COVID-19 associated rhinomaxillary mucormycosis: a case series and review of literature

During COVID-19 pandemic, fulminant deep fungal infection started emerging in India, known as Mucormycosis. This type of mucormycosis was termed as COVID-19 associated mucormycosis (CAM). These patients had previous history of COVID-19 infection. Such cases were mainly reported in immunocompromised patients such as patients with poorly controlled diabetes and chronic renal diseases etc. Rhinomaxillary mucormycosis is an aggressive, fulminant, fatal deep fungal infection of head and neck region. Early diagnosis and prompt treatment can reduce the mortality and morbidity associated with the disease; hence we present case series of rhinomaxillary mucormycosis to create awareness amongst dental surgeons

Study of Admitted Patients of Mucormycosis : Experience of A Tertiary Care Centre

A prospective study was done during mid-April to mid-June 2021 to analyze the sudden rise in cases of Mucormycosis. We assessed characteristics, related comorbidities, disease locale, steroid administration and disease outcome in patients. Cases of Mucormycosis associated with RTPCR positive for Coronavirus disease (COVID-19) and Mucormycosis occurring in patients with negative RTPCR for COVID-19 were compared. A total of 103 Mucormycosis patients were analyzed, 84 (81.55%) were RTPCR positive. Uncontrolled Diabetes Mellitus (70.87%) was the most common comorbidity present among RTPCR positive and negative Mucormycosis patients. Rhino-orbital and Rhino-sinusoidal sites were equally involved (44.0%), followed by Rhino-orbital-cerebral (11.9%) region. We ascribe the spike in Mucormycosis episodes to the trio of diabetes, excessive corticosteroid usage in the face of the COVID-19 Pandemic.

Alterantes microbianos atípicos en yogures argentinos: mohos gasógenos y bacterias del género Gluconobacter / Atypical spoilage microorganisms in Argentinean yogurts: Gas-producing molds and bacteria of the genus Gluconobacter

RESUMEN El deterioro microbiológico de alimentos conduce a productos no aptos para consumo, y su descarte, a importantes pérdidas económicas para la industria alimenticia. Durante su almacenamiento, los alimentos frescos representan nichos atractivos para la supervivencia y el crecimiento de microorganismos indeseables. En productos lácteos, la presencia de alterantes o patógenos bacterianos está mejor documentada que la de mohos y levaduras. Estos productos son menos proclives al deterioro por mohos que otros, como frutas y verduras, debido a su almacenamiento refrigerado, su elaboración a partir de leche tratada térmicamente y, para fermentados, a la microbiota dominante, que acidifica el medio. Sin embargo, incluso quesos y yogures pueden sufrir deterioro por mohos. Este trabajo presenta casos atípicos de muestras de yogur con desarrollo de mohos gasógenos y bacterias del géneroGluconobactercomo microorganismos alterantes no reportados previamente como tales en leches fermentadas argentinas. Los organismos alterantes «clásicos¼ de yogur fueron siempre levaduras y, en otros países, mohos del géneroAspergillus.

ABSTRACT Microbial food alterations lead to unfit products for consumption, and their discarding, to significant economic losses for the food industry. During storage, fresh foods offer available niches for the survival and growth of undesirable microorganisms. In dairy products, data regarding spoilage and/or pathogenic bacteria is better documented than those for molds and yeasts. Dairy products are less susceptible to mold's contamination than products such as fruits and vegetables, due to their refrigerated storage; their elaboration from heat-treated milk and, for fermented ones, the dominant microbiota that acidifies the medium. However, even cheeses and yogurts may be susceptible to mold contamination. Atypical cases of yogurt samples containing spoilage microorganisms not previously reported (molds producing gas and bacteria of the genusGluconobacter) in Argentinean fermented milks are presented here. For yogurt, in particular, the "classic" altering organisms were always being yeasts, and in other countries, molds belonging to the genusAspergillus.

Different types of mucormycosis: case series

Mucormycosis is the third invasive mycosis in order of importance after candidiasis and aspergillosis and is caused by fungi of the class Zygomycetes. The most important species causing Mucormycosis is Rhizopus arrhizus (oryzae). Identification of the agents responsible for mucormycosis is based on macroscopic and microscopic morphological criteria, carbohydrate assimilation and the maximum temperature compatible with its growth. The incidence of mucormycosis is approximately 1.7 cases per 1000 000 inhabitants per year. Clinical diagnosis of mucormycosis is difficult, and is often made at a late stage of the disease or post-mortem. We present here a series of five cases of different types of mucormycosis that were reported in our hospital till date. Of which three patients had good recovery and other two had a fatal outcome. Treatment of mucormycosis requires a rapid diagnosis, correction of predisposing factors, surgical resection or debridement as part of source control-and appropriate anti-fungal therapy. Liposomal amphotericin B is the drug of choice for this condition. The overall rate of mortality of mucormycosis is approximately 40%.

