Necrotizing fasciitis caused by Apophysomyces variabilis in an immunocompetent patient

Rodríguez, José Yesid; Morales-López, Soraya E.; Rodríguez, Gerson J.; Álvarez-Moreno, Carlos; Ocampo, Walter; Cepeda, Martha; Mora-Valderrama, Miguel A.

doi:10.1016/j.mmcr.2017.12.002

Cited by 11 publications

(11 citation statements)

References 13 publications

(23 reference statements)

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“…The wound progressed to cellulitis which then extended along the fascial planes to cause necrotizing fasciitis. Rodriguez et al [13] also reported similar findings in an immunocompetent male who sustained friction burns following a car accident. The infection may also be acquired in healthcare settings (healthcare-associated mucormycosis).…”

Section: Discussionsupporting

confidence: 52%

Necrotizing fasciitis caused by Apophysomyces variabilis in a burn patient

Samaddar

Sharma

Maurya

et al. 2019

IDCases

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The genus Apophysomyces belonging to the order Mucorales is increasingly being reported as a cause of mucormycosis in immunocompetent patients. We report a case of necrotizing fasciitis caused by Apophysomyces variabilis in a 52-year-old immunocompetent male who sustained thermal burn in his right leg following a road-traffic accident. There was rapidly progressive necrosis of skin, soft tissues and underlying muscles which required extensive surgical debridement. Microscopic examination of excised tissues revealed broad aseptate fungal hyphae. Fungal culture on Sabouraud dextrose agar (SDA) showed growth of a mucoraceous mould which was identified as A. variabilis based on characteristic microscopic morphology and internal transcribed spacer sequencing of the ribosomal DNA. The isolate was found to sporulate on SDA, a finding that was unique as Apophysomyces spp. does not usually sporulate on primary isolation medium used in mycology laboratories. The disease progressed as there was an initial assumption of bacterial infection and the fungus was isolated late in the course of the disease because of which no antifungal drug was added to the regime. The patient left against medical advice and eventually underwent below-knee amputation at another city hospital a week later. Infection due to A. variabilis should be considered as a differential diagnosis of rapidly progressive necrosis of skin and soft tissues in immunocompetent individuals as early diagnosis and management will prevent the disease progression and a possible amputation.

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Section: Discussionsupporting

confidence: 52%

Necrotizing fasciitis caused by Apophysomyces variabilis in a burn patient

Samaddar

Sharma

Maurya

et al. 2019

IDCases

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“…Mucormycoses are rare infections that more commonly afflict immunocompromised patients; however, recent reports demonstrate that Apophysomyces spp are an emerging pathogen in the immunocompetent host [5]. As seen in our case report, Apophysomyces varibilis has specifically been noted to mainly affect immunocompetent patients [1]. Traumatic inoculation of the organism is the most common mode of Apophysomyces infections, with almost half of all documented cases secondary to trauma.…”

Section: Discussionsupporting

confidence: 53%

“…Mucormycoses are rare infections associated with high rates of morbidity and mortality more commonly seen in immunosuppressed patients but can occur in the immunocompetent [1]. Most cases of mucormycoses are caused by the genus Rhizopus, followed by Mucor and Lichtheimia; together accounting for 70-80% of all cases.…”

Section: Introductionmentioning

confidence: 99%

“…Apophysomyces elegans was first isolated from a soil sample from northern India in 1979; while the first case of mucormycosis secondary to A. elegans in the United States (US) was reported in 1985 [3,4]. In 2010, three new species of Apophysomyces were identified, including A. varibilis [1]. Successful management of mucormycosis requires early diagnosis, surgical debridement, and systemic antifungal therapy [2].…”

Section: Introductionmentioning

confidence: 99%

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Apophysomyces Necrotizing Infection in an Immunocompetent Child

Arthur¹,

Bayouth²,

Zeri³

et al. 2019

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Background: Mucormycoses are uncommon fungal infections with high morbidity and mortality rates. Apophysomyces spp are a known but rare pathogen. Successful treatment necessitates early diagnosis, surgical debridement, and systemic antifungal treatment. Case Presentation: A 7-year-old boy sustained a minor trauma to his leg and developed necrotizing acute soft tissue infection secondary to Apophysomyces varibilis. He required multiple surgical debridements and systemic antifungal therapy. He recovered well and had excellent results following skin grafting. Conclusion: Apophysomyces varibilis is an emerging pathogen in immunocompetent patients, most commonly acquired by traumatic innoculation.

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“…Frequent agents of trauma-related mucormycosis include Apophysomes, Saksenae and licthemia [9]. Apophysomyces and Saksenae species had been reported in a number of patients with aggressive necrotising fasciitis [10,11]. An early case reports the presence of Apophysomyces in Saudi Arabia in 10-year-old girl with necrotising fasciitis following a MVA [12].…”

Section: Discussionmentioning

confidence: 99%

Complication of massive trauma by fungal infection and bone tuberculosis

Elzein

Mohammed

Arafah

et al. 2020

Medical Mycology Case Reports

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We report a middle aged man who was admitted with severe necrotising fasciitis following a motor vehicle accident (MVA). Histopathology of the excised tissue suggested mucormycosis while a bone tissue culture revealed fully sensitive Mycobacterium tuberculosis. He received intravenous liposomal amphotericin B combined with multiple surgical debridements and ended with right shoulder disarticulation. In addition he completed a nine months course of anti-tuberculosis treatment. He remained stable one year following his admission.We believe that trauma contributed to both conditions by direct inoculation of fungal spores and through immunological reactivation of old healed tuberculosis focus. This case highlights the importance of considering diagnosis of invasive fungal infections following MVA.

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Necrotizing fasciitis caused by Apophysomyces variabilis in an immunocompetent patient

Cited by 11 publications

References 13 publications

Necrotizing fasciitis caused by Apophysomyces variabilis in a burn patient

Necrotizing fasciitis caused by Apophysomyces variabilis in a burn patient

Apophysomyces Necrotizing Infection in an Immunocompetent Child

Complication of massive trauma by fungal infection and bone tuberculosis

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