Invasive fungal infections secondary to traumatic injury

Invasive fungal infection (IFI) is a rare but serious complication of traumatic injury. The purpose of this article is to review the epidemiology, natural history, mycology, risk factors, diagnosis, treatment, and outcomes associated with post-traumatic IFI in military and civilian populations. The epidemiology of post-traumatic IFI is poorly characterized, but incidence appears to be rising. Patients often suffer from severe injuries and require extensive medical interventions. Fungi belonging to the order Mucorales are responsible for most post-traumatic IFI in both civilian and military populations. Risk factors differ between these cohorts but include specific injury patterns and comorbidities. Diagnosis of post-traumatic IFI typically follows positive laboratory results in the appropriate clinical context. The gold standard of treatment is surgical debridement in addition to systemic antifungal therapy. Patients with post-traumatic IFI may be at greater risk of amputation, delays in wound healing, hospital complications, and death as compared to trauma patients who do not develop IFI. More research is needed to understand the factors surrounding the development and management of post-traumatic IFI to reduce the significant morbidity and mortality associated with this disease

Taxonomy and phylogeny of clinically important mucoralean fungi

Recientemente, varios estudios han comunicado la creciente incidencia de mucormicosis tanto en pacientes inmunosuprimidos como inmunocompetentes (Bitar et al., 2009; Roden et al., 2005; Saegeman et al., 2010). Algunas especies pertenecientes al orden Mucorales (subphylum Mucoromycotina) son considerados patógenos oportunistas, causando infecciones con una alta tasa de mortalidad. Interesante es el cambio epidemiológico observado tanto en Apophysomyces elegans, como en Saksenaea vasiformis, dos especies consideradas patógenos emergentes, con una gran relevancia clínica en los últimos años, debido a la infección en personas inmunocompetentes. Otro aspecto relevante es el hecho de que los Mucorales son resistentes a la mayoría de los antifúngicos disponibles en la actualidad. La anfotericina B es el único medicamento antimicótico que ha demostrado una potente actividad in vitro y una considerable eficacia in vivo. Sin embargo, la eficacia clínica sigue siendo limitada, con una alta tasa de mortalidad, sobre todo cuando las infecciones son causadas por agentes tales como Saksenaea vasiformis o Apophysomyces elegans. En la presente tesis, se analizó un amplio panel de aislamientos procedentes de muestras clínicas, principalmente de los Estados Unidos de América. Hemos sido capaces de demostrar la utilidad de las herramientas morfológicas en la identificación de los mucorales, obteniendo un 92% de correlación con las herramientas moleculares. Además, y en base a un enfoque polifásico, que incluyó el análisis de la morfología, la fisiología y las secuencias de diversos genes; siete nuevas especies de mucorales han sido descubiertas y descritas: Apophysomyces ossiformis; Apophysomyces trapeziformis; Apophysomyces variabilis; Mucor ellipsoideus; Mucor velutinosus; Saksenaea erythrospora, y Saksenaea oblongispora.Recently, several studies have reported the increasing incidence of mucormycosis in both immunocompromised and immunocompetent patients (Bitar et al., 2009; Roden et al., 2005; Saegeman et al., 2010). Some species belonging to the order Mucorales (subphylum Mucoromycotina) are considered opportunistic pathogens, causing infections with a high mortality rate. Interesting is the epidemiological change observed in both Apophysomyces elegans and Saksenaea vasiformis, two species considered emerging pathogens, with a high clinical relevance in recent years, due to the infection in immunocompetent people. Another relevant aspect is the fact that the Mucorales are resistant to most of the currently available antifungal drugs. Amphotericin B is the only antifungal drug to show potent in vitro activity and in vivo efficacy. Nevertheless, the clinical efficacy remains limited, with high mortality rate, especially when the infections are caused by either Saksenaea vasiformis or Apophysomyces elegans. In the present thesis, we analyzed a large panel of isolates from clinical samples, principally from of the United States of America. We have been able to demonstrate the useful of morphological tools in the identification of mucoralean fungi, obtaining a 92% of correlation with the molecular tools. Additionally, and based on a polyphasic taxonomy approach which included morphology, physiology and DNA sequence analyses, 7 new species of mucoralean fungi have been discovered and described: Apophysomyces ossiformis; Apophysomyces trapeziformis; Apophysomyces variabilis; Mucor ellipsoideus; Mucor velutinosus; Saksenaea erythrospora, and Saksenaea oblongispora

Cutaneous mucormycosis

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. Keywords: Mucormycosis; Mucorales; Mucor; Zygomycosis; Rhizopu

Zygomycosis in Immunocompromised non-Haematological Patients

Zygomycoses caused by fungi of the mucorales order (mucormycoses) are emerging fungal diseases with a high fatality rate. The most important risk factors include neutropenia or functional neutropenia, diabetic ketoacidosis, iron overload, major trauma, prolonged use of corticosteroids, illicit intravenous drug (ID) use, neonatal prematurity, malnourishment, and maybe a previous exposure to antifungal agents with no activity against zygomycetes, such as voriconazole and echinocandins

AN OVERVIEW OF MUCORMYCOSIS

Mucormycosis is an angioinvasive infection caused by Zygomycosis in the order of Mucorales. It is mainly affected in immunocompromised individuals followed by risk factors such as diabetes mellitus, stem cell transplantation, organ transplantation, hematological malignancy, and more intake of steroids. Rhino-orbito-cerebral mucormycosis, pulmonary mucormycosis, cutaneous mucormycosis, gastrointestinal mucormycosis, and disseminated mucormycosis are the most common types. Moreover, it can be diagnosed to overcome this infection using the following methods such as histopathology cultures, computed axial tomography, and resonance imaging. Moreover, it can be treated with amphotericin B, the first-line drug, and posaconazole and isavuconazole are also used. The in vitro studies reveal the antifungal drugs which show the best activity against mucormycosis. The main aim of this review shows the detailed study of mucormycosis and the outcome of this infection

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

Mucormycosis of oral cavity: a descriptive case report from a tertiary care hospital

We presented an interesting case report of mucormycosis (Rhizopus Oryzae) in a recovered COVID-19 patient, its diagnosis and identification. The patient in past visited our institute with symptoms of COVID-19, she was a known case of tuberculosis and was taking ATT and diabetic (DM-2) patient. She was diagnosed COVID positive and successfully treated at our institution and discharged after recovering from the complications. After approximately two months of getting discharged from the hospital she again visited the post COVID clinic with symptoms of fever and numbness around face and on routine examination a blackish tissue like growth seen involving the hard palate and post nasal area. Mucormycosis (phycomycosis, zygomycosis) is an acute opportunistic infection generally develops secondary to debilitating diseases. But increased incidence was noticed in COVID-19 affected individuals. In head, neck and oral cavity the mold usually gains entry through respiratory route involving maxillary sinuses and oral cavity. The fungus causes great damage to the anatomical structures leading its necrosis. Hence an early diagnosis and surgical interventions is must for a good prognosis, decreasing morbidity and mortality. Extensive Research needs to be carried out in COVID patient specially treatment to prevent and reduce the cases of opportunistic infection in order to reduce its incidence and morbidity/mortality

El Subphylum Mucoromycotina: generalidades y aspectos taxonómicos recientes

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