Conidiobolomycosis

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Conidiobolomycosis
Other namesRhinoentomophthoromycosis [1]
Conidiobolus coronatus (10.3897-mycokeys.66.46575) Figure 4.jpg
Conidiobolus coronatus [2]
Specialty Infectious disease [3]
Symptoms Firm painless swelling in nose, sinuses, cheeks and upper lips, blocked nose, runny nose, nose bleed [4]
Complications
Usual onsetSlowly progressive [6]
Duration Long term [4]
Causesfungi of the genus Conidiobolus [4]
Diagnostic method Medical imaging, biopsy, microscopy, culture [5]
Differential diagnosis Soft tissue tumors, [4] Mucormycosis
Treatment Antifungals, surgical debridement [6]
Medication oral Itraconazole, topical Potassium iodide [6] Severe disease: intravenous Amphotericin B [5]
Prognosis Longterm morbidity: facial disfigurement, [4] good response to treatment [7]
FrequencyRare, M>F [4] adults>children [5]
DeathsRare [6]

Conidiobolomycosis is a rare long-term fungal infection that is typically found just under the skin of the nose, sinuses, cheeks and upper lips. [3] [4] It may present with a nose bleed or a blocked or runny nose. [4] Typically there is a firm painless swelling which can slowly extend to the nasal bridge and eyes, sometimes causing facial disfigurement. [6]

Contents

Most cases are caused by Conidiobolus coronatus , a fungus found in soil and in the environment in general, which can infect healthy people. [4] It is usually acquired by inhaling the spores of the fungus, but can be by direct infection through a cut in the skin such as an insect bite. [3] [4]

The extent of disease may be seen using medical imaging such as CT scanning of the nose and sinus. [4] Diagnosis may be confirmed by biopsy, microscopy, culture and histopathology. [4] [5] Treatment is with long courses of antifungals and sometimes cutting out infected tissue. [6] The condition has a good response to antifungal treatment, [7] but can recur. [8] The infection is rarely fatal. [6]

The condition occurs more frequently in adults working or living in the tropical forests of South and Central America, West Africa and Southeast Asia. [4] [5] Males are affected more than females. [4] The first case in a human was described in Jamaica in 1965. [4]

Signs and symptoms

The infection presents with firm lumps just under the skin of the nose, sinuses, upper lips, mouth and cheeks. [4] The swelling is painless and may feel "woody". [8] Sinus pain may occur. [6] Infection may extend to involve the nasal bridge, face and eyes, sometimes resulting in facial disfigurement. [4] The nose may feel blocked or have a discharge, and may bleed. [4]

Cause

Conidiobolomycosis is a type of Entomophthoromycosis, the other being basidiobolomycosis, and is caused by mainly Conidiobolus coronatus , but also Conidiobolus incongruus and Conidiobolus lamprauges [4]

Mechanism

Conidiobolomycosis chiefly affects the central face, usually beginning in the nose before extending onto paranasal sinuses, cheeks, upper lip and pharynx. [5] The disease is acquired usually by breathing in the spores of the fungus, which then infect the tissue of the nose and paranasal sinuses, from where it slowly spreads. [4] It can attach to underlying tissues, but not bone. [4] [5] It can be acquired by direct infection through a small cut in the skin such as an insect bite. [3] Thrombosis, infarction of tissue and spread into blood vessels does not occur. [4] Deep and systemic infection is possible in people with a weakened immune system. [4] Infection causes a local chronic granulomatous reaction. [6]

Diagnosis

The condition is typically diagnosed after noticing facial changes. [6] The extent of disease may be seen using medical imaging such as CT scanning of the nose and sinus. [4] Diagnosis can be confirmed by biopsy, microscopy, and culture. [4] Histology reveals wide but thin-walled fungal filaments with branching at right-angles. [5] There are only a few septae. [5] The fungus is fragile and hence rarely isolated. [1] An immunoallergic reaction might be observed, where a local antigen–antibody reaction causes eosinophils and hyaline material to surround the organism. [5] Molecular methods may also be used to identify the fungus. [5]

Differential diagnosis

Differential diagnosis includes soft tissue tumors. [4] Other conditions that may appear similar include mucormycosis, cellulitis, rhinoscleroma and lymphoma. [6]

Treatment

Treatment is with long courses of antifungals and sometimes cutting out infected tissue. [6] Generally, treatment is with triazoles, preferably itraconazole. [5] A second choice is potassium iodide, either alone or combined with itraconazole. [5] In severe widespread disease, amphotericin B may be an option. [5] The condition has a good response to antifungal treatment, [7] but can recur. [8] The infection is rarely fatal but often disfiguring. [6]

Epidemiology

The disease is rare, occurring mainly in those working or living in the tropical forests of West Africa, Southeast Asia, South and Central America, [4] as well India, Saudi Arabia and Oman. [5] Conidiobolus species have been found in areas of high humidity such as the coasts of the United Kingdom, eastern United States and West Africa. [6]

Adults are affected more than children. [5] Males are affected more than females. [4]

History

The condition was first reported in 1961 in horses in Texas. [4] The first case in a human was described in 1965 in Jamaica. [4] Previously this genus was thought to only infect insects. [4]

