Riesgo de mortalidad en infecciones invasivas por Mucor SPP. en niños con enfermedades hemato-oncológicas: revisión sistemática / Mortality risk of invasive Mucor spp. infections in children with cancer: A systematic review

Los estudios sobre la infección fúngica invasiva (IFI) por Mucor spp. en pacientes pediátricos con patología hematooncológica, son de baja solidez científica, lo que dificulta conocer en profundidad sus características y evolución. Con el objetivo de analizar la evolución fatal de esos pacientes, se llevó a cabo esta revisión sistemática (RS). Material y métodos: La búsqueda bibliográfica se realizó con fecha 23 de marzo de 2023, en las principales bases de datos (Medline (a través de Pubmed), Embase (a través de Embase-Elsevier), The Cochrane Library (a través de Wiley), Cinahl (a través de Ebsco HOST), SCI-EXPANDED, SciELO (a través de la WOS) y Scopus (a través de Scopus-Elsevier), libre (mediante el motor Google) y revisando las citas de los artículos incluidos. Resultados: Se rescataron 1393 artículos, de los cuales se descartaron 1386 por diversas razones. Mediante el análisis de los textos completos, finalmente se incluyeron 7 estudios. Todos los estudios eran series de casos (nivel 4). La mediana de la frecuencia de muerte observada fue de 36,6% (Q1 20% - Q347%). Conclusiones: Esta RS mostró en niños con patología hemato-oncológica, que la mortalidad por IFI por Mucor spp. alcanzó a casi un tercio de los pacientes (AU)

Studies on invasive fungal infection (IFI) by Mucor spp. in pediatric patients with cancer have a low level of evidence, which makes it difficult to elucidate its characteristics and progression. To analyze the fatal outcome of these patients, this systematic review (SR) was conducted. Material and methods: A literature search was carried out on March 23, 2023, in the following main databases (Medline (via Pubmed), Embase (via Embase-Elsevier), The Cochrane Library (via Wiley), Cinahl (via Ebsco HOST), SCI-EXPANDED, SciELO (via the WOS) and Scopus (via Scopus-Elsevier). Additionally, a complementary search was carried out using free search engines (such as Google) and by reviewing the references of the included articles. Results: A total of 1393 articles were retrieved, of which 1386 were excluded for various reasons. After a thorough analysis of the full-text articles, 7 studies were ultimately included in the review. All studies were case series (level 4). The median observed death rate was 36.6% (IQR, 20% - 47%). Conclusions: This SR showed that in children with hematological-oncological disease, mortality due to IFI by Mucor spp. affected almost one third of the patients (AU)

A hospital-based study on COVID-19 patients with rhino-orbital mucormycosis

Coronavirus diseases 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 virus produce opportunistic fungal infections. Mucormycosis is an acute onset rapidly progressive fatal infection. Incidence of rhino-orbital mucormycosis raised during the second wave of COVID-19 pandemic in India. Diabetes, steroid therapy, cancer, prolonged hospitalization, and metabolic acidosis are the risk factors of post-COVID-19 mucormycosis. Objectives of this study were to suggest the risk factors, clinical features, investigations, and treatment of post-COVID-19 rhino-orbital mucormycosis. This study will guide the future research and the clinician will be aware about this complication of COVID-19. After getting permission from the Institutional Ethical Committee and consent from patients, we studied 10 cases of post-COVID-19 rhino-orbital mucormycosis from April to September 2021 during our duty in COVID-19 admission desk and COVID-19 ward in NRS Medical College, Kolkata. After taking history, we observed the clinical features, investigations, and treatment of the patients. Symptoms of the patients were nasal discharge, nasal block, headache, facial swelling, and blackish discoloration of skin. Most of the patients were diabetic. Magnetic resonance imaging (MRI)-PNS was showed sinonasal mass. Amphotericin-B was used and debridement was the main surgical procedure. Microscopy showed broad aseptate hyphae suggesting mucor. Early diagnosis and proper treatment will reduce the morbidity and mortality of the patient with post-COVID rhino-orbital mucormycosis.

