Severe cutaneous mucormycosis (zygomycosis) due to <i>apophysomyces elegans</i>

Page, R.E.; Gardam, Dianne; Heath, Christopher H.

doi:10.1046/j.1440-1622.2001.02054.x

Cited by 17 publications

(19 citation statements)

References 27 publications

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“…These include fever, headache, sinusitis, facial or orbital pain and swelling, orbital cellulitis, external ophthalmoplegia, decreased vision or blindness, proptosis, chemosis, nasal congestion, mucosal ulceration and/or necrosis, and central retinal artery occlusion. Radiographic findings are also similar and include proptosis, sinus thickening or opacification, and intraorbital inflammation (1,5,7,15,23,29). Morphological features of large sparsely septate or nonseptate hyphae with right-angle branching, often with angioinvasion, on histopathologic examination suggest the etiology (32).…”

Section: Discussionmentioning

confidence: 99%

“…At that time, there were 21 reported cases of mucormycosis caused by A. elegans since 1985, only 4 of which were rhino-orbitocerebral mucormycosis (ROCM) (2-4, 8-10, 13, 17, 19-22, 24-28, 31, 36-37). Since then, there have been 13 more reported cases of Apophysomyces elegans, mostly cutaneous infections, 8 of which were from India and 2 of which were cases of ROCM (1,5,7,15,23,29). We report an additional case of ROCM caused by A. elegans and review the literature specifically for ROCM caused by A. elegans to better understand the characteristics of this rare disease.…”

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confidence: 95%

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Rhino-Orbitocerebral Mucormycosis Caused by Apophysomyces elegans

Liang¹,

Tleyjeh²,

Wilson³

et al. 2006

J Clin Microbiol

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Rhino-orbitocerebral mucormycosis (ROCM) caused by more common zygomycetes (e.g., Mucor) is known to cause rapidly fatal infections in immunocompromised patients. Apophysomyces elegans is an emerging zygomycete that has been reported to cause invasive cutaneous and rhino-orbitocerebral infections in immunocompetent individuals. Limited data exist describing the syndrome of ROCM caused by A. elegans. We describe a recent case and performed a comprehensive literature review to delineate the clinical characteristics of ROCM caused by A. elegans. Our case is a 50-year-old man with diabetes mellitus who presented with facial pain and right eye proptosis. Endoscopic sinus sampling revealed A. elegans. He was treated with liposomal amphotericin B and multiple debridements, with no disease on 1.5-year follow-up examination. Seven cases were identified on literature review, including the present case. Most patients (86%) were male, with a mean age of 40 years. Most patients (71%) did not have predisposing medical conditions. Three patients had predisposing head trauma. All presented with facial and/or periorbital pain. All had magnetic resonance imaging or computed tomography of the head showing intraorbital and/or sinus inflammation. Diagnosis was confirmed by histopathology and deep tissue culture in all cases. All patients required eye exenteration and extensive surgical debridement, in addition to intravenous amphotericin B. Six of the seven patients (86%) recovered. ROCM caused by A. elegans is rarely reported in the literature. Most such infections occurred in immunocompetent patients, often after facial trauma. Survival in ROCM caused by A. elegans is favorable in reported cases, with prompt surgical debridement and antifungal therapy. Mucormycosis is a rare necrotizing infection caused by fungi within the class Zygomycetes and the order Mucorales (7). These fungi can cause serious and rapidly fatal infections, particularly in the immunocompromised, such as poorly controlled diabetics with ketoacidosis (17). The genera reported to cause invasive infection include Absidia, Mucor, Rhizomucor, Rhizopus, Apophysomyces, Saksenaea, Cunninghamella, Cokeromyces, and Syncephalastrum, with the first four being the most commonly reported pathogens (7). Apophysomyces elegans is an emerging pathogen that, unlike the other members of Mucorales, has been reported to cause invasive cutaneous and rhino-orbitocerebral infections in immunocompetent individuals (37). In rhino-orbitocerebral infections, inhalation is the natural route of infection. However, traumatic inoculation has been described, particularly with Apophysomyces elegans (17).In 2001, Garcia-Covarrubias et al. reported a review of the literature of mucormycosis attributable to Apophysomyces elegans (17). At that time, there were 21 reported cases of mucormycosis caused by A. elegans since 1985, only 4 of which were rhino-orbitocerebral mucormycosis (ROCM) (2-4, 8-10, 13, 17, 19-22, 24-28, 31, 36-37). Since then, there have been 13 more reported cases of Apophysomyces ...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 95%

Rhino-Orbitocerebral Mucormycosis Caused by Apophysomyces elegans

Liang¹,

Tleyjeh²,

Wilson³

et al. 2006

J Clin Microbiol

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“…Its distribution in tropical and subtropical climates is further substantiated by the occurrence of most human cases in such climates (3, 5-7, 9, 11, 14, 16, 17, 20, 22, 24, 25, 29, 34, 35). However, infection due to A. elegans was considered rare, as about 26 cases have been reported to date (12,13,15,28,30). Interestingly, eight patients with A. elegans infection were reported from MCCL from 1990 to 1999, and the agent made up 32% of all zygomycetes isolated during the same period (4).…”

