Zygomycosis: A report of eleven cases and a review of the Brazilian literature

Eleven cases of zygomycosis (mucormycosis) observed throughout an eighteen year period (1982-2000) have been reviewed. The most important demographic and clinical data of seven patients were tabulated. The remaining four are related as illustrative cases. Seven patients presented with the pulmonary form of the disease; two patients presented with the pulmonary manifestation associated with sinusitis; and two patients presented with the rhinocerebral form. Predisposing conditions, in decreasing order of frequency, were diabetes mellitus (6), renal transplantation (2), associated with pancreas-kidney transplantation and diabetes (1), bone marrow aplasia (1), and chronic obstructive lung disease treated with corticosteroids (1). The diagnoses were based on the detection of characteristic zygomycetous hyphae in tissue. The causative organim was isolated and identified in only four cases; three were due to Rhizopus arrhizus, and one to Absidia corymbifera. In addition the Brazilian literature on zygomycosis is reviewed.     

Gari as culture medium for moulds

No significant differences (P<0.05 occurred in the frequency of isolation from soil of four common moulds – Rhizopus stolonifer, Monilia sitophila, Aspergillus niger and Penicillium sp., on malt extract agar (MEA) and gelled gari (carbohydrate gel). Growth of the moulds on slide microcultures of potato dextrose agar (PDA) and gari showed typical diagnostic features of the organisms, which were often clearer on gari. It is concluded that gari, which is much cheaper and far more readily available in Nigeria than MEA or PDA, is an effective alternative to the two standard mycological media.     

Experimental cerebral zygomycosis in alloxan-diabetic rabbits: variation in virulence among zygomycetes

We investigated the potential of 33 different zygomycete isolates to cause cerebral disease following the intranasal instillation of their spores into ketotic rabbits with alloxan induced diabetes. The isolates represented six thermotolerant species of Rhizopus (R. arrhizus, R. chinensis, R. microsporus, R. oligosporus, R. oryzae, and R. rhizopodiformis), Absidia corymbifera, Cunninghamella bertholletiae, and Rhizomucor pusillus. All 13 isolates of the thermotolerant Rhizopus species proved to be cerebral pathogens as confirmed by culture and histopathology. One isolate of R. oligosporus and one isolate of R. rhizopodiformis, however, were less pathogenic than isolates of other Rhizopus species tested. Cerebral pathogenicity was noted with 2 of 5 isolates of Rh. pusillus and only 1 of 13 A. corymbifera isolates. Two thermotolerant C. bertholletiae cultures, recovered from human lesions, did not cause either cerebral or pulmonary disease in ketotic rabbits. The incidence of pulmonary zygomycosis caused by the isolates of the species of the four genera under study was as follows: Rhizomucor 24%, Rhizopus 22%, Absidia 9%, and Cunninghamella 0%. This study confirms the pathogenic potential of the thermotolerant species of Rhizopus to cause cerebral zygomycosis in ketotic diabetic rabbits and also revealed the potential of Rh. pusillus and A. corymbifera occasionally to cause the same disease in animals and humans.     

急性早幼粒细胞白血病患者小孢根霉变种感染1例

报道1例由小孢根霉变种导致的皮肤毛霉病.患者女,30岁.因患急性早幼粒细胞白血病,化疗后继发口腔颌面部小孢根霉变种感染,表现为发热、右侧颊黏膜水肿,皮损中央溃疡、焦痂,周边组织炎性水肿,以面颊部、颌下区为中心明显肿胀,逐渐累及右侧颈部及右下颌,进行性加重.坏死组织涂片镜检显示有粗大、无分隔直角菌丝,真菌学检查鉴定为小孢根霉,分子测序证实为小孢根霉变种.给予两性霉素B、伊曲康唑静脉滴注和手术清创,坏死组织连续3次真菌培养均未培养出小孢根霉变种,患者体温逐渐恢复正常,治疗2周后颔面部肿胀明显减退,浅表淋巴结未触及肿大,4周后额部及右眼睑肿胀已完全消退,伤口结痂愈合.随访2 a,右侧颌下可见长约2 cm手术疤痕,未见皮肤毛霉病复发.     

