First human culture-proven australian case of entomophthoromycosis caused by<i>Basidiobolus ranarum</i>

Davis, Stephen R.; Ellis, David; Goldwater, Paul N.; Dimitriou, Sophia M.; Byard, Roger W.

doi:10.1080/02681219480000291

Cited by 29 publications

(19 citation statements)

References 12 publications

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“…It is unclear whether itraconazole alone is sufficient or if simultaneous resection of the affected tissue is necessary to eradicate the infection (Khan et al, 2001). There is some reservation that surgical debridement of the infected area may spread the infection (Cameroon, 1990), a concern which is not shared by others (Davis et al, 1994;Pasha et al, 1997). Among the Fig.…”

Section: Discussionmentioning

confidence: 99%

“…PCR products were amplified as described in the text by using a uniform annealing temperature of 55 6C and additional 60 6C for Ba1/Ba2. Lanes: M, 1 kb molecular mass marker (MBI Fermentas); 1, DNA from the FFPE tissue sample; 2, no DNA (negative control); azoles, ketoconazole and fluconazole have also been found to be effective in a few reports of subcutaneous basidiobolomycosis (Drouhet & Dupont, 1983;Davis et al, 1994).…”

Section: Discussionmentioning

confidence: 99%

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Gastrointestinal basidiobolomycosis: an emerging fungal infection causing bowel perforation in a child

El-Shabrawi

Kamal

Jouini

et al. 2011

Journal of Medical Microbiology

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Basidiobolomycosis is an unusual fungal skin infection that rarely involves the gastrointestinal (GI) tract. We report a 10-year-old boy diagnosed as suffering GI basidiobolomycosis after being misdiagnosed first as suffering intestinal malignancy then schistosomiasis. The patient presented with fever, abdominal pain, vomiting, abdominal tenderness and rigidity with marked blood eosinophilia. Abdominal ultrasonographic and computed tomographic scans revealed a large caecal mass. Biopsy of the mass showed transmural granulomatous inflammation interpreted as schistosomal granuloma, ruling out lymphoma. The patient's condition deteriorated despite anti-schistosomal therapy. Emergency surgery was then performed, and caecal perforation was found. The mass was excised; cultures were negative and histopathological examination was suggestive of schistosomal granuloma. The mass recurred 3 weeks post-operatively. Secondopinion histopathological examination diagnosed Basidiobolus ranarum infection. Treatment with itraconazole produced marked improvement, with diminution of the mass. B. ranarum was unequivocally identified in the archival formalin-fixed and paraffin-embedded (FFPE) tissue by PCR. This case emphasizes the need to consider GI basidiobolomycosis in children presenting with fever, abdominal mass and eosinophilia, especially those complicated by bowel perforation. IntroductionBasidiobolus species are filamentous fungi that belong to the order Entomophthorales. Unlike other fungi (e.g. Mucorales) classified to the former zygomycetes, they cause subcutaneous zygomycosis in healthy individuals (Singh et al., 2008). Basidiobolus ranarum was first described as an isolate from frogs in 1886. It was cultured from frogs' intestinal contents and excreta (Ribes et al., 2000). It is commonly found in soil and decaying vegetable matter. It is occasionally present as a commensal in the gastrointestinal (GI) tracts of amphibians, reptiles, fish and mammals such as frogs, toads, turtles, fish, chameleons, horses, dogs and bats (Kaufman et al., 1990;Zahari et al., 1990;Gugnani, 1999). The micro-organism was first isolated in 1955 from decaying plants in the United States. Subsequently it was found in soil and vegetation worldwide (Greer & Friedman, 1966). Basidiobolus is endemic in Uganda and certain other areas of Africa, and in parts of Asia including India (Ribes et al., 2000). In the past, clinical isolates of Basidiobolus were classified as B. ranarum, B. meristosporus and B. haptosporus. However, recent taxonomic studies based on antigenic analysis, isoenzyme banding and restriction enzyme analysis indicate that all human pathogens belong to B. ranarum. In two studies, B. ranarum was commonly isolated from South India (Khan et al., 2001;Sujatha et al., 2003).Zygomycosis is characterized by tissue invasion with broad, non-septate hyphae of fungal species such as Rhizopus, Rhizomucor, Absidia and Basidiobolus. Fungal elements of B. ranarum include hyphae and zygospores (Hocquet, 1979;Gugnani, 1999). The hyphae are thin-wall...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gastrointestinal basidiobolomycosis: an emerging fungal infection causing bowel perforation in a child

