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Fathaddin A, Alobaid S, Alhumoudi D, Almarshoud G, Alsubaie A, Alotaibi NH. Gastrointestinal basidiobolomycosis: a rare manifestation of Basidiobolus ranarum in a non-endemic region. J Surg Case Rep 2024; 2024:rjae289. [PMID: 38706477 PMCID: PMC11068474 DOI: 10.1093/jscr/rjae289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024] Open
Abstract
Gastrointestinal basidiobolomycosis (GIB) is a rare fungal infection caused by the Basidiobolus ranarum, and it possesses a significant challenge to diagnose it as it presents with non-specific symptoms that often mimic cancer. Herein, we report a case of GIB in a 51-year-old male from the central region of Saudi Arabia, a non-endemic region of GIB, which was initially misdiagnosed as colon cancer. A 51-year-old man presented with abdominal pain for two-months, non-bloody diarrhea, loss of appetite, and weight loss. Abdominal examination revealed a large mass measuring ~10x15cm. Radiological findings prompted the diagnosis of a colon mass, and the patient was surgically treated under that impression. Hemicolectomy and end colostomy with mucous fistula from distal sigmoid stump were done. Histopathology was consistent with GIB. The diagnosis of GIB presents a serious challenge and requires a high index of clinical suspicion.
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Affiliation(s)
- Amany Fathaddin
- Department of Pathology, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Sarah Alobaid
- College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Duaa Alhumoudi
- College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Ghaida Almarshoud
- College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Abdulaziz Alsubaie
- Department of Medicine, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Naif H Alotaibi
- Department of Medicine, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
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2
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Meeralam Y, Basfar AM, Alzanbagi A, Tashkandi A, Al Harthi W, Saba F, Khairo M, Alzhrani S, Shariff M. Gastrointestinal Basidiobolomycosis: A Case Series. Cureus 2024; 16:e55008. [PMID: 38414515 PMCID: PMC10897526 DOI: 10.7759/cureus.55008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 02/29/2024] Open
Abstract
Gastrointestinal basidiobolomycosis (GIB) is a rare fungal infection caused by Basidiobolus ranarum, a saprophytic fungus that belongs to the class of Basidiobolomycetes. It mainly infects immunocompetent individuals and is mainly found in arid tropical and subtropical regions, including Southwestern America, Saudi Arabia, Africa, and Asia. Not surprisingly, a great number of human infections have been reported from these warm, humid climate regions that are felicitous for the growth of this fungus, especially from the southern region of Saudi Arabia and Arizona in the United States of America. GIB is easily misdiagnosed as malignancy, inflammatory bowel disease, diverticulitis, lymphoma, and chronic intestinal infections due to its rarity. In this case series, we summarize the clinical features, imaging, histopathological features, and treatment of patients diagnosed with GIB in our institution.
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Affiliation(s)
- Yaser Meeralam
- Gastroenterology, Digestive and Liver Center, King Abdullah Medical City, Makkah, SAU
| | - Abdulrahman M Basfar
- Gastroenterology, Digestive and Liver Center, King Abdullah Medical City, Makkah, SAU
| | - Adnan Alzanbagi
- Gastroenterology, Digestive and Liver Center, King Abdullah Medical City, Makkah, SAU
| | - Abdulaziz Tashkandi
- Gastroenterology, Digestive and Liver Center, King Abdullah Medical City, Makkah, SAU
| | - Wallaa Al Harthi
- Gastroenterology, Digestive and Liver Center, King Abdullah Medical City, Makkah, SAU
| | - Firdos Saba
- Pathology, King Abdullah Medical City, Makkah, SAU
| | - Mutaz Khairo
- Radiology, King Abdullah Medical City, Makkah, SAU
| | - Saleh Alzhrani
- Surgery, Specialized Surgical Unit, King Abdullah Medical City, Makkah, SAU
| | - Mohammed Shariff
- Gastroenterology, Digestive and Liver Center, King Abdullah Medical City, Makkah, SAU
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3
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Meeralam Y, Alsulami H, Aljoaid AM, Khayat M, Zahrani S, Khairo M, Alotaibi S. Basidiobolomycosis Mimicking Fistulizing Crohn's Disease: A Case Report From Saudi Arabia. Cureus 2023; 15:e37981. [PMID: 37223202 PMCID: PMC10202126 DOI: 10.7759/cureus.37981] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
Gastrointestinal basidiobolomycosis (GIB) is a rare, emerging fungal infection caused by Basidiobolus ranarum, which requires a high index of clinical suspicion for early diagnosis and management. It is prevalent in hot and humid regions, and its clinical manifestations may mimic inflammatory bowel disease (IBD), malignancy, and tuberculosis (TB). This often results in the disease being missed or incorrectly diagnosed. We present the case of a 58-year-old female patient from the southern region of Saudi Arabia who presented with persistent non-bloody diarrhea for four weeks and was found to have GIB. This condition is associated with significant morbidity and mortality if not diagnosed and treated in a timely manner. The optimal therapeutic strategy for managing this rare infection has not yet been established. Most patients described in the literature have received a combination of pharmaceutical and surgical therapy. Including GIB in the differential diagnosis of gastrointestinal disorders that do not fit the diagnosis may help with its early diagnosis and management.
