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Soleimani N, Anbardar MH, Nikoupour H, Derakhshan F, Shafiekhani M, Mohammadzadeh S, Sakhaei SM, Farhadi M. Disseminated Gastrointestinal Basidiobolomycosis: A Case Report with Review of Diagnostic Clues. Case Rep Med 2024; 2024:5741625. [PMID: 39233673 PMCID: PMC11374415 DOI: 10.1155/2024/5741625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/10/2024] [Accepted: 08/14/2024] [Indexed: 09/06/2024] Open
Abstract
Introduction Basidiobolomycosis is a rare fungal infection caused by an environmental saprophyte, Basidiobolus ranarum. It usually presents as a chronic subcutaneous infection; however, few cases of gastrointestinal involvement have been reported. The exact transmission route of gastrointestinal cases is not clear, and diagnosis always requires a high index of suspicion because it tends to mimic other inflammatory and neoplastic conditions. Case Report. A 31-year-old immunocompetent woman presented with abdominal pain and an advanced colon mass. She was completely well until about 1.5 years ago, when she underwent bariatric surgery. One year after surgery, chronic abdominal pain developed. A colonoscopy showed an ulcerative lesion in the descending colon, and the biopsy was in favor of ulcerative colitis. Despite immunosuppressive treatment, there was no improvement, and with worsening symptoms, more investigations revealed advanced colon mass with entrapment of the stomach and pancreas. Colonic mucosa biopsy and trucut biopsy of the mass showed just necrosis and acute inflammation; thus, she underwent exploratory laparotomy with colectomy, partial gastrectomy, distal pancreatectomy, and left nephrectomy. On pathologic examination, there was granulomatous inflammation plus the Splendore-Hoeppli phenomenon around fungal hyphae, which was diagnostic for gastrointestinal basidiobolomycosis. Previous pathology slides were reviewed and revealed a tiny focus of basidiobolomycosis. After 6 months of treatment with itraconazole, she is relatively well without any clinical or radiologic abnormalities. Conclusion Our case highlights the significance of suspicion for basidiobolomycosis in ulcerative and necrotic lesions with increased eosinophils, especially in the presence of abdominal mass and systemic eosinophilia.
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Affiliation(s)
- Neda Soleimani
- Department of Pathology Shiraz Medical School Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pathology Shiraz Transplant Center Abu Ali Sina Hospital Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Anbardar
- Department of Pathology Shiraz Medical School Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pathology Shiraz Transplant Center Abu Ali Sina Hospital Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Nikoupour
- Shiraz Organ Transplant Center Abu-Ali Sina Hospital Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Surgery Shiraz Transplant Center Abu Ali Sina Hospital Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faranak Derakhshan
- Department of Pathology Shiraz Medical School Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Shafiekhani
- Department of Clinical Pharmacy Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahand Mohammadzadeh
- Department of Pathology Shiraz Medical School Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pathology Shiraz Transplant Center Abu Ali Sina Hospital Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahsa Farhadi
- Department of Pathology Shiraz Transplant Center Abu Ali Sina Hospital Shiraz University of Medical Sciences, Shiraz, Iran
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Meeralam Y, Basfar AM, Alzanbagi A, Tashkandi A, Al Harthi W, Saba F, Khairo M, Alzhrani S, Shariff M. Gastrointestinal Basidiobolomycosis: A Case Series. Cureus 2024; 16:e55008. [PMID: 38414515 PMCID: PMC10897526 DOI: 10.7759/cureus.55008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 02/29/2024] Open
Abstract
Gastrointestinal basidiobolomycosis (GIB) is a rare fungal infection caused by Basidiobolus ranarum, a saprophytic fungus that belongs to the class of Basidiobolomycetes. It mainly infects immunocompetent individuals and is mainly found in arid tropical and subtropical regions, including Southwestern America, Saudi Arabia, Africa, and Asia. Not surprisingly, a great number of human infections have been reported from these warm, humid climate regions that are felicitous for the growth of this fungus, especially from the southern region of Saudi Arabia and Arizona in the United States of America. GIB is easily misdiagnosed as malignancy, inflammatory bowel disease, diverticulitis, lymphoma, and chronic intestinal infections due to its rarity. In this case series, we summarize the clinical features, imaging, histopathological features, and treatment of patients diagnosed with GIB in our institution.
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Affiliation(s)
- Yaser Meeralam
- Gastroenterology, Digestive and Liver Center, King Abdullah Medical City, Makkah, SAU
| | - Abdulrahman M Basfar
- Gastroenterology, Digestive and Liver Center, King Abdullah Medical City, Makkah, SAU
| | - Adnan Alzanbagi
- Gastroenterology, Digestive and Liver Center, King Abdullah Medical City, Makkah, SAU
| | - Abdulaziz Tashkandi
- Gastroenterology, Digestive and Liver Center, King Abdullah Medical City, Makkah, SAU
| | - Wallaa Al Harthi
- Gastroenterology, Digestive and Liver Center, King Abdullah Medical City, Makkah, SAU
| | - Firdos Saba
- Pathology, King Abdullah Medical City, Makkah, SAU
| | - Mutaz Khairo
- Radiology, King Abdullah Medical City, Makkah, SAU
| | - Saleh Alzhrani
- Surgery, Specialized Surgical Unit, King Abdullah Medical City, Makkah, SAU
| | - Mohammed Shariff
- Gastroenterology, Digestive and Liver Center, King Abdullah Medical City, Makkah, SAU
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3
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Panarelli NC. Infectious Mimics of Inflammatory Bowel Disease. Mod Pathol 2023:100210. [PMID: 37172904 DOI: 10.1016/j.modpat.2023.100210] [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: 03/28/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
Distinguishing inflammatory bowel disease (IBD) from its mimics remains a diagnostic challenge for surgical pathologists. Several gastrointestinal infections produce inflammatory patterns that overlap with typical findings of IBD. Although stool culture, PCR, and other clinical assays may identify infectious enterocolitides, these tests may not be performed or the results may be unavailable at the time of histologic evaluation. Furthermore, some clinical tests, including stool PCR, may reflect past exposure rather than ongoing infection. It is important for surgical pathologists to be knowledgeable about infections that simulate IBD in order to generate an accurate differential diagnosis, perform appropriate ancillary studies, and prompt clinical follow-up. This review covers bacterial, fungal, and protozoal infections in the differential diagnosis of IBD.
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Affiliation(s)
- Nicole C Panarelli
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
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4
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Barasheed MO, Althubaiti R, Hafiz B, Damanhouri E, Altaf F. Incidental Appendiceal Basidiobolomycosis in a Clinical Setting of Intestinal Intussusception in a Five-Year-Old Patient: A Case Report. Cureus 2022; 14:e31392. [DOI: 10.7759/cureus.31392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/13/2022] Open
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5
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Colonic basidiobolomycosis in a patient with systemic lupus erythematosus (SLE). BMC Infect Dis 2022; 22:740. [PMID: 36114527 PMCID: PMC9482316 DOI: 10.1186/s12879-022-07720-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Basidiobolus ranarum belongs to the Entomophthorales order and the Zygomycetes class. This fungus is an environmental saprophyte that can be found in soil and rotting vegetables.Primarily restricted to tropical regions including Asia, Africa, and South America. It might cause chronic inflammatory diseases, mostly affect subcutaneous tissue. Systemic infections involving the gastrointestinal tract are extremely rare. Case presentation Herein, we present a 44-year-old Persian man with the past medical history of lupus erythematosus with colicky abdominal pain started from three months before admission with many vomiting episodes, and a mass on the right lower quadrant, who had been thought initially to have an abdominal malignancy. The patient had vital signs were within normal ranges. His physical examination revealed tenderness and rebound tenderness on the right lower quadrant of the abdomen. A fixed mass 10 × 10 centimeter in diameter was palpated in the same quadrant. Laboratory, radiologic, colonoscopic examination was requested. The patient underwent laparotomy which revealed a mass in the terminal ileum and ascending colon with retroperitoneal adhesion and invasion to the right ureter behind it. Pathologic examination showed basidiobolomycosis infection in the specimen. Conclusion Fungal infection should be among the differential diagnoses for adults present with abdominal mass in endemic regions of the world.
