Facial and systemic mucormycosis caused by Lichtheimia corymbifera in a goat: case report and literature review of fungal infections in goats

An 8-y-old Pygora doe was presented to the University of California-Davis, Veterinary Medical Teaching Hospital because of non-healing facial swelling of 2-wk duration. The lesion grew despite medical treatment, causing discomfort masticating, little-to-no airflow from the right nasal passage, and led to euthanasia. On gross examination, a large facial mass with a draining tract through the skin and hard palate was identified. On section, the mass was brown-pink, homogeneous, and friable. Abscess-like masses were identified in the lungs and kidney. Histopathology of the face, including oral and nasal cavities, salivary glands, and lymph nodes, as well as the lung and kidney lesions, revealed large areas of necrosis with numerous wide ribbon-like, mostly aseptate, fungal hyphae consistent with zygomycetes. PCR for fungal organisms performed on formalin-fixed, paraffin-embedded tissue from the face identified Lichtheimia corymbifera (formerly Absidia corymbifera) of the order Mucorales and an Aspergillus sp. The lesion was suspected to have started either as a fungal rhinitis or dental feed impaction, subsequently spreading to the face and systemically to the lungs and kidney. We describe here the lesions associated with facial mucormycosis in a goat and present a literature review of L. corymbifera infection in veterinary species and fungal infections in goats.

Keratitis caused by Absidia corymbifera in an immunocompetent male with no corneal injuries

Case Report A healthy 55-years-old male went to emergency due to a white infiltrate in the left eye without corneal trauma which partially responds to antibiotic treatment. The infiltrate worsened by the use of topical steroids. Direct microscopic evaluation and Gram stain are a valuable diagnostic tool for the detection of Absidia filaments. There is a successful treatment with anphotericin and posaconazole. Discussion Keratitis caused by Zygomicetes are unusual. This is a rare condition in healthy patients with no corneal trauma. The treatment with amphotericin and posaconazole are synergistic against filamentous fungi.

A comparative characterization of indigenous keratinase enzymes from district Khairpur, Sindh, Pakistan

To isolate and characterize keratinolytic fungi and bacteria from indigenous soils, a total of 80 samples were collected from Ghari Mori District. Khairpur, and these organisms were isolated using standard microbiological technique. The isolated keratinolytic microorganisms comprised: Absidia sp., Chrysosporium asperatum, Chrysosporium keratinophilum, Entomophthora coronata, Bacillus subtilis and Staphylococcus aureus and their keratinolytic properties were distinguished from the production of keratinase by measurement of zone of hydrolysis on skimmed milk agar (p<0.05). C.keratinophylum and B. subtilis produced largest zone among all the isolated species. The crude keratinase revealed that the optimum time for production of the enzyme was seven days, optimum temperature 30°C and optimum pH 9 for C.keratinophylum but for B. subtilis, the optimum time was three days, optimum temperature 37°C and optimum pH 7. The enzyme activity of C. keratinophylum and B. subtilis were determined to be 220 U/ml and 260 U/ml respectively (P<0.05).

[Zygomycosis (mucormycosis) in patients with haematologic malignancy]

Zygomycosis is an invasive and increasingly emerging life-threatening infection. Diabetes is the most common risk factor; however, zygomycosis has increased among patients with haematologic malignancy, which is now the second most common risk factor with an incidence of 16%. Rapid diagnosis and treatment are essential for patient survival. In the Danish literature, only a few cases have been reported. We present two cases of zygomycosis, both with a fatal outcome, and we discuss the pathogenesis and treatment of invasive zygomycosis.

Antifungal activity of statins and their interaction with amphotericin B against clinically important Zygomycetes

The in vitro antifungal activity of different statins and the combinations of the two most effective ones (fluvastatin and rosuvastatin) with amphotericin B were investigated in this study on 6 fungal isolates representing 4 clinically important genera, namely Absidia, Rhizomucor, Rhizopus and Syncephalastrum . The antifungal effects of statins revealed substantial differences. The synthetic statins proved to be more effective than the fungal metabolites. All investigated strains proved to be sensitive to fluvastatin. Fluvastatin and rosuvastatin acted synergistically and additively with amphotericin B in inhibiting the fungal growth in clinically available concentration ranges. Results suggest that statins combined with amphotericin B have a therapeutic potential against fungal infections caused by Zygomycetes species.

