Zigomicosis y síndrome hemofagocítico en un paciente inmunocompetente: informe de caso / Zygomycosis and hemophagocytic lymphohistiocytosis in an immunocompetent patient: a case report

Introducción: la zigomicosis es una infección fúngica poco frecuente, con alta tasa de mortalidad y de mal pronóstico. Afecta principalmente a pacientes inmunocomprometidos. La asociación con el síndrome hemofagocítico es extremadamente inusual, más aún en pacientes inmunocompetentes, con pocos ejemplos registrados en la literatura. Caso clínico: se presenta el caso de un paciente masculino inmunocompetente de 40 años con diagnóstico de mucormicosis y síndrome hemofagocítico que evoluciona desfavorablemente, con fallo multiorgánico, a pesar de los esfuerzos médicos. Conclusión: la asociación de mucormicosis con síndrome hemofagocítico en un paciente inmunocompetente es extremadamente rara; existen pocos casos informados en Latinoamérica. Debemos tener presente esta asociación, ya que requiere un tratamiento agresivo y soporte vital avanzado. (AU)

Introduction: zygomycosis is a rare fungal infection that carries with high mortality rates. This poor prognosis, rapidly progressive infection mainly affects immunocompromised patients. The association with hemophagocytic lymphohistiocytosis is extremely unusual, even more in immunocompetent patients, with few cases reported. Case: we present the case of an immunocompetent male patient who was diagnosed with zygomycosis and hemophagocytic lymphohistiocytosis. Despite medical efforts he developed multiorganic failure. Conclusion: the association of mucormycosis with hemophagocytic lymphohistiocytosis in an immunocompetent patient is exceptional with few cases reported in Latin America. We must always suspect this association considering they require aggressive treatment and advanced life support. (AU)

Ocorrência de micoses e pitiose em animais domésticos: 230 casos / Occurrence of mycoses and pythiosis in domestic animals: 230 cases

A retrospective study was performed to determine the main mycoses and oomycosis that affected domestic animals diagnosed in the Laboratório de Patologia Veterinária (LPV) of the Universidade Federal de Santa Maria (UFSM). A total of 29,686 exams (9,487 necropsy reports and 20,199 biopsy reports) performed between January 1990 and December 2012 were analyzed. Two hundred and thirty cases (78% of mycoses and 22% of pythiosis) were found. Data about epidemiology, clinical signs, gross and histologic lesions were obtained from the reports. In two cases the fungi observed were not identified. The main diseases observed, in descending order of prevalence, were: pythiosis, candidiasis, aspergillosis, zygomycosis, dermatophytosis, mallasseziosis, cryptococcosis, megabacteriosis, and sporothrichosis. Others diseases with only one cases each were histoplasmosis and pneumocystosis. Pythiosis affected mainly horses and the mycosis affected mainly companion animals (dogs and cats).

Para determinar as principais micoses e oomicoses que acometeram animais domésticos na área de abrangência do Laboratório de Patologia Veterinária (LPV) da Universidade Federal de Santa Maria (UFSM), foi realizado um estudo retrospectivo em 9.487 protocolos de necropsias e 20.199 exames histopatológicos (totalizando 29.686 casos), realizados no LPV-UFSM, entre janeiro de 1990 e dezembro de 2012. Do total de protocolos analisados, 230 apresentaram micoses ou pitiose (oomicose), sendo 179 casos (78%) de micoses e 51 casos (22%) de pitiose. Os protocolos foram revisados para determinar os principais achados referentes à epidemiologia, sinais clínicos e às alterações macroscópicas e microscópicas. Em dois casos (0,8%) não foi possível determinar o gênero ou o grupo do fungo observado. As principais doenças diagnosticadas, em ordem decrescente de prevalência, foram: pitiose, candidíase, aspergilose, zigomicose, dermatofitose, malasseziose, criptococose, megabacteriose e esporotricose. Outras doenças diagnosticadas numa única ocorrência cada foram histoplasmose e pneumocistose. Os equinos foram os mais acometidos pela pitiose e os animais de companhia (cães e gatos) foram os mais acometidos pelas micoses.

