RESUMEN
Primary cutaneous mucormycosis is caused by environmental fungi and may complicate leg ulcers or traumatic wounds even in immunocompetent individuals. This case report highlights recurrent lower limb ulcers and cellulitis in a patient with type two diabetes mellitus, which was unresponsive to conventional antibiotic treatment. Histopathology revealed the diagnosis of cutaneous mucormycosis, and fungal cultures identified Rhizopus variabilis as the causative organism. Initial courses of oral azole antifungals yielded only partial response and he eventually required more aggressive treatment with i.v. amphotericin B and oral posaconazole. Good treatment outcomes for this condition require a high index of clinical suspicion, early histopathological and microbiological diagnosis, targeted systemic antifungal therapy, and surgical debridement if necessary.
Asunto(s)
Antifúngicos , Celulitis (Flemón) , Dermatomicosis , Diabetes Mellitus Tipo 2 , Úlcera de la Pierna , Mucormicosis , Humanos , Mucormicosis/diagnóstico , Mucormicosis/complicaciones , Celulitis (Flemón)/microbiología , Celulitis (Flemón)/tratamiento farmacológico , Masculino , Diabetes Mellitus Tipo 2/complicaciones , Antifúngicos/uso terapéutico , Úlcera de la Pierna/microbiología , Dermatomicosis/diagnóstico , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/patología , Rhizomucor/aislamiento & purificación , Anfotericina B/uso terapéutico , Recurrencia , Persona de Mediana Edad , Triazoles/uso terapéutico , Rhizopus/aislamiento & purificaciónRESUMEN
The order Mucorales is an ancient group of fungi classified in the subphylum Mucoromycotina. Mucorales are mainly fast-growing saprotrophs that belong to the first colonizers of diverse organic materials and represent a permanent part of the human environment. Several species are able to cause human infections (mucormycoses) predominantly in patients with impaired immune system, diabetes, or deep trauma. In this review, we compiled 32 reports on community- and hospital-acquired outbreaks caused by Mucorales. The most common source of mucoralean outbreaks was contaminated medical devices that are responsible for 40.7% of the outbreaks followed by contaminated air (31.3%), traumatic inoculation of soil or foreign bodies (9.4%), and the contact (6.2%) or the ingestion (6.2%) of contaminated plant material. The most prevalent species were Rhizopus arrhizus and R. microsporus causing 57% of the outbreaks. The genus Rhizomucor was dominating in outbreaks related to contaminated air while outbreaks of Lichtheimia species and Mucor circinelloides were transmitted by direct contact. Outbreaks with the involvement of several species are reported. Subtyping of strains revealed clonality in two outbreaks and no close relation in two other outbreaks. Based on the existing data, outbreaks of Mucorales can be caused by heterogeneous sources consisting of different strains or different species. Person-to-person transmission cannot be excluded because Mucorales can sporulate on wounds. For a better understanding and prevention of outbreaks, we need to increase our knowledge on the physiology, ecology, and population structure of outbreak causing species and more subtyping data.
