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Pham D, Howard-Jones AR, Sparks R, Stefani M, Sivalingam V, Halliday CL, Beardsley J, Chen SCA. Epidemiology, Modern Diagnostics, and the Management of Mucorales Infections. J Fungi (Basel) 2023; 9:659. [PMID: 37367595 DOI: 10.3390/jof9060659] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023] Open
Abstract
Mucormycosis is an uncommon, yet deadly invasive fungal infection caused by the Mucorales moulds. These pathogens are a WHO-assigned high-priority pathogen group, as mucormycosis incidence is increasing, and there is unacceptably high mortality with current antifungal therapies. Current diagnostic methods have inadequate sensitivity and specificity and may have issues with accessibility or turnaround time. Patients with diabetes mellitus and immune compromise are predisposed to infection with these environmental fungi, but COVID-19 has established itself as a new risk factor. Mucorales also cause healthcare-associated outbreaks, and clusters associated with natural disasters have also been identified. Robust epidemiological surveillance into burden of disease, at-risk populations, and emerging pathogens is required. Emerging serological and molecular techniques may offer a faster route to diagnosis, while newly developed antifungal agents show promise in preliminary studies. Equitable access to these emerging diagnostic techniques and antifungal therapies will be key in identifying and treating mucormycosis, as delayed initiation of therapy is associated with higher mortality.
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Affiliation(s)
- David Pham
- Centre for Infectious Diseases & Microbiology, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Annaleise R Howard-Jones
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
- Faculty of Medicine & Health, University of Sydney, Camperdown, NSW 2006, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW 2006, Australia
| | - Rebecca Sparks
- Douglass Hanly Moir Pathology, Sydney, NSW 2113, Australia
| | - Maurizio Stefani
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Varsha Sivalingam
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Catriona L Halliday
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Justin Beardsley
- Centre for Infectious Diseases & Microbiology, Westmead Hospital, Westmead, NSW 2170, Australia
- Faculty of Medicine & Health, University of Sydney, Camperdown, NSW 2006, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW 2006, Australia
- Westmead Institute for Medical Research, Sydney, NSW 2145, Australia
| | - Sharon C-A Chen
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
- Faculty of Medicine & Health, University of Sydney, Camperdown, NSW 2006, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW 2006, Australia
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Lynch JP, Fishbein MC, Abtin F, Zhanel GG. Part 1: Mucormycosis: Prevalence, Risk Factors, Clinical Features and Diagnosis. Expert Rev Anti Infect Ther 2023. [PMID: 37262298 DOI: 10.1080/14787210.2023.2220964] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/30/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Mucormycosis (MCR) is caused by filamentous molds within the Class Zygomycetes and Order Mucorales. Infections can result from inhalation of spores into the nares, oropharynx or lungs, ingestion of contaminated food or water, or inoculation into disrupted skin or wounds. In developed countries, MCR occurs primarily in severely immunocompromised hosts. In contrast, in developing/low income countries, most cases of MCR occur in persons with poorly controlled diabetes mellitus and some cases in immunocompetent subjects following trauma. Mucormycosis exhibits a propensity to invade blood vessels, leading to thrombosis and infarction of tissue. Mortality rates associated with invasive MCR are high and can exceed 90% with disseminated disease. Mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM); (2) pulmonary; (3) cutaneous; (4) gastrointestinal or renal (5); disseminated; (6) uncommon (focal) sites. AREAS COVERED The authors discuss the prevalence, risk factors and clinical features of mucormycosis.A literature search of mucormycosis was performed via PubMed (up to November 2022), using the key words: invasive fungal infections; mold; mucormycosis; Mucorales; Zyzomyces; Zygomycosis; Rhizopus, diagnosis. EXPERT OPINION Mucormycosis occurs primarily in severely immunocompromised hosts. Mucormycosis can progress rapidly, and delay in initiating treatment by even a few days worsens outcomes.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, the David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Fereidoun Abtin
- Section of Radiology Cardiothoracic and Interventional, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - George G Zhanel
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba
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3
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Samaddar A, Shrimali T, Sharma A. Mucormycosis caused by Apophysomyces species: An experience from a tertiary care hospital in Western India and systematic review of global cases. Mycoses 2023; 66:181-195. [PMID: 36227645 DOI: 10.1111/myc.13538] [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: 08/18/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 02/04/2023]
Abstract
Apophysomyces species are an emerging cause of mucormycosis in several regions of the world, primarily affecting immunocompetent individuals. The present study addresses the global epidemiology, clinical presentation, management and outcome of mucormycosis caused by Apophysomyces spp. The study included patients diagnosed with Apophysomyces infection at our hospital between March 2019 and August 2020. In addition, cases published in PubMed and Google Scholar from inception to July 2022 were systematically searched and analysed. Only proven and probable cases that meet the eligibility criteria were included. The Indian cases were compared with those from other countries, and the results were analysed by descriptive statistics. In total, six cases of mucormycosis due to Apophysomyces spp. were diagnosed at our hospital, with additional 250 cases identified through literature search. The main underlying diseases were diabetes mellitus (24%), malignancy (3.2%) and chronic kidney disease (2.8%). The major predisposing factor was trauma (55.6%). Necrotizing fasciitis was the most common (63.2%) clinical presentation. Healthcare-associated mucormycosis accounted for 10.4% of the cases. Globally, A. elegans was the most common species (48.8%), whereas A. variabilis was predominant (86.2%) in India. Surgery was performed in 83.5% of patients. Among those treated with antifungal agents, 98% received amphotericin B and 8.1% received posaconazole. Inappropriate antifungal usage was observed in 12.7%. The overall mortality was 42.3%. A combined medical and surgical management was associated with higher survival. Our study highlights the knowledge gap among physicians regarding this infection. A timely diagnosis and aggressive management can improve the outcomes in such cases.
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Affiliation(s)
- Arghadip Samaddar
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Twishi Shrimali
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Anuradha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India.,Department of Microbiology, All India Institute of Medical Sciences, Bilaspur, India
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Alkhamiss AS, Ahmed AA, Rasheed Z, Alghsham R, Shariq A, Alsaeed T, Althwab SA, Alsagaby S, Aljohani ASM, Alhumaydhi FA, Alduraibi SK, Alduraibi AK, Alhomaidan HT, Allemailem KS, Alharbi RA, Alamro SA, Alqusayer AM, Alharbi SA, Alharby TA, Almujaydil MS, Mousa AM, Alghaniam SA, Alghunaim AA, Alghamdi R, Fernández N, Al Abdulmonem W. Mucormycosis co-infection in COVID-19 patients: An update. Open Life Sci 2022; 17:917-937. [PMID: 36045713 PMCID: PMC9372758 DOI: 10.1515/biol-2022-0085] [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: 03/02/2022] [Revised: 04/09/2022] [Accepted: 04/15/2022] [Indexed: 01/08/2023] Open
Abstract
Mucormycosis (MCM) is a rare fungal disorder that has recently been increased in parallel with novel COVID-19 infection. MCM with COVID-19 is extremely lethal, particularly in immunocompromised individuals. The collection of available scientific information helps in the management of this co-infection, but still, the main question on COVID-19, whether it is occasional, participatory, concurrent, or coincidental needs to be addressed. Several case reports of these co-infections have been explained as causal associations, but the direct contribution in immunocompromised individuals remains to be explored completely. This review aims to provide an update that serves as a guide for the diagnosis and treatment of MCM patients' co-infection with COVID-19. The initial report has suggested that COVID-19 patients might be susceptible to developing invasive fungal infections by different species, including MCM as a co-infection. In spite of this, co-infection has been explored only in severe cases with common triangles: diabetes, diabetes ketoacidosis, and corticosteroids. Pathogenic mechanisms in the aggressiveness of MCM infection involves the reduction of phagocytic activity, attainable quantities of ferritin attributed with transferrin in diabetic ketoacidosis, and fungal heme oxygenase, which enhances iron absorption for its metabolism. Therefore, severe COVID-19 cases are associated with increased risk factors of invasive fungal co-infections. In addition, COVID-19 infection leads to reduction in cluster of differentiation, especially CD4+ and CD8+ T cell counts, which may be highly implicated in fungal co-infections. Thus, the progress in MCM management is dependent on a different strategy, including reduction or stopping of implicit predisposing factors, early intake of active antifungal drugs at appropriate doses, and complete elimination via surgical debridement of infected tissues.
