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Antunes-Duarte S, Marcos-Pinto A, Ferreira J, Soares-de-Almeida L, Filipe P. Rhinoentomophthoromycosis: A cause of central face disfigurement. Int J Dermatol 2023; 62:562-564. [PMID: 36183330 DOI: 10.1111/ijd.16436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/03/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sofia Antunes-Duarte
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, E.P.E., Lisbon, Portugal
| | - Ana Marcos-Pinto
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, E.P.E., Lisbon, Portugal
| | - João Ferreira
- Micology Laboratory, Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, E.P.E., Lisbon, Portugal
| | - Luís Soares-de-Almeida
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, E.P.E., Lisbon, Portugal.,Unit of Research in Dermatology, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Paulo Filipe
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, E.P.E., Lisbon, Portugal.,Unit of Research in Dermatology, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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2
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Acosta-España JD, Voigt K. An old confusion: Entomophthoromycosis versus mucormycosis and their main differences. Front Microbiol 2022; 13:1035100. [PMID: 36406416 PMCID: PMC9670544 DOI: 10.3389/fmicb.2022.1035100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Fungal diseases were underestimated for many years. And the global burden of fungal infections is substantial and has increased in recent years. Invasive fungal infections have been linked to several risk factors in humans which basically depend on the individual homeostasis of the patients. However, many fungi can infect even apparently healthy people. Knowledge of these pathogens is critical in reducing or stopping morbidity and/or mortality statistics due to fungal pathogens. Successful therapeutic strategies rely on rapid diagnosis of the causative fungal agent and the underlying disease. However, the terminology of the diseases was updated to existing phylogenetic classifications and led to confusion in the definition of mucormycosis, conidiobolomycosis, and basidiobolomycosis, which were previously grouped under the now-uncommon term zygomycosis. Therefore, the ecological, taxonomic, clinical, and diagnostic differences are addressed to optimize the understanding and definition of these diseases. The term "coenocytic hyphomycosis" is proposed to summarize all fungal infections caused by Mucorales and species of Basidiobolus and Conidiobolus.
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Affiliation(s)
- Jaime David Acosta-España
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology – Hans Knöll Institute, Jena, Germany,Institute of Microbiology, Friedrich Schiller University Jena, Jena, Germany,Postgraduate Program in Infectious Diseases, School of Medicine, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Kerstin Voigt
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology – Hans Knöll Institute, Jena, Germany,Institute of Microbiology, Friedrich Schiller University Jena, Jena, Germany,*Correspondence: Kerstin Voigt,
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3
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Varghese L, Kurien R, Diana Sahni R, Manesh A, Mary Cherian L, Peter D, Dayanand D, Sarojini Michael J, Thomas M, Rupa V, Pulimood S, Varghese GM. Rhinofacial conidiobolomycosis: Clinical and microbiological characterisation and shift in the management of a rare disease. Mycoses 2021; 64:882-889. [PMID: 33915007 DOI: 10.1111/myc.13294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Conidiobolomycosis is a rare tropical rhinofacial fungal infection which has not been well characterised. The available evidence in its management is sparse due to lack of clinical studies and the limited data on antifungal susceptibility patterns. OBJECTIVE To analyse the clinical manifestations, antifungal treatment and outcomes of patients with conidiobolomycosis and to determine antifungal susceptibility profiles of the isolates. PATIENTS/METHODS Retrospective analysis of data of all patients with a diagnosis of conidiobolomycosis confirmed by histopathology and culture at a tertiary care hospital from 2012 to 2019 was done. RESULTS There were 22 patients, 21 males and one female, with a mean age of 37.1 years. Most common presenting symptom was nasal obstruction, found in 20 (90.90%) patients. Patients who presented within 12 months had a better cure rate (85%) compared to those who presented late (67%). Among the 19 patients who had a follow-up, good outcome was seen in 15 of the 17 (88.24%) patients who were on itraconazole or potassium iodide containing regimen. Of the six patients who received additional trimethoprim-sulphamethoxazole (co-trimoxazole), 67% showed good outcome with two patients showing complete cure and two patients still on treatment with significant improvement. High minimum inhibitory concentration (MIC) values were noted for azoles and amphotericin B, whereas co-trimoxazole showed lowest MIC ranges. CONCLUSION Itraconazole and potassium iodide are reasonable first-line options for the treatment of conidiobolomycosis. Good clinical response to KI and comparatively lower MIC of co-trimoxazole are promising. Further studies are required for developing clinical breakpoints that can predict therapeutic outcomes.
