Conidiobolus coronatus Infection Treated With Ketoconazole

Abstract

We describe a case of subcutaneous zygomycosis caused by Conidiobolus coronatus of six years' duration. Following treatment failure using potassium iodide, the patient responded with ketoconazole therapy. She remained well three years following therapy. Brazilian cases of subcutaneous infections caused by C coronatus and Basidiobolus ranarum are reviewed.

Relationships of the Insect-Pathogenic Order Entomophthorales (Zygomycota, Fungi) Based on Phylogenetic Analyses of Nuclear Small Subunit Ribosomal DNA Sequences (SSU rDNA)

“…It is worth noting that members of Conidiobolus, such as C. coronatus, occasionally occur as human pathogens, causing subcutaneous (Towersey et al, 1988) or pulmonary (Walsh et al, 1994) infections. Recognizing the apparently separate origins of the two studied Conidiobolus species, one of which includes clinically important strains, is essential information for risk assessments of Conidiobolus.…”

Zygomycetes in Human Disease

“…Yangco et al (515) reported in vitro results for the imidazoles and found that ketoconazole was most effective. Favorable in vivo responses to ketoconazole have been reported in the literature (39,82,131,458,466), as have failures (131). Other imidazoles have been effective, including itraconazole (39,458) and fluconazole (186).…”

“…The majority of infections have been limited to tropical areas, particularly the African rain forest (184), but cases have been reported worldwide (283,389), including Nigeria (87,165,183,283,336,345), Congo (71,283), Zaire (282), Cameroon (82,165,283,378), Côte d'Ivoire (132,165), Central Africa (71,165,283,458), India (165,283,312), Brazil (16,43,99,466), Jamaica (57), Costa Rica (416), Columbia (165), Puerto Rico (165), Thailand (63), Malaysia (323), and the United States (136,165,239,319,486,487).…”

“…Infection in the pharynx and larynx, causing dysphagia and obstruction of the larynx, as well as extensive and chronic lymphedema, has been reported (184,282,337). Sinusitis zygomycosis with C. coronatus has been reported worldwide in patients considered to be physiologically and immunologically competent, with different lengths of illness and varying success with treatments (99,312,323,416,454,466). Disseminated infections, including those with fatal outcomes, have been reported with C. coronatus in both immunocompetent and immunocompromised hosts.…”

“…Potassium iodide, co-trimoxazole, amphotericin B, ketoconazole, itraconazole, and combinations of these agents have been used with different degrees of success (184). Potassium iodide has traditionally been used in treatment of Conidiobolus infection with both successes (388) and failures (82,336,466) reported in the literature. High in vitro doses of potassium iodide must be used (337), but Taylor et al (454) warn that the method of action of KI is not known and that it may not have a direct antifungal effect, making in vitro testing less meaningful.…”