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Affiliation(s)
- Yaser Meeralam
- Digestive and Liver Health Center, King Abdullah Medical City, Makkah, SAU
| | - Hajar Alsulami
- Digestive and Liver Health Center, King Abdullah Medical City, Makkah, SAU
| | - Anas M Aljoaid
- Internal Medicine, Al-Noor Specialist Hospital, Makkah, SAU
| | | | - Saad Zahrani
- Digestive and Liver Health Center, King Abdullah Medical City, Makkah, SAU
| | - Mutaz Khairo
- Radiology Department, King Abdullah Medical City, Makkah, SAU
| | - Salem Alotaibi
- Digestive and Liver Health Center, King Abdullah Medical City, Makkah, SAU
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A rare case of fatal gastrointestinal basidiobolomycosis. IDCases 2023; 31:e01709. [PMID: 36852406 PMCID: PMC9958272 DOI: 10.1016/j.idcr.2023.e01709] [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: 01/17/2023] [Revised: 02/05/2023] [Accepted: 02/11/2023] [Indexed: 02/15/2023] Open
Abstract
Basidiobolomycosis is an uncommon fungal infection caused by the environmental saprophyte Basidiobolus ranarum. Basidiobolomycosis typically manifests as a subcutaneous infection, and rarely affects the gastrointestinal tract. It lacks a distinct clinical manifestation, and most initial cases are incorrectly identified. We report a 69-year-old male patient who presented to the emergency department with history of abdominal pain, fever, and weight loss for 1 year that turned to be gastrointestinal basidiobolomycosis.
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5
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Basidiobolus omanensis sp. nov. Causing Angioinvasive Abdominal Basidiobolomycosis. J Fungi (Basel) 2021; 7:jof7080653. [PMID: 34436192 PMCID: PMC8400364 DOI: 10.3390/jof7080653] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/31/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022] Open
Abstract
Human infectious fungal diseases are increasing, despite improved hygienic conditions. We present a case of gastrointestinal basidiobolomycosis (GIB) in a 20-year-old male with a history of progressively worsening abdominal pain. The causative agent was identified as a novel Basidiobolus species. Validation of its novelty was established by analysis of the partial ribosomal operon of two isolates from different organs. Phylogeny of ITS and LSU rRNA showed that these isolates belonged to the genus Basidiobolus, positioned closely to B. heterosporus and B. minor. Morphological and physiological data supported the identity of the species, which was named Basidiobolus omanensis, with CBS 146281 as the holotype. The strains showed high minimum inhibitory concentrations (MICs) to fluconazole (>64 µg/mL), itraconazole and voriconazole (>16 µg/mL), anidulafungin and micafungin (>16 µg/mL), but had a low MIC to amphotericin B (1 µg/mL). The pathogenic role of B. omanensis in gastrointestinal disease is discussed. We highlight the crucial role of molecular identification of these rarely encountered opportunistic fungi.
