Invasive Infection Due to Apophysomyces elegans in Immunocompetent Hosts

Weinberg, Winkler G.; Wade, Barbara H.; Cierný, G; Stacy, David; Rinaldi, Michael G.

doi:10.1093/clinids/17.5.881

Cited by 59 publications

(52 citation statements)

References 16 publications

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“…By far, A. elegans most commonly causes infections in apparently healthy individuals (3,7,20,29,30,32,35). In the present series, similarly, only two patients had underlying conditions (diabetes mellitus and chronic alcoholism).…”

Section: Discussionsupporting

confidence: 42%

“…In the present series, similarly, only two patients had underlying conditions (diabetes mellitus and chronic alcoholism). Infection of cutaneous and subcutaneous tissues with A. elegans is predominantly the result of the introduction of spore-containing soil and vegetation into wounds arising from trauma or surgery (16,20), burns (8), injection (5), or an insect bite (35). In two of our patients with subcutaneous tissue involvement, the infection occurred at the injection site, and in another patient the infection was possibly acquired from a site of trauma.…”

Section: Discussionmentioning

confidence: 80%

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Apophysomyces elegans : an Emerging Zygomycete in India

Chakrabarti¹,

Ghosh²,

et al. 2003

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Apophysomyces elegans was considered a rare but medically important zygomycete. We analyzed the clinical records of eight patients from a single center in whom zygomycosis due to A. elegans was diagnosed over a span of 25 months. We also attempted a DNA-based method for rapid identification of the fungi and looked for interstrain polymorphism using microsattelite primers. Three patients had cutaneous and subcutaneous infections, three had isolated renal involvement, one had rhino-orbital tissue infection, and the final patient had a disseminated infection involving the spleen and kidney. Underlying illnesses were found in two patients, one with diabetes mellitus and the other with chronic alcoholism. A history of traumatic implantation was available for three patients. All except two of the patients responded to surgical and/or medical therapy; the diagnosis for the two exceptions was made at the terminal stage of infection. Restriction enzyme (MboI, MspI, HinfI) digestion of the PCR-amplified internal transcribed spacer region helped with the rapid and specific identification of A. elegans. The strains could be divided into two groups according to their patterns, with clustering into one pattern obtained by using microsatellite [(GTG) 5 and (GAC) 5 ] PCR fingerprinting. The study highlights the epidemiology, clinical spectrum, and diagnosis of emerging A. elegans infections.Zygomycosis is a serious and often rapidly fatal infection especially in immunocompromised patients. It is caused by sparsely septate filamentous, saprophytic fungi belonging to the class Zygomycetes and the order Mucorales.

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Section: Discussionsupporting

confidence: 42%

Section: Discussionmentioning

confidence: 80%

Apophysomyces elegans : an Emerging Zygomycete in India

Chakrabarti¹,

Ghosh²,

et al. 2003

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“…Morphologically, this fungus typically produces pyriform sporangia; conspicuous funnel-and/or a bellshaped apophyses; and clear, thin, and smooth-walled sporangiospores that are mostly oblong with rounded ends. It is a thermotolerant fungus that grows rapidly between 26 and 42°C (5,14,20). While most isolates have been reported from India, it also has been isolated in Australia, Southeast Asia, the United States, and South America, suggesting a broad distribution which covers tropical and subtropical climates.…”

mentioning

confidence: 99%

“…This is in contrast to infections caused by other members of the order Mucorales that tend to involve immunocompromised individuals and are most commonly seen in patients with poorly controlled diabetes. The most common mode of infection is traumatic implantation of contaminated soil or water leading to cutaneous or subcutaneous infections, rhino-orbital infection after facial trauma (9, 10, 12), or osteomyelitis after breakdown of the overlying skin (7,13,20). Renal infection by Apophysomyces has been reported, suggesting a possible hematogenous mode of infection following traumatic implantation through the skin (17).…”

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confidence: 99%

Invasive Apophysomyces variabilis Infection in a Burn Patient

et al. 2012

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“…Over the last decade, zygomycosis caused by A. elegans has emerged as an important disease affecting immunocompetent hosts (19), especially following trauma (4,6,9). An environmental fungus, Apophysomyces is a member of the fungal class Zygomycetes, order Mucorales.…”

mentioning

confidence: 99%

Posaconazole Treatment for Apophysomyces elegans Rhino-Orbital Zygomycosis following Trauma for a Male with Well-Controlled Diabetes

Ferguson¹,

Schniederjan²,

Dionne-Odom³

et al. 2007

J Clin Microbiol

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We report a case of rhino-orbital zygomycosis in a 43-year-old male with well-controlled diabetes mellitus. The patient initially received liposomal amphotericin B, but the infection continued to progress, so posaconazole treatment was begun and eventually led to the cure of his infection. The causative agent was identified as Apophysomyces elegans, an emerging cause of zygomycosis in immunocompetent hosts. CASE REPORTA 43-year-old male with a history of diabetes mellitus, well controlled (hemoglobin A1c, 5.2%) with oral hypoglycemic agents, was involved in a motor vehicle collision in June 2006. He was ejected from the automobile and sustained multiple injuries, including a right orbital fracture, multiple rib fractures, a thoracic vertebral body fracture causing a left pneumothorax, and a right tibia-fibular fracture. He was initially treated at a hospital facility. During the course of his first 2 weeks of hospitalization, he began to develop right orbital cellulitis, edema, proptosis, and decreased visual acuity in the right eye. At that time, he was placed on broad-spectrum antibacterial and antifungal agents, including clindamycin, daptomycin, imipenem, and amphotericin B. An ear, nose, and throat evaluation demonstrated no signs of necrotic tissue or fungal elements, and several attempts to decompress the orbit were unsuccessful. Imaging at the hospital, including computed tomography scanning and magnetic resonance imaging, demonstrated the opacification of the ethmoid and maxillary sinuses, most consistent with posttraumatic change and edema. The patient's condition and visual acuity continued to worsen, and he was subsequently transferred to the Emory University Hospital, Atlanta, GA, for further management.Upon arrival, another ear, nose, and throat exam was performed, again with no signs of mucosal disease. Repeat imaging, however, demonstrated findings suggestive of invasive fungal disease, including marked edema, sinus opacification, proptosis of the right globe, and the extension of inflammatory changes into the bony orbit. The patient was urgently taken to the operating room for right orbital exenteration and partial right facial resection. Specimens were sent to pathology and microbiology laboratories. On frozen and surgical pathology sections, fungal elements were seen but were not further identified. While routine Gram staining and all cultures were negative, fungal cultures were not initially performed. As a result, the patient continued to receive antifungal therapy with liposomal amphotericin B at a dose of 5 mg/kg of body weight/day, as well as broad-spectrum antibacterial coverage with vancomycin and piperacillin-tazobactam.For approximately 1 week after the initial debridement, the wound was examined daily and packed with amphotericinsoaked dressings. Fungal elements, including the visible regrowth of woolly-appearing colonies, and necrotic changes continued to be present upon inspection, and the wound was debrided daily at the bedside. During this week, the level of creatinine in the pat...

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Invasive Infection Due to Apophysomyces elegans in Immunocompetent Hosts

Cited by 59 publications

References 16 publications

Apophysomyces elegans : an Emerging Zygomycete in India

Apophysomyces elegans : an Emerging Zygomycete in India

Invasive Apophysomyces variabilis Infection in a Burn Patient

Posaconazole Treatment for Apophysomyces elegans Rhino-Orbital Zygomycosis following Trauma for a Male with Well-Controlled Diabetes

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