Development and application of polymerase chain reaction test for detection of Conidiobolus lamprauges / Desenvolvimento e aplicação da reação em cadeia da polimerase para detecção de Conidiobolus lamprauges

Conidiobolomycosis is a granulomatous disease caused by the fungus Conidiobolus spp. in humans and animals. Traditional technique for diagnosis of the disease is isolation of the agent associated with the presence of typical clinical signs and pathological conditions. The aim of this study was to describe the development of a specific polymerase chain reaction (PCR) test for Conidiobolus lamprauges to detect the fungus in clinical samples. Samples from suspected animals were collected and submitted to isolation, histopathological analysis and amplification by PCR. DNA from tissues was subjected to PCR with fungi universal primers 18S rDNA gene, and specific primers were designed based on the same gene in C. lamprauges that generated products of about 540 bp and 222 bp respectively. The culture was positive in 26.6% of clinical samples. The PCR technique for C. lamprauges showed amplification of DNA from fresh tissues (80%) and paraffin sections (44.4%). In conclusion, the PCR technique described here demonstrated a high sensitivity and specificity for detection of fungal DNA in tissue samples, providing a tool for the rapid diagnosis of C. lamprauges.

A conidiobolomicose é uma doença granulomatosa causada pelo fungo Conidiobolus spp., observada em humanos e animais. As técnicas tradicionais de diagnóstico da doença são o isolamento do agente associado à presença de sinais clínicos típicos e condições patológicas. O objetivo deste trabalho é descrever o desenvolvimento de um teste da reação em cadeia da polimerase (PCR) específico para Conidiobolus lamprauges em amostras clínicas. As amostras de animais suspeitos foram coletadas e submetidas ao isolamento, análise histopatológica e amplificação pela PCR. O DNA de tecidos foi submetido a PCR com os iniciadores universais de fungos baseados no gene 18S rDNA e iniciadores específicos foram concebidos com base no mesmo gene em C. lamprauges que gerou produtos de aproximadamente 540 pb e 222 pb, respectivamente. A cultura foi positiva em 26,6% das amostras clínicas. A técnica de PCR para C. lamprauges mostrou a amplificação de DNA a partir de tecidos frescos (80%) e secções de parafina (44,4%). Em conclusão, a técnica de PCR aqui descrita demonstrou elevada sensibilidade e especificidade na detecção de DNA de fungos em amostras de tecido, proporcionando uma ferramenta rápida para o diagnóstico de C. lamprauges.

Intestinal obstruction due to Basidiobolus ranarum: An unusual case.

A case of intestinal obstruction caused by extensive soft tissue fungal infection of the perineum due to Basidiobolus ranarum is presented here. There was excellent response to antifungal treatment. A literature search revealed the case report of intestinal obstruction due to intrinsic mucosal involvement by the fungus, but extensive soft tissue involvement of the perineum resulting in extraneous obstruction to the rectum, has not been reported so far.

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

Zygomycosis is an infection caused by opportunistic fungi of the Zygomycetes class, specifically those from the Mucorales and Entomophthorales orders. It is an uncommon disease, mainly restricted to immunocompromised patients. We report a case of a 73-year-old male patient with a history of fever (39°C) lasting for 1 day, accompanied by shivering, trembling, and intense asthenia. The patient was admitted to the intensive care unit with complex partial seizures, and submitted to orotracheal intubation and mechanical ventilation under sedation with midazolam. The electroencephalogram showed evidence of non-convulsive status epilepticus. There is no fast specific laboratory test that permits confirmation of invasive fungal disease. Unless the physician suspects this condition, the disease may progress rapidly while the patient is treated with broad-spectrum antibiotics. Differential diagnosis between fungal and bacterial infection is often difficult. The clinical presentation is sometimes atypical, and etiological investigation is not always successful. In the present case, the histopathological examination of the biopsy obtained from the right temporal lobe indicated the presence of irregular, round, thick-walled fungi forming papillae and elongated structures of irregular diameter, with no septa, indicative of zygomycete (Basidiobolus). Treatment with liposomal amphotericin B and fluconazole was initiated after diagnosis of meningoencephalitis by zygomycete, with a successful outcome.

Primary cutaneous zygomycosis from a tertiary care centre in north-west India.