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A Comprehensive Review of Infectious Granulomatous Diseases of the Gastrointestinal Tract. Gastroenterol Res Pract 2021; 2021:8167149. [PMID: 33628227 PMCID: PMC7886506 DOI: 10.1155/2021/8167149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/01/2021] [Accepted: 01/28/2021] [Indexed: 12/21/2022] Open
Abstract
A granuloma is defined as a localized inflammatory reaction or a hypersensitive response to a nondegradable product leading to an organized collection of epithelioid histiocytes. Etiologies of granulomatous disorders can be divided into two broad categories: infectious and noninfectious (autoimmune conditions, toxins, etc.) causes. The endless list of causalities may prove challenging for gastroenterologists and pathologists to formulate a list of clearly defined differentials. This is true when distinguishing these etiologies based on various clinical presentations and endoscopic and histological findings. We aim to provide a comprehensive review of some of the frequent and rare infectious granulomatous diseases of the gastrointestinal tract documented in the literature to date. We provide an overview of each infectious pathology with an emphasis on epidemiology, clinical presentation, and endoscopic and histologic findings, in addition to treatment.
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7
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Mohammed SA, Abdelsatir AA, Abdellatif M, Suliman SH, Elbasheer OMI, Abdalla AR, Widattalla AH, Tamimeldar SAM, Amin AA, Ahmed MH, Abdelsatir AM. Challenging Presentations of Seven Cases of Gastrointestinal Basidiobolomycosis in Sudan: Clinical Features, Histology, Imaging, and Recommendations. J Lab Physicians 2020; 12:281-284. [PMID: 33390679 PMCID: PMC7773445 DOI: 10.1055/s-0040-1721149] [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] [Indexed: 11/01/2022] Open
Abstract
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.
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Affiliation(s)
- Sawsan A Mohammed
- Department of Pathology, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Mohamed Abdellatif
- Department of Pathology, Faculty of Medicine, Omdurman Islamic University, Khartoum, Sudan
| | | | | | | | - Abubakr H Widattalla
- Department of Surgery, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Abdelgadir A Amin
- Pathology Department, Sudan Medical Specialization Board, Khartoum, Sudan
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, United Kingdom
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8
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Marclay M, Langohr IM, Gaschen FP, Rodrigues-Hoffmann A, Carossino M, Stewart MA, Myers AN, Grooters AM. Colorectal basidiobolomycosis in a dog. J Vet Intern Med 2020; 34:2091-2095. [PMID: 32681715 PMCID: PMC7517509 DOI: 10.1111/jvim.15859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022] Open
Abstract
A 7‐year‐old castrated male French Bulldog was examined for chronic large intestinal enteropathy. A colonic mass and thickened rectal mucosa were identified, and histopathologic examination of endoscopic biopsy specimens disclosed eosinophilic proctitis with large (5‐20 μm), irregularly shaped, pauciseptate hyphae that were Gomori methenamine silver and periodic acid‐Schiff positive. Amplification and sequencing of ribosomal DNA extracted from paraffin‐embedded tissues yielded a sequence with 97% identity to GenBank sequences for Basidiobolus ranarum. After itraconazole, terbinafine, and prednisone administration, clinical signs resolved rapidly, and sonographic lesions were largely absent after 6 weeks. Treatment was discontinued by the owner 15 weeks after diagnosis. Three weeks later, the dog collapsed acutely and was euthanized. Necropsy identified metastatic islet cell carcinoma and grossly unremarkable colorectal tissues. However, histopathology of the rectum disclosed multifocal submucosal granulomas with intralesional hyphae morphologically similar to those previously observed. This report is the first to describe medical treatment of gastrointestinal basidiobolomycosis in a dog.
