Conidiobolomycosis in Sheep in Brazil

Conidiobolomycosis is reported in the state of Piauí, in the semiarid region of northeastern Brazil. Affected sheep had depression, weight loss, serous or mucohemorrhagic nasal discharge, and cranium-facial asymmetry from exophthalmos of 1 eye, generally with increased volume of the eyeball, keratitis, and corneal ulceration. At necropsy of 60 sheep, friable masses were observed in the posterior region of the nasal cavity, often destroying the ethmoturbinate bones. Frequently, the lesions invaded the nasal sinuses, cribiform plate, orbit, and brain. The masses were irregular, granular with moist surfaces, and soft and friable with white, yellow, or tan coloration. Dissemination of the lesion to lungs was observed in 27 sheep, to the brain in 26, to lymph nodes in 3, to the kidney in 2, and to the gallbladder and heart in 1. The microscopic examination showed granulomatous inflammation composed of central necrosis surrounded by lymphocytes, epithelioid and giant cells, and fibrous tissue. In all lesions, negatively stained structures representing hyphae were surrounded by Splendore-Hoeppli material. Coagulative necrosis, thrombosis, and vasculitis were also observed. Grocott methenamine silver stain showed 8–30-μm-thick hyphae, rarely septate or ramified, irregular in shape, and with black contoured wall, sometimes with bulbous dilatation in the extremities. On electron microscopy, the hyphae had a thick double wall surrounded by cellular remnants and an inflammatory exudate. Conidiobolus coronatus was isolated from the lesions of 6 sheep. Conidiobolomycosis is an important disease of sheep in the state of Piauí, and other regions of northeastern Brazil.

Conidiobolus coronatus granuloma of the right inferior turbinate: A rare presentation

Fungal infections are common in tropical countries such as India. Very few clinical cases caused by the Entomophthorales Zygomycetes have been reported. Rhinofacial infection is a rare form of zygomycosis in humans, and only limited information regarding optimal treatment is available. We report here a rare case of rhinofacial Conidiobolus coronatus infection in a previously healthy 18-year-old man who presented with a fungal granuloma of the right inferior turbinate and face. Diagnosis was confirmed by microbiologic culture from a tissue biopsy. The infection was successfully treated with surgery and itraconazole therapy for 12 months. The clinical presentation and treatment of this rare, chronic, indolent form of fungal infection are highlighted in this article.

[Rhinofacial conidiobolomycosis associated with cervical, thoracic and brachial localizations: one clinical case in Nigeria]

We report here the clinical case of a Nigerian adult patient who received medical care during October 2010, at the Center for Diagnosis and Treatment of Buruli ulcer in Pobè (Benin). He presented a massive facial tumor associated with several subcutaneous (cervical, thoracic and upper limbs) nodules, evolving since several years. Tissue samples collected at Pobè medical center were addressed to the mycology and histology laboratories of Angers University Hospital (France), according to the medical exchange agreement between the two institutions about the diagnosis and treatment of Buruli ulcer disease. Histological examination showed a Splendore-Hoeppli phenomenon, consisting of a granulomatous reaction made of eosinophilic polynuclear cells surrounding rare, large and irregular, non-septate hyphae. A filamentous fungus was isolated by cultivation of the clinical samples, which was identified as Conidiobolus coronatus. The patient was treated orally with daily doses of ketoconazole (400 mg per day). After 4 months of treatment, a marked regression of the facial lesion was obtained. A first constructive facial surgery was achieved, but the patient did not attend the second step. This case report allows us to remind the mycological diagnosis of this exotic mycosis, but also to emphasize the main difficulties encountered in medical management in the developing countries.

Entomophthoramycosis: a rare fungal orbital infection presenting with dacryocystitis

We report a case of a rare fungal orbital infection in an infant presenting with dacryocystitis. The causative organism was Conidiobolus sp. of the order Entomophthorales. There is no standard treatment for entomophthoramycosis. Our patient responded well to combined antifungal therapy without aggressive surgical débridement.

Rhinofacial entomophthoramycosis; a case series and review of the literature

Rhinofacial entomophthoramycosis is an uncommon chronic mycotic disease caused by exposure to the organism Conidiobolus coronatus. The authors report a case series of 5 patients with rhinofacial entomophthoramycosis and review the literature. All patients had typical involvement of the rhinofacial area with formation of subcutaneous lesions causing a chronic granulomatous inflammatory response with tissue eosinophilia and Splendore-Hoeppli reaction. Diagnoses were made based on histopathologic examination in all cases and fungi were isolated and identified in one case. The clinicopathologic features and therapeutic management of rhinofacial entomophthoramycosis are described.

