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Epidemiology of fungal infections: What, where, and when
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
Frederic Lamoth, Sylvia F. Costa, Barbara D. Alexander
The agents of mucormycosis are members either of the order Entomophthorales or of the order Mucorales. These organisms are characterized by sparsely septate hyphae in tissue. The hyphae are broad, variable in diameter, and polymorphic, with irregular branching, and in the case of the Mucorales, may invade blood vessels with thrombosis, tissue infarction, and necrosis [5,70,215,273]. The molds of the order Entomophthorales are usually found in tropical areas, in soil, decaying vegetation, on insects, and as saprobes in the gastrointestinal tract of reptiles, amphibians, and mammals. Of the Entomophthorales, Basidiobolus and Conidiobolus species are pathogenic to humans, causing subcutaneous infections of the extremities and trunk, and of the nasal submucosa, respectively [274]. Members of the order Mucorales are found in soil, decaying vegetation, fruits, foodstuffs, and animal excreta in a wide geographic distribution. The portal of entry for infection is likely pulmonary with eventual dissemination to other sites, though primary cutaneous infection has been reported [275]. The Mucorales cause the majority of cases of human mucormycosis, with Rhizopus, Mucor, Rhizomucor, Lichtheimia (formerly Absidia), Apophysomyces, and Cunninghamella, among others, found in the literature [47,274,276–279]. The most commonly reported cause of human infection is Rhizopus.
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).
Serodiagnosis: Antibody and Antigen Detection
Published in Johan A. Maertens, Kieren A. Marr, Diagnosis of Fungal Infections, 2007
Christine J. Morrison, David W. Warnock
The definitive diagnosis of subcutaneous and gastrointestinal forms of basidiobolomycosis and conidiobolomycosis (also termed entomophthoramycosis or subcutaneous zygomycosis) depends on microscopic examination and culture. However, ID has proved useful as an adjunctive method for the detection of these uncommon infections (302,303). The ID test appears to be specific for Basidiobolus ranarum, but its sensitivity has not been determined. It also appears to be useful for monitoring the response to treatment (304).
Basidiobolomycosis complicated by hydronephrosis and a perinephric abscess presenting as a hypertensive emergency in a 7-year-old boy
Published in Paediatrics and International Child Health, 2018
Sriram Krishnamurthy, Rakesh Singh, Venkatesh Chandrasekaran, Gopinathan Mathiyazhagan, Meenachi Chidambaram, S. Deepak Barathi, Subramanian Mahadevan
Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum, a common environmental saprophyte belonging to the order Entomophthorales which usually presents as subcutaneous zygomycosis. Usually, it is characterised by chronic subcutaneous indurations affecting the limbs, trunk and buttocks [1−4]. Visceral organ involvement including the gastro-intestinal and pulmonary systems has been documented [1,5], but it seldom spreads to cause disseminated infection [2]. Minor trauma, insect bites and local inoculation have been described as predominant causes [6,7]. Our patient was from a rural area, had a history of exposure to manure and defaecated in the open (and used leaves to clean the skin afterwards) which could have been the source of the fungal infection.
Basidiobolomycosis: an unusual, mysterious, and emerging endemic fungal infection
Published in Paediatrics and International Child Health, 2018
Jamie Bering, Neema Mafi, Holenarasipur R. Vikram
Potassium iodide (KI) as a saturated solution has been utilized for the treatment of cutaneous dermatoses, sporotrichosis, and entomophthoramycoses, in addition to several non-infectious entities [26]. There is little knowledge of its exact mechanism of action. Toxicity caused by high doses, advent of newer antifungals, lack of a conventional standard prescription recommendation, and unawareness to the exact amount of KI salt being delivered, has led to subdued enthusiasm for using this drug. In vitro studies have documented complete absence of inhibition or killing of B. ranarum at maximum concentrations of KI [20]. However, several published reports attest to dramatic and complete response, mainly in patients with subcutaneous basidiobolus infection. Its immunomodulatory properties may have a role to play in its observed in vivo efficacy in some patients. It is unclear if combination of KI with azoles and/or amphotericin-B translates into synergistic activity by potentiating the performance of the parent antifungal. If available and accessible, azole antifungals appear to have a more favorable efficacy and toxicity profile compared to KI.
Gastro-intestinal basidiobolomycosis in a 2-year-old boy: dramatic response to potassium iodide
Published in Paediatrics and International Child Health, 2018
Anahita Sanaei Dashti, Amir Nasimfar, Hossein Hosseini Khorami, Gholamreza Pouladfar, Mohammad Rahim Kadivar, Bita Geramizadeh, Masoomeh Khalifeh
The optimal management of infection includes resection of the mass and other involved structures along with long-term treatment with antifungal drugs.4 There are some reports of improvement on antifungal therapy alone.4,9,13 There is no specific choice of antifungal agent for GIB, probably because the disease is so uncommon. Itraconazole is the most commonly used agent for basidiobolomycosis (i.e. the drug of choice for 73% of the patients who received antifungal drugs until 2012), followed by amphotericin products (22%).4,12 Amphotericin B has led to several unsatisfactory results, and resistance has been documented in isolated cases of infectious basidiobolus.14,15 Although there are few clinical reports of antagonism between azoles and amphotericin B, there are some supportive pre-clinical studies.16 In one study, itraconazole and amphotericin B were used against Aspergillus fumigatus.17In vitro results indicated that there was an antagonistic effect between the two drugs in both concomitant and sequential treatment.