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Affiliation(s)
- Abdullah S Alkhamiss
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ahmed A Ahmed
- Research Center, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Zafar Rasheed
- Department of Medical Biochemistry, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ruqaih Alghsham
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ali Shariq
- Departments of Microbiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Thamir Alsaeed
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Sami A Althwab
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Suliman Alsagaby
- Department of Medical Laboratories Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Abdullah S M Aljohani
- Department of Veterinary Medicine, College of Agricultural and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Fahad A Alhumaydhi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia
| | - Sharifa K Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Alaa K Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Homaidan T Alhomaidan
- Department of Family and Community Medicine, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Khaled S Allemailem
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia
| | - Raya A Alharbi
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Samar A Alamro
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Arwa M Alqusayer
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Sahim A Alharbi
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Thekra A Alharby
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Mona S Almujaydil
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ayman M Mousa
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia.,Department of Histology and Cell Biology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Sultan A Alghaniam
- Department of Clinical Nutrition, Qassim Health Affairs, Ministry of Health, Buraidah, Saudi Arabia
| | | | - Rana Alghamdi
- Department of Chemistry, Science and Arts College, Rabigh Campus, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Waleed Al Abdulmonem
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
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5
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Sharma A, Goel A. Mucormycosis: risk factors, diagnosis, treatments, and challenges during COVID-19 pandemic. Folia Microbiol (Praha) 2022; 67:363-387. [PMID: 35220559 PMCID: PMC8881997 DOI: 10.1007/s12223-021-00934-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/15/2021] [Indexed: 12/29/2022]
Abstract
Mucormycosis is a deadly opportunistic disease caused by a group of fungus named mucormycetes. Fungal spores are normally present in the environment and the immune system of the body prevents them from causing disease in a healthy immunocompetent individual. But when the defense mechanism of the body is compromised such as in the patients of diabetes mellites, neustropenia, organ transplantation recipients, and other immune-compromised states, these fungal spores invade our defense mechanism easily causing a severe systemic infection with approximately 45-80% of case fatality. In the present scenario, during the COVID-19 pandemic, patients are on immunosuppressive drugs, glucocorticoids, thus are at high risk of mucormycosis. Patients with diabetes mellitus are further getting a high chance of infection. Usually, the spores gain entry through our respiratory tract affecting the lungs and paranasal sinuses. Besides, they can also enter through damage into the skin or through the gastrointestinal route. This review article presents the current statistics, the causes of this infection in the human body, and its diagnosis with available recent therapies through recent databases collected from several clinics and agencies. The diagnosis and identification of the infection were made possible through various latest medical techniques such as computed tomography scans, direct microscopic observations, MALDI-TOF mass spectrometry, serology, molecular assay, and histopathology. Mucormycosis is so uncommon, no randomized controlled treatment studies have been conducted. The newer triazoles, posaconazole (POSA) and isavuconazole (ISAV) (the active component of the prodrug isavuconazonium sulfate) may be beneficial in patients who are refractory to or intolerant of Liposomal Amphotericin B. but due to lack of early diagnosis and aggressive surgical debridement or excision, the mortality rate remains high. In the course of COVID-19 treatments, there must be more vigilance and alertness are required from clinicians to evaluate these invasive fungal infections.
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Affiliation(s)
- Ayushi Sharma
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, 281 406, Mathura, UP, India
| | - Anjana Goel
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, 281 406, Mathura, UP, India.
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First Molecular Identification of Three Clinical Isolates of Fungi Causing Mucormycosis in Honduras. Infect Dis Rep 2022; 14:258-265. [PMID: 35447883 PMCID: PMC9027499 DOI: 10.3390/idr14020031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023] Open
Abstract
Mucormycoses are rare but serious opportunistic fungal infections caused by filamentous organisms of the order Mucorales. Here we report the first molecular identification of Rhizopus oryzae (heterotypic synonym Rhizopus arrhizus), R. delemar, and Apophysomyces ossiformis as the etiological agents of three cases of severe mucormycosis in Honduras. Conventional microbiological cultures were carried out, and DNA was extracted from both clinical samples and axenic cultures. The ITS ribosomal region was amplified and sequenced. Molecular tools are suitable strategies for diagnosing and identifying Mucorales in tissues and cultures, especially in middle-income countries lacking routine diagnostic strategies.
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7
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Global Cutaneous Mucormycosis: A Systematic Review. J Fungi (Basel) 2022; 8:jof8020194. [PMID: 35205948 PMCID: PMC8878367 DOI: 10.3390/jof8020194] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 01/27/2023] Open
Abstract
Cutaneous mucormycosis is the third most common clinical type of mucormycosis. The signs and symptoms vary widely, and it is important to make the diagnosis as early as possible in order to achieve a better outcome. We present a systematic review of its epidemiology, clinical presentation, diagnosis, and treatment, analyzing cases published from 1958 until 2021. The review was conducted according to the PRISMA guidelines and included 693 cases from 485 articles from 46 countries. Most publications were from North America (256 cases, 36.9%) and Asia (216 cases, 31.2%). The most common risk factors were diabetes mellitus (20%) and hematological malignancies (15.7%). However, a large proportion of published cases (275, 39.6%) had no identified underlying disease. The most common mode of transmission was trauma (54%), and 108 (15.6%) cases were healthcare-associated. In this review, 291 (42.5%) patients had localized infection, and 90 (13%) had disseminated mucormycosis. In Europe, N. America and S. America, the most common genus was Rhizopus spp., while in Asia it was Apophysomyces spp. (34.7%). Treatment was performed with antifungals, mainly amphotericin B, and/or surgery. Mortality was significantly lower when both antifungals and surgery were applied (29.6%).
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8
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Clark JM, Liu H, Collins S, Watson C, Ferber L, Richards WT, Taylor D, Ang DN. The Statewide Epidemiology of Mucormycosis Among Trauma Patients in Florida. Am Surg 2021:31348211050576. [PMID: 34645294 DOI: 10.1177/00031348211050576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Mucormycosis is a rare angioinvasive infection caused by filamentous fungi with a high lethality among the immunocompromised. In healthy people, the innate immune system is sufficient to prevent infection. The exception to this is deep tissue exposure seen during trauma. The purpose of this study is to evaluate the epidemiology of mucormycosis using a statewide population-based data set. METHODS This is a retrospective cohort study of all hospital admissions for mucormycosis within the state of Florida from 1997 through the beginning of 2020. A distribution map was created to evaluate for geographic variation. Botanical growth zones, based on plant hardiness, used by state environmental agencies and landscapers were also used to detect possible patterns based on climate conditions throughout Florida. A multivariable regression analysis was performed to account for confounders and limit bias. RESULTS A total of 1190 patients were identified for mucormycosis infection. Only 86 of these patients were admitted for trauma. Cutaneous infections were more prevalent among trauma patients while non-trauma patients had more pulmonary infections (P = .04). Trauma patients with infection tended to be younger and less likely to suffer from comorbidities such as immunosuppression (36% vs 46%, P = .07) and diabetes (22.1% vs 47.1%, P ≤ .0001) as compared to their non-trauma counterparts. Mortality was similar with 17.8% for non-trauma patients and 15.1% for traumatized patients (AOR .80 [.42, 1.52]). Length of stay was longer for trauma patients (37.3 vs 23.0, P < .0001). Infections were less prominent in plant hardiness Zone 9 and Zone 10 as compared to Zone 8 (AOR .71 [.61, .82]; AOR .54 [.46, .64], respectively). CONCLUSION Trauma patients who develop infection from mucormycosis are at high risk of death despite being a younger and healthier population. Mucormycosis infections were primarily soft tissue based among trauma patients. These infections are more prevalent in colder regions within Florida.
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Affiliation(s)
- Jason Michael Clark
- Department of Surgery, 33697University of South Florida, Tampa, FL, USA.,Department of Medical Education, 124506University of Central Florida, Orlando, FL, USA.,Department of Trauma, 23703Ocala Regional Medical Center, Ocala, FL, USA
| | - Huazhi Liu
- Department of Medical Education, 124506University of Central Florida, Orlando, FL, USA.,Department of Trauma, 23703Ocala Regional Medical Center, Ocala, FL, USA
| | - Susan Collins
- Department of Medical Education, 124506University of Central Florida, Orlando, FL, USA.,Department of Trauma, 23703Ocala Regional Medical Center, Ocala, FL, USA
| | - Carrie Watson
- Department of Surgery, 33697University of South Florida, Tampa, FL, USA.,Department of Medical Education, 124506University of Central Florida, Orlando, FL, USA.,Department of Trauma, 23703Ocala Regional Medical Center, Ocala, FL, USA
| | - Laurence Ferber
- Department of Surgery, 33697University of South Florida, Tampa, FL, USA.,Department of Medical Education, 124506University of Central Florida, Orlando, FL, USA.,Department of Trauma, 23703Ocala Regional Medical Center, Ocala, FL, USA
| | - Winston T Richards
- Department of Surgery, 33697University of South Florida, Tampa, FL, USA.,Department of Medical Education, 124506University of Central Florida, Orlando, FL, USA.,Department of Trauma, 23703Ocala Regional Medical Center, Ocala, FL, USA
| | - Dana Taylor
- Department of Surgery, 33697University of South Florida, Tampa, FL, USA.,Department of Medical Education, 124506University of Central Florida, Orlando, FL, USA.,Department of Trauma, 23703Ocala Regional Medical Center, Ocala, FL, USA
| | - Darwin N Ang
- Department of Surgery, 33697University of South Florida, Tampa, FL, USA.,Department of Medical Education, 124506University of Central Florida, Orlando, FL, USA.,Department of Trauma, 23703Ocala Regional Medical Center, Ocala, FL, USA
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9
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Sharma B, Nonzom S. Superficial mycoses, a matter of concern: Global and Indian scenario-an updated analysis. Mycoses 2021; 64:890-908. [PMID: 33665915 DOI: 10.1111/myc.13264] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 01/19/2023]
Abstract
Superficial mycoses of skin, nails and hair are among the common fungal infections. They are caused by dermatophytes, non-dermatophyte moulds, yeasts and yeast-like fungi. Such fungal infections are widespread all over the world and are predominant in tropical as well as subtropical regions. Environmental factors, such as warm, humid and pitiable hygienic conditions, are conducive for their growth and proliferation. Although it does not cause mortality, it is known to be associated with excessive morbidity which may be psychological or physical. This affects the quality of life of the infected individuals which leads to a negative impact on their occupational, emotional and social status. Such infections are increasing on a global scale and, therefore, are of serious concern worldwide. This review article covers the global and Indian scenario of superficial mycoses taking into account the historical background, aetiological agents, prevalence, cultural and environmental factors, risk factors, pathogenesis and hygienic practices for the prevention of superficial mycoses.
