RESUMO
BACKGROUND: Reports of pulmonary aspergillosis and mucormycosis co-infections are rare; thus, limited guidance is available on early diagnosis and treatment. We present a case of mixed pulmonary Aspergillus and Mucor infection and review the literature regarding this co-infection. The diagnosis and treatment methods are summarized to improve clinicians' understanding of the disease and to facilitate early diagnosis and treatment. CASE PRESENTATION: A 60-year-old male farmer with poorly controlled diabetes mellitus was admitted to hospital with a fever of unknown origin that had been present for 15 days and pulmonary aspergillosis complicated by Mucor spp. INFECTION: Because multiple lobes were involved, the infection worsened despite surgical resection and antifungal therapy. Finally, we treated this patient with a bronchoscopic infusion of amphotericin B. After four courses of bronchoscopic amphotericin B infusion, we observed rapid clinical improvement and subsequent resolution of pulmonary infiltrates. CONCLUSION: Our case highlights the use of bronchoscopy in the successful clinical treatment of invasive fungal diseases of the lung.
Assuntos
Anfotericina B , Antifúngicos , Broncoscopia , Mucormicose , Aspergilose Pulmonar , Humanos , Masculino , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Pessoa de Meia-Idade , Mucormicose/tratamento farmacológico , Mucormicose/diagnóstico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Aspergilose Pulmonar/tratamento farmacológico , Aspergilose Pulmonar/diagnóstico , Coinfecção/tratamento farmacológico , Mucor/isolamento & purificação , Tomografia Computadorizada por Raios XRESUMO
Dimorphism is known among the etiologic agents of endemic mycoses as well as in filamentous Mucorales. Under appropriate thermal conditions, mononuclear yeast forms alternate with multi-nucleate hyphae. Here, we describe a dimorphic mucoralean fungus obtained from the sputum of a patient with Burkitt lymphoma and ongoing graft-versus-host reactions. The fungus is described as Mucor germinans sp. nov. Laboratory studies were performed to simulate temperature-dependent dimorphism, with two environmental strains Mucor circinelloides and Mucor kunryangriensis as controls. Both strains could be induced to form multinucleate arthrospores and subsequent yeast-like cells in vitro. Multilateral yeast cells emerge in all three Mucor species at elevated temperatures. This morphological transformation appears to occur at body temperature since the yeast-like cells were observed in the lungs of our immunocompromised patient. The microscopic appearance of the yeast-like cells in the clinical samples is easily confused with that of Paracoccidioides. The ecological role of yeast forms in Mucorales is discussed.IMPORTANCEMucormycosis is a devastating disease with high morbidity and mortality in susceptible patients. Accurate diagnosis is required for timely clinical management since antifungal susceptibility differs between species. Irregular hyphal elements are usually taken as the hallmark of mucormycosis, but here, we show that some species may also produce yeast-like cells, potentially being mistaken for Candida or Paracoccidioides. We demonstrate that the dimorphic transition is common in Mucor species and can be driven by many factors. The multi-nucleate yeast-like cells provide an effective parameter to distinguish mucoralean infections from similar yeast-like species in clinical samples.
Assuntos
Mucor , Mucormicose , Humanos , Mucormicose/microbiologia , Mucormicose/diagnóstico , Mucor/isolamento & purificação , Mucor/genética , Mucor/classificação , Paracoccidioides/isolamento & purificação , Paracoccidioides/genética , Escarro/microbiologia , Filogenia , DNA Fúngico/genética , DNA Fúngico/química , Hospedeiro Imunocomprometido , Masculino , Análise de Sequência de DNA , TemperaturaRESUMO
OBJECTIVES: Mucor within the airways of immunocompromised patients often signifies an invasive life-threatening infection. However, its significance in immunocompetent patients with chronic lung diseases is less clear. We aimed to assess the clinical implication of mucor in airway-secretion cultures of these patients. METHODS: A single-center retrospective cohort study was performed. Patients with cystic fibrosis (CF), primary ciliary dyskinesia (PCD) or non-CF/non-PCD bronchiectasis followed in our Pediatric Pulmonary Institute, with sputum or bronchoalveolar lavage cultures growing Mucorales molds in the years 2010-2022, were included. Demographic and clinical parameters such as body mass index and spirometry values (forced expiratory volume at 1 second) were collected and compared with values up to 12 months prior to and following the index (positive culture) visit. RESULTS: A total of 27 patients of whom 22 (82%) patients were with CF, 3 with PCD (11%) and 2 (7%) with non-CF/non-PCD bronchiectasis were included. Median age was 21.8 (14.9-32.1) years, with forced expiratory volume at 1 second of 62.8% ± 21.9% at the index visit. None of the patients developed disseminated disease, none had clinical or radiological evidence of fungal disease and none required antifungal therapy. Throughout the 12 months prior to and following the positive cultures, no significant changes were noted in body mass index, forced expiratory volume at 1 second, frequency of pulmonary exacerbations, days of hospitalization or days of antibiotic treatment. CONCLUSIONS: Evidence of mucor in airway cultures of immunocompetent patients with chronic lung disease does not necessarily signify clinical deterioration nor suggests invasive fungal disease. Larger, long-term prospective studies are required to obviate the need for a thorough evaluation in these patients.