Asunto(s)
Mucorales , Mucormicosis , Infección Hospitalaria/microbiología , Complicaciones de la Diabetes/microbiología , Brotes de Enfermedades , Microbiología de Alimentos , Humanos , Huésped Inmunocomprometido , Tipificación Molecular/métodos , Mucor/crecimiento & desarrollo , Mucor/aislamiento & purificación , Mucor/patogenicidad , Mucorales/clasificación , Mucorales/crecimiento & desarrollo , Mucorales/aislamiento & purificación , Mucorales/patogenicidad , Mucormicosis/etiología , Mucormicosis/mortalidad , Mucormicosis/transmisión , Técnicas de Tipificación Micológica/métodos , Infecciones Oportunistas/microbiología , Rhizomucor/crecimiento & desarrollo , Rhizomucor/aislamiento & purificación , Rhizomucor/patogenicidad , Rhizopus/crecimiento & desarrollo , Rhizopus/aislamiento & purificación , Rhizopus/patogenicidad , Rhizopus oryzae/crecimiento & desarrollo , Rhizopus oryzae/aislamiento & purificación , Rhizopus oryzae/patogenicidad , Heridas y Lesiones/microbiologíaRESUMEN
A 4-year-old captive ringed seal (Pusa hispida) was treated with subcutaneous antibacterial injections for pus exuding wounds in the skin and associated blubber following a bite attack. Three months after the incident, the animal presented nystagmus and died the following day. At necropsy, there was a 25 × 18 × 25 mm well-delineated, opaque nodular mass in the lung, besides the skin ulcers and localized areas of discoloration in the blubber correlating with the bite wound and injection sites. Histopathology of the pulmonary mass demonstrated severe eosinophilic inflammatory infiltration among numerous intralesional fungal hyphae. The hyphae were irregularly branched, broad and aseptate, consistent of zygomycosis. Magnetic resonance imaging was conducted on the head, which was initially frozen intact, revealing diffuse areas of hyperintensity in the cerebellum. Restricted histopathologic examination of the cerebellum showed severe granulomatous inflammation well spread within the neuroparenchyma, associated with abundant intralesional fungal hyphae similar to those appreciated in the pulmonary mass. Molecular analyses of the fungi in the pulmonary and cerebellar tissue identified the etiologic agent in both sites as Rhizomucor pusillus. The likely route of infection is through inhalation of R. pusillus spores or fragmented hyphae from the environment that developed into an initial pulmonary infection, becoming the source of hematogenous dissemination to the cerebellum. The skin and blubber lesions likely contributed to immunosuppression. Zygomycosis is uncommon in pinnipeds, and the present report emphasizes the importance of considering zygomycete dissemination even when the primary focus is highly confined.
Asunto(s)
Infecciones Fúngicas del Sistema Nervioso Central/veterinaria , Enfermedades Pulmonares Fúngicas/veterinaria , Mucormicosis/veterinaria , Rhizomucor/aislamiento & purificación , Phocidae , Infección de Heridas/veterinaria , Animales , Infecciones Fúngicas del Sistema Nervioso Central/microbiología , Infecciones Fúngicas del Sistema Nervioso Central/patología , Resultado Fatal , Cabeza/diagnóstico por imagen , Histocitoquímica , Enfermedades Pulmonares Fúngicas/microbiología , Enfermedades Pulmonares Fúngicas/patología , Imagen por Resonancia Magnética , Masculino , Mucormicosis/microbiología , Mucormicosis/patología , Rhizomucor/clasificación , Rhizomucor/genética , Infección de Heridas/complicaciones , Infección de Heridas/patologíaRESUMEN
We describe a case of primary cutaneous mucormycosis in a 44-year-old man with an 18-month history of infiltrative erythematous plaques and haemorrhagic crusting on the dorsum of his left hand. The isolate was identified as Mucor irregularis (formerly Rhizomucor variabilis) based on the fungus morphology and DNA sequencing results. Improvement was observed after a 6-month treatment course of itraconazole. No recrudescence was seen during a follow-up of 23 months after treatment.
Asunto(s)
Dermatomicosis/microbiología , Dermatosis de la Mano/microbiología , Mucormicosis/microbiología , Rhizomucor/aislamiento & purificación , Adulto , Antifúngicos/uso terapéutico , Dermatomicosis/tratamiento farmacológico , Dermatosis de la Mano/tratamiento farmacológico , Humanos , Itraconazol/uso terapéutico , Masculino , Mucormicosis/tratamiento farmacológico , Resultado del TratamientoRESUMEN
We report a patient with relapsed acute myelogenous leukemia after allogeneic stem cell transplantation who developed disseminated mucormycosis due to Rhizomucor pusillus/R. miehei involving lung, brain, and skin. After failing posaconazole and being intolerant to amphotericin, he was treated effectively with isavuconazole for over 6 months despite ongoing treatment for relapsed leukemia.
