1. Zygomycosis Order Mucorales Order Entomophthorales Zygomycetes Zygomycota MucormycosisEntomophthomycosis Acute Chronic

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

3. Clinical forms The infection typically involves the: Rhino-facial-cranial area Lungs, gastrointestinal tract or skin Other parts can also be affected

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

5. Invasive zygomycosis A 45-year-old woman with poorly controlled diabetes mellitus with facial and periorbital swelling due to zygomycosis. Author: Jose A Vazquez, MD, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Wayne State University School of Medicine

6. Order Entomophthorales

7. Entomophthorales infections Causes subcutaneous zygomycosis Tow genera are involved: Conidiobolus Basidiobolus

8. Entomophthorales infections Infections are: Chronic Slowly progressive Restricted to the subcutaneous tissue Not like Mucorales: No vascular invasion or infarction

9. Basidiobolus infection Chronic inflammatory or granulomatous disease Subcutaneous tissue of the limbs, chest, back or buttocks Mostly in children (predominance in males)

10. Conidiobolus infection Chronic inflammatory or granulomatous disease Nasal submucosa Characterized by polyps or palpable subcutaneous masses Occur mainly in adult (80% of cases)

11. Zygomycosis caused by Conidiobolus Basidiobolus ranarum Zygomycosis caused by Basidiobolus ranarum

12. Laboratory diagnosis Specimens: Aspirated material from sinuses Sputum in pulmonary disease Biopsy material 10 or 20% KOH: Typically contain thick-walled aseptate hyphae Swollen cells (up to 50 um) and distorted hyphae may be present

13. Zygomycosis Tissue sections stained with PAS

14. Laboratory diagnosis (continued) Culture: SDA without cycloheximide at 30°C Characterized by rapid growth

15. Zygomycetes colony growing on Sabouraud glucose agar. 25C

16. Rhizomucor Absidia

17. 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

18. Management of Entomophthoromycosis Infections caused by Basidiobolus Drug of choice saturated potassium iodide solution for 6-12 months Oral ketoconazole and fluconazole Sub-mucosal infections caused by Conidiobolus species: Potassium iodide solution Amphotericin B Trimethoprim-sulfamethoxazole