Assuntos
Fibrose Cística , Mucor , Humanos , Estudos Retrospectivos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Mucor/isolamento & purificação , Fibrose Cística/microbiologia , Fibrose Cística/complicações , Doença Crônica , Bronquiectasia/microbiologia , Bronquiectasia/fisiopatologia , Mucormicose/microbiologia , Escarro/microbiologia , Líquido da Lavagem Broncoalveolar/microbiologia , Mucorales/isolamento & purificação , Pneumopatias/microbiologia , Imunocompetência , Relevância ClínicaRESUMO
OBJECTIVES: The present study aimed to assess the features, clinical characteristics, and species diversity among patients admitted to referral Hospitals for SARS-CoV-2 pneumonia and mucormycosis in Tehran, Iran, and the relationship between seasonal and species diversity was considered. METHODS: Confirmed COVID-19 patients with a positive reverse-transcriptase real-time (rRT-PCR) test for SARS-CoV2 were primarily included based on clinically suspected mucormycosis infection and confirmed by histopathology and mycology examination of biopsy specimens. The PCR technique was performed by the amplification of the high-affinity iron permease 1 (FTR1) gene for identification and discrimination between Rhizopus arrhizus and non- Rhizopus arrhizus isolates. In contrast, species identification of non-Rhizopus arrhizus was performed by sequencing of ITS rDNA region. RESULTS: Rhino-sino-orbital mucormycosis was identified in the majority of cases (n = 33), with 66 % and 34 % of the cases involving male and female patients, respectively. Rhizopus arrhizus was found to be the most prevalent (84.6 %), followed by Mucor circinelloides (7.6 %). Rhizopus arrhizus was the most prevalent species and present in all the seasons; however, Mucor circinelloides was only present in the autumn. The overall mortality of the total population was 24.6 % (16/ 65); the mortality rates occurring in patients diagnosed with rhino-sino-orbital infection and rhino-sinusal form were 21.4 % and 25 %, respectively. CONCLUSION: CAM can be a serious complication of severe COVID-19, especially in patients with uncontrolled diabetes. It is important to monitor the epidemiology of mucormycosis to raise awareness of the disease and improve diagnosis, treatment and prognosis, particularly in the setting of pandemic.
Assuntos
COVID-19 , Mucormicose , SARS-CoV-2 , Humanos , Mucormicose/epidemiologia , Mucormicose/microbiologia , Mucormicose/diagnóstico , COVID-19/complicações , COVID-19/epidemiologia , Irã (Geográfico)/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , SARS-CoV-2/genética , Rhizopus/isolamento & purificação , Rhizopus/genética , Adulto Jovem , Mucor/isolamento & purificação , Mucor/genética , Encaminhamento e Consulta/estatística & dados numéricos , Estações do Ano , Doenças Orbitárias/microbiologia , Doenças Orbitárias/epidemiologiaRESUMO
BACKGROUND: The body of evidence on cutaneous mucormycosis is largely derived from case reports or single-centre databases. OBJECTIVES: Our study aimed to describe incidence, predisposing factors and inpatient outcomes of cutaneous mucormycosis in the United States. METHODS: We conducted a population-based retrospective study using the National Inpatient Sample 2016-17 data. Fifty-six discharges had a diagnosis of cutaneous mucormycosis on the International Classification of Diseases, tenth revision. Descriptive analysis was performed for the demographics, predisposing factors, length of stay (LOS), cost and inpatient mortality. The NIS represents 20% of all discharges in the United States, which allowed us to estimate the national incidence of cutaneous mucormycosis. RESULTS: An estimated total of 280 admissions occurred between 2016 and 2017, indicating 3.9 cases per million admissions across the United States. The estimated incidence rate was 0.43 cases per million people per year. Median age was 49.5 (19-59) years, 44.6% were female, and 54.9% were Caucasian. We identified haematologic malignancies (48.2%) and solid organ transplantations (10.7%), often accompanied by skin/soft tissue or post-procedural infections, were the most common predisposing conditions. Median LOS was 15 (6-31) days, median total charges were 187,030 (65,962-446,265) USD, and in-hospital mortality rate was 16.1%. CONCLUSIONS: In current clinical practice, physicians may encounter cutaneous mucormycosis most commonly in severely immunocompromised hosts with haematologic malignancies or transplantations, accompanied by skin/soft tissue or post-procedural infections. A high index of suspicion and prompt tissue sampling in at-risk groups is important to improve the outcomes.
