Emerging mould infections: Get prepared to meet unexpected fungi in your patient Sarah Dellière, Olga Rivero-Menendez, Cécile Gautier, Dea Garcia-Hermoso, Ana Alastruey-Izquierdo, Alexandre Alanio To cite this version: Sarah Dellière, Olga Rivero-Menendez, Cécile Gautier, Dea Garcia-Hermoso, Ana Alastruey-Izquierdo, et al.. Emerging mould infections: Get prepared to meet unexpected fungi in your patient. Medical Mycology, Oxford University Press, 2020, 58 (2), pp.156-162. 10.1093/mmy/myz039. pasteur- 03223966 HAL Id: pasteur-03223966 https://hal-pasteur.archives-ouvertes.fr/pasteur-03223966 Submitted on 11 May 2021 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. 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Copyright Medical Mycology, 2020, 58, 156–162 doi: 10.1093/mmy/myz039 Advance Access Publication Date: 21 May 2019 Review Article Review Article Emerging mould infections: Get prepared to meet unexpected fungi in your patient Downloaded from https://academic.oup.com/mmy/article/58/2/156/5492538 by Institut Pasteur user on 07 May 2021 Sarah Delliere` 1, Olga Rivero-Menendez2,Cecile´ Gautier3, Dea Garcia-Hermoso3, Ana Alastruey-Izquierdo 2 and Alexandre Alanio 1,3,4,∗ 1Universite´ de Paris, Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisiere-` Fernand-Widal, Paris, France, 2Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain, 3Institut Pasteur, Molecular Mycology Unit, CNRS UMR2000, National Reference Center for Invasive Mycoses and Antifungals (NRCMA), Paris, France and 4Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA ∗To whom correspondence should be addressed. Alexandre Alanio, MD, PhD, Molecular Mycology unit, Institut Pasteur, 25 rue du Dr Roux 75724 Paris Cedex 15. Tel: +33140613255; Fax: +33145688420; E-mail: [email protected] Received 18 December 2018; Revised 1 March 2019; Accepted 5 April 2019; Editorial Decision 29 March 2019 Abstract Invasive fungal diseases are increasing issues in modern medicine, where the human immunodeficiency virus (HIV) pandemic and the wider use of immunosuppressive drugs generate an ever-growing number of immunocompromised patients with an increased susceptibility to uncommon fungal pathogens. In the past decade, new species have been reported as being responsible for disseminated and invasive fungal diseases in humans. Among them, the following genera are rare but seem emerging issues: Scopulariopsis, Hormographiella, Emergomyces, Westerdykella, Trametes, Actinomucor, Saksenaea, Apophysomyces, and Rhytidhysteron. Delay in diagnosis, which is often the case in these infections, jeopardizes patients’ prog- nosis and leads to increased mortality. Here we summarize the clinical and biological presentation and the key features to identify these emerging pathogens and we discuss the available antifungal classes to treat them. We focused on Pubmed to recover extensively reported human invasive cases and articles regarding the nine previously cited fungal organisms. Information concerning patient background, macroscopic and microscopic description and pictures of these fungal organisms, histological features in tissues, findings with commonly used antigen tests in practice, and hints on potential efficient antifungal classes were gath- ered. This review’s purpose is to help clinical microbiologists and physicians to suspect, identify, diagnose, and treat newly encountered fungi in hospital settings. Key words: invasive fungal disease, emerging fungi, Emergomyces, Scopulariopsis, Hormographiella, Actinomucor, Apophysomyces, Rhytidhysteron, Saksenaea, Trametes, Westerdykella. Introduction and Scedosporium spp. are the most isolated moulds.1 However, Invasive fungal infections (IFIs) are increasing due to the grow- the part attributed to other fungal organisms is increasing and ing use of immunosuppressive chemotherapy and the persis- emerging uncommon species responsible for IFIs are more fre- tence of the AIDS pandemic in specific areas. In addition, the quently described around the world. In this review, we describe improvement of diagnostic means may concur to that trend. unusual emerging moulds responsible for IFIs with a focus on Candida spp. and Cryptococcus spp. are the most frequent iso- the fungus—morphology, environmental niche, location, mode lated yeasts in human IFIs, while Aspergillus spp., Fusarium spp. of transmission—and on the infection (clinical presentation and treatments available). These genera and species where selected 156 C The Author(s) 2019. