First report of rhino-orbital mucormycosis caused by Syncephalastrum racemosum in a diabetic patient with COVID-19 in Iran and review of recent literature

Background and Purpose

Invasive mucormycosis is a rare mycosis that affects most cases of uncontrolled diabetes and has a high mortality rate. Patients with COVID-19 are at high risk of developing invasive mucormycosis due to the consumption of anti-inflammatory drugs such as corticosteroids and dexamethasone. Rhizopus species followed by Rhizomucor spp. and Mucor spp. are the main common etiological agents of rhino-orbital mucormycosis. Therefore, this study aimed to present a case of mucormycosis due to Syncephalastrum racemosum in a diabetic patient with COVID-19 for the first time in Iran.

Case report

A 73-year-old diabetic female was referred to Ayatollah Rouhani Hospital in Babol, Iran, with a confirmed COVID-19 diagnosis, based on positive RT-PCR and computed tomography of the lungs. She has received methylprednisolone due to severe lung complications. Nasal involvement and left orbital swelling were observed 20 days after the hospitalization. By sinus endoscopic surgery, debridement was done and histopathology indicated wide hyphae (without septa). The sequenced PCR products displayed Syncephalastrum racemosum. In the antifungal susceptibility test, amphotericin B showed good activity against S. racemosum and the patient survived with timely treatment.

Conclusion

This is the first case report of rhino-orbital mucormycosis due to S. racemosum in COVID-19 patient; therefore, S. racemosum can be considered one of the etiological factors of rhino-orbital mucormycosis in COVID-19 cases.

Gastrointestinal involvement of unusual Mucormycete Syncephalastrum racemosum in a diabetic patient with adenocarcinoma: rare case presentation with review of literature

BACKGROUND

Mucormycosis is a serious and often fatal mycotic infection caused by members of class Mucormycetes in populations with immunologic or metabolic disorders. Though several clinical manifestations are associated with mucormycetes, gastrointestinal involvement is quite rare.

CASE DESCRIPTION

We described a rare case of invasive fungal infection due to Syncephalastrum racemosum associated with gastric adenocarcinoma in a 48-year-old male patient with type II Diabetes mellitus. He presented with complaints of abdominal pain, nausea, vomiting, dyspepsia, dysphagia, loss of appetite, and weight. Histopathological examination showed broad and aseptate hyphae and culture of endoscopic biopsy tissue from pylorus and antrum yielded the fungal pathogen S. racemosum. The species was confirmed by molecular sequencing of D1/D2 region of the ribosomal DNA. The in vitro susceptibility of S. racemosum was tested by broth microdilution assay as per CLSI guidelines. The MICs suggest that the isolate was susceptible to Amphotericin B (0.25 µg/ml), Itraconazole (0.25 µg/ml) and Posaconazole (0.06 µg/ml) and showed resistance to Micafungin (>16 µg/ml). The patient was successfully treated with radical subtotal gastrectomy with lymphadenectomy and Amphotericin B antifungal therapy. There was a dilemma in concluding the pathogenicity of the isolate since; the symptoms noted were common for both gastric adenocarcinoma and mucormycosis. A review of previously reported cases on Syncephalastrum was presented in the paper with their clinical manifestations, treatment, and outcome.

CONCLUSION

To the best of our knowledge, this is the first report from India on the gastrointestinal involvement of S. racemosum. Patients with immunocompromised status are more prone to mucormycotic infections, and any typical presentations should be carefully examined for their etiological agent, and appropriate species directed therapy would help in a better outcome.

Total Dystrophic Onychomycosis Due to Syncephalastrum racemosum - A Rare Cause and its Novel Treatment Option

Onychomycosis is a fungal infection of the nail caused by dermatophytic (99%) and/or non-dermatophytic (1%) (including yeasts) infections of the nailplate. Among the non-dermatophytes, the yeast Candida albicans, Candida tropicalis, and other molds like Scopulariopsis spp., Scytalidium spp., Fusarium spp., and Aspergillus spp. may be responsible. Herein, we report a case of total dystrophic onychomycosis in a 41-year-old female, caused by Syncephalastrum racemosum and its complete improvement with a combination of oral pulse itraconazole and 1064 nm Q-switched Nd-YAG laser. This case is being reported due to the rarity of causative organism for onychomycosis and a novel approach in its treatment.

Antifungal and antiproliferative activities of endophytic fungi isolated from the leaves of Markhamia tomentosa

CONTEXT

Plants harbor endophytes with potential bioactivity. Markhamia tomentosa (Benth) K. Schum ex. Engl. (Bignoniaceae) is reported to possess antioxidant, anti-inflammatory and anticancer activities.