Assuntos
Causalidade , Incidência , Mucormicose/epidemiologia , Pele/microbiologia , Resultado do Tratamento , Adulto , Feminino , Humanos , Hospedeiro Imunocomprometido , Pacientes Internados/estatística & dados numéricos , Leucemia/complicações , Masculino , Pessoa de Meia-Idade , Mortalidade , Mucor/isolamento & purificação , Mucor/patogenicidade , Mucormicose/etiologia , Transplante de Órgãos/efeitos adversos , Estudos Retrospectivos , Pele/patologia , Estados Unidos/epidemiologia , Adulto Jovem , Zigomicose/epidemiologiaRESUMO
Fluorene, a low molecular weight polycyclic aromatic hydrocarbon (PAH), is of immense environmental interest because of its carcinogenicity, teratogenicity, mutagenicity, toxicity and persistence to microbial degradation. Existentially, there is paucity of information on PAH degradation by fungi isolated from marine environment. Therefore, this study investigated fluorene degradation efficiency of marine derived filamentous fungus, Mucor irregularis strain bpo1 (GenBank Accession Number: MK373020). Response Surface Methodology (RSM) using Box-Behnken Design (BBD) was successfully deployed in the optimization of process parameters (pH-7, temperature-32.5 °C, substrate concentration-100 mg L-1 and dry weight-2 g) resulting in 81.50% fluorene degradation on 5th day. The design and regression model were found to be statistically significant, adequate and appropriate with p < 0.0001, F value= 202.39, and predicted coefficient of determination (R2 =0.9991). Optimization of the vital constituents of the mineral salt medium (MSM) used for the study using RSM-Central Composite Design (CCD) resulted in 79.80% fluorene degradation rate. Enhanced fluorene degradation efficiency (82.50%) was recorded when the optimized process variables were subjected to growth-linked validation experiments. The enzyme activities revealed 87%, 59% and 31% induction of laccase, manganese peroxidase and lignin peroxidase respectively. Four metabolites; 9H-fluoren-9-one, benzene-1,2-dicarboxylic acid, 2-hydroxybenzoic acid and phenol obtained after the experiment were characterized and confirmed with GC-MS analysis. The findings revealed the promising potentials of M. irregularis in PAH degradation and by extension green remediation technology.
Assuntos
Fluorenos/metabolismo , Modelos Teóricos , Mucor/metabolismo , Biodegradação Ambiental , Biomassa , Fluorenos/análise , Lacase/metabolismo , Mucor/crescimento & desenvolvimento , Mucor/isolamento & purificação , Peroxidases/metabolismo , Água do Mar/microbiologiaRESUMO
Mucormycosis is an invasive, life-threatening fungal infection that mainly affects immunocompromised hosts. We collected data of pediatric mucormycosis cases from all 7 Greek Hematology-Oncology Departments for the years 2008-2017. Six cases of invasive mucormycosis diagnosed during treatment for malignancies were included in the study. In 4 children (66%) mucormycosis occurred within the first 20 days after diagnosis of the underlying disease. Two cases were classified as proven mucormycosis and 4 as probable. The most frequently recorded species was Rhizopus arrhizus (2 patients), followed by Mucor spp (1), and Lichtheimia spp (1). All patients received liposomal amphotericin B. Combined antifungal treatment was used in 5 cases. Surgical excision was performed in 4 cases (66%). Two patients died at 6 and 12 months after the diagnosis, respectively, 1 (17%) because of mucormycosis. Our data suggest that mucormycosis may occur early after the initiation of intensive chemotherapy in children with malignancies.
