Pulmonary Mucormycosis due to Lichtheimia ramosa in a Patient with HIV Infection

Mucormycosis is increasingly common in patients with risk factors such as diabetes mellitus, neutropenia, and corticosteroid therapy. However, mucormycosis seems to be less common in patients with human immunodeficiency virus (HIV) infection compared to patients with other risk factors. Despite their lower virulence, Lichtheimia species should be regarded as emerging pathogens among Mucoralean fungi. We report a fatal case of pulmonary mucormycosis due to Lichtheimia ramosa in a 52-year-old man with an end-stage HIV infection. He had a cachectic appearance and his CD4 count was 8 cells/mm³. The fungal infection was diagnosed based on a positive sputum culture with histopathologic confirmation. The fungus was resistant to caspofungin, anidulafungin, and voriconazole [minimum inhibitory concentration (MCI) >32 µg/ml], whereas the E test MIC values of itraconazole, posaconazole, and amphotericin B were 0.38, 0.38, and 0.5 µg/ml, respectively. Although intravenous drug use is the main risk factor for the development of mucormycosis in HIV-infected patients, it may also develop in patients with low CD4 count, opportunistic infections and/or additional diseases, such as Kaposi’s sarcoma or severe immunodeficiency, as in our case.     

Chlamydospores of Rhizopus microsporus var. rhizopodiformis in Tissue of Pulmonary Mucormycosis

Hyphae are usually the only fungal elements found in tissue of mucormycosis, and other fungal elements are quite rarely encountered. We found chlamydospores in bronchial lumina in autopsied tissue of pulmonary mucormycosis of a diabetic patient. Chlamydospores are thick-walled, asexually produced spores arising from the modification of a hyphal segment. This is the first histologic demonstration of chlamydospores in mucormycosis in which the causative fungus is culturally identified to species level. Rhizopus microsporus var. rhizopodiformis was isolated from the present autopsied pulmonary tissue. A literature review of human infection by this fungus found 27 cases with histopathologic evidence.     

Pulmonary Artery Pseudoaneurysm in COVID-19-Associated Pulmonary Mucormycosis: Case Series and Systematic Review of the Literature

Mycopathologia - Literature on COVID-19-associated pulmonary mucormycosis (CAPM) is sparse. Pulmonary artery pseudoaneurysm (PAP) is an uncommon complication of pulmonary mucormycosis (PM), and...     

暗纹东方鲀毛霉菌感染的组织病理学观察

对病症表现为溃疡性疾病的暗纹东方纯(Takifagu obscurus)进行了病原菌培养和组织病理观察.镜检溃疡和肌肉组织,可见丝状型粗大、无隔、分枝,革兰氏染色阳性的真菌菌丝.心、肝、脾和肠组织有少量炎细胞侵润,未见真菌菌丝和明显组织病理变化.经Sabouraud培养基培养观察,37℃,24 h菌丝顶端有淡黄色球形孢子囊;72 h出现气生菌丝,孢子囊成熟,释放卵圆形孢囊孢子;120 h后菌落充满平皿.肌体溃疡处皮下和肌肉组织切片镜检显示,大量菌丝体侵入皮下组织,炎细胞侵润,引起邻近肌肉组织变性坏死和间质水肿;粗大菌丝穿透粘膜入侵基底组织,同时导致小血管发生栓塞;菌丝着色显蓝色、分枝、呈直角.依据Ainsworth真菌分类系统鉴定为毛霉属(Mucor sp.)真菌.     

Fatal Pulmonary Mucormycosis due to <Emphasis Type="Italic">Rhizopus homothallicus</Emphasis>

We report here a case of cavitary pneumonia due to Rhizopus homothallicus in a diabetic patient. This is the first proven case of R. homothallicus infection in Western countries and the third case described worldwide. The organism was isolated from lung biopsy and identified after amplification and sequencing of the internal transcribed spacer region.     

Epidemiology of Mucormycosis in India

Current Fungal Infection Reports - Mucormycosis is an emerging healthcare problem in the Indian population. The epidemiology of the disease is distinct with very high incidence among uncontrolled...     