Background & objectives: Zygomycosis is highly invasive fungal infection, with high mortality rate. In most of patients, diabetes mellitus is an underlying factor but in primary cutaneous zygomycosis, presentation may be different. Here we present the description of clinical presentation, fungi isolated and management of cases with cutaneous zygomycosis seen in a tertiary care hospital in north India during 2001-2007. Methods: All patients diagnosed with primary cutaneous zygomycosis between November 2001 and September 2007 presenting with clinical diagnosis of necrotizing fasciitis were included. Detailed history of each patient was taken, clinical presentation, site of involvement, underlying illness and risk factor, if any were noted. The diagnosis was established by direct microscopic evidence of broad, aseptate or sparsely septate ribbon-like hyphae with right angle branching in KOH wet mount and histopathological examination of stained sections. Cultures were put up for fungal isolation and species identification. Outcome of the therapy was analysed. Results: Of the nine patients reviewed, only one had diabetes mellitus. Commonest risk factor was injection abscess (33.3%). Apophysomyces elegans was isolated in four cases, Saksenaea vasiformis and Absidia corymbifera in one each. The fungal culture was sterile in three cases. Mortality rate was high with only four patients responded well to surgical and/or medical therapy. Interpretation & conclusion: Primary cutaneous zygomycosis appears to be on rise in India that calls for high index of clinical suspicion and an early biopsy of the affected area for timely diagnosis. The standard treatment is a combination of amphotericin B therapy, surgical debridement, and reversal of the underlying disease or immunosuppression.

Capítulo 7 - Zigomicose / Chapter 7 - Zygomycosis

A zigomicose (mucormicose) é uma infecção rara, mas altamente invasiva, causada por fungos da ordem Mucorales (gêneros Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Saksenaea, Cunninghamella, Cokeromyces e Syncephalastrum). Esse tipo de infecção é usualmente associado a doenças hematológicas, cetoacidose diabética e transplante de órgãos. A apresentação clínica mais frequente é a mucormicose rinocerebral, com ou sem envolvimento pulmonar. A zigomicose pulmonar ocorre mais frequentemente em pacientes com neutropenia profunda e prolongada e pode se apresentar como infiltrado lobar ou segmentar, nódulos isolados, lesões cavitárias, hemorragia ou infarto. As manifestações clínicas e radiológicas são na maioria dos casos indistinguíveis daquelas associadas com aspergilose invasiva. Este artigo descreve as características gerais da zigomicose pulmonar, com ênfase no diagnóstico laboratorial, e ilustra a morfologia de algumas lesões.

Zygomycosis (mucormycosis) is a rare but highly invasive infection caused by fungi belonging to the order Mucorales, which includes the genera Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Saksenaea, Cunninghamella, Cokeromyces and Syncephalastrum. This type of infection is usually associated with hematologic diseases, diabetic ketoacidosis and organ transplantation. The most common form of presentation is rhinocerebral mucormycosis, with or without pulmonary involvement. Pulmonary zygomycosis is more common in patients with profound, prolonged neutropenia and can present as segmental or lobar infiltrates, isolated nodules, cavitary lesions, hemorrhage or infarction. The clinical and radiological manifestations are often indistinguishable from those associated with invasive aspergillosis. This article describes the general characteristics of pulmonary zygomycosis, emphasizing laboratory diagnosis, and illustrates the morphology of some lesions.

Zigomicosis cutánea primaria en paciente pediátrica inmunocomprometida / Primary zygomycosis in a pediatric inmunocompromised patient

La zigomicosis es una infección infrecuente causada por hongos oportunistas que pertenecen al orden Mucorales, cuya característica es la invasión vascular por hifas, lo que determina trombosis, infarto y necrosis tisular. En General afecta a pacientes con efermedades subyacentes, causando infecciones invasoras severas y a menudo fulminantes. Algunas condiciones de riesgo son: leucemias y linfomas con neutropenia prolongada, cetoacidosis diabética, malnutrición severa, ruptura de la integridad de la barrera cutánea y terapia inmunosupresora. Se presenta un caso de zigomicosis cutánea primaria en el antebrazo, en una paciente pedíatrica con leucemia linfobástica aguda de tipo B, con grave neutropenia y tratamiento con corticoides, y describimos los aspectos histológicos y clínicos de la lesión necrótica en la zona de punción venosa.