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Affiliation(s)
- Bharti Sharma
- Department of Botany, University of Jammu, Jammu, Jammu and Kashmir, India
| | - Skarma Nonzom
- Department of Botany, University of Jammu, Jammu, Jammu and Kashmir, India
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10
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Cutaneous mucormycosis of the lower extremity leading amputation in two diabetic patients. Arch Plast Surg 2021; 48:231-236. [PMID: 33657778 PMCID: PMC8007453 DOI: 10.5999/aps.2020.00549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 08/12/2020] [Indexed: 11/17/2022] Open
Abstract
Mucormycosis is an invasive, rapidly progressive, life-threatening fungal infection, with a propensity for diabetic, immunosuppressed, and trauma patients. The classic rhinocerebral variation is most common in diabetic patients. While the cutaneous form is usually caused by direct inoculation in immunocompetent patients. Cutaneous mucormycosis manifests in soft tissue and risks involvement of underlying structures. Tibial osteomyelitis can also occur secondary to cutaneous mucormycosis but is rare. Limb salvage is typically successful after lower extremity cutaneous mucormycosis even when the bone is involved. Herein, we report two cases of lower extremity cutaneous mucormycosis in diabetic patients that presented as acute worsening of chronic pretibial ulcers. Despite aggressive antifungal therapy and surgical debridement, both ultimately required amputation. Such aggressive presentation has not been reported in the absence of major penetrating trauma, recent surgery, or burns.
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11
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Li S, Han R, Zhang H, Song Y, Zhao F, Qin P. Apophysomyces jiangsuensis sp. nov., a Salt Tolerant and Phosphate-Solubilizing Fungus from the Tidelands of Jiangsu Province of China. Microorganisms 2020; 8:microorganisms8121868. [PMID: 33256164 PMCID: PMC7760925 DOI: 10.3390/microorganisms8121868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022] Open
Abstract
A newly isolated phosphate-solubilizing fungus from the topsoil of Spartina alterniflora habitats in Yancheng coastal salt marsh was cultivated. Scanning electron microscopy observation revealed that the sporangia are nearly spherical, peach-shaped, and the spores formed on the top of sporangia. The spores are ellipsoidal with raised white nubbins on the surface. Based on a polyphasic study and the genetic distance analysis referring to the sequence analysis of ITS (ITS1 + 5.8S + ITS2) and 28S rDNA (D1/D2 domains) genes, the novel species belongs to the genus Apophysomyces and is named as A. jiangsuensis. The optimum growth temperature and salinity of the new species were 28 °C and 1.15% NaCl, respectively. A study of its phosphate-solubilizing ability revealed that the fungus had an obvious decomposition effect on lecithin, Ca3(PO4)2, and AlPO3, respectively. The pH of the fermented liquid progressively decreased from 6.85 to 2.27 after 7 days of incubation, indicating that the low molecular weight organic acids excreted into the culture liquor were oxalic, succinic, and malic acids and a trace amount of citric acid. Among these, oxalic acid was the major organic acid, and its amount reached 652.5 mg/L. These results indicated that the main mechanism underlying the dissolved phosphorus was related to the secretion of large amounts of organic acids.
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Affiliation(s)
- Siyu Li
- Halophyte Research Lab, Nanjing University, Nanjing 210008, China; (S.L.); (R.H.); (F.Z.)
- Qu Jiang Experimental Middle School, Quzhou 324022, China
| | - Ruiming Han
- Halophyte Research Lab, Nanjing University, Nanjing 210008, China; (S.L.); (R.H.); (F.Z.)
- Jiangsu Center for Collaborative Innovation in Geographical Information Resource Development and Application, Jiangsu Key Laboratory of Environmental Change and Ecological Construction, School of Environment, Nanjing Normal University, Nanjing 210023, China
| | - Huanshi Zhang
- Nanjing Institute for Comprehensive Utilization of Wild Plants, Nanjing 210042, China;
| | - Yongchun Song
- Institute of Functional Biomolecules, Nanjing University, Nanjing 210093, China;
| | - Fugeng Zhao
- Halophyte Research Lab, Nanjing University, Nanjing 210008, China; (S.L.); (R.H.); (F.Z.)
| | - Pei Qin
- Halophyte Research Lab, Nanjing University, Nanjing 210008, China; (S.L.); (R.H.); (F.Z.)
- Correspondence: ; Tel.: +86-25-13951966461
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Bonifaz A, Tirado-Sánchez A, Hernández-Medel ML, Kassack JJ, Araiza J, González GM. Mucormycosis with cutaneous involvement. A retrospective study of 115 cases at a tertiary care hospital in Mexico. Australas J Dermatol 2020; 62:162-167. [PMID: 33222179 DOI: 10.1111/ajd.13508] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/07/2020] [Accepted: 10/11/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND/OBJECTIVES Cutaneous mucormycosis is an emerging opportunistic mycosis caused by Mucorales. It can be divided into primary caused by trauma and secondary by extension of rhino-cerebral and disseminated cases. The objective is to present a retrospective study of cases of mucormycosis with cutaneous involvement. METHODS A retrospective and descriptive study was carried out. Mucormycosis patients were included and divided into two groups: a) Primary Cutaneous and b) Secondary Cutaneous. Mycological tests were performed; the agents were identified by morphology and molecular studies (PCR and sequencing); some cases underwent histopathology. Clinical data and response to treatment were collected. RESULTS 115 cases were included, 18 of primary, and 97 of secondary cutaneous mucormycosis. Primary cutaneous mucormycosis was most associated with adhesive bands (44.4%) and trauma from traffic accidents (33.3%). The principal clinical form was extensive and deep necrotic ulcers. Secondary cutaneous mucormycosis cases were rhino-cerebral with uncontrolled diabetes (81.4%) The most frequent clinical presentation was necrosis of the eyelid and the nose (65.9%). In both groups, the principal agent was Rhizopus arrhizus, 38.8% and 74.2% respectively. The most effective treatment was the combination of amphotericin B with surgical debridement. The clinical and mycological cure was achieved in 31.0% of primary cases, and 44.4% for secondary cases. CONCLUSION Primary cutaneous mucormycosis is caused by implantation of the Mucorales due to trauma or rupture of the cutaneous barrier-breach, and secondary cutaneous mucormycosis develops as part of the rhino-cerebral process. The response to treatment depends on the extension and depth, as well as the predisposing factors.
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Affiliation(s)
- Alexandro Bonifaz
- Dermatology Service & Mycology department, Hospital General de México, "Dr Eduardo Liceaga", Mexico City, Mexico
| | - Andrés Tirado-Sánchez
- Dermatology Service & Mycology department, Hospital General de México, "Dr Eduardo Liceaga", Mexico City, Mexico
| | - María L Hernández-Medel
- Infectology Service, Hospital General de México, "Dr Eduardo Liceaga", Ciudad de Mexico, Mexico
| | - Juan J Kassack
- Hematology Service, Hospital General de México, "Dr Eduardo Liceaga", Ciudad de Mexico, Mexico
| | - Javier Araiza
- Dermatology Service & Mycology department, Hospital General de México, "Dr Eduardo Liceaga", Mexico City, Mexico
| | - Gloria M González
- Facultad de Medicina, Microbiology Department, Universidad Autónoma de Nuevo León, San Nicolas de los Garza, Mexico
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13
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Dellière S, Rivero-Menendez O, Gautier C, Garcia-Hermoso D, Alastruey-Izquierdo A, Alanio A. Emerging mould infections: Get prepared to meet unexpected fungi in your patient. Med Mycol 2020; 58:156-162. [PMID: 31111906 DOI: 10.1093/mmy/myz039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/01/2019] [Accepted: 04/05/2019] [Indexed: 01/19/2023] Open
Abstract
Invasive fungal diseases are increasing issues in modern medicine, where the human immunodeficiency virus (HIV) pandemic and the wider use of immunosuppressive drugs generate an ever-growing number of immunocompromised patients with an increased susceptibility to uncommon fungal pathogens. In the past decade, new species have been reported as being responsible for disseminated and invasive fungal diseases in humans. Among them, the following genera are rare but seem emerging issues: Scopulariopsis, Hormographiella, Emergomyces, Westerdykella, Trametes, Actinomucor, Saksenaea, Apophysomyces, and Rhytidhysteron. Delay in diagnosis, which is often the case in these infections, jeopardizes patients' prognosis and leads to increased mortality. Here we summarize the clinical and biological presentation and the key features to identify these emerging pathogens and we discuss the available antifungal classes to treat them. We focused on Pubmed to recover extensively reported human invasive cases and articles regarding the nine previously cited fungal organisms. Information concerning patient background, macroscopic and microscopic description and pictures of these fungal organisms, histological features in tissues, findings with commonly used antigen tests in practice, and hints on potential efficient antifungal classes were gathered. This review's purpose is to help clinical microbiologists and physicians to suspect, identify, diagnose, and treat newly encountered fungi in hospital settings.