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Mahmoud W, Khawar M, Petkar M, Odaippurath T, Kurer M. Visceral Basidiobolomycosis Causing Bowel Ischemia. Cureus 2022; 14:e26157. [PMID: 35891862 PMCID: PMC9302554 DOI: 10.7759/cureus.26157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
Basidiobolomycosis is a rare fungal infection caused by saprophyte Basidiobolus ranarum. It is rarely seen in healthy adult patients; however, it usually affects children. The commonly involved sites are skin and subcutaneous tissue, mostly found in the Middle East and the southwestern United States. The diagnosis is challenging because of the lack of specific clinical presentation and the absence of predisposing factors. In our case report, we discuss a 38-year-old male patient who presented with a 2-months history of right lower quadrant pain. Initially, his pain was intermittent and gradually increased in intensity; it localized to the right lower quadrant and radiated to the right flank region. No relieving or aggravating factors were noted. In addition, the patient mentioned a history of constipation, weight loss, decreased appetite, and vomiting-however, no history of fever, night sweats, trauma, or recent travel. The diagnosis was made based on computerized tomography (CT) guided biopsy of the mass, illustrating the findings of fungal hyphae with a gradual increase in the eosinophilic count since admission. The patient was managed using a combined medical and surgical approach, including surgical debulking of the mass and a well-monitored course of anti-fungal therapy. Gastrointestinal basidiobolomycosis infection (GBI) can present in many forms, with an increasing potential to invade the colon, ultimately forming an inflamed mass. Nonetheless, the presence of a mass invading the colon, adjacent vessels, and a retroperitoneal area, along with an increase in the number of eosinophil count in the Middle East region, should raise the suspicion of basidiobolomycosis fungal infection.
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Shaaban HED, Almatrafi MA, Telmesani A. A Pediatric Case of Basidiobolomycosis Presenting With an Abdominal Mass. Cureus 2022; 14:e25986. [PMID: 35855237 PMCID: PMC9286300 DOI: 10.7759/cureus.25986] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/15/2022] Open
Abstract
Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum. The condition has been reported in children and adults presenting with abdominal pain, weight loss, abdominal distension, vomiting, diarrhea, fever, and an abdominal mass. We report a case of a previously healthy 2.5 years old male who presented to the ER complaining of abdominal pain and distension for two weeks together with significant weight loss. He looked ill and cachectic. He had tachycardia but was afebrile. His abdominal examination showed a right-sided abdominal mass. His initial abdominal ultrasound (US) suggested an abdominal tumor. The patient was referred to a tertiary center where he had an ultrasound-guided biopsy that showed fungal hyphae consistent with basidiobolomycosis.
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8
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Paliwal V, Chaudhary K, Agrawal K, Bhargava P, Mathur D. Subcutaneous zygomycosis: A diagnostic and therapeutic challenge. INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2022. [DOI: 10.4103/ijpd.ijpd_137_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Histologic features of colonic infections. DER PATHOLOGE 2021; 43:16-30. [PMID: 34767063 PMCID: PMC8588779 DOI: 10.1007/s00292-021-01015-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
Background The histopathologic diagnosis of infectious colitis remains relevant despite recent advances in microbiologic techniques. Objective This article aims to describe the histologic features of selected infectious diseases of the colon. Materials and methods Existing reports on histopathologic and clinical aspects of colonic infectious agents were reviewed. Results While histology alone may not be as sensitive as current microbiologic methods, tissue identification of infectious agents still plays an important role in patient care. Infectious colitis can have a variety of clinical manifestations, ranging from strongyloidiasis, which can cause a smoldering, subclinical infection for decades, to syphilis, which can clinically mimic cancer or inflammatory bowel disease. Therefore, the histopathologic identification of infection as the cause of a patient’s colitis has a considerable impact on treatment decisions. Morphologic overlap can occur between infection and other diseases, however. Moreover, some infections can elicit various tissue responses beyond acute colitis. Immunosuppressed patients may not mount an inflammatory response to pathogens such as cytomegalovirus or adenovirus. Sexually transmitted proctocolitis can cause plasma-cell-rich inflammation. Gastrointestinal histoplasmosis is more likely to cause diffuse histiocyte infiltration rather than the expected granuloma formation. In some cases, ancillary tests are useful, but equivocal results can cause diagnostic dilemmas. Conclusion Given the range with which colonic infectious disorders can manifest, pathologists should be aware of the typical features of infectious colitis, as well as findings beyond the classic morphologies.
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Mousavi MR, Pouladfar G, Taherifard E, Badiee P, Anbardar MH. An Infant with Acute Bloody Diarrhea and Gastrointestinal Basidiobolomycosis: An Unusual Presentation of a Rare Disease. J Trop Pediatr 2021; 67:5879101. [PMID: 32734302 DOI: 10.1093/tropej/fmaa039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Basidiobolomycosis is a fungal infection caused mainly by Basidiobolus ranarum, a filamentous fungus of the order Entomophthorales and the family Basidiobolaceae. This infection typically involves the skin and soft tissue; however, visceral organ involvement has also been reported. Here, we report a case of gastrointestinal basidiobolomycosis in a young child who presented with acute bloody diarrhea which was initially misdiagnosed as intussusception.
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Affiliation(s)
- Mohammad Reza Mousavi
- Department of Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran 7134814336
| | - Gholamreza Pouladfar
- Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran 7193711351
| | - Erfan Taherifard
- Department of Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran 7134814336
| | - Parisa Badiee
- Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran 7193711351
| | - Mohammad Hossein Anbardar
- Department of Pathology, Namazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran 7134814336
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Abstract
Gastrointestinal basidiobolomycosis (GIB) is a rare fungal infection with limited geographic distribution. However, the incidence of GIB has shown an increasing trend because of globalization and frequent traveling. GIB is commonly seen to mimic gastrointestinal malignancy and other diseases such as intestinal tuberculosis and inflammatory bowel disease. Tissue diagnosis is considered to be the gold standard for differentiating these mycotic lesions from tuberculosis and malignancy with confirmation of species performed by culture or polymerase chain reaction. The diagnosis of GIB should be conjectured in patients with suspicion of malignancy, with an inconclusive biopsy. It seems prudent to proceed with radical excision of mass early because both colonic malignancy and GIB have high mortality if untreated.
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12
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Sethy M, Sahu S, Sachan S. Basidiobolomycosis: Case Report and Literature Overview. Indian Dermatol Online J 2021; 12:307-311. [PMID: 33959531 PMCID: PMC8088161 DOI: 10.4103/idoj.idoj_456_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/04/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022] Open
Abstract
Basidiobolomycosis or subcutaneous zygomycosis or subcutaneous phycomycosis is a chronic granulomatous infection of skin and subcutaneous tissue, caused by a saprophytic filamentous fungus, Basidiobolus ranarum, clinically characterized by firm, painless subcutaneous swelling with smooth and rounded edges. Histopathological features include the peculiar Splendore–Hoeppli phenomenon. Culture on Sabouraud dextrose agar shows creamy white, heaped up, and furrowed colonies. This entity has been reported from tropical and subtropical regions of the world and the southern part of India. We report a case of Basidiobolomycosis in a seven-year-old girl from Eastern India, which was excised twice before presenting to us. We diagnosed the case as Basidiobolomycosis based on clinical features, histopathology, and culture findings, and treated it with itraconazole.