Genetic variability in the species Rhizopus stolonifer, assessed by random amplified polymorphic DNA analysis

Rhizopus stolonifer is an important post-harvest pathogenic fungus. Recent taxonomic findings based on morphological and growth characteristics led to a dramatic reduction in the number of accepted species within the genus. The aim of this study was to examine this situation with molecular markers. Twenty-nine R. stolonifer strains isolated from various locations and substrates were characterized by random amplified polymorphic DNA (RAPD) analysis. The numerical analysis of the RAPD data revealed four main clusters with extremely high dissimilarity values, but only low or moderate variability was observed within these groups. These results suggest a high genetic heterogeneity in the case of R. stolonifer: isolates of R. stolonifer var. stolonifer, R. stolonifer var. reflexus and R. niveus displayed species-level genetic distances, which gives rise to considerations that they might be separate species.     

In vitro activity of glucosinolate-derived isothiocyanates against postharvest fruit pathogens*

The authors assayed the ability of some reaction products, essentially isothiocyanates, derived from the myrosinase-catalysed hydrolysis (neutral pH) of six natural glucosinolates to inhibit germination and mycelial growth of Botrytis cinerea, Rhizopus stolonifer, Monilinia laxa, Mucor piriformis and Penicillium expansum, the leading postharvest fungal pathogens of fruit and vegetable crops. All of the tested products showed antifungal activity, although they proved less effective against mycelial growth than in germination control. The isothiocyanates produced by enzymatic hydrolysis of glucoraphenin, sinalbin and sinigrin were particularly effective because they completely inhibited conidic germination of all five pathogens considered. The sinigrin-derived isothiocyanate exhibited a wide pathogen-control spectrum, either inhibiting conidia germination altogether or delaying by 3–6 days the onset of mycelial growth compared to the control.     

Antigenic characterization of some potentially pathogenic mucoraceous fungi

The antigenic profiles of 10 mucoraceous fungi--Absidia corymbifera, Mortierella wolfii, Mucor miehei, M. pusillus, M. racemosus, Rhizopus arrhizus, R. microsporus, R. oryzae, R. rhizopodiformis, R. stolonifer,--Candida albicans and Aspergillus fumigatus were compared by crossed immunoelectrophoresis (XIE). Antigen-rich material was obtained from homogenized hyphae (or yeasts in the case of C. albicans), and antisera by multiple subcutaneous innoculation of rabbits with macerated but viable hyphal fragments of Ab. corymbifera, M. pusillus, R. oryzae or Asp. fumigatus. Unique and common antigens were demonstrable amongst the mucoraceous species although Mort. wolfii revealed little antigenic similarity with the others. Considerable sharing of antigens between Ab. corymbifera and M. pusillus was evident. Little or no cross reactivity was seen between extracts of C. albicans and Asp. fumigatus and the mucoraeceous antisera. R. oryzae and R. arrhizus, now regarded as synonymous, revealed close antigenic similarity. On the other hand, the distinction between both M. pusillus and M. miehei--which are regarded by some as belonging to a separate genus Rhizomucor--and less thermotolerant M. racemosus was reflected in their antigenic dissimilarity. Partial separation and characterization of antigens from the crude Absidia extract was achieved by concanavalin A-Sepharose chromatography. Antigens with and without affinity for concanavalin A could be demonstrated. Cross reactivity between Absidia antigens and M. pusillus antiserum appeared to be contained predominantly in material (possibly carbohydrate) which bound to concanavalin A and could be eluted with alpha-methyl-D-mannoside.     

