Lymphoedema and Elephantiasis in Basidiobolomycosis: Lymphödem und Elephantiasis bei Basidiobolomykose

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Lymphoedema with subsequent elephantiasis as sequelae to chronic basidiobolomycosis in one of our previously reported cases is described. The possible prevention of such changes in this infection when detected and treated in its earlier stages before lymph node invasion is emphasised. Zusammenfassung: Beschreibung emes Lymphödems mit nachfolgender Elephantiasis als Folge einer chronischen Basidiobolomykose bei einem bereits früher publizierten Fall. Es wird hervorgehoben, daß durch eine rechtzeitige Erkennung und Behandlung vor dem Stadium der Lymphknoteninvasion denutige Folgeerscheinungen verhindert werden können.

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... A few cases of involvement of the muscles and enlargement of the local lymph nodes have been reported [4, 21±22]. One case of lymph node involvement on the leg (Figure 2) had massive lympoedema resembling ®larial elephantiasis [22]. A case mimicking Burkitt's lymphoma has been reported [23]. ...
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Zygomycosis due to Basidiobolus ranarum (entomophthoromycosis basidiobolae, subcutaneous zygomycosis, subcutaneous phycomycosis, basidiobolomycosis) is a granulomatous infection of the skin and subcutaneous tissues characterized by the formation of fluctuant firm and non-tender swellings, generally on the extremities, trunk and rarely other parts of the body. The causative agent is common in soil, decaying vegetable matter, and the gastrointestinal tracts of amphibians, reptiles, fish and bats. It is presumed that infection is acquired through exposure to B. ranarum following minor trauma to skin or insect bites. The disease usually occurs in children, less often in adolescents and rarely in adults. Males are much more frequently affected than females. Laboratory diagnosis is based on histopathology and culture. The typical histopathological feature is the presence of thin-walled, broad often aseptate hyphae or hyphal fragments with an eosinophilic sheath, frequently phagocytized within giant cells. Basidiobolus ranarum is known to produce several enzymes, e.g. lipase and protease that probably play roles in the pathogenesis of infections caused by this mould. An immunological test has been developed for specific diagnosis of the disease. Though potassium iodide (KI) has been the traditional drug employed in the treatment of infections by B. ranarum, several other drugs, viz amphotericin B, cotrimoxazole, ketoconazole, itraconazole and fluconazole have been successfully tried.
A brief account is given of the history and early progress of medical mycology in India, including the contributions of British Army physicians, surgeons, and our physicians (MDs, DM) and scientists with PhD in mycology, medical mycology, or medical microbiology. A noteworthy feature is the discovery by our eminent mycologists, Prof. S.B. Saxena and Prof. P.C. Misra, of new genera and species of fungi, namely, Saksenaea vasiformis and Apophysomyces elegans, which are now recognized as agents of human fungal infections worldwide. A mention is also made of the discovery of several new species of species of pathogenic molds and yeasts, novel pathogens, and novel lab techniques by medical mycologists. Recent progress of medical mycology in different medical institutions including the four internationally recognized centers of research on ocular fungal infections in India is covered in detail with lists of important publications (2000–2020) from these institutions. Aspects of training graduates in medicine and postgraduates in microbiology, medical microbiology, and biological sciences are adequately dealt with including the mention of self-learning resources. The need for their attending workshops and training courses offered by premier medical institutions in India is emphasized. Suggestions are given in detail for surveys by Department of Preventive and Social Medicine in medical colleges with the collaboration of state departments of health/primary health centers in communities representative of their areas to investigate the occurrence of fungal infections like ringworm, keratitis, and mycetoma to estimate their burden and chalk out preventive measures. The need for exploring antifungal therapy by herbal drugs by our mycologists and physicians is also emphasized. In the end of the chapter, the history of Indian Society of Medical Mycologists (ISMM) and its present status, ISMM awards, and ISMM Newsletter are mentioned.KeywordsHistorical accountEarly progressRecent progressNew speciesNovel pathogensPreventionHerbal therapyISMMSelf-learningResources
Entomophthoromycosis basidiobolae in a 2½ year old female child is described with clinical, mycological and histopathological findings. Oral potassium iodide resolved the condition successfully. Zusammenfassung: Entomophthoromycosis basidiobolae in einem zweieinhalbjährigen Kind (Mädchen) wird mit Angaben von klinischen, mykologischen und histopathologischen Befunden beschrieben. Orale Kaliumjodid-Gaben haben den Krankheits-zustand mit Erfolg behoben.
