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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).
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
Ketoconazole and voriconazole are other drugs that have rarely been used.1,4 Posaconazole is an antifungal triazole currently used for zygomycosis. There are few clinical data on its usage in children and high-risk patients. Posaconazole is well tolerated with few adverse side-effects. Its activity is similar to that of voriconazole with greater effectiveness against zygomycosis.18 However, its high cost and availability only as an oral suspension limit its use.12 Voriconazole is another broad-spectrum triazole which has good results in treating many fungal infections including invasive aspergillosis and a variety of paediatric mycoses.19 There are many interactions between voriconazole and other drugs which limit its usefulness.20 Co-trimoxazole has also proved effective in several cases of basidiobolomycosis.7,21,22 Potassium iodide is the drug of choice for the subcutaneous form of basidiobolomycosis although some patients do not respond.22,23 There is one other report of a dramatic response to KI: an 8-year-old Pakistani boy with a retroperitoneal mass owing to B. ranarum.15 In addition to B. ranarum, subcutaneous zygomycosis can be caused by Conidiobolus coronatus which involves the nose, paranasal tissue and upper lip.24,25 Although some reports indicate success with KI for conidiobolus infection, some cases did not respond.26 A Brazilian woman with C. coronatus infection for 6 years failed to respond to KI but treatment with ketoconazole was successful.25 Treatment of systemic basidiobolomycosis should include a combination of two or more drugs.27,28 Responses to the combination treatment of itraconazole and KI were evaluated in a case series of ten patients with rhino-facial conidiobolomycosis; the combination treatment was effective in seven (70%). Potassium iodide was commenced at approximately 1 g/day and gradually increased to a maximum 3 g/day, depending on the patient’s condition.27
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].