Diagnostic value and analysis of two cases with Mucor infection after renal transplantation / 中国热带医学

@#Abstract: To report the diagnosis and treatment of Mucor infection in two cases of renal transplantation, and to provide reference for diagnosis and treatment of Mucor infection. Case 1, a male patient, who underwent allogeneic kidney transplantation due to increased creatinine for more than 8 years. The renal function had partially recovered 25 days after the operation, but then the patient suddenly got worse epigastric pain. Pathogen culture, smear microscopy, mass spectrometry identification and next-generation metagenomic sequencing (mNGS) were performed on the peritoneal drainage, with the result pointing to Rhizopus microsporus. The patient's condition improved after antifungal treatment using amphotericin B lipid complex (ABLC) and was discharged. Case 2, a male patient with hypertension and increased creatinine for more than 7 years was admitted to the hospital. After allograft kidney transplantation, tissue culture smear and histopathological examination suggested Mucor infection. The patient then underwent a "hand muscle debridement surgery + closed negative pressure drainage (VSD)" procedure, and amphotericin B was given postoperative treatment against Mucor infection and debridement. Subsequent retesting with mNGS showed no signs of Mucor infection. In the course of treatment, two patients developed abdominal pain after treatment with tegacycline, which was immediately diagnosed as pancreatitis and recovered after withdrawal. Both patients being male, with one case associated with hypertension. After initially guiding the diagnosis with traditional smear tests, final confirmation was done using histopathological examination, mNGS and mass spectrometry. One case was infected by Rhizopus microspora, and the other was infected by Rhizopus oryzae and Cunninghamia microbicans. The causes leading to Mucor infection in patients post renal transplantation varied greatly. Early diagnosis is the key to treatment of patients with Mucor infection after renal transplantation. Treatment with amphoteric B and its liposome is an effective means to improve mucormycosis patients after renal transplantation. The use of amphotericin B lipid complex treatment proved to be an effective treatment method for patients with Mucor infection after renal transplantation.

A Study Of Paranasal Sinus Complications In Post Covid Patients At A Tertiary Care Centre

Background:Paranasal sinus complications in patients recovering from COVID 19 ison the rise. This study is to evaluate the clinically suspected cases of Post Covid Sinusitis patients.Material And Methods:Total 200 cases of Post Covid Sinusitis patients were included in this study. The demographic profile, clinical and radiological presentation, underlying immunocompromised status, laboratory results and treatment outcome of the patients was analysed.Result:Post Covid Sinusitis was observed mainly in the fifth and sixth decade of life with a male predominance. Most common associated disease was diabetes mellitus (77%). Laboratory analysis revealed infection with Mucor and Aspergillus species most commonly. Sino-nasal, orbital, cerebral, palatine and skin involvement found in 100%, 40%, 12.5%,37% and 2.5% of patients, respectively. Symptoms and signs are headache (62.5%), cheek swelling(40%),and decreased vision(26.5%). All patients were treated by surgical debridement, antibiotics and antifungal medications. Overall survival rate was 87.5%.Conclusion:Clinical suspicion and early diagnosis in post covid patients followed by surgical debridement of diseased tissue, antifungal and antibiotic medications are crucial for better prognosis and improved survival rates.

Buffaloes (Bubalus bubalis) mycotic eye infection: reported herd cases in Thi-Qar province, Iraq / Infecção ocular micótica em búfalos (Bubalus bubalis): relato de casos em rebanho na província de Thi-Qar, Iraque

Buffaloes are one of the important farm animals in the south of Iraq and play an essential economical role mainly acting as dairy, meat, and draft animals. This study intended to diagnose buffalo mycotic eye infections in Thi-Qar province/Iraq. Some 250 buffaloes in the herd of 3,700 animals suffered from eye infections from December 2017 to November 2018. Eye swabs were collected from each infected eye of the affected buffaloes of both sexes before treatment. The animals were in different age groups. All samples were transferred to the laboratory in transfer media, and cultured on Sabouraud dextrose (SDA) agar with and without 0.05 g/mL and 0.4 g/mL chloramphenicol and cycloheximide, respectively. Later, the agars were incubated at 25oC and 37oC. The total percentage of eye infection was (6.75%), constituting (49.2%) mycotic infections. The predominant clinical manifestations that appeared on the infected buffaloes were eye inflammation represented by congestion, lacrimation, the opacity of cornea and edema, and reduced productivity of the infected animals. Different fungal isolates were identified from the samples including Aspergillus fumigates, Aspergillus flavus, Aspergillus niger, Penicillium spp., Alternaria spp., Fusarium spp., Candida spp., Cladosporium spp., Rhodotorula spp., Mucor spp. and Rhizopus spp. Calves buffaloes below one-year-old were more prone to mycotic infection than one-year-old or more. Additionally, male buffaloes were more susceptible to infection than females. In conclusion, this study isolated various types of fungus from the inflamed eyes of buffaloes. Fungal eye infection and the potential risk factors for fungal keratitis in buffaloes were also investigated. The study also approved the rapid diagnosis of fungi by direct microscopic detection and culture. The author recommends future studies including large numbers of the buffalo herd in Iraq to determine the epidemiology of this condition in the country.(AU)