OBJECTIVE

The antifungal and antiproliferative properties of endophytic fungi extracts and fractions from M. tomentosa were evaluated.

MATERIAL AND METHODS

Endophytic fungi were isolated from the leaves of M. tomentosa and identified by ITS-rDNA sequence analysis. The antagonistic effect of the fungal strains was investigated against pathogenic fungi viz, Fusarium oxysporum, Sclerotinia sclerotiorium, Rhizoctonia solani, and Botrytis cinerea using the dual culture assay for 5-7 days. Antiproliferative effect of the fungal extracts and fractions (3.91-250 μg/mL) on HeLa cancer cell line was tested and IC₅₀ was calculated. Poisoning food assay and antifeedant activity against the pathogenic fungi and Spodoptera litura larvae, for 7 days and 2 h, respectively, was also tested at concentrations of 250, 500 and 1000 μg/mL.

RESULTS

Fungal endophytes Trichoderma longibrachiatum and Syncephalastrum racemosum were isolated from the leaves of M. tomentosa. Isolated endophytic fungal strains and solvent extracts showed MIC value of 1000 μg/mL against tested pathogenic fungi in the dual culture and poisoning food assays. Methanol fraction of S. racemosum isolate showed the most effective antiproliferative activity with IC₅₀ of 43.56 μg/mL. Minimal feeding deterrent activity against S. litura larvae was also observed.

DISCUSSION AND CONCLUSION

These findings showed that the leaves of Markhamia tomentosa harbor strains of endophytic fungi with promising health benefits, and suggest their antifungal and antiproliferative effects against pathogenic fungi and HeLa cancer cell line.

Syncephalastrum racemosum amine oxidase with high catalytic efficiency toward ethanolamine and its application in ethanolamine determination

Our screening study yielded a copper amine oxidase (SrAOX) from Syncephalastrum racemosum, which showed much higher affinity and catalytic efficiency toward ethanolamine (EA) than any other amine oxidase (AOX). Following purification of the enzyme to electrophoretic homogeneity from a cell-free extract, the maximum activity toward EA was detected at pH 7.2-7.5 and 45 °C. The SrAOX complementary DNA (cDNA) was composed of a 2052-bp open reading frame encoding a 683-amino acid protein with a molecular mass of 77,162 Da. The enzyme functions as a homodimer. The deduced amino acid sequence of SrAOX showed 55.3 % identity to Rhizopus delemar AOX and contains two consensus sequences of Cu-AOX, NYDY, and HHQH, suggesting SrAOX is a type 1 Cu-AOX (i.e., a topaquinone enzyme). Structural homology modeling showed that residues (112)ML(113), (141)FADTWG(146) M158, and N318 are unique, and T144 possibly characterizes the substrate specificity of SrAOX. The recombinant enzyme (rSrAOX) was produced using Escherichia coli. Steady-state kinetic analysis of rSrAOX activity toward EA (pH 7.5 and 45 °C) gave K m and k cat values of 0.848 ± 0.009 mM and 9.11 ± 0.13 s(-1), respectively. The standard curves were linear between 0.1 and 2 mM EA, and 10 μg mL(-1)-2.5 mg mL(-1) (15 μM-3.6 mM) phosphatidylethanolamine using Streptomyces chromofuscus phospholipase D, respectively, was sufficiently sensitive for clinical use.

Onychomycosis by syncephalastrum racemosum: case report from kerala, India

We report a rare case of onychomycosis caused by Syncephalastrum racemosum in a 50-year-old diabetic patient. The patient's nail was surgically excised and thorough debridement was done. The patient was successfully treated with topical nystatin.

Water soluble exo-polysaccharide from Syncephalastrum racemosum, a strong inducer of plant defence reactions

This study examines the production, characterization and bioactivity on plant cell cultured in vitro of exopolysaccharides (EPS) from Syncephalastrum racemosum CBS 443.59. Firstly, the influence of the fungus culture condition in shake flasks (pH, temperature and different carbon and nitrogen sources) on EPS and biomass production was evaluated. In order to enhance EPS production, a new protocol based on two-stage pH fermentation in a 3 L stirred fermentor was developed. Under this condition, EPS production increased by 3.55 times, compared to a constant pH process, reaching a maximal EPS concentration of 2.62 g/L. Structurally, the EPS contains a polyglucuronic acid backbone, linked essentially with mannose and fucose units and some galactose and glucose units. The bioactivity of EPS as inducer of defence reactions in plant suspension-cultured cells was also studied. Our results show, for first time, that EPS from S. racemosum CBS 443.59 induces, depending on the concentration, PAL activation and H2O2 synthesis in Arabidopsis thaliana cell suspensions.