Assuntos
Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Neoplasias Hematológicas/complicações , Mucormicose/complicações , Mucormicose/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Feminino , Neoplasias Hematológicas/imunologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Mucor/efeitos dos fármacos , Mucor/imunologia , Mucor/isolamento & purificação , Mucorales/efeitos dos fármacos , Mucorales/imunologia , Mucorales/isolamento & purificação , Mucormicose/imunologia , Rhizopus oryzae/efeitos dos fármacos , Rhizopus oryzae/imunologia , Rhizopus oryzae/isolamento & purificaçãoRESUMO
Determinamos los géneros de hongos anamorfos que contaminan los libros del área de cuarentena y limpieza, dentro del Área Histórica de la Universidad Central del Ecuador (UCE). Realizamos un hisopado aleatorio a una muestra representativa de 50 de estos libros de acuerdo a una Tabla militarizada estándar. También hisopamos como muestra preferencial a 21 libros gravemente contaminados con hongos. Los hisopados tuvieron una superficie de 5x5 cm, friccionando en la pasta, el borde y el interior de estos libros. Las 213 muestras tomadas fueron inoculadas en medio de cultivo Agar Malta. Los medios fueron incubados a una temperatura de 28°C durante 7 días. Realizamos observaciones por microscopía a 40 y 100x además de usar literatura especializada para la identificación hasta el nivel de género de hongos anamorfos. Los géneros más abundantes en este estudio fueron Penicillium (80,2%) y Mucor (8,1%). (AU)
We determined the genera of anamorphic fungi that contaminate the books in the quarantine and cleaning area, within the Historical Area of the Central University of Ecuador (CUE). We performed a random swab on a representative sample of 50 of these books according to a standard militarized Table. We also swabbed as a preferential sample 21 books seriously contaminated with fungi. The swabs had a surface area of 5x5 cm, rubbing on the paste, the edge and the interior of these books. The 213 samples taken were inoculated in Agar Malta culture medium. The media were incubated at a temperature of 28° C for 7 days. We made observations by microscopy at 40 and 100x in addition to using specialized literature for the identification down to the genus level of anamorphic fungi. The most abundant genus in this study were Penicillium(80,2%) and Mucor(8,1%). (AU)
Assuntos
Penicillium/isolamento & purificação , Mucor/isolamento & purificação , Penicillium/patogenicidade , Contagem de Colônia Microbiana/métodos , Fungos Mitospóricos/patogenicidade , Equador , Bibliotecas EspecializadasRESUMO
Mucor infection is rarely reported in non-immunocompromised population, especially in isolated gastrointestinal tracts. IgG(4)-related diseases (IgG(4)-RD) have been recognized in recent years, but secondary causes of IgG(4) elevation should be differentiated. We reported a young man with duodenal mass and ulcer and high serum IgG(4) level. Histological biopsy of the mass revealed positive mucor mycelium and infiltration of IgG(4) positive plasma cells. Serum IgG(4) decreased to normal range after surgical resection and systemic antifungal treatment. This case suggests that isolated mucor mycosis infection can develop in the digestive tract and mimics as IgG(4)-related disease.
Assuntos
Antifúngicos/uso terapêutico , Úlcera Duodenal/patologia , Doença Relacionada a Imunoglobulina G4/tratamento farmacológico , Imunoglobulina G/sangue , Mucor/isolamento & purificação , Mucormicose/tratamento farmacológico , Biópsia , Úlcera Duodenal/cirurgia , Humanos , Hospedeiro Imunocomprometido , Imunoglobulina G/efeitos dos fármacos , Doença Relacionada a Imunoglobulina G4/diagnóstico , Doença Relacionada a Imunoglobulina G4/microbiologia , Masculino , Mucor/efeitos dos fármacos , Mucormicose/microbiologia , Resultado do TratamentoRESUMO
We report a case of primary cutaneous mucormycosis caused by Mucor irregularis. A 52-year-old male farmer was presented to our hospital with a history of progressive nodule and plaque with ulceration on the face for two and a half years. Broad, aseptate hyphae were seen in direct KOH examination and biopsy. Fungal culture showed light yellow filamentous colonies. The rRNA sequencing revealed M. irregularis was the responsible fungus. Amphotericin B in gradually increasing dose and itraconazole were administered. When the cumulative dose of amphotericin B was 1500 mg, the skin lesion improved significantly with remaining scars on the face. Then, the patient received sequential oral itraconazole treatment for 8 months. There was no recurrence up to now through follow-ups.
