• Users Online: 2232
  • Print this page
  • Email this page


 
  Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 6  |  Issue : 6  |  Page : 410-412  

Subcutaneous entomophthoromycoses


1 Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
2 Department of Dermatology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India

Date of Web Publication17-Nov-2015

Correspondence Address:
Tadepalli Karuna
Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bhopal - 462 020
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.169730

Rights and Permissions
   Abstract 

Subcutaneous entomophthoromycoses is a zygomycosis caused by Basidiobolus ranarum that is endemic in southern India. We report the case of a 63-year-old male from central India who presented with a nontender subcutaneous hyperpigmented plaque on his leg with mild discharge that yielded Basidiobolus ranarum.

Keywords: Basidiobolomycosis, Basidiobolus ranarum, entomophthoromycoses


How to cite this article:
Karuna T, Asati DP, Biswas D, Purwar S. Subcutaneous entomophthoromycoses. Indian Dermatol Online J 2015;6:410-2

How to cite this URL:
Karuna T, Asati DP, Biswas D, Purwar S. Subcutaneous entomophthoromycoses. Indian Dermatol Online J [serial online] 2015 [cited 2020 Sep 26];6:410-2. Available from: http://www.idoj.in/text.asp?2015/6/6/410/169730


   Introduction Top


Basidiobolus species are filamentous fungi belonging to the order Entomophthorales. Unlike other zygomycetes, Basidiobolus species can cause subcutaneous zygomycosis in healthy individuals.[1] Subcutaneous zygomycosis is a common presentation reported from many tropical countries. It is low endemic in southern India, including Pondicherry.[2],[3],[4],[5] The disease usually occurs in children, less often in adolescents, and rarely in adults.[6] Males are much more frequently affected than females.[6]

It is mainly isolated from the extremities, trunk, intestinal tract, and rarely other parts of the body.[7] Herein we report a case of subcutaneous basidiobolomycosis caused by Basidiobolus ranarum in a male executive residing at Bhopal, central India.


   Case Report Top


A 63-year-old man presented to the dermatology department of AIIMS, Bhopal, with a chronic, nonhealing, nodular, hyperpigmented plaque with superficial erosions and oozing on his left leg since three years with a history of unspecified casual trauma. He was a nonsmoker and a teetotaller. On local examination, there was a solitary nodule 5 cm in size and a nonindurated, nontender, hyperpigmented, and superficially eroded plaque covering almost three fourths of his leg with scanty non-foul smelling pus discharge on its surface [Figure 1]. Systemic examination was within normal limits. His routine hematologic and biochemical parameters including complete hemogram, liver and kidney function tests, fasting, and postprandial blood glucose levels, serum proteins, and erythrocyte sedimentation rate were in normal range. Chest radiography and local limb radiography did not reveal any significant abnormalities. A provisional diagnosis of a soft tissue fungal infection was made. The hematoxylin and eosin stained sections after skin biopsy revealed inflammatory granulation tissue. Tissue material and several skin scrapings from the plaque were examined in 10% potassium hydroxide preparation, that showed broad, hyaline, thin-walled, infrequently septate mycelia. Samples were inoculated in two sets of Sabouraud dextrose agar (SDA). One set was incubated at 37°C and another at 25°C. Growth was observed within 5 days at both temperatures and as creamy white, waxy, and glabrous colonies with many radial folds and a few satellite colonies [Figure 2]. On performing lactophenol cotton blue wet mount of the fungus, infrequently septate hyphae, and numerous globose, smooth-walled zygospores with conjugation beaks were observed characteristic of Basidiobolus ranarum [Figure 3],[Figure 4],[Figure 5]. The patient was started on oral itraconazole 400 mg/day and placed on follow up.
Figure 1: Subcutaneous hyperpigmented plaque

Click here to view
Figure 2: Sabouraud dextrose agar at 35°C and 25°C with creamy white, waxy, and glabrous colony with many radial folds and few satellite colonies

Click here to view
Figure 3: Lactophenol cotton blue mount showing aseptate hyphae and numerous globose, smooth-walled zygospores

Click here to view
Figure 4: Zygospores with characteristic conjugation beaks

Click here to view
Figure 5: Globose primary conidia with a few clavate-shaped secondary conidia

Click here to view



   Discussion Top


Subcutaneous zygomycosis, the commonest clinical form of basidiobolomycosis, is a low endemic fungal infection in southern India.[2],[3],[4] There are scarce case reports from other parts of India, including north-eastern India (a 11-year-old girl) and Chattisgarh (a 58-year-old female patient).[8],[9] Our patient belonged to Bhopal, central India. No predisposing factor identifiable in this case, although traumatic implantation was the likely mode of entry.[5] Histologically, basidiobolomycosis is associated with eosinophilic infiltration. It has been postulated that the predominant Th2 type of immune response with the release of the cytokines IL-4 and IL-10 recruits eosinophils to the affected site.[5] Basidiobolus can be cultured on routine media such as Sabouraud dextrose agar (SDA), potato dextrose agar, or cornmeal agar. The colonies are typically flat and furrowed, with a wavy texture, a yellow-gray surface with pale reverse, and a musty odour. Microscopically, the colonies produce large vegetative hyphae, which become increasingly septate as they mature. The role of KOH smear cannot be underestimated and is a valuable aid in diagnosis.[10] In our case also, KOH mount and culture on SDA were valuable in the diagnosis.