Asunto(s)
Antifúngicos/uso terapéutico , Mucormicosis/diagnóstico , Mucormicosis/tratamiento farmacológico , Nitrilos/uso terapéutico , Piridinas/uso terapéutico , Rhizomucor/aislamiento & purificación , Triazoles/uso terapéutico , Encéfalo/microbiología , Encéfalo/patología , Humanos , Huésped Inmunocomprometido , Leucemia Mieloide Aguda/complicaciones , Leucemia Mieloide Aguda/terapia , Pulmón/microbiología , Pulmón/patología , Masculino , Persona de Mediana Edad , Mucormicosis/microbiología , Piel/microbiología , Piel/patología , Trasplante de Células Madre/efectos adversos , Trasplante Homólogo/efectos adversos , Resultado del TratamientoRESUMEN
The number of patients with haematopoietic malignancies receiving chemotherapy and stem-cell transplantation has increased the incidence of severe opportunistic infections. Systemic fungal infections are of major concern in immunocompromised patients, as these infections are often fatal. We report a case of a patient with acute myeloid leukaemia who developed multiple cutaneous plaques and necrotizing infiltrates in the lungs during chemotherapy. Using real-time PCR on a wax-embedded tissue sample, Rhizomucor pusillus was identified. We provide an overview of the literature on cutaneous mucormycosis and its diagnosis by PCR.
Asunto(s)
Dermatomicosis/microbiología , Huésped Inmunocomprometido , Enfermedades Pulmonares Fúngicas/microbiología , Mucormicosis/microbiología , Rhizomucor/aislamiento & purificación , Sinusitis/microbiología , Enfermedad Aguda , Anciano , Humanos , Masculino , Reacción en Cadena de la PolimerasaRESUMEN
In this article, we describe a chronic case of rhinofacial mucormycosis caused by Mucor irregularis, formerly known as Rhizomucor variabilis var. variabilis, a rare mycotic agent in humans. The infection caused progressive destruction of the nasal septum and soft and hard palate, leading to collapse of the nose bridge and an ulcerative gaping hole. The mucoralean mold cultured from a nasal biopsy specimen was determined by multilocus DNA sequence data to be conspecific with M. irregularis.
Asunto(s)
Mucormicosis/diagnóstico , Rhizomucor/aislamiento & purificación , Adolescente , Biopsia , Análisis por Conglomerados , ADN de Hongos/química , ADN de Hongos/genética , ADN Ribosómico/química , ADN Ribosómico/genética , Proteínas Fúngicas/genética , Genes de ARNr , Humanos , India , Masculino , Datos de Secuencia Molecular , Mucormicosis/microbiología , Mucormicosis/patología , Tipificación de Secuencias Multilocus , Técnicas de Tipificación Micológica , Tabique Nasal/patología , Hueso Paladar/patología , Factor 1 de Elongación Peptídica/genética , Filogenia , ARN de Hongos/genética , ARN Ribosómico/genética , ARN Ribosómico 18S/genética , Rhizomucor/clasificación , Rhizomucor/genética , Análisis de Secuencia de ADN , Úlcera Cutánea/patologíaRESUMEN
Zygomycosis is a relatively uncommon mycosis with a morbidity that is increasing worldwide. Cutaneous zygomycosis, one of the clinical manifestations of the disease, has also emerged in recent decades. The major reported etiologic agents in China include Rhizomucor spp., Rhizopus spp., Mucor spp., and Lichtheimia spp. (formerly Absidia spp.). This study examined 11 clinical isolates of Rhizomucor that belong to three species (R. variabilis, R. regularior, and R. chlamydosporus). They were identified by both morphological and molecular methods and were found to have a high degree of correlation. In vitro susceptibility of the Rhizomucor isolates to seven antifungal drugs (amphotericin B, itraconazole, terbinafine, voriconazole, fluconazole, flucytosine, and micafungin) were tested, which resulted in amphotericin B being found to be the most active agent against all species evaluated in this study. The investigation also reviewed case reports of cutaneous zygomycosis in China.
