[Conidiobolomycosis (rhinofacial entomophthoromycosis) in Gabon. About of one case]. / Conidiobolomycose (entomophthoromycose rhinofaciale) au Gabon, à propos d'une observation.

Background: Entomophthoromycosis constitutes a nosological group of subcutaneous mycoses including conidiobolomycosis (rhinofacial form) and basidiobomomycosis (subcutaneous form involving the trunk and the limbs). Conidiobolomycosis is characterized by a progressive nasal and facial deformity giving, in the evolved forms, a "hippopotamus snout". The literature review finds a hundred cases, with a tropism for the humid tropical regions. Methods. We report the observation of a 25-year-old patient, living in the equatorial zone, in the south of Gabon in a humid forest area, presenting a swollen aspect of the face mainly involving the eyelids, the nose and the upper lips. Results: The diagnosis of entomophthoromycosis was compatible with the histopathological and clinical aspects. The evolution was favorable in terms of facial aesthetics under itraconazole 300 mg/day for 2 months and corticosteroid therapy (bolus of methylprednisone 240 mg/day for 3 days relayed per os at a dose of 0.5 mg/kg/day, i.e. 30 mg/day) of prednisone), maintained for 3 months. The average nasal improvement could not be completed by surgery and the patient was lost to follow-up. Conclusion: This second observation of conidiobolomycosis in Gabon in the same province makes Ngounié a privileged ecosystem for this affection.

An old confusion: Entomophthoromycosis versus mucormycosis and their main differences.

Fungal diseases were underestimated for many years. And the global burden of fungal infections is substantial and has increased in recent years. Invasive fungal infections have been linked to several risk factors in humans which basically depend on the individual homeostasis of the patients. However, many fungi can infect even apparently healthy people. Knowledge of these pathogens is critical in reducing or stopping morbidity and/or mortality statistics due to fungal pathogens. Successful therapeutic strategies rely on rapid diagnosis of the causative fungal agent and the underlying disease. However, the terminology of the diseases was updated to existing phylogenetic classifications and led to confusion in the definition of mucormycosis, conidiobolomycosis, and basidiobolomycosis, which were previously grouped under the now-uncommon term zygomycosis. Therefore, the ecological, taxonomic, clinical, and diagnostic differences are addressed to optimize the understanding and definition of these diseases. The term "coenocytic hyphomycosis" is proposed to summarize all fungal infections caused by Mucorales and species of Basidiobolus and Conidiobolus.

Rhinofacial entomophthoramycosis: an uncommon infection of the subcutaneous tissue.

Entomophthoramycosis can be found in subtropical and tropical regions. This case illustrates common clinical features of conidiobolomycosis. Although this disease is not common, physicians working in these regions should be familiar with the clinical manifestations to enable early diagnosis and treatment.

A rare case of condiobolomycosis due to Conidiobolus coronatus presenting with dysphagia.

Conidiobolomycosis is a neglected tropical fungal infection involving the head and neck region. Here we report the first case of atypical conidiobolomycosis presenting with dysphagia and significant weight loss from Odisha, India. It was diagnosed by histopathology and fungal culture and was suscessfully treated with saturated solution of potassium iodide.

Rhinofacial conidiobolomycosis: Clinical and microbiological characterisation and shift in the management of a rare disease.