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Affiliation(s)
- Lalee Varghese
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - Regi Kurien
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - Rani Diana Sahni
- Department of Microbiology, Christian Medical College, Vellore, India
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Lisa Mary Cherian
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - Dincy Peter
- Department of Dermatology, Christian Medical College, Vellore, India
| | - Divya Dayanand
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | | | - Meera Thomas
- Department of Pathology, Christian Medical College, Vellore, India
| | - V Rupa
- Department of Otorhinolaryngology, Christian Medical College, Vellore, India
| | - Susanne Pulimood
- Department of Dermatology, Christian Medical College, Vellore, India
| | - George M Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, India
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Sigera LSM, Janappriya GHDC, Lakshan MTD, Pitigalage NJ, Jayasekera PI, Dayasena RP, Patabendige CGUA, Gunasekera CN. Rhinofacial Conidiobolomycosis: A Case Series and Review of the Literature. EAR, NOSE & THROAT JOURNAL 2020; 100:835S-841S. [PMID: 32204618 DOI: 10.1177/0145561319892475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Conidiobolomycosis is an uncommon, chronic, localized subcutaneous mycosis primarily affecting rhinofacial region. It is reported mainly from tropical and subtropical countries. The condition is underreported due to the lack of clinical suspicion and usually mismanaged. This rare mycosis is due to the genus Conidiobolus within the order Entomophthorales of class Zygomycetes. Here we present 3 cases of rhinofacial conidiobolomycosis in otherwise healthy adults from different parts of Sri Lanka over 1-year period. All patients had disfiguring subcutaneous lesions in the rhinofacial area. The diagnoses were based on isolation of Conidiobolus coronatus in clinical specimens.
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Affiliation(s)
- L S M Sigera
- Department of Mycology, Medical Research Institute, Colombo, Sri Lanka
| | | | | | | | - P I Jayasekera
- Department of Mycology, Medical Research Institute, Colombo, Sri Lanka
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5
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Conidiobolomycosis: An Unusual Fungal Disease-Our Experience. Indian J Otolaryngol Head Neck Surg 2019; 71:1821-1826. [PMID: 31763253 DOI: 10.1007/s12070-017-1182-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 08/12/2017] [Indexed: 10/19/2022] Open
Abstract
Conidiobolomycosis is a rare mycotic disease caused by Conidiobolus coronatus. Very few cases have been reported in English literature. Often it is clinically misdiagnosed as soft tissue tumour. A prospective case study was done from 2006 to 2015 in a tertiary care hospital of West Bengal, India. The objectives of our study were to describe the epidemiological and clinical features and treatment of Conidiobolomycosis to prevent disfigurement. Patients clinically suspected to be suffering from Conidiobolomycosis were subjected to biopsy followed by histopathological and mycological examinations. Then they were treated with oral saturated solution of potassium iodide along with other drugs. Total six cases were histopathologically proved to be suffering from Conidiobolomycosis. Fungus was isolated and identified in one case. Complete resolution was seen in five patients. Conidiobolomycosis should be brought into mind as differential diagnosis of subcutaneous swelling in the rhinofacial region.
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Thomas G, Thekkethil J, Koshy J, Thomas S. Rhinoentomophthoromycosis: An uncommon but not rare fungal infection of the nose. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2019. [DOI: 10.4103/jcrsm.jcrsm_27_19] [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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Dhurat R, Kothavade RJ, Kumar A. A first-line antiretroviral therapy-resistant HIV patient with rhinoentomophthoromycosis. Indian J Med Microbiol 2018; 36:136-139. [PMID: 29735845 DOI: 10.4103/ijmm.ijmm_16_330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Conidiobolus coronatus-related rhinoentomophthoromycosis in immunocompetent and immunocompromised (HIV negative) individuals has been treated successfully with antifungal drugs. However, C. coronatus infections in first-line antiretroviral therapy (ART)-resistant (HIV infected) individuals particularly with rhinoentomophthoromycosis have not been reported previously. Here, we describe a case of itraconazole non-responding rhinoentomophthoromycosis in an HIV-infected patient with first-line antiretroviral (ART) drug resistance which was successfully managed through systematic diagnostic and therapeutic approaches in dermatologic setting. A 32-year-old HIV-1-infected man presented with painless swelling, nasal redness and respiratory difficulty. The patient was receiving first-line ART and had a history of traumatic injury before the onset of nasopharyngeal manifestations. The patient's previous history included oral candidiasis and pulmonary tuberculosis.