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Affiliation(s)
- Margaux Marclay
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Ingeborg M Langohr
- Department of Pathobiological Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Frederic P Gaschen
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | | | - Mariano Carossino
- Department of Pathobiological Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Mathew A Stewart
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Alexandra N Myers
- Department of Veterinary Pathobiology, Texas A&M University, College Station, Texas, USA
| | - Amy M Grooters
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
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9
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Saeed A, Assiri AM, Bukhari IA, Assiri R. Antifungals in a case of basidiobolomycosis: role and limitations. BMJ Case Rep 2019; 12:e230206. [PMID: 31570348 PMCID: PMC6768487 DOI: 10.1136/bcr-2019-230206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2019] [Indexed: 11/04/2022] Open
Abstract
A 10-year-old Saudi boy was diagnosed to have basidiobolomycosis after a stormy course of his ailment. Therapy was initiated with intravenous antifungal, voriconazole, which was well tolerated for 6 weeks except for local excoriation at the site of ileostomy. He developed drug-induced hepatitis on oral voriconazole, therefore, switched to oral itraconazole following which he experienced severe chest pain. Alternatively, co-trimoxazole (bactrim) an antibacterial with antifungal activity was prescribed but he had the intolerance to it as well. Unfortunately, posaconazole as an alternative antifungal was not available in our centre. We report here a Saudi boy who developed an intolerance to most common antifungals used clinically 6 weeks after the therapy was initiated.
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Affiliation(s)
- Anjum Saeed
- Department of Pediatric Medicine, Children’s Hospital and Institute of Child Health, Lahore, Pakistan
| | - Asaad M Assiri
- Department of Pediatric, King Saud University College of Medicine, Riyadh, Saudi Arabia
| | - Ishfaq A Bukhari
- Department of Pharmacology, King Saud University College of Medicine, Riyadh, Saudi Arabia
| | - Rasha Assiri
- Department of Basic Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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Omar Takrouni A, Heitham Schammut M, Al-Otaibi M, Al-Mulla M, Privitera A. Disseminated intestinal basidiobolomycosis with mycotic aneurysm mimicking obstructing colon cancer. BMJ Case Rep 2019; 12:12/1/e225054. [PMID: 30700449 PMCID: PMC6352788 DOI: 10.1136/bcr-2018-225054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Basidiobolomycosis is a rare fungal infection that may affect the gastrointestinal tract. It is caused by Basidiobolus ranarum and less than 80 cases have been reported in the literature. The incidence seems to be higher in the Middle East and in particular Saudi Arabia where most cases are diagnosed in the south-western region. An 18-year-old woman presented to the emergency department with an obstructing caecal mass initially suspected to be malignant. Surgical resection was complicated by bowel perforation, histology and cultures confirmed basidiobolomycosis infection. The postoperative course was complicated by an enterocutaneous fistula, fungal intra-abdominal abscesses, liver and lung abscesses, formation of mycotic hepatic artery aneurysm and meningoencephalitis. The patient eventually expired due to sepsis despite aggressive treatment. Diagnosis and management of such rare cases are very challenging and require a multidisciplinary approach. Complications are common and associated with a high mortality.
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Affiliation(s)
- Arwa Omar Takrouni
- Department of General Surgery, Ministry of Health, Dammam, Eastern Province, Saudi Arabia
| | | | - Mishal Al-Otaibi
- Department of General Surgery, Ministry of Health, Dammam, Eastern Province, Saudi Arabia
| | - Manal Al-Mulla
- Department of General Surgery, Ministry of Health, Dammam, Eastern Province, Saudi Arabia
| | - Antonio Privitera
- Department of General Surgery, Ministry of Health, Dammam, Eastern Province, Saudi Arabia
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Pezzani MD, Di Cristo V, Parravicini C, Sonzogni A, Tonello C, Franzetti M, Sollima S, Corbellino M, Galli M, Milazzo L, Antinori S. Gastrointestinal basidiobolomycosis: An emerging mycosis difficult to diagnose but curable. Case report and review of the literature. Travel Med Infect Dis 2019; 31:101378. [PMID: 30660554 DOI: 10.1016/j.tmaid.2019.01.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/18/2018] [Accepted: 01/16/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Gastrointestinal basidiobolomycosis (GIB) is a rare mycosis affecting almost exclusively immunocompetent subjects. METHODS We describe a case of GIB caused by Basidiobolus ranarum in a 25-year-old Italian immunocompetent man resident in Ireland who presented a 2-month history of epigastric pain. Suspecting colon cancer he underwent a right hemicolectomy subsequently leading to a diagnosis of GIB by means of molecular biology. After surgery a 9-month therapy with itraconazole was employed with a good outcome. A review of medical literature regarding GIB cases published in the period 1964-2017 is presented. RESULTS One-hundred and two cases of GIB were included in this analysis. The disease was observed predominantly in male gender (74.5%) and children (41.2%). Abdominal pain was the single most common complaint (86.3%) followed by fever (40.2%) and evidence of an abdominal mass (30.4%). Peripheral blood eosinophilia was detected in 85.7% of cases. Most of the patients were diagnosed in Saudi Arabia (37.2%) followed by USA (21.6%) and Iran (20.6%). Surgery plus antifungal therapy was employed in the majority of patients (77.5%). An unfavourable outcome was documented globally in 18.6% of patients. CONCLUSIONS GIB seems to be an emerging intestinal mycosis among immunocompetent patients living in the Middle East and Arizona.