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Affiliation(s)
- Mitanjali Sethy
- Department of Dermatology, Venereology and Leprosy, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India
| | - Satyajit Sahu
- Department of Dermatology, Venereology and Leprosy, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India
| | - Suvigya Sachan
- Department of Dermatology, Venereology and Leprosy, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India
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13
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Hussein MRA, Alqahtani AS, Alhagawi Y, Al Saglan NS, Albishi AM, Ahmed FO, Rabie ME, Bazeed MF, Abu-Dief EE. Primary Basidiobolomycosis of the Cecum in Immunocompetent Patients: Two Case Reports. Gastroenterology Res 2021; 14:116-124. [PMID: 34007354 PMCID: PMC8110240 DOI: 10.14740/gr1368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/25/2021] [Indexed: 01/06/2023] Open
Abstract
Colonic basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum. Primary cecal basidiobolomycosis is an exceptionally rare condition. The study describes two cases of primary basidiobolomycosis of the cecum in immunocompetent male and female patients (one each). The patients presented with fever, abdominal pain, weight loss, eosinophilia, and high erythrocyte sedimentation rates. Computed tomography revealed wall thickening and mass lesions involving the cecum, suggesting malignancy. Right hemicolectomies were performed to relieve the intestinal obstruction. On microscopy, there were destructive, transmural eosinophil-rich pyogranulomatous reactions with thin-walled, pauci-septated fungal elements surrounded by Splendore-Hoeppli bodies. The patients received antifungal drugs, with no evidence of dissemination or recurrence on follow-up. Primary cecal basidiobolomycosis in immunocompetent hosts is a rare occurrence. It oftentimes clinically masquerades malignant neoplasms and therefore its identification mandates its inclusion in the differential diagnosis of a colonic mass, equally both on the part of the clinicians and pathologists.
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Affiliation(s)
- Mahmoud R A Hussein
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdullah S Alqahtani
- Department of General Surgery, Armed Forces Hospital, Southern Region, Saudi Arabia
| | - Yahia Alhagawi
- Department of Gastroenterology, Armed Forces Hospital, Southern Region, Saudi Arabia
| | - Naif S Al Saglan
- Department of Infectious Diseases, Armed Forces Hospital, Southern Region, Saudi Arabia
| | - Abdullah M Albishi
- Department of Gastroenterology, Armed Forces Hospital, Southern Region, Saudi Arabia
| | - Feras O Ahmed
- Department of General Surgery, Armed Forces Hospital, Southern Region, Saudi Arabia
| | - Mohammad E Rabie
- Department of General Surgery, Armed Forces Hospital, Southern Region, Saudi Arabia
| | - Mohamed F Bazeed
- Department of Radiology, Armed Forces Hospital, Southern Region, Saudi Arabia
| | - Eman E Abu-Dief
- Department of Histology, Faculty of Medicine, Sohag and Merit Universities, Sohag, Egypt
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Mohammed SA, Abdelsatir AA, Abdellatif M, Suliman SH, Elbasheer OMI, Abdalla AR, Widattalla AH, Tamimeldar SAM, Amin AA, Ahmed MH, Abdelsatir AM. Challenging Presentations of Seven Cases of Gastrointestinal Basidiobolomycosis in Sudan: Clinical Features, Histology, Imaging, and Recommendations. J Lab Physicians 2020; 12:281-284. [PMID: 33390679 PMCID: PMC7773445 DOI: 10.1055/s-0040-1721149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Basidiobolomycosis is a fungal infection caused by Basidiobolus ranarum which affects the skin and subcutaneous tissue and rarely the gastrointestinal tract. We report seven cases of gastrointestinal basidiobolomycosis with interesting clinical, radiological, and histological presentations. To our knowledge, this is the first case series of abdominal basidiobolomycosis to be reported from Sudan.
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Affiliation(s)
- Sawsan A Mohammed
- Department of Pathology, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Mohamed Abdellatif
- Department of Pathology, Faculty of Medicine, Omdurman Islamic University, Khartoum, Sudan
| | | | | | | | - Abubakr H Widattalla
- Department of Surgery, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Abdelgadir A Amin
- Pathology Department, Sudan Medical Specialization Board, Khartoum, Sudan
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, United Kingdom
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Abstract
Anatomic pathology is an important resource for detection and exclusion of infectious diseases in tissue specimens. Detection of a microorganism (i.e. bacteria, fungi, parasite) in tissue sections is frequently the beginning of a work-up and occasionally sufficient for definitive microbiologic identification. Close correlation with cultures and ancillary testing in the microbiology laboratory is of paramount importance in arriving at a diagnosis and identify with certitude causative pathogen(s). This review will discuss the adequacy and limitations of histopathology in the diagnosis of infectious diseases, describe potential pitfalls, and discuss the appropriate use of molecular diagnostics in formalin-fixed, paraffin embedded tissues.
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Affiliation(s)
- Alvaro C Laga
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Amory-3, Boston, MA 02115, USA.
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16
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Martínez-Girón R, Pantanowitz L. "Splendore-Hoeppli" phenomenon. Diagn Cytopathol 2020; 48:1316-1317. [PMID: 32501649 DOI: 10.1002/dc.24512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/06/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Rafael Martínez-Girón
- INCLÍNICA Foundation for Clinical, Pneumological and Carcinogenic Research, Oviedo, Spain
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center Shadyside, Pittsburgh, Pennsylvania, USA
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Sharma A, Saxena R, Sinha A, Singh S, Yadav T. Disseminated Gastrointestinal Basidiobolomycosis (GIB) in an infant from Western India. Med Mycol Case Rep 2019; 26:38-41. [PMID: 31667059 PMCID: PMC6812021 DOI: 10.1016/j.mmcr.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/23/2019] [Accepted: 10/02/2019] [Indexed: 12/02/2022] Open
Abstract
Basidiobolomycosis is an infection due to the fungus Basidiobolus ranarum, an environmental saprophyte found worldwide. We are reporting youngest case of Gastrointestinal Basidiobolomycosis (GIB) in a two month old boy from India. He presented with a mass in right iliac fossa with the signs of intestinal obstruction. Histopathology of the lesion showed broad aseptate hyphae. It disseminated to kidneys. Aspirate culture from nephrostomy yielded growth of B. ranarum. It is important to differentiate it from mucormycosis to institute right therapy. Culture remains the gold standard for its diagnosis.
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Affiliation(s)
- Anuradha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Rahul Saxena
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Arvind Sinha
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Shambhavi Singh
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Taruna Yadav
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
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18
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Colonic basidiobolomycosis presenting with intestinal obstruction and a normal eosinophil count. IDCases 2019; 17:e00565. [PMID: 31194167 PMCID: PMC6555899 DOI: 10.1016/j.idcr.2019.e00565] [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: 05/07/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 11/23/2022] Open
Abstract
Gastrointestinal basidiobolomycosis (GIB), caused by Basidiobolus ranrum, is a rare fungal infection with a limited geographic distribution. The majority of the cases are reported from the warm areas of Arizona in USA, Saudi Arabia and Iran. We report a middle aged patient who was admitted to hospital with suspected metastatic colonic carcinoma. He presented with constipation, anorexia and weight loss. Computed tomography scan disclosed a mass involving the mid and distal sigmoid colon and hypodense lesion in hepatic segment IV. Excised tissue during a Hartmann's surgery showed an extensive eosinophil-rich transmural inflammation with mural necrotizing granulomas and several broad septated fungal hyphae. He was commenced on voriconazole following surgery. The diagnosis of basidiobolomycosis was established by histopathological examination. Since the diagnosis was not suspected preoperatively tissue culture for fungi was not collected. However molecular testing confirmed the diagnosis of GIB. Therapy involved a combination of surgical resection of the mass and prolonged voriconazole treatment. Increased awareness among physicians is needed for early diagnosis and treatment of GIB.