BACKGROUND: Conidiobolomycosis is a rare tropical rhinofacial fungal infection which has not been well characterised. The available evidence in its management is sparse due to lack of clinical studies and the limited data on antifungal susceptibility patterns. OBJECTIVE: To analyse the clinical manifestations, antifungal treatment and outcomes of patients with conidiobolomycosis and to determine antifungal susceptibility profiles of the isolates. PATIENTS/METHODS: Retrospective analysis of data of all patients with a diagnosis of conidiobolomycosis confirmed by histopathology and culture at a tertiary care hospital from 2012 to 2019 was done. RESULTS: There were 22 patients, 21 males and one female, with a mean age of 37.1 years. Most common presenting symptom was nasal obstruction, found in 20 (90.90%) patients. Patients who presented within 12 months had a better cure rate (85%) compared to those who presented late (67%). Among the 19 patients who had a follow-up, good outcome was seen in 15 of the 17 (88.24%) patients who were on itraconazole or potassium iodide containing regimen. Of the six patients who received additional trimethoprim-sulphamethoxazole (co-trimoxazole), 67% showed good outcome with two patients showing complete cure and two patients still on treatment with significant improvement. High minimum inhibitory concentration (MIC) values were noted for azoles and amphotericin B, whereas co-trimoxazole showed lowest MIC ranges. CONCLUSION: Itraconazole and potassium iodide are reasonable first-line options for the treatment of conidiobolomycosis. Good clinical response to KI and comparatively lower MIC of co-trimoxazole are promising. Further studies are required for developing clinical breakpoints that can predict therapeutic outcomes.

Case Report: Successful Management of Conidiobolus Lamprauges Rhinitis in a Dog.

This is a case of Conidiobolus lamprauges rhinitis in a Goldendoodle, that was presented for evaluation of sneezing, coughing, lethargy, as well as right-sided epistaxis and clear ocular discharge. Computed tomography revealed a large amount of soft tissue within the right nasal passage that obscured the osseous turbinates from the right maxillary canine tooth to the right side of the choanae. Biopsies revealed eosinophilic granulomas with variable number of basophilic to negatively staining, septate, fungal hyphae with non-parallel walls and irregular branching that were subsequently determined to be Conidiobolus lamprauges via panfungal PCR and sequencing. Complete and sustained resolution of clinical disease was achieved after 75 days of systemic antifungal therapy. This report describes for the first time, important clinical features of a dog with nasal conidiobolomycosis that will facilitate its recognition, prognostication, and treatment in clinical practice.

Rhinofacial Conidiobolomycosis: A Case Series and Review of the Literature.

Conidiobolomycosis is an uncommon, chronic, localized subcutaneous mycosis primarily affecting rhinofacial region. It is reported mainly from tropical and subtropical countries. The condition is underreported due to the lack of clinical suspicion and usually mismanaged. This rare mycosis is due to the genus Conidiobolus within the order Entomophthorales of class Zygomycetes. Here we present 3 cases of rhinofacial conidiobolomycosis in otherwise healthy adults from different parts of Sri Lanka over 1-year period. All patients had disfiguring subcutaneous lesions in the rhinofacial area. The diagnoses were based on isolation of Conidiobolus coronatus in clinical specimens.

Conidiobolomycosis in goats

ABSTRACT: The present article presents cases of conidiobolomycosis in adult goats with clinical signs characterized by serous nasal discharge, dyspnea, apathy, and weight loss. Two goats were necropsied. Necropsy displayed increased volume on the sagittal section of the head and an ulcerated surface containing a yellow friable mass with irregular and granular consistency in the nasal septum and in the ventral nasal turbinate. One goat also presented lesions on the ears skin and the right pelvic limb. Microscopically, lesions were characterized by multifocal granulomas with a central necrotic area containing non-stained fungal hyphae images surrounded by a granulomatous infiltrate. Samples of the lesions examined by immunohistochemistry and polymerase chain reaction were positive for Conidiobolus lamprauges. This is the first report of conidiobolomycosis in goats, and the disease should be considered in the differential diagnoses for rhinitis and dermatitis in goats.

RESUMO: O presente artigo apresenta casos de conidiobolomicose em cabras adultas com sinais clínicos caracterizados por secreção nasal serosa, dispneia, apatia e perda de peso. Dois caprinos foram necropsiados. Na necropsia, em corte sagital da cabeça, foi observado aumento de volume e superfície ulcerada contendo massa amarela e friável com consistência irregular e granular no septo nasal e conchas nasais ventrais. Uma cabra apresentou também lesões na pele da orelha e no membro pélvico direito. Microscopicamente, as lesões foram caracterizadas por granulomas multifocais com área central de necrose, contendo imagens de hifas fúngicas não coradas, circundadas por infiltrado inflamatório granulomatoso. Amostras das lesões submetidas à imuno-histoquímica e reação em cadeia da polimerase foram positivas para Conidiobolus lamprauges. Este é o primeiro registro de conidiobolomicose em caprinos e deve ser considerado no diagnóstico diferencial de rinite e dermatite em caprinos.

