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Mucor and Mucormycosis
Published in Dongyou Liu, Handbook of Foodborne Diseases, 2018
The order Entomophthorales in the subphylum Entomophthoromycotina contains fungi that are found in tropical and subtropical regions of the world; produce a single conidium (with no sporangium) on each conidiophore, with conidia being forcibly ejected upon maturation and then replicating to produce secondary conidia; form zygospores with two contiguous cells of a hypha; and cause indolent cutaneous, subcutaneous, nasal, and sinus infections (known as entomophthoromycosis due mainly to the genera Basidiobolus and Conidiobolus), mostly in immunocompetent individuals. It is of note that Entomophthorales hyphae are characteristically surrounded by thick eosinophilic sleeves in the histopathologic sections with hematoxylin and eosin stain, while Mucorales hyphae are not [2].
Fungal Infections
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Emily Young, Yujay Ramakrishnan, Laura Jackson, Shahzada K. Ahmed
The genus Conidiobolus contains several species. The most common ones are Conidiobolus coronatus, Conidiobolus incongruus and Conidiobolus lamprauges. Conidiobolus is a mould most commonly found in soil and decaying plant debris. It is mostly distributed in tropical areas and particularly in Central America, equatorial Africa and India (www.mycology.adelaide.edu.au). The most common clinical picture caused by Conidiobolus spp. is a subcutaneous infection involving nasal mucosa and maxillofacial tissues. This chronic inflammatory granulomatous disease is also referred to as entomophthoromycosis conidiobolae.7 It involves facial subcutaneous tissues and paranasal sinuses, leading to formation of firm, subcutaneous nodules or polyps. The infection may be acquired via inhalation of spores or a minor trauma such as an insect bite. The infected host is frequently an otherwise healthy individual working outdoors in tropical areas. However, the infection may also develop in patients with underlying pathologies, such as neutropenia or Burkitt’s lymphoma.
Ketoconazole
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Caused by the molds Conidiobolus and Basidiobolus spp., entomophthoromycosis is manifest as a chronic inflammatory disease with a subcutaneous form involving the limbs, trunk, and buttocks (basidiobolomycosis), or a mucocutaneous form localized to the face (conidiobolomycosis). A case of subcutaneous Conidiobolus coronatus infection, involving the nose, forehead, and neck, present for 6 years, initially improved with potassium iodide but developed recurrent disease which resolved completely when treated with ketoconazole 200 mg twice daily for 6 months. No relapse occurred during 3 years’ follow-up (Towersey et al., 1988). Hay (1983) has reported a case that did not respond to 5 months’ treatment with ketoconazole. Infections by Basidiobolus ranarum usually occurs in children. Most cases resolve spontaneously. Ketoconazole 400 mg daily has been used with some success (Gugnani, 1999). The number of cases reported in the literature is too small to make any recommendations concerning the efficacy of ketoconazole for this infection. Potassium iodide or itraconazole are recommended as reasonable first drugs of choice. However, other agents, including miconazole, cotrimoxazole, amphotericin B, and terbinafine, have been used with variable success (Prabhu and Patel, 2004).
Basidiobolomycosis: an unusual, mysterious, and emerging endemic fungal infection
Published in Paediatrics and International Child Health, 2018
Jamie Bering, Neema Mafi, Holenarasipur R. Vikram
Entomophthoramycosis refers to subcutaneous chronic granulomatous infection caused by fungi of the order entomophthorales in tropical and subtropical countries. The two forms of entomophthoramycosis includes conidiobolomycosis (caused by Conidiobolus coronatus and C. incongruus), and Basidiobolomycosis (caused by B. ranarum). Although B. ranarum is found worldwide, basidiobolomycosis is endemic to the tropical and subtropical areas of South America, Africa, Asia, and the southwestern United States. It is a saprophytic fungus typically found in decaying plants, soil, and gastrointestinal tract of amphibians, fish, bats, reptiles, and insects [1–3]. Fifty percent of trapped reptiles and amphibians in Florida were found to be colonized with Basidiobolus [4]. It is hypothesised that insects and arthropods consume B. ranarum found on vegetation and organic matter, which in turn fall prey to lizards, frogs, and other animals. They might be responsible for further disseminating the fungus in the environment [5].The precise mechanism of human exposure and acquisition of B. ranarum is incompletely understood. Despite widespread presence of B. ranarum in the environment, human infection is extremely uncommon and is thought to result from insect bites, local inoculation, or minor trauma. For example, walking through contaminated soil or using decaying leaves for cleansing after a bowel movement have been implicated as activities leading to direct inoculation and infection [3]. One of the earliest reports of human infection with B. ranarum describes two young children who contracted subcutaneous basidiobolomycosis of the chest wall in Indonesia [6]. Humans may also be exposed to B. ranarum through unintentional ingestion of contaminated soil, fruits and vegetables as evidenced by a report of an eight-month-old child who contracted gastrointestinal basidiobolomycosis after consumption of a lizard, and several case reports and case series of gastrointestinal basidiobolomycosis, wherein extensive involvement of abdominal organs occurred in the absence of subcutaneous infection [2, 7]. Although clear-cut predisposing conditions have not been established for systemic infection beyond subcutaneous tissues, certain host factors such as gastric acid suppression, gastrectomy, diabetes, and duration of residence in endemic areas may enhance risk of infection [8, 9].