Os búfalos são um dos animais de fazenda mais importantes no sul do Iraque e desempenham um papel econômico essencial, atuando principalmente na produção de leite, carne e como animal de tração. Este estudo objetivou diagnosticar infecções oculares micóticas em búfalos na província de Thi-Qar, Iraque. 250 búfalos no rebanho de um total de 3700 animais apresentaram infecção ocular durante o período compreendido entre dezembro de 2017 e novembro de 2018. Os esfregaços oculares foram colhidos dos olhos infectados dos búfalos afetados de ambos os sexos antes do tratamento. Os animais estavam em diferentes faixas etárias. Todas as amostras foram transferidas para o laboratório por meio de transferência e cultivadas em Ágar Sabouraud e Dextrose (SDA) com e sem 0,05 g/mL e 0,4 g/mL de cloranfenicol e cicloheximida, respectivamente. Posteriormente, os ágares foram incubados a 25ºC e 37ºC. A porcentagem total de infecção ocular foi de 6,75%, representando 49,2% de infecção micótica. As manifestações clínicas predominantes nos búfalos infectados foram inflamação ocular com congestão, lacrimejamento, opacidade da córnea e edema. Os animais acometidos também apresentaram redução de produtividade. Diferentes isolados de fungos foram identificados a partir das amostras, incluindo Aspergillus fumigatus, Aspergillus flavus, Aspergillus niger, Penicillium spp., Alternaria spp., Fusarium spp., Candida spp., Cladosporium spp., Rhodotorula spp., Mucour spp. e Rizopus spp. Búfalos com menos de um ano de idade foram mais propensos a infecções micóticas do que com um ano ou mais. Além disso, os búfalos machos foram mais suscetíveis a infecção do que as fêmeas. Em conclusão, este estudo registrou o isolamento de vários tipos de fungos em olhos inflamados de búfalos. Além disso, a infecção ocular por fungos e os fatores de risco potenciais para ceratite fúngica em búfalos também foram observados. O estudo também aprovou o diagnóstico rápido de fungos por detecção microscópica direta e cultura. O autor recomenda outro estudo futuro, incluindo um grande número de rebanhos de búfalos no Iraque para determinar a epidemiologia desta condição no país.(AU)

Biosurfactant and bioemulsifier as promising molecules produced by Mucor hiemalis isolated from Caatinga soil

BACKGROUND: The present study describes the production of biosurfactant (BS) and emulsifier (BE) by the filamentous fungus Mucor hiemalis UCP 0039, as well as the characterization and stability of the both biomolecules for environmental or industrial applications. RESULTS: Biosurfactants and bioemulsifiers are amphiphilic compounds and are produced as extracellular molecules. The results showed that bioproduct obtained by shaker condition reduced the water surface tension of 72 to 32 mN/m and reached an emulsification index of 96%, while the static cultivation resulted in a biomolecule with a surface tension of 40 mN/m and an emulsification index of 96%, suggesting the production of a biosurfactant and bioemulsifier, respectively. The compounds showed glycolipid nature but the biosurfactant presented cationic charge, while the bioemulsifier, anionic charge. Thus, the results confirmed that M. hiemalis produced two distinct biomolecules under different parameters and in the same culture medium. CONCLUSIONS: It is the first time that biosurfactant and emulsifier production has been described in the same medium and under different physical conditions by Mucor hiemalis. Both biomolecules showed thermal stability, as well as have significant effect on the viscosity of hydrophobic compounds, indicating the excellent potential for environmental safety or industrial applications to improve the efficiency of sustainable and economic technologies.

How could hypoglycemia-inducing glycogen storage disease lead to hyperglycemia-induced mucormycosis?