Conidiobolomycosis in goats / Conidiobolomicose em caprinos

The present article presents cases of conidiobolomycosis in adult goats with clinical signs characterized by serous nasal discharge, dyspnea, apathy, and weight loss. Two goats were necropsied. Necropsy displayed increased volume on the sagittal section of the head and an ulcerated surface containing a yellow friable mass with irregular and granular consistency in the nasal septum and in the ventral nasal turbinate. One goat also presented lesions on the ear's skin and the right pelvic limb. Microscopically, lesions were characterized by multifocal granulomas with a central necrotic area containing non-stained fungal hyphae images surrounded by a granulomatous infiltrate. Samples of the lesions examined by immunohistochemistry and polymerase chain reaction were positive for Conidiobolus lamprauges. This is the first report of conidiobolomycosis in goats, and the disease should be considered in the differential diagnoses for rhinitis and dermatitis in goats.(AU)

O presente artigo apresenta casos de conidiobolomicose em cabras adultas com sinais clínicos caracterizados por secreção nasal serosa, dispneia, apatia e perda de peso. Dois caprinos foram necropsiados. Na necropsia, em corte sagital da cabeça, foi observado aumento de volume e superfície ulcerada contendo massa amarela e friável com consistência irregular e granular no septo nasal e conchas nasais ventrais. Uma cabra apresentou também lesões na pele da orelha e no membro pélvico direito. Microscopicamente, as lesões foram caracterizadas por granulomas multifocais com área central de necrose, contendo imagens de hifas fúngicas não coradas, circundadas por infiltrado inflamatório granulomatoso. Amostras das lesões submetidas à imuno-histoquímica e reação em cadeia da polimerase foram positivas para Conidiobolus lamprauges. Este é o primeiro registro de conidiobolomicose em caprinos e deve ser considerado no diagnóstico diferencial de rinite e dermatite em caprinos.(AU)

Nasofacial rhinoentomophthoramycosis: A report of two cases from Central India.

Rhinoentomophthoromycosis due to Conidiobolus coronatus is a rare, chronic, granulomatous disease, occurring mainly in tropical countries including India. We report two cases of rhinoentomophthoromycosis in an 18-year-old female and a farmer of 35 years residents of Chhattisgarh shifted from Madhya Pradesh and Orrisa. It was diagnosed by microscopy and isolation C. coronatus in culture. The patient presented with a swollen nose with obstruction that had progressed slowly over 1 year. His nasal swelling was bilateral, diffuse, mildly tender, erythematous, nonpitting, with mucosal crusting and hypertrophy of inferior turbinates but no regional lymphadenopathy. Culture of tissue from the nasal biopsy on sabouraud dextrose agar yielded multiple colonies of a mold with satellite smaller colonies at periphery. The isolate demonstrated the macroscopic and microscopic morphologic characteristics of C. coronatus. The patients were earlier treated with itraconazole or its combination with potassium iodide and the patients were treated successfully with amphotericin B.

In vitro assessment of antifungal, antibacterial, and antiprotozoal drugs against clinical isolates of Conidiobolus lamprauges.

We have determined the in vitro activity of antifungal, antibacterial, and antiprotozoal drugs alone and in combination against seven Conidiobolus lamprauges clinical isolates. The assays were based on the M38-A2 protocol and the checkerboard microdilution method. The lowest inhibitory concentrations were observed for amphotericin B, miconazole (MCZ), terbinafine, and miltefosine (MTF) (MIC range 0.25-1; 2-8; 0.25-2; 2-16 µg/ml, respectively). The main synergism observed was through the combination of azithromycin (AZI)+MTF and dapsone (DAP)+MTF (100%), AZI+DAP (85.7%), AZI+MCZ (57.1%) as well as MCZ plus CTX and DAP (42.9%). The in vitro activities suggest that the combination of MTF and AZI or DAP are promising candidate therapies for conidiobolomycosis.

