Conidiobolomycosis/Nasofacial zygomycosis is a relatively rare disease entity. It is almost always caused by Conidiobolus coronatus and is also known as conidiobolomycosis. It has been more commonly reported in tropical countries than in other regions. Diagnosis is made mainly on a clinical and pathological basis as fungal cultures may be difficult to grow. Different antimycotic drugs have been tried for its treatment. This report probably is the first case in English literature that has shown a very good response to treatment with itraconazole.
Conidiobolus ; Diagnosis ; Itraconazole* ; Rare Diseases ; Zygomycosis*

Introduction: Subcutaneous zygomycosis or basidiobolomycosis is caused by a saprophytic fungi Basidiobolus ranarum (B. ranarum). It presents clinically as a slowly growing painless subcutaneous nodule more commonly on the extremity, trunk and rarely on other parts of the body. Mode of infection has not been established but most likely follows traumatic implantation. We report a gradually evolving case of basidiobolomycosis in a 12-year-old immunocompetent Filipino male with no history of trauma who responded dramatically to itraconazole. Case summary: Subcutaneous zygomycosis is caused by Basidiobolus ranarum (B. ranarum) which is endemic in parts of Africa, India and other parts of Asia. We report an evolving case of a Filipino male child who presented with chronic and persistent subcutaneous nodules and plaques on the left extremity. Dense cell infiltrates consisting of lymphocytes, histiocytes and eosinophils were seen on histology with non-septated hyphal structures on Gomori’s methenamine silver stain. Fungal culture of the lesion yielded B. ranarum. Complete resolution of the lesions were observed after 6 months of itraconazole therapy alone. Conclusion: This case demonstrated the gradual progression of the disease, and that the lack of a history of trauma does not exclude its diagnosis. Subcutaneous zygomycosis should be highly suspected in chronic painless subcutaneous nodules with swelling, and its early recognition is crucial to prevent progression of the disease. In patients whom an infectious cause is suspected, appropriate cultures, special staining, and sometimes repeat biopsies of new cutaneous lesions may be helpful in determining or ruling out the associated disease. Furthermore, performing PAS stain alone to identify the presence or absence of a fungi is insufficient, rather, additional staining such as GMS should be done to heighten detection of fungal elements.
Child ; Dermatology ; Itraconazole ; Basidiobolus ranarum ; entomophthoromycosis ; Zygomycosis

Indonesia is a tropical country and is the largest archipelago in the world. The country consists of more than 17,000 islands, although only 6,000 are inhabited by a population of more than 201 million people. In tropical countries, superficial mycosis are prevalent all the time, pytiriasis versicolor, several clinical forms of tineas and cutaneous candidosis comprise the most common spectrum of the disease. In our clinic this group diseases ranks the second or third place after dermatitis and acne vulgaris. Besides these common superficial fungal diseases, tines imbricate is endemic in eastern parts of islands in Indonesia. Sporotrichosis, chromomycosis, mycetoma and subcutaneous zygomycosis are occasionally seen in our clinic. The incidence of mycosis profunda is 0~2 per year in our department. Besides dermatomycosis, systemic mycosis s. a. lung aspergillosis, candidosis of the G. I. tract were also observed. Other systemic mycosis reported as endemic are histoplasmosis and cryptococcosis.
Acne Vulgaris ; Chromoblastomycosis ; Cryptococcosis ; Dermatitis ; Dermatomycoses ; Histoplasmosis ; Incidence ; Indonesia ; Islands ; Mycetoma ; Pulmonary Aspergillosis ; Skin* ; Sporotrichosis ; Tinea ; Zygomycosis

Various oxidases and hydrolytic enzymes were analyzed to investigate the relationship between these enzymes and the skin pathogenicity of 18 Mucorales strains. Each strain was cultured in a nutrient medium containing starch as a carbon source. The cells grew quickly and were at a good state of growth after incubation for three days. Oxidase activity was not detected in any strain, whereas Mucor spp. including Mucor racemosus IFM47053 typically had high alcohol dehydrogenase (ADH) activity and all the strains had catalase activity. The culture filtrate and the cell free extract of each strain were applied to APIZYM test system, which revealed that all the strains examined produced many hydrolytic enzymes both inside and outside their mycelia. In the case of Absidia corymbifera strains, lipase activity was comparatively high, and polysaccharide hydrolytic enzymes such as alpha-glucosidase, beta-glucosidase, N-acetyl-beta-glucosaminidase, alpha-mannosidase, and alpha-fucosidase were produced.
Absidia ; Alcohol Dehydrogenase ; alpha-Glucosidases ; alpha-L-Fucosidase ; alpha-Mannosidase ; beta-Glucosidase ; Carbon ; Catalase ; Hydrolases ; Lipase ; Mucor ; Mucorales* ; Oxidoreductases ; Skin ; Starch ; Virulence ; Zygomycosis*