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Affiliation(s)
- Maria Diletta Pezzani
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy
| | - Valentina Di Cristo
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy
| | | | | | | | - Marco Franzetti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy
| | - Salvatore Sollima
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy
| | - Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy.
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12
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An unusual case of gastrointestinal basidiobolomycosis mimicking colon cancer; literature and review. J Mycol Med 2018; 29:75-79. [PMID: 30553627 DOI: 10.1016/j.mycmed.2018.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/14/2018] [Accepted: 11/30/2018] [Indexed: 11/22/2022]
Abstract
Gastrointestinal basidiobolomycosis (GIB), a rare fungal infection associated with high mortality, has been reported worldwide mainly from tropical and subtropical regions of Asia, USA, and Latin America. The clinical manifestations are highly diverse and non-specific depending on the underlying disease, but fever, abdominal pain, weight loss, diarrhea, constipation and chills have been observed. There are no prominent risk factors for GIB but climatic conditions and life style are related to this infection in arid and semi-arid regions. Therefore timely diagnosis and early treatment is a challenge. Herein, we present an unusual case of gastrointestinal basidiobolomycosis in a 54-year-old male, initially misdiagnosed as colon cancer. After follow-up, no evidence of relapse and the patient was successfully cured by liposomal amphotericin B. In addition, the differential diagnosis and histopathological findings are discussed with a review of the literature.
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13
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Al-Helal AS, Jetley NK, Al Gathradi MA, Al-Shahrani A. Infiltrating, Quasi-Cancerous Rectal Lesions: Unique Manifestation of Visceral Basidiobolus ranarum. Indian J Pediatr 2018; 85:1096-1100. [PMID: 29948734 DOI: 10.1007/s12098-018-2728-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To report the finding of transmural rectal involvement, in four children with lesions which seemed to be neoplastic in appearance and progression. METHODS The case records of four children presenting with rectal involvement by the fungus Basidiobolus ranarum, were retrospectively analyzed for clinical presentation, hematological and radiological investigations, the procurement of histopathological material for diagnosis and the findings thereof, the treatment of these patients and the follow-up. RESULTS The four children presented with non-specific symptoms of fever, loss of weight and appetite, constipation and bleeding per rectum. One presented with excoriation and ulceration of the perineum and perianal skin. Examination generally unremarkable, however, showed the rectum extensively involved by a lesion which narrowed the lumen. Hematological investigations showed leukocytosis with eosinophilia and raised levels of acute phase reactants like ESR, platelets, and C-reactive proteins. Ultrasonogram (USG) and CT scan confirmed the lesion to be involving all layers of the rectum and compromising the rectal lumen. The right colon was also involved in one patient. One underwent a colonoscopy and biopsy which proved inconclusive. All four underwent a Tru-cut biopsy which was diagnostic. Histopathologically the disease was based in Basidiobolus ranarum, a fungus which is emerging as a cause of visceral abdominal involvement. CONCLUSIONS Lesions involving the rectum, and appearing to be neoplastic may be caused by the fungus Basidiobolus ranarum. The symptomatology and presentation may be non-specific. High levels of eosinophils in the blood, a raised ESR, and C-reactive protein may be useful pointers to the diagnosis. USG and CT scans localize the lesions and also provide a guide for biopsies. The characteristic histopathological findings are diagnostic and based on these, treatment with Itroconazole / Voriconazole is beneficial.