Assuntos
Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Face/patologia , Itraconazol/administração & dosagem , Mucor/isolamento & purificação , Mucormicose/diagnóstico , Dermatopatias/diagnóstico , Biópsia , DNA Ribossômico/química , DNA Ribossômico/genética , Humanos , Masculino , Microscopia , Pessoa de Meia-Idade , Mucor/classificação , Mucor/genética , Mucormicose/tratamento farmacológico , Mucormicose/patologia , Análise de Sequência de DNA , Dermatopatias/tratamento farmacológico , Dermatopatias/patologia , Resultado do TratamentoRESUMO
Mucor circinelloides is a pathogenic fungus and etiologic agent of mucormycosis. In 2013, cases of gastrointestinal illness after yogurt consumption were reported to the US FDA, and the producer found that its products were contaminated with Mucor. A previous study found that the Mucor strain isolated from an open contaminated yogurt exhibited virulence in a murine systemic infection model and showed that this strain is capable of surviving passage through the gastrointestinal tract of mice. In this study, we isolated another Mucor strain from an unopened yogurt that is closely related but distinct from the first Mucor strain and subsequently examined if Mucor alters the gut microbiota in a murine host model. DNA extracted from a ten-day course of stool samples was used to analyze the microbiota in the gastrointestinal tracts of mice exposed via ingestion of Mucor spores. The bacterial 16S rRNA gene and fungal ITS1 sequences obtained were used to identify taxa of each kingdom. Linear regressions revealed that there are changes in bacterial and fungal abundance in the gastrointestinal tracts of mice which ingested Mucor. Furthermore, we found an increased abundance of the bacterial genus Bacteroides and a decreased abundance of the bacteria Akkermansia muciniphila in the gastrointestinal tracts of exposed mice. Measurements of abundances show shifts in relative levels of multiple bacterial and fungal taxa between mouse groups. These findings suggest that exposure of the gastrointestinal tract to Mucor can alter the microbiota and, more importantly, illustrate an interaction between the intestinal mycobiota and bacteriota. In addition, Mucor was able to induce increased permeability in epithelial cell monolayers in vitro, which might be indicative of unstable intestinal barriers. Understanding how the gut microbiota is shaped is important to understand the basis of potential methods of treatment for gastrointestinal illness. How the gut microbiota changes in response to exposure, even by pathogens not considered to be causative agents of food-borne illness, may be important to how commercial food producers prevent and respond to contamination of products aimed at the public. This study provides evidence that the fungal microbiota, though understudied, may play an important role in diseases of the human gut.
Assuntos
Microbioma Gastrointestinal/fisiologia , Trato Gastrointestinal/microbiologia , Interações Microbianas/fisiologia , Mucor/fisiologia , Mucor/patogenicidade , Animais , Bactérias/classificação , Bactérias/genética , Biodiversidade , Permeabilidade da Membrana Celular , DNA Bacteriano/isolamento & purificação , DNA Fúngico , Modelos Animais de Doenças , Células Epiteliais , Fezes/microbiologia , Microbioma Gastrointestinal/genética , Camundongos , Mucor/genética , Mucor/isolamento & purificação , Mucormicose/microbiologia , RNA Ribossômico 16S/genética , Virulência , Iogurte/microbiologiaRESUMO
This study focused on the bioremediation mechanisms of lead (0, 100, 500, 1000â¯mgâ¯kg-1) and cadmium (0,10,50,100â¯mgâ¯kg-1) contaminated soil using two indigenous fungi selected from mine tailings as the phytostimulation of Arabidopsis thaliana. The two fungal strains were characterized as Mucor circinelloides (MC) and Trichoderma asperellum (TA) by internal transcribed spacer sequencing at the genetic levels. Our research revealed that Cadmium was more toxic to plant growth than lead and meanwhile, MC and TA can strengthen A. thaliana tolerance to cadmium and lead with 40.19-117.50% higher root length and 58.31-154.14% shoot fresh weight of plant compared to non-inoculation. In this study, TA exhibited a higher potential to the inactivation of cadmium; however, MC was more effective in lead passivation. There was a direct correlation between the type of fungi, heavy metal content, heavy metal type and oxidative damage in plant. Both lead and cadmium induced oxidative damage as indicated by increased superoxide dismutase and catalase activities, while the antioxidant levels were significantly higher in fungal inoculated plants compared with those non-inoculated. The analysis of soil enzyme activity and taxonomic richness uncovered that the dominant structures of soil microbial community were altered by exogenous microbial agents. MC enhanced higher microbial diversity and soil enzyme activity than TA. The two indigenous fungi lessened several limiting factors with respect to phytoremediation technology, such as soil chemistry, contamination level and transformation, and metal solubility.