Human Pathogenic Entomophthorales.

The pathogenic entomophthoralean fungi cause infection in insects and mammalian hosts. Basidiobolus and Conidiobolus species can be found in soil and insect, reptile, and amphibian droppings in tropical and subtropical areas. The life cycles of these fungi occur in these environments where infecting sticky conidia are developed. The infection is acquired by insect bite or contact with contaminated environments through open skin. Conidiobolus coronatus typically causes chronic rhinofacial disease in immunocompetent hosts, whereas some Conidiobolus species can be found in immunocompromised patients. Basidiobolus ranarum infection is restricted to subcutaneous tissues but may be involved in intestinal and disseminated infections. Its early diagnosis remains challenging due to clinical similarities to other intestinal diseases. Infected tissues characteristically display eosinophilic granulomas with the Splendore-Höeppli phenomenon. However, in immunocompromised patients, the above-mentioned inflammatory reaction is absent. Laboratory diagnosis includes wet mount, culture serological assays, and molecular methodologies. The management of entomophthoralean fungi relies on traditional antifungal therapies, such as potassium iodide (KI), amphotericin B, itraconazole, and ketoconazole, and surgery. These species are intrinsically resistant to some antifungals, prompting physicians to experiment with combinations of therapies. Research is needed to investigate the immunology of entomophthoralean fungi in infected hosts. The absence of an animal model and lack of funding severely limit research on these fungi.

Rhinofacial conidiobolomycosis in a 16-year-old girl

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To present the case of a 16-year-old girl with progressive facial disfigurement spanning 11 months due to conidiobolomycosis<br /><strong>METHODS:</strong><br /><strong>Design</strong>: Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 16-year-old girl presented with a severe facial deformity of 11 months duration. The lesion started as a swelling in the right nasal vestibule, which later involved the entire nose, forehead, cheeks, upper and lower lip. A series of tissue biopsies revealed varied results-- chronic inflammation, chronic granulomatous inflammation with foreign body type giant cells, and eosinophilic granuloma- resulting in delayed provision of appropriate treatment. On the fourth biopsy using the Grocott methenamine silver staining technique, septate fungal hyphae were identified. With a diagnosis of rhinofacial conidiobolomycosis, she was started on Itraconazole 100mg three times daily for eight months. Her facial swelling subsided gradually during the course of treatment and no systemic drug-related complications were observed. <br /><strong>CONCLUSION:</strong> Rhinofacial conidiobolomycosis is a rare chronic localized fungal infection that usually affects midline facial structures in immunocompetent hosts. Early detection and diagnosis, and appropriate medication can give rapid resolution. To the best of our knowledge, this may be the first documented case of rhinofacial conidiobolomycosis in the Philippines.</p>

Update on fungal respiratory disease in horses.

Fungal respiratory disease is a rare occurrence in horses. Fungal organisms are ubiquitous in the equine environment; however, there is a geographic predisposition for disease development, with fungal respiratory infections seen more commonly by practitioners working in tropical or subtropical environments. Diagnosis and treatment of fungal respiratory infections pose a challenge for the equine practitioner, and the prognosis for complete resolution of infection is often guarded; however, new antifungal medications are likely to improve treatment success. This article summarizes the available literature regarding the cause, diagnosis, and treatment of equine fungal respiratory disease.

Conidiobolomycosis: A case report of rare fungal infection from the eastern India.

Conidiobolomycosis is a rare chronic subcutaneous mycosis of nose and paranasal sinuse predominately affects the middle age men in tropical countries. It is caused by a saprophytic fungus "Conodiobolus coronatus", which can survives in soils and dried vegetables for long period of time. C. coronatus belongs to the class Zygomycetes, order Entomophthorales. It is a fungus composed of thick- walled, short hyphae that grows at temperatures of 30 to 37 degrees C. Here we report a case of conidiobolomycosis in a 55- year- old farmer presented with a subcutaneous swelling over the left side of nose extending to left cheek.

