Soft tissue infection with Absidia corymbifera in a patient with idiopathic aplastic anemia

Diversity of Fungi Isolated from Potato Nematode Cysts in Guizhou Province, China

Potatoes rank third in terms of human consumption after rice and wheat. Globodera spp. are significant pests of potato crop worldwide. Globodera rostochiensis was found in Weining County, Guizhou Province, China, in 2019. We collected soil from the rhizosphere zone from infected potato plants and separated mature cysts through simple floatation and sieving methods. The selected cysts were surface-sterilized, and the colonized fungi were isolated and purified. At the same time, the preliminary identification of fungi and fungi parasites on the cysts of nematodes was carried out. This study aimed to define the species and frequency of fungi-colonizing cysts of G. rostochiensis collected from Weining County, Guizhou Province, China, and provide a basis for the control of G. rostochiensis. As a result, 139 strains of colonized fungi were successfully isolated. Multigene analyses showed that these isolates included 11 orders, 17 families, and 23 genera. The genera Fusarium (with a separation frequency of 59%), Penicillium (11%), Edenia (3.6%), and Paraphaeosphaeria (3.6%) were the most frequently occurring. Among the 44 strains, 27 had a colonization rate of 100% on the cysts of G. rostochiensis. Meanwhile, the functional annotation of 23 genera indicated that some fungi have multitrophic lifestyles combining endophytic, pathogenic, and saprophytic behavior. In conclusion, this study showed the species composition and lifestyle diversity of colonized fungi from G. rostochiensis and demonstrated these isolates as potential sources of biocontrol agents. Colonized fungi were isolated from G. rostochiensis for the first time in China, and the taxonomic diversity of fungi from G. rostochiensis was clarified.

A Rare Fungal Orbital Infection in an Immunocompetent Young Male Caused by Lichtheimia corymbifera (Absidia corymbifera)

AIM

To present a case of orbital fungal infection caused by a rare fungus, Lichtheimia corymbifera (Absidia corymbifera) in an immunocompetent individual.

MATERIALS AND METHODS

A retrospective case study.

RESULT

A 23-year-old male presented with painful proptosis of the right eye for 3 months. Examination revealed normal vision and pupillary light reflex but restricted ocular movements in the right eye. A tender, firm mass was palpable along the inferomedial quadrant of the right orbit. He had acute worsening of proptosis with loss of light perception within 24 hours. Magnetic resonance imaging (MRI) showed a heterogeneously enhancing lesion in the right orbit. Urgent incisional biopsy revealed the growth of Absidial fungal infection. He received intravenous Amphotericin B for 2 weeks with no response. Repeat MRI revealed an extension of the infection up to the cavernous sinus and intracranial optic nerve. He was managed by subtotal exenteration, socket irrigation with Amphotericin B, and intravenous Amphotericin B.

CONCLUSION

Invasive orbital fungal infection, though rare, should be considered a differential diagnosis in immunocompetent patients with fulminant proptosis and vision loss.

Invasive Fungal Infection with Absidia Corymbifera in Immunocompetent Patient with Electrical Scalp Burn

Invasive fungal infection in burn injury is caused by inoculation of fungal spore from patient skin, respiratory tract or from care giver. The risk factors for acquiring fungal infection in burns include age of burns, total burn size, full thickness burns, inhalational injury, prolonged hospital stay, late surgical excision, open dressing, central venous catheters, antibiotics, steroid treatment, long-term artificial ventilation, fungal wound colonization, hyperglycemic episodes and other immunosuppressive disorders. Invasive fungal infection with Absidia corymbifera is rare opportunistic infection encountered in patient with burn injury. The key for treatment is early clinical diagnosis, wide and repeated debridement and systemic and local antifungal treatment. We describe a case of invasive fungal infection with A. corymbifera in a patient with post-electrical scalp burn with late presentation after 10 days of injury in an immunocompetent patient.

Molecular Identification of Mucor and Lichtheimia Species in Pure Cultures of Zygomycetes

Background

The Mucorales are an important opportunistic fungi that can cause mucormycosis in immunocompromised patients. The fast and precise diagnosis of mucormycosis is very important because, if the diagnosis is not made early enough, dissemination often occurs. It is now well established that molecular methods such as polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) are feasible and reliable tools for the early and accurate diagnosis of mucormycosis agents.

Objectives

The present study was conducted to evaluate the validity of PCR-RFLP for the identification of Mucorales and some important Mucor and Lichtheimia species in pure cultures of Zygomycetes.

Materials and Methods

Specific sense and anti-sense primers were used to amplify the Mucorales, Mucor, and Lichtheimia DNA. The PCR products were digested by AfIII, XmnI, and AcII restriction enzymes, and the resultant restriction pattern was analyzed.