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Affiliation(s)
- Sarah Dellière
- Université de Paris, Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
| | - Olga Rivero-Menendez
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Cécile Gautier
- Institut Pasteur, Molecular Mycology Unit, CNRS UMR2000, National Reference Center for Invasive Mycoses and Antifungals (NRCMA), Paris, France
| | - Dea Garcia-Hermoso
- Institut Pasteur, Molecular Mycology Unit, CNRS UMR2000, National Reference Center for Invasive Mycoses and Antifungals (NRCMA), Paris, France
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Alexandre Alanio
- Université de Paris, Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France.,Institut Pasteur, Molecular Mycology Unit, CNRS UMR2000, National Reference Center for Invasive Mycoses and Antifungals (NRCMA), Paris, France.,Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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14
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Martínez-Herrera E, Frías-De-León MG, Julián-Castrejón A, Cruz-Benítez L, Xicohtencatl-Cortes J, Hernández-Castro R. Rhino-orbital mucormycosis due to Apophysomyces ossiformis in a patient with diabetes mellitus: a case report. BMC Infect Dis 2020; 20:614. [PMID: 32811466 PMCID: PMC7437167 DOI: 10.1186/s12879-020-05337-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 08/11/2020] [Indexed: 02/05/2023] Open
Abstract
Background The most common aetiological agents of mucormycosis are Rhizopus, Mucor, Apophysomyces and Lichtheimia. Apophysomyces is comparatively rare, as it has been reported in less than 3% of mucormycosis cases. The genus Apophysomyces includes six species, and only A. elegans, A. mexicanus, A. variabilis and A. ossiformis have been reported to cause infections in both immunocompetent and immunocompromised patients. Case presentation We present a case of a 46-year-old male patient with bilateral blepharoedema, corneal opacity in the left eye and poorly controlled diabetes mellitus. The patient was subjected to total maxillectomy, exenteration of the left orbit and treatment with liposomal amphotericin B. Direct mycological analysis with KOH 10% revealed hyaline, coenocytic, long and wide hyphae. Apophysomyces ossiformis was identified from maxillary biopsy using 18S-ITS1–5.8S-ITS2-28S rRNA gene amplification and sequencing. The patient requested to be transferred to another hospital to continue treatment, where he died on the ninth day after admittance. Conclusion To the best of our knowledge, this is the first case of rhino-orbital mucormycosis due to A. ossiformis with a fatal outcome. This case reveals the need to identify the fungus causing mucormycosis with molecular methods to identify adequate treatment therapies for patients with this infection.
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Affiliation(s)
| | | | | | - Luis Cruz-Benítez
- Hospital Regional de Alta Especialidad de Ixtapaluca, Estado de México, Mexico
| | - Juan Xicohtencatl-Cortes
- Laboratorio de Bacteriología Intestinal, Hospital Infantil de México "Dr. Federico Gómez", 06720, Ciudad de México, Cuauhtémoc, Mexico
| | - Rigoberto Hernández-Castro
- Departamento de Ecología de Agentes Patógenos, Hospital General "Dr. Manuel Gea González", Sección XVI, Tlalpan 14080, Ciudad de México, Mexico.
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15
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Pamidimukkala U, Sudhaharan S, Kancharla A, Vemu L, Challa S, Karanam SD, Chavali P, Prakash H, Ghosh AK, Gupta S, Rudramurthy SM, Chakrabarti A. Mucormycosis due to Apophysomyces species complex- 25 years' experience at a tertiary care hospital in southern India. Med Mycol 2020; 58:425-433. [PMID: 31342074 DOI: 10.1093/mmy/myz081] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/06/2019] [Accepted: 07/03/2019] [Indexed: 12/18/2022] Open
Abstract
Apophysomyces elegans species complex is an important cause of cutaneous mucormycosis in India. However, majority of those cases are reported as case reports only. We desired to analyze our patients with Apophysomyces infection reported over 25 years (1992-2017) to understand the epidemiology, management, and outcome of the disease. During the study period 24 cases were reported, and the majority (95.8%) of them presented with necrotizing fasciitis following accidental/surgical/iatrogenic trauma. One patient presented with continuous ambulatory peritoneal dialysis (CAPD) related peritonitis. Healthcare related Apophysomyces infection was noted in 29.2% patients. In addition to trauma, comorbidities were noted in 37.5% patients (type 2diabetes mellitus-6, chronic alcoholism-2, and chronic kidney disease-1). Of the 24 isolates, 11 isolates starting from year 2014 were identified as Apophysomyces variabilis by molecular methods. Majority (95.8%) of the patients were managed surgically with or without amphotericin B deoxycholate therapy, while one patient was treated with amphotericin B deoxycholate alone. Among 24 patients, seven (29.1%) recovered, six (25%) patients could not afford antifungal management and left the hospital against medical advice, and 11 (45.9%) patients died.The present case series highlights that necrotizing fasciitis caused by A. variabilis is prevalent in India, and the disease may be healthcare related. Although diagnosis is not difficult, awareness among surgeons is still limited about the infection, leading to a delay in sending samples to the mycology laboratory. Apophysomyces infection must be considered in the differential diagnosis in apatient with progressive necrosis of a wound who is not responding to antibacterial therapy.
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Affiliation(s)
- Umabala Pamidimukkala
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telengana state, India
| | - Sukanya Sudhaharan
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telengana state, India
| | - Anuradha Kancharla
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telengana state, India
| | - Lakshmi Vemu
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telengana state, India
| | - Sundaram Challa
- Dept. of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telengana state, India
| | - Sandhya Devi Karanam
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telengana state, India
| | - Padmasri Chavali
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telengana state, India
| | - Hariprasath Prakash
- Department of Medical Microbiology, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anup Kumar Ghosh
- Department of Medical Microbiology, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunita Gupta
- Department of Medical Microbiology, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Post graduate Institute of Medical Education and Research, Chandigarh, India
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16
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Meidani M, Abtahi SH, Mohammadi R. Traumatic Mucormycosis of Auricular Cartilage in an Iranian Diabetic Patient. Int Med Case Rep J 2020; 13:95-99. [PMID: 32256124 PMCID: PMC7090215 DOI: 10.2147/imcrj.s246072] [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: 01/15/2020] [Accepted: 03/11/2020] [Indexed: 12/02/2022] Open
Abstract
Mucormycosis is an uncommon and acute fungal infection, with high morbidity and mortality. Traumatic mucormycosis mainly occurs in military conflicts, civilian trauma, and vehicle accidents. Hurricanes, tornadoes, floods, and tsunamis also play a major role in causing mucormycosis by inoculation. Herein, we presented a case of trauma-related mucormycosis in a 70-year-old diabetic male. He referred to a specialty clinic due to the auricular swelling after having fallen and having a major trauma in his ear. Pathologic examination of necrotic cartilage revealed broad ribbon like aseptate hyphae. Antifungal therapy with amphotericin B deoxycholate (1.5 mg/kg/day) was administered for 6 weeks as an initial therapy, and the patient was discharged with a regimen of posaconazole oral solution (400 mg PO bid with meals) for 8 weeks. He followed up for one year and there was no recurrence of the infection. In conclusion, traumatic mucormycosis is a rare but potentially life-threatening fungal infection. Early diagnosis and surgical excision are essential regarding the management of this critical condition. Knowing the underlying diseases is preferable to early diagnosis and timely initiation of antifungal therapy in order to improve survival rates.