Zigomicosis cutánea primaria por Rhyzopus oryzae en una niña con leucemia linfoblástica aguda tipo B / Primary cutaneous zygomycosis by Rhyzopus oryzae in a girl diagnosed with an acute lymphoblastic leukemia B type

La Zigomicosis es una infección infrecuente causada por hongos oportunistas integrantes del orden Mucorales, que se presenta en pacientes de alto riego como en: leucemia, linfomas con neutropenia prolongada, cetoacidosis diabética, malnutrición severa, ruptura de la integridad de la barrera cutánea y terapia inmunosupresora. Se presenta un caso de Zigomicosis cutánea en una paciente pediátrica con leucemia linfoblástica aguda de tipo B, con severa neutropenia y tratamiento con corticoides. A los cinco días de su hospitalización desarrolló en el antebrazo (zona de punción venosa), una lesión indurada, eritematosa, que progresó y ulceró. A partir de exudados y biopsias del tejido subcutáneo se realizaron exámenes microscópicos directos con KOH, cultivos en agar Sabouraud y estudio histológico a través de técnicas convencionales de hematoxilinaeosina y PAS. Los análisis de los materiales clínicos revelaron la presencia de hifas hialinas, no tabicadas, gruesas, compatibles con un Zygomycete. En todos los tubos se obtuvo abundante desarrollo de un hongo filamentoso, identificado como Rhizopus oryzae. Posteriormente a la escisión quirúrgica y tratamiento con anfotericina B se obtuvo una evolución favorable del paciente hasta el presente.

Zygomycosis is an infrequent infection caused by opportunistic fungi which belong to the order Mucorales and which is present in high risk patients diagnosed with : leukemia, lymphomas with prolonged neutropenia, diabetic cetoacidosis, severe malnutrition, rupture of the entire cutaneous barrier and immunesuppressing therapy. This paper deals with a case of cutaneous Zygomycosis in a pediatric patient diagnosed with acute lymphoblastic leukemia B type, suffering a severe neutropenia and corticosteroid treatment. On the fifth day of hospitalization, her forearm (venous puncture zone) showed an indured, erimatose lesion which progressed and ulcerated. Collection of exudates and biopsies of subcutaneous tissue served to carry out direct microsco-pic examinations with KOH, cultures in Sabouraud Agar and a histologic study through conventional hematoxilin-eosin and PAS techniques. Analyses of the clinical materials revealed the presence of hyaline, not septated and broad hyphae suitable to a Zygomycete. In all the tubes there was an abundant development of filamentous fungus identified as Rhizopus oryzae. After the surgical scission and treatment with anfotericine B, the patient showed a favorable evolution up to now.

Autofluorescence: a screening test for mycotic infection in tissues.

Fungal infection is a major health concern as the clinical features are not very distinctive. Lack of rapid diagnostic techniques results in delay in diagnosis, which may even culminate in a fatal outcome. The fact that many pathogenic fungal organisms autofluoresce in hematoxylin and eosin (H and E)-stained sections under ultraviolet illumination led us to evaluate the role of autofluorescence as a rapid screening technique for fungal infections. The aim of the present study was to assess the value of autofluorescence as a screening method for detecting fungi on tissue sections and to compare the results of autofluorescence with conventional histochemical stains for fungi. Hematoxylin and eosin-stained slides of mycotic lesions were examined under fluorescent microscope and the findings were compared with results of Gomori's methenamine silver and periodic acid-Schiff stains. We found fungal autofluorescence in 63 out of 64 cases studied, with a sensitivity of 97.8% and specificity of 100% in comparison with fungal stains. This was statistically significant (P < 0.05). We conclude that autofluorescence can be used as a rapid screening method for identification of fungi in tissue sections as it does not require any other specialized staining procedure.

Conidiobolomicose em ovinos no Estado de Mato Grosso / Conidiobolomycosis in sheep in the state of Mato Grosso, Brazil