The control of postharvest decay in table grapes using acetaldehyde vapours

Grapes ( Vitis vinifera L. cv. 'Sultanina') harvested at the end of the 1985–1988 seasons, received postharvest application of acetaldehyde (AA) vapours for 24–40 h. Treatment with AA vapour at 20 °C or 0 °C reduced significantly the decay caused by several fungi: Botrytis cinerea, Rhizopus stolonifer, Aspergillus niger and Alternaria alternata . In grapes treated with 0.5% AA for 24 h, no R. stolonifer was found after 8 days of storage at 20 °C. Treatment with 0.25% AA vapour for 40 h of grapes cv. 'Perlette' inoculated with R. stolonifer reduced the decay by 89%.     

Invasive maxilar sinusitis by Rhizopus oryzae

We herein present a diabetic with non Hodgkin lymphoma patient that had been treated with steroids and developed fungal invasive sinusitis. The patient had intensive facial pain that did not respond to antibiotics and on clinical inspection had a necrotic lesion on right nasal area. A smear and biopsy tissue showed broad non septate hyphae and on cultures Rhizopus oryzae was isolated. There was an unfavorable outcome, and the patient died even though liposomal Amphotericin B was administered and surgical treatment was performed.     

Early antibiotic treatment of reactive arthritis associated with enteric infections: clinical and serological study.

OBJECTIVE--To find out whether a 10-14 days'' course of antibiotics early in the course of reactive arthritis associated with enteric infections could reduce the severity and duration of the disease and whether the antibody response in patients with reactive arthritis associated with yersinia infection differed between those treated and those not treated with the antibiotics. DESIGN--Prospective multicentre trial in which patients were randomised to treatment or no treatment with antibiotics. Patients were seen at three and six weeks and three, six, nine, 12, and 18 months after their first visit. SETTING--Departments of infectious diseases in three hospitals in Linköping, Malmö, and Stockholm, Sweden. PATIENTS--40 Consecutive patients who had had symptoms of reactive arthritis associated with enteric infection for less than four weeks. INTERVENTIONS--20 Patients were allocated to treatment with antibiotics and 20 patients did not receive antibiotics. All patients received non-steroidal anti-inflammatory drugs, and four also received intra-articular steroid injections after at least six weeks'' observation. MAIN OUTCOME MEASURES--Arthritic symptoms assessed clinically and by using Ritchies'' index; blood measurements reflecting inflammatory activity; serum IgG, IgM, and IgA antibody titres; HLA tissue type. RESULTS--No difference was observed concerning duration of arthritis, grade of inflammation, and number of joints affected between patients treated and those not treated with antibiotics. Furthermore, there was no significant difference between the two groups in erythrocyte sedimentation rate and haptoglobin, IgG, and IgA concentrations. All values had returned to normal within three months. No patient developed chronic arthritis, but sustained slight arthralgia occurred in three patients. The HLA-B27 antigen was found in 23 (58%) of the patients, and its presence did not affect clinical outcome. The IgG, IgM, and IgA antibody responses were similar in patients treated with antibiotics and those not treated. CONCLUSION--Short term antibiotic treatment has no beneficial effect on the clinical outcome of reactive arthritis associated with enteric infection.     

不同N端序列长度匍枝根霉△6-脂肪酸脱氢酶重组子的表达

克隆并在酵母中表达两个不同N段序列长度的匍枝根霉△6-脂肪酸脱氢酶重组子,其中长序列的重组子LYRnD6D是从匍枝根霉中克隆的△6-脂肪酸脱氢酶基因,编码459个氨基酸,N端序列为MSTLDRQSIFTIKELESISQRIHDG-DEEAMKFIII;短序列重组子SYRnD6D是预测的匍枝根霉△6-脂肪酸脱氢酶基因的ORF序列,N端序列为MKFIIIDKKVY,编码430个氨基酸;两个重组子均具有△6-脂肪酸脱氢酶保守的组氨酸序列和HPGG序列,长序列的N端比短序列长29个氨基酸残基(MSTLDRQSIFTIKELESISQRIHDGDE-EA)。两个重组子在缺陷型酵母中均得到了的表达,产生了γ-亚麻酸。利用酶的相对活力比较两个重组子在同一温度下的稳定性,长序列重组子的酶在15℃下反应4h后相对活力仍有74%,而短序列酶的相对活力只有43%,所以长序列重组子酶在低温下比短序列酶稳定性高,是因为长序列多出的氨基酸序列增加了酶的稳定性。     