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19
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Omar Takrouni A, Heitham Schammut M, Al-Otaibi M, Al-Mulla M, Privitera A. Disseminated intestinal basidiobolomycosis with mycotic aneurysm mimicking obstructing colon cancer. BMJ Case Rep 2019; 12:12/1/e225054. [PMID: 30700449 PMCID: PMC6352788 DOI: 10.1136/bcr-2018-225054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Basidiobolomycosis is a rare fungal infection that may affect the gastrointestinal tract. It is caused by Basidiobolus ranarum and less than 80 cases have been reported in the literature. The incidence seems to be higher in the Middle East and in particular Saudi Arabia where most cases are diagnosed in the south-western region. An 18-year-old woman presented to the emergency department with an obstructing caecal mass initially suspected to be malignant. Surgical resection was complicated by bowel perforation, histology and cultures confirmed basidiobolomycosis infection. The postoperative course was complicated by an enterocutaneous fistula, fungal intra-abdominal abscesses, liver and lung abscesses, formation of mycotic hepatic artery aneurysm and meningoencephalitis. The patient eventually expired due to sepsis despite aggressive treatment. Diagnosis and management of such rare cases are very challenging and require a multidisciplinary approach. Complications are common and associated with a high mortality.
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Affiliation(s)
- Arwa Omar Takrouni
- Department of General Surgery, Ministry of Health, Dammam, Eastern Province, Saudi Arabia
| | | | - Mishal Al-Otaibi
- Department of General Surgery, Ministry of Health, Dammam, Eastern Province, Saudi Arabia
| | - Manal Al-Mulla
- Department of General Surgery, Ministry of Health, Dammam, Eastern Province, Saudi Arabia
| | - Antonio Privitera
- Department of General Surgery, Ministry of Health, Dammam, Eastern Province, Saudi Arabia
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Pezzani MD, Di Cristo V, Parravicini C, Sonzogni A, Tonello C, Franzetti M, Sollima S, Corbellino M, Galli M, Milazzo L, Antinori S. Gastrointestinal basidiobolomycosis: An emerging mycosis difficult to diagnose but curable. Case report and review of the literature. Travel Med Infect Dis 2019; 31:101378. [PMID: 30660554 DOI: 10.1016/j.tmaid.2019.01.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/18/2018] [Accepted: 01/16/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Gastrointestinal basidiobolomycosis (GIB) is a rare mycosis affecting almost exclusively immunocompetent subjects. METHODS We describe a case of GIB caused by Basidiobolus ranarum in a 25-year-old Italian immunocompetent man resident in Ireland who presented a 2-month history of epigastric pain. Suspecting colon cancer he underwent a right hemicolectomy subsequently leading to a diagnosis of GIB by means of molecular biology. After surgery a 9-month therapy with itraconazole was employed with a good outcome. A review of medical literature regarding GIB cases published in the period 1964-2017 is presented. RESULTS One-hundred and two cases of GIB were included in this analysis. The disease was observed predominantly in male gender (74.5%) and children (41.2%). Abdominal pain was the single most common complaint (86.3%) followed by fever (40.2%) and evidence of an abdominal mass (30.4%). Peripheral blood eosinophilia was detected in 85.7% of cases. Most of the patients were diagnosed in Saudi Arabia (37.2%) followed by USA (21.6%) and Iran (20.6%). Surgery plus antifungal therapy was employed in the majority of patients (77.5%). An unfavourable outcome was documented globally in 18.6% of patients. CONCLUSIONS GIB seems to be an emerging intestinal mycosis among immunocompetent patients living in the Middle East and Arizona.
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Affiliation(s)
- Maria Diletta Pezzani
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy
| | - Valentina Di Cristo
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy
| | | | | | | | - Marco Franzetti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy
| | - Salvatore Sollima
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy
| | - Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Ospedale L Sacco, Milano, Italy.
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Arabi RI, Aljudaibi A, Shafei BA, AlKholi HM, Salem ME, Eibani KA. Paediatric case of gastrointestinal basidiobolomycosis mimicking appendicitis – Case report. Int J Surg Case Rep 2019; 63:80-84. [PMID: 31585327 PMCID: PMC6796750 DOI: 10.1016/j.ijscr.2019.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/04/2019] [Accepted: 09/07/2019] [Indexed: 12/02/2022] Open
Abstract
Basidiobolomycosis is a rare fungal infection that leads to subcutaneous infection. Gastrointestinal basidiobolomycosis is difficult to diagnose primarily due to its non-specific clinical presentation. Gastrointestinal basidiobolomycosis should be a differential especially in paediatric patients present with abdominal mass and eosinophilia. Optimal way to manage gastrointestinal basidiobolomycosis is by surgical resection followed by 3 months of antifungal treatment.
Introduction Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum that normally leads to subcutaneous infection and, rarely, to involvement in the gastrointestinal tract. Presentation of case A 6-year-old boy presented to the Emergency department (ED) complaining of abdominal pain of a few weeks’ duration in the right lower quadrant, associated with fever and vomiting. A computed tomography (CT) of the abdomen was done. It showed an enlarged tubular structure in the right iliac fossa, a suspected appendicular lesion, and free fluid collection, as well as multiple enlarged mesenteric and right iliac lymph nodes. Based on these results, the decision was made to do surgical exploration on the patient. After two weeks, the patient developed tachycardia, abdominal distention, constipation, and spikes of fever. Two days later, re-exploration was performed. An ileostomy and colostomy were performed and drains inserted. Post-operative, the patient was pushed to paediatric intensive care unit (PICU), while still intubated and hemodynamically stable. However, he developed cardiac arrest on the same day and cardiopulmonary resuscitation (CPR) was performed, but he couldn't be resuscitated. Discussion The patient presented with severe abdominal pain in the right lower quadrant, as well as fever and vomiting. These complaints may have been misdiagnosed as appendicitis. The diagnosis of gastrointestinal basidiobolomycosis was confirmed by histopathology, based on a surgical specimen taken during the primary exploration. The management was a combination between surgical intervention and medical treatment.
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Farkas NG, Welman TJP, Ross T, Brown S, Smith JJ, Pawa N. Unusual causes of large bowel obstruction. Curr Probl Surg 2018; 56:49-90. [PMID: 30777150 DOI: 10.1067/j.cpsurg.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Nicholas G Farkas
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
| | - Ted Joseph P Welman
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Talisa Ross
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sarah Brown
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jason J Smith
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nikhil Pawa
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Abstract
This manuscript presents a review of infectious causes of gastritis aimed at the practicing anatomic pathologist. We shall highlight unique histologic findings and clinical attributes that will assist those analyzing endoscopically obtained mucosal biopsies of the stomach or resection specimens.
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Abstract
Basidiobolomycosis is an uncommon chronic deep fungal infection in which gradually enlarging granulomas form, usually in the subcutaneous fat tissues of the limbs, chest or trunk of immunocompetent hosts, primarily children and young adults. It is caused by the fungus Basidiobolus ranarum. Definitive diagnosis is by microscopy and histopathology. Effective treatments include ketoconazole, itraconazole, potassium iodide and co-trimoxazole. A 3 year old girl presented with ulcerations on the right thigh for one month, and painful swelling of the right leg and right buttock for six months. The right lower limb and vulva were swollen, tender and hard with hyperpigmentation and inguinal lymphadenopathy. She had severe anaemia, eosinophilia and negative serology for HIV I and II. Histopathological examination showed a dermal chronic granulomatous infiltrate with fungal hyphae and yeast forms suggestive of Basidiobolus ranarum. There was marked reduction in right leg size and inguinal lymphadenopathy after several weeks of oral itraconazole, and complete healing of ulcers after 10 weeks. The purpose of this report is to increase awareness of this disfiguring condition which is treatable but, if not correctly diagnosed, could result in inappropriate interventions such as amputation and anti-coagulant therapy. FUNDING None declared.
