Gastrointestinal Basidiobolomycosis in Arizona: Clinical and Epidemiological Characteristics and Review of the Literature

Abstract

Gastrointestinal basidiobolomycosis (GIB) is an unusual fungal infection that is rarely reported in the medical literature. From April 1994 through May 1999, 7 cases of GIB occurred in Arizona, 4 from December 1998 through May 1999. We reviewed the clinical characteristics of the patients and conducted a case-control study to generate hypotheses about potential risk factors. All patients had histopathologic signs characteristic of basidiobolomycosis. Five patients were male (median age, 52 years; range, 37--59 years) and had a history of diabetes mellitus (in 3 patients), peptic ulcer disease (in 2), or pica (in 1). All patients underwent partial or complete surgical resection of the infected portions of their gastrointestinal tracts, and all received itraconazole postoperatively for a median of 10 months (range, 3--19 months). Potential risk factors included prior ranitidine use and longer residence in Arizona. GIB is a newly emerging infection that causes substantial morbidity and diagnostic confusion. Further studies are needed to better define its risk factors and treatment.

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

“…Thus, B. ranarum was unequivocally identified in the FFPE tissue. B. ranarum has been detected as aetiological agent in other cases of GI zygomycoses in previous analyses (Khan et al, 2001;Lyon et al, 2001). …”

“…It is caused by Basidiobolus ranarum, a member of the former zygomycetes, subphylum Entomophthoromycotina, order Entomophthorales (Hibbett et al, 2007;Kirk et al, 2008). The fungus is an environmental saprophyte, and is found worldwide (Kwon-Chung & Bennett, 1992;Khan et al, 2001;Lyon et al, 2001;Dromer & McGinnis, 2002). Basidiobolomycosis is usually a subcutaneous infection that affects mostly young males, and it is transmitted through traumatic inoculation (Sugar, 2005).…”

Unusual Fungal and Pseudofungal Infections of Humans

“…has been reported from Latin America as well (16,31). Cases of basidiobolomycosis and conidiobolomycosis in the United States are extremely rare and appear to be more acutely invasive than those seen more commonly in the tropics (25,40,53,91,97,98). Both basidiobolomycosis and conidiobolomycosis are rare diseases without known predisposing factors such as acidosis or immunodeficiency.…”

“…Alternatively, potassium iodide, amphotericin B, fluconazole, or terbinafine or combinations of these drugs have been used (28,31,33,53). The role of new and investigational azoles (e.g., posaconazole, which is active against some Mucorales) in treatment of entomophthoromycosis is not known.…”

“…Facial reconstructive surgery may be necessary in the case of conidiobolomycosis, as the extensive fibrosis remains after eradication of the fungus. In the case of gastrointestinal basidiobolomycosis, it is recommended that patients undergo resection of all affected bowel and debridement of other involved tissues, fol- lowed by Ն3 months of antifungal therapy with itraconazole (53).…”