Application of Hormetic UV-C for Delayed Ripening and Reduction of Rhizopus Soft Rot in Tomatoes: the Effect of Tomatine on Storage Rot Development

The application of ultraviolet-light C (UV-C, 254 nm) hormesis on tomato fruits to stimulate beneficial responses is a new method of inducing host resistance to Rhizopus soft rot, with maximum protection at 72 h following artificial inoculation with Rhizopus stolonifer and delay fruit ripening. In the tomato-Rhizopus soft rot pathosystem, UV-C induced resistance of tomatoes to soft rot was reversed by fluorescent light, and not by storage under dark condition. The present study was aimed at finding a possible fungal toxic mechanism that was involved in the control of Rhizopus soft rot. The development of carotenoids, loss of chlorophyll and ethylene production were significantly retarded during storage after treatment with hormetic doses of UV-C. The delayed ripening of UV-C treated fruits was attributed in part to the high level of putrescine and spermine polyamines. In a time-control study, it was found that the resistance of UV-C-treated tomatoes artificially inoculated with R. stolonifer correlated with a high concentration of tomatine which accumulated up to 72 h after UV-C treatment. However, there was a higher tomatine content in UV-C-treated fruits compared to untreated fruits where it was transitory at 96 h after treatment in the time-course study.     

Hospital-acquired gangrenous mucormycosis

A post-operative diabetic patient who had been treated for Serratia marcescens bacterial sepsis developed recurrent thrombosis of the left femoral artery following intra-arterial instrumentation. Pathological examination of arterial thrombus ultimately demonstrated invasive mucormycosis of the femoral artery and cultures of this material grew Rhizopus oryzae. The occurrence of cutaneous and subcutaneous mucormycosis is reviewed, as well as recently recognized nosocomial risk factors for mucormycosis, such as elasticized bandages and wound dressings.     

Microbial transformations of alpha-santonin

Fungal biotransformations of alpha-santonin (1) were conducted with Mucor plumbeus (ATCC 4740), Cunninghamella bainieri (ATCC 9244), Cunninghamella echinulata (ATCC 9245), Curvularia lunata (ATCC 12017) and Rhizopus stolonifer (ATCC 10404). Rhizopus stolonifer (ATCC 10404) metabolized compound 1 to afford 3,4-epoxy-alpha-santonin (2) and 4,5-dihydro-alpha-santonin (3) while Cunninghamella bainieri (ATCC 9244), Cunninghamella echinulata (ATCC 9245) and Mucor plumbeus (ATCC 4740) were capable of metabolizing compound 1 to give a reported metabolite, 1,2-dihydro-alpha-santonin (4). The structures of these transformed metabolites were established with the aid of extensive spectroscopic studies. These fungi regiospecifically reduced the carbon-carbon double bond in ring A of alpha-santonin.     

Zygomycota associated with traditional meju, a fermented soybean starting material for soy sauce and soybean paste

Various zygomycota species were detected during a study of the mycobiota of meju, a brick of dried fermented soybeans, used in Korean cuisine. Two hundred and sixty-eight strains were isolated from 98 finished meju products collected in various regions of Korea from 2009 to 2011, and 96 strains were isolated from in-process meju on various farms from 2010 to 2011. The isolated zygomycota were identified using phenotypic characteristics combined with DNA sequences of the internal transcribed spacer regions of ribosomal DNA and the D1/D2 nuclear ribosomal large subunit. Of 364 zygomycota strains, 108 were identified as Mucor circinelloides, 96 as M. racemosus, 60 as Lichtheimia ramosa, 22 as Rhizopus stolonifer, 16 as Lichtheimia corymbifera, and the other 62 strains comprised 10 other species. The psychrotrophic species, Mucor circinelloides and M. racemosus were predominantly present during low temperature fermentation (LTF) and the thermotolerant species Lichtheimia ramosa and Rhizomucor species were predominant during high temperature fermentation (HTF). The results suggest that temperature has a large influence on the zygomycota composition during the fermentation process of meju.     