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Affiliation(s)
- Adziri Sackey
- Department of Child Health, School of Medicine and Dentistry, College of Health Sciences, P.O. Box 4236, Accra, Ghana
| | - Nenyin Ghartey
- Children's Block, Korle Bu Teaching Hospital, P.O. Box 77, Korle Bu, Accra
| | - Richard Gyasi
- Department of Pathology, School of Medicine and Dentistry, College of Health Sciences, PO Box GP 4236, Accra, Ghana
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Sanaei Dashti A, Nasimfar A, Hosseini Khorami H, Pouladfar G, Kadivar MR, Geramizadeh B, Khalifeh M. Gastro-intestinal basidiobolomycosis in a 2-year-old boy: dramatic response to potassium iodide. Paediatr Int Child Health 2018; 38:150-153. [PMID: 27376878 DOI: 10.1080/20469047.2016.1186343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Gastro-intestinal basidiobolomycosis (GIB) is a rare fungal infection caused by Basidiobolus ranarum. Treatment includes surgical resection and long-term antifungal therapy. A 2.5-year-old boy presented with a 10-day history of abdominal pain, fever and diarrhoea, and a palpable abdominal mass was detected. Resection was undertaken and histology confirmed basidiobolomycosis. Treatment with amphotericin B and itraconazole was commenced, but the infection progressed and spread to involve the intestines, liver, ribs and lung, and also the abdominal wall after 6 months, requiring four operative procedures. Because of unresponsiveness to amphotericin and itraconazole, oral potassium iodide was added which resulted in complete resolution of the infection. Potassium iodide is an essential component of the treatment of systemic B. ranarum.
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Affiliation(s)
- Anahita Sanaei Dashti
- a Professor Alborzi Clinical Microbiology Research Center, Nemazee Hospital , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Amir Nasimfar
- b Pediatric Department , Urmia University of Medical Sciences , Urmia , Iran
| | | | - Gholamreza Pouladfar
- a Professor Alborzi Clinical Microbiology Research Center, Nemazee Hospital , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Mohammad Rahim Kadivar
- a Professor Alborzi Clinical Microbiology Research Center, Nemazee Hospital , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Bita Geramizadeh
- d Transplant Research Center, Department of Pathology, Nemazee Hospital , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Masoomeh Khalifeh
- a Professor Alborzi Clinical Microbiology Research Center, Nemazee Hospital , Shiraz University of Medical Sciences , Shiraz , Iran
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Abd El Maksoud WM, Bawahab MA, Ashraf TH, Al Shehri DM, Mirza NI. Surgical management of colonic basidiobolomycosis among adolescent and adult patients: presentation and outcome. Colorectal Dis 2018; 20:296-303. [PMID: 29059483 DOI: 10.1111/codi.13939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/31/2017] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to review retrospectively the clinical presentations, indications for surgery and surgical outcomes of adolescent and adult patients who were diagnosed with colonic basidiobolomycosis in the last 10 years. METHOD The study was carried out in Aseer Central Hospital, Abha, Saudi Arabia by reviewing the medical files of all patients in the last 10 years who were diagnosed with colonic basidiobolomycosis and required surgical intervention. RESULTS There were 22 patients. Common findings in all patients were weight loss, abdominal pain and an abdominal mass. The right colon was affected in 21 patients. The initial diagnosis was correct in seven patients while nine were thought to be malignant. All patients underwent colonic resection followed by at least 1 year of antifungal medical treatment. Intra-operatively, all patients had moderate or dense adhesions, an abdominal mass and lymphadenopathy. Most surgeons had the impression intra-operatively that the diagnosis was inflammatory rather than malignant. Postoperatively, three patients died within 6 months of the operation due to progression of the disease. Four patients developed severe wound infections, three of whom had abdominal dehiscence and required re-closure. CONCLUSION Colonic basidiobolomycosis is a life-threatening fungal infection that should be considered a surgical condition. A high index of suspicion including basidiobolomycosis in the differential diagnosis for the acute abdomen with a colonic mass is required for a proper diagnosis. Early aggressive surgical management followed by a prolonged course of itraconazole postoperatively could improve the outcome of the condition.
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Affiliation(s)
- W M Abd El Maksoud
- Colorectal Surgery Unit, General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - M A Bawahab
- General Surgery Department, Faculty of Medicine, King Khalid University, Abha, Saudi Arabia
| | - T H Ashraf
- General Surgery Department, Faculty of Medicine, King Khalid University, Abha, Saudi Arabia
| | - D M Al Shehri
- General Surgery Department, Aseer Central Hospital, Abha, Saudi Arabia
| | - N I Mirza
- Histopathology Department, Aseer Central Hospital, Abha, Saudi Arabia
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27
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Conner JR, Kirsch R. The pathology and causes of tissue eosinophilia in the gastrointestinal tract. Histopathology 2017; 71:177-199. [DOI: 10.1111/his.13228] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- James R Conner
- Department of Pathology and Laboratory Medicine; Mount Sinai Hospital; Toronto ON Canada
| | - Richard Kirsch
- Department of Pathology and Laboratory Medicine; Mount Sinai Hospital; Toronto ON Canada
- Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto ON Canada
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Hamad I, Raoult D, Bittar F. Repertory of eukaryotes (eukaryome) in the human gastrointestinal tract: taxonomy and detection methods. Parasite Immunol 2016; 38:12-36. [PMID: 26434599 DOI: 10.1111/pim.12284] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/23/2015] [Indexed: 12/22/2022]
Abstract
Eukaryotes are an important component of the human gut, and their relationship with the human host varies from parasitic to commensal. Understanding the diversity of human intestinal eukaryotes has important significance for human health. In the past few decades, most of the multitudes of techniques that are involved in the diagnosis of the eukaryotic population in the human intestinal tract were confined to pathological and parasitological aspects that mainly rely on traditionally based methods. However, development of culture-independent molecular techniques comprised of direct DNA extraction from faeces followed by sequencing, offer new opportunities to estimate the occurrence of eukaryotes in the human gut by providing data on the entire eukaryotic community, particularly not-yet-cultured or fastidious organisms. Further broad surveys of the eukaryotic communities in the gut based on high throughput tools such as next generation sequencing might lead to uncovering the real diversity of these ubiquitous organisms in the human intestinal tract and discovering the unrecognized roles of these eukaryotes in modulating the host immune system and inducing changes in host gut physiology and ecosystem.