Relatam-se os achados epidemiológicos, clínicos, patológicos e micológicos de conidiobolomicose em ovinos no Estado de Mato Grosso. A doença ocorreu em uma propriedade no município de Nobres, em um rebanho com 40 ovelhas adultas, entre os meses de janeiro a junho de 2007. Aproximadamente 30 por cento dos ovinos da propriedade adoeceram e todos os doentes morreram em curso clínico de 2-5 semanas. O quadro clínico foi caracterizado por apatia, emagrecimento, dificuldade respiratória com dispnéia, respiração ruidosa e oral, secreção nasal mucosa ou sero-sanguinolenta, exoftalmia unilateral, por vezes com cegueira, e morte. Havia desaparecimento de etmoturbinados com substituição por tecido bran-cacento, finamente granular, multilobulado e friável infil-trando-se na lâmina cribiforme, no septo nasal e nas coa-nas em todos os ovinos necropsiados. Lesões similares foram encontradas em linfonodos regionais (2 casos), pulmões (3), encéfalo (2) e em linfonodos do abomaso (1). Microscopicamente havia inflamação granulomatosa da região rinocerebral, caracterizada por necrose, proliferação de tecido conjuntivo, infiltrado de neutrófilos, eosinófilos, células epitelióides e células gigantes multinucleadas freqüentemente circundando material Splendori-Hoeppli, onde havia imagens negativas de hifas. Na impregnação pela Prata-Metenamina, as hifas tinham septos e ramificações escassas e irregulares, com dilatação balonosa terminal e com forte demarcação de contornos. Iso-lou-se de tecido nasal de quatro ovinos Conidiobolus sp.

The epidemiological, clinical, pathological and mycological findings of an outbreak of conidiobolomycosis in a flock of 40 Santa Ines sheep, in the state of Mato Grosso, Brazil, are reported. The illness occurred in the municipality of Nobres during January-June, 2007, resulting in death of about 30 percent of the affected sheep within 2-5 weeks. The clinical signs were characterized by apathy, weight loss, labored and noisy breathing with dyspnea, and mucous or serohemorrhagic nasal discharge. In three sheep there was unilateral exophthalmia, keratitis and corneal ulceration. A firm whitish, multi-lobulated, friable growth was evident in the ethmoturbinate region at the coronal sections of the head from six affected sheep. In all sheep the choana had similar nodular infiltration which resulted in local obstruction. In three of those there was exophthalmia. There was infiltration in the cribiform plate and brain (2 cases), regional lymph nodes (2), lungs (3), and abomasums (1). Microscopic findings were granulomatous inflammation of the rhinoetimoidal region, with necrosis, lymphocytic infiltration, epithelioid multinucleated giant cells and fibrovascular tissue, surrounding Splendore-Hoeppli material wich contained unstained ghost images of hyphae. The methenamine-silver stain uncover fungi hyphae, rarely ramified with bulbous dilatation in their extremities. Conidiobolus sp. was isolated from nasal tissue lesions of four sheep.

Entomoftoromicosis Zigomicosis: histopatología con relatos de casos clínicos / Entomoftoromicosis Zigomicosis: histopathology with stories of clinical cases

Los onicomatricomas son tumores benignos inusuales, que se originan a partir de la matriz ungueal y del estroma que la rodea. La proporción entre epitelio y estroma varía. Aquellas lesiones donde el componente epitelial predomina son consideradas como unguioblastomas. En contraste, aquellas donde el componente estromal predomina son consideradas como fibromas unguioblásticos. En raros casos donde el componente estromal es atípico, es aplicable la denominación de fibromas unguioblasticos atípicos. Esta clasificación es análoga a la utilizada para neoplasias fibroepiteliales tricoblásticas. La presencia de pigmentación asociada a este tumor como melanoquia longitudinal es extremadamente rara. Este fenómeno probablemente es causado por activación de los melanocitos matricales.

Epidemiologia e sinais clínicos da conidiobolomicose em ovinos no Estado do Piauí / Epidemiology and symptoms of conidiobolomycosis in sheep in the State of Piauí, Brazil

Foi realizado um estudo de ocorrência da conidiobolomicose ovina em 25 rebanhos no Estado do Piauí, de janeiro de 2002 a dezembro de 2004. A enfermidade acometeu apenas ovinos e ocorreu principalmente em abril-julho. A incidência média anual foi de 2,80 por cento e a incidência semestral foi significativamente mais alta (P <0,05) no primeiro semestre (2,10 por cento), durante a época chuvosa, do que no segundo semestre (0,69 por cento), durante a seca. A incidência entre rebanhos variou de 0,1-14,3 por cento e a letalidade foi de 100 por cento. Ao exame clínico, os animais apresentavam apatia, emagrecimento progressivo, secreção nasal serosa, mucosa e/ou hemorrágica, dificuldade respiratória, respiração ruidosa, febre e na maioria dos casos assimetria crânio-facial e exoftalmia. Alguns ovinos permaneciam com a cabeça baixa ou a pressionavam contra objetos. O curso clínico foi de 1-5 semanas. As lesões macroscópicas, microscópicas e ultrastructurais e a identificação do agente são descritas separadamente. Este é o primeiro registro de conidiobolomicose em ovinos no Brasil, enfermidade endêmica no Estado do Piauí, associada à alta pluviosidade (1000-1600mm anuais) e alta temperatura (19-36ºC).