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Affiliation(s)
- Mohsen Meidani
- Department of Infectious Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Rasoul Mohammadi
- Department of Medical Parasitology and Mycology, School of Medicine, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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17
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Wound Infection with an Unusual Pathogen after Liver Transplantation. Case Rep Transplant 2020; 2020:8396507. [PMID: 32309007 PMCID: PMC7154978 DOI: 10.1155/2020/8396507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/15/2020] [Accepted: 03/21/2020] [Indexed: 11/23/2022] Open
Abstract
Mucormycosis is a rare and highly invasive fungal infection caused by Mucorales fungi of the class Zygomycetes. Cutaneous mucormycosis typically has a good survival rate when diagnosed early. In this report, we presented a patient with surgical site mucormycosis after liver transplant surgery. Our patient was a 50-year-old man with cirrhosis due to nonalcoholic steatohepatitis who received liver transplant from a deceased donor. On the 8th day of transplant, the patient had fever and purulent discharge from the surgical site. The wound became black and necrotic in the next day. A microbiologic study showed mycelium in wound culture. The smear of the discharge was positive for aseptate hyphae, and the report of fungal culture revealed Rhizopus sp. In the histopathologic examination, mucormycosis was confirmed. The combination of antifungal and surgical debridement was a successful treatment in this case. Cutaneous fungal infections should be considered in the differential diagnosis of any nonhealing or black scar-infected wound that does not respond to broad-spectrum antibiotics.
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18
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Mtibaa L, Halwani C, Tbini M, Boufares S, Souid H, Ben Sassi R, Gharsallah H, Ben Mhamed R, Akkari K, Jemli B. Successful treatment of rhino-facial mucormycosis in a diabetic patient. Med Mycol Case Rep 2020; 27:64-67. [PMID: 32123659 PMCID: PMC7036620 DOI: 10.1016/j.mmcr.2020.01.003] [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: 11/27/2019] [Revised: 12/24/2019] [Accepted: 01/13/2020] [Indexed: 12/22/2022] Open
Abstract
Mucormycosis is a rapidly progressing and lethal infection caused by fungi of the order mucorales. The disease occurs mostly in patients with uncontrolled diabetes or other predisposing systemic conditions. We report a case of rhinofacial mucormycosis in a 39-year-old diabetic patient. The diagnosis was established by clinical examination, imaging, and confirmed by mycological examination. Rhizopus arrhizus was isolated. He was successfully treated with amphotericin B, surgical resection, diabetes control and hyperbaric oxygen therapy.
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Affiliation(s)
- Latifa Mtibaa
- Laboratory of Parasitology-Mycology, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Chiraz Halwani
- Department of ENT, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Makram Tbini
- Department of ENT, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Siwar Boufares
- Laboratory of Parasitology-Mycology, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Hana Souid
- Laboratory of Parasitology-Mycology, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Raja Ben Sassi
- Department of Hyperbaric Oxygenotherapy, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Hedi Gharsallah
- Department of Hyperbaric Oxygenotherapy, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Rania Ben Mhamed
- Department of ENT, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Khemaies Akkari
- Department of ENT, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Boutheina Jemli
- Laboratory of Parasitology-Mycology, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
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19
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Outbreaks of Mucorales and the Species Involved. Mycopathologia 2019; 185:765-781. [PMID: 31734800 DOI: 10.1007/s11046-019-00403-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/22/2019] [Indexed: 01/27/2023]
Abstract
The order Mucorales is an ancient group of fungi classified in the subphylum Mucoromycotina. Mucorales are mainly fast-growing saprotrophs that belong to the first colonizers of diverse organic materials and represent a permanent part of the human environment. Several species are able to cause human infections (mucormycoses) predominantly in patients with impaired immune system, diabetes, or deep trauma. In this review, we compiled 32 reports on community- and hospital-acquired outbreaks caused by Mucorales. The most common source of mucoralean outbreaks was contaminated medical devices that are responsible for 40.7% of the outbreaks followed by contaminated air (31.3%), traumatic inoculation of soil or foreign bodies (9.4%), and the contact (6.2%) or the ingestion (6.2%) of contaminated plant material. The most prevalent species were Rhizopus arrhizus and R. microsporus causing 57% of the outbreaks. The genus Rhizomucor was dominating in outbreaks related to contaminated air while outbreaks of Lichtheimia species and Mucor circinelloides were transmitted by direct contact. Outbreaks with the involvement of several species are reported. Subtyping of strains revealed clonality in two outbreaks and no close relation in two other outbreaks. Based on the existing data, outbreaks of Mucorales can be caused by heterogeneous sources consisting of different strains or different species. Person-to-person transmission cannot be excluded because Mucorales can sporulate on wounds. For a better understanding and prevention of outbreaks, we need to increase our knowledge on the physiology, ecology, and population structure of outbreak causing species and more subtyping data.
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20
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Walther G, Wagner L, Kurzai O. Updates on the Taxonomy of Mucorales with an Emphasis on Clinically Important Taxa. J Fungi (Basel) 2019; 5:E106. [PMID: 31739583 PMCID: PMC6958464 DOI: 10.3390/jof5040106] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 12/11/2022] Open
Abstract
Fungi of the order Mucorales colonize all kinds of wet, organic materials and represent a permanent part of the human environment. They are economically important as fermenting agents of soybean products and producers of enzymes, but also as plant parasites and spoilage organisms. Several taxa cause life-threatening infections, predominantly in patients with impaired immunity. The order Mucorales has now been assigned to the phylum Mucoromycota and is comprised of 261 species in 55 genera. Of these accepted species, 38 have been reported to cause infections in humans, as a clinical entity known as mucormycosis. Due to molecular phylogenetic studies, the taxonomy of the order has changed widely during the last years. Characteristics such as homothallism, the shape of the suspensors, or the formation of sporangiola are shown to be not taxonomically relevant. Several genera including Absidia, Backusella, Circinella, Mucor, and Rhizomucor have been amended and their revisions are summarized in this review. Medically important species that have been affected by recent changes include Lichtheimia corymbifera, Mucor circinelloides, and Rhizopus microsporus. The species concept of Rhizopus arrhizus (syn. R. oryzae) is still a matter of debate. Currently, species identification of the Mucorales is best performed by sequencing of the internal transcribed spacer (ITS) region. Ecologically, the Mucorales represent a diverse group but for the majority of taxa, the ecological role and the geographic distribution remain unknown. Understanding the biology of these opportunistic fungal pathogens is a prerequisite for the prevention of infections, and, consequently, studies on the ecology of the Mucorales are urgently needed.
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Affiliation(s)
- Grit Walther
- German National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research and Infection Biology – Hans Knöll Institute, 07745 Jena, Germany; (L.W.); (O.K.)
| | - Lysett Wagner
- German National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research and Infection Biology – Hans Knöll Institute, 07745 Jena, Germany; (L.W.); (O.K.)
| | - Oliver Kurzai
- German National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research and Infection Biology – Hans Knöll Institute, 07745 Jena, Germany; (L.W.); (O.K.)
- Institute for Hygiene and Microbiology, University of Würzburg, 97080 Würzburg, Germany
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21
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Samaddar A, Sharma A, Maurya VK, Tak V. Necrotizing fasciitis caused by Apophysomyces variabilis in a burn patient. IDCases 2019; 18:e00660. [PMID: 31799119 PMCID: PMC6883305 DOI: 10.1016/j.idcr.2019.e00660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/28/2019] [Indexed: 12/27/2022] Open
Abstract
The genus Apophysomyces belonging to the order Mucorales is increasingly being reported as a cause of mucormycosis in immunocompetent patients. We report a case of necrotizing fasciitis caused by Apophysomyces variabilis in a 52-year-old immunocompetent male who sustained thermal burn in his right leg following a road-traffic accident. There was rapidly progressive necrosis of skin, soft tissues and underlying muscles which required extensive surgical debridement. Microscopic examination of excised tissues revealed broad aseptate fungal hyphae. Fungal culture on Sabouraud dextrose agar (SDA) showed growth of a mucoraceous mould which was identified as A. variabilis based on characteristic microscopic morphology and internal transcribed spacer sequencing of the ribosomal DNA. The isolate was found to sporulate on SDA, a finding that was unique as Apophysomyces spp. does not usually sporulate on primary isolation medium used in mycology laboratories. The disease progressed as there was an initial assumption of bacterial infection and the fungus was isolated late in the course of the disease because of which no antifungal drug was added to the regime. The patient left against medical advice and eventually underwent below-knee amputation at another city hospital a week later. Infection due to A. variabilis should be considered as a differential diagnosis of rapidly progressive necrosis of skin and soft tissues in immunocompetent individuals as early diagnosis and management will prevent the disease progression and a possible amputation.
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Affiliation(s)
- Arghadip Samaddar
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
| | - Anuradha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
| | - Vinod Kumar Maurya
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
| | - Vibhor Tak
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, 342005, Rajasthan, India
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22
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Macias AM, Marek PE, Morrissey EM, Brewer MS, Short DP, Stauder CM, Wickert KL, Berger MC, Metheny AM, Stajich JE, Boyce G, Rio RVM, Panaccione DG, Wong V, Jones TH, Kasson MT. Diversity and function of fungi associated with the fungivorous millipede, Brachycybe lecontii. FUNGAL ECOL 2019; 41:187-197. [PMID: 31871487 PMCID: PMC6927558 DOI: 10.1016/j.funeco.2019.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fungivorous millipedes (subterclass Colobognatha) likely represent some of the earliest known mycophagous terrestrial arthropods, yet their fungal partners remain elusive. Here we describe relationships between fungi and the fungivorous millipede, Brachycybe lecontii. Their fungal community is surprisingly diverse, including 176 genera, 39 orders, four phyla, and several undescribed species. Of particular interest are twelve genera conserved across wood substrates and millipede clades that comprise the core fungal community of B. lecontii. Wood decay fungi, long speculated to serve as the primary food source for Brachycybe species, were absent from this core assemblage and proved lethal to millipedes in pathogenicity assays while entomopathogenic Hypocreales were more common in the core but had little effect on millipede health. This study represents the first survey of fungal communities associated with any colobognath millipede, and these results offer a glimpse into the complexity of millipede fungal communities.