El-Shabrawi

Kamal

Jouini

et al. 2011

Journal of Medical Microbiology

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“…Pharmaceutical agents that have been used to successfully treat Basidiobolus infection include most commonly potassium iodide (KI) (42,228,384,480), trimethoprim-sulfamethoxazole (384), amphotericin B (133), oral azoles (109,131,359) and KI combined with oral azoles (44). Treatment of Basidiobolus is not always successful, and no single drug has proved effective in the treatment of all cases of basidiobolomycosis (320, 384).…”

Section: Entomophthorales Causing Zygomycosis In Humansmentioning

confidence: 99%

Zygomycetes in Human Disease

Ribes¹,

Vanover-Sams²,

Baker³

2000

Clinical Microbiology Reviews

1,091

1,053

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“…Whether itraconazole alone is sufficient to eradicate the infection or simultaneous resection of the affected tissue is necessary to achieve a cure remains unclear. There is some reservation about the surgical debridement of the infected area because of the possibility of the spread of infection (3), a concern which is not shared by others (4,14). Among the azoles, ketoconazole and fluconazole have also been found to be effective in a few reports of subcutaneous basidiobolomycosis (4,6).…”

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confidence: 99%

Basidiobolus ranarum as an Etiologic Agent of Gastrointestinal Zygomycosis

Khoursheed²,

et al. 2001

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Basidiobolus ranarum is a known cause of subcutaneous zygomycosis. Recently, its etiologic role in gastrointestinal infections has been increasingly recognized. While the clinical presentation of the subcutaneous disease is quite characteristic and the disease is easy to diagnose, gastrointestinal basidiobolomycosis poses diagnostic difficulties; its clinical presentation is nonspecific, there are no identifiable risk factors, and all age groups are susceptible. The case of gastrointestinal basidiobolomycosis described in the present report occurred in a 41-year-old Indian male who had a history of repair of a left inguinal hernia 2 years earlier and who is native to the southern part of India, where the subcutaneous form of the disease is indigenous. Diagnosis is based on the isolation of B. ranarum from cultures of urine and demonstration of broad, sparsely septate hyphal elements in histopathologic sections of the colon, with characteristic eosinophilic infiltration and the Splendore-Hoeppli phenomenon. The titers of both immunoglobulin G (IgG) and IgM antibodies to locally produced antigen of the fungus were elevated. The patient failed to respond to 8 weeks of amphotericin B therapy, and the isolate was later found to be resistant to amphotericin B, itraconazole, fluconazole, and flucytosine but susceptible to ketoconazole and miconazole. One other noteworthy feature of the fungus was that the patient's serum showed raised levels of Th2-type cytokines (interleukins 4 and 10) and tumor necrosis factor alpha. The present report underscores the need to consider gastrointestinal basidiobolomycosis in the differential diagnosis of inflammatory bowel diseases and suggests that, perhaps, more time should be invested in developing standardized serologic reagents that can be used as part of a less invasive means of diagnosis of the disease. CASE REPORTA 41-year-old, Indian male was admitted to Mubarak AlKabeer Hospital, Kuwait, in December 1999 with a history of abdominal pain of 20 days' duration. On examination, he was febrile (38.8°C) and his abdomen was tender and distended, particularly at the right hypochondrium and the right iliac fossa, where a palpable, nodular mass (9 by 5 cm) was located. The patient's history was not remarkable, except that he had a history of repair of a left inguinal hernia 2 years earlier. He was nondiabetic and nonneutropenic but had persistently low hemoglobin levels (7.7 to 8.7 g/dl). Ultrasound of the abdomen and pelvis confirmed the presence of a thick mass in the right iliac fossa and showed a marked thickening of the ascending colon and cecum and an increased echogenicity of the renal cortex, suggesting bilateral compromised function. Moreover, his prostate was markedly enlarged. There was fecal impaction in the colon. His blood urea nitrogen, serum creatinine, and uric acid levels were within the normal ranges. Examination of his urine showed many leukocytes and red blood cells, besides elevated levels of protein and bilirubin. On 11 January 2000, a right hemicolectomy was per...

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First human culture-proven australian case of entomophthoromycosis caused byBasidiobolus ranarum

Cited by 29 publications

References 12 publications

Gastrointestinal basidiobolomycosis: an emerging fungal infection causing bowel perforation in a child

Gastrointestinal basidiobolomycosis: an emerging fungal infection causing bowel perforation in a child

Zygomycetes in Human Disease

Basidiobolus ranarum as an Etiologic Agent of Gastrointestinal Zygomycosis

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