Mucormicosis diseminada en un paciente diabético: un reporte de caso / Disseminated mucormycosis in a diabetic patient: a case report

La mucormicosis es una infección fúngica altamente mortal que se presenta en pacientes con algún grado de inmunosupresión, siendo la forma rinocerebral la más común. Es el primer reporte en el Perú de mucormicosis diseminada con compromiso multisistémico en un paciente con cetoacidosis diabética. Se presenta el caso de un varón de 47 años diabético procedente de la selva peruana con cuadro de insuficiencia respiratoria en ventilación mecánica. A su ingreso presenta leucocitosis, acidosis metabólica anion gap elevado, hiperglicemia e hipoalbuminemia. Posteriormente, es intervenido quirúrgicamente en tres oportunidades por presentar abdomen agudo con hallazgos en la patología de necrosis y perforación de varios órganos, falleciendo a los pocos días. Paciente se encontraba recibiendo su quinta dosis de anfotericina B deoxicolato. Se observaron hifas con angulación recta compatible con mucormicosis en estómago, intestino y pulmón.

Mucormycosis is a highly lethal fungal infection occurring in patients with some degree of immunosuppression. The rhinocerebral form is the most frequent presentation. This is the first report in Peru of a case of disseminated mucormycosis in a patient with diabetic ketoacidosis. This is a 47-year-old diabetic male subject who was referred from the Amazon jungle and presented with respiratory insufficiency receiving mechanical ventilation. On admission, the patient had leukocytosis, metabolic acidosis with high anion gap, hyperglycemia, and hypoalbuminemia. Soon afterwards, the patient underwent surgery because of acute abdomen, and the anatomopathological examination revealed necrosis and hollow viscus perforation, and he ultimately died. At this time, he was receiving amphotericin B deoxycholate. Straight angle hyphae compatible with mucormycosis were found in stomach, intestine, and lungs.

An Emergent Entity: Indolent Mucormycosis of the Paranasal Sinuses. A Multicenter Study

Abstract Introduction Indolent or chronic mucormycosis is a rare entity that affects both immunosuppressed and immunocompetent individuals. Additionally, its clinical evolution is nonspecific and there is no standardized treatment for this condition. Objective To describe the clinical characteristics and management of patients with indolent mucormycosis. Methods In the project of study with chart review in the Interinstitutional secondary care centers, patients with evidence of indolentmucormycosis, defined as pathological confirmation of nasal/paranasal sinus mucormycosis for more than 1 month, were included. All patients underwent complete laboratory workup, imaging studies, surgical treatment and adequate follow-up. No evidence of disease status was defined when patient had subsequent biopsies with no evidence of mucormycosis. Results We included seven patients, three female and four male subjects. The mean age was 53.14 years. Four patients were immunosuppressed and three immunocompetent. Among the immunosuppressed patients three had diabetes and one had dermatomyositis. The symptomswere nonspecific: facial pain/headache, mucoid discharge and cacosmiawere the ones most frequently reported. Maxillary sinus involvement was present in all patients. Two immunosuppressed subjects received amphotericin. Posaconazole was the only treatmentinoneimmunosuppressedpatient. Allimmunocompetent patientshadsingleparanasal sinus disease and received only surgical treatment. All patients are alive and free of disease. Conclusion Indolent mucormycosis is a new and emerging clinical entity in immunosuppressed and immunocompetent patients. Single paranasal sinus disease is a frequent presentation and should not be overlooked as a differential diagnosis in these patients. Immunocompetent patients should only be treated surgically. (AU)

Isolation and Characterization of Two Rare Mucoralean Species with Specific Habitats

The order Mucorales, the largest in number of species within the Mucoromycotina, comprises typically fast-growing saprotrophic fungi. During a study of the fungal diversity of undiscovered taxa in Korea, two novel mucoralean strains, CNUFC-GWD3-9 and CNUFC-EGF1-4, were isolated from specific habitats including freshwater and fecal samples, respectively. On the basis of their morphological characteristics and sequence analyses of internal transcribed spacer and large subunit ribosomal DNA, the CNUFC-GWD3-9 and CNUFC-EGF1-4 isolates were confirmed to be Gilbertella persicaria and Pilobolus crystallinus, respectively. It is ecologically, pathologically, and mycologically significant to find such rare zygomycetous fungi in such specific habitats.