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Affiliation(s)
- I Hamad
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, Marseille, France
| | - D Raoult
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, Marseille, France
| | - F Bittar
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix Marseille Université, Marseille, France
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Shaikh N, Hussain KA, Petraitiene R, Schuetz AN, Walsh TJ. Entomophthoramycosis: a neglected tropical mycosis. Clin Microbiol Infect 2016; 22:688-94. [PMID: 27109491 DOI: 10.1016/j.cmi.2016.04.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
Abstract
The term 'entomophthoramycosis' classically refers to infections caused by members of the order Entomophthorales. A new subphylum, Entomophthoramycota, has been created to include Basidiobolomycetes, Neozygitomycetes and Entomophthoramycetes. Basidiobolomycetes encompass Basidiobolus spp., while the Entomophthoramycetes include Conidiobolus spp. Conidiobolus spp. characteristically cause rhinofacial entomophthoramycosis in apparently immunocompetent hosts. Conidiobolus spp. may also cause disseminated infection in immunocompromised patients. Basidiobolus spp. more typically cause subcutaneous entomophthoramycosis of the limbs, buttocks, back and thorax in immunocompetent patients. While once considered to be rare, there is an increasing number of reported cases of gastrointestinal infection caused by Basidiobolus spp. worldwide in countries such as United States, Thailand, Australia, Iran, Egypt and Saudi Arabia. These cases have clinical presentations similar to those of inflammatory bowel diseases, particularly Crohn's disease. Retroperitoneal, pulmonary, nasal and disseminated basidiobolomycosis have also been reported. Histology of entomophthoramycosis may reveal the Splendore-Hoeppli phenomenon. Culture of infected tissue remains the definitive method of laboratory diagnosis. However, molecular methods with specific DNA probes and panfungal primers, as well as real time PCR, are increasingly used to detect and identify these organisms in tissue. Treatment largely consists of therapy with antifungal triazoles. Surgery plays a selective role in the management of entomophthoramycosis, depending upon location, organism and extent of the infection.
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Affiliation(s)
- N Shaikh
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - K A Hussain
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - R Petraitiene
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - A N Schuetz
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - T J Walsh
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY, USA; Departments of Pediatrics and Microbiology and Immunology, Weill Cornell Medicine of Cornell University, New York, NY, USA.
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Al-Naemi AQ, Khan LA, Al-Naemi I, Amin K, Athlawy YA, Awad A, Sun Z. A Case Report of Gastrointestinal Basidiobolomycosis Treated With Voriconazole: A Rare Emerging Entity. Medicine (Baltimore) 2015; 94:e1430. [PMID: 26334903 PMCID: PMC4616499 DOI: 10.1097/md.0000000000001430] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Basidiobolomycosis is an unusual fungal disease that rarely involves the visceral organs such as gastrointestinal tract. Gastrointestinal basidiobolomycosis (GIB) has been increasingly reported in the literature, and it is an emerging disease from arid regions worldwide, in particular, the south-western Saudi Arabia. We report a case of GIB in a 36-year-old Saudi Arabian male patient showing resistance to itraconazole and best treated with voriconazole. Computed tomography showed diffusely thickened small bowel with edematous change. CONCLUSIONS As GIB presents diagnostic challenges due to lack of specific features, this case emphasizes the importance of considering GIB in the differential diagnosis in patients presenting with fever, abdominal pain with fast-growing abdominal mass.
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Affiliation(s)
- Awaji Qasim Al-Naemi
- From the Department of General and Laparoscopic Surgery, Sabya General Hospital Jazan, 3261300, Kingdom of Saudi Arabia (AQA-N, LAK, IA-N, SA, YA-A, AA); and Department of Medical Radiation Sciences, Curtin University, Perth, 6845, Australia (ZS)
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Abstract
An 8-year-old, spayed, female Shiba dog was presented to a referring veterinarian with a
complaint of chronic diarrhea and anorexia. Ultrasound and radiographs revealed an
irregular mass in the pelvic cavity. The mass and the affected section of colon were
surgically removed. Histopathological examination revealed multifocal coalescing
granulomas and effaced intestinal structures. Central necrotic debris surrounded by
multinucleated giant cells, lymphocytes, plasma cells and neutrophils was observed.
Numerous, irregularly branched hyphae with pale basophilic, thin walls and occasional
bulbous enlargements at the tips were present. Polymerase chain reaction identified
Basidiobolus ranarum, successfully confirming a definitive diagnosis of
basidiobolomycosis. To the best of our knowledge, this is the first report of intestinal
basidiobolomycosis in a dog.
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Affiliation(s)
- Kazuki Okada
- North Lab, 8-35 Hondori 2-chome Kita, Shiroisi-ku, Sapporo, Hokkaido 003-0027, Japan
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Saeed MA, Al Khuwaitir TS, Attia TH. Gastrointestinal basidiobolomycosis with hepatic dissemination: a case report. JMM Case Rep 2014; 1:e003269. [PMID: 28663810 PMCID: PMC5415933 DOI: 10.1099/jmmcr.0.003269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 10/15/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Gastrointestinal basidiobolomycosis (GIB) is an emerging fungal infection with a few cases reported worldwide. It is caused by Basidiobolus ranarum, which does not usually invade blood vessels and rarely disseminates. CASE PRESENTATION We present a rare case of GIB with hepatic dissemination in a 12-year-old Yemeni boy living in southwestern Saudi Arabia. The initial provisional diagnosis was intestinal lymphoma, and a right hemicolectomy was carried out, but histopathological assessment ruled out lymphoma and suggested intestinal tuberculosis. Two weeks after starting antituberculous medications, the patient was referred to our hospital because of fever and right upper abdominal discomfort. There was leukocytosis with marked eosinophilia, and a liver biopsy showed evidence of B. ranarum infection. A second opinion by histopathological examination of resected tissues diagnosed colonic basidiobolomycosis. The patient was treated successfully with itraconazole. CONCLUSION GIB is an emerging disease in southwestern Saudi Arabia and should be considered in a patient with an abdominal mass and eosinophilia coming from this region. Persistent elevation of leukocytes and eosinophils after surgical resection of the affected tissue could be used as a predictor of fungal dissemination. Further research is needed for a better understanding of GIB.
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Ejtehadi F, Anushiravani A, Bananzadeh A, Geramizadeh B. Gastrointestinal basidiobolomycosis accompanied by liver involvement: a case report. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e14109. [PMID: 25593711 PMCID: PMC4270646 DOI: 10.5812/ircmj.14109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 12/28/2013] [Accepted: 02/18/2014] [Indexed: 11/16/2022]
Abstract
Introduction: Basidiobolomycosis is a rare disease that, unlike other fungal infections, affects immunocompetent individuals. It is caused by an environmental saprophyte named the fungus Basidiobolus ranarum. Basidiobolomycosis usually appears as a subcutaneous infection. GI basidiobolomycosis is an emerging disease, and the colon is the most frequent involved part of the GI tract. Case Presentation: The present study presents a middle-aged lady suffered from basidiobolomycosis with concomitant lesions in the cecum and liver involvement. This disease is extremely rare in adults and only a few cases have been reported so far. Conclusions: GI basidiobolomycosis is a very rare disease which resembles as an infiltrative, infectious, or inflammatory process. Concomitant liver and bowel involvement is extremely rare too. It is an aggressive disease which has a high mortality rate despite treatments like surgical resection and prolonged antifungal therapy.
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Affiliation(s)
- Fardad Ejtehadi
- Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Amir Anushiravani
- Internal medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Alimohammad Bananzadeh
- Colorectal Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Author: Alimohammad Bananzadeh, Colorectal Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +98-7112331006, E-mail:
| | - Bita Geramizadeh
- Transplant Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Flicek KT, Vikram HR, De Petris GD, Johnson CD. Abdominal imaging findings in gastrointestinal basidiobolomycosis. ACTA ACUST UNITED AC 2014; 40:246-50. [DOI: 10.1007/s00261-014-0212-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lamps LW, Lai KKT, Milner DA. Fungal infections of the gastrointestinal tract in the immunocompromised host: an update. Adv Anat Pathol 2014; 21:217-27. [PMID: 24911247 PMCID: PMC4061496 DOI: 10.1097/pap.0000000000000016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fungal infections are one of the most significant causes of morbidity and mortality in immunocompromised patients. The incidence of invasive fungal infections, including those of the gastrointestinal tract, has increased significantly as numbers of immunocompromised patients have increased. The diagnosis of fungal infections in immunocompromised patients may be particularly problematic as these patients may present with atypical clinical features. Although Candida and Aspergillus species represent the majority of fungi diagnosed in the immunocompromised patient population, other fungi are emerging as increasingly common pathogens, and this review will focus on several important emerging fungal infections in immunocompromised patients.