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Affiliation(s)
- Rachita Dhurat
- Department of Dermatology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Rajendra J Kothavade
- Department of Medical Microbiology, Sepsis Research Group, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anand Kumar
- Department of Medical Microbiology, Sepsis Research Group, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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8
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Abstract
Entomopthoromycosis is a rare subcutaneous fungal infection caused by onidiobolus coronatus affecting mainly the upper respiratory mucosa in immunocompetent people.The manifestations of this disease masquerades other clinical entities.Hence, high index of suspicion is required for prompt diagnosis.Histopathological examination and culture are the gold standard diagnostic tools, however no standard treatment protocols ha been mentioned in literature.We present a case of rhinofacial entomopthoromycosis in a yearold ma with a leftsided rhinofacial swelling to highlight the presence of this unusual fungal infection and its treatment.
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Affiliation(s)
- Shalini Menon
- Head and Neck surgery, Kasturba Medical College, Manipal, India
| | - Kailesh Pujary
- Head and Neck surgery, Kasturba Medical College, Manipal, India
| | - Ranjini Kudva
- Department of Pathology, Kasturba Medical College, Manipal, India
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9
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Vascular sinonasal lesions. How useful is radiology in the diagnosis of rare lesions? Braz J Otorhinolaryngol 2016; 86:255-260. [PMID: 27256034 PMCID: PMC9422458 DOI: 10.1016/j.bjorl.2016.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/18/2016] [Accepted: 04/27/2016] [Indexed: 12/02/2022] Open
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10
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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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11
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Orofacial infection by Conidiobolus coronatus. BIOMEDICA 2016; 36:15-22. [PMID: 27622620 DOI: 10.7705/biomedica.v36i2.2806] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 09/07/2015] [Indexed: 11/21/2022]
Abstract
Entomophtoramycosis is a type of subcutaneous mycosis which includes both basidiobolomycosis and conidiobolomycosis; the latter is caused by Conidiobolus coronatus, a saprophytic fungus which lives in tropical soils. This mycosis characteristically affects the paranasal sinuses and oropharynx, with the potential to deform the face in patients without apparent immunodeficiency. It has a chronic course of infection with a tendency to form granulomas visible using histology. We present the case of a 28 year-old male agricultural worker, with a clinical profile of 6 months' evolution of rhinofacial tumefaction, nasal obstruction and post-nasal drip who was diagnosed with conidiobolomycosis by means of tissue culture after multiple biopsies of the facial area. The patient received antifungal treatment with amphotericin B and subsequently with itraconazol, resulting in a dramatic improvement without the need for surgical treatment; itraconazol was administered for one year and there was no evidence of relapse at the end of this period. Due to the low frequency of this disease there is no established treatment strategy; however, the use of azoles such as itraconazol with or without adjuvant surgical treatment is increasingly seen in case reports. The present report adds to the clinical experience in Colombia of this rare mycosis and also describes the long-term clinical and therapeutic response.
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12
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Hamid ME, Joseph MRP, Al-Qahtani AS. Chronic rhinofacial basidiobolomycosis caused by Basidiobolus ranarum: Report of a case from Aseer Region, Kingdom of Saudi Arabia. J Mycol Med 2015; 25:306-9. [PMID: 26482354 DOI: 10.1016/j.mycmed.2015.09.001] [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: 06/08/2015] [Revised: 08/22/2015] [Accepted: 09/11/2015] [Indexed: 10/22/2022]
Abstract
We present a case of fungal sinusitis caused by Basidiobolus ranarum in a 22-year-old male patient with chronic rhinosinusitis in Aseer region, Kingdom of Saudi Arabia. The patient was admitted with nasal obstruction accompanied by itching, sneezing, rhinorrhea, epistaxis and recurrent headache. Axial computed tomography (CT) scan of the paranasal sinuses showed a clear left facial swelling chronic inflammation and granulomata. Basidiobolus ranarum fungus was isolated on Sabouraud dextrose agar from a biopsy specimen. The organism was characterized by flat, yellowish-grey, glabrous, becoming radially folded fungus that under the microscope showed broad vegetative hyaline hyphae that bear zygospores with protuberances. The patient made good recovery and was discharged home with no recurrences after receiving oral itraconazole and removal of the polyps surgically.