Cutaneous mucormycosis

Abstract Cutaneous mucormycosis is an emerging fungal infection caused by opportunistic fungi of the phylum Glomeromycota. It is frequent in poorly controlled diabetic patients and individuals with immunosuppression. It is usually acquired by direct inoculation through trauma. The clinical presentation is nonspecific, but an indurated plaque that rapidly evolves to necrosis is a common finding. Diagnosis should be confirmed by demonstration of the etiological agent and new molecular diagnostic tools have recently been described. It is an invasive life-threatening disease and in order to improve survival, a prompt diagnosis and multidisciplinary management should be provided. The treatment of choice is amphotericin B, but new azoles, such as posaconazole and isavuconazole, must be considered.

Characterization of Two New Records of Mucoralean Species Isolated from Gut of Soldier Fly Larva in Korea

While surveying the diversity of fungi of the order Mucorales, two isolates, EML-PUKI12-1 and EML-PUKI06-1, were obtained from the gut of soldier fly larvae inhabiting the bulrush at a pond located in the Chonnam National University Arboretum, Gwangju, Korea. The isolates were confirmed as Mucor irregularis and Mucor fragilis species, respectively, based on the morphological characteristics and phylogenetic analysis of rDNA internal transcribed spacer region. Such mucoralean species belonging to undiscovered taxa has not previously been described in Korea.

Identification of Mucorales From Clinical Specimens: A 4-Year Experience in a Single Institution

Mucormycosis, a fatal opportunistic infection in immunocompromised hosts, is caused by fungi belonging to the order Mucorales. Early diagnosis based on exact identification and multidisciplinary treatments is critical. However, identification of Mucorales fungi is difficult and often delayed, resulting in poor prognosis. This study aimed to compare the results of phenotypic and molecular identification of 12 Mucorales isolates collected from 4-yr-accumulated data. All isolates were identified on the basis of phenotypic characteristics such as growth rate, colony morphology, and reproductive structures. PCR and direct sequencing were performed to target internal transcribed spacer (ITS) and/or D1/D2 regions. Target DNA sequencing identified five Lichtheimia isolates, two Rhizopus microsporus isolates, two Rhizomucor pusillus isolates, one Cunninghamella bertholletiae isolate, one Mucor fragilis isolate, and one Syncephalastrum racemosum isolate. Five of the 12 (41.7%) isolates were incorrectly identified on the basis of phenotypic identification. DNA sequencing showed that of these five isolates, two were Lichtheimia isolates, one was Mucor isolate, one was Rhizomucor isolate, and one was Rhizopus microspores. All the isolates were identified at the species level by ITS and/or D1/D2 analyses. Phenotypic differentiation and identification of Mucorales is difficult because different Mucorales share similar morphology. Our results indicate that the molecular methods employed in this study are valuable for identifying Mucorales.

A Non-healing Ulcer with Unilateral Facial Palsy

Introduction: Oral cavity is a hub for millions of microorganisms which are non pathogenic, but in immunocompromised states, plethora of diseases emerge which may be the most rarest and fatal. Mucormycosis has emerged as one such disease due to rise in the incidence of immunosuppressive conditions such as uncontrolled diabetes. It manifests as rhinocerebral, gastrointestinal, pulmonary and cutaneous forms. Presentation of Case: A 53 year old female patient reported with a chief complaint of noticing a painless large ulcer in the palate. There was also history of swelling associated with continuous burning sensation only on the right middle third of face with difficulty in closing right eye, raising right eyebrow, speaking and inabilty to smile. Bell’s sign was positive. She also had recurrent episodes of fever and vomiting. Imaging with CT and MRI showed no bony destruction but a wide spread soft tissue lesion from palate upto the cavernous sinus. Culture and histopathology confirmed mucormycosis. Discussion: Mucormycosis is the third most common opportunistic fungal infection caused by a saprophytic fungus Mucor. This invasive infection can spread rapidly to intracranium causing various morbidities. Facial nerve palsy is one such rare complication reported in the present case. Explicit investigations including imaging, serology, histopathology and culture are crucial for appropriate diagnosis. Treatment includes parenteral and oral antifungals. Conclusion: Mucormycosis is a rare encounter in dental practice especially with initial presenting intraoral symptom. The present paper presents one such rare extensive case of Mucormycosis in a compromised patient with extensive investigations and management.