Mucormycosis is an increasingly frequent, difficult to diagnose, difficult to treat, often fatal infection, especially in patients with hyperglycemia from uncontrolled diabetes. Type I (von Gierke) glycogen storage disease is due to inherited deficiency of enzymes in glycogen metabolism, which causes hypoglycemia. This report is the case of a patient with von Gierke disease and a missed diagnosis of pulmonary mucormycosis. This report illustrates the importance of having a high index of suspicion for mucormycosis in the appropriate clinical context.

Histomorphological spectrum of fungal infections

Background: Fungal infections have become very common resulting in a wide range of diseases from superficial infections to invasive fungal lesions. These organisms are now capable of affecting not only the immunocompromised patients but also healthy immune-competent individuals. All other non-culture methods except histologic method cannot detect all the types of fungi and are not available widely especially in developing countries like India.Methods: This retrospective study conducted in the department of Pathology for a period of 5 years. A total of 29 cases were studied. The aim of this study was to detect the type of fungal infections and their distribution according to age, sex, and organ involvement in histopathologic specimens received in our department.Results: Twenty-nine cases with fungal infections were studied. Of these (22; 75.8%) were males, (7; 24.1%) were females with male dominance. The cases displayed extensive range of age prevalence between 12 and 77 years. The most common type of fungal infection encountered in this study was mucormycosis. The most common site involved in infection was maxillary sinus. Maxillary sinus was the most common site for mucormycosis.Conclusions: The histopathologic examination can provide a swift provisional identification of infectious fungal organisms and remains the only existing reliable means to identify certain pathogens.

The 471st case: duodenal ulcer, mucor infection, and elevated IgG4 / 中华内科杂志

Mucor infection is rarely reported in non-immunocompromised population, especially in isolated gastrointestinal tracts. IgG4-related diseases (IgG4-RD) have been recognized in recent years, but secondary causes of IgG4 elevation should be differentiated. We reported a young man with duodenal mass and ulcer and high serum IgG4 level. Histological biopsy of the mass revealed positive mucor mycelium and infiltration of IgG4 positive plasma cells. Serum IgG4 decreased to normal range after surgical resection and systemic antifungal treatment. This case suggests that isolated mucor mycosis infection can develop in the digestive tract and mimics as IgG4-related disease.

Aislamiento, identificación y evaluación de la actividad antimicrobiana de metabolitos producidos por Mucor circinelloides ( Cepa Nativa SPG 321) / Isolation identification and evaluation of the antimicrobial activity for metabolites produced by Mucor circinelloides

Resumen Objetivo. Identificar y evaluar la capacidad antimicrobiana de los metabolitos aislados a partir del proceso de fermentación en una cepa de Mucor circinelloides. Método. En el presente estudio se trabajó la cepa nativa de Mucor circinelloides SPG 321 suministrada por el Grupo de Investigación de Biotrasformación (GIBUJ), con el fin de evaluar su actividad antimicrobiana. La cinética de crecimiento determinó que la ideofase culminó a la hora 264, hora determinada como la finalización de la fermentación. Se separó el micelio del caldo y posteriormente se fraccionaron los extractos con cromatografías de capa fina y columna en sílica gel, eluidas con diferentes relaciones de solventes. Resultados. Los resultados arrojados por la técnica de gases acoplado a masas CG-EM confirman la importancia de Mucor circinelloides en la producción de ácidos grasos insaturados. A partir del micelio se obtuvo un esterol, compuesto M. cB3. La fracción CHCl3 en biomasa mostró actividad inhibitoria para los microorganismos Gram positivos.

Abstract Objective. To identify and evaluate the antimicrobial capacity of the metabolites isolated from the fermentation process in a strain of Mucor circinelloides. Method. For this study it was taken the 321 SPG native strain of Mucor circinelloides provided by GIBUJ. The kinetics growth was made, observing the ending of the idiofase at hour 264, hour taken for the conclusion of fermentation. Mycelium was separated from the broth and then purified with thin layer chromatography and silica gel column, eluted with different relations of solvents. Results. The results given by the technique of coupled gases with GC-MS mass confirm the importance of Mucor circinelloides in the production of unsaturated fatty acids. A sterol was obtained from the mycelium, M.cB3 compound. The fraction CHCl3 in biomass showed inhibitory activity for Gram-positive microorganisms.

