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Mucormycosis is a fungal disease caused by members of the fungal order Mucorales, which are abundantly found in terrestrial environments. The fungi propagate clonally via mitospores, which are transmitted to humans through the air and cause superficial or invasive infections. The disease has emerged in recent years and coincides generally with immunosuppression on the patient side. Mucormycosis is still rarely recognized in the clinical because of its unspecific symptoms which often triggers misdiagnosis with bacterial or viral infections leading to prolonged therapeutic cycles and loss of valuable time to manage mucormycosis properly. Infected patients develop various clinical forms, most notably ranging from rhinocerebral via pulmonary to gastrointestinal forms. Traditional diagnosis is based on culture and histopathologic examinations of the affected tissue. But, the achievement of a precise result is time-consuming, labor-intensive, requires mycological expertise and the finding appears often too late. A rapid and precise diagnosis is mandatory because symptoms are non-specific and the disease is rapidly progressing with often fatal outcome. Mucormycosis was increasingly associated with other infections and underlying conditions and risk factors causing comorbidities, which are difficult to successfully manage. This mini-review summarizes the current knowledge on the epidemiology and causative agents of mucormycosis, transmission, risk factors, clinical presentation, diagnosis, and highlights the lack of appropriate biomarkers on the pathogen and the host sides for rapid pathogen and host susceptibility detection, respectively. Fungal antigens and single nucleotide polymorphisms (SNPs) in human host genes are useful for the assessment of susceptibility. This mini-review addresses possibilities for early prediction of susceptibility to mucormycosis based on forecasting of the risk of infection with fungal pathogens other than Mucorales. The topic of early prediction and diagnosis of mucormycosis represents a current research gap and highlights the importance of potential future developments in the area of risk assessment, susceptibility prognosis in conjunction with early diagnosis to reduce mortality in patients suffering from mucormycosis.

Fungal diseases were underestimated for many years. And the global burden of fungal infections is substantial and has increased in recent years. Invasive fungal infections have been linked to several risk factors in humans which basically depend on the individual homeostasis of the patients. However, many fungi can infect even apparently healthy people. Knowledge of these pathogens is critical in reducing or stopping morbidity and/or mortality statistics due to fungal pathogens. Successful therapeutic strategies rely on rapid diagnosis of the causative fungal agent and the underlying disease. However, the terminology of the diseases was updated to existing phylogenetic classifications and led to confusion in the definition of mucormycosis, conidiobolomycosis, and basidiobolomycosis, which were previously grouped under the now-uncommon term zygomycosis. Therefore, the ecological, taxonomic, clinical, and diagnostic differences are addressed to optimize the understanding and definition of these diseases. The term “coenocytic hyphomycosis” is proposed to summarize all fungal infections caused by Mucorales and species of Basidiobolus and Conidiobolus.

Mycetoma is a chronic and slow-developing granulomatous disease characterized by the triad of large painless tumour-like subcutaneous swellings, the formation of sinuses, and discharge that usually contains grains. Phellinus spp. are saprophytic wood-decaying filamentous basidiomycetes. They are an under-recognised cause of invasive fungal infections and are rarely reported worldwide. We report a 59-year-old male patient with mycetoma caused by Phellinus spp. The diagnosis was confirmed with clinical examination, magnetic resonance imaging (MRI) study, soft tissue and bone biopsy culture, and polymerase chain reaction. To the best of our knowledge, this is the first reported case of mycetoma due to Phellinus spp. without chronic granulomatous disease (CGD).

Introducción: Streptococcus pneumoniae (neumococo) sigue siendo una causa importante de neumonía, sepsis y meningitis en niños en todo el mundo. En Ecuador, hay escasez de información sobre la enfermedad neumocócica invasiva. Métodos: Se trata de un estudio de cohorte retrospectivo que se llevó a cabo en el hospital público pediátrico de tercer nivel más grande de Quito, Ecuador. El estudio se realizó entre 2014 y 2018. Se analizaron las historias clínicas de los pacientes con enfermedad neumocócica invasiva (ENI). Se identificaron serotipos de S. pneumoniae, su susceptibilidad antimicrobiana, manifestaciones clínicas y mortalidad de ENI en un hospital de tercer nivel en Quito, de 2014 a 2018. Resultados: La mayoría de los pacientes con ENI tenían menos de 2 años. La neumonía fue la presentación clínica más frecuente y el serotipo 19A fue el más prevalente. Los aislados de S. pneumoniae fueron resistentes en diferentes porcentajes a clindamicina, eritromicina, trimetoprim sulfametoxazol, penicilina, levofloxacina, ceftriaxona. Los aislados meníngeos mostraron una mayor frecuencia de resistencia a los antimicrobianos. Aunque la mayoría de los pacientes habían recibido una vacuna antineumocócica conjugada contra 10 serotipos (PCV10), aún presentaron ENI. Discusión: A pesar de que la mayoría de los pacientes (88,2%) habían recibido una vacuna antineumocócica conjugada contra 10 serotipos (PCV10), aún tenían ENI. El serotipo 19A de S. pneumoniae fue la causa más común de ENI y mostró la mayor prevalencia de resistencia a los antibióticos en los niños infectados incluidos en este estudio. Conclusiones: Los tipos de ENIs más frecuentes fueron neumonía y sepsis, el serotipo más común fue 19A. Es de extrema importancia reforzar la vigilancia epidemiológica en el país para precisar la realidad de serotipos circulantes y valorar la efectividad e impacto vacunal.

Introduction: RNA viruses are known to have a high genetic variability. To date, SARS-CoV-2 has produced several variants that can change the clinical presentation of COVID-19. The first clinical case of variant B.1.1.7 with a critical clinical status in a pediatric patient is presented. It indicates that surveillance of new variants and their relationship to critical cases in pediatric patients are required. Clinical case: A pediatric patient with a history of infantile cerebral palsy, complete severe subcortical atrophy, Lennox−Gastaut syndrome, and recurrent pneumonia. She had a slow evolution requiring intensive therapy for acute respiratory distress syndrome (ARDS) that was related to SARS-CoV-2 variant B 1.1.7. Evolution: Initially, she was treated at a private hospital because she required intensive care due to ARDS, and she was then transferred to a public hospital. She was discharged after 35 days due to a favorable evolution of her infectious etiology. Conclusions: New SARS-CoV-2 variants may show new clinical behaviors. Despite this patient’s history, a clinical course towards severe symptoms had not been previously observed in pediatric patients with COVID-19. The severe symptoms could be related to the SARS-CoV-2 variant B.1.1.7 infection in this patient.

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