Unknown fixed cutaneous sporotrichosis

Sporotrichosis is the most frequent subcutaneous mycosis in Mexico. The clinical forms are commonly described as lympho-cutaneous and cutaneous-fixed. The case of a male patient who developed an eritematous plaque with radial growth is reported. The patient received empirical therapy and topic steroids which modified the clinical picture with vesicles to vesicles, ulcers and blood and honey crusts. Diagnosis of fixed cutaneous sporotrichosis incognito was established by clinical, mycological and histopathological studies. Delayed cellular immunity in vitro and in vivo were normal. The patient received oral itraconazole showing clinical and mycological cure after four months.     

Porous polyethylene implants in orbital floor reconstruction

The purpose of this article is to present the authors' experience with the use of porous polyethylene ultrathin sheets for orbital floor reconstruction. Thirty-two patients with orbital floor fractures were treated with porous polyethylene ultrathin sheets. Sixteen cases corresponded to orbitozygomatic fractures, 11 cases corresponded to pure orbital floor fractures, and five corresponded to panfacial fractures. The subciliary approach was used in 15 patients and the transconjunctival approach in nine; another three patients were operated on through a preexisting eyebrow wound, two were operated on with a subtarsal approach, two were operated on through an eyebrow extension of a facial wound, and one patient was operated on through the facial wound. Intraoperatively, all patients received a prophylactic dose of intravenous antibiotics. Postoperatively, 24 patients received amoxicillin clavulanate for 5 to 7 days, two patients received clindamycin, and six patients received no antibiotics. Enophthalmos was corrected in 15 of 24 patients (62.5 percent), and hypoglobus in nine of 11 (82 percent). Diplopia was resolved in 25 of 28 patients (89.3 percent) with preoperative impairment. Extrinsic eye movement impairment was resolved in 25 of 27 patients (92.6 percent). A preoperative visual acuity deficit was present in four patients (12.5 percent) and was resolved in one (from 20/100 to 20/20). Visual acuity improved in one patient (from 20/60 to 20/30). In the other two patients, visual acuity remained altered (from 20/30 to 20/30). One patient (3.1 percent) suffered blindness induced by surgery. Nine of 26 patients (34.6 percent) had residual infraorbital nerve hypesthesia and five (19.2 percent) had residual paresthesias. Postoperatively, epiphora was present in six patients (18.8 percent) and ectropion in five (15.6 percent). Although there was no statistical significance between the surgical approach and the presence of epiphora (p = 0.211) and ectropion (p = 0.422), patients who were treated using the transconjunctival approach suffered reduced ectropion (0 percent) compared with patients treated using the subciliary approach (20 percent). However, patients treated using the transconjunctival approach suffered increased epiphora (22.2 percent) compared with those treated with the subciliary approach (13.3 percent). There were four cases (12.5 percent) of postoperative facial infections. Two of these cases were resolved with systemic antibiotics, one was resolved with bone sequestrum resection, and one patient needed removal of the implant. Orbital infections were related in all cases to titanium osteosynthesis miniplates or skull bone graft. When comparing patients who were treated with and without antibiotics, no statistical differences (p = 0.958) were found relative to the presence of infections. Correction of hypoglobus is technically easier than enophthalmos, because enophthalmic correction requires a wide, deep subperiosteal dissection and implant positioning, posterior to the equator of the globe, with the inherent risk of orbital apex injury.     

Factors affecting production of mold mycelium and protein in synthetic media.