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Affiliation(s)
- Angie M. Macias
- Division of Plant and Soil Sciences, West Virginia University, Morgantown, WV, 26506, USA
| | - Paul E. Marek
- Department of Entomology, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24061, USA
| | - Ember M. Morrissey
- Division of Plant and Soil Sciences, West Virginia University, Morgantown, WV, 26506, USA
| | - Michael S. Brewer
- Department of Biology, East Carolina University, Greenville, NC 27858, USA
| | | | - Cameron M. Stauder
- Division of Plant and Soil Sciences, West Virginia University, Morgantown, WV, 26506, USA
| | - Kristen L. Wickert
- Division of Plant and Soil Sciences, West Virginia University, Morgantown, WV, 26506, USA
| | - Matthew C. Berger
- Division of Plant and Soil Sciences, West Virginia University, Morgantown, WV, 26506, USA
| | - Amy M. Metheny
- Division of Plant and Soil Sciences, West Virginia University, Morgantown, WV, 26506, USA
| | - Jason E. Stajich
- Department of Microbiology and Plant Pathology and Institute for Integrative Genome Biology, University of California, Riverside, CA 92521, USA
| | - Greg Boyce
- Division of Plant and Soil Sciences, West Virginia University, Morgantown, WV, 26506, USA
| | - Rita V. M. Rio
- Department of Biology, West Virginia University, Morgantown, WV, 26506, USA
| | - Daniel G. Panaccione
- Division of Plant and Soil Sciences, West Virginia University, Morgantown, WV, 26506, USA
| | - Victoria Wong
- Department of Entomology, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24061, USA
| | - Tappey H. Jones
- Department of Chemistry, Virginia Military Institute, Lexington, VA, 24450, USA
| | - Matt T. Kasson
- Division of Plant and Soil Sciences, West Virginia University, Morgantown, WV, 26506, USA
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23
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Khuna S, Suwannarach N, Kumla J, Jomkhwan Meerak, Nuangmek W, Kiatsiriroat T, Saisamorn Lumyong. Apophysomycesthailandensis (Mucorales, Mucoromycota), a new species isolated from soil in northern Thailand and its solubilization of non-soluble minerals. MycoKeys 2019:75-92. [PMID: 30733638 PMCID: PMC6363719 DOI: 10.3897/mycokeys.45.30813] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/02/2019] [Indexed: 12/30/2022] Open
Abstract
A new species of soil fungi, described herein as Apophysomycesthailandensis, was isolated from soil in Chiang Mai Province, Thailand. Morphologically, this species was distinguished from previously described Apophysomyces species by its narrower trapezoidal sporangiospores. A physiological determination showed that A.thailandensis differs from other Apophysomyces species by its assimilation of D-turanose, D-tagatose, D-fucose, L-fucose, and nitrite. A phylogenetic analysis, performed using combined internal transcribed spacers (ITS), the large subunit (LSU) of ribosomal DNA (rDNA) regions, and a part of the histone 3 (H3) gene, lends support to our the finding that A.thailandensis is distinct from other Apophysomyces species. The genetic distance analysis of the ITS sequence supports A.thailandensis as a new fungal species. A full description, illustrations, phylogenetic tree, and taxonomic key to the new species are provided. Its metal minerals solubilization ability is reported.
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Affiliation(s)
- Surapong Khuna
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand Chiang Mai University Chiang Mai Thailand.,PhD Degree Program in Applied Microbiology, Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand University of Phayao Phayao Thailand
| | - Nakarin Suwannarach
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand Chiang Mai University Chiang Mai Thailand.,Center of Excellence in Microbial Diversity and Sustainable Utilization, Chiang Mai University, Chiang Mai 50200, Thailand Academy of Science, The Royal Society of Thailand Bangkok Thailand
| | - Jaturong Kumla
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand Chiang Mai University Chiang Mai Thailand.,Center of Excellence in Microbial Diversity and Sustainable Utilization, Chiang Mai University, Chiang Mai 50200, Thailand Academy of Science, The Royal Society of Thailand Bangkok Thailand
| | - Jomkhwan Meerak
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand Chiang Mai University Chiang Mai Thailand
| | - Wipornpan Nuangmek
- Faculty of Agriculture and Natural Resources, University of Phayao, Phayao 56000, Thailand Chiang Mai University Chiang Mai Thailand
| | - Tanongkiat Kiatsiriroat
- Center of Excellence for Renewable Energy, Chiang Mai University, Chiang Mai 50200, Thailand University of Phayao Phayao Thailand
| | - Saisamorn Lumyong
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand Chiang Mai University Chiang Mai Thailand.,Center of Excellence in Microbial Diversity and Sustainable Utilization, Chiang Mai University, Chiang Mai 50200, Thailand Academy of Science, The Royal Society of Thailand Bangkok Thailand.,Center of Excellence for Renewable Energy, Chiang Mai University, Chiang Mai 50200, Thailand University of Phayao Phayao Thailand.,Academy of Science, The Royal Society of Thailand, Bangkok 10300, Thailand Academy of Science, The Royal Society of Thailand Bangkok Thailand
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24
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Wiederhold NP, Gibas CFC. From the Clinical Mycology Laboratory: New Species and Changes in Fungal Taxonomy and Nomenclature. J Fungi (Basel) 2018; 4:E138. [PMID: 30558386 PMCID: PMC6308937 DOI: 10.3390/jof4040138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 12/14/2022] Open
Abstract
Fungal taxonomy is the branch of mycology by which we classify and group fungi based on similarities or differences. Historically, this was done by morphologic characteristics and other phenotypic traits. However, with the advent of the molecular age in mycology, phylogenetic analysis based on DNA sequences has replaced these classic means for grouping related species. This, along with the abandonment of the dual nomenclature system, has led to a marked increase in the number of new species and reclassification of known species. Although these evaluations and changes are necessary to move the field forward, there is concern among medical mycologists that the rapidity by which fungal nomenclature is changing could cause confusion in the clinical literature. Thus, there is a proposal to allow medical mycologists to adopt changes in taxonomy and nomenclature at a slower pace. In this review, changes in the taxonomy and nomenclature of medically relevant fungi will be discussed along with the impact this may have on clinicians and patient care. Specific examples of changes and current controversies will also be given.
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Affiliation(s)
- Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
| | - Connie F C Gibas
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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25
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Skiada A, Lass-Floerl C, Klimko N, Ibrahim A, Roilides E, Petrikkos G. Challenges in the diagnosis and treatment of mucormycosis. Med Mycol 2018. [PMID: 29538730 DOI: 10.1093/mmy/myx101] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The diagnosis and treatment of mucormycosis are challenging. The incidence of the disease seems to be increasing. Hematological malignancies are the most common underlying disease in countries with high income and uncontrolled diabetes in developing countries. Clinical approach to diagnosis lacks sensitivity and specificity. Radiologically, multiple (≥10) nodules and pleural effusion are reportedly associated with pulmonary mucormycosis. Another finding on computerized tomography (CT) scan, which seems to indicate the presence of mucormycosis, is the reverse halo sign. Microscopy (direct and on histopathology) and culture are the cornerstones of diagnosis. Molecular assays can be used either for detection or identification of mucormycetes, and they can be recommended as valuable add-on tools that complement conventional diagnostic procedures. Successful management of mucormycosis is based on a multimodal approach, including reversal or discontinuation of underlying predisposing factors, early administration of active antifungal agents at optimal doses, complete removal of all infected tissues, and use of various adjunctive therapies. Our armamentarium of antifungals is slightly enriched by the addition of two newer azoles (posaconazole and isavuconazole) to liposomal amphotericin B, which remains the drug of choice for the initial antifungal treatment, according to the recently published guidelines by ECIL-6, as well as those published by ECMM/ESCMID. Despite the efforts for better understanding of the pathogenesis, early diagnosis and aggressive treatment of mucormycosis, the mortality rate of the disease remains high.