Asunto(s)
Anfotericina B/farmacología , Antifúngicos/farmacología , Dermatomicosis/microbiología , Mucormicosis/microbiología , Rhizomucor/efectos de los fármacos , Rhizomucor/aislamiento & purificación , Secuencia de Bases , China , ADN Ribosómico/química , ADN Ribosómico/genética , ADN Espaciador Ribosómico/química , ADN Espaciador Ribosómico/genética , Humanos , Pruebas de Sensibilidad Microbiana , Datos de Secuencia Molecular , Filogenia , ARN Ribosómico 5.8S/genética , Rhizomucor/citología , Rhizomucor/genética , Análisis de Secuencia de ADNRESUMEN
This study reports on the discovery of heterothallic mating in Mucor irregularis (formerly Rhizomucor variabilis var. variabilis) and it extends the range of this species from Asia to the United States. We report on a case of primary cutaneous mucormycosis, involving the forearms of a cotton farmer from North Carolina, in which the infection was cured using amphotericin B therapy. Intraspecific crosses between the North Carolina strain DUMC 150.04 and M. irregularis CBS 103.93, the ex-type strain of R. variabilis var. variabilis from China, resulted in the formation of abundant fertile zygospores. By way of contrast, interspecific crosses between the North Carolina isolate and the ex-neotype strain of M. hiemalis NRRL 3624 resulted in the formation of putative azygospores by M. irregularis DUMC 150.04.
Asunto(s)
Mucormicosis/diagnóstico , Mucormicosis/microbiología , Rhizomucor/aislamiento & purificación , Rhizomucor/fisiología , Agricultura , Anfotericina B/administración & dosificación , Antifúngicos/administración & dosificación , Cruzamientos Genéticos , ADN de Hongos/química , ADN de Hongos/genética , ADN Ribosómico/química , ADN Ribosómico/genética , Antebrazo/microbiología , Antebrazo/patología , Humanos , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Mucormicosis/tratamiento farmacológico , Mucormicosis/patología , North Carolina , Factor 1 de Elongación Peptídica/genética , Filogenia , Rhizomucor/crecimiento & desarrollo , Análisis de Secuencia de ADN , Esporas Fúngicas/citología , CigotoRESUMEN
Zygomycoses are opportunistic infections caused by the Mucorales fungi. They are typically seen in immunosuppressed patients. The incidence of zygomycosis cases seems to be increasing. We report on zygomycosis in a pediatric, female stem-cell-transplant recipient. This case report underlines the difficulty of taking care of patients with zygomycosis. In fungal infections of immunosuppressive patients on broad-coverage antibiotics, foci of skin necrosis are unique and typical for zygomycoses, and may be helpful in this challenging diagnosis.
Asunto(s)
Inmunosupresores/efectos adversos , Rhizomucor/aislamiento & purificación , Trasplante de Células Madre/efectos adversos , Trasplante , Cigomicosis/diagnóstico , Adolescente , Femenino , Humanos , Huésped Inmunocomprometido , Inmunosupresores/administración & dosificación , Necrosis/patología , Piel/patología , Cigomicosis/microbiologíaRESUMEN
Fungal infections are generally observed in immunosuppressed patients only, with a diagnostic challenge due to non-specific symptoms. For this reason, appropriate management may be delayed. This case report concerns a 36-year-old man with history of pancreas and kidney transplantation. He had chemotherapy for post-transplant B-cell lymphoma and presented with left upper abdominal pain and fever. Multiple investigations led to a final diagnosis of disseminated abdominal mucormycosis with multiple Rhizomucor abscesses in the liver, spleen and kidney transplant. Treatment was antifungal therapy and laparotomy with splenectomy, wedge resection of two fungal abscesses in segments II and IVb, and segmental left colic resection.
