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Scheler J, Binder U. Alternative in-vivo models of mucormycosis. Front Cell Infect Microbiol 2024; 14:1343834. [PMID: 38362495 PMCID: PMC10867140 DOI: 10.3389/fcimb.2024.1343834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Mucormycosis is still regarded a rare fungal infection, but the high incidences of COVID-associated cases in India and other countries have shown its potential threat to large patient cohorts. In addition, infections by these fast-growing fungi are often fatal and cause disfigurement, badly affecting patients' lives. In advancing our understanding of pathogenicity factors involved in this disease, to enhance the diagnostic toolset and to evaluate novel treatment regimes, animal models are indispensable. As ethical and practical considerations typically favor the use of alternative model systems, this review provides an overview of alternative animal models employed for mucormycosis and discusses advantages and limitations of the respective model.
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Affiliation(s)
| | - Ulrike Binder
- Department of Hygiene, Microbiology and Public Health, Division of Hygiene and Medical Microbiology, Medical University Innsbruck, Innsbruck, Tirol, Austria
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Peng X, Wei Z, Wang L, Cheng J. Invasive splenic mucormycosis due to Rhizopus microsporus during chemotherapy for acute monocytic leukemia: a case report and literature review. Front Oncol 2023; 13:1237807. [PMID: 37746273 PMCID: PMC10514904 DOI: 10.3389/fonc.2023.1237807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Mucormycosis is a rare opportunistic fungal infection associated with high mortality that typically occurs in immunocompromised patients. It is difficult to diagnose owing to non-specific clinical manifestations, the serologic index, imaging features, and the limitations of diagnostic methods. The incidence of invasive splenic mucormycosis is extremely rare, with only a few cases documented in the literature. We report a survival case of invasive splenic mucormycosis involving the liver caused by Rhizopus microsporus in a patient during consolidation therapy for acute monocytic leukemia (AML-M5). The patient initially presented with recurrent fever and splenomegaly accompanied by multiple focal hypodensities unresponsive to empiric anti-infective treatment. Splenic mucormycosis was diagnosed by Contrast-Enhanced Ultrasonography (CEUS) and metagenomic next-generation sequencing (mNGS). However, surgical intervention carries a high risk due to the progressive involvement of the liver in invasive splenic mucormycosis. Fortunately, monotherapy with amphotericin B was effective, and the patient underwent allo-HSCT. This case aims to emphasize the importance of utilizing mNGS and CEUS for the timely diagnosis of mucormycosis to help clinicians identify splenic mucormycosis and initiate appropriate therapy as soon as possible to improve therapeutic efficacy and prognosis.
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Affiliation(s)
- Xiru Peng
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Zixiu Wei
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Lijuan Wang
- Department of Hematology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Juan Cheng
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
- Department of Hematology, The First Hospital of Lanzhou University, Lanzhou, China
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Aerts R, De Vlieger G, Debaveye Y, Topal H, De Hertogh G, Lagrou K, Maertens J. Mucorales PCR in blood as an early marker of invasive gastrointestinal mucormycosis might decrease the delay in treatment: A case report. Med Mycol Case Rep 2022; 39:8-12. [PMID: 36590367 PMCID: PMC9794765 DOI: 10.1016/j.mmcr.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/16/2022] Open
Abstract
We describe the fatal case of a patient with gastric perforation due to ischemia and necrosis of the stomach secondary to generalized vascular thrombosis following allogeneic hematopoietic cell transplantation. Histopathological examination of the resected stomach, spleen and omentum unexpectedly showed fungal hyphae suggestive of invasive mucormycosis. We retrospectively performed Mucorales PCR (MucorGenius®, PathoNostics, Maastricht, The Netherlands) in blood and tissue samples of this patient. The PCR was positive 16 days before time of death and 9 days before abdominal pain.
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Affiliation(s)
- Robina Aerts
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium,Corresponding author. Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
| | - Greet De Vlieger
- Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium,Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium
| | - Yves Debaveye
- Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium,Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium
| | - Halit Topal
- Department of Visceral Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium,Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Johan Maertens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium,Department of Hematology, University Hospitals Leuven, Leuven, Belgium
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Bauschert L, Sermet K, Fréalle E, Khodr J, Magro L, Yakoub-Agha I, Alfandari S, Beauvais D. A case of subacute bowel obstruction revealing slowly-evolutive gastro-intestinal mucormycosis following allogeneic hematopoietic cell transplantation. J Mycol Med 2022; 32:101312. [PMID: 35914432 DOI: 10.1016/j.mycmed.2022.101312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022]
Abstract
Gastro-intestinal mucormycosis (GIMM) is a highly lethal invasive fungal disease partly because of a challenging diagnosis. An allogeneic hematopoietic cell transplant recipient experienced bowel obstruction caused by slowly-evolutive gastro-intestinal mucormycosis and was successfully treated with surgery and antifungal therapy. Pathological findings revealed a granuloma without angio-invasion, which is unusual in this fungal disease and has incomplete similarities with an immune reconstitution inflammatory syndrome. Mucorales-specific PCR in both serum and resected tissue was positive and helped assessing the diagnosis. GIMM should be considered in front of unexplained granulomatosis or bowel obstruction in immunocompromised patients.