Isolation and Characterization of Three Zygomycetous Fungi in Korea: Backusella circina, Circinella muscae, and Mucor ramosissimus

While surveying undiscovered fungal taxa in Korea, three rare zygomycetous fungal strains, CNUFC-PTF2-1, CNUFC-TF3-1, and CNUFC-ESAF3-1, were isolated from soil, leaf, and freshwater samples, respectively. The strains were analyzed morphologically as well as phylogenetically based on the internal transcribed spacer region and 28S rDNA sequences. Sequence analysis of the two loci revealed that the isolates, CNUFC-PTF2-1, CNUFC-TF3-1, and CNUFC-ESAF3-1, were identified as Backusella circina, Circinella muscae, and Mucor ramosissimus, respectively. These species have not yet been previously described in Korea.

Osteomielitis por mucorales (OMM) asociada a artroscopia de reparación de ligamento cruzado anterior: investigación epidemiológica y recomendaciones para su prevención / Mucor osteomyelitis after arthroscopic repair of ACL. Epidemiological investigation

OBJETIVO: Describir la investigación epidemiológica de osteomielitis por Mucorales (OMM) post reparación artroscópica de LCA (RA-LCA) en Argentina. MATERIAL Y MÉTODO: 1) Revisión de los casos; 2) Relevamiento de 3 instituciones; 3) Cultivo micológico de materiales quirúrgicos; 4) Encuesta a instrumentadoras; 5) Secuenciación de las cepas de Rhizopus y 6) Redacción de recomendaciones. RESULTADOS: Del 2005 al 2017 se identificaron 40 casos de OMM (Rhizopus sp.) post reparación artroscópica de LCA en pacientes inmunocompetentes de 12 jurisdicciones de Argentina. El diagnóstico fue por cultivo (22/31), y por anatomía patológica (9). La edad promedio fue 29 años. El 84% de 38 casos eran varones. Intervinieron 13 ortopedias. El implante fue importado en 8/20 casos y nacional en 12. En las 3 instituciones se observó: manejo inadecuado del aire de quirófano, variabilidad en la limpieza del artroscopio, en el taladro utilizado, y en el manejo de materiales que llegan de las ortopedias y falta de trazabilidad de los implantes. Los cultivos micológicos de los materiales fueron negativos. La encuesta a instrumentadores confirmó los hallazgos de los relevamientos. La secuenciación de las cepas de Rhizopus demostró predominio de policlonalidad. CONCLUSIÓN: La OMM es una complicación posible luego de la RA-LCA en instituciones privadas de Argentina. No se identificó un origen único. Se detectaron múltiples prácticas que favorecen la contaminación de la cirugía con hongos filamentosos (manejo del aire de quirófano, del artroscopio, de los materiales provenientes de ortopedia, etc.). En base a estos hallazgos la Asociación Argentina de Artroscopía sugiere medidas de prevención. Implicancia clínica: Prevención de osteomielitis por Mucorales post- cirugía artroscópica para ligamento cruzado anterior. Tipo de estudio: Serie de casos. Nivel de Evidencia: IV.

OBJECTIVE: To describe the epidemiological investigation of Mucor osteomyelitis (MO) after arthroscopic repair of ACL (ARACL) in Argentina. MATERIAL Y METHODS: 1) Review of cases; 2) Survey of 3 institutions; 3) Mycological culture of surgical materials; 4) Survey of instrumentists; 5) Sequencing of Rhizopus strains and 6) Writing of recommendations. RESULTS: From 2005 to 2017, 40 cases of MO (Rhizopus sp.) Post AR-ACL were identified in immunocompetent patients from 12 jurisdictions of Argentina. The diagnosis was made by culture (22/31), and by pathology (9). The average age was 29 years. 84% of 38 cases were male. Thirteen orthopedics intervened. The implant was imported in 8/20 cases and national in 12. In the 3 institutions it was observed: inadequate handling of the operating room air, variability in the cleaning of the arthroscope, in the drill used, and in the handling of materials that come from the orthopedics and lack of traceability of the implants. The mycological cultures of the materials were negative. The survey of instrumentists confirmed the findings of the surveys. The sequencing of Rhizopus strains showed a predominance of polyclonality. CONCLUSION: MO is a possible complication after AR-ACL in private institutions in Argentina. A unique origin was not identified. Multiple practices that favor the contamination of surgery with filamentous fungi (handling of operating room air, arthroscope, materials from orthopedics, etc.) were detected. Based on these findings, the Argentine Association of Arthroscopy suggests prevention measures. Clinical relevance: Prevention of Mucor osteomyelitis after arthroscopic surgery for anterior cruciate ligament. Type study: Cases series. Level of evidence: IV.