Conidiobolomycosis is reported in 25 farms, from January 2002 to December 2004, in the state of Piauí. The disease affects only sheep, mainly in April-June. The mean morbidity rate was 2.80 percent, but was higher in the first semester (2.1 percent), during the raining period, than in the second one (0.69 percent), during the dry period. Morbidity rate among flocks varied from 0.1-14.3 percent. Case fatality rate was 100 percent, and the clinical manifestation period varied from 1-5 weeks. Clinical signs were serous, mucous and/or bloody nasal secretion, respiratory distress, snoring respiration, cranium-facial asymmetry, exophthalmia, fever and progressive emaciation. Marked depression, sometimes with the head down or head pressing was observed in some cases. Gross, microscopic and ultrastructural lesions and identification of the agent are reported elsewhere. This is the first report of conidiobolomycosis in Brazil, which is endemic and has a high frequency in sheep in the State of Piauí, associated with high rainfalls (1000-1600mm annually) and high temperature (19-36ºC).

Rhinoentomophthoromycosis.

A sixty year old patient presented with a slowly progressive swelling of the nose, of one year duration, suggesting a clinical diagnosis of subcutaneous zygomycosis. On investigation, the tissue fungal culture grew Conidiobolus coronatus, confirming the diagnosis as rhinoentomophthoromycosis. He was treated with a combination of oral fluconazole and oral potassium iodide for a total period of 5 months. His symptoms subsided completely. Serial CT scanning of paranasal sinuses showed the gradual resolution of the swelling, in response to the treatment. Early detection of the disease and combination therapy gave rapid and good results. This is the first case of its kind to be reported from Kerala, the southern state of India.

A mediastinal mass resembling lymphoma: an unusual manifestation of probable case of invasive zygomycosis in an immunocompetent child.

A 2-year-old girl presented with prolonged fever and progressive dyspnea for 3 weeks. A chest radiograph revealed a left lung infiltrate and associated pleural effusion. Echocardiography revealed a large posterior mediastinal mass extending to the left atrial wall and massive pericardial effusion. The presumptive diagnosis was lymphoma. At operation, a large brownish-yellow mass was noted at the posterior mediastinum, with matted hilar, and subcarinal lymph nodes. Pericardial and pleural effusions with left lung consolidation were also noted. Histopathological examination of biopsy specimens revealed a granulomatous inflammatory reaction with a diffuse eosinophilic infiltrate and broad septated fungal hyphae with right angle branching compatible with zygomycosis. Surgical removal of the mass could not be performed due to the adjacent great vessels and carina. She subsequently died from airway obstruction and respiratory failure ten days later.

Case report of subcutaneous entomophthoromycosis with retroperitoneal invasion

Os autores descrevem um caso de entomoftoromicose em paciente previamente saudável, que apresentou abscesso em nádega direita, evoluindo, após drenagem cirúrgica, para tumoração retroperitoneal. Após ressecção da massa, o paciente obteve melhora clínica, em uso de cetoconazol. A análise histopatológica evidenciou fenômeno de Splendore-Hoeppli, sugerindo infecção por Basidiobolus ranarum, uma zigomicose geralmente restrita ao tecido subcutâneo, com raro comprometimento gastrintestinal.

Experiencia en mucormicosis Hospital Clinico Universidad de Chile / Experience in mucormycosis Hospital Clínico Universidad de Chile

Revisamos los hallazgos clínicos, patológicos y tratamiento en 12 pacientes con mucormicosis en el Hospital Clínico de la Universidad de Chile entre los años 1990 y 2004. Del total de pacientes estudiados, 7 eran hombres y 5 mujeres. La edad promedio fue de 54 años, con un rango de 29 a 79 años. El diagnóstico de mucormicosisse realizó por biopsia en 10 pacientes y por estudio directo en 2 pacientes. Los factores predisponentes presentes en los pacientes estudiados fueron, diabetes mellitus, HIV en etapa SIDA y enfermedades hematológicas en tratamiento oncológico. La histología demostró necrosis e infarto con invasión de vasos sanguíneos y trombosis micótica. Todos los pacientes estudiados recibieron tratamiento con Anfotericina B y 6 fueron intervenidos quirúrgicamente. Del total de 12 pacientes, 4 fallecieron (33 por ciento) y 8 permanecen vivos (66 por ciento).