Section: Discussionmentioning

confidence: 99%

Apophysomyces elegans : an Emerging Zygomycete in India

Chakrabarti¹,

Ghosh²,

Prasad

et al. 2003

J Clin Microbiol

103

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Apophysomyces elegans was considered a rare but medically important zygomycete. We analyzed the clinical records of eight patients from a single center in whom zygomycosis due to A. elegans was diagnosed over a span of 25 months. We also attempted a DNA-based method for rapid identification of the fungi and looked for interstrain polymorphism using microsattelite primers. Three patients had cutaneous and subcutaneous infections, three had isolated renal involvement, one had rhino-orbital tissue infection, and the final patient had a disseminated infection involving the spleen and kidney. Underlying illnesses were found in two patients, one with diabetes mellitus and the other with chronic alcoholism. A history of traumatic implantation was available for three patients. All except two of the patients responded to surgical and/or medical therapy; the diagnosis for the two exceptions was made at the terminal stage of infection. Restriction enzyme (MboI, MspI, HinfI) digestion of the PCR-amplified internal transcribed spacer region helped with the rapid and specific identification of A. elegans. The strains could be divided into two groups according to their patterns, with clustering into one pattern obtained by using microsatellite [(GTG) 5 and (GAC) 5 ] PCR fingerprinting. The study highlights the epidemiology, clinical spectrum, and diagnosis of emerging A. elegans infections.Zygomycosis is a serious and often rapidly fatal infection especially in immunocompromised patients. It is caused by sparsely septate filamentous, saprophytic fungi belonging to the class Zygomycetes and the order Mucorales.

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“…A lack of awareness about fungal infections in most centers in developing countries probably contributes to underestimation of its importance (55). The most common underlying immunosuppressive conditions predisposing patients to Apophysomyces elegans infections include diabetes mellitus (36,55,56,64,99,116,158,187,190,221,246,275,363), organ transplantation (8,221), alcoholic cirrhosis (157,355), and idiopathic myelofibrosis (56).…”

Section: Apophysomyces Elegans Complexmentioning

confidence: 99%

“…Among cases with unknown or undescribed (n ϭ 12) or no (n ϭ 12) predisposing factors (Table 2), and excluding cases with underlying conditions (n ϭ 5) (55, 56, 117a, 246, 307), 8 (40%) were rhino-orbital infections where the acquisition was likely related to spore inhalation (55,304,318,322). Therefore, in 11 (15%) previously healthy patients who developed soft tissue infection (n ϭ 5) (55,144,246), osteomyelitis and arthritis (n ϭ 1) (212), or kidney (n ϭ 4) (55,184,204,327) or intra-abdominal infection with kidney involvement (n ϭ 1) (55) caused by Apophysomyces elegans, no predisposing factor was detected. Apophysomyces elegans is believed to be incapable of penetrating intact skin (64), but trauma without visible breakage of skin integrity was deemed responsible for Apophysomyces elegans osteomyelitis of the sternum that appeared clinically 2 months later in a previously healthy individual (88).…”

Section: Apophysomyces Elegans Complexmentioning

confidence: 99%

Mucormycosis Caused by Unusual Mucormycetes, Non-Rhizopus, -Mucor, and -Lichtheimia Species

2011

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SUMMARY Rhizopus , Mucor , and Lichtheimia (formerly Absidia ) species are the most common members of the order Mucorales that cause mucormycosis, accounting for 70 to 80% of all cases. In contrast, Cunninghamella , Apophysomyces , Saksenaea , Rhizomucor , Cokeromyces , Actinomucor , and Syncephalastrum species individually are responsible for fewer than 1 to 5% of reported cases of mucormycosis. In this review, we provide an overview of the epidemiology, clinical manifestations, diagnosis of, treatment of, and prognosis for unusual Mucormycetes infections (non- Rhizopus , - Mucor , and - Lichtheimia species). The infections caused by these less frequent members of the order Mucorales frequently differ in their epidemiology, geographic distribution, and disease manifestations. Cunninghamella bertholletiae and Rhizomucor pusillus affect primarily immunocompromised hosts, mostly resulting from spore inhalation, causing pulmonary and disseminated infections with high mortality rates. R. pusillus infections are nosocomial or health care related in a large proportion of cases. While Apophysomyces elegans and Saksenaea vasiformis are occasionally responsible for infections in immunocompromised individuals, most cases are encountered in immunocompetent individuals as a result of trauma, leading to soft tissue infections with relatively low mortality rates. Increased knowledge of the epidemiology and clinical presentations of these unusual Mucormycetes infections may improve early diagnosis and treatment.

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Severe cutaneous mucormycosis (zygomycosis) due to apophysomyces elegans

Cited by 17 publications

References 27 publications

Rhino-Orbitocerebral Mucormycosis Caused by Apophysomyces elegans

Rhino-Orbitocerebral Mucormycosis Caused by Apophysomyces elegans

Apophysomyces elegans : an Emerging Zygomycete in India

Mucormycosis Caused by Unusual Mucormycetes, Non-Rhizopus, -Mucor, and -Lichtheimia Species

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