Results

On the basis of the molecular and morphological data, we identified Mucor plumbeus (10.83%), M. circinelloides (9.17%), Lichtheimia corymbifera (9.17%), M. racemosus (5.83%), M. ramosissimus (3.33%), and L. blakesleeana (0.83%).

Conclusions

It seems that PCR-RFLP is a suitable technique for the identification of Mucorales at the species level.

Prevalence and risk factors for skin diseases among antiretroviral-naïve HIV-infected pregnant women in Dar es Salaam, Tanzania

BACKGROUND

Reduced cell-mediated immunity associated with pregnancy may cause a flaring or exacerbation of some skin conditions. Little is known about the magnitude of and risk factors for skin diseases among human immunodeficiency virus (HIV)-infected antiretroviral therapy-naïve pregnant women.

METHODS

Cross-sectional study of 1078 HIV-infected antiretroviral therapy-naïve pregnant women was conducted in Dar es Salaam, Tanzania. Skin diagnoses were mainly clinical. Log-binomial regression models were used to explore factors associated with the outcomes.

RESULTS

About 84% of the women were in World Health Organization (WHO) HIV stage I. Median CD4(+) count was 405 × 10(6)  cells/l. The prevalence of any skin disease was 18%. Fungal infections (11%), genital ulcers (7%), and viral infections (5%) were the most common skin conditions. Skin infections were 2.64 times more common in HIV stage III (95% CI 1.51-4.62) compared to stage I. Fungal infections were 1.77 times common among single, divorced, and widowed women than among married women (95% CI 1.16-2.69), 2.8 times common among women in HIV stage III (95% CI 1.18-6.64) compared to stage I. Genital ulcers were significantly more common among women whose source of income was their own compared with those who got full support from partners, and among WHO HIV stage III disease compared to stage I.

CONCLUSION

The burden of skin diseases was relatively low. Advanced HIV stage was associated with a range of skin conditions. CD4(+) cell count was not related to skin infection prevalence.

Mucormycosis in immunochallenged patients

Mucorales species are deadly opportunistic fungi with a rapidly invasive nature. A rare disease, mucormycosis is most commonly reported in patients with diabetes mellitus, because the favorable carbohydrate-rich environment allows the Mucorales fungi to flourish, especially in the setting of ketoacidosis. However, case reports over the past 20 years show that a growing number of cases of mucormycosis are occurring during treatment following bone marrow transplants (BMT) and hematological malignancies (HM) such as leukemia and lymphoma. This is due to the prolonged treatment of these patients with steroids and immunosuppressive agents. Liposomal amphotericin B treatment and posaconazole are two pharmacologic agents that seem to be effective against mucormycosis, but the inherently rapid onset and course of the disease, in conjunction with the difficulty in correctly identifying it, hinder prompt institution of appropriate antifungal therapy. This review of the literature discusses the clinical presentation, diagnosis, and treatment of mucormycosis among the BMT and HM populations.

Molecular diagnosis of Saksenaea vasiformis cutaneous infection after scorpion sting in an immunocompetent adolescent

We report the first case of cutaneous mucormycosis after a scorpion sting in Tunisia. Histopathology showed broad aseptate hyphae suggestive of a Zygomycete. Saksenaea vasiformis was identified by PCR amplification and sequencing of the fungal DNA on a cutaneous biopsy. Successful treatment was obtained by surgery and liposomal amphotericin B.

Imagerie des formes viscérales graves de la mucormycose chez 5 patients immunodéprimés

OBJECTIVES

Show the contribution of imaging to the diagnosis and follow-up of serious mucormycosis in immunodepressed patients.

MATERIALS AND METHODS

Retrospective analysis of the 5-year radiological data in serious forms of mucormycosis occurring in patients with bone marrow allografts who are in refractory chronic graft-versus-host disease after bone marrow transplantation from 2002 to 2005. The positive diagnosis was bacteriologically and pathologically positive in all cases.

RESULTS

This study involved three patients with isolated pulmonary involvement and two cases of disseminated mucormycosis. Areas of pulmonary condensations were found in all cases, one of whom had a low-attenuation zone and parenchymal nodules. The kidney, liver, and spleen lesions were clearly limited, hypoechogenic, hypodense, and homogenous with no peripheral contrast material uptake. There was thyroid involvement in the form of hypoechogenic nodules. Rapid growth of the lesions was observed on follow-up CT (n=3) and despite surgical treatment (n=2) and intensive medical management, all cases ended in death.

CONCLUSION

Mucormycosis is an integral part of the differential diagnosis of infectious syndromes in immunodepressed patients during the period after bone marrow transplantation. Imaging can assist in the diagnosis but pathological confirmation remains indispensable.