Fungal diseases are grouped arbitarily into three broad categories based on the predominant location of infection within the body : superficial, cutaneous and subcutansous, and systemic. The Histopathologic features of more common fungal diseases were summarized in the table 1. and described in the text briefly. Herein described were superficial mycoses including dermatophytoses, pityriasis versicolor, cutaneous and subcutaneous including chromomycosis, rhinosporiodiosis, sporotrichosis, and systemic mycoses such as aspergillosis, candidiasis, cryptococcosis, fusariosis, zygomycosis and pneumocystosis. Characteristic and main histologic findings are granulomatous inflammation with respective organisms. The diagnosis of mycotic disease has four basic approach: clinical, mycologic, immunologivc and pathologic. Variety of host reaction are noted from non-specific reaction to granulomatous or mycetoma formation. Most important thing is mycological isolation and identification in the tissue. Multiple sections and special stains such as Gomori`s methenamine silver, Perioidic Acid Schiff, mucin stains, gram stains, acid fast stain, Giemsa stains are also very useful.
Aspergillosis ; Azure Stains ; Candidiasis ; Chromoblastomycosis ; Coloring Agents ; Cryptococcosis ; Diagnosis ; Fusariosis ; Inflammation ; Methenamine ; Mucins ; Mycetoma ; Mycoses ; Pneumonia, Pneumocystis ; Sporotrichosis ; Tinea ; Tinea Versicolor ; Zygomycosis

Rhinocerebral mucormycosis is the most common fungal infection and is frequently seen in patients with poorly controlled diabetes mellitus. We report a rare case of cavernous sinus mucormycosis in a 70-year-old man with insulin-dependent diabetes mellitus. An endoscopic surgical removal of the mucocele was performed. The histopathologic examination revealed characteristic aseptate branching hyphae with invasion of blood vessels, which is consistent with zygomycosis. The patient was administered high-dose amphotericin B therapy. While undergoing amphotericin-B treatment, the patient developed a left-sided hemiparesis. Magnetic resonance imaging and magnetic resonance angiography revealed acute infarction in the right hemisphere and occlusion of the right internal carotid artery in the right cavernous sinus. The patient was managed with conventional medical treatment for acute cerebral infarction and additional amphotericin B infusion. The patient survived, but with severe neurologic sequelae despite extensive medical therapy, including complete-visual loss, leftsided hemiparesis, impairment of cognitive function, dysphagia, and neuropathic pain on the left side of the body. We report herein the clinical course and treatment of a patient with cerebral complications due to mucormycosis and also present a brief literature review.
Aged ; Amphotericin B ; Blood Vessels ; Carotid Artery, Internal ; Cavernous Sinus ; Caves ; Cerebral Infarction ; Deglutition Disorders ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Humans ; Hyphae ; Immunosuppression ; Infarction ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Mucocele ; Mucormycosis ; Neuralgia ; Paresis ; Zygomycosis

OBJECTIVETo study the clinicopathologic features of malignant tumors in head and neck region complicated by fungal infection.

METHODSTwenty-one cases of malignant tumors occurring in head and neck region complicated by fungal infection were retrieved from the archival file. The light microscopic findings were reviewed. Histochemical (for PAS and GMS) and immunohistochemical (for MUC5B) studies were carried out. Fungal culture results were available in 13 of the 21 cases.

RESULTSThe age of the patients ranged from 12 to 72 years (median = 48 years). The male-to-female ratio was 17:4. Eight cases (38.1%) were complicated by invasive fungal sinusitis, with orbital involvement in 6 cases and brain involvement in 1 case. The primary tumors in such cases included leukemia (n = 7) and nasopharyngeal carcinoma (n = 1). The fungi belonged to Zygomycete in 5 cases and Aspergillus in 3 cases. These patients had history of chemotherapy/radiotherapy or antibiotics usage. The remaining 13 cases of fungal infection often affected necrotic tumor tissue in nasal cavity, paranasal sinuses, pharynx, larynx and palate. The fungi involved were Aspergillus (n = 6) and Candida (n = 4). Seven of such patients had received radiotherapy. Fungal culture was positive in 9 cases. Fourteen patients had follow-up information available and six of them died of the disease.

CONCLUSIONSMalignant tumors occurring in head and neck region can be complicated by fungal infection. Invasive fungal sinusitis (due to Zygomycetes and Aspergillus) often occurs in patients with leukemia, tends to involve orbit and is associated with poor prognosis. On the other hand, Aspergillus and Candida are the commonest fungi found in the necrotic tumor tissue. Pathologic examination remains the hallmark in confirming the diagnosis and fungal typing.

Adolescent ; Adult ; Aged ; Antifungal Agents ; therapeutic use ; Aspergillosis ; drug therapy ; microbiology ; pathology ; Aspergillus ; isolation & purification ; Candida ; isolation & purification ; Candidiasis ; drug therapy ; microbiology ; pathology ; Carcinoma, Squamous Cell ; drug therapy ; microbiology ; pathology ; Child ; Female ; Follow-Up Studies ; Head and Neck Neoplasms ; drug therapy ; microbiology ; pathology ; Humans ; Leukemia ; drug therapy ; microbiology ; pathology ; Lymphoma, Extranodal NK-T-Cell ; drug therapy ; microbiology ; pathology ; Male ; Middle Aged ; Mycoses ; drug therapy ; microbiology ; pathology ; Retrospective Studies ; Sinusitis ; drug therapy ; microbiology ; pathology ; Young Adult ; Zygomycosis ; drug therapy ; microbiology ; pathology