Intraventricular amphotericin for absidiomycosis in an immunocompetent child

Brain abscesses are uncommon in children. We report a 3-year-old, previously healthy and immunocompetent boy, with an Absidia brain abscess. He presented with decreased sensorium and status epilepticus. The brain abscess was detected using cranial computed tomography and magnetic resonance imaging, and the diagnosis was confirmed with pus and brain tissue cultures. The patient responded to surgical drainage with concomitant intravenous and intraventricular amphotericin B.

Isolation and characterization of a strain of Lichtheimia corymbifera (ex Absidia corymbifera) from a case of bovine abortion

BACKGROUND

Lichtheimia corymbifera (previously Absidia corymbifera) is a filamentous zygomycetes belonging to the order Mucorales and to the family Lichtheimiaceae. Members of genus Lichtheimia spp. are cosmopolitan and ubiquitous in nature. Lichtheimia corymbifera is a recognized agent of diseases in man and animals. In cattle it causes abortion and mastitis. Three cases of bovine abortion occurred in a herd located in the Po Valley. Serological examinations were performed on fetal and mother's blood. One of the aborted fetus was referred to our laboratory. The paper describes the isolation and characterization of Lichtheimia corymbifera from a bovine aborted fetus.

METHODS

Serological examinations were performed on fetal and mother's blood. Lesions on fetal tissues and placenta leaded the diagnostic suspect towards a mycotic aetiology. Tissues were then put in culture, and at the same time an histological examination was performed, together with bacteriological and virological tests. The isolate from placenta and fetal tissues was identified and characterized by PCR and RFLP, using the ITS region as a target sequence and AclI restriction site within the amplicon to distinguish Lichtheimia corymbifera among the other fungi.

RESULTS

Serological, bacteriological and virological tests gave aspecific results. Histological examination evidenced numerous PAS positive hyphae within the necrotic cotiledons and numerous fungal nonseptate hyphae to the GMS stain. Colonies with typical morphological features of fungi grew up on Sabouraud agar from fetal skin and placenta. On the developed colonies the microscopic examination has shown a large number of nonseptate hyphae and sporangia consistent with Mucorales. PCR and RFLP allowed the identification of the isolate as Lichtheimia corymbifera.

CONCLUSION

The present report describes the isolation and the molecular characterisation of a fungal isolate from bovine aborted fetus and placenta. The diagnostic protocol allowed to identify and characterise the strain. This is the first isolation in Italy of Lichtheimia corymbifera in a bovine aborted fetus.

Acute refractory hyperkalaemia and fatal cardiac arrest related to administration of liposomal amphotericin B

A 36-year-old male with acute myeloid leukaemia was treated with liposomal amphotericin B for a breakthrough fungal infection with Absidia corymbifera during voriconazole and caspofungin therapy for invasive pulmonary aspergillosis. Four episodes of hyperkalaemia developed with a highly probable relation to infusion of liposomal amphotericin B, of which the last episode was characterised by severe, refractory hyperkalaemia and fatal cardiac arrest. The available literature on severe hyperkalaemia and cardiac arrest during administration of both conventional and liposomal amphotericin B is reviewed here and revealed only four similar cases. The most likely mechanism of toxicity is the release of potassium from a variety of mammal cells including erythrocytes and endothelial cells. Whether prevention of toxicity can be established by decreasing the infusion rate is unclear but conceivable.

A rare cutaneous fungal infection complicating bacterial necrotising fasciitis

We report a case of bacterial necrotising fasciitis complicated by the rare fungus Absidia corymbifera. Although this fungal infection is rare, the prognosis is poor and it therefore requires attention. Only 30 cases have been reported since 1874, and we are the first group to report this clinical scenario in our locality. Using a comprehensive journal review, we discuss the expected clinical course and optimal management.

Multiple discharging sinuses: An unusual presentation caused by Absidia corymbifera

A case of zygomycosis presenting with non-healing multiple discharging sinuses in a diabetic patient is reported here. The debrided tissue on histopathological examination revealed dense infiltration with aseptate fungal hyphae. Potassium hydroxide mount showed hyaline aseptate hyphae suggestive of zygomycosis. On culture, Absidia corymbifera was isolated. The patient responded to surgical debridement and therapy with amphotericin B followed by itraconazole.