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Affiliation(s)
- Laura W Lamps
- *Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR †Department of Pathology, Brigham and Women's, Harvard Medical School, Boston, MA
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Cazorla A, Grenouillet F, Piton G, Faure É, Delabrousse É, Mathieu P, Viennet G, Kantelip B, Millon L, Valmary-Degano S. Une forme gastro-intestinale de basidiobolomycose d’évolution fatale. Ann Pathol 2014; 34:228-32. [PMID: 24950873 DOI: 10.1016/j.annpat.2014.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 08/16/2013] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
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Abstract
Zygomycosis is an acute or chronic infection caused by several fungal agents belonging to the phylum Zygomycota. These are saprophytic fungi and are found ubiquitously in the environment. These are emerging highly opportunistic pathogenic organisms. Basidiobolus ranarum (B. haptosporus, B. meristoporus) is a fungus belonging to the order Entomophthorales under the family Zygomycota. Basidiobolomycosis is a predominantly subcutaneous infection involving the trunk and limbs in immunocompetent hosts. We hereby report a case of Basidiobolomycosis from the Department of Microbiology, Siddhartha Medical College, Vijayawada in a 6 month old child who presented to us with a painless swelling over her left knee following an insect bite.
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Affiliation(s)
- Usha Rani Anaparthy
- Department of Microbiology, Siddhartha Medical College, Vijayawada, Andhra Pradesh, India
| | - G Deepika
- Department of Microbiology, Siddhartha Medical College, Vijayawada, Andhra Pradesh, India
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Zahir ST, Sharahjin NS, Kargar S. Basidiobolomycosis a mysterious fungal infection mimic small intestinal and colonic tumour with renal insufficiency and ominous outcome. BMJ Case Rep 2013; 2013:bcr-2013-200244. [PMID: 23893284 DOI: 10.1136/bcr-2013-200244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum a worldwide environmental saprophyte fungus that is potentially a pathogen. B ranarum mainly affects the subcutaneous tissues but gastrointestinal and disseminated infections rarely have been reported previously. We report a case of B ranarum infection in a 12-year-old immunocompetent boy presented with abdominal pain from 2 months earlier before admission in the hospital. Abdominal CT scan revealed a lobulated mass-like lesion in the vicinity of right lower quadrant enveloping ascending colon and terminal ileum with involvement of mesentery. Histopathological examination showed severe full-thickness infiltration of inflammatory cells mainly eosinophils admixed with multinucleated giant cells and large areas of necrosis with granulomatous feature. Periodic acid Schiff staining demonstrated thin-walled septate fungal hyphae's surrounded by eosinophilic material (Splendore-Hoppeli phenomenon) identified as a basidiobolomycosis.
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Affiliation(s)
- Shokouh Taghipour Zahir
- Department of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Islamic Republic of Iran.
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Hassan HA, Majid RA, Rashid NG, Nuradeen BE, Abdulkarim QH, Hawramy TA, Rashid RM, Farris AB, Guarner J, Hughson MD. Eosinophilic granulomatous gastrointestinal and hepatic abscesses attributable to basidiobolomycosis and fasciolias: a simultaneous emergence in Iraqi Kurdistan. BMC Infect Dis 2013; 13:91. [PMID: 23421741 PMCID: PMC3583806 DOI: 10.1186/1471-2334-13-91] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 02/01/2013] [Indexed: 11/10/2022] Open
Abstract
Background Deep eosinophilic granulomatous abscesses, as distinguished from eosinophilic subcutaneous abscesses, are rare. Most reports are from the Far-East and India where the most commonly attributed cause is Toxocara. Sulaimaniyah in Northeastern Iraq has experienced an outbreak of eosinophilic granulomatous liver and gastrointestinal (GI) abscesses beginning in 2009. The purpose of this study was to determine the etiology and guide treatment. Methods The study was an ongoing investigation of patients having a histopathologic diagnosis of eosinophilic granulomatous abdominal abscesses in Sulaimaniyah hospitals from May 2009 to August 2012. Tissues were examined for organisms, and Enzyme Linked Immunoabsorbent Assays (ELISA) were performed for serum antibodies to Fasciola hepatica, Toxocara, and Echinococcus granulosus. Results Fourteen patients had granulomatous inflammation surrounding a central necrotizing eosinophilic exudate identified in surgical pathology specimens from abdominal surgeries. Two children and four adults had abscesses that formed GI masses. These patients included a 39 year old male with oropharyngeal and transverse colon disease, and a 48 year old male with liver and GI abscesses. All sites demonstrated a Zygomycete fungus surrounded by eosinophilic Splendori-Hoeppli material consistent with basidiobolomycosis. Five of the six patients with fungal disease were treated by surgery and 4 to 7 months of itraconozol. One child died of intestinal perforation while receiving IV amphotericin B; two adults required additional surgery for recurrent GI obstruction. Eight patients had isolated liver abscesses with no organisms identified by histopathology: ELISA results for F. hepatica were positive for five, borderline for one, and negative for two patients. These eight patients were treated for fascioliasis by surgical resection of localized abscesses and albendazol. One patient serologically positive for F. Hepatica was found to have a common duct fluke two years after initial diagnosis. Serological testing for Toxocara and Echinococcus granulosus was negative in all 14 patients. Conclusions Basidiobolomycosis and F. hepatica are implicated as the cause of abdominal eosinophilic granulomatous abscesses in 12 of 14 patients identified over a period of 40 months in northern Iraq. Treatment was complicated by chronic biliary tract disease in fascioliasis and perforation and recurrent intestinal obstruction with basidiobolomycosis.
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Affiliation(s)
- Hemmin A Hassan
- Department of Pathology, Shorsh General Hospital, and Department of Microbiology, Sulaimaniyah University College of Medicine, Sulaimaniyah, Iraq
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Geramizadeh B, Foroughi R, Keshtkar-Jahromi M, Malek-Hosseini SA, Alborzi A. Gastrointestinal basidiobolomycosis, an emerging infection in the immunocompetent host: a report of 14 patients. J Med Microbiol 2012; 61:1770-1774. [DOI: 10.1099/jmm.0.046839-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Shiraz University of Medical Sciences, PO Box 71345-1864, Shiraz, Iran
- Transplant Research Center, Shiraz University of Medical Sciences, PO Box 71345-1864, Shiraz, Iran
| | - Razieh Foroughi
- Department of Pathology, Shiraz University of Medical Sciences, PO Box 71345-1864, Shiraz, Iran
| | | | | | - Abdolvahab Alborzi
- Microbiology Research Center, Shiraz University of Medical Sciences, PO Box 71345-1864, Shiraz, Iran
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Rose SR, Lindsley MD, Hurst SF, Paddock CD, Damodaran T, Bennett J. Gastrointestinal basidiobolomycosis treated with posaconazole. Med Mycol Case Rep 2012; 2:11-4. [PMID: 24432205 PMCID: PMC3885966 DOI: 10.1016/j.mmcr.2012.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 10/30/2012] [Accepted: 11/08/2012] [Indexed: 11/25/2022] Open
Abstract
A 67 year-old Caucasian male from Arizona presented with indolent symptoms of intestinal obstruction and hydronephrosis, found at surgery to be caused by a mass involving the terminal ileum and cecum, extending into the posterior abdominal wall and obstructing the right ureter. Histopathology was diagnostic of basidiobolomycosis. PCR of tissue and sequencing identified the fungus as, Basidiobolus ranarum. During one year of posaconazole treatment, the residual mass shrank, hydronephrosis was relieved and peripheral eosinophilia resolved.