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Affiliation(s)
- A Skiada
- Laiko Hospital, National and Kapodistrian University of Athens, Greece
| | - C Lass-Floerl
- Division of Hygiene and Medical Microbiology, Laboratory for Invasive Fungal Infections, Medical University of Innsbruck, Austria
| | - N Klimko
- Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University, Saint Petersburg, Russia
| | - A Ibrahim
- Division of Infectious Diseases, David Geffen School of Medicine, UCLA.,Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, USA
| | - E Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - G Petrikkos
- School of Medicine, European University of Cyprus
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26
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Wijayawardene NN, Pawłowska J, Letcher PM, Kirk PM, Humber RA, Schüßler A, Wrzosek M, Muszewska A, Okrasińska A, Istel Ł, Gęsiorska A, Mungai P, Lateef AA, Rajeshkumar KC, Singh RV, Radek R, Walther G, Wagner L, Walker C, Wijesundara DSA, Papizadeh M, Dolatabadi S, Shenoy BD, Tokarev YS, Lumyong S, Hyde KD. Notes for genera: basal clades of Fungi (including Aphelidiomycota, Basidiobolomycota, Blastocladiomycota, Calcarisporiellomycota, Caulochytriomycota, Chytridiomycota, Entomophthoromycota, Glomeromycota, Kickxellomycota, Monoblepharomycota, Mortierellomycota, Mucoromycota, Neocallimastigomycota, Olpidiomycota, Rozellomycota and Zoopagomycota). FUNGAL DIVERS 2018. [DOI: 10.1007/s13225-018-0409-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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27
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Corzo-León DE, Chora-Hernández LD, Rodríguez-Zulueta AP, Walsh TJ. Diabetes mellitus as the major risk factor for mucormycosis in Mexico: Epidemiology, diagnosis, and outcomes of reported cases. Med Mycol 2018; 56:29-43. [PMID: 28431008 DOI: 10.1093/mmy/myx017] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Indexed: 12/16/2022] Open
Abstract
Mucormycosis is an emerging infectious disease with high rates of associated mortality and morbidity. Little is known about the characteristics of mucormycosis or entomophthoromycosis occurring in Mexico. A search strategy was performed of literature published in journals found in available databases and theses published online at Universidad Nacional Autónoma de México (UNAM) library website reporting clinical cases or clinical case series of mucormycosis and entomophthoromycosis occurring in Mexico between 1982 and 2016. Among the 418 cases identified, 72% were diabetic patients, and sinusitis accounted for 75% of the reported cases. Diabetes mellitus was not a risk factor for entomophthoromycosis. Mortality rate was 51% (125/244). Rhizopus species were the most frequent isolates (59%, 148/250). Amphotericin B deoxycholate was used in 89% of cases (204/227), while surgery and antifungal management as combined treatment was used in 90% (172/191). In diabetic individuals, this combined treatment approach was associated with a higher probability of survival (95% vs 66%, OR = 0.1, 95% CI, 0.02-0.43' P = .002). The most common complications were associated with nephrotoxicity and prolonged hospitalization due to IV antifungal therapy. An algorithm is proposed to establish an early diagnosis of rhino-orbital cerebral (ROC) mucormycosis based on standardized identification of warning signs and symptoms and performing an early direct microbiological exam and histopathological identification through a multidisciplinary medical and surgical team. In summary, diabetes mellitus was the most common risk factor for mucormycosis in Mexico; combined antifungal therapy and surgery in ROC mucormycosis significantly improved survival.
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Affiliation(s)
- Dora E Corzo-León
- Department of Epidemiology and Infectious Diseases, Hospital General Dr. Manuel Gea González, Mexico City, Mexico.,Medical Mycology and Fungal immunology / Wellcome Trust Strategic Award Program. Aberdeen Fungal Group, University of Aberdeen, Aberdeen, UK
| | - Luis D Chora-Hernández
- Department of Epidemiology and Infectious Diseases, Hospital General Dr. Manuel Gea González, Mexico City, Mexico.,Department of Infectious Diseases. Hospital General No. 1 Instituto Mexicano del Seguro Social. Morelia Michoacan
| | - Ana P Rodríguez-Zulueta
- Department of Epidemiology and Infectious Diseases, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program and Infectious Diseases Translational Research Laboratory, Departments of Medicine, Pediatrics, and Microbiology & Immunology, Weill Cornell Medicine of Cornell University, New York, NY, USA
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28
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Chander J, Kaur M, Singla N, Punia RPS, Singhal SK, Attri AK, Alastruey-Izquierdo A, Stchigel AM, Cano-Lira JF, Guarro J. Mucormycosis: Battle with the Deadly Enemy over a Five-Year Period in India. J Fungi (Basel) 2018; 4:jof4020046. [PMID: 29642408 PMCID: PMC6023269 DOI: 10.3390/jof4020046] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 01/10/2023] Open
Abstract
Mucormycosis is an emerging opportunistic fungal infection. Increasing immunocompromization, widespread use of antibacterial and antifungal agents (such as voriconazole prophylaxis), carcinomas, transplantation and lifestyle diseases such as diabetes are the main contributors to this situation. The predominant clinical manifestations of mucormycosis vary from host to host, with rhino-orbital-cerebral, pulmonary, cutaneous, and gastrointestinal infections being the most common. In India, the prevalence of mucormycosis is approximately 0.14 cases/1000 population, which is about 70 times the worldwide-estimated rate for mucormycosis. The present study was undertaken over a period of five years (January 2009-December 2014) to determine the prevalence of mucormycosis. The samples suspected of mucormycosis were examined by direct KOH wet mount and cultured on Sabouraud's dextrose agar without actidione and on blood agar as per standard mycological techniques. Histopathological correlation was done for most of the cases. Antifungal susceptibility testing was performed by the EUCAST reference method. We identified a total of 82 cases of mucormycosis out of a total of 6365 samples received for mycological culture and examination during the said time period. Out of these, 56 were male patients and 27 were females. Most common presentation was rhino-orbito-cerebral (37), followed by cutaneous (25), pulmonary (14), oral cavity involvement (4) and gastrointestinal (2). The most common risk factors were diabetes and intramuscular injections. The fungi isolated were Rhizopus arrhizus (17), Apophysomyces variabilis (12), R. microsporus (9), Lichtheimia ramosa (8), Saksenaea erythrospora (5), Syncephalastrum racemosus (4), R. homothallicus (2), Rhizomucor pusillus (1), Mucor irregularis (1) and A. elegans (1). The mainstay of the treatment was amphotericin B, along with extensive surgical debridement whenever feasible. Most of the patients (50) recovered, but 25 died. The rest of the patients left against medical advice. "Nip in the Bud" should be the mantra for clinicians/surgeons for a favorable prognosis. Early diagnosis, prompt institution of appropriate antifungal therapy, surgical debridement whenever necessary, knowledge of risk factors and their timely reversal is the key for management.
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Affiliation(s)
- Jagdish Chander
- Departments of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh, PIN 160030, India.
| | - Mandeep Kaur
- Departments of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh, PIN 160030, India.
| | - Nidhi Singla
- Departments of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh, PIN 160030, India.
| | - R P S Punia
- Pathology, Government Medical College Hospital, Sector 32-B, Chandigarh, PIN 160030, India.
| | - Surinder K Singhal
- Otorhinolaryngology, Government Medical College Hospital, Sector 32-B, Chandigarh, PIN 160030, India.
| | - Ashok K Attri
- General Surgery, Government Medical College Hospital, Sector 32-B, Chandigarh, PIN 160030, India.
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, Spanish National Center for Microbiology, Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Alberto M Stchigel
- Mycology Unit, Medical School and IISPV, Universitat Rovira I Virgili, 43201 Reus, Spain.
| | - Jose F Cano-Lira
- Mycology Unit, Medical School and IISPV, Universitat Rovira I Virgili, 43201 Reus, Spain.
| | - Josep Guarro
- Mycology Unit, Medical School and IISPV, Universitat Rovira I Virgili, 43201 Reus, Spain.
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29
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Castrejón-Pérez AD, Welsh EC, Miranda I, Ocampo-Candiani J, Welsh O. Cutaneous mucormycosis. An Bras Dermatol 2018; 92:304-311. [PMID: 29186239 PMCID: PMC5514567 DOI: 10.1590/abd1806-4841.20176614] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/14/2017] [Indexed: 12/31/2022] Open
Abstract
Cutaneous mucormycosis is an emerging fungal infection caused by opportunistic
fungi of the phylum Glomeromycota. It is frequent in poorly controlled diabetic
patients and individuals with immunosuppression. It is usually acquired by
direct inoculation through trauma. The clinical presentation is nonspecific, but
an indurated plaque that rapidly evolves to necrosis is a common finding.
Diagnosis should be confirmed by demonstration of the etiological agent and new
molecular diagnostic tools have recently been described. It is an invasive
life-threatening disease and in order to improve survival, a prompt diagnosis
and multidisciplinary management should be provided. The treatment of choice is
amphotericin B, but new azoles, such as posaconazole and isavuconazole, must be
considered.