Assuntos
Arabidopsis/efeitos dos fármacos , Cádmio/toxicidade , Chumbo/toxicidade , Mucor/fisiologia , Trichoderma/fisiologia , Arabidopsis/crescimento & desenvolvimento , Arabidopsis/metabolismo , Arabidopsis/microbiologia , Biodegradação Ambiental , Cádmio/metabolismo , Chumbo/metabolismo , Metais Pesados/análise , Mucor/genética , Mucor/isolamento & purificação , Plantas/efeitos dos fármacos , Solo/química , Microbiologia do Solo , Poluentes do Solo/toxicidade , Trichoderma/genética , Trichoderma/isolamento & purificaçãoRESUMO
We report here the isolation of Mucor velutinosus from multiple blood cultures performed on samples from Broviac catheters and culture of a Broviac insertion-site wound sample from a 6-year-old boy with a history of intestinal failure secondary to chronic intestinal pseudo-obstruction, parenteral nutrition, and jejunostomy tube dependence. Examination of a slide from the culture revealed the presence of wide nonseptate hyphae with sporangiophores, columella, and chlamydospores. The fungal isolate was sent to the National Institutes of Health for further evaluation and was identified as Mucor velutinosus by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry and genomic sequencing. The patient was treated successfully with intravenous amphotericin B and prompt removal of his central line. To the best of our knowledge, this is the first case of M velutinosus bloodstream infection in a child without cancer.
Assuntos
Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/microbiologia , Cateteres Venosos Centrais/microbiologia , Fungemia/diagnóstico , Mucor/isolamento & purificação , Mucormicose/diagnóstico , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Infecções Relacionadas a Cateter/tratamento farmacológico , Criança , Fungemia/tratamento farmacológico , Humanos , Imunocompetência , Pseudo-Obstrução Intestinal/terapia , Jejunostomia/instrumentação , Masculino , Mucormicose/tratamento farmacológico , Nutrição Parenteral/instrumentaçãoRESUMO
We report a case of primary cutaneous mucormycosis caused by Mucor irregularis. A 66-year-old man was presented to our hospital with a history of gradually enlarging plaque on the right leg for about a year. The identification of pathogen based on the fungus morphology and DNA sequencing revealed M. irregularis as the responsible fungus for skin lesion. The lesion was removed incidentally by a surgery procedure, and no recrudescence was seen during a follow-up of 24-month observation.
Assuntos
Dermatomicoses/diagnóstico , Dermatomicoses/cirurgia , Mucor/isolamento & purificação , Mucormicose/diagnóstico , Mucormicose/cirurgia , Idoso , Dermatomicoses/patologia , Histocitoquímica , Humanos , Masculino , Técnicas Microbiológicas , Microscopia , Mucor/classificação , Mucor/citologia , Mucor/genética , Mucormicose/patologia , Análise de Sequência de DNA , Resultado do TratamentoRESUMO
Mucormycosis is a rare fungal infection caused by Mucor indicus. Phylogenetic analysis of many M. indicus isolates, mainly sampled from different clinical and environmental specimens collected worldwide, revealed two genotypes, I and II, based on ITS and D1/D2 LSU rDNA sequences. A retrospective review of the literature revealed 13 cases. Eight (76.9%) patients had disseminated infections, and the overall mortality rate was 30.7%. A pulmonary infection caused by M. indicus genotype I in a liver transplant recipient was disseminated to include the skin and was successfully treated with liposomal amphotericin B and aggressive surgery. M. indicus can infect a wide variety of patients with no real preference for the site of infection. We concluded that M. indicus has emerged as a significant cause of invasive mycosis in severely immunocompromised patients worldwide. Early diagnosis and initiation of appropriate therapy could enhance survival in these immunocompromised patient populations.