[Rhinofacial conidiobolomycosis associated with cervical, thoracic and brachial localizations: one clinical case in Nigeria]. / Conidiobolomycose rhinofaciale avec localisations cervicales, thoraciques et brachiales: à propos d'un cas nigérian.

We report here the clinical case of a Nigerian adult patient who received medical care during October 2010, at the Center for Diagnosis and Treatment of Buruli ulcer in Pobè (Benin). He presented a massive facial tumor associated with several subcutaneous (cervical, thoracic and upper limbs) nodules, evolving since several years. Tissue samples collected at Pobè medical center were addressed to the mycology and histology laboratories of Angers University Hospital (France), according to the medical exchange agreement between the two institutions about the diagnosis and treatment of Buruli ulcer disease. Histological examination showed a Splendore-Hoeppli phenomenon, consisting of a granulomatous reaction made of eosinophilic polynuclear cells surrounding rare, large and irregular, non-septate hyphae. A filamentous fungus was isolated by cultivation of the clinical samples, which was identified as Conidiobolus coronatus. The patient was treated orally with daily doses of ketoconazole (400 mg per day). After 4 months of treatment, a marked regression of the facial lesion was obtained. A first constructive facial surgery was achieved, but the patient did not attend the second step. This case report allows us to remind the mycological diagnosis of this exotic mycosis, but also to emphasize the main difficulties encountered in medical management in the developing countries.

In vitro susceptibility of Conidiobolus lamprauges recovered from sheep to antifungal agents.

Data regarding the susceptibility of Conidiobolus lamprauges is limited and there is no consensus about the optimal treatment for infections caused by Conidiobolus spp. In this context, the objective of this study was to evaluate the in vitro susceptibility of six C. lamprauges strains isolated from sheep conidiobolomycosis to amphotericin B, ketoconazole, fluconazole, itraconazole, posaconazole, voriconazole, anidulafungin, caspofungin, micafungin, flucytosine, and terbinafine using the CLSI M38-A2 microdilution technique. Terbinafine was the most active (MIC range <0.06-0.5 µg/mL). Resistance or reduced susceptibility was observed for amphotericin B and azole and echinocandin antifungals. Additional studies are necessary to determine the therapeutic potential of terbinafine as monotherapy or in combination therapy with other antifungals.

Descripción clíiica e histopatológica de la rintis micótica granulomatosa en oovinos de córdoba, Colombia / Clinicand histoppathological description of granulomatus fungal rhiniitis in sheep of cordoba, Colombia

El objetivo de este estudio fue describir clínica e histopatológicamente la rinitis micótica granulomatosa causada por Conidiobolus spp. en ovinos del departamento de Córdoba, Colombia. Fueron analizados siete ovinos criollos, hembras, con edades comprendidas entre 2 y 4 años, los cuales recibieron diagnóstico clínico e histopatológico de conidiobolomicosis. Se observaron manifestaciones clínicas similares en todos los ovinos: dificultad respiratoria debido a la obstrucción parcial de los orificios nasales, intolerancia al ejercicio, respiración ruidosa, secreción puro-sanguinolenta bilateral y aumento de volumen de la cavidad nasal. A la necropsia, las cabezas fueron seccionadas longitudinalmente sobre la línea media y se observaron masas de coloración amarillenta irregular con áreas focalizadas de color café oscuro, friable y con coágulos de sangre en la región rinofacial y conchas nasales. En la coloración de H-E, la mucosa de la cavidad nasal presentó necrosis piogranulomatosa multifocal, conteniendo estructuras semejantes a hifas escasamente coloreadas y circundadas por infiltrado de neutrófilos, macrófagos y células gigantes, además de tejido conjuntivo fibroso organizados de forma paralela al rededor del área de necrosis y rodeados por material de Splendore-Hoeppli. En la coloración de Grocott, se observaron hifas irregulares, filamentosas y raramente septadas, cuya morfología es característica de conidiobolomicosis. El diagnóstico se fundamentó en las características clínicas y en los hallazgos histopatológicos, siendo el primer reporte de esta enfermedad en ovinos del departamento de Córdoba y en Colombia.