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.

Rhinocerebral zygomycosis in a young girl undergoing allogeneic stem cell transplantation for severe aplastic anaemia

We report on a 10-year-old girl with severe aplastic anaemia who developed rhinocerebral infection caused by Absidia corymbifera and a possible co-infection caused by Alternaria alternata. Despite prolonged neutropenia, therapy with liposomal amphotericin B and posaconazole improved the clinical condition. Subsequently, the girl underwent allogeneic haematopoietic stem cell transplantation (HSCT) for the underlying disease, but the fungal infection remained under control with the antifungal treatment. No severe side effect of the antifungal drugs was noted. Unfortunately, the girl died 5 months after HSCT due to disseminated adenovirus infection.

Mucormycose pulmonaire chez un patient polytraumatisé

Mucormycosis are opportunist infections occurring usually among predisposed patients. We report a case of an 18-year-old male with a severe thoracic trauma who developed an Absidia infection on his contused pulmonary parenchyma, without presenting the usual risk factors (diabetes mellitus, immunodeficiency). The early diagnosis using bronchoscopy has probably improved the outcome by allowing a faster treatment. After 18-months, the infectious process resolved thanks to a combination of a medical treatment composed of high-dose amphotericin B lipid formulation, itraconazole and a complementary surgical treatment.

Zygomycosis in the immunocompromised patient: a case report

Zygomycosis is a highly aggressive infection observed in immunocompromised patients, such as those with haematological malignancies. The sites most frequently involved are the sinuses and the lungs. New diagnostic tools and new antifungal treatments are essential in order to diagnose early and treat efficiently infections due to moulds. We report a case of sinusitis due to Absidia corymbifera occurring during chemotherapy-induced bone marrow aplasia in a patient with acute leukaemia. The sinusitis was successfully treated with AmBisome, and surgical debridement.

Impact of agricultural practices on microbiology of hay, silage and flour on Finnish and French farms

Exposure to microorganisms in farm environments may cause respiratory disorders, e.g. asthma, organic dust toxic syndrome and allergic alveolitis. By reducing microbiological deterioration of organic materials, some agricultural practices have a protective effect. Microbiological analyses were carried out on hay, silage and flour samples (n=107) from farms in Finland and France (n=23) that use different methods of haymaking. High concentrations of Absidia corymbifera were found in approximately 35 % of French hay samples and only 10 % of Finnish hay samples. Concentrations of Eurotium spp. were found in 20 % of hay samples from both regions. High concentrations of Wallemia sebi typified Finnish hay (38 %) more than French hay (8 %). Rhodotorula yeast was frequently and abundantly found in Finland, but never in France. The method used to make hay appeared to be the main factor affecting the microbiology of the hay. A. corymbifera and Eurotium spp. concentrations were smaller in low-density square bales than in others. In conclusion, our results emphasize the importance of good agricultural practice in the microbiological quality of fodder.

Necrotizing (malignant) otitis externa: An unusual localization of mucormycosis

Malignant otitis externa (MOE) is a severe infection of external auditory canal and skull base. A 17-year-old diabetic girl was admitted with diabetic ketoacidosis. Cellulitis of her right ear occurred on the second day of hospitalization and a black necrotic scar in the same region appeared on the next day. The lesion rapidly invaded to right side of neck and surrounding tissue of the patient. Therefore, antimycotic therapy was started. Unfortunately the patient died on seventh day of hospitalization because of probably extensive fungal invasion. Physicians should suspect MOE connected to mucormycosis especially in patients with cutaneous lesions of ear unresponsive to antibiotic therapy.

[Abdominal zygomycosis in a bitch due to Absidia corymbifera]

We report a case of abdominal zygomicosis in a Doberman bitch. Clinical signs consisted of urinary incontinence and hard abdominal masses detected by palpation. The masses were surgically removed by exploratory laparatomy and had a tumoral-like appearance. A granulomatous reaction containing coarse and non septate hyphae was the main histological finding. Direct microscopic examination revealed the presence of fungal structures. On Sabouraud honey agar the fungus developed fluffy, greyish white colonies that were identified as Absidia corymbifera on the basis of their macro and microscopic morphology.