Assuntos
Hospedeiro Imunocomprometido , Mucor/classificação , Mucor/genética , Mucormicose/microbiologia , Filogenia , Idoso , Anfotericina B/farmacologia , Anfotericina B/uso terapêutico , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Doenças Transmissíveis Emergentes/microbiologia , DNA Espaçador Ribossômico , Genótipo , Humanos , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/microbiologia , Transplante de Fígado , Pulmão/microbiologia , Masculino , Pessoa de Meia-Idade , Mucor/efeitos dos fármacos , Mucor/isolamento & purificação , Mucormicose/tratamento farmacológico , Infecções Oportunistas/microbiologia , Estudos Retrospectivos , Pele/microbiologiaRESUMO
Infections caused by filamentous fungi represent a major burden in the ICU. Invasive aspergillosis is emerging in non-neutropenic individuals with predisposing conditions, e.g. corticosteroid treatment, chronic obstructive pulmonary disease, liver cirrhosis, solid organ cancer, HIV infection and transplantation. Diagnosis is challenging because the signs and symptoms are non-specific, and initiation of additional diagnostic examinations is often delayed because clinical suspicion is low. Isolation of an Aspergillus species from the respiratory tract in critically ill patients, and tests such as serum galactomannan, bronchoalveolar lavage 1-3-ß-d-glucan and specific PCR should be interpreted with caution. ICU patients should start adequate antifungal therapy upon suspicion of invasive aspergillosis, without awaiting definitive proof. Voriconazole, and now isavuconazole, are the drugs of choice. Mucormycosis is a rare, but increasingly prevalent disease that occurs mainly in patients with uncontrolled diabetes mellitus, immunocompromised individuals or previously healthy patients with open wounds contaminated with Mucorales. A high proportion of cases are diagnosed in the ICU. Rapidly progressing necrotizing lesions in the rhino-sinusal area, the lungs or skin and soft tissues are the characteristic presentation. Confirmation of diagnosis is based on demonstration of tissue invasion by non-septate hyphae, and by new promising molecular techniques. Control of underlying predisposing conditions, rapid surgical resection and administration of liposomal amphotericin B are the main therapeutic actions, but new agents such as isavuconazole are a promising alternative. Patients with mucormycosis receive a substantial part of their care in ICUs and, despite advances in diagnosis and treatment, mortality remains very high.
Assuntos
Antifúngicos/uso terapêutico , Aspergilose/diagnóstico , Aspergilose/tratamento farmacológico , Infecções Fúngicas Invasivas/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Infecções Oportunistas/diagnóstico , Aspergilose/epidemiologia , Aspergillus/efeitos dos fármacos , Aspergillus/isolamento & purificação , Estado Terminal , Galactose/análogos & derivados , Humanos , Hospedeiro Imunocomprometido , Unidades de Terapia Intensiva , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/microbiologia , Pneumopatias Fúngicas/microbiologia , Mananas/sangue , Mucor/efeitos dos fármacos , Mucor/isolamento & purificação , Mucormicose/epidemiologia , Nitrilas/uso terapêutico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Piridinas/uso terapêutico , Sistema Respiratório/microbiologia , Triazóis/uso terapêutico , Voriconazol/uso terapêutico , beta-Glucanas/sangueRESUMO
Disease can be conceptualized as the result of interactions between infecting microbe and holobiont, the combination of a host and its microbial communities. It is likely that genomic variation in the host, infecting microbe, and commensal microbiota are key determinants of infectious disease clinical outcomes. However, until recently, simultaneous, multiomic investigation of infecting microbe and holobiont components has rarely been explored. Herein, we characterized the infecting microbe, host, micro- and mycobiomes leading up to infection onset in a leukemia patient that developed invasive mucormycosis. We discovered that the patient was infected with a strain of the recently described Mucor velutinosus species which we determined was hypervirulent in a Drosophila challenge model and has a predisposition for skin dissemination. After completing the infecting M. velutinosus genome and genomes from four other Mucor species, comparative pathogenomics was performed and assisted in identifying 66 M. velutinosus-specific putatively secreted proteins, including multiple novel secreted aspartyl proteinases which may contribute to the unique clinical presentation of skin dissemination. Whole exome sequencing of the patient revealed multiple non-synonymous polymorphisms in genes critical to control of fungal proliferation, such as TLR6 and PTX3. Moreover, the patient had a non-synonymous polymorphism in the NOD2 gene and a missense mutation in FUT2, which have been linked to microbial dysbiosis and microbiome diversity maintenance during physiologic stress, respectively. In concert with host genetic polymorphism data, the micro- and mycobiome analyses revealed that the infection developed amid a dysbiotic microbiome with low α-diversity, dominated by staphylococci. Additionally, longitudinal mycobiome data showed that M. velutinosus DNA was detectable in oral samples preceding disease onset. Our genome-level study of the host-infecting microbe-commensal triad extends the concept of personalized genomic medicine to the holobiont-infecting microbe interface thereby offering novel opportunities for using synergistic genetic methods to increase understanding of infectious diseases pathogenesis and clinical outcomes.
