Rhinofacial Zygomycosis Caused by Conidiobolus coronatus: A Case Report Including in Vitro Sensitivity to Antimycotic Agents

Abstract

A case of zygomycosis caused by Conidiobolus coronatus, occurring in a 31-year-old priest from the Ivory Coast, is reported. Lesions eventually resolved after 2 1/2 years, during which the patient was variously treated with intravenous amphotericin B and miconazole as well as surgical resection. It is difficult to be certain which, if any, of these treatments contributed to resolution of lesions. A report of in vitro sensitivity data to a variety of antifungal agents is included.

Zygomycetes in Human Disease

“…They found that in vitro, amphotericin B was active against only 50% of Basidiobolus isolates and that both KI and 5-fluorocytosine failed to inhibit or kill at the maximum concentration. Since the action of KI is unknown and may not be mediated by direct fungal killing, these in vitro findings may not be significant (454). The imidazole derivatives, especially ketoconazole, were found to be active against the organism.…”

“…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.…”

“…This mirrors the treatment regimen successfully used to treat infections with Basidiobolus and Conidiobolus spp. (454). Similarly, topical treatment of Mucor-associated otomycosis has been optimal with mercurochrome applications (preferable to clotrimazole and miconazole) after adequate cleaning of the auditory canal (78).…”

“…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.…”

“…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. Trimethoprimsulfamethoxazole has given good results (184,282,336), but in vitro high doses have been required for organism inhibition with this drug as well (384).…”