Cutaneous zygomycosis due to Saksenaea vasiformis in an immunocompetent host

Abstract

Saksenaea vasiformis is an emerging zygomycete species, most often associated with cutaneous, subcutaneous and rhino- orbito-cerebral infections. Herein, we report a case of cutaneous zygomycosis of face caused by Saksenaea vasiformis in a 54-year-old immunocompetent female. The diagnosis was carried out by microscopy using KOH mount, Gram staining, Gomori's methenamine silver staining, hemotoxylin and eosin staining and culture on Sabouraud's Dextrose agar without actidione. Slide cultures were put up on Czapek Dox agar, which showed typical flask-shaped sporangium with rhizoids. The patient was treated successfully with intravenous amphotericin B.

Molecular Phylogeny and Proposal of Two New Species of the Emerging Pathogenic FungusSaksenaea

“…Up to now, approximately 40 cases of zygomycete infections, mostly cutaneous infections, have been attributed to Saksenaea (6,40,46,47), although for the reasons indicated above, it is likely that the actual number of clinical cases has been underestimated. To avoid difficulties in the detection and identification of Saksenaea in clinical samples, several authors have emphasized the need for special culture techniques, such as the use of floating agar blocks on water, or the use of BorelliЈs lactrimel agar (15,29) to induce sporulation.…”

“…Mucormycosis caused by S. vasiformis most often occurs after traumatic implantation of the fungus but can also be due to inhalation of spores (18), spider bites, insect stings, and the use of indwelling catheters (11,22,28,31). Clinical cases seems to be more common in tropical and subtropical climates than elsewhere and have been reported from Australia (16,19,22,40,48), India (6,7,11,33), the United States (1,8,31,35,45), Thailand (44), Tunisia (28), the Middle East (2,25), and Central and South America (9,47).…”

Mucormycosis Caused by Unusual Mucormycetes, Non-Rhizopus, -Mucor, and -Lichtheimia Species

“…The size of S. vasiformis spores ranges from 1.2 to 1.4 by 2.8 to 4.2 m (279), making them capable of reaching the alveoli when inhaled. Importantly, in a third of the cases reported thus far, no predisposing factors were identified (Table 2) (1,26,27,29,37,48,58,90,127,134,150,266,316,329).…”

“…Necrosis (250), scars of old healed lesions (9), with (240) or without (9, 250) regional adenopathy, and low-grade fever (240) may occur. Progression to necrotizing fasciitis (26) and formation of a subcutaneous mass extending to muscle without ulceration, necrosis, or lymphadenopathy (199) have also been described. Without diagnosis, lesions caused by S. vasiformis infection have progressed over 3 (26), 8 (9, 199), 15 (250), and 18 (240) months.…”

“…Chronic primary cutaneous or subcutaneous infections caused by S. vasiformis have been reported as painless (9), painful (26,240), and erythematous (9,240), with swelling (240), papules (199) or nodules (9,26), and small satellite lesions (9,199,240,250), occasionally forming bullae (240), gradually increasing in size (9,26,199,240), with induration (199,240,250), and finally rupturing and discharging a whitish purulent material (9,26,240) and forming ulcers (26,240,250). Necrosis (250), scars of old healed lesions (9), with (240) or without (9, 250) regional adenopathy, and low-grade fever (240) may occur.…”