Assuntos
Microbioma Gastrointestinal/genética , Genoma Fúngico , Leucemia Mieloide Aguda/complicações , Mucor/genética , Mucormicose/microbiologia , Infecções Oportunistas/microbiologia , Antifúngicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neutropenia Febril Induzida por Quimioterapia , Proteínas Fúngicas/genética , Fungemia/microbiologia , Interações Hospedeiro-Patógeno , Humanos , Masculino , Pessoa de Meia-Idade , Mucor/isolamento & purificação , Mucormicose/tratamento farmacológico , Proteínas de Neoplasias/genética , Onicomicose/complicações , Infecções Oportunistas/tratamento farmacológicoRESUMO
Over a 25-mo span from a single zoologic collection, two bufflehead ducklings (Bucephala albeola) presented with pelvic limb paresis and were euthanized. On postmortem examination, the first duckling had intralesional fungal hyphae consistent with Aspergillus sp. in the spinal vertebrae and within pulmonary granulomas. In the second duckling, evidence of a thoracic spinal lesion was detected antemortem by using thermographic imaging. At postmortem examination, fungal hyphae consistent with Mucor sp. were found within the vertebrae. Although fungal infections of the respiratory system are commonly reported in waterfowl, infections that involve the spinal cord and vertebrae are unusual. These cases highlight the importance of consideration of axial skeleton fungal disease in neurologic presentations and the use of thermography for noninvasive diagnostic screening.
Assuntos
Aspergilose/veterinária , Doenças das Aves/microbiologia , Patos , Mucormicose/veterinária , Osteomielite/veterinária , Animais , Animais de Zoológico , Aspergilose/microbiologia , Aspergilose/patologia , Aspergillus/isolamento & purificação , Doenças das Aves/patologia , Mucor/isolamento & purificação , Mucormicose/microbiologia , Mucormicose/patologia , Osteomielite/microbiologiaRESUMO
A patient with refractory diffuse lymphoma treated for pulmonary invasive aspergillosis developed a concomitant primary cutaneous mucormycosis. The mucormycete was identified by sequencing as Mucor circinelloides. This case confirms the importance of a rapid pathogen diagnosis in immunocompromised patients and the usefulness of molecular methods for identification of rare fungal species.
Assuntos
Mucor/isolamento & purificação , Mucormicose/microbiologia , Zigomicose/microbiologia , Aspergilose/complicações , Aspergilose/microbiologia , Coinfecção , Dermatomicoses/microbiologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/imunologia , Linfoma Difuso de Grandes Células B/microbiologia , Pessoa de Meia-Idade , Mucormicose/complicaçõesRESUMO
Mucormycosis has emerged as a relatively common severe mycosis in patients with haematological and allogeneic stem cell transplantation. Source of transmission is from unidentified sources in the environment. Early diagnosis of infection and its source of contamination are paramount for rapid and appropriate therapy. In this study, rolling circle amplification (RCA) is introduced as a sensitive, specific and reproducible isothermal DNA amplification technique for rapid molecular identification of six of the most virulent species (Rhizopus microsporus, R. arrhizus var. arrhizus, R. arrhizus var. delemar, Mucor irregularis, Mucor circinelloides, Lichtheimia ramosa, Lichtheimia corymbifera). DNAs of target species were successfully amplified, with no cross reactivity between species. RCA can be considered as a rapid detection method with high specificity and sensitivity, suitable for large screening.