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Mucormycological Pearls © by author Jagdish Chander GovernmentESCMID Online Medical Lecture College Library Hospital Sector 32, Chandigarh Introduction • Mucormycosis is a rapidly destructive necrotizing infection usually seen in diabetics and also in patients with other types of immunocompromised background • It occurs occurs due to disruption of normal protective barrier • Local risk factors for mucormycosis include trauma, burns, surgery, surgical splints, arterial lines, injection sites, biopsy sites, tattoos and insect or spider bites • Systemic risk factors for mucormycosis are hyperglycemia, ketoacidosis, malignancy,© byleucopenia authorand immunosuppressive therapy, however, infections in immunocompetent host is well described ESCMID Online Lecture Library • Mucormycetes are upcoming as emerging agents leading to fatal consequences, if not timely detected. Clinical Types of Mucormycosis • Rhino-orbito-cerebral (44-49%) • Cutaneous (10-16%) • Pulmonary (10-11%), • Disseminated (6-12%) • Gastrointestinal© by (2 -author11%) • Isolated Renal mucormycosis (Case ESCMIDReports About Online 40) Lecture Library Broad Categories of Mucormycetes Phylum: Glomeromycota (Former Zygomycota) Subphylum: Mucormycotina Mucormycetes Mucorales: Mucormycosis Acute angioinvasive infection in immunocompromised© by author individuals Entomophthorales: Entomophthoromycosis ESCMIDChronic subcutaneous Online Lecture infections Library in immunocompetent patients Agents of Mucormycosis Mucorales : Mucormycosis •Rhizopus arrhizus •Rhizopus microsporus var. rhizopodiformis •Lichtheimia (Mycocladus corymbiferus, Absidia corymbifera) •Rhizomucor pusillus •Mucor species •Mortierella species •Cunninghamella species •Apophysomyces elegans, A. variabilis, A. trapeziformis •Saksenaea vasiformis, ©S. erythrospora,by author S. oblongispora •Cokeromyces recurvatus and others species Entomophthorales:ESCMID Online Entomophthoromycosis Lecture Library •Conidiobolomycosis – Conidiobolus coronatus •Basidiobolomycosis – Basidiobolus ranarum Apophysomyces spp. © by author ESCMID Online Lecture Library Introduction • The mucoralean fungus Apophysomyces elegans is a thermotolerant species causing severe infections in humans, being the most common site of disease manifestation the cutaneous and subcutaneous tissues, with local invasion into muscle and fat tissue resulting in necrotizing fasciitis. • In contrast to the other fungi causing mucormycosis, which have a world-wide distribution and occur only rarely in immunocompetent hosts, A. elegans has been mainly reported in warm climate areas as© anbyemerging authorpathogen causing mostly cutaneous infections after injury to the cutaneous barrier. • This fungus was discovered in 1979 from Indian soils and until recentlyESCMIDit was considered Onlinethe Lectureonly species Libraryof the genus . Now, there are four species i.e. A .elegans, A. trapeziformis, A. ossiformis and A. variabilis. Patients & Methods • A total of 18 cases of primary cutaneous infection caused by the novel species Apophysomyces variabilis are being described. • The identification of the isolates was confirmed by ITS sequencing analysis. The clinical disease was characterized by an aggressive infection following traumatic implantation of the fungus, which caused a prompt tissue invasion eventually death of the patients. • The 18 isolates tentatively identified as A. elegans were sent to the mycology reference laboratory in Spain for molecular confirmation. • The ITS region of such isolates was sequenced and compared with those of the type strains©of thebyspecies authorof Apophysomyces . • These isolates were confirmed as Apophysomyces variabilis on the basisESCMIDof morphological Onlinefeatures Lectureof spored and molecularLibrarytyping . Patients and Methods Patients: