Chronic Rhinofacial Mucormycosis Caused by Mucor irregularis (Rhizomucor variabilis) in India

Hemashettar, B. M.; Patil, Ravikant; O’Donnell, Kerry; Chaturvedi, Vishnu; Ren, Ping; Padhye, A. A.

doi:10.1128/jcm.02326-10

Cited by 51 publications

(44 citation statements)

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“…Drogari-Apiranthitou et al (23) studied potential interactions between anidulafungin and amphotericin B against 21 mucormycetes and observed synergism against one Mucor circinelloides isolate and no antagonism. Further, synergism of caspofungin-amphotericin B and caspofungin-posaconazole combinations against M. irregularis isolates has been observed, according to a few case reports (7,8). Besides, previous research has shown that an echinocandin plus a polyene could markedly improve the survival of mice with diabetic ketoacidosis and disseminated mucormycosis (24,25).…”

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confidence: 98%

“…To our knowledge, with the exception of some reported cases (7,9), no susceptibility of M. irregularis to combinations of antifungal drugs in vitro has been reported. In the present study, the combinations of terbinafine or caspofungin with amphotericin B, posaconazole, or itraconazole were assessed against M. irregularis isolates in vitro.…”

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confidence: 99%

“…Cutaneous zygomycosis caused by Mucor irregularis (formerly Rhizomucor variabilis) is an emerging disease in China that is characterized by progressive swelling, ulceration, and destruction of involved skin at exposed sites, especially the central face, and leads to severe disfigurement and even death if left untreated (2)(3)(4). Notably, it seemed that most of the patients infected with M. irregularis were immunocompetent (2)(3)(4)(5)(6)(7)(8)(9).…”

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Drug Combinations against Mucor irregularis In Vitro

Zhang

2013

Antimicrob Agents Chemother

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Combinations of terbinafine or caspofungin with amphotericin B, posaconazole, or itraconazole were studied as potential treatments against 18 isolates of Mucor irregularis in vitro. Synergism of the combinations of terbinafine with amphotericin B, posaconazole, and itraconazole against 38.9, 33.3, and 44.4% of the strains studied was observed. In contrast, synergism of the combinations of caspofungin with amphotericin B, posaconazole, and itraconazole against 99.4, 66.7, and 99.4% of the strains studied was observed. Furthermore, no antagonism was observed.C utanous zygomycosis is a fungal infection caused mainly by members of the order Mucorales that affect the skin. The most frequently reported genus in the English literature is Rhizopus, followed by Lichtheimia spp. and Rhizomucor pusillus (1). Cutaneous zygomycosis caused by Mucor irregularis (formerly Rhizomucor variabilis) is an emerging disease in China that is characterized by progressive swelling, ulceration, and destruction of involved skin at exposed sites, especially the central face, and leads to severe disfigurement and even death if left untreated (2-4). Notably, it seemed that most of the patients infected with M. irregularis were immunocompetent (2-9).Amphotericin B is the most potent drug used for the treatment of M. irregularis infection, but the toxicity of amphotericin B limits its long-term clinical application. Posaconazole has been used primarily as salvage therapy, but at present, there is no strong published clinical evidence supporting its role as a single agent for the treatment of mucormycosis (10). Itraconazole has variable effectiveness against M. irregularis in vitro (11) but was proven to be effective against some M. irregularis infections (2, 5). Terbinafine is an allylamine antifungal agent used primarily to treat dermotropic infections and onychomycosis but has potential for use in adjunct therapy in combination with azoles, polyenes, or echinocandins in the management of severe drug-resistant or refractory mycosis (12). Besides, terbinafine could reach high concentrations in the stratum corneum and sebum because of its lipophilic nature (13), which provided the possibility that terbinafine can be used in combination therapies to treat cutaneous zygomycosis.To our knowledge, with the exception of some reported cases (7, 9), no susceptibility of M. irregularis to combinations of antifungal drugs in vitro has been reported. In the present study, the combinations of terbinafine or caspofungin with amphotericin B, posaconazole, or itraconazole were assessed against M. irregularis isolates in vitro.A total of 18 M. irregularis patient isolates preserved by the Research Center for Medical Mycology at Peking University were tested. Isolates were identified by both conventional morphological methods and the internal transcribed spacer sequence analysis method (11).Drug combinations were conducted by using a checkerboard method based on Clinical and Laboratory Standards Institute document M38-A2 (14) that provided the MICs of each agen...