Asunto(s)
Absceso Abdominal/diagnóstico , Trasplante de Riñón , Mucormicosis/diagnóstico , Trasplante de Páncreas , Complicaciones Posoperatorias/diagnóstico , Rhizomucor/aislamiento & purificación , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Adulto , Hepatectomía , Humanos , Hepatopatías/diagnóstico , Hepatopatías/etiología , Hepatopatías/cirugía , Masculino , Mucormicosis/etiología , Mucormicosis/cirugía , Complicaciones Posoperatorias/cirugía , Esplenectomía , Enfermedades del Bazo/diagnóstico , Enfermedades del Bazo/etiología , Enfermedades del Bazo/cirugíaRESUMEN
We describe the case of a 19-year-old boy with acute leukaemia who developed primary hepatic zygomycosis. The patient presented with febrile neutropenia and severe abdominal tenderness. Despite the administration of antibiotics and liposomal Amphotericin-B (L-AmB), the CT scan demonstrated an increase in the size of liver lesions. A wide surgical resection was carried out and liver specimens demonstrated a branching, filamentous fungus that was identified as Rhizomucor pusillus by both phenotypic and molecular methods. The patient was treated with L-AmB combined with posaconazole, and deferasirox was subsequently added given the potential synergistic effect of this iron chelator in combination with L-AmB. Three months after surgical intervention, an allogeneic stem-cell transplantation was successfully carried out. The present case confirms that an early surgical management combined with antifungal agents is crucial to optimise the outcome of patients with zygomycosis and the use of deferasirox is a promising alternative.
Asunto(s)
Antifúngicos/uso terapéutico , Desbridamiento , Quelantes del Hierro/uso terapéutico , Leucemia/complicaciones , Hepatopatías/tratamiento farmacológico , Rhizomucor/aislamiento & purificación , Cigomicosis/tratamiento farmacológico , Quimioterapia Combinada/métodos , Humanos , Hígado/diagnóstico por imagen , Hígado/patología , Hepatopatías/microbiología , Hepatopatías/cirugía , Masculino , Radiografía , Tomografía , Resultado del Tratamiento , Adulto Joven , Cigomicosis/cirugíaRESUMEN
BACKGROUND: Zygomycosis is the preferred name for the angiotropic infection produced by the Zygomycete class of fungi. Although healthy individuals may be affected, the majority of patients diagnosed with zygomycosis have diabetes, malignancy, or have had solid organ or bone marrow transplantation. Unlike other filamentous fungi that tend to disseminate hematogenously to skin, cutaneous zygomycosis most commonly arises via direct inoculation. Cutaneous lesions of zygomycosis are characteristically hemorrhagic, ulcerated or necrotic plaques. Histology typically demonstrates angioinvasion with associated necrosis. CASE: We present a case of a neutropenic patient who presented with disseminated zygomycosis heralded by a clinically non-specific erythematous macule that showed non-specific, mild, inflammatory changes on histological examination. Tissue culture was performed at the time of initial evaluation and was consistent with zygomycosis. Rhizomucor was subsequently confirmed by PCR. The patient was diagnosed with disseminated zygomycosis, treatment was promptly initiated, and the patient recovered completely. Our case represents an atypical clinical and histological presentation of disseminated zygomycosis and highlights the value of performing tissue culture of non-distinctive cutaneous lesions, especially in the setting of severely immunocompromised states.
Asunto(s)
Dermatomicosis/microbiología , Huésped Inmunocomprometido , Mucormicosis/diagnóstico , Rhizomucor/aislamiento & purificación , Humanos , Leucemia Mieloide Aguda/complicaciones , Leucemia Mieloide Aguda/inmunología , Masculino , Persona de Mediana Edad , Mucormicosis/etiologíaRESUMEN
The in vitro antifungal activity of different statins and the combinations of the two most effective ones (fluvastatin and rosuvastatin) with amphotericin B were investigated in this study on 6 fungal isolates representing 4 clinically important genera, namely Absidia, Rhizomucor, Rhizopus and Syncephalastrum . The antifungal effects of statins revealed substantial differences. The synthetic statins proved to be more effective than the fungal metabolites. All investigated strains proved to be sensitive to fluvastatin. Fluvastatin and rosuvastatin acted synergistically and additively with amphotericin B in inhibiting the fungal growth in clinically available concentration ranges. Results suggest that statins combined with amphotericin B have a therapeutic potential against fungal infections caused by Zygomycetes species.
