Are mosque carpets' reservoirs for fungi causing superficial foot mycosis? A cross-sectional study in Riyadh, Saudi Arabia

The possibility of superficial foot mycoses to spread through contaminated mosque carpets between worshipers imposes a great health burden and is never addressed in Riyadh, SA. We aimed to assess the prevalence of fungal infections, especially human dermatophytosis acquired from mosque carpets, in five different regions of Riyadh, Saudi Arabia and establish a means of contamination control. A cross-sectional study of 100 mosques in Riyadh, Saudi Arabia, was conducted, using a multistage random cluster sampling technique. The study included mosques that had an ablution area and regularly hosted five prayers a day. Sterile swabs were used for sampling, and the samples were transported to the laboratory for culture and analysis using a micro-scan system. A total of 199 (65%) samples contained several fungal species. Rhodotorula (74%), Cladosporium (47%), Bipolaris (46.6%), other yeasts (43.7%), Alternaria (40%), dematiaceous molds (34%), Curvularia (32.4%), and Candida (31%) were the most frequently isolated species. Species belonging to several other genera were also detected. This study revealed a relatively high prevalence of fungal organisms in mosque carpets in Riyadh, suggesting the need for implementing new strategies and laws to increase the level of hygiene awareness among worshipers and mosque caretakers to limit the spread of foot fungal infections.

Basidiobolomycosis: Case series

BACKGROUND

Basidiobolus ranarum is a fungus found in the dung of amphibians, reptiles and insectivorous bats. Basidiobolomycosis is a chronic subcutaneous infection of the trunk and limbs caused by B. ranarum. The disease is a well-known infection in the tropical areas. It usually presents with subcutaneous or gastrointestinal lesions and rarely with systemic affection. Recently, the etiologic role of B. ranarum in the gastrointestinal infections has been increasingly recognized.

PATIENTS AND METHODS

Here, we retrospectively reviewed the records of five patients with basidiobolomycosis, all from the same geographic region (Tohama area, Aseer province, southern region of the Kingdom of Saudi Arabia).

RESULTS

All the cases presented with prolonged fever and other manifestations suggestive of either chronic infection (such as tuberculosis) or malignancies (such as lymphoma). The diagnosis of gastrointestinal basidiobolomycosis was established on histolological ground (granulomatous reaction, dense infiltrate of eosinophils and fungal structures). One case was diagnosed based on the histological features combined with positive tissue culture for B. ranarum. One case was treated by surgical resection of fungal masses (Case I), followed by itraconazole and amphoterecin-B therapy. The other four cases had non-resectable fungal masses and they responded very well for antifungal therapy (cases II, III, and IV received amphotericin-B and itraconazole and case V received amphotericin-B and voriconazole).

CONCLUSIONS

Our study raises several notions. Gastrointestinal basidiobolomycosis is often misdiagnosed as cancer (lymphoma or carcinoma), tuberculosis or inflammatory bowel disease. Its recognition needs high index of suspicion and increased awareness especially in patients with chest, abdominal or neck masses and eosinophilia. The diagnosis of basidiobolomycosis can be established on histological basis in most cases. The fungal morphology and the Splendore-Hoeppli phenomenon are characteristic histological features of this condition. There are no prominent risk factors. Usually, surgery and prolonged antifungal therapy are required.