All patients diagnosed with cutaneous mucormycosis due to Apophysomyces species at Government Medical College Hospital (GMCH), Chandigarh, India, during one year period (2005 to 2014) Clinical diagnosis was confirmed by KOH, Calcofluor wet mounts and histopathological examination of tissue specimens of infected site Fungal culture was done on Sabouraud Dextrose Agar (SDA) incubated at 22◦C and 37◦C over a period of 4 weeks Identification of fungi: Gross morphological examination along with microscopic examination using Lactophenol Cotton Blue (LCB) mount, particularly the spore morphology of the Mucormycete isolates Molecular analysis: All the isolates sent to the Universitat Rovira i Virgili (Reus, Spain) for molecular analysis by sequencing internal transcribed spacer region and comparing with those of type strains of Apophysomyces species © by author Antifungal susceptibility testing was done against these fungal isolates by using standard protocol Clinical history: Detailed clinical history of these patients pertaining to ESCMIDrisk factors, immunocompromised Online status,Lectureetc., was taken Library Outcome: Local debridement with liposomal amphotericin B (topical as well as I/V) was given and regular follow up of all patients was done Table 1. Clinical profile of patients infected by Apophysomyces spp. presented at GMCH, Chandigarh No. Dates Name / Age / Sex / Residence Anatomical sites involved Clinical presentations Underlying illnesses Risk factors Isolates Outcome 1. 03.05.05 Roshni Devi, 32 F Anterior abdominal wall (left Fever, black discoloration 15×15cms on ant. abdominal wall with None Massage on abdomen for abdominal A. variabilis Expired after 7 days side) surrounding edema and induration pain 10 days prior 2. 22.08.05 Jay Kumar, 43 M Anterior abdominal wall (right 15×15cms debrided wound on right ant. abdominal wall, necrotic fat None H/o of injection on right ant. A. variabilis Recovered in 6 weeks side) at margin present, laterally skin discolored abdominal wall which developed period into small blister 3. 02.06.07 Balbir Singh, 29 M, Kapurthla (Punjab) Right arm, axilla and right Necrosed area on right arm at the site of Plaster of Paris cast None Plaster of Paris cast applied at the A. variabilis Recovered after 2 weeks part of chest wall extending to axilla and right part of chest wall site for fracture of right humerus 4. 13.08.07 Paramjeet Kaur, 35 F, Sangrur (Punjab) Left thigh & anterior Massive wound on left thigh & anterior abdominal wall with black Diabetes mellitus I.M. injection over left gluteal A. variabilis Expired after 1 week abdominal wall necrotic areas region 7 days prior 5. 22.04.09 Kanta Devi, 43 F, Dera Bassi (Punjab) Right sided chest wall Massive wound on right sided chest wall including the breast with Diabetes mellitus I/M injection over left gluteal region A. variabilis Expired after 6 days including breast black necrotic areas 7 days prior 6. 22.09.10 Bimla Devi, 50 F, Karnal (Haryana) Left gluteal area Fever, painful ulcerated lesion (16x20cm) on left gluteal region None I/M injection on left gluteal region A. variabilis Died two weeks later 15 days earlier 7. 11.10.10 Bimal Singh, 45 M, Mujaffarnagar Right gluteal and postero- Fever, necrosed area (30x24cm) on right gluteal region spreading None I/M injections on right gluteal A. variabilis Discharged after 15 days (Uttar Pradesh) lateral aspect of thigh posterolateral aspect of thigh region following appendectomy one month earlier 8. 15.10.10 Amarjeet Singh, 42 M, Mohali Right scapular region Painful ulcerated lesion (20x15cm) over right scapular area None No obvious risk factor could be A. variabilis Discharged after 15 days (Punjab) elucidated 9. 23.10.10 Kashmir Singh, 32 M, Chandigarh Swelling of right side of cheek He developed black necrotic patch on right side of hard palate. None No obvious risk factor could be A. variabilis Discharged after 15 days following tooth extraction, 2 elucidated weeks ago. 10. 