Asunto(s)
Anfotericina B/farmacología , Antifúngicos/farmacología , Inhibidores de Hidroximetilglutaril-CoA Reductasas/farmacología , Mucorales/efectos de los fármacos , Absidia/efectos de los fármacos , Absidia/aislamiento & purificación , Absidia/patogenicidad , Anfotericina B/administración & dosificación , Antifúngicos/administración & dosificación , Interacciones Farmacológicas , Farmacorresistencia Fúngica , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Pruebas de Sensibilidad Microbiana , Mucorales/aislamiento & purificación , Mucorales/patogenicidad , Rhizomucor/efectos de los fármacos , Rhizomucor/aislamiento & purificación , Rhizomucor/patogenicidad , Rhizopus/efectos de los fármacos , Rhizopus/aislamiento & purificación , Rhizopus/patogenicidad , Cigomicosis/tratamiento farmacológico , Cigomicosis/microbiologíaRESUMEN
γ-Linolenic acid (GLA) and carotenoids have attracted much interest due to their nutraceutical and pharmaceutical importance. Mucoromycota, typical oleaginous filamentous fungi, are known for their production of valuable essential fatty acids and carotenoids. In the present study, 81 fungal strains were isolated from different Egyptian localities, out of which 11 Mucoromycota were selected for further GLA and carotenoid investigation. Comparative analysis of total lipids by GC of selected isolates showed that GLA content was the highest in Rhizomucor pusillus AUMC 11616.A, Mucor circinelloides AUMC 6696.A, and M. hiemalis AUMC 6031 that represented 0.213, 0.211, and 0.20% of CDW, respectively. Carotenoid analysis of selected isolates by spectrophotometer demonstrated that the highest yield of total carotenoids (640 µg/g) was exhibited by M. hiemalis AUMC 6031 and M. hiemalis AUMC 6695, and these isolates were found to have a similar carotenoid profile with, ß-carotene (65%), zeaxanthin (34%), astaxanthin, and canthaxanthin (5%) of total carotenoids. The total fatty acids of all tested isolates showed moderate antimicrobial activity against Staphylococcus aureus and Salmonella Typhi, and Penicillium chrysogenum. To the best of our knowledge, this is the first report on the highest yield of total lipid accumulation (51.74% CDW) by a new oleaginous fungal isolate R. pusillus AUMC 11616.A. A new scope for a further study on this strain will be established to optimize and improve its total lipids with high GLA production. So, R. pusillus AUMC 11616.A might be a potential candidate for industrial application.
Asunto(s)
Carotenoides/metabolismo , Ácido Linoleico/biosíntesis , Mucor/metabolismo , Rhizomucor/metabolismo , Ácido gammalinolénico/metabolismo , Antiinfecciosos/farmacología , Egipto , Ácidos Grasos/análisis , Ácidos Grasos/metabolismo , Liofilización , Metabolismo de los Lípidos , Pruebas de Sensibilidad Microbiana , Mucor/química , Mucor/genética , Mucor/aislamiento & purificación , Filogenia , Rhizomucor/química , Rhizomucor/genética , Rhizomucor/aislamiento & purificaciónRESUMEN
We report a case of primary cutaneous zygomycosis caused by Rhizomucor variabilis and review 6 cases reported from China that share similar features and are different from those cases caused by other species of Mucorales. It is noteworthy that all 6 of the cases were observed in 3 adjacent provinces of eastern China.
Asunto(s)
Dermatomicosis/diagnóstico , Rhizomucor/aislamiento & purificación , Cigomicosis/diagnóstico , Adulto , Preescolar , China , ADN de Hongos/química , ADN de Hongos/genética , ADN Ribosómico/química , ADN Ribosómico/genética , ADN Espaciador Ribosómico/química , ADN Espaciador Ribosómico/genética , Dermatomicosis/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , ARN Ribosómico 5.8S/genética , Rhizomucor/clasificación , Rhizomucor/genética , Análisis de Secuencia de ADN , Cigomicosis/microbiologíaRESUMEN
Rhizomucor variabilis and Hormographiella aspergillata rarely cause human infections. This report details a fatal case of a 14-year-old female with leukemia posthematopoietic cell transplant and relapse with refractory pancytopenia. The patient first developed an R. variabilis var. regularior palate infection and later developed a cutaneous H. aspergillata infection while on posaconazole and caspofungin therapy.
