Entomophthoromycosis

Excerpt

Entomophthoromycosis is a group of rare subcutaneous and mucocutaneous fungal infections predominant in tropical and subtropical areas. Entomon in Greek means "insect," reflecting the initial recognition of these fungi as parasites infecting insects. This gradually advancing infection commonly arises from the traumatic implantation of plant material or the inhalation of spores. The 2 distinct types of entomophthoromycosis include basidiobolomycosis and conidobolomycosis. Soil, insect, reptile, and amphibian excreta harbor Basidiobolus and Conidiobolus.

Conidobolomycosis, most commonly caused by Conidiobolus coronatus, is usually a chronic rhinofacial subcutaneous infection that originates in the nasal sinuses and subsequently spreads to the subcutaneous tissues of the face. Infection can lead to disfigurement, primarily affecting immunocompetent hosts. Some Conidiobolus spp are found in immunocompromised hosts. Basidiobolomycosis is a chronic subcutaneous infection caused by Basidiobolus ranarum, which affects the limbs, trunk, buttocks, and gastrointestinal system. The symptoms of gastrointestinal basidiobolomycosis (GIB) closely resemble those of more common illnesses, such as malignancy and inflammatory bowel disease, thereby challenging accurate diagnosis. Basidiobolomycosis affects both immunocompetent and immunocompromised patients.

With early treatment, the prognosis is favorable. However, in untreated cases or patients with compromised immune systems or systemic illness, disfigurement and death may occur. Accurate diagnosis necessitates a high index of suspicion. The gold standard for diagnosis involves a wet mount, cultures, and molecular methodologies using DNA probes and polymerase chain reaction (PCR). Advanced imaging using magnetic resonance imaging (MRI) or computed tomography (CT) may be necessary in some cases. Histologically, the Splendore-Hoeppli phenomenon may be apparent. Although typical antifungals are the standard treatment, the fungi display resistance, requiring prolonged combination therapy. Surgical debridement and reconstruction may also be essential. Healthcare professionals should consider entomophthoromycosis in patients with classic symptoms, especially those who lived in or traveled to tropical or subtropical climates, due to its potential for disfigurement and mortality.