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: [email protected] Delliere` et al. 157 for their scarcity and their recent emergence during the past two ical features such as the prominent bell-shaped, vase-shaped decades. or funnel-shaped apophyses. While smooth walled sporangio- phores (including the apophyse) are a common feature of this genus, the verrucose texture of the wall in A. mexicanus consti- Actinomucor spp. tutes its distinctive characteristic.11 A molecular approach with The genus Actinomucor belongs to the order Mucorales and the amplification of the ITS1-5.8S-ITS2 region of rDNA is re- is commonly isolated from soil, from the rhizosphere of plants quired to assure definite species-level identification. The biggest and from mouse and rabbit dung.2 Actinomucor elegans is in- case series of Apophysomyces sp. reports 13 cases after cuta- volved in traditional fermentation of sufu, a cheese-like soy- neous injury during a tornado in Missouri in May 2011.15 Five bean very common in Asia.3 The only species of the genus patients (38%) died, however; a focus on patients treated appro- Actinomucor is Actinomucor elegans. divided in var. elegans, priately according to guidelines (i.e., amphotericin B in combi- Downloaded from https://academic.oup.com/mmy/article/58/2/156/5492538 by Institut Pasteur user on 07 May 2021 var. kuwaitiensis, and var. taiwanensis, considered synonyms nation with surgical debridement)16 shows a treatment efficiency (http://www.indexfungorum.org). A. elegans has white to cream of 85% with only two deaths.15 floccose cultures growing rapidly at 30◦C. Microscopically they are verticillately branched sporangiophores with terminate spo- Saksenaea erythrospora rangia in various lengths. The smooth or spiny sporangia wall Among the subphylum Mucoromycotina the genus Saksenaea 4 encloses spherical to ovoidal sporangiospores. Sequencing of comprises three species: S. vasiformis species complex, S. ery- the ITS1-5.8S-ITS2 region of rDNA is currently used to identify throspora and S. oblongispora.10 These cosmopolitan muco- accurately species of this genus. ralean organisms produce white-gray expanding colonies with a Only five cases of superficial and invasive mucormycosis in- maximum temperature of 44◦C. Sporulation may be promoted volving Actinomucor have been described in the literature since by subculturing the fungus on water agar 1% or Czapek medium 2001. Two cases were associated with maxillary sinusitis in at 30◦ to 37◦C.4 The multispored flask-shaped sporangium is 5 an immunocompetent 11-year-old female andinanallogeneic characteristic of the genus. Species recognition is based mainly 6 transplant patient with a lymphoblastic lymphoma; a third case on differences in length of sporangiophores and sporangia; shape 7 was a necrotic foot lesion in a diabetic patient. Disseminated and size of sporangiophores and maximum growth tempera- infection was diagnosed in two cases following a trauma during tures. Accurate species identification also relies on sequencing of 8 combat in Iran and in a diabetic patient with refractory apla- the ITS1-5.8S-ITS2 region and the D1-D2 domains of the large- 9 sic anemia. Out of five patients, two were cured with surgery subunit ribosomal DNA. Mucormycosis due to Saksenaea spp. 5,6 debridement and amphotericin B administration, two died have been mostly associated with cutaneous infections in healthy 8,9 despite debridement and broad spectrum antifungal, and one and immunocompetent subjects following traumatic implanta- 7 was lost to follow-up. tion with soil and water contamination, inhalation of spores, insect stings, or the use of indwelling catheters.17,18 Up to now, nine cases of the newly described species S. erythrospora have Apophysomyces mexicanus been reported. The majority of infections were observed in im- Among the subphylum Mucoromycotina,theApophysomyces munocompetent individuals (except for one diabetic patient)19 10 species complex encompasses five species: A. elegans, A. vari- and were associated with trauma (sailing accident, combat abilis, A. trapeziformis, A. ossiformis, and the most recently pro- trauma, intramuscular injection or application of medicated ad- 11 posed A. mexicanus. The members of this complex are mainly hesive tape),19–21 medical tourism activities (esthetical