Cutaneous Mucormycosis in Tornado Survivors

A total of 18 suspected cases of cutaneous mucormycosis were identified in survivors of the May 2011 tornado in Joplin, Missouri. Apophysomyces trapeziformis was identified in 13 of the patients with microbiologically or histologically proven infection by DNA sequencing. Apophysomyces are classically associated with necrotizing skin and soft-tissue infections following traumatic inoculation of the fungal spores. Although cases of Apophysomyces infection were previously reported in survivors of tsunamis and volcanic eruptions, this is believed to be the first reported case series of cutaneous mucormycosis in tornado survivors.     

Nosocomial Rhinocerebral Mucormycosis: Two Cases with a Temporal Relationship

Mucormycosis is an unusual fungal infection that usually affects immunosuppressed patients. Small outbreaks of mucormycosis have been previously reported. We present two clinical cases of fatal rhinocerebral mucormycosis with a close temporal relationship between them and a possible nosocomial transmission: case 1 was a 75-year-old male with diabetes and COPD, treated with antibiotics and systemic corticosteroids, who developed rhinocerebral mucormycosis. Case 2 was an 88-year-old woman who was treated with systemic antibiotics and corticosteroids and developed the same infection after insertion of a nasogastric tube. Both patients concurred at the same time in our hospital, and healthcare staff was common to both of them. These cases, along with previously reported cases, highlight that, although infrequent, transmission of the fungus in the hospital environment is a real possibility that should be taken into account in order to initiate contact and air isolation precautions that could avoid nosocomial transmission of this infection.     

Mucormycosis: The hidden and forgotten disease

Mucormycosis is a rare but serious fungal infection caused by a group of moulds called mucormycetes. More attention has recently been paid to it due to its association with coronavirus disease 2019 (COVID-19). Thus, it is important to review the progress of studies on mucormycosis and highlight the important findings in relation to epidemiology, clinical manifestation, major risk factors, diagnostic strategies and management. An electronic literature search was performed in PubMed using the keywords: Rhizopus, Mucorales, mucormycosis, zygomycosis, zygomycetes, COVID-19, the drugs (azoles, posaconazole, isavuconazole, amphotericin B pharmaceutical preparations and caspofungin), combination therapy, diagnosis and clinical manifestations. Studies written in the English language from January 1960 to 2021 were considered for this review article. All search results were reviewed, and the relevance of each article was determined by the authors independently. The review emphasized the fact that the diagnosis of mucormycosis is difficult, it is necessary to have a high index of suspicion to identify it, surgical debridement should be done prior to the dissemination of infection to improve clinical outcomes and identifying underlying risk factors is important for proper treatment. Moreover, antifungal therapeutic options are few with polyenes and their combinations should be appropriate for empirical therapy while posaconazole and isavuconazole are best reserved for de-escalation, refractory cases or patients intolerant to amphotericin B.     

Primary Cutaneous Mucormycosis in a Patient with Burn Wounds Due to Lichtheimia ramosa

Mucormycosis is usually an invasive mycotic disease caused by fungi in the class mucormycetes. Here we report a case of cutaneous mucormycosis due to Lichtheimia ramosa in a 20-year-old female patient with burn injuries. She was admitted to the hospital with accidental flame burns covering 60 % total burn surface area. After 15 days of admission to hospital, the burn wound showed features of fungal infection. Culture showed white cottony growth belonging to the Mucorales order. Morphological identification confirmed it as L. ramosa. She was managed surgically and medically with the help of amphotericin B. Patient survived due to prompt diagnosis and appropriate medical and surgical treatment. Early diagnosis is critical in prevention of morbidity and mortality associated with the disease. Fungal infection in burn wounds can be difficult to diagnose and manage.     

Identification of Phagocytosed Pneumocystis Carinii In Human Pulmonary Alveolar Macrophages

Examination of Papanicolaou-stained bronchoalveolar lavage samples from cases with Pneumocystis carinii pneumonitis under ultra-violet light reveals alveolar macrophages packed with fluorescent inclusions. Immunoenzymatic staining of the alveolar macrophages with a monoclonal antibody specific for P. carinii (3F6) showed that these inclusions contain intact pneumocysts or their degradation products. Fluorescence microscopy of Papanicolaou-stained smears is advocated as a sensitive and specific method of diagnosing P. carinii infection.