Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment

Abstract

The class Zygomycetes is divided into two orders, Mucorales and Entomophthorales. These two orders produce dramatically different infections. Genera from the order Mucorales (Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Cunninghamella and Saksenaea) cause an angioinvasive infection called mucormycosis. Mucormycosis presents with rhino-orbito-cerebral, pulmonary, disseminated, cutaneous, or gastrointestinal involvement. Immunocompromising states such as haematological malignancy, bone marrow or peripheral blood stem cell transplantation, neutropenia, solid organ transplantation, diabetes mellitus with or without ketoacidosis, corticosteroids, and deferoxamine therapy for iron overload predispose patients to infection. Mucormycosis in immunocompetent hosts is rare, and is often related to trauma. Mortality rates can approach 100% depending on the patient's underlying disease and form of mucormycosis. Early diagnosis, along with treatment of the underlying medical condition, surgery, and an amphotericin B product are needed for a successful outcome. Genera from the order Entomophthorales produce a chronic subcutaneous infection called entomophthoramycosis in immunocompetent patients. This infection occurs in tropical and subtropical climates. The genus Basidiobolus typically produces a chronic subcutaneous infection of the thigh, buttock, and/or trunk. Rarely, it has been reported to involve the gastrointestinal tract. The genus Conidiobolus causes a chronic infection of the nasal submucosa and subcutaneous tissue of the nose and face. This paper will review the clinical manifestations, diagnosis and treatment of mucormycosis and entomophthoramycosis.

Hemograma, proteinograma, ionograma e dosagens bioquímicas e enzimáticas de ovinos acometidos por conidiobolomicose no nordeste do Brasil

“…Em humanos as infecções por Entomophtorales têm sido associadas a situações de estresse e queda de imunidade, porém, em animais não há clareza sobre esse aspecto (Rippon 1988, Prabhu & Patel 2004.…”

Rhinocerebral and rhinopharyngeal conidiobolomycosis in sheep

“…The reason for this unprecedented discrepancy may be explained by the high rainfall in 2009, which was atypical for this region. Importantly, the presence of high humidity, increased temperatures and large amount of decomposing vegetation are factors that favor the development of fungi and the formation of their reproductive structures (PRABHU & PATEL, 2004). Consequently, there is a spreading in the environment of a high number of spores, which contaminate the grazing habits of sheep and predispose animals to infection via inhalation (RIET-CORREA et al, 2008).…”

“…Northeastern Brazil (SILVA et al, 2007), C. lamprauges in Santa Catarina, Southern Brazil (FURLAN et al, 2010) and C. incongruus in Australia (KETTERER et al, 1992).…”

Meningoencephalitis caused by a zygomycete fungus (Basidiobolus) associated with septic shock in an immunocompetent patient: 1-year follow-up after treatment

“…Involvement of the gastrointestinal tract has rarely been reported. The genus Conidiobolus causes chronic infection of the nasal submucosa and subcutaneous tissue of the nose and face (14). The diagnosis of zygomycosis is based on clinical examination and is confirmed by biopsy, with detection of nonseptate hyphae with right-angle branches and tissue invasion (15).…”