Rhinoentomophthoromycosis: rarity revisited

We describe a case of rhinoentomophthoromycosis, also known as rhinophycomycosis, in an Indian man hailing from the tropical northern region of the country. The patient presented with subcutaneous swelling in the midline of the forehead, dorsum of the nose, adjoining cheek area (more on the right side), philtrum, and upper lip. Biopsy taken from the right nostril area revealed nasofacial phycomycosis. The patient was treated successfully with itraconazole, 200 mg twice daily, and potassium iodide, 5 drops in fruit juice three times daily.

Rhinofacial conidiobolomycosis caused by Conidiobolus coronatus in a Chinese rice farmer

We provide the first report of rhinofacial conidiobolomycosis caused by Conidiobolus coronatus in China. The patient was a 36-year-old male rice farmer from Jiang Xi province who presented with diffuse swelling with classical centrofacial distribution and involvement of the right paranasal sinuses. Histopathology showed granulomas with hyphae surrounded by an eosinophilic sheath (Splendore-Hoeppli phenomenon). Culture of biopsy specimens on Sabouraud's dextrose agar led to the growth of fungi with microscopically visible conidiophores and terminal spherical conidia (primary conidium), with multiple secondary conidia and villose conidia. The patient was successfully treated with combination therapy, primarily itraconazole and terbinafine. We conclude with a brief literature review of the epidemiology of conidiobolomycosis.

[Conidiobolomycosis, a rare fungal tumor: a case report in Ouagadougou, Burkina Faso]

Conidiobolomycosis is a deep, rare mycosis, due to Conidiobolus coronatus which is a saprophyte of vegetation in decomposition. We report one case in Burkina Faso. A 17 years old man, shepherd, consulted for tumefactions on the face. It could date back insidiously to a traumatism, one year before. A month later some painless tumefactions appeared on the cheekbone, the right eyelid, the nose with epistaxis. The upper lip then the lower one had swollen. Dermatological exam revealed multiple, painless, hard, sub-cutaneous swellings, affecting the cheekbone, the eyelids, the root and the ala of the nose. This tumefaction sometimes adhered to underlying tissues and to the overlying skin, sometimes mobile; painless and hard swelling of the two lips was also noted. ENT exam showed an inflammation of the nasal mucous without ulceration and the permeability of the nasal tracts was subnormal. The cephalic tomodensitometry showed a thickness of the soft tissues of the lips and the nose with an infectious feature associated to a pansinusitis without bone lesion. Histology was in favour of conidiobolomycosis. The patient was treated with fluconazole and the swelling progressively disappeared. Conidiobolomycosis is a disease generally reported in some humid tropical countries. It begins in the nasal cavities leading then to a nasal obstruction. This case was singular by the fact it happened in a dry Sudano-Sahelian climate and by its clinical features.

Nasofacial Phycomycosis

Nasofacial phycomycosis caused by Conidiobolus is a rare fungal infection most often encountered in the developing world in conditions of poverty. A clinical presentation of the natural history of this condition observed over a period of 6 years by a visiting volunteer surgical team demonstrates the role of multimodality surgical and antifungal drug treatment in producing a successful outcome. The particular sensitivity of this infection to the new generation antifungal Voriconazole is noted.

Rhinoentomophthoromycosis

A sixty year old patient presented with a slowly progressive swelling of the nose, of one year duration, suggesting a clinical diagnosis of subcutaneous zygomycosis. On investigation, the tissue fungal culture grew Conidiobolus coronatus, confirming the diagnosis as rhinoentomophthoromycosis. He was treated with a combination of oral fluconazole and oral potassium iodide for a total period of 5 months. His symptoms subsided completely. Serial CT scanning of paranasal sinuses showed the gradual resolution of the swelling, in response to the treatment. Early detection of the disease and combination therapy gave rapid and good results. This is the first case of its kind to be reported from Kerala, the southern state of India.