Fatal course of pulmonary Absidia sp. infection in a 4-year-old girl undergoing treatment for acute lymphoblastic leukemia

Absidia sp. is a rare etiologic agent responsible for infectious complications in immunosuppressed patients. The authors describe a 4-year-old girl with acute lymphoblastic leukemia complicated with pleuropneumonia caused by an Absidia infection during the induction of remission. A review of the published reports in current literature is included for comparison. To the authors' knowledge only six cases of primary pulmonary absidiomycosis have been published. Despite its uncommon pulmonary presentation, mucormycosis should be considered in patients with an immunosuppressing illness and positive risk factors and when a pulmonary lesion is not responding to appropriate antibiotic therapy.

Failure of voriconazole to cure disseminated zygomycosis in an immunocompromised child

Voriconazole is increasingly used as a first-line agent for empirical antifungal therapy of prolonged febrile neutropenia in paediatric cancer patients. We describe the case of a 9-year-old patient with stage IV Burkitt lymphoma, who developed pulmonary and splenic zygomycosis while receiving voriconazole for persistent febrile neutropenia. The causative agent, Absidia corymbifera, was identified by broad-range fungal PCR in a lung biopsy sample. The patient was successfully treated with a combination of partial resection of the left upper lobe and antifungal therapy with high-dose liposomal amphotericin B followed by oral itraconazole as demonstrated by resolving pulmonary infiltrates on serial high resolution CT scans.

CONCLUSION

This case emphasises that the lack of in vitro activity of voriconazole against zygomycetes is clinically relevant. Failure of voriconazole in suspected fungal infection should be investigated for the possibility of zygomycosis. Broad-range polymerase chain reaction may be able to identify the causative organism when cultures remain sterile.

Zygomycosis after prolonged use of voriconazole in immunocompromised patients with hematologic disease: attention required

We describe 4 cases of zygomycosis that occurred after prolonged use of voriconazole in severely immunocompromised patients with hematologic disease. An invasive infection was present in 3 patients who died soon after the diagnosis at 12, 13, and 45 days. Physicians should be mindful of this potential risk after treatment with voriconazole.

Evaluation of salting as a hay preservative against farmer's lung disease agents

Salting is a traditional, empirical practice used commonly in dairy farming regions to prevent moulding and heating in hay. Our aim was to evaluate the effect of salting hay on the proliferation of microorganisms, particularly thermophilic actinomycetes and moulds involved in farmer's lung disease. Fifty-one pairs of salted and unsalted hay bales from 14 farms were produced during the haymaking season between March and July. Both the salted and the unsalted bales came from the same field, and were packed and stored under identical conditions. Sampling was performed by microbiological analysis including 6 culture media during the winter following salting (January-February). The use of salt did not significantly decrease the amount of Saccharopolyspora rectivirgula , the actinomycetes most commonly involved in farmer's lung disease, or that of Absidia corymbifera, Eurotium amstelodami and Wallemia sebi , three moulds responsible for farmer's lung disease in eastern France. Our results are important in that they can inform farmers and dispel the false sense of security induced by salting, which is reinforced by the misconception that palatable hay is healthy hay.

Successful treatment of a primary cutaneous zygomycosis caused by Absidia corymbifera in a premature newborn

Mucormycosis (zygomycosis) normally occurs among individuals with predisposing factors such as prematurity, use of broad spectrum antibiotics, metabolic acidosis or advanced stages of immunosuppression. There have been reports of sporadic cases of cutaneous mucormycosis related to predisposing skin lesions and contact with contaminated material such as adhesive bandages and tongue depressors placed close to intravenous catheter insertion sites. We report successful treatment of a case of Absidia corymbifera infection with the combination of amphotericin B and surgical debridement of the affected area.

Effects of Fungal Bioaugmentation and Cyclodextrin Amendment on Fluorene Degradation in Soil Slurry

This study assesses the potential of fungal bioaugmentation and the effect of maltosyl-cyclodextrin amendment, as an approach to accelerate fluorene biodegradation in soil slurries. 47 fungal strains isolated from a contaminated site were tested in the biodegradation of fluorene. Results showed the greater efficiency of "adaptated" fungi isolated from contaminated soil vs. reference strains belonging to the collection of the laboratory. These assays allowed us to select the most efficient strain, Absidia cylindrospora, which was used in a bioaugmentation process. In the presence of Absidia cylindrospora, more than 90% of the fluorene was removed in 288 h while 576 h were necessary in the absence of fungal bioaugmentation. Maltosyl-cyclodextrin, a branched-cyclodextrin was chosen in order to optimize fluorene bioavailability and biodegradation in soil slurries. The results of this study indicate that Absidia cylindrospora and maltosyl-cyclodextrin could be used successfully in bioremediation systems.