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Affiliation(s)
- Abdullah S Al-Helal
- Department of Pediatric Surgery, Abha Maternity and Children's Hospital, Abha, 62521, Saudi Arabia
| | - Nishith Kumar Jetley
- Department of Pediatric Surgery, Abha Maternity and Children's Hospital, Abha, 62521, Saudi Arabia.
| | - Mohammed Ahmed Al Gathradi
- Department of Radiology, College of Medicine, King Khalid University and Abha Maternity and Children's Hospital, Abha, Saudi Arabia
| | - Adil Al-Shahrani
- Department of Pediatric Gastro-enterology, Abha Maternity and Children's Hospital, Abha, Saudi Arabia
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Abstract
The pathogenic entomophthoralean fungi cause infection in insects and mammalian hosts. Basidiobolus and Conidiobolus species can be found in soil and insect, reptile, and amphibian droppings in tropical and subtropical areas. The life cycles of these fungi occur in these environments where infecting sticky conidia are developed. The infection is acquired by insect bite or contact with contaminated environments through open skin. Conidiobolus coronatus typically causes chronic rhinofacial disease in immunocompetent hosts, whereas some Conidiobolus species can be found in immunocompromised patients. Basidiobolus ranarum infection is restricted to subcutaneous tissues but may be involved in intestinal and disseminated infections. Its early diagnosis remains challenging due to clinical similarities to other intestinal diseases. Infected tissues characteristically display eosinophilic granulomas with the Splendore-Höeppli phenomenon. However, in immunocompromised patients, the above-mentioned inflammatory reaction is absent. Laboratory diagnosis includes wet mount, culture serological assays, and molecular methodologies. The management of entomophthoralean fungi relies on traditional antifungal therapies, such as potassium iodide (KI), amphotericin B, itraconazole, and ketoconazole, and surgery. These species are intrinsically resistant to some antifungals, prompting physicians to experiment with combinations of therapies. Research is needed to investigate the immunology of entomophthoralean fungi in infected hosts. The absence of an animal model and lack of funding severely limit research on these fungi.
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Affiliation(s)
- Raquel Vilela
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, Michigan, USA
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Leonel Mendoza
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, Michigan, USA
- Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan, USA
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15
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Bering J, Mafi N, Vikram HR. Basidiobolomycosis: an unusual, mysterious, and emerging endemic fungal infection. Paediatr Int Child Health 2018; 38:81-84. [PMID: 29846151 DOI: 10.1080/20469047.2018.1458772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jamie Bering
- a Department of Internal Medicine , Mayo Clinic , Phoenix , AZ , USA
| | - Neema Mafi
- b Division of Infectious Diseases , Mayo Clinic , Phoenix , AZ , USA
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16
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Antifungal Resistant Gastrointestinal Basidiobolomycosis Without Eosinophilia: A Case Report. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2017. [DOI: 10.5812/archcid.66110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sitterlé E, Rodriguez C, Mounier R, Calderaro J, Foulet F, Develoux M, Pawlotsky JM, Botterel F. Contribution of Ultra Deep Sequencing in the Clinical Diagnosis of a New Fungal Pathogen Species: Basidiobolus meristosporus. Front Microbiol 2017; 8:334. [PMID: 28326064 PMCID: PMC5339647 DOI: 10.3389/fmicb.2017.00334] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/17/2017] [Indexed: 12/02/2022] Open
Abstract
Some cases of fungal infection remained undiagnosed, especially when the pathogens are uncommon, require specific conditions for in vitro growth, or when several microbial species are present in the specimen. Ultra-Deep Sequencing (UDS) could be considered as a precise tool in the identification of involved pathogens in order to upgrade patient treatment. In this study, we report the implementation of UDS technology in medical laboratory during the follow-up of an atypical fungal infection case. Thanks to UDS technology, we document the first case of gastro-intestinal basidiobolomycosis (GIB) due to Basidiobolus meristosporus. The diagnosis was suspected after histopathological examination but conventional microbiological methods failed to supply proof. The final diagnosis was made by means of an original approach based on UDS. DNA was extracted from the embedded colon biopsy obtained after hemicolectomy, and a fragment encompassing the internal transcribed spacer (ITS) rDNA region was PCR-amplified. An Amplicon library was then prepared using Genome Sequencer Junior Titanium Kits (Roche/454 Life Sciences) and the library was pyrosequenced on a GS Junior (Roche/454 Life Sciences). Using this method, 2,247 sequences with more than 100 bases were generated and used for UDS analysis. B. meristosporus represented 80% of the sequences, with an average homology of 98.8%. A phylogenetic tree with Basidiobolus reference sequences confirmed the presence of B. meristosporus (bootstrap value of 99%). Conclusion : UDS-based diagnostic approaches are ready to integrate conventional diagnostic testing to improve documentation of infectious disease and the therapeutic management of patients.