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Drug Combinations against Mucor irregularis In Vitro

Zhang

2013

Antimicrob Agents Chemother

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“…This infer- ence is based on the fact that hyaline, coenocytic hyphae were detected by direct microscopy in the nasal crust specimen; this fungus was the only mold cultured from the patient's nasal cavity and grew well at 37°C and 40°C. Although rhino-orbitocerebral infections caused by mucoraceous molds are the most common mycoses among Indian patients (5, 6, 9), only about one-fifth are cultured and identified at the genus level (11), suggesting that novel etiologic agents are likely overlooked in India in the absence of detailed morphological and/or molecular phylogenetic data confirming the identification. Note that our data strongly suggest but do not confirm that T. lucknowense caused the infection, because no cultures were made using tissue samples from deep within the patient and an autopsy was not performed.…”

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“…Methods to obtain multilocus DNA sequence data, including extraction of total genomic DNA, PCR amplification, and DNA sequencing, followed published protocols (11,14,15). Briefly, isolate NRRL 54533, and the ex-type strains of Thamnostylum nigricans NRRL 6243, T. piriforme NRRL 2342, and T. lucknowense NRRL 2892 and the ex-neotype strain of T. repens NRRL 6241, were cultured in yeast-malt broth (0.3% yeast extract, 0.3% malt extract, 0.5% peptone, 2% dextrose; Difco, Detroit, MI) and then harvested over a Büchner funnel.…”

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Evidence Implicating Thamnostylum lucknowense as an Etiological Agent of Rhino-Orbital Mucormycosis

et al. 2012

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e In this report, we present a case of rhino-orbital mucormycosis in a 57-year-old female with poorly controlled diabetes mellitus. The only mold cultured at 25°C, 37°C, and 40°C from a specimen of the nasal crust was identified phenotypically and independently using nuclear ribosomal DNA sequence data as Thamnostylum lucknowense. To our knowledge, this report presents the first data implicating this mucoraceous fungus as a mycotic agent of human infection. CASE REPORTA 57-year-old female patient was admitted to the Emergency Department of the All India Institute of Medical Sciences, New Delhi, India, in February 2009 with complaints of swelling and loss of vision in the right eye over the previous 10 days and right-sided nasal obstruction for the previous week. She had a history of fever, vomiting, and itching in the right eye, with intermittent episodes of altered sensorium. Her current symptoms started with itching followed by loss of vision in the right eye and nasal obstruction and then altered sensorium. She had poorly controlled diabetes mellitus for the previous 8 years and hypertension for 5 years. Her blood pressure was controlled with oral amlodipine at 5 mg daily. There was no history of seizures or trauma.On examination, the patient was disoriented. Her heart rate was 120/min, and blood pressure was 160/70 mm Hg. Ophthalmological examination revealed hyperemia, proptosis, discharge, and sluggish papillary reaction to light in her right eye. Her random blood sugar was 19.7 mmol/liter. She was treated initially with ceftazidime (1 g) every 12 h, vancomycin (500 mg) infusion every 6 h, and subcutaneous injection of human insulin (Actrapid). The patient was transferred to the otorhinolaryngology department for further management.A contrast-enhanced computed tomographic (CT) scan of her brain and orbit showed bilateral polypoidal opacification of the maxillary, sphenoid, and ethmoid sinuses together with involvement of the cavernous sinus. A specimen of the nasal crust was sent to the microbiology laboratory for testing. Direct examination of a portion of the nasal crust in a KOH mount using light microscopy showed hyaline, coenocytic hyphae 4.0 to 7.0 m in diameter. A portion of the nasal crust was cultured on Sabouraud dextrose agar with and without chloramphenicol at 25°C, 37°C, and 40°C in the dark. After 48 h of incubation, only white, cottony colonies producing aerial hyphae were observed on slant cultures at each temperature. No bacterial growth was evident. Over the next 2 to 3 days, the colonies turned from white to olive brown and filled the culture tubes. The in vitro MICs of the following four antifungals were determined by the broth microdilution technique according to the CLSI M38-A2 protocol (7): amphotericin B, 0.5 g/ml; itraconazole, 0.5 g/ml; posaconazole, 0.25 g/ml; and voriconazole, Ͼ64.0 g/ml.Once the diagnosis of acute rhino-orbital mucormycosis was made, the patient was treated with an intravenous infusion of conventional amphotericin B deoxycholate at 50 mg/day. However, the patie...

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Mucormycosis in Asia

Chakrabarti

2019

Clinical Practice of Medical Mycology in Asia

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Chronic Rhinofacial Mucormycosis Caused by Mucor irregularis (Rhizomucor variabilis) in India

Cited by 51 publications

References 19 publications

Drug Combinations against Mucor irregularis In Vitro

Drug Combinations against Mucor irregularis In Vitro

Evidence Implicating Thamnostylum lucknowense as an Etiological Agent of Rhino-Orbital Mucormycosis

Mucormycosis in Asia

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