Sino-oral zygomycosis due toAbsidiacorymbiferain a patient with acute leukemia

Fungi belonging to class Zygomycetes become pathogenic in certain predisposing conditions; principally diabetes mellitus, immunosuppression, trauma or burns. We report a case of a 31-year-old man with acute promyelocytic leukemia who developed infection of the sino-oral cavity, due to Absidia corymbifera during a neutropenic phase following induction chemotherapy. A provisional diagnosis of zygomycosis was made by demonstration of broad aseptate branching filamentous hyphae in the scrapings of the palate, which was subsequently confirmed as A. corymbifera by culture. Surgical debridement could not be done due to the thrombocytopenic status of the patient; instead antifungal therapy with amphotericin B was instituted. However, the patient succumbed to the infection after 15 days of its diagnosis. Although infections with Absidia are infrequent, this case highlights the need for its awareness as a potentially lethal opportunistic fungal infection that can present even with short duration of exposure to the usual risk factors.

Microbiological evolution of hay and relapse in patients with farmer's lung

BACKGROUND

Recent studies in France have shown that Absidia corymbifera and, to a lesser degree Eurotium amstelodami and Wallemia sebi, play a role in farmer's lung disease (FLD), but that Saccharopolyspora rectivirgula, classically incriminated, does not. Little is known about farmers' reactions to these fungi or the circumstances which lead to exposure.

AIMS

To investigate the conditions which favour the development of these microorganisms in hay and to analyse the relation between their concentration and the risk of occurrence of FLD.

METHODS

Sequential microbiological analyses of each batch of hay stored in 10 farms at risk for FLD and a serological survey of 10 farmers (five with a past history of FLD).

RESULTS

Exposure to microorganisms varied widely according to farms and periods. These microorganisms usually reached a peak in January and proliferated when harvesting conditions favoured excessive humidity in hay (rain during harvest, soil in the hay). Three of the five FLD patients presented with FLD respiratory recurrence and positive serology for A corymbifera during the winter (2000-01), after exposure to a significantly higher amount of A corymbifera than other farmers. Similar, but less significant, results were found for E amstelodami exposure, but not with W sebi.

CONCLUSIONS

Results contribute to confirming A corymbifera as a major aetiological agent of FLD in Doubs, and encourage further studies with a view to implementing preventive measures.

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.

Biodegradation capability of Absidia fusca Linnemann towards environmental pollutants

The purpose of this work was to study the bioremediation capability of Absidia fusca Linnemann (Zygomycete) towards different classes of xenobiotics (lignin-derived compounds, chloroaromatic compounds, polycyclic aromatic hydrocarbons) the presence of which in contaminated soils, water and sediments poses a significant risk to the environment and human health. Two strains from different origins were compared. One was from an official collection and grown in non-inducing conditions, while the other was isolated during the course of the survey of fungal flora in a polluted soil from Annaba (Algeria). All data were analyzed and results validated via a statistical treatment. We showed the effect of the factors studied (origin of the strain, xenobiotic) but also the interactions between these factors. The strain of A. fusca isolated from a polluted soil was able to efficiently degrade most of the xenobiotics tested, particularly: pentachlorophenol, phenol, catechol, guaiacol and ferulic acid. This property also existed in the other strain but at a very low level.

Primary cutaneous Absidia corymbifera infection in a premature newborn

An unusual case of a primary cutaneous Absidia corymbifera infection in a premature twin successfully treated with low doses of intravenous amphotericin B and topical natamycin is described. Epidemiological and therapeutical aspects of the case are discussed and in vitro antifungal susceptibility data are presented.

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

We describe a case of primary cutaneous mucormycosis (zygomycosis) in a patient with idiopathic aplastic anemia which responded to surgical debridement and therapy with liposomal amphotericin B. The tissue removed at surgery showed dense infiltration with fungal hyphae on histopathological examination. Primary cultures of tissue on solid media were negative, but Absidia corymbifera was isolated from unprocessed tissue placed in brain heart infusion broth.