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.

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.

Microbial Transformation of Two Prenylated Naringenins

Microbial transformation of (±)-6-(1,1-dimethylallyl)naringenin (6-DMAN, 1) and (±)-5-(O-prenyl) naringenin-4′,7-diacetate (5-O-PN, 2) was performed by using fungi. Scale-up fermentation studies with Mucor hiemalis, Cunninghamella elegans var. elegans, and Penicillium chrysogenum led to the isolation of five microbial metabolites. Chemical structures of the metabolites were determined by spectral analyses as (±)-8-prenylnaringenin (3), (2S)-5,4′-dihydroxy-7,8-[(R)-2-(1-hydroxy-1-methylethyl)-2,3-dihydrofurano]flavanone (4), (±)-5-(O-prenyl)naringenin-4′-acetate (5), (±)-naringenin-4′-acetate (6), and (±)-naringenin (7), of which 5 was identified as a new compound.

A New Acetylcholinesterase Inhibitor from Green Glycosylation of Trachyloban-19-oic Acid by Mucor plumbeus

ABSTRACT The in vitro metabolism of a widespread natural product, trachyloban-19-oic acid (1), by the fungal species Mucor plumbeus was studied in a sucrose-yeast liquid medium. Two products were isolated, and their structures were determined by spectroscopic means as 7β-hydroxytrachyloban-19-oic acid (5) and trachyloban-19-O-β-D-glucopyranosyl ester (6). To the best of our knowledge, compound 6 is herein reported by the first time in the literature. These compounds were assayed for acetylcholinesterase inhibition along with some related compounds. Compound 6 showed the highest acetylcholinesterase inhibitory activity at 10000 µg/mL among the tested compounds, a result (92.89%) comparable to the activity of the positive control, galanthamine (94.21%). Therefore, biotransformation of the natural product 1 by M. plumbeus produced a novel compound with potential as a new lead to develop anti-Alzheimer medicines.

Diagnóstico y tratamiento de la mucormicosis pulmonar. Reporte de un caso / Diagnosis and treatment of pulmonary mucormycosis. A case report

Resumen La mucormicosis es una infección causada por hongos del orden de los mucorales; las infecciones causadas por estos hongos generalmente se adquieren por vía respiratoria ya que las esporas de estos se encuentran en el ambiente. En pacientes inmunocomprometidos o diabéticos descompensados, estos microorganismos pueden causar cuadros fatales. Puede presentarse en varias localizaciones, en este caso se tratará la localización pulmonar. La fiebre, la hemoptisis y el infarto tisular son característicos de la mucormicosis pulmonar. Radiológicamente, se puede encontrar consolidación lobar, lesiones aisladas, enfermedad nodular y cavitación. Una vez realizado el diagnóstico de mucormicosis de cualquier localización, se deben identificar los factores predisponentes y corregirlos o atenuarlos. En esta ocasión se presenta el caso clínico de una paciente de 61 años de edad con diabetes mellitus tipo 2 (DM2) de 10 años de evolución que ingresa al servicio de urgencias de esta institución con descontrol glucémico de 520 mg/dL, acompañado de fiebre y con cuadro clínico de infección de vías respiratorias en tratamiento. Se realiza la presentación del caso, su comparación con la literatura disponible y las conclusiones a las que se llegaron.

Abstract Mucormycosis is an infection caused by organisms that belong to a group of fungi called Mucoromycotina in the order Mucorales; Infections caused by these microorganisms, are usually acquired through the respiratory route since the spores of fungi are found in the environment. These infections are more common among people with a weakened immune system or diabetic people, and they could be fatal. Mucormycosis can be found in several localizations but this case will focus specifically in the lung. The symptoms associated with it are fever, hemoptysis, and tissular infarct. Radiographically, lobar consolidation, isolate mass, nodular component and cavitation can be found. Once the diagnostics is made, in any location, its important to identify the risk factors, and try to correct or improve them. In this occasion, the we present the case of a 62-years-old female, with diabetes mellitus type 2 with and 10 years of evolution,. She arrives to the emergency room of this institution with uncontrolled blood glucose (520 mg / dL), accompanied by fever.and respiratory infection, and is treated by a multidisciplinary team (internal medicine, surgery and infectology). This is the presentation of the case, its comparison with the available literature and the conclusions of the author.