The objective of this study was to describe clinic and histopathological granulomatous fungal rhinitis caused by Conidiobolusspp. in sheep of the department of Cordoba, Colombia. Seven native sheep were analyzed, females, aged between 2 and 4 years, who were diagnosed clinically with conidiobolomycosis and correlated with histopathological aspects. In describing cases similar clinical manifestations were observed in all animals, difficulty breathing due to partial obstruction of the nostrils, exercise intolerance, noisy breathing, bloody purulent bilateral, similarly showed increased volume of nasal cavity. At necropsy, the heads were sectioned longitudinally on the midline and observed masses of irregular yellowing targeted areas dark brown, friable and blood clots in the nasal region and shells rhinofacial. In the HE stain, the mucosa of the nasal cavity showed multifocal necrosis pyogranulomatous containing hyphae like structures slightly colored and surrounded by infiltration of neutrophils, macrophages and giant cells, and fibrous connective tissue arranged in parallel around the area of necrosis and surrounded by Splendore-Hoeppli material. In the Grocott stain, irregular, filamentous and rarely septate hyphae were observed, suggesting the morphology of the hyphae in the tissue, which is characteristic of conidiobolomycosis. The diagnosis was based on the clinic and histopathological findings, the first report of the disease in sheep of department of Córdoba and Colombia.

Rhinocerebral and rhinopharyngeal conidiobolomycosis in sheep / Conidiobolomicose rinocerebral e rinofaríngea em ovinos

The present study aimed to report the occurrence as well as the clinical, laboratorial, pathological and mycological findings of three outbreaks of rhinocerebral and rhinopharyngeal conidiobolomycosis in sheep from Rio Grande do Norte state, Brazil. A total of six sheep with clinical signs of conidiobolomycosis were evaluated, and information on history was obtained from ranchers. Clinical signs included depression, progressive emaciation, sero-sanguinolent nasal discharge, tachycardia, dyspnea, miosis and unilateral exophthalmia with increased ocular globe volume, corneal ulceration and nervous system signs. The main hematological alteration was neutrophilia. Serum biochemical evaluation revealed increased values for AST, GGT, creatinine, urea, and glucose, and decreased total proteins and albumin levels. Cerebrospinal fluid analysis showed the presence of fibrin reticules and pleocytosis. Upon necropsy, longitudinal sections of the head revealed the presence of a nodular mass with a friable consistency and a white-yellowish coloration. Microscopic findings included meningitis, cortex necrosis and encephalitis with the presence of eosinophilic Splendore-Hoeppli substance. Histopathology of the lungs revealed a Splendore-Hoeppli-like material and hyperplasia of alveolar and bronchiolar epithelium. Renal lesions were suggestive of amyloidosis.

O presente estudo objetivou relatar a ocorrência e os achados clínicos, laboratoriais, patológicos e micológicos de três surtos de conidiobolomicose rinocerebral e rinofaríngea em ovinos do estado do Rio Grande do Norte, Brasil. Um total de seis ovinos com sinais clínicos de conidiobolomicose foi avaliado, e informações sobre o histórico foram obtidas dos proprietários. Os sinais clínicos incluíram depressão, emaciação progressiva, descarga nasal serossanguinolenta, taquicardia, dispneia, miosite e exoftalmia unilateral com aumento do volume do globo ocular, ulceração da córnea e sinais nervosos. A principal alteração hematológica foi neutrofilia. A avaliação bioquímica sérica revelou aumento nos valores de AST, GGT, creatinina, ureia e glicose, e redução nos níveis de proteínas totais e albumina. A análise do fluido cerebrospinal revelou presença de retículos de fibrina e pleocitose. À necropsia, secções longitudinais da cabeça revelaram presença de uma massa nodular com consistência friável e coloração branco-amarelada. Os achados microscópicos incluíram meningite, necrose do córtex e encefalite com presença da substância eosinofílica de Splendore-Hoeppli. A histopatologia dos pulmões revelou uma substância similar à de Splendore-Hoeppli e hiperplasia do epitélio alveolar e bronquiolar. As lesões renais foram sugestivas de amiloidose.