Asunto(s)
Trasplante de Médula Ósea/efectos adversos , Coprinus , Micosis , Neutropenia/complicaciones , Rhizomucor , Adolescente , Coprinus/clasificación , Coprinus/aislamiento & purificación , Dermatomicosis/diagnóstico , Dermatomicosis/microbiología , Resultado Fatal , Femenino , Humanos , Leucemia Mieloide Aguda/complicaciones , Leucemia Mieloide Aguda/terapia , Mucormicosis/diagnóstico , Mucormicosis/microbiología , Micosis/diagnóstico , Micosis/microbiología , Hueso Paladar/microbiología , Rhizomucor/clasificación , Rhizomucor/aislamiento & purificaciónRESUMEN
Zygomycosis is usually an invasive mycotic disease caused by fungi in the class Zygomycetes. It often occurs in immunocompromised patients, but sporadic cases without apparent immune impairment have been described. This report presents the first case of pleural zygomycosis caused by Rhizomucor pusillus, an uncommon pathogen of human infection. A 19-year-old man was found to have pleuritis several days after a drainage catheter was implanted to cure a pneumothorax caused by a ruptured bulla. Local pneumonectomy to resect the ruptured bulla and vacuuming of the pleural fluid was performed. Rhizomucor pusillus was cultured from the pleural fluid and irregular broad sparsely septate hyphae, consistent with zygomycetes, were histologically detected in the thickened pleura of the resected bulla. The catheter was suspected of having been contaminated with the fungus, but no evidence could be obtained. His fungal pleuritis subsided without any antifungal medical therapy and his immunocompetence seemed to contribute to limiting the infection.
Asunto(s)
Enfermedades Pleurales/microbiología , Rhizomucor/aislamiento & purificación , Cigomicosis/microbiología , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , ADN de Hongos/análisis , Humanos , Inmunocompetencia , Inmunohistoquímica , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/cirugía , Masculino , Pruebas de Sensibilidad Microbiana , Enfermedades Pleurales/tratamiento farmacológico , Enfermedades Pleurales/inmunología , Enfermedades Pleurales/cirugía , Reacción en Cadena de la Polimerasa , Radiografía , Esporas Fúngicas/citología , Adulto Joven , Cigomicosis/tratamiento farmacológico , Cigomicosis/inmunología , Cigomicosis/cirugíaRESUMEN
A new method was developed in this work for extraction of chitosan from the zygomycetes cell wall. It is based on the temperature-dependent solubility of chitosan in dilute sulfuric acid. Chitin is soluble in neither cold nor hot dilute sulfuric acid. Similarly chitosan is not soluble at room temperature but is dissolved in 1% H 2SO 4 at 121 degrees C within 20 min. The new method was developed to measure the chitosan content of the biomass and cell wall. The procedures were investigated by measuring phosphate, protein, ash, glucuronic acid, and degree of acetylation. The cell wall derivatives of fungus Rhizomucor pusillus were then examined by this new method. The results indicated 8% of the biomass as chitosan. After treatment with NaOH, the alkali-insoluble material (AIM) contained 45.3% chitosan. Treatment of AIM with acetic acid resulted in 16.5% acetic-acid-soluble material (AcSM) and 79.0% alkali- and acid-insoluble material (AAIM). AcSM is usually cited as pure chitosan, but the new method shows major impurities by, for example, phosphate. Furthermore, AAIM is usually considered to be the chitosan-free fraction, whereas the new method shows more than 76% of the chitosan present in AIM is found in AAIM. It might indicate the inability of acetic acid to separate chitosan from the cell wall.