Lymph node invasion with presence of conidia, their replicates, germ tubes, condidia with hair-like projections and hyphae have been observed in a case of entomophthoromycosis caused by Conidiobolus coronatus. This rare occurrence of conidia with hair-like projections that is usually observed in vitro, has been observed in vivo, in the content of an abscess produced by this agent, C. coronatus in the present case. Severe disfigurement and destruction of facial and nasopharyngeal tissues, have also been observed in this case. Response to therapy with oral KI, surgery, combinations of trimethoprim and sulphamethoxazole and steroids though found useful initially, was ineffective subsequently as the disease progressed over 7 years. Findings of lymphatic invasion and the extensive destruction observed in the present case warrants a guarded prognosis. Free conidial reproduction found in lymph nodes may suggest the possibility of this disease being infectious, requiring an active and vigorous treatment schedule and control measures in this infection.
Two cases of Basidiobolomycosis caused by species of the order Entomophthorales are discussed with the report on lymph node involvement by B. haptosphorus. A clearer aetiological classification of the diseases caused by various agents belonging to the class Phycomycetes is preferred in view of the distinct clinical entities produced by them. Involvement of the lymph nodes is also an evidence that the disease produced by B. haptosporus is not restricted to subcutaneous tissue. A routine lymph node biopsy with mycological studies of the node is suggested in such cases.
Three cases of subcutaneous phycomycoses in south Indians are reported. Two of the lesions were in children: an 8 year-old girl having a lesion of the thigh and a 2 1/2 year-old boy of the whole upper limb and pectoral region; the third was in a 28 year-old man who had lesions of the thigh and gluteal region. The specific diagnosis was made by histopathology and by the isolation of Basidiobolus haptosporus from each of the cases. The girl responded well to wide excision and skin grafting followed by potassium iodide (KI) treatment. With KI treatment there was remarkable improvement in the boy and fair response in 9 days in the 28 year-old man. Es wird über drei Fälle einer subkutanen Phycomycosis in Südindien berichtet. Zwei Läsionen betrafen Kinder: ein 8-jähriges Mädchen mit der Krankheit am Oberschenkel und einen 2 1/2-jährigen Knaben, bei dem eine ganze obere Extremität bis in die Pectoralgegend betroffen war. Bei dem dritten Fall handelte es sich um einen 28-jährigen Mann, der Herde am Oberschenkel und am Gesäß aufwies. In jedem der Fälle wurde die genaue Diagnose histologisch und durch Isolierung des Basidiobolus haptosporus gestellt. Die erste Patientin reagierte gut eine weite Excision mit anschließender Hautverpflanzung und einer Nachbehandlung mit Kalium jodatum. Eine bemerkenswerte Besserung nach der Behandlung mit Kalium jodatum machte sich im Falle des Jungen bemerkbar. Bei dem 28-jährigen Mann zeitigte die Behandlung mit Kalium jodatum eine gute Reaktion im Frühstadium.
SUMMARYA case of subcutaneous phycomycosis with clinical, histological and mycological studies is reported. An excellent result with oral potassium iodide therapy was observed.
Basidiobolomycosis following intramuscular injection in a 6 year old female child is reported. Regional lymph nodes in the inguinal areas on both sides conforms to such findings in our previous cases, denoting that this infection is systemic. Simple oral potassium iodide (KI) has cured the disease without a relapse during follow up of nearly 3 years. Zusammenfassung: Bei einem 6jährigen Mädchen entwickelte sich im Anschluß an eine intramuskuläre Injektion eine Basidiobolomykose. Ähnlich wie bei anderen Fäillen lag eine Beteiligung der regionalen Lymphknoten in beiden Leisten vor, wodurch eine systemische Ausbreitung angezeigt wird. Behandlung mit Kaliumjodid oral führte zur vollständigen Heilung ohne Rückfall bei dreijähriger Nachbeobachtungszeit.
Evolution and treatment of a case of
  • R Vanbreuseghem