Post-traumatic and post-surgical Absidia corymbifera infection in a young, healthy man

Absidia corymbifera infection in a healthy individual is rare. Most of the infection occurs in immunocompromised patients or diabetic patients. Cutaneous and subcutaneous mucormycosis have been increasingly reported in the literature as a result of massive trauma with contaminated wounds. We present a case of cutaneous mucormycosis in a healthy, young patient after surgical amputation for a crush injury of the leg. We also highlight the importance of the high index of clinical suspicion in the diagnosis and treatment of this fungal infection in the hype of methicillin-resistant Staphylococcus aureus (MRSA) infection in hospital setting these days. Despite an initial life-saving amputation, it was inadequate to ensure the eradication of A. corymbifera infection. A second amputation was required with parenteral liposomal amphotericin B to achieve a satisfactory cure.

Cardiac mucormycosis in a child with severe aplastic anemia: a case report

Mucormycosis is an uncommon, severe, life-threatening fungal infection in the immunocompromised host. Mucormycosis with aplastic anemia is seen rarely. Only a few cases of cardiac mucormycosis with aplastic anemia have been reported in the literature. The authors present a case with severe aplastic anemia that did not respond to classic and immunosuppressive treatment for disease and developing invasive cardiac mucormycosis despite empiric treatment for febrile neutropenia.

Epidemiology and outcome of zygomycosis: a review of 929 reported cases

BACKGROUND

Zygomycosis is an increasingly emerging life-threatening infection. There is no single comprehensive literature review that describes the epidemiology and outcome of this disease.

METHODS

We reviewed reports of zygomycosis in the English-language literature since 1885 and analyzed 929 eligible cases. We included in the database only those cases for which the underlying condition, the pattern of infection, the surgical and antifungal treatments, and survival were described.

RESULTS

The mean age of patients was 38.8 years; 65% were male. The prevalence and overall mortality were 36% and 44%, respectively, for diabetes; 19% and 35%, respectively, for no underlying condition; and 17% and 66%, respectively, for malignancy. The most common types of infection were sinus (39%), pulmonary (24%), and cutaneous (19%). Dissemination developed in 23% of cases. Mortality varied with the site of infection: 96% of patients with disseminated disease died, 85% with gastrointestinal infection died, and 76% with pulmonary infection died. The majority of patients with malignancy (92 [60%] of 154) had pulmonary disease, whereas the majority of patients with diabetes (222 [66%] of 337) had sinus disease. Rhinocerebral disease was seen more frequently in patients with diabetes (145 [33%] of 337), compared with patients with malignancy (6 [4%] of 154). Hematogenous dissemination to skin was rare; however, 78 (44%) of 176 cutaneous infections were complicated by deep extension or dissemination. Survival was 3% (8 of 241 patients) for cases that were not treated, 61% (324 of 532) for cases treated with amphotericin B deoxycholate, 57% (51 of 90) for cases treated with surgery alone, and 70% (328 of 470) for cases treated with antifungal therapy and surgery. By multivariate analysis, infection due to Cunninghamella species and disseminated disease were independently associated with increased rates of death (odds ratios, 2.78 and 11.2, respectively).

CONCLUSIONS

Outcome from zygomycosis varies as a function of the underlying condition, site of infection, and use of antifungal therapy.

Hypodermite granulomateuse révélatrice d’une mucormycose chez une malade immunodéprimée

INTRODUCTION

Mucormycosis is an exceptional opportunist fungal infection, despite the ubiquitous nature of its pathogenic agents. It is sometimes revealed by primary cutaneous involvement and its prognosis is bad in the case of visceral dissemination. Our observation illustrates the need for early diagnosis and treatment of this infection.

OBSERVATION

An immunodepressed, 45 year-old woman, had developed necrotic hypodermitis lesions on the lower limbs. The skin biopsy led to the diagnosis of mucormycosis. Despite treatment with liposomal amphotericin, the fungal infection worsened, spread to the organs (lungs and brain) and the patient died.

DISCUSSION

This case report underlines the potential severity of mucormycosis, which is presently emerging in the onco-hematological field. The infection is sometimes revealed by inaugural ulcerated and/or necrotic cutaneous lesions. Its diagnosis must be evoked early so that salvage medical-surgical treatment can be initiated.

Wound infection due toAbsidiacorymbiferaandCandida albicanswith fatal outcome

A case of a mixed infection due to Candida albicans and the zygomycete Absidia corymbifera in a 38-year-old, previously healthy, Caucasian male is presented. The infection developed following serial rib fractures, and ruptures of kidney, liver and biliary tract as well as a pancreatic contusion resulting from a traffic accident. During intensive care treatment the patient underwent several surgical procedures but subsequently experienced multi-organ failure and sepsis. Some weeks later, fungal growth was observed macroscopically on the patient's skin and wounds. From wound swabs C. albicans and A. corymbifera were grown. Histopathology of abdominal tissue yielded pseudohyphae and coenocytic hyphae. Although surgical debridement and antifungal treatment with amphotericin B and 5-flucytosine were started immediately, the patient died in therapy-refractory septic multi-organ failure.