Zygomycosis: the re-emerging fungal infection

Abstract

Invasive fungal infections are major medical complications in immunocompromised patients. The recent rise in the incidence of cancer and the increased use of newer medical treatment modalities, including organ transplantations, have resulted in growing numbers of highly immunosuppressed individuals. Although aspergillosis and candidiasis are among the most common invasive mycoses in such patients, there is evidence that the incidence of infectious diseases caused by Zygomycetes has risen significantly over the past decade. Patients with diabetes, malignancies, solid organ or bone marrow transplants, or iron overload and those receiving immunosuppressive agents, deferoxamine therapy, or broad-spectrum antimicrobial drugs are at highest risk for zygomycosis. This review details the emergence and importance of zygomycosis in current clinical practice and its manifestations and management. The etiologic species, pathogenesis and risk factors for zygomycosis are reviewed and updated. The clinical spectrum of zygomycosis is now broader, and it can be difficult to distinguish between mucormycosis and enthomophthoramycosis, both of which can manifest as disease ranging from a superficial infection to an angioinvasive infection with high mortality. Finally, the three-part treatment strategy (antifungal drugs, surgery, control of underlying diseases) is reviewed. Lipid formulations of amphotericin B are the antifungal agents of choice for treatment of zygomycosis. A novel antifungal triazole, posaconazole, has been developed and may become approved for treatment of zygomycosis. The clinical experience with adjunctive treatments like colony-stimulating factors, interferon-gamma, and hyperbaric oxygen therapy is still limited.

Épidémiologie des mucormycoses en France métropolitaine, 1997–2010

“…L'étude des pathologies associées aux mucormycoses a porté sur neuf conditions définies et hierarchisées afin de ne retenir qu'un facteur de risque par patient. La première catégorie considérée comme la plus à risque, intitulée « hémopathies malignes » (HM) a inclus par ordre d'importance les hémopathies malignes avec greffe de cellules souches hématopoïétiques, les hémopathies malignes avec neutropénie sans greffe de cellule souches et les hémopathies malignes sans aucune Une augmentation de l'incidence des mucormycoses (zygomycoses)a été suggérée par différents auteurs [1,2], mais les données épidémiologiques sont le plus souvent issues d'études monocentriques portant sur des cohortes de patients sévèrement immunodéprimés, chez lesquels la probabilité de survenue d'une mucormycose ou d'autres infections fongiques invasives est considé-rée comme élevée [3]. Les études en population géné-rale étant rares, il est difficile d'estimer l'incidence à l'échelle d'un pays.…”

Epidemiological, clinical and diagnostic aspects of sheep conidiobolomycosis in Brazil

“…Rounded dilations are often seen at the ends of hyphae and these enlargements have been also described in case of conidiobolomycosis (KETTERER et al, 1992;SILVA et al, 2007b, BOABAID et al, 2008. These fungi are characterized by producing asexual spores, which are relatively large globose (CHAYAKULKEEREE et al, 2006). SILVA et al (2012) also reported that C. lamprauges when exposed to temperature of 37°C overexpresses enolase, suggesting that this enzyme has potential involvement in host-pathogen relationship and virulence of this fungus.…”

“…Morphologically, Conidiobolus spp. have hyaline, coenocytic hyphae or shorter hyphal bodies, although septa may be more infrequentthanl the older parts of the mycelium (CHAYAKULKEEREE et al, 2006). Rounded dilations are often seen at the ends of hyphae and these enlargements have been also described in case of conidiobolomycosis (KETTERER et al, 1992;SILVA et al, 2007b, BOABAID et al, 2008.…”

“…Conidiobolomycosis cases were described in tropical regions such as: Africa, South America, Central America, and Asia (CHAYAKULKEEREE et al, 2006;EL-SHABRAWI et al, 2014). In Brazil, the disease is considered endemic in flocks of the Northeast and Midwest regions, being reported in ovine in the states of Piauí (SILVA et al, 2007a,b), Paraíba (RIET-CORREA et al, 2008), Pernambuco (MENDONÇA et al, 2012), and Mato Grosso (BOABAID et al, 2008;DE PAULA et al, 2010).…”

Meningoencephalitis caused by a zygomycete fungus (Basidiobolus) associated with septic shock in an immunocompetent patient: 1-year follow-up after treatment

“…Despite the rise in the frequency of zycomycosis over the last 10 years (8,9), there are few reports on this infection in immunocompetent patients. We report here a severe case of zycomycosis caused by fungi of the order Entomophthorales, family Basidiobolaceae and genus Basidiobolus, which resulted in meningoencephalitis and septic shock in an immunocompetent individual.…”