Case report of subcutaneous entomophthoromycosis with retroperitoneal invasion

Vianna, Leonora Maciel de Souza; Lacerda, Marcus Vinícius Guimarães; Moraes, Mário Augusto Pinto de

doi:10.1590/s0037-86822005000400014

Cited by 12 publications

(11 citation statements)

References 9 publications

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“…Although a definite diagnosis can be obtained with culture [14,15,18,19,[22][23][24]30,33,35,41,45,47,[49][50][51]54,59,62], it was frequently missed in previous reports because of the lack of suspicion that made tissue specimens unavailable for culture purpose. Therefore, the diagnosis of gastrointestinal infection by B. ranarum was mainly obtained on histologic examination, which typical morphologic features include granulomatous inflammation and a diffuse eosinophilic infiltrate with thin walled branched hyphae surrounded by eosinophilic material (Splendore-Höeppli phenomenon) and sometimes zygospores (spherical bodies with foamy cytoplasm) [4,6,12,16,17,20,24,[26][27][28][29][31][32][33][35][36][37][38][39][42][43][44]46,49,52,53,…”

Section: Discussionmentioning

confidence: 99%

“…decades a 15-fold increase in cases of gastrointestinal infection by B. ranarum has been reported worldwide. Although most of the cases have been described in the Middle East (Saudi Arabia, Iran, Iraq, Kuwait, Oman, Qatar) [23-26,29,31-39,41-46,48-50,52-55,57,60,62] and the southwestern of United States (Arizona and Utah)[15,[17][18][19][20]40,47,56], sporadic reports came from South America, Africa, Europe and the Indian Subcontinent[4,12,14,16,27,28,30,51,59,PR] and no clear environmental risk factors have been identified. In the case-control study performed by Lyon et al in Arizona, ranitidine use (OR 6.0) and a longer period of smoking (OR 2.1/additional 20 years of smoking) were both associated with the development of the disease…”

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confidence: 99%

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Gastrointestinal basidiobolomycosis: An emerging mycosis difficult to diagnose but curable. Case report and review of the literature

Pezzani

Cristo

Parravicini

et al. 2019

Travel Medicine and Infectious Disease

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Background: Gastrointestinal basidiobolomycosis (GIB) is a rare mycosis affecting almost exclusively immunocompetent subjects. Methods: We describe a case of GIB caused by Basidiobolus ranarum in a 25-year-old Italian immunocompetent man resident in Ireland who presented a 2-month history of epigastric pain. Suspecting colon cancer he underwent a right hemicolectomy subsequently leading to a diagnosis of GIB by means of molecular biology. After surgery a 9-month therapy with itraconazole was employed with a good outcome. A review of medical literature regarding GIB cases published in the period 1964-2017 is presented. Results: One-hundred and two cases of GIB were included in this analysis. The disease was observed predominantly in male gender (74.5%) and children (41.2%). Abdominal pain was the single most common complaint (86.3%) followed by fever (40.2%) and evidence of an abdominal mass (30.4%). Peripheral blood eosinophilia was detected in 85.7% of cases. Most of the patients were diagnosed in Saudi Arabia (37.2%) followed by USA (21.6%) and Iran (20.6%). Surgery plus antifungal therapy was employed in the majority of patients (77.5%). An unfavourable outcome was documented globally in 18.6% of patients. Conclusions: GIB seems to be an emerging intestinal mycosis among immunocompetent patients living in the Middle East and Arizona. 1 MDP and VDC contributed equally to this work.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Gastrointestinal basidiobolomycosis: An emerging mycosis difficult to diagnose but curable. Case report and review of the literature

Pezzani

Cristo

Parravicini

et al. 2019

Travel Medicine and Infectious Disease

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“…The examiner may note hyperpigmentation and/or ulceration of the overlying skin. The mass lesions also may extend deeply into muscle and fascia with the potential for retroperitoneal invasion [51]. Beginning as a subcutaneous nodule, the lesion may expand over months to form lobular subcutaneous masses that can eventually ulcerate the overlying skin.…”