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Affiliation(s)
- Stacey R. Rose
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 10 Center Drive, Bethesda 20892, USA
| | - Mark D. Lindsley
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta 30033, USA
| | - Steven F. Hurst
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta 30033, USA
| | - Christopher D. Paddock
- Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta 30033, USA
| | - Thara Damodaran
- Mercy Gilbert Medical Center, 3555 S. Val Vista Drive, Gilbert 85297, USA
| | - John Bennett
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 10 Center Drive, Bethesda 20892, USA
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Saadah OI, Farouq MF, Daajani NA, Kamal JS, Ghanem AT. Gastrointestinal basidiobolomycosis in a child; an unusual fungal infection mimicking fistulising Crohn's disease. J Crohns Colitis 2012; 6:368-72. [PMID: 22405176 DOI: 10.1016/j.crohns.2011.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 10/22/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastrointestinal basidiobolomycosis is a rare disease caused by the fungus Basidiobolus ranarum. It has been reported in both children and adults. The disease mainly affects the colon and the small bowel; however, cases of the stomach, liver, pancreas, and renal system being affected have been reported. CASE REPORT A 2 year old boy presented with the following symptoms; abdominal pain, vomiting, diarrhea, fever and palpable right iliac fossa mass. Laboratory investigations revealed elevated inflammatory markers and peripheral eosinophilia. Colonoscopy showed severely inflamed mucosa of the terminal ileum, cecum and ascending colon. CT scan of the abdomen demonstrated an inflammatory mass with wall thickening of the terminal ileum and the colon. Surgical exploration demonstrated retroperitoneal mass and inflamed terminal ileum, cecum and ascending colon. Upon laparotomy, multiple internal fistulas involving the bowel loops, the urinary bladder, the right ureter and the gallbladder were observed. Further investigations using histopathology of the resected diseased bowel showed extensive necrosis, multinucleated giant cells and numerous eosinophils and large fungal hyphae surrounded by strongly eosinophilic material were seen in the tissue suggestive of B. ranarum infection. The patient responded well to treatment with voriconazole. CONCLUSION Gastrointestinal basidiobolomycosis should be considered in the differential diagnosis of every child presenting with abdominal pain, fever and palpable abdominal mass with peripheral eosinophilia. The presence of bowel inflammation and fistulas should not preclude such diagnosis.
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Affiliation(s)
- Omar I Saadah
- Department of Pediatrics, Faculty of Medicine & King Abdul-Aziz University Hospital, King Abdul-Aziz University, Jeddah, Saudi Arabia.
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Vikram HR, Smilack JD, Leighton JA, Crowell MD, De Petris G. Emergence of gastrointestinal basidiobolomycosis in the United States, with a review of worldwide cases. Clin Infect Dis 2012; 54:1685-91. [PMID: 22441651 DOI: 10.1093/cid/cis250] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We examined the epidemiology, clinical manifestations, histopathology, management, and outcomes of gastrointestinal basidiobolomycosis, an uncommon manifestation of infection caused by the fungus Basidiobolus ranarum. METHODS In this retrospective observational cohort study, cases of gastrointestinal basidiobolomycosis in the United States were identified by reviewing medical records from Mayo Clinic Hospital (Phoenix, AZ) and contacting local infectious diseases specialists, pathologists, gastroenterologists, the Arizona Department of Health Services, health departments of adjacent states, the Armed Forces Institute of Pathology, and the US Centers for Disease Control and Prevention. A comprehensive literature review identified additional cases worldwide. RESULTS Of 44 patients (mean age, 37 years [range, 2-81 years]) with gastrointestinal basidiobolomycosis, most were from the United States (19 patients [43%], of whom 17 [89%] were from Arizona) or Saudi Arabia (11 [25%]). Most (28 [64%]) were previously healthy. Common chronic medical conditions among 15 patients (34%) were diabetes mellitus (8 patients [18%]) and gastric disorders (7 [16%]). Common findings were abdominal pain (37 patients [84%]) and a palpable abdominal mass (19 [43%]). Intraabdominal malignancy was the leading provisional diagnosis (19 patients [43%]). The large bowel was involved in 36 (82%), the small intestine in 16 (36%), and the liver or gallbladder in 13 (30%). Characteristic histopathologic findings were observed in 43 (98%). Eight patients (18%) died. Combined surgical intervention and antifungal therapy was the preferred treatment. CONCLUSIONS Gastrointestinal basidiobolomycosis is an emerging invasive fungal infection in desert regions of the US Southwest. Clinical findings mimic malignancy and inflammatory bowel disease. Surgical excision and prolonged antifungal therapy are associated with favorable outcomes.
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Affiliation(s)
- Holenarasipur R Vikram
- Division of Infectious Diseases, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
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Gómez-Muñoz MT, Fernández-Barredo S, Martínez-Díaz RA, Pérez-Gracia MT, Ponce-Gordo F. Development of a specific polymerase chain reaction assay for the detection of Basidiobolus. Mycologia 2011; 104:585-91. [PMID: 22075784 DOI: 10.3852/10-271] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The etiology of chronic diarrhea is complex in humans and animals. It is always necessary to evaluate a list of differential diagnosis, including bacteria, protozoa and fungi. Basidiobolomycosis is a fungal disease reported sporadically worldwide, mainly caused by B. ranarum, a frequent organism found in soil or in the intestine and skin of lizards and frogs. It is an opportunistic pathogen that causes infections characterized by granulomatous lesions in the subcutaneous tissues as well as in the intestinal wall in humans and animals. In this work we have developed a PCR technique to differentiate Basidiobolus from other causes of intestinal disease in dogs and humans. To test the specificity of the PCR assay we included closely related organisms, common intestinal microbiota and pathogenic organisms, such as Aspergillus, Candida, Cryptosporidium, Escherichia, Giardia, Mucor, Proteus, Rhizopus and Salmonella. Pythium insidiosum, which cause clinically similar disease in dogs but require a different treatment. Only Basidiobolus was positive to the PCR assay.
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Basidiobolomycosis of the colon masquerading as stenotic colon cancer. Case Rep Surg 2011; 2011:685460. [PMID: 22606589 PMCID: PMC3350237 DOI: 10.1155/2011/685460] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 08/08/2011] [Indexed: 11/18/2022] Open
Abstract
Basidiobolus ranarum
is a widespread saprophyte fungus with pathogenic potential. It affects mainly the subcutaneous tissues of the trunk and limbs. Relatively recently, occasional reports of gastrointestinal basidiobolomycosis appeared in the literature. Due to the rarity of the condition and the nonspecific presenting features, the correct diagnosis is usually hard to reach. In this paper, we describe the clinical course of an otherwise healthy female, who presented with a colonic mass. She received subtotal colectomy followed by oral itraconazole, with successful outcome.
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Abstract
Fungal infections are becoming more frequent because of expansion of at-risk populations and the use of treatment modalities that permit longer survival of these patients. Because histopathologic examination of tissues detects fungal invasion of tissues and vessels as well as the host reaction to the fungus, it is and will remain an important tool to define the diagnostic significance of positive culture isolates or results from PCR testing. However, there are very few instances where the morphological characteristics of fungi are specific. Therefore, histopathologic diagnosis should be primarily descriptive of the fungus and should include the presence or absence of tissue invasion and the host reaction to the infection. The pathology report should also include a comment stating the most frequent fungi associated with that morphology as well as other possible fungi and parasites that should be considered in the differential diagnosis. Alternate techniques have been used to determine the specific agent present in the histopathologic specimen, including immunohistochemistry, in situ hybridization, and PCR. In addition, techniques such as laser microdissection will be useful to detect the now more frequently recognized dual fungal infections and the local environment in which this phenomenon occurs.
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