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Affiliation(s)
- Emilie Sitterlé
- Département de Microbiologie, Créteil, Dynamyc, ENVA, UPEC Creteil, France
| | - Christophe Rodriguez
- Département de Microbiologie, Next-Generation Sequencing Platform pACT, IMRB CréteilFrance; Institut Mondor de Recherche Biomédicale U955Créteil, France
| | | | | | - Françoise Foulet
- Département de Microbiologie, Créteil, Dynamyc, ENVA, UPEC Creteil, France
| | | | - Jean-Michel Pawlotsky
- Département de Microbiologie, Next-Generation Sequencing Platform pACT, IMRB CréteilFrance; Institut Mondor de Recherche Biomédicale U955Créteil, France
| | - Françoise Botterel
- Département de Microbiologie, Créteil, Dynamyc, ENVA, UPEC Creteil, France
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Shaikh N, Hussain KA, Petraitiene R, Schuetz AN, Walsh TJ. Entomophthoramycosis: a neglected tropical mycosis. Clin Microbiol Infect 2016; 22:688-94. [PMID: 27109491 DOI: 10.1016/j.cmi.2016.04.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
Abstract
The term 'entomophthoramycosis' classically refers to infections caused by members of the order Entomophthorales. A new subphylum, Entomophthoramycota, has been created to include Basidiobolomycetes, Neozygitomycetes and Entomophthoramycetes. Basidiobolomycetes encompass Basidiobolus spp., while the Entomophthoramycetes include Conidiobolus spp. Conidiobolus spp. characteristically cause rhinofacial entomophthoramycosis in apparently immunocompetent hosts. Conidiobolus spp. may also cause disseminated infection in immunocompromised patients. Basidiobolus spp. more typically cause subcutaneous entomophthoramycosis of the limbs, buttocks, back and thorax in immunocompetent patients. While once considered to be rare, there is an increasing number of reported cases of gastrointestinal infection caused by Basidiobolus spp. worldwide in countries such as United States, Thailand, Australia, Iran, Egypt and Saudi Arabia. These cases have clinical presentations similar to those of inflammatory bowel diseases, particularly Crohn's disease. Retroperitoneal, pulmonary, nasal and disseminated basidiobolomycosis have also been reported. Histology of entomophthoramycosis may reveal the Splendore-Hoeppli phenomenon. Culture of infected tissue remains the definitive method of laboratory diagnosis. However, molecular methods with specific DNA probes and panfungal primers, as well as real time PCR, are increasingly used to detect and identify these organisms in tissue. Treatment largely consists of therapy with antifungal triazoles. Surgery plays a selective role in the management of entomophthoramycosis, depending upon location, organism and extent of the infection.
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Affiliation(s)
- N Shaikh
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - K A Hussain
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - R Petraitiene
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - A N Schuetz
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - T J Walsh
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY, USA; Departments of Pediatrics and Microbiology and Immunology, Weill Cornell Medicine of Cornell University, New York, NY, USA.
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