<i>Apophysomyces variabilis</i>Infections in Humans

Guarro, Josep; Chander, Jagdish; Álvarez, Enrique José Varela; Stchigel, Alberto M.; Kaushik, Robin; Dalal, Usha; Rani, Hena; Punia, Rajpal Singh; Cano, J.

doi:10.3201/eid1701.101139

Cited by 42 publications

(31 citation statements)

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“…The present case, from a clinical perspective, is similar to others reported (3,8,9). We believe that the infection was acquired through a skin laceration and inoculation of a foreign body of small diameter during the accident and encouraged by the location of the Philadelphia collar, which probably created an optimal microenvironment for the fungus.…”

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confidence: 86%

Primary Cutaneous Mucormycosis Produced by the New Species Apophysomyces mexicanus

et al. 2014

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A case of fungal necrotizing fasciitis that appeared in an immunocompetent Mexican woman after a car accident is described. The patient did not respond to antifungal treatment and died 4 days later. The fungus was molecularly identified as a new species of Apophysomyces, namely, Apophysomyces mexicanus. CASE REPORTA 46-year-old woman was admitted to an emergency department 6 days after she suffered a rollover car accident, which occurred on a highway in a semiarid region with 75% relative humidity; the patient was ejected 10 meters from the car during the rollover, with consequent T12 vertebral fracture, Frankel grade B spinal cord injury, and superficial abrasions and lacerations over the neck. The patient was immobilized with a Philadelphia collar immediately after the accident, and her medical history showed type 2 diabetes mellitus, controlled with metformin-glibenclamide, and an allergy to nonsteroidal anti-inflammatory drugs. She received initial treatment in a regional hospital and was transferred to the emergency department of the Lic. Adolfo López Mateos Hospital 6 days later. After the collar was removed, a 3-cm-diameter fixed, irregular, red, swollen area was observed with a central necrosis of about 1 cm in length over the right posterior cervical triangle (Fig. 1A), along with multiple abrasions of the neck. Initial laboratory test results showed leukocytosis of 17 ϫ 10 9 /liter, glucose at 10.77 mmol/liter, hemoglobin at 121 g/liter, hematocrit at 0.352 liter/liter, urea nitrogen at 3.92 mmol/ liter, urea at 3.92 mmol/liter, and creatinine at 53.04 mmol/liter. A computed tomography (CT) scan of the neck after administration of contrast material revealed isodense homogeneous soft tissue bulking posterior to the sternocleidomastoid muscle, with no evidence of foreign bodies. An escharectomy was carried out, and ceftriaxone (2 g/day) and clindamycin (1.2 g/day) were administered. On the second day, the cellulitis and necrosis areas expanded to 10 cm in length (Fig. 1B), affecting the posterior, muscular, and submandibular cervical triangles. The patient underwent surgical exploration of the neck and debridement, which showed necrotic tissue that extended as far as the muscle. Material was collected and sent to the laboratory for histopathological examination and microbial culture. Direct mountings on KOH (10% [wt/vol]) showed dichotomously branched, broad coenocytic hyphae (Fig. 1C), similar to those observed on hematoxylin-eosin histopathology preparations (Fig. 1D). Culturing on Sabouraud dextrose agar (Difco/Becton Dickinson, Mexico) produced white, cottony fungal colonies made of pauciseptated hyphae evocative of a fungus belonging to Mucorales. Consequently, primary cutaneous mucormycosis (PCM) was diagnosed; therefore, amphotericin B deoxycholate (0.5 mg/kg of body weight/ day) and fluconazole (400 mg/day) were administered. A second debridement removed all necrotic tissue, reaching the free edges of the lesion and leaving a surgical mark (10 by 15 cm) (Fig. 1E). Despite antifungal treatment, th...

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confidence: 86%

Primary Cutaneous Mucormycosis Produced by the New Species Apophysomyces mexicanus

et al. 2014

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“…Apophysomyces ossiformis, Apophysomyces trapeziformis and Apophysomyces variabilis, the latter being the most common in clinical infections. 1,9 The aim of this study was to investigate a series of cases suspected of necrotizing fasciitis caused by Apophysomyces species over one-year period in a northern Indian hospital.…”

Section: Fascitis Necrotizante Fúngica Una Enfermedad Infecciosa Emementioning

confidence: 99%

Fungal necrotizing fasciitis, an emerging infectious disease caused by Apophysomyces (Mucorales)

Chander

Stchigel

Alastruey‐Izquierdo

et al. 2015

Revista Iberoamericana de Micología

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“…Most reports of infections due to Apophysomyces have been attributed to A. elegans prior to the identification of the four distinct species of Apophysomyces. The organisms responsible for the first reported cases of human A. variabilis infection were identified as A. elegans morphologically and subsequently identified as A. variabilis by ITS sequencing (11). It is likely that some of the reported cases of A. elegans infection were due to A. variabilis, although the extent to which these infections are due to A. variabilis is uncertain.…”

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confidence: 99%