The effects of certain cultural conditions on the yield of dry mycelium, protein, and total amino acid content of Rhizopus oligosporus Saito (NRRL 2710), Rhizopus rhizopodiformis (Cohn apud Lichtheim) Zopf (NRRL 6246), and Absidia corymbifera (Cohn) Sacc. et Trotter (NRRL 6247) were studied. The yield of mycelium was found to significantly increase as the spore inoculum was increased from 187,500 to 2,250,000 spores. But the total amino acids (grams/liter) did not change significantly, whereas the percentage of crude protein decreased. An inoculum containing approximately 750,000 spores/ml was used in all of the other experiments. Mycelial production was highest at 37 degrees C for all three molds. However, the best temperature for percentage of crude protein and total amino acids varied with the organism. The mycelial yield and total crude protein of R. oligosporus showed some significant changes as the C/N ratio was increased in 3% glucose medium. In a synthetic medium having a 15:1 C/N ratio, the strains of R. oligosporus, R. rhizopodiformis, and A. corymbifera had better yields from falactose than glucose, not only in dry mycelium but also in total crude protein (grams/liter) and total amino acids (grams/liter). R. oligosporus grew very well on several ammonium salts. but the maximum yield of dry mycelium, total crude protein (grams/liter), and total amino acids (grams/liter) occurred with ammonium sulfate. The optimum pH for both Rhizopus species was 4.0, although R. oligosporus grew equally well at pH 3.0 and slightly less at pH 5.0. The highest yield of mycelium for A. corymbifera was obtained in a medium with an initial pH of 8.0. It was calculated that a fermenter chanrged with an adequate medium and 1,000 lb (about 450 kg) of R. oligosporus or A. corymbifera cells could produce 88 or 90 lb of protein (on a dry-weight basis) per h if the product was removed continuously.     

Protein Synthesis During Fungal Spore Germination IV. Transfer Ribonucleic Acid from Germinated and Ungerminated Spores

Transfer ribonucleic acid (tRNA) fractions isolated from germinated and ungerminated spores of Botryodiplodia theobromae and Rhizopus stolonifer had acceptor activity for all 20 amino acids commonly found in protein, when tested with an enzyme fraction from germinated spores. Accordingly, it is unlikely that the absence of tRNA for a particular amino acid limits protein synthesis in fungal spores.     

Biochemical studies on the cell wall degradation of Fusarium oxysporum f.sp. lycopersici race 2 by lytic enzymes from Mucorales for its biocontrol

The lysis of cell wall, cell wall fractions (F1S—alkali and water soluble, F1I—alkali soluble and water insoluble, and F4—β-chitin-glucan) and chlamydospores of Fusarium oxysporum f.sp. lycopersici race 2 (Fol 2) with crude enzyme preparations from Mucorales (Absidia californica, Mortierella vinacea, Mucor hiemalis, Phycomyces blakesleeanus, Rhizopus stolonifer and Syncephalastrum racemosum ) has been studied during an incubation period of 72 h. The lysis of the F1S fraction and chlamydospores was followed by the release of reducing substances. The lysis of the other fractions and cell walls was followed by percentage of decrease in optical density (lysis degree) and release of reducing substances. A correlation between the degradation of cell walls and cell wall fractions was observed. The soluble fraction was the most resistant to lysis by these enzymes, with the highest release of reducing substances at 4% of the material as glucose equivalent using the crude enzyme preparation from Mucor hiemalis. Crude enzyme preparations from Rhizopus stolonifer produced the highest lysis (33.4%) and release of reducing substances (22.1%) from the Fol 2 cell wall. The enzymes from M. hiemalis produced the highest degradation of chlamydospores. A possible biological control of Fol 2 with lytic enzymes from R. stolonifer or M. hiemalis is indicated.
We wish to thank Dr J. Tello for the Fol 2 strain, Dr P. Melgarejo for her valuable discussion and Mrs Carmelina Rodríguez for her technical assistance. This work was supported by the Spanish programmes 'Plan Nacional de Investigación Científica y Desarrollo Tecnológico' (AGR91-0014-C02-02) and 'Plan Nacional de Investigación de la Comunidad de Madrid' (C052/91) and DGICYT PB92–0001. We also wish to thank Norel S.A. for their contract to one of us (O.M. Nuero).