06.11.10 Baljinder Kaur, 39 F, Ropar (Punjab) Right gluteal area Fever, painful ulcerated lesion (40x40cm) on right gluteal region Diabetes mellitus I/M injection on right gluteal region A. variabilis Left against medical one month earlier advice, presumed to have died 11. 29.04.11 Mayawati, 40 F, Bhiwani (Haryana) Left gluteal area Large ulcerative lesion (22x17mm) on left gluteal region None I/M injection on left gluteal region A. variabilis Left against medical one and a half month earlier. advice, presumed to have died 12. 25.06.11 Malkit Kaur, 52 F, Mohali (Punjab) Left gluteal region Painful, Large necrotic lesion (16x20cm) on left gluteal region Diabetes mellitus I/M injection on left gluteal region A. elegans Died after 10 days © by author one month earlier 13. 27.08.11 Amrt Lal, 50 M, Mauli Jagran, Left arm region Large necrotic area on left arm None Fall in bathroom 15 days earlier A. variabilis Discharged after 40 days Chandigarh 14. 07.08.13 Roopmati, 40 F, Pehoa (Haryana) Right gluteal area Necrotizing ulcerative area over right gluteal area None I/M injection on right gluteal region A. variabilis Expired after 1 week of 2 weeks earlier admission 15. 03.09.13 Jasveer Kaur , 22 F, Mohali (Punjab) Right gluteal area Large ulcerative lesion (25x20 mm) on right gluteal region None I/M injection on right gluteal region A. variabilis Expired after 1 month of 3 weeks earlier admission 16. 01.11.13 Kuldeep Singh, 40 M, (Punjab) Right Arm Necrotizing ulcerative area on right arm Diabetes mellitus Ulcerative lesion after motorcycle A. variabilis Discharged after 1 ESCMID Online Lecture Libraryaccident month of admission 17. 02.12.13 Mangat Rai, 59 M, Ambala (Haryana) Back and medial aspect of Necrotizing ulcerative lesion over backside and medial aspect
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  • Saksenaea Loutrophoriformis Fungal Planet Description Sheets 377

    Saksenaea Loutrophoriformis Fungal Planet Description Sheets 377

    376 Persoonia – Volume 38, 2017 Saksenaea loutrophoriformis Fungal Planet description sheets 377 Fungal Planet 622 – 20 June 2017 Saksenaea loutrophoriformis D.A. Sutton, Stchigel, Chander, Guarro & Cano, sp. nov. Etymology. From the ancient Greek λουτροφόρος-, and from the Latin Based on a megablast search of NCBIs GenBank nucleotide -forma, because of the vessel-shape of the sporangiophore. database, the closest hit with the ex-type strain using the Classification — Saksenaeaceae, Mucorales, Mucoromy- ITS sequence is Saksenaea vasiformis PWQ2338 (GenBank cotina. KP132601; Identities = 694/739 (94 %), Gaps 27/739 (3 %)); using the LSU sequence it is Saksenaea erythrospora strain Hyphae sparsely septate, branched, hyaline, smooth-walled, UTHSC 06-576 (GenBank HM776683; Identities = 714/735 3–15 μm wide. Sporangiophores erect, generally arising singly, (97 %), Gaps 3/735 (0 %)); and using the EF1-α sequence it is at first hyaline, soon becoming brown, unbranched, 50–75 μm Saksenaea vasiformis strain FMR 10131 (HM776689; Identities long, 5–10 μm wide, slightly verrucose. Sporangia terminal, = 465/477 (97 %), no gaps). Our phylogenetic tree, built from multi-spored, flask-shaped, asperulate, 70–125 μm long, with the ITS, LSU, and EF1-α nucleotide sequences, corroborated a long (60–100 μm) neck; apex of the neck closed with a mu- that our isolates represent a new species, the closest species cilaginous plug. Sporangiospores mostly bacilliform, bilaterally being S. vasiformis, with 93.6 % similarity with respect to the compressed and rounded at both ends, more or less trapezoidal ex-type strain (NRRL 2443). The sporangiospores of S. loutro- in lateral view, smooth-walled, 3.5–6(–7) × 2–3.5 μm, pale olive phoriformis are similar in size to the S.