Other animals

Conidiobolomycosis affects spiders, termites and other arthropods. [4] The condition has been described in dogs, horses, sheep and other mammals. [9] Affected mammals typically present with irregular lumps in one or both nostrils that cause obstruction, bloody nasal discharge and noisy abnormal breathing. [9]

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<span class="mw-page-title-main">Tinea capitis</span> Cutaneous fungal infection of the scalp

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<span class="mw-page-title-main">Zygomycosis</span> Medical condition

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<span class="mw-page-title-main">Fungal infection</span> Disease caused by fungi to animals or humans

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Eumycetoma, also known as Madura foot, is a persistent fungal infection of the skin and the tissues just under the skin, affecting most commonly the feet, although it can occur in hands and other body parts. It starts as a painless wet nodule, which may be present for years before ulceration, swelling, grainy discharge and weeping from sinuses and fistulae, followed by bone deformity.

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<span class="mw-page-title-main">Onychomycosis</span> Medical condition

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<span class="mw-page-title-main">Aspergilloma</span> Medical condition

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<span class="mw-page-title-main">Sporotrichosis</span> Medical condition

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<span class="mw-page-title-main">Aspergillosis</span> Medical condition

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<i>Basidiobolus ranarum</i> Species of fungus

Basidiobolus ranarum is a filamentous fungus with worldwide distribution. The fungus was first isolated by Eidam in 1886. It can saprophytically live in the intestines of mainly cold-blooded vertebrates and on decaying fruits and soil. The fungus prefers glucose as a carbon source and grows rapidly at room temperature. Basidiobolus ranarum is also known as a cause of subcutaneous zygomycosis, usually causing granulomatous infections on a host's limbs. Infections are generally geographically limited to tropical and subtropical regions such as East and West Africa. Subcutaneous zygomycosis caused by B. ranarum is a rare disease and predominantly affects children and males. Common subcutaneous zygomycosis shows characteristic features and is relatively easy to be diagnosed; while, certain rare cases might show non-specific clinical features that might pose a difficulty on its identification. Although disease caused by this fungus is known to resolve spontaneously on its own, there are a number of treatments available.

<span class="mw-page-title-main">Tinea nigra</span> Medical condition

Tinea nigra, also known as superficial phaeohyphomycosis and Tinea nigra palmaris et plantaris, is a superficial fungal infection, a type of phaeohyphomycosis rather than a tinea, that causes usually a single 1–5 cm dark brown-black, non-scaly, flat, painless patch on the palms of the hands and the soles of the feet of healthy people. There may be multiple spots. The macules occasionally extend to the fingers, toes, and nails, and may be reported on the chest, neck, or genital area. Tinea nigra infections can present with multiple macules that can be mottled or velvety in appearance, and may be oval or irregular in shape. The macules can be anywhere from a few mm to several cm in size.

A sinus is a sac or cavity in any organ or tissue, or an abnormal cavity or passage. In common usage, "sinus" usually refers to the paranasal sinuses, which are air cavities in the cranial bones, especially those near the nose and connecting to it. Most individuals have four paired cavities located in the cranial bone or skull.

<span class="mw-page-title-main">Mucormycosis</span> Fungal infection

Mucormycosis, also known as black fungus, is a serious fungal infection that comes under fulminant fungal sinusitis, usually in people who are immunocompromised. It is curable only when diagnosed early. Symptoms depend on where in the body the infection occurs. It most commonly infects the nose, sinuses, eyes and brain resulting in a runny nose, one-sided facial swelling and pain, headache, fever, blurred vision, bulging or displacement of the eye (proptosis), and tissue death. Other forms of disease may infect the lungs, stomach and intestines, and skin. The fatality rate is about 54%.

<i>Conidiobolus coronatus</i> Species of fungus

Conidiobolus coronatus is a saprotrophic fungus, first described by Costantin in 1897 as Boudierella coronata. Though this fungus has also been known by the name Entomophthora coronata, the correct name is Conidiobolus coronatus. C. coronatus is able to infect humans and animals, and the first human infection with C. coronatus was reported in Jamaica in 1965.

Phaeohyphomycosis is a diverse group of fungal infections, caused by dematiaceous fungi whose morphologic characteristics in tissue include hyphae, yeast-like cells, or a combination of these. It can be associated with an array of melanistic filamentous fungi including Alternaria species, Exophiala jeanselmei, and Rhinocladiella mackenziei.

<span class="mw-page-title-main">Fungal sinusitis</span> Inflammation of the paranasal sinuses due to fungal infection

Fungal sinusitis or fungal rhinosinusitis is the inflammation of the lining mucosa of the paranasal sinuses due to a fungal infection. It occurs in people with reduced immunity. The maxillary sinus is the most commonly involved. Fungi responsible for fungal sinusitis are Aspergillus fumigatus (90%), Aspergillus flavus, and Aspergillus niger. Fungal sinusitis occurs most commonly in middle-aged populations. Diabetes mellitus is the most common risk factor involved.

<i>Aspergillus felis</i> Species of fungus

Aspergillus felis is a heterothallic species of fungus in the genus Aspergillus which can cause aspergillosis in humans, dogs and cats. It was described for the first time in 2013 after being isolated from different hosts worldwide.

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