Section: Disease Manifestations and Clinical Diagnosismentioning

confidence: 99%

Entomophthoramycosis: a neglected tropical mycosis

Shaikh

Hussain

Petraitienė

et al. 2016

Clinical Microbiology and Infection

124

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The term 'entomophthoramycosis' classically refers to infections caused by members of the order Entomophthorales. A new subphylum, Entomophthoramycota, has been created to include Basidiobolomycetes, Neozygitomycetes and Entomophthoramycetes. Basidiobolomycetes encompass Basidiobolus spp., while the Entomophthoramycetes include Conidiobolus spp. Conidiobolus spp. characteristically cause rhinofacial entomophthoramycosis in apparently immunocompetent hosts. Conidiobolus spp. may also cause disseminated infection in immunocompromised patients. Basidiobolus spp. more typically cause subcutaneous entomophthoramycosis of the limbs, buttocks, back and thorax in immunocompetent patients. While once considered to be rare, there is an increasing number of reported cases of gastrointestinal infection caused by Basidiobolus spp. worldwide in countries such as United States, Thailand, Australia, Iran, Egypt and Saudi Arabia. These cases have clinical presentations similar to those of inflammatory bowel diseases, particularly Crohn's disease. Retroperitoneal, pulmonary, nasal and disseminated basidiobolomycosis have also been reported. Histology of entomophthoramycosis may reveal the Splendore-Hoeppli phenomenon. Culture of infected tissue remains the definitive method of laboratory diagnosis. However, molecular methods with specific DNA probes and panfungal primers, as well as real time PCR, are increasingly used to detect and identify these organisms in tissue. Treatment largely consists of therapy with antifungal triazoles. Surgery plays a selective role in the management of entomophthoramycosis, depending upon location, organism and extent of the infection.

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“…The inflammatory reaction can be suppurative or granulomatous. The histological examination sometimes shows the characteristic asteroid Splendore‐Hoeppli reaction 36 . The hyphae are thin‐walled, may be twisted or collapsed and often appear ring‐shaped or oval in cross‐sections.…”

Section: Mucocutaneous Infections Associated With Splendore‐hoeppli Pmentioning

confidence: 99%

Mucocutaneous Splendore‐Hoeppli phenomenon

2008

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Splendore-Hoeppli phenomenon (asteroid bodies) is the in vivo formation of intensely eosinophilic material (radiate, star-like, asteroid or club-shaped configurations) around microorganisms (fungi, bacteria and parasites) or biologically inert substances. This study presents a literature review concerning Splendore-Hoeppli reaction in the mucocutaneous diseases. It examines the histopathological features, nature and differential diagnosis of this reaction. It also discusses the mucocutaneous infections and the non-infective diseases associated with it. Available studies indicate that several mucocutaneous infections can generate Splendore-Hoeppli reaction. The fungal infections include sporotrichosis, pityrosporum folliculitis, zygomycosis, candidiasis, aspergillosis and blastomycosis. The bacterial infections include botryomycosis, nocardiosis and actinomycosis. The parasitic conditions include orbital pythiosis, strongyloidiasis, schistosomiasis and cutaneous larva migrans. In addition, Splendore-Hoeppli reaction may be seen with non-infective pathology such as hypereosinophilic syndrome and allergic conjunctival granulomas. The Splendore-Hoeppli reaction material comprises antigen-antibody complex, tissue debris and fibrin. Although the exact nature of this reaction is unknown, it is thought to be a localized immunological response to an antigen-antibody precipitate related to fungi, parasites, bacteria or inert materials. The characteristic formation of the peribacterial or perifungal Splendore-Hoeppli reaction probably prevents phagocytosis and intracellular killing of the insulting agent leading to chronicity of infection. To conclude, Splendore-Hoeppli reaction is a tell tale of a spectrum of infections and reactive conditions. The molecular pathways involved in the development of this reaction are open for future investigations.

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Case report of subcutaneous entomophthoromycosis with retroperitoneal invasion

Cited by 12 publications

References 9 publications

Gastrointestinal basidiobolomycosis: An emerging mycosis difficult to diagnose but curable. Case report and review of the literature

Gastrointestinal basidiobolomycosis: An emerging mycosis difficult to diagnose but curable. Case report and review of the literature

Entomophthoramycosis: a neglected tropical mycosis

Mucocutaneous Splendore‐Hoeppli phenomenon

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