Fungi causing Subcutaneous Zygomycosis. Order Mucorales Order Entomophthorales Acute Chronic

Zygomycosis (Mucorales). Mucorales infections Definition: Angiotropic (blood vessel-invading) The most common genera causing disease are: Rhizopus Rhizomucor Mucor Absidia Fast growing non-septate molds

Geographical distribution & normal habitat World-wide Soil and decomposing organic matter Found in outdoor and indoor air Food and dust Clinical forms The infection typically involves the: Rhino-facial-cranial area Lungs, gastrointestinal tract or skin Other parts can also be affected

Risk factors The disease is associated with: Diabetic ketoacidosis Malnourished children Severely burned patients It is also seen in patients with Leukemia Lymphoma AIDS In patients using corticosteroids

Laboratory diagnosis Specimens: Aspirated material from sinuses Sputum in pulmonary disease Biopsy material Management of mucormycosis The prognosis is bad Most cases of gastric and pelvic disease are diagnosed at autopsy Cases occurred in patients with pulmonary disease, leukemia, or with lymphomas, are usually fatal Control of the diabetes, aggressive surgical debridement of involved tissue, and high doses of Amphotericin B are recommended

2- Zygomycosis Order Entomophthorales Entomophthorales infections Causes subcutaneous zygomycosis Known as Entomophthoromycosis Tow genera are involved: Conidiobolus Basidiobolus Infections are: Chronic Slowly progressive Restricted to the subcutaneous tissue

Not like Mucorales: No vascular invasion or infarction Chronic inflammatory response Basidiobolus infection Chronic inflammatory or granulomatous disease Subcutaneous tissue of the limbs, chest, back or buttocks Mostly in children (predominance in males)

Conidiobolus infection Chronic inflammatory or granulomatous disease Nasal submucosa Characterized by polyps or palpable subcutaneous masses Occur mainly in adult (80% of cases) Laboratory diagnosis Specimens: Aspirated material from sinuses Biopsy material

The following steps are used for the both types of Zygomycosis: 10 or 20% KOH: Typically contain thick-walled aseptate hyphae Swollen cells (up to 50 um) and distorted hyphae may be present Culture: SDA without cycloheximide at 30°C Rapid growth 3- A diagnosis can also be made by examining a biopsy for granuloma formation and the presence of aseptate hyphae, eosinophils, neutrophils, and fibroblasts. Tissue for culture should be send in a dry sterile container, and biopsies should be fixed and send in formal saline.

Sporangium containing sporangiospores

Spherical, brown zygospores formed between opposite suspensors Spherical, brown zygospores formed between opposite suspensors. Also, present sporangiola.

Typical colony on Sabouraud glucose agar at 25C

Hyphae in lung tissue

Hyaline sparsely septate hyphae biopsy specimen of palate.

A peach, which has been colonized by Rhizopus sp

A gastric proliferative mycosis in a chicken caused by Rhyzopus arrhizus

Wide, sparsely-septate hyphae and striated sporangiospores

Non-septate (coenocytic) hyphal strand characteristic of the fungi belonging to the Zygomycetes