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Affiliation(s)
- M E Hamid
- College of Medicine, King Khalid University, Abha, Aseer 61314, Saudi Arabia.
| | - M R P Joseph
- College of Medicine, King Khalid University, Abha, Aseer 61314, Saudi Arabia
| | - A S Al-Qahtani
- College of Medicine, King Khalid University, Abha, Aseer 61314, Saudi Arabia
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Bhat RM, Monteiro RC, Bala N, Dandakeri S, Martis J, Kamath GH, Kambil SM, Asha Vadakayil R. Subcutaneous mycoses in coastal Karnataka in south India. Int J Dermatol 2015; 55:70-8. [PMID: 26267755 DOI: 10.1111/ijd.12943] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 10/27/2014] [Accepted: 12/03/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Subcutaneous mycoses are chronic, localized infections of the skin and subcutaneous tissue which occur following traumatic implantation of the etiological agent. The causative organisms are soil saprophytes of regional epidemiology with varying ability to adapt to the tissue environment and elicit disease. OBJECTIVES This study was conducted to evaluate the various types of subcutaneous mycoses, including actinomycotic mycetomas, in south coastal Karnataka, India. METHODS Between January 2005 and January 2013, a total of 25 patients were diagnosed with subcutaneous mycoses based on a detailed clinical history and presentation, histopathology, and culture of organisms. RESULTS Chromoblastomycosis was the infection most commonly seen (n = 16 patients, 64%), followed by mycetoma (n = 4, 16%), sporotrichosis (n = 4, 16%), and rhinoentomophthoromycosis (n = 1, 4%). The extremities were the most common site of involvement, with the lower limb being most affected (64%). Males were more commonly afflicted (64%) than females (36%). Most patients were agricultural workers, although preceding trauma was noted in only three patients. The majority of patients responded well to therapy and were disease-free on follow-up. CONCLUSIONS Subcutaneous mycoses are a rare group of disorders. Chromoblastomycosis is the most frequent subcutaneous fungal infection in south India. Morphologically, chromomoblastomycoses present as verrucous, ulcerative, nodular, or eczematous lesions. Clinical diagnosis is important as culture is often negative. The incidence of infection is higher among rubber tappers. It is important to clinically differentiate chromoblastomycosis from tuberculosis verrucosa cutis. Most of the subcutaneous mycoses respond well to treatment, with the exception of rhinoentomophthoromycosis, which is a rare form of deep mycosis with associated mutilation. Eumycetomas are not observed in this part of India.
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Affiliation(s)
- Ramesh M Bhat
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India
| | - Rochelle C Monteiro
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India
| | - Nandakishore Bala
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India
| | - Sukumar Dandakeri
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India
| | - Jacintha Martis
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India
| | - Ganesh H Kamath
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India
| | - Srinath M Kambil
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India
| | - Ramay Asha Vadakayil
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India
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Gupta M, Narang T, Kaur RJ, Manhas A, Saikia UN, Dogra S. A prospective case series evaluating efficacy and safety of combination of itraconazole and potassium iodide in rhinofacial conidiobolomycosis. Int J Dermatol 2015; 55:208-14. [PMID: 26234812 DOI: 10.1111/ijd.12966] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 01/03/2015] [Accepted: 01/05/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rhinofacial conidiobolomycosis (RFC) is an uncommon subcutaneous fungal infection producing painless swelling with grotesque deformity of the face. Although there are case reports and small case series; there are very few prospective studies evaluating treatment outcome and long-term follow-up. OBJECTIVE To evaluate the safety and efficacy of combination of itraconazole (200 mg twice daily) and saturated solution of potassium iodide (SSKI) in patients with RFC. METHODS Ten patients of RFC were studied over a period of 5 years. Diagnosis was confirmed by clinical, histopathological, and microbiological evaluation. Conidiobolus was cultured in four cases and in the rest of the cases, the histopathology was suggestive of RFC. They were treated with itraconazole (200 mg twice daily) and SSKI and followed up for a minimum of 1 year after stopping treatment. RESULTS The mean age was 38.7 years and the mean duration of symptoms was 22.4 months. Males were predominantly involved (9 : 1). Seven patients responded to the combination treatment, five had complete resolution and two had good improvement (50-75%); however, in two patients the response was minimal (<25% regression of the swelling) and one patient did not show any improvement after 6 months of treatment. CONCLUSION Combination of itraconazole and SSKI is an effective treatment modality for RFC with relatively faster onset of action, low relapse rates, and minimal adverse effects. It can be considered as first-line treatment in patients with RFC.
