A case series of Covid-19-associated fungal infections: The gruesome twosome

Severe Acute Respiratory Syndrome Coronavirus-2(SARS-CoV-2) is the novel coronavirus responsible for causing Coronavirus disease (COVID-19). The pandemic has seen many ebbs and flows since its detection, particularly regarding various manifestations coupled with it. Secondary fungal infections, especially COVID-19-associated mucormycosis, have seen a summit, especially during the second wave of the pandemic. However, we reported a series of three cases of mucormycosis in association with another fungal mould from the sample received from patients infected with this virus that presented to our hospital during this pandemic. Our report is about the novelty of dual fungal infection caused by a Zygomycete group along with Aspergillus isolated from pulmonary as well as extra-pulmonary sites, all of which were confirmed on culture. Timely and multidisciplinary management of these patients helped patient survival

Phylogenetic Status of Two Undescribed Zygomycete Species from Korea: Actinomucor elegans and Mucor minutus

During a survey of fungal diversity of the order Mucorales, three zygomycete isolates, CNUFC-YR113-1, CNUFC-KNU16-7, and CNUFC-BS1-1 were isolated from freshwater and soil samples in Korea. The strains were analyzed both morphologically and phylogenetically based on internal transcribed spacer and 28S rDNA gene sequences. Based on their morphology and phylogeny, the CNUFC-YR113-1 and CNUFC-KNU16-7 isolates were identified as Actinomucor elegans, and CNUFC-BS1-1 was identified as Mucor minutus. To the best of our knowledge, the species A. elegans and M. minutus, belonging to an undiscovered taxon, have not been previously described in Korea.

Characterization of Two New Records of Zygomycete Species Belonging to Undiscovered Taxa in Korea

During a biodiversity survey of undiscovered taxa in Korea, two zygomycetous fungal strains were isolated. The first strain, EML-FSDY6-1 was isolated from a soil sample collected at Dokdo Island in the East Sea of Korea in 2013, and the second strain, EML-DG-NH3-1 was isolated from a rat dung sample collected at Chonnam National University garden, Gwangju, Korea in 2014. Based on the morphological characteristics and phylogenetic analysis of the internal transcribed spacer, 18S and 28S rDNA, actin and translation elongation factor-1α genes. EML-FSDY6-1 and EML-DG-NH3-1 isolates were confirmed as zygomycete species, Absidia pseudocylindrospora and Absidia glauca, respectively. Neither species has previously been described in Korea.

Expressão diferencial de proteínas do fungo Conidiobolus lamprauges cultivado em diferentes temperaturas / Differential expression of protein of the fungus Conidiobolus lamprauges cultivated at different temperatures

Para sobreviverem na temperatura corpórea de seu hospedeiro, os fungos patogênicos têm desenvolvido mecanismos moleculares importantes, como a expressão de proteínas relacionadas ao crescimento em altas temperaturas. Assim, o objetivo deste trabalho foi analisar o crescimento in vitro de Conidiobolus lamprauges em diferentes temperaturas e comparar o perfil de proteínas expressas através de eletroforese bidimensional (2D), em duas temperaturas distintas, sendo uma considerada baixa (28°C) e alta (37°C). Para análise do crescimento em diferentes temperaturas, cinco isolados de C. lamprauges, oriundos de ovinos doentes, foram incubados a 20, 25, 30, 35 e 40°C e o crescimento radial foi medido a cada 24 horas. Para análise da expressão diferencial, realizou-se a extração de proteínas do fungo cultivado a 28°C e a 37°C por 48 horas. A média de crescimento radial dos isolados foi diferente nas temperaturas analisadas, sendo 35°C a melhor temperatura para crescimento em todas as amostras. A temperatura ótima ajustada variou entre 33,3°C a 34,8°C. Os limites inferior e superior de inibição de crescimento foram 18°C e 42°C, respectivamente. Na análise da expressão diferencial, foram encontrados 16 spots diferencialmente expressos, sete (7/16) estavam com expressão diminuída e nove (9/16) com expressão aumentada a 37°C, quando comparado a 28°C. Além disso, oito spots estavam presentes apenas a 28°C e seis a 37°C. Sugere-se que C. lamprauges produza um perfil de proteínas relacionadas à termorregulação desencadeado pela alta temperatura do hospedeiro.

To survive at the body temperature of their hosts, pathogenic fungi have developed important molecular mechanisms, such as protein expression associated with growth at high temperatures. Thus, the aim of this study was to analyze the in vitro growth of Conidiobolus lamprauges at different temperatures and compare proteins expressed by two-dimensional electrophoresis (2D), for the pathogen cultivated at low (28°C) and high (37°C) temperatures. For the analysis of growth temperatures, five isolates of C. lamprauges from sick sheep were incubated at 20, 25, 30, 35 and 40°C and radial growth was measured every 24 hours. For the analysis of differential expression, protein extraction and two-dimensional polyacrylamide gel electrophoresis were performed with C. lamprauges cultivated at 28°C and 37°C for 48 hours. The average radial growth was different at the temperatures tested, and 35°C was found to be the best growth temperature for all isolates. The optimum adjusted temperature ranged between 33.3°C and 34.8°C. The upper and lower limits of growth inhibition were 18°C and 42°C, respectively. Upon expression analysis, a total of 16 spots were differentially expressed, seven (7/16) proteins were downregulated and nine (9/16) were over-expressed at 37ºC compared to 28°C. In addition, eight spots were present only at 28ºC and six were present only at 37ºC. It is suggested that C. lamprauges produces a profile of proteins that is related to thermoregulation triggered by the high temperature of the host.

Meningoencephalitis caused by a zygomycete fungus (Basidiobolus) associated with septic shock in an immunocompetent patient: 1-year follow-up after treatment

Zygomycosis is an infection caused by opportunistic fungi of the Zygomycetes class, specifically those from the Mucorales and Entomophthorales orders. It is an uncommon disease, mainly restricted to immunocompromised patients. We report a case of a 73-year-old male patient with a history of fever (39°C) lasting for 1 day, accompanied by shivering, trembling, and intense asthenia. The patient was admitted to the intensive care unit with complex partial seizures, and submitted to orotracheal intubation and mechanical ventilation under sedation with midazolam. The electroencephalogram showed evidence of non-convulsive status epilepticus. There is no fast specific laboratory test that permits confirmation of invasive fungal disease. Unless the physician suspects this condition, the disease may progress rapidly while the patient is treated with broad-spectrum antibiotics. Differential diagnosis between fungal and bacterial infection is often difficult. The clinical presentation is sometimes atypical, and etiological investigation is not always successful. In the present case, the histopathological examination of the biopsy obtained from the right temporal lobe indicated the presence of irregular, round, thick-walled fungi forming papillae and elongated structures of irregular diameter, with no septa, indicative of zygomycete (Basidiobolus). Treatment with liposomal amphotericin B and fluconazole was initiated after diagnosis of meningoencephalitis by zygomycete, with a successful outcome.