxillary sinus in an uncontrolled diabetic patient following tooth extraction highlighting the etiopathogenesis, spread of this infection and cone beam computed tomography (CBCT) features.

The endemic mycoses are a group of infections caused by fungi with a distinct geographic distribution, defined by climatic and environmental conditions. The systemic endemic mycoses, namely histoplasmosis, blastomycosis, talaromycosis, coccidioidomycosis and paracoccidioidomycosis, occur after the inhalation of fungal spores. The cutaneous endemic mycoses, including sporotrichosis, mycetoma, entomophthoramycosis and chromoblastomycosis, enter the host via traumatic inoculation of the skin. Clinical presentation varies between these relatively heterogeneous infections, as does the susceptibility of immunosuppressed patients to disease. An understanding of the geographic range, typical manifestations, diagnostic methods, and treatment of the endemic mycoses is key in assessing patients presenting with atypical infections who may have traveled to endemic areas.

Background: Mucormycosis is a rare opportunistic fungal infection typically affecting diabetic or immunosuppressed patients. In most of the cases, infection is caused by inhalation of fungal spores. The aim of the study is to assess the different modes of presentation, risk factors management and prognosis of patients with mucormycosis.Methods: It is a retrospective study conducted in Father Muller medical college hospital between January 2016 to October 2017 and included all patients hospitalized for mucormycosis confirmed by mycological and /or histological findings. This study was approved by the institutional research and ethics committee. All case records were identified from in patient MRD with the diagnosis of mucormycosis over the last one year. For each case taken, the clinical information was recorded from case sheetResults: Out of the 7 cases studied 5 (71.4%) had rhinoorbital involvement 28.6% had pulmonary involvement with hemoptysis being the primary symptom. The mean age of the affected population was 55.7 years. Uncontrolled diabetes mellitus was the most common predisposing factor as seen in 71.4% cases with mean Hba1c levels 13. The mean ESR in present study was 79. There was increased WBC count in all the cases studied with neutrophilic predominance. Urine ketones was positive (++) in all the cases of diabetes with rhinoorbital involvement.Conclusions: Uncontrolled diabetes mellitus is a predisposing factor for mucormycosis. Elevated ESR was noted in all the cases.

Inhalation of fungal spores can cause various spectrums of fungal diseases in immunocompromised hosts. The aim of this study was to evaluate the concentrations and profiles of fungal species in air collected at different locations in hematology wards and outside of the hospital in Seoul St. Mary’s Hospital over the course of a year. Air sampling was performed at four locations—outside the hospital (O), in the general ward (GW), in the lounge in the cleanroom (CRL), and in the patients’ room in the cleanroom (CRR)—by using Andersen single-stage air sampler at every two weeks between May 2017 and May 2018. The results showed higher mean fungal density in summer, and the concentrations of fungi decreased as follows: O (954.8 colony-forming units, CFU/m3) > GW (4.2 CFU/m3) > CRL (0.7 CFU/m3) > CRR (0 CFU/m3). Aspergillus was most prevalent both inside (47%) and outside (62%) of the hospital. However, the outdoor fungal profile was more diverse than the indoor profile. Within the hospital, Penicillium was the second most dominant species. In conclusion, the outdoor fungal profile is diverse even in Seoul, a highly urbanized area in Korea. The distribution of indoor air fungi is significantly different from outdoor due to air quality systems. Heating, ventilation, and air conditioning (HVAC), as well as high-efficiency particulate air (HEPA)-filtered systems should be established to effectively reduce levels of indoor fungi.