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Affiliation(s)
- Manish Gupta
- Department of ENT, Gian Sagar Medical College & Hospital, Banur District, Patiala, Punjab, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rupinder Jeet Kaur
- Department of Pathology, Gian Sagar Medical College & Hospital, Banur District, Patiala, Punjab, India
| | - Ashwani Manhas
- Department of Microbiology, Gian Sagar Medical College & Hospital, Banur District, Patiala, Punjab, India
| | - Uma Nahar Saikia
- Department of Histopathology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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El-Shabrawi MHF, Arnaout H, Madkour L, Kamal NM. Entomophthoromycosis: a challenging emerging disease. Mycoses 2014; 57 Suppl 3:132-7. [PMID: 25319641 DOI: 10.1111/myc.12248] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/27/2014] [Accepted: 03/04/2014] [Indexed: 11/29/2022]
Abstract
Entomophthoromycosis is a rare fungal infection that may affect immunocompetent hosts; predominantly in tropical and subtropical regions. Recently, the importance of this emerging mycosis has increased and the scope of its manifestations has been expanded. These manifestations; however, may masquerade as other clinical entities. Prompt diagnosis of this infection requires a high index of suspicion. Although histopathological examination and cultures are the gold standard diagnostic tools; molecular diagnosis is now available and started to play an important role. The cornerstone treatment is prolonged anti-fungal therapy along with surgical debridement. More awareness of this mycosis is warranted for definitive diagnosis and implementation of early proper therapeutic strategies.
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Chakravarti A, Mishra M. A Rare Case of Rhinofacial Zygomycosis due to Conidiobolus Infection. ACTA ACUST UNITED AC 2014. [DOI: 10.5005/jp-journals-10003-1155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Background
Rhinofacial zygomycosis is the infection of subcutaneous tissues of maxillofacial region caused by zygomycetes class of fungi. It is commonly caused by the order mucorales and is acute and fulminant. Infections by the order entomophthorales are rare but indolent.
Case report
We report an unusual case of rhinofacial zygomycosis due to Conidiobolus coronatus of the order Entomophthorales in an immunocompetent adult male to highlight the clinical presentation, diagnosis and treatment. We treated the patient with multiple drugs, that is amphotericin-B, cotrimoxazole, and itraconazole along with endoscopic debridement of nasal polyps with excellent result.
Conclusion
Rhinofacial zygomycosis due to entomophthorales is rare but treatable condition. Appropriate histopathological diagnosis and a multipronged approach with timely medical as well as surgical management is the key to clinical cure.
How to cite this article
Chakravarti A, Mishra M. A Rare Case of Rhinofacial Zygomycosis due to Conidiobolus Infection. Int J Otorhinolaryngol Clin 2014;6(2):65-67.
