Entomophthorales infection of the maxillofacial region

Abstract

Phycomycosis infections caused by the fungi Rhizopus and Mucor are commonly termed mucormycosis. Mucormycosis infections exhibit a rapidly progressive course characterized by angioinvasion and necrosis. The rhinocerebral form has been described thoroughly in the literature. However, there exists another order of Phycomycetes, the Entomophthorales, which rarely cause clinical disease. Their infection is indolent and is associated with granulomatous inflammation and a protracted clinical course. Presented here is a rare case of suspected Canidiobolus coronato infection occurring in the maxillofacial region of a previously healthy male. The authors believe this to be the first reported case occurring in the United States. Because of the poorly documented natural history of this infection and the patient's relative intolerance to parenteral antifungal therapy, a multidisciplinary therapeutic approach was designed. It consisted of long-term, low-dosage amphotericin-B, hyperbaric oxygen and sequential surgical debridements. This unusual disease entity must now be considered in the differential diagnosis of granulomatous disorders of the head and neck.

Zygomycetes in Human Disease

“…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).…”

“…Other imidazoles have been effective, including itraconazole (39,458) and fluconazole (186). Amphotericin B is usually not the first choice for treatment but is often tried after other agents have failed (136,297,319,384,395,454). Gugnani found amphotericin B more effective than imidazoles in the treatment of C. coronatus (H. C. Gugnani, Abstr.…”

A Rare Case of Rhinofacial Zygomycosis due to Conidiobolus Infection

“…2,3 Mucorales cause mucormycosis, also known as rhinocerebral mucor mycosis which is a fulminant fungal infection seen in immunocompromised patients and is a well-known clinical entity. 2,3 Basidiobolus infection typically involves the leg, thigh, and buttocks.…”

“…2,3 Mucorales cause mucormycosis, also known as rhinocerebral mucor mycosis which is a fulminant fungal infection seen in immunocompromised patients and is a well-known clinical entity. 2,3 Basidiobolus infection typically involves the leg, thigh, and buttocks. 4,5 Infection caused by conidiobolus affects the upper respiratory tract, with involvement of nasal and paranasal mucosa and extension to the skin of the nose, superior lip and frontoglabellar region.…”

“…[1][2][3] Infections caused by entomophthorales are rare, and are known to be indolent, chronic, associated with granulomatous inflammation and a protracted clinical course. Entomophthorales com prises of two species, namely conidiobolus and basidio bolus.…”