Detection of villous conidia of Conidiobolus coronatus in a blood sample by scanning electron microscopy investigation

Conidiobolus coronatus is a major insect pathogen belonging to the fungal order Entomophthorales, causing a rare subcutaneous infection of the nasofacial region, resulting in swelling of predominantly the nose, mouth, and perinasal tissue. Later in the course of the infection firm, painless, subcutaneous nodules develop that are attached to the underlying tissues but not to the skin. No morphological studies are available in the literature on the morphology of C. coronatus in vivo and all morphological studies have been conducted on in vitro cultures. Here the authors report on the ultrastructural pathology as seen with a scanning electron microscope (SEM) of villous conidia of C. coronatus, detected in a 37-year-old woman who presented to the casualty department at Pretoria Academic Hospital, South Africa with left-sided facial pain and headache. The diagnosis of C. coronatus was confirmed by LightCycler real-time flourescence PCR technique. Research shows that typically diagnosis of the pathogen is established only on histological examination, and in over 85% of cases cultures for the causative organism is negative. This pathogen has not previously been found in a blood sample and the authors present for the first time the morphology of C. coronatus in blood using the SEM.

[Rhinofacial entomophthoromycosis. About two new cases in Mayotte]

Conidiobolus entomophthoromycosis is a rare mycosis due to an ubiquitary telluric fungus. Although the organism is found around the world, it is more concentrated in warm, wet climates. Cases have been described in West Africa, Australia, South America and India. Conidiobolus spp was also to be found in animal like horse. The transmission mode of Conidiobolus has not been established but probably occurs via inhalation of fungal spores covering the nasal mucous membrane or from a minor trauma such as an insect bite. The clinical syndromes include intranasal tumour, nasal obstruction, broadening of the nose bridge, paranasal sinuses, cheeks and upper lip. Diagnostic is made by demonstrating distinctive non-septate hyphea with surrounding eosinophilic sleeve (Splendore-Hoeppli phenomenom) in tissue sections. We report here two cases contracted in Comoro Islands. The first one was a 26 year-old man treated by amphotericin B during six weeks and then by itraconazole, with a clear improvement. The second one was a 37 year-old woman. She has been treated by amphotericin B, subsequently by imidazoles. There was a clear benefit on life duration, but the results for aesthetic aspect are not satisfactory. In the discussion, we review treatment efficacy and failure; in fact, surgery which includes removal of infected tissue and reconstructive procedures, is seldom curative. Several combinations of drugs have been used with different degrees of success. Nevertheless imidazoles remain more efficient than amphotericin B.

Rhino-orbitocerebral entomophthoramycosis

Conidiobolus coronatus is recognized as a human pathogen causing subcutaneous fungal infection of the face in immunocompetent patients. The disease process is usually benign. We report, what we believe to be the first case of intracranial extension of C. coronatus producing rhino-orbitocerebral syndrome, and subsequent dissemination of C. coronatus in an immunocompetent patient.

[Entomophthoramycosis (zygomycosis) caused by Conidiobolus coronatus in Mato Grosso (Brazil): case report]

Zygomycosis is a subcutaneous mycosis caused by soil fungi, such as Conidiobolus coronatus. In general, the main clinical manifestation is a chronic rhinofacial tumor. We report the first case of zygomycosis (entomophthoramycosis) caused by Conidiobolus coronatus, occurring in Mato Grosso, West Brazil.

[Conidiobolomycosis: a case report with histophathologic findings]

Conidiobolomycosis is a subcutaneous mycosis of the facial midline affecting primarily adult males. It is caused by the saprophytic fungus, Conodiobolus coronatus, present in soils and dried vegetables, characteristic of intertropical regions. C. coronatus belongs to the class Zygomycetes, order Entomophthorales; it is a fungus composed of thick, short hyphae that grows at temperatures between 30 degrees C and 37 degrees C and causes nasal granulomas. The histologic findings are described of a case of conidiobolomycosis in a 31-year-old male, born and resident in the Urabá region of Colombia. He presented with a mid-facial deformity of the nose and upper lip edema, and polypoid images in the maxillary sinuses with destruction of the nasal septum. The biopsy revealed a diffuse inflammatory lesion located in the deep dermis and in the hypodermis corresponding to a necrotizing granuloma. Associated eosinophils and the presence of the Splendore-Hoeppli phenomenon were noted in the vacant central zone which apparently corresponded to location of the fungal hyphae. They did not stain with HE stain, but reacted to the PAS and Grocott staining techniques and appeared as rigid, thick-walled hyphae, centrally twisted and with cone-shaped endings.