Most patients with basidiobolomycosis respond well to oral potassium iodide as also to azoles, particularly itraconazole.[11],[12] Treatment with amphotericin B has given unsatisfactory results, with some strains even showing in vitro resistance to this drug.[13] Our case also responded to oral itraconazole.


   Acknowledgments Top


The authors thank Dr. Kajal Gupta, Mr. Suneel Bhooshan, and Mr. Pradeep Kumar Gupta for their technical work.

 
   References Top

1.
Zavasky DM, Samowitz W, Loftus T, Segal H, Carroll K. Gastrointestinal zygomycotic infection caused by Basidiobolus ranarum: Case report and review. Clin Infect Dis 1999;28:1244-8.  Back to cited text no. 1
    
2.
Sood S, Sethi S, Banerjee U. Entomophthoromycosis due to Basidiobolus haptosporus. Mycoses 1997;40:345-6.  Back to cited text no. 2
    
3.
Koshi G, Kurien T, Sudarsanam D, Selvapandian AJ, Mammen KE. Subcutaneous phycomycosis caused by Basidiobolus. A report of three cases. Sabouraudia 1972;10:237-43.  Back to cited text no. 3
[PUBMED]    
4.
Dasgupta LR, Agarwall SC, Varma RA, Bedi BM, Chatterjee H. Subcutaneous phycomycosis from Pondicherry, South India. Sabouraudia 1976;14:123-7.  Back to cited text no. 4
[PUBMED]    
5.
Sujatha S, Sheeladevi C, Khyriem AB, Parija SC, Thappa DM. Subcutaneous zygomycosis caused by Basidiobolusranarum: A case report. Indian J Med Microbiol 2003;21:205-6.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Gugnani HC. A review of zygomycosis due to Basidiobolus ranarum. Eur J Epidemiol 1999;15:923-9.  Back to cited text no. 6
    
7.
Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev 2000;13:236-301.  Back to cited text no. 7
    
8.
Singh R, Xess I, Ramavat AS, Arora R. Basidiobolomycosis: A rare case report. Indian J Med Microbiol 2008;26:265-7.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.
Jayanth ST, Gaikwad P, Promila M, Muthusami JC. The sinus that breeds fungus: Subcutaneous zygomycosis caused by Basidiobolus ranarum at the injection site. Case Rep Infect Dis 2013;2013:534192.  Back to cited text no. 9
    
10.
Kumar Verma R, Shivaprakash MR, Shanker A, Panda NK. Subcutaneous zygomycosis of the cervicotemporal region: Due to Basidiobolus ranaram. Med Mycol Case Rep 2012;1:59-62.  Back to cited text no. 10
    
11.
Thotan SP, Kumar V, Gupta A, Mallya A, Rao S. Subcutaneous phycomycosis--fungal infection mimicking a soft tissue tumor: A case report and review of literature. J Trop Pediatr 2009;56:65-6.  Back to cited text no. 11
    
12.
Mathew R, Kumaravel S, Kuruvilla S, Varghese RG, Shashikala, Srinivasan S, et al. Successful treatment of extensive basidiobolomycosis with oral itraconazole in a child. Int J Dermatol 2005;44:572-5.  Back to cited text no. 12
    
13.
Khan ZU, Khoursheed M, Makar R, Al-Waheeb S, Al-Bader I, Al-Muzaini A, et al. Basidiobolus ranarum as an etiologic agent of gastrointestinal zygomycosis. J Clin Microbiol 2001;39:2360-3.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


This article has been cited by
1 Cutaneous basidiobolomycosis: Seven cases in southern Benin
F. Atadokpédé,J. Gnossikè,H. Adégbidi,B. Dégboé,Y. Sissinto-Savi de Tovè,A. Adéyé,C. Koudoukpo,A. Chauty,D. Chabasse,J.-P. Saint-André,M.-T. Dieng,M.-C. Koeppel,H.-G. Yedomon,F. do-Ango-Padonou
Annales de Dermatologie et de Vénéréologie. 2017;
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Report
   Discussion
   Acknowledgments
    References
    Article Figures

 Article Access Statistics
    Viewed1196    
    Printed8    
    Emailed0    
    PDF Downloaded200    
    Comments [Add]    
    Cited by others 1    

Recommend this journal