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Affiliation(s)
- Loïc Bauschert
- Department of Hematology, CHU Lille, Univ Lille, Lille, France
| | - Kevin Sermet
- Department of Infectious Disease, CHU Lille, Univ Lille, Lille, France
| | - Emilie Fréalle
- Department of Parasitology-Mycology, CHU Lille, Lille, France
| | - Justine Khodr
- Department of Visceral and Digestive Surgery, CHU Lille, Univ Lille, Lille, France
| | - Léonardo Magro
- Department of Hematology, CHU Lille, Univ Lille, Lille, France
| | - Ibrahim Yakoub-Agha
- Department of Hematology, CHU Lille, Univ Lille, Lille, France; Univ. Lille, CHU Lille, INSERM, Infinite, U1286, Lille, France
| | - Serge Alfandari
- Department of Infectious Diseases, Gustave Dron Hospital, Tourcoing, France
| | - David Beauvais
- Department of Hematology, CHU Lille, Univ Lille, Lille, France; Univ. Lille, CHU Lille, INSERM, Infinite, U1286, Lille, France.
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Luo S, Huang X, Li Y, Wang J. Isolated splenic mucormycosis secondary to diabetic ketoacidosis: a case report. BMC Infect Dis 2022; 22:596. [PMID: 35799111 PMCID: PMC9264645 DOI: 10.1186/s12879-022-07564-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 06/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Mucormycosis is a rare but serious opportunistic fungal infection that occurs in immunocompromised individuals, especially those with diabetic ketoacidosis. Presently, early diagnosis of the disease remains a challenge for clinicians. Case presentation The patient, a 68-year-old woman with type 2 diabetes mellitus, was admitted with paroxic sharp pain in the left upper abdomen. CT imaging revealed a patchy hypodense shadow of the spleen with wedge-shaped changes. The patient was not considered early for fungal infection. The diagnosis of spleen mucormycosis was not confirmed until pathological biopsy after splenectomy. After surgery, blood glucose level was controlled, acidosis was corrected, and antifungal therapy was effective. Conclusions We report here, for the first time ever, a case of isolated splenic mucormycosis secondary to diabetic ketoacidosis that was diagnosed and treated with antifungal drugs and splenectomy. Following splenectomy, the presence of splenic mucormycosis was confirmed when characteristic mycelia were observed in a tissue biopsy. As the location of any fungal infection is extremely relevant for treatment options and prognoses, early diagnosis and clinical intervention can greatly affect outcomes and prognoses for patients.
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Affiliation(s)
- Shuai Luo
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People's Republic of China
| | - Xiang Huang
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People's Republic of China
| | - Yao Li
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People's Republic of China
| | - Jinjing Wang
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People's Republic of China.
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Didehdar M, Chegini Z, Moradabadi A, Anoushirvani AA, Tabaeian SP, Yousefimashouf M, Shariati A. Gastrointestinal mucormycosis: A periodic systematic review of case reports from 2015 to 2021. Microb Pathog 2022; 163:105388. [PMID: 34995749 DOI: 10.1016/j.micpath.2022.105388] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/01/2022] [Accepted: 01/01/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND GI mucormycosis (GI) is a rare but highly lethal infection in patients. There is no single comprehensive review of the literature that demonstrates the various clinical aspects of this infection. METHODS A structured search of PubMed/Medline was used to collect case reports of GI mucormycosis in patients of all ages published between 2015 and November 2021. RESULTS Eighty-seven cases were identified through PubMed bibliographic database searches, and final analyses were conducted on 70 adults and ten neonatal patients with GI mucormycosis. Asia had the highest number of reported cases, with 46 (57.5%). Neonatal cases had a mortality rate of 70%, while other cases had a mortality rate of 44%. Corticosteroid therapy and diabetes were the most significant risk factors in patients, while 11% were immunocompetent with no apparent underlying condition. COVID-19 positivity was detected in four adult patients. Moreover, neonatal cases included premature and low-weight infants, metabolic acidosis, and malnutrition. Abdominal pain, fever, and GI perforation were the most common signs of infection, while vomiting occurred in 40% of neonatal cases. In 97% of patients, a histopathologic examination was used to detect infection, whereas culture and molecular methods were used in only 28% and 17% of patients, respectively. Surgery plus anti-infection therapy, anti-infection therapy alone, and surgery alone were used in 61%, 28%, and 11% of patients, respectively. Nonetheless, all neonatal patients underwent surgery. Although used in a small number of patients, posaconazole (30%) and isavuconazole (11%) demonstrated high efficacy in treating patients. CONCLUSION GI mucormycosis is a rare but highly lethal disease. Treatment of underlying conditions, the use of multiple diagnostic techniques, and appropriate antifungals in conjunction with surgery can all contribute to infection control.
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Affiliation(s)
- Mojtaba Didehdar
- Department of Medical Parasitology and Mycology, Arak University of Medical Sciences, Arak, Iran
| | - Zahra Chegini
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Alireza Moradabadi
- Molecular and medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran; Department of medical Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
| | - Ali Arash Anoushirvani
- Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seidamir Pasha Tabaeian
- Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Yousefimashouf
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Borujerd Branch, Islamic Azad University, Borujerd, Iran
| | - Aref Shariati
- Molecular and medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran; Department of medical Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran.
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