The Imaging Appearance of Sinus Mycetoma: A Case Series / El Aspecto Imagenológico del Micetoma Sinusal: Serie de Casos

Sinus mycetoma is a dense accumulation of hyphae that form a rounded mass within the mucosal confines of a paranasal sinus. The aim of this study was to present a case series of three patients with maxillary sinus mycetoma and to describe their radiographic presentations. Three cases are presented. The first two, a 44-year-old woman and an 88 year-old man, both diabetics, were referred to maxillofacial treatment by other specialties. They both had a bad odor of unknown origin on the facial level and their respective computerized tomographies revealed a unilateral opacification of the maxillary sinus with a region of greater radio-opacity. The third case is a 31-year-old woman with a history of a severe facial trauma who had undergone surgery and for whom orthognathic surgery had been planned to correct side effects. In addition to the orthognathic surgery, the removal of the lesion that appeared opacified in the pre-surgery scan was planned. She showed opacification of the maxillary sinus and during the intraoperative stage, tissue of a whitish-gray appearance was detected on the maxillary sinus. The lesion was completely removed and the result of the histopathological study was sinus mycetoma. The patients evolved favorably and the symptomatology disappeared completely. The growing occurrence of mycetoma and the lack of information on it make publicizing this pathology fundamental so it can be considered as a differential imaging, clinical, and pathological diagnosis and in that way receive adequate and opportune treatment.

El micetoma sinusal es una patología de origen fúngico, que afecta a pacientes inmunocomprometidos, capaz de desorientar en su diagnóstico por su clínica y expresión imagenológica particular. El objetivo de este estudio es presentar una serie de tres casos con micetoma en el seno maxilar y describir su presentación imagenológica. Se presentan tres casos. Los dos primeros, una mujer de 44 años y un hombre de 88 años, ambos diabéticos y derivados a atención maxilofacial por otras especialidades. Coincidía un mal olor expelido de origen desconocido a nivel facial y en sus respectivas tomografías computarizadas se observó velamiento unilateral del seno maxilar con una zona de mayor hiperdensidad. El tercer caso corresponde a una mujer de 31 años con antecedente de trauma facial severo operado, a la cual se le planificó cirugía ortognática para corregir secuelas. En conjunto con la cirugía ortognática, se planificó la biopsia excisional de una lesión hiperdensa que se presentó en el escáner pre-quirúrgico; en el intraoperatorio se pesquisó tejido de aspecto blanquecino grisáceo en el seno maxilar. A todos los pacientes se les realizó la exéresis total de la lesión y el estudio histopatológico dio como resultado micetoma sinusal. Los pacientes evolucionaron favorablemente, desapareciendo por completo la sintomatología. La creciente incidencia del micetoma y el desconocimiento sobre el mismo hacen que sea fundamental la difusión de esta patología para ser considerada como diagnóstico diferencial clínico y patológico, y realizar así un tratamiento adecuado y oportuno.

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.

A Brief Review of Mucormycosis: Report of Five Cases.

Mucormycosis is an emerging and slowly rising fatal infectious disease in most countries. It is the third most common invasive mycosis after candidiasis and aspergillosis. Hematologic malignancies notably acute myeloblastic leukemia (AML) and diabetes mellitus (DM) especially when uncontrolled or there is ketoacidosis are the most common predisposing conditions. Clinical manifestations vary according to the organ involved. Based on anatomic localization, mucormycosis can be classified as one of 6 forms: Rhinocerebral, Pulmonary, Cutaneous, Gastrointestinal, Disseminated and Uncommon presentations. The mortality rate is often very high. Early diagnosis and aggressive treatment are the cornerstone of management. Here we report 5 cases of mucormycosis in patients admitted to Imam Reza hospital, the tertiary referral center in Northwest of Iran. We will also have a brief review of this fungal infection.