Exposure to airborne microorganisms in furniture factories

Microbiological air sampling was performed in 2 furniture factories located in eastern Poland. In one factory furniture were made from fibreboards and chipboards while in the other from beech wood. It was found that the concentration of total microorganisms (bacteria + fungi) in the air of the facility using beech wood for furniture production (mean 10.7 x (3) cfu/m(3), range 3.3 27.5 x (3) cfu/m(3)) was significantly higher (p < 0.01) compared to microbial concentration in the facility using fibre- and chipboards (mean 3.6 x (3) cfu/m(3), range 1.9-6.2 x (3) cfu/m(3)). On average, the commonest microorganisms in the air of the furniture factories were corynebacteria (Corynebacterium spp., Arthrobacter spp., Brevibacterium spp.) which formed 18.1-50.0% of the total airborne microflora, and fungi (mostly Aspergillus spp., Penicillium spp., Absidia spp. and yeasts) which formed 6.2-54.4% of the total count. The values of the respirable fraction of airborne microflora in the furniture factories varied within fairly wide limits and were between 15.0-62.4%. Altogether, 28 species or genera of bacteria and 12 species or genera of fungi were identified in the air of examined factories, of which respectively 8 and 7 species or genera were reported as having allergenic and/or immunotoxic properties. In conclusion, the workers of furniture factories are exposed to relatively low concentrations of airborne microorganisms which do not exceed the suggested occupational exposure limits. Nevertheless, the presence of allergenic and/or immunotoxic microbial species in the air of factories poses a potential risk of respiratory disease, in particular in sensitive workers.

Rhinocerebral zygomycosis in childhood acute lymphoblastic leukaemia

The hazards associated with invasive candidiasis and aspergillosis in oncology patients are well recognised. These conditions typically present late in treatment, often after prolonged or recurrent episodes of neutropenia. We report the occurrence of Absidia corymbifera infection causing rhinocerebral zygomycosis in two children with acute lymphoblastic leukaemia, early in the induction phase of treatment and within a 3-month interval, in the same oncology unit. The initial presentation of facial pain was rapidly followed by the development of cranial nerve palsies, cavernous sinus thrombosis, diabetes insipidus, seizures and death within 9 days of symptom onset, despite aggressive management with high-dose liposomal amphotericin (Ambisome), surgical debridement and local instillation of amphotericin solution. These cases highlight the need for awareness of zygomycosis as a potentially lethal fungal infection that can present even with short duration exposure to the usual risk factors. Their occurrence within a limited time period raises questions as to the relative importance of environmental exposure. The failure of medical and surgical intervention to impact on the course illustrates the need to develop appropriate preventative strategies which may have to incorporate measures to reduce the environmental exposure of susceptible patients.

Zygomycosis in relapsed acute leukaemia

We would like to report the use of liposomal amphotericin in eradicating mucormycosis in two patients who had relapsed acute leukaemia. The first patient with relapsed acute myeloid leukaemia developed a rapidly expanding solitary necrotic neck lesion associated with opacity of maxilliary sinus at a time when he was profoundly pancytopenic following high dose chemotherapy. The second patient was a 3-year-old boy with pre-B acute lymphoblastic leukaemia who developed a central nervous system relapse whilst on his first line treatment and was treated with more aggressive chemotherapy on the Medical Research Council Relapse Protocol. During a period of profound pancytopenia following re-induction therapy, including high dose steroids and prolonged course of antibiotics for proven septicaemia, he developed periorbital swelling and proptosis and a clinical diagnosis of rhinocerebral mucormycosis was made. Both patients were treated with high doses of liposomal amphotericin (Ambisome Nexstar). The doses were escalated to 10 and 15 mg/kg/day, resulting in successful eradication of the mucormycosis.