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Chowdhary A, Randhawa HS, Khan ZU, Ahmad S, Khanna G, Gupta R, Chakravarti A, Roy P. Rhinoentomophthoromycosis due to Conidiobolus coronatus. A case report and an overview of the disease in India. Med Mycol 2010; 48:870-9. [PMID: 20482451 DOI: 10.3109/13693786.2010.486010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Rhinoentomophthoromycosis due to Conidiobolus coronatus is a rare, chronic, granulomatous disease, occurring mainly in tropical Africa, South and Central America and south-east Asia, including India. We report a case of rhinoentomophthoromycosis in a 30-year-old male farmer, a resident of Gorakhpur city in Uttar Pradesh, which was diagnosed by histopathology and isolation C. coronatus in culture. The patient presented with a swollen nose with obstruction that had progressed slowly over one year. His nasal swelling was bilateral, diffuse, mildly tender, erythematous, non-pitting, with mucosal crusting and hypertrophy of inferior turbinates but no regional lympha-denopathy. A contrast-enhanced computed tomography (CECT) scan revealed bilateral pan-sinusitis with nasoethmoid polyposis. Culture of tissue from the nasal biopsy on Sabouraud glucose agar yielded multiple colonies of a mold with satellite smaller colonies at periphery. The isolate demonstrated the macroscopic and microscopic morphologic characteristics of C. coronatus. Its identity was further confirmed by direct DNA sequencing of internal transcribed spacer (ITS) and D1/D2 regions of rDNA. Haemotoxylin and eosin stained tissue sections of the skin biopsy revealed irregular epidermal acanthosis, marked inflammatory and granulomatous reaction with sparse, non-septate hyphae. The patient was treated successfully with a combination therapy of oral saturated potassium iodide solution, itraconazole, and intravenous infusion of amphotericin B. An overview of rhinoentomophthoromycosis cases reported to-date in India is presented.
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Affiliation(s)
- Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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Bhat RM, Srinivas M, Sequeira F, Sukumar D, Swethadri GK. Rhinoentomophthoromycosis with mutilation. Clin Exp Dermatol 2009; 35:501-4. [DOI: 10.1111/j.1365-2230.2009.03687.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nasofacial Entomophthoromycosis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2009. [DOI: 10.1097/ipc.0b013e31816fd5b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Boabaid FM, Ferreira EV, Arruda LPD, Gasparetto ND, Souza RLD, Silva MCD, Dutra V, Nakazato L, Colodel EM. Conidiobolomicose em ovinos no Estado de Mato Grosso. PESQUISA VETERINARIA BRASILEIRA 2008. [DOI: 10.1590/s0100-736x2008000100012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Relatam-se os achados epidemiológicos, clínicos, patológicos e micológicos de conidiobolomicose em ovinos no Estado de Mato Grosso. A doença ocorreu em uma propriedade no município de Nobres, em um rebanho com 40 ovelhas adultas, entre os meses de janeiro a junho de 2007. Aproximadamente 30% dos ovinos da propriedade adoeceram e todos os doentes morreram em curso clínico de 2-5 semanas. O quadro clínico foi caracterizado por apatia, emagrecimento, dificuldade respiratória com dispnéia, respiração ruidosa e oral, secreção nasal mucosa ou sero-sanguinolenta, exoftalmia unilateral, por vezes com cegueira, e morte. Havia desaparecimento de etmoturbinados com substituição por tecido bran-cacento, finamente granular, multilobulado e friável infil-trando-se na lâmina cribiforme, no septo nasal e nas coa-nas em todos os ovinos necropsiados. Lesões similares foram encontradas em linfonodos regionais (2 casos), pulmões (3), encéfalo (2) e em linfonodos do abomaso (1). Microscopicamente havia inflamação granulomatosa da região rinocerebral, caracterizada por necrose, proliferação de tecido conjuntivo, infiltrado de neutrófilos, eosinófilos, células epitelióides e células gigantes multinucleadas freqüentemente circundando material Splendori-Hoeppli, onde havia imagens negativas de hifas. Na impregnação pela Prata-Metenamina, as hifas tinham septos e ramificações escassas e irregulares, com dilatação balonosa terminal e com forte demarcação de contornos. Iso-lou-se de tecido nasal de quatro ovinos Conidiobolus sp.
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Hernandez MJ, Landaeta W, Salazar BN, Vargas J, Rodriguez-Morales AJ. Subcutaneous zygomycosis due to Conidiobolus incongruus. Int J Infect Dis 2007; 11:468-70. [PMID: 17331786 DOI: 10.1016/j.ijid.2007.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Revised: 12/21/2006] [Accepted: 01/03/2007] [Indexed: 01/19/2023] Open
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