El Subphylum Mucoromycotina: generalidades y aspectostaxonómicos recientes / Mucoromycotina Subphylum: overview and recent taxonomic aspects

El subphylum Mucoromycotina es un grupo de hongos ubicuos, saprobios, caracterizados por la presencia de hifas cenocíticas. También se caracterizan por presentar una fase sexual con la formación de una zigospora. Los mucormycetes son capaces de infectar plantas, animales y seres humanos. Recientemente, varios estudios han comunicado de la creciente incidencia de mucormicosis en pacientes inmunocomprometidos e inmunocompetentes. Dados los avances en biología molecular, la sistemática de este grupo de hongos ha experimentado varios cambios taxonómicos en los últimos años. Este artículo discutirá los principales cambios taxonómicos, en especial de los géneros y especies de interés clínico.

The subphylum Mucoromycotina is a group of fungi with several ubiquitous, and saprotrophic species which are characterized by the presence of coenocytic hyphae. Also have a sexual phase characterized by the formation of zygospores. The mucormycetes are able to infect plants, animals and humans. Recently, several studies have reported the increasing incidence of mucormycosis in both immunocompromised and immunocompetent patients. Given the advances in molecular biology, the systematic of this group of fungi has experimented several taxonomical changes. This paper will discuss the major taxonomic changes, particularly of those genera and species of clinical interest.

Glycoprotein secreted by Absidia corymbifera is associated with apoptosis of human umbilical vein endothelial cells / 中华微生物学和免疫学杂志

Objective To partially purify the toxic factor secreted by A. corymbifera and to analyze the mechanism of A. corymbifera-induced human umbilical vein endothelial cell (HUVEC) apoptosis. Methods Glycoprotein secreted by A. corymbifera was purified by Con A Lectin chromatography. The influence of different protein fractions on HUVEC apoptosis was determined by flow eytometer. Both denaturing and nondenaturing deglycosylation of purified glycoprotein was performed and the ability of the protein moiety and carbohydrate moiety to induce HUVEC apoptosis was evaluated respectively. Activation of related caspases during A. corymbifera-induced apoptosis was analyzed by Western blot. The role of caspase-8 and -9 in HUVEC apoptosis was investigated using caspase inhibitors. Caspase inhibitors were used to stop the suppression of HUVEC viability by XTT assay. Results Flow cytometric analysis shows the total protein as well as the glycoprotein fraction of A. corymbifera may induce HUVEC apoptosis in a dose dependent manner. In contrast, similar activity was not observed in the non-glycoprotein fraction. Neither deglycosylated protein nor carbohydrate moiety is able to induce HUVEC apoptosis alone. In the apoptotic signaling pathway, caspase9, caspase-3 and cytochrome C were activated significantly, except caspase-8. Moreover, caspase-9 inhibitor, instead of caspase-8 inhibitor, completely abrogates A. corymbifera-induced HUVEC apoptosis. Caspase9 and caspase-3 inhibitors completely waived the suppression of HUVEC viability by A. corymbifera. Conclusion Glycoprotein secreted by A. corymbifera is associated with HUVEC apoptosis. Intact glycoprotein is essential for the apoptotic progress. Intrinsic apoptotic signaling pathway mediates A. corymbifera-induced HUVEC apoptosis.

Absidia corymbifera induces apoptosis of human umbilical vein endothelial cells in vitro / 中华微生物学和免疫学杂志

Objective To analyze the influence of Absidia corymbifera on cell activity of human umbilical vein endothelial cells (HUVEC) as well as the related mechanism. Methods Time course analy sis of the influence of A. corymbifera on cell viability of HUVEC was determined by cell counting after Trypan blue staining. Apoptosis of HUVEC induced by A. corymbifera was observed under fluorescence microscope after treatment with apoptosis detection kit. Time course analysis of HUVEC apoptosis induced by A. corymbifera was detected by flow cytometry quantitatively. Effect of caspase-3 inhibitor on A. corymbifera associated apoptosis was also evaluated at the same time. Activation of caspase-3 inside HUVEC was detected by Western blot. Results A. corymbifera inhibited cell viability of HUVEC in a time-dependent manner by Trypan blue staining. After 12 hours' co-culture, A. corymbifera began to show suppression on cell viability (P =0. 001 ). Fluorescence microscope observation revealed A. corymbifera induced apoptosis of HUVEC instead of necrosis. Flow cytometry analysis showed A. corymbifera induced apoptosis of HUVEC in a time-dependent manner. A. corymbifera began to show obvious effect on apoptosis after 12 h co-culture (P =0.0036). Moreover, A. corymbifera-associated apoptosis was almost abrogated completely by caspase-3 inhibitor. Western blot analysis demonstrated that A. corymbifera triggered the activation of caspase-3 inside HUVEC in a timedependent fashion. Conclusion A. corymbifera induces apoptosis of HUVEC in vitro. Such apoptotic signal is transmitted through caspase cascade reaction.