Disseminated mucormycosis caused by Absidia corymbifera leading to cerebral vasculitis

An 18-year-old woman was admitted to hospital because of subcutaneous hematoma and fever of unknown origin. Acute myeloid leukemia was diagnosed and empirical antimicrobial treatment and induction chemotherapy were started. After initial defervescence, fever relapsed 2 days after the onset of neutropenia. The CT scan of the lung was consistent with an invasive fungal infection. Treatment with amphotericin B was started and antimicrobial treatment was continued with liposomal amphotericin B because of an increase in creatinine later. The fever persisted and the patient suddenly developed progressive neurological symptoms. CT scan of the head suggested cerebral infarction and angiography of the extra- and intracranial arteries showed signs of vasculitis. Six days after the onset of neurological symptoms cerebral death was diagnosed. Autopsy revealed non-septate, irregularly branched hyphae in various histologic sections including brain. Absidia corymbifera could be isolated from lung tissue confirming the diagnosis of disseminated mucormycosis. In this case, angiographic findings suggested severe cerebral vasculitis which was in fact caused by thromboembolic dissemination of fungal hyphae. This case underlines the fact that cerebral symptoms in febrile neutropenic patients are highly indicative for fungal infections of the brain.

Influence of fowl uropygial gland and its secretory lipid components on the growth of skin surface fungi of fowl

Fungal species, which were shown to colonize consistently on the skin surface of the breast region of adult (1 year old) white leghorn fowl, were identified as Aspergillus sydowii, A. tamarii, A. rugulosus and Absidia corymbifera. Of these, A. sydowii and A. tamarii were the dominant forms. Two species of fungi, namely, Aspergillus niger and Scopulariopsis brevicaulis were shown to be present in the cultures of the scrubbings from breast skin surface after 60 days of captivity of the fowls. Extirpation of the uropygial gland resulted in encouragement of the in vitro population growth of all species of fungi except that of A. rugulosus. The effect was found to be very conspicuous for A. sydowii and A. tamarii, particularly after 60 days of gland removal. Addition of total lipids and the wax diester component of free-flowing uropygial secretion as 0.2% suspension in Sabouraud's agar medium of individual fungal isolates caused marked suppression of the population growth of A. sydowii, A. tamarii, Absidia corymbifera and to some extent of S. brevicaulis. Other components of secretory lipids, such as wax alcohols (2,3-alkane-diols), wax acids, triglycerides and hydrocarbons (including squalene) when supplemented separately to culture medium of individual fungi at identical concentration, were also shown to cause inhibition of the growth of most of fungal species at different degrees.

Post-traumatic course complicated by cutaneous infection with Absidia corymbifera

Cutaneous mucormycosis is a rare but serious infection in trauma patients. Reported here is the case of a young patient with cutaneous mucormycosis due to Absidia corymbifera probably caused by a soil-contaminated wound. Despite daily surgical debridement and amphotericin B therapy, cure could be achieved only by amputation of the lower limb.

Experimental zygomycosis in rabbits: clinicopathological studies

Zygomycosis was produced experimentally in 20 New Zealand white rabbits (Oryctolagus cuniculus) by intra-nasal administration of spores of Absidia corymbifera. Infected animals showed dullness, depression, coughing and mucopurulent nasal discharge, but no mortality. Haematology revealed no significant change in Hb and PCV, but leukocytosis due to neutrophilia in the initial stages of the experiment. There was a significant increase in serum total proteins, creatinine, AST, ALT, total Igs and CICs. A. corymbifera specific IgM and IgG antibodies were detected in the sera of the infected animals. Gross lesions consisted of pneumonic consolidations of the anteroventral lobes of the lungs. Microscopically, histology showed formation of pyogranulommas in the lungs. Fungal elements typical of A. corymbifera were demonstrated in the tissues upto 15 days after infection by special stains and confirmed by indirect immunoperoxidase. Re-isolation of the fungus from lungs was also achieved consistently upto 15 days only. It was concluded that intra-nasal instillation of A. corymbifera in rabbits produced significant clinico-pathological alterations with the lesions confined mainly to the lungs. In the present study, neither systemic dissemination of the disease occurred nor were kidneys site of predilection as reported earlier.

Infection due to Absidia corymbifera in a patient with a massive crush trauma of the foot

We report the case of a patient with a massive crushing trauma of the right foot who developed a local infection due to Absidia corymbifera. Systemic and local antifungal therapy with ketoconazole associated with hyperbaric oxygen therapy (HBO) yielded a rapid clinical and microbiological resolution. Controlled clinical studies are warranted to further elucidate the potential utility of HBO/antifungal combination therapy.