We made a review of the clinical and pathological findings and the treatment in 12 patients presenting mucormycosis in the Clinical Hospital of the University of Chile between 1990 and 2004. Of the whole studied patients, 7 were men and 5 women. The average age was 54 years, with a range from 29 to 79 years. The diagnosis of mucormycosis was performed by biopsy in 10 patients andby direct study in 2 patients. The predisposing factors in the studied patients were: Diabetes Mellitus, HIV at AIDS stage and hematological diseases in oncologic treatment. The histology demonstrated necrosis and infarction with blood vessels invasion and mycotic thrombosis. All the studied patientsreceived treatment with Anphotericine B and 6 required surgical intervention. Of the total of 12 patients, 4 died (33 percent) and 8 remain alive (66 percent).

Entomophthoromycosis in South Bengal (Eastern India): a 9 years study.

Subcutaneous mycoses caused by the family Entomophthoraceae is very rare type of disease and is being reported sporadically from various Tropical countries including India. Here we report 8 cases of rhinoentomophthoromycosis caused by Conidiobolous coronatus and 7 cases of chronic subcutaneous phycomycosis caused by Basidiobolus ranarum. Cases were detected during a span of 9 years between 1991 to 1999, from 9 districts in and around Kolkata (Eastern India). Former type of lesions were detected among 20 to 65 age group of healthy individuals, predominantly males (7:1). In the latter type, male-female ratio was 2:5, and except for one all cases belonged to below 20 years age group of healthy individuals. Several cases were detected only after examination of repeat biopsy samples. With high degree of clinical suspicion, right approach is needed for laboratory confirmation of diagnosis.

Entomophthoromycosis in Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To review documented entomophthoromycosis patients at Maharaj Nakorn Chiang Mai Hospital from 1985 to 2001. MATERIAL AND METHOD: A retrospective review was performed at Maharaj Nakorn Chiang Mai Hospital from 1985 to 2001. Eight cases of entomophthoromycosis were found between 1988 and 1993, with five patients diagnosed as subcutaneous zygomycosis, I GI entomophthoromycosis and 2 rhinofacial zygomycosis. RESULTS: The subcutaneous zygomycosis group was composed of 5 female patients, aged 7- 77 years. They presented with a painless subcutaneous mass, which was solitary or multiple and most commonly found on the extremities. The duration of disease was between 3 months to 5 years. The cultures grew Basidiobolus ranarum. A case of GI entomophthoromycosis was seen in a 34 year old man, who presented with dyspepsia, multiple intraabodminal masses and peritonitis. Two cases of conidiobolomycosis (rhinofacial zygomycosis) were seen. These two patients were male, 26 and 39 years old, and they presented with unilateral nasal obstruction from a mass at the inferior turbinate. The cultures grew Conidiobolus coronatus. CONCLUSION: Entomophthoromycosis in the northern part of Thailand is rare. The disease should be differentially diagnosed by a chronic painless tumor. The patients in this review responded very well to the recommended therapy.

Zygomycosis due to Conidiobolus coronatus in west Bengal.

Zygomycosis of upper respiratory tract, caused by Conidiobolus coronatus, in eight Bengalee males and one female is described. The clinical syndrome of the cases included initial coryza, epistaxis, intranasal tumor, nasal obstruction, broadening of bridge of nose with swelling of paranasal sinuses, dorsum of nose, alae nasi, cheek and glabella in all or majority of the cases. In addition upper lip or both lips and pharynx were involved in some cases. Swellings were fixed to the skin in seven cases and to the deeper tissues in five cases. The fungus was demonstrated by direct microscopy in the nasal mucosa, and was isolated in culture. The isolates produced conidia, replicative conidia and villose conidia but not multiplicative conidia. The disease was cured with KI and/or ketoconazole/fluconazole. The cases described here constitute the first report on zygomycosis due to C. coronatus from North-eastern India.