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Affiliation(s)
- Ana Daniela Castrejón-Pérez
- Department of Dermatology, Universidad Autonoma de Nuevo Leon, School of Medicine, University Hospital Dr. Jose Eleuterio Gonzalez - Monterrey, Mexico
| | - Esperanza C Welsh
- Department of Dermatology, Universidad Autonoma de Nuevo Leon, School of Medicine, University Hospital Dr. Jose Eleuterio Gonzalez - Monterrey, Mexico
| | - Ivett Miranda
- Department of Dermatology, Universidad Autonoma de Nuevo Leon, School of Medicine, University Hospital Dr. Jose Eleuterio Gonzalez - Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Department of Dermatology, Universidad Autonoma de Nuevo Leon, School of Medicine, University Hospital Dr. Jose Eleuterio Gonzalez - Monterrey, Mexico
| | - Oliverio Welsh
- Department of Dermatology, Universidad Autonoma de Nuevo Leon, School of Medicine, University Hospital Dr. Jose Eleuterio Gonzalez - Monterrey, Mexico
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30
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Rodríguez JY, Morales-López SE, Rodríguez GJ, Álvarez-Moreno CA, Ocampo W, Cepeda ML, Mora-Valderrama MA. Necrotizing fasciitis caused by Apophysomyces variabilis in an immunocompetent patient. Med Mycol Case Rep 2017; 20:4-6. [PMID: 30148054 PMCID: PMC6105916 DOI: 10.1016/j.mmcr.2017.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 12/25/2022] Open
Abstract
Mucormycosis caused by Apophysomyces variabilis is rarely reported in humans. A case of A. variabilis infection in an immunocompetent men after friction burns in a car accident is described. The infection presented as a rapidly progressive necrotizing infection of the skin and soft tissue, which required extensive surgical debridement and total colonic defunctioning colostomy associated with prolonged antifungal therapy. A. variabilis infection should be considered as a differential diagnosis of rapidly progressive necrotizing skin and soft tissue infections in immunocompetent individuals.
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Affiliation(s)
- José Y Rodríguez
- Centro de Investigaciones Microbiológicas del Cesar (CIMCE), Hospital Rosario Pumarejo de Lopez, Clínica Laura Daniela, Clínica médicos LTDA, Valledupar, Colombia
| | | | - Gerson J Rodríguez
- Centro de Investigaciones Microbiológicas del Cesar (CIMCE), Hospital Rosario Pumarejo de Lopez, Clínica Laura Daniela, Clínica médicos LTDA, Valledupar, Colombia
| | - Carlos A Álvarez-Moreno
- Universidad Nacional de Colombia, Medicine Faculty and Clínica Universitaria Colombia, Colsanitas, Bogota, Colombia
| | - Walter Ocampo
- Molecular Biotechnology Research Group, Corporación CorpoGen, Bogotá, Colombia
| | - Martha L Cepeda
- Molecular Biotechnology Research Group, Corporación CorpoGen, Bogotá, Colombia
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31
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Apophysomyces variabilis: draft genome sequence and comparison of predictive virulence determinants with other medically important Mucorales. BMC Genomics 2017; 18:736. [PMID: 28923009 PMCID: PMC5604411 DOI: 10.1186/s12864-017-4136-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 09/08/2017] [Indexed: 12/28/2022] Open
Abstract
Background Apophysomyces species are prevalent in tropical countries and A. variabilis is the second most frequent agent causing mucormycosis in India. Among Apophysomyces species, A. elegans, A. trapeziformis and A. variabilis are commonly incriminated in human infections. The genome sequences of A. elegans and A. trapeziformis are available in public database, but not A. variabilis. We, therefore, performed the whole genome sequence of A. variabilis to explore its genomic structure and possible genes determining the virulence of the organism. Results The whole genome of A. variabilis NCCPF 102052 was sequenced and the genomic structure of A. variabilis was compared with already available genome structures of A. elegans, A. trapeziformis and other medically important Mucorales. The total size of genome assembly of A. variabilis was 39.38 Mb with 12,764 protein-coding genes. The transposable elements (TEs) were low in Apophysomyces genome and the retrotransposon Ty3-gypsy was the common TE. Phylogenetically, Apophysomyces species were grouped closely with Phycomyces blakesleeanus. OrthoMCL analysis revealed 3025 orthologues proteins, which were common in those three pathogenic Apophysomyces species. Expansion of multiple gene families/duplication was observed in Apophysomyces genomes. Approximately 6% of Apophysomyces genes were predicted to be associated with virulence on PHIbase analysis. The virulence determinants included the protein families of CotH proteins (invasins), proteases, iron utilisation pathways, siderophores and signal transduction pathways. Serine proteases were the major group of proteases found in all Apophysomyces genomes. The carbohydrate active enzymes (CAZymes) constitute the majority of the secretory proteins. Conclusion The present study is the maiden attempt to sequence and analyze the genomic structure of A. variabilis. Together with available genome sequence of A. elegans and A. trapeziformis, the study helped to indicate the possible virulence determinants of pathogenic Apophysomyces species. The presence of unique CAZymes in cell wall might be exploited in future for antifungal drug development. Electronic supplementary material The online version of this article (10.1186/s12864-017-4136-1) contains supplementary material, which is available to authorized users.
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Abstract
This article lists proposed new or revised species names and classification changes associated with fungi of medical importance for the years 2012 through 2015. While many of the revised names listed have been widely adopted without further discussion, some may take longer to achieve more general usage.
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Prakash H, Ghosh AK, Rudramurthy SM, Paul RA, Gupta S, Negi V, Chakrabarti A. The environmental source of emerging Apophysomyces variabilis infection in India. Med Mycol 2016; 54:567-75. [PMID: 27118802 DOI: 10.1093/mmy/myw014] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/15/2016] [Indexed: 11/14/2022] Open
Abstract
The rare mucoraceous fungus, Apophysomyces species complex ranks second after Rhizopus arrhizus causing mucormycosis in India. The source of this agent in the environment is not clearly known. We conducted an environmental study to find its presence in Indian soil. The soil samples from different geographical locations were analyzed for isolation of Mucorales. Rhizopus arrhizus (24.6%) was most commonly isolated from soil, followed by Lichtheimia spp. (23.2%), Cunninghamella spp. (21.7%), Rhizopus microsporus (14%) and Apophysomyces spp. (4.5%). The isolation of Apophysomyces species complex was significantly associated with low nitrogen content of the soil. Based on sequencing of internal transcribed spacer (ITS) and 28S (D1/D2) regions of ribosomal DNA, the Apophysomyces isolates were identified as Apophysomyces variabilis with 98 to 100% similarity to type strain A. variabilis (CBS658.93). The analysis of amplified fragment length polymorphism (AFLP) fingerprinting data demonstrated genomic diversity of A. variabilis isolates with multiple clades (similarity 40-90%). The minimum inhibitory concentrations (MIC), MIC50 and MIC90 for A. variabilis isolates were 1 and 4 μg/ml for amphotericin B, 0.25 and 0.5 μg/ml for itraconazole, 0.125 and 0.25 μg/ml for posaconazole, 0.06 and 0.12 μg/ml for terbinafine, respectively. The present study revealed abundant presence of A. variabilis in Indian soil with low nitrogen content, its genetic heterogeneity and relatively high MICs for amphotericin B.
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Affiliation(s)
- Hariprasath Prakash
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anup Kumar Ghosh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Raees Ahmad Paul
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunita Gupta
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishwanand Negi
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Douglas AP, Chen SCA, Slavin MA. Emerging infections caused by non-Aspergillus filamentous fungi. Clin Microbiol Infect 2016; 22:670-80. [PMID: 26812445 DOI: 10.1016/j.cmi.2016.01.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/02/2016] [Accepted: 01/09/2016] [Indexed: 12/25/2022]
Abstract
There are three broad groups of non-Aspergillus moulds: the mucormycetes, the hyalohyphomycetes and the phaeohyphomycetes. Infections with these pathogens are increasingly reported, particularly in the context of increasing use of immunosuppressant agents and improved diagnostics. The epidemiology of non-Aspergillus mould infections varies with geography, climate and level of immunosuppression. Skin and soft-tissue infections are the predominant presentation in the immunocompetent host and pulmonary and other invasive infections in the immunocompromised host. The more common non-Aspergillus moulds include Rhizopus, Mucor, Fusarium and Scedosporium species; however, other emerging pathogens are Rasamsonia and Verruconis species, which are discussed in this article. Outbreaks of non-Aspergillus mould infections have been increasingly reported, with contaminated medical supplies and natural disasters as common sources. Currently culture and other conventional diagnostic methods are the cornerstone of diagnosis. Molecular methods to directly detect and identify mould pathogens in tissue and body fluids are increasingly used.
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Affiliation(s)
- A P Douglas
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - S C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, University of Sydney, New South Wales, Australia
| | - M A Slavin
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
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35
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Benny GL, Smith ME, Kirk PM, Tretter ED, White MM. Challenges and Future Perspectives in the Systematics of Kickxellomycotina, Mortierellomycotina, Mucoromycotina, and Zoopagomycotina. BIOLOGY OF MICROFUNGI 2016. [DOI: 10.1007/978-3-319-29137-6_5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Cutaneous Mucormycosis: Mycological, Clinical, and Therapeutic Aspects. CURRENT FUNGAL INFECTION REPORTS 2015. [DOI: 10.1007/s12281-015-0236-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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