Basidiobolomycosis in Togo: clinico-pathological study of a series of 12 presumed cases

Abstract

ObjectiveThe purpose of our study was to describe the histological diagnosed of the Basidiobolomycosis cases from 1990 to 2017 (28 years) in the only Pathology Anatomy Laboratory in Togo.ResultsA total of 12 cases of suspected Basidiobolomycosis have been identified. The sex ratio (M/F) was 2. The average age of the patients was 24.8 ± 1.6 years. Six patients (6/12) had a pathological history: HIV infection (n = 4 cases) and tuberculosis (n = 2 cases). The clinical manifestations were localized to pure skin (n = 9 cases), skin and mucous digestive (n = 2 cases) and disseminated (n = 1 cases). Direct mycological examination and culture in 4 patients was positive in 3 patients. The samples examined consisted of 11 cutaneous biopsies measuring 1–3 cm and a biopsy of the intestinal mucosa. Histology showed granulomatous inflammation of the dermohypodermal site with numerous giant cells associated with eosinophilic polynuclear cells, in which there are 5–7 mm non-septate, irregular mycelial filaments. Patients were treated with ketoconazole at a dose of 10 mg/kg daily. The progression of the patients’ condition was favorable after 4 weeks of treatment with a regression of the closets size. Patients were completely healed after 8 weeks of treatment, without recurrence after 6 months. No deaths have been recorded.

Estimated burden of serious fungal infections in Togo

“…A few cases of basidiobolomycosis have been reported with an incidence rate estimated between 0.4 and 4.3 cases annually in Togo 29,44 . This is similar to the range between 1 and 4 cases found in Côte d’Ivoire, Benin and in Ghana and also consistent with the global annual incidence of 4.5 cases 45‐48 .…”

Subcutaneous Mycosis in Hospitals: Study of 3 Cases at The National University Hospital Centre Hubert Koutoukou Maga in Cotonou (Benin)

“…The clinical presentation was comparable to the literature [4,5]. Basidiobolus ranarum was isolated from our two patients; in the study by Tchin Darré [6] the same pathogen was identified in three of the four patients who underwent mycological examination. Physicians and other primary care workers often misdiagnose this condition because of its slow progression, painlessness, lack of response to antibiotics and anti-inflammatory drugs, and lack of awareness of the disease.…”

“…Madurella mycetomatis and Leptosphaeria sp are the main pathogens of fungal mycetoma in Africa; our case is no exception. Therapeutically, azole derivatives are effective and well tolerated on these two subcutaneous mycosis; most studies confirm the effectiveness of Ketoconazole prescribed in our three patients [4][5][6][7][8][9]. According to Develoux [10], the combination of ketoconazole and surgery gives better results in the treatment of fungal mycetomas and allows conservative surgery while reducing the risk of recurrence.…”

Disseminated and ulcerative basidiobolomycosis simulating a buruli ulcer in an immunocompetent girl in Southern Benin

“…These cupboards can ulcerate during evolution [ 3 ]. Due to its non-specific clinical features, it raises the problem of differential diagnosis with Buruli ulcer especially in co-endemic areas [ 2 , 4 - 6 ]. Basidiobolomycosis can cause invasive pathology by lymphatic or vascular dissemination [ 3 , 7 ].…”

“…Basidiobolomycosis can cause invasive pathology by lymphatic or vascular dissemination [ 3 , 7 ]. Positive diagnosis is based on histopathology with the presence of the Splendore-Hoeppli phenomenon in the dermis [ 3 , 6 ]. Treatment currently relies on imidazole antifungals: itraconazole or long-term ketoconazole with few side effects [ 1 , 3 , 8 ].…”