Entomophthoromycosis in South Bengal (Eastern India): a 9 years study

Subcutaneous mycoses caused by the family Entomophthoraceae is very rare type of disease and is being reported sporadically from various Tropical countries including India. Here we report 8 cases of rhinoentomophthoromycosis caused by Conidiobolous coronatus and 7 cases of chronic subcutaneous phycomycosis caused by Basidiobolus ranarum. Cases were detected during a span of 9 years between 1991 to 1999, from 9 districts in and around Kolkata (Eastern India). Former type of lesions were detected among 20 to 65 age group of healthy individuals, predominantly males (7:1). In the latter type, male-female ratio was 2:5, and except for one all cases belonged to below 20 years age group of healthy individuals. Several cases were detected only after examination of repeat biopsy samples. With high degree of clinical suspicion, right approach is needed for laboratory confirmation of diagnosis.

Distribution, occurrence and characterization of entomopathogenic fungi in agricultural soil in the Palestinian area

The occurrence of entomopathogenic fungi was investigated in irrigated vegetable fields and citrus orchards soils, over a nine-month period (April-December 1999), using the Galleria bait method (GBM). Entomopathogenic fungi were found to occur in 33.6% of the soil samples studied, with positive samples yielding 70 fungal isolates, belonging to 20 species from 13 genera. Conidiobolus coronatus was the most frequent and abundant entomopathogenic species recovered, comprising 31.4% of the total number of isolates. Soil pH, soil moisture content and the geographical location had minor or no effect on the isolation of entomopathogenic fungi in the fields studied. On the other hand, organic matter content of soil, and vegetation type were found to significantly affect the occurrence of entomopathogenic fungi in soil habitats, with orchard fields yielding larger numbers of isolates than vegetable fields. Using Koch's postulates the pathogenicity of fungal isolates to Galleria larvae was found to range from 16-100% (mortality rate). Isolates of C. coronatus proved to be the most virulent isolates recovered. The effect of media and temperature on mycelial growth rate, conidial production and conidial germination of six entomopathogenic fungal species (C. coronatus, Entomophaga grylli, Erynia castrans, Hirsutella jonesii, Paecilomyces farinosus and Sporodiniella umbellata) was also studied. Mycelial growth rate, spore production and spore germination were significantly affected by media, temperature and isolates. In view of the present results, C. coronatus appears to be a good candidate for pest control in agricultural soils, as it has a wide tolerance to agricultural practices, has frequently been isolated from both vegetable and orchard fields, and is characterized by high mycelial growth rate, conidial production and conidial germination.

Orofacial conidiobolomycosis due to Conidiobolus incongruus

We report here a patient of orofacial conidiobolomycosis presenting with classical centrofacial distribution described typically for Conidiobolus coronatus infection. The culture, however, showed C. incongruus. The mode of infection and its possible correlation with patient's occupation is also discussed.

Zoosporic and conidial fungi within the Podlasie stretch of the river bug

Zoosporic and conidial fungi species and environmental factors in 5 various sites of the Podlasie stretch of the river Bug were studied. Samples of water were collected in October 1999 and April 2000 for hydrochemical analysis and the order to determine the number of fungal species. Buckwheat-seeds, hemp-seeds, cellophane and snake exuviae were used as bait during the exposure in laboratory. Sixty-four zoosporic fungus species and forty-six conidial species were found in various sites of the Podlasie stretch of the river Bug. 8 species were recorded for the first time from Poland.

Further studies on aquatic fungi in the River Narew within the Narew National Park

Zoosporic and conidial fungi species and environmental factors in 10 various sites of River Narew in the Narew National Park were studied. Samples of water were collected in autumn 1999 and spring 2000 for hydrochemical analysis and the order to determine the number of fungal species. Buckwheat-seeds, hemp-seeds, cellophane and snake exuviae were used as bait during the exposure in laboratory. 198 lower aquatic fungus species were found in various sites of River Narew. 13 species were recorded for the first time from Poland.

Zygomycosis due to Conidiobolus coronatus in west Bengal

Zygomycosis of upper respiratory tract, caused by Conidiobolus coronatus, in eight Bengalee males and one female is described. The clinical syndrome of the cases included initial coryza, epistaxis, intranasal tumor, nasal obstruction, broadening of bridge of nose with swelling of paranasal sinuses, dorsum of nose, alae nasi, cheek and glabella in all or majority of the cases. In addition upper lip or both lips and pharynx were involved in some cases. Swellings were fixed to the skin in seven cases and to the deeper tissues in five cases. The fungus was demonstrated by direct microscopy in the nasal mucosa, and was isolated in culture. The isolates produced conidia, replicative conidia and villose conidia but not multiplicative conidia. The disease was cured with KI and/or ketoconazole/fluconazole. The cases described here constitute the first report on zygomycosis due to C. coronatus from North-eastern India.