Different types of mucormycosis: case series
DOI:
https://doi.org/10.18203/2320-6012.ijrms20202281Keywords:
Amphotericin-B, Mucorales, Mucormycosis, Rhizopus, ZygomycetesAbstract
Mucormycosis is the third invasive mycosis in order of importance after candidiasis and aspergillosis and is caused by fungi of the class Zygomycetes. The most important species causing Mucormycosis is Rhizopus arrhizus (oryzae). Identification of the agents responsible for mucormycosis is based on macroscopic and microscopic morphological criteria, carbohydrate assimilation and the maximum temperature compatible with its growth. The incidence of mucormycosis is approximately 1.7 cases per 1000 000 inhabitants per year. Clinical diagnosis of mucormycosis is difficult, and is often made at a late stage of the disease or post-mortem. We present here a series of five cases of different types of mucormycosis that were reported in our hospital till date. Of which three patients had good recovery and other two had a fatal outcome. Treatment of mucormycosis requires a rapid diagnosis, correction of predisposing factors, surgical resection or debridement as part of source control-and appropriate anti-fungal therapy. Liposomal amphotericin B is the drug of choice for this condition. The overall rate of mortality of mucormycosis is approximately 40%.
References
Prabhu RM, Patel R. Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment. Clin Microbiol Infect 2004;10(suppl 1):31-47.
Rees JR, Pinner RW, Hajjeh RA, Brandt ME, Reingold AL. The epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992-1993: results of population-based laboratory active surveillance. Clin Infect Dis 1998;27(5):1138-47.
Kontoyiannis DP, Wessel VC, Bodey GP, Rolston KV. Zygomycosis in the 1990s in a tertiary-care cancer center. Clin Infect Dis 2000;30(6):851-6.
Nussbaum ES, Hall WA. Rhinocerebral mucormycosis: changing patterns of disease. Surg Neurol 1994;41(2):152-6.
Rickerts V, Bohme A, Just-Nubling G. Risk factor for invasive zygomycosis in patients with hematologic malignancies. Mycoses 2002; 45(suppl 1):27-30.
Kauffman CA. Zygomycosis: reemergence of an old pathogen. Clin Infect Dis 2004;39(4):588-90.
Gartenberg G, Bottone EJ, Keusch GT, Weitzman I. Hospital-acquired mucormycosis (Rhizopus rhizopodiformis) of skin and subcutaneous tissue: epidemiology, mycology and treatment. N Engl J Med 1978;299(20):1115-8.
Petrikkos G, Skiada A, Sambatakou H, Toskas A, Vaiopoulos G, Giannopoulou M, et al. Mucormycosis: ten-year experience at a tertiary-care center in Greece. Eur J Clin Microbiol Infect Dis 2003; 22(12):753-6.
Baraia J, Munoz P, Bernaldo de Quiros JC, Bouza E. Cutaneous mucormycosis in a heart transplant patient associated with a peripheral catheter. Eur J Clin Microbiol Infect Dis 1995;14(9):813-5.
Ritz N, Ammann RA, Aebischer CC, Gugger M, Jaton K, Schmid RA, et al. Failure of voriconazole to cure disseminated zygomycosis in an immunocompromised child. Eur J Pediatr 2005; 164(4):231-5.
Oren I. Breakthrough zygomycosis during empirical voriconazole therapy in febrile patients with neutropenia. Clin Infect Dis 2005;40(5):770-1.
Lionakis MS, Kontoyiannis DP. Sinus zygomycosis in a patient receiving voriconazole prophylaxis. Br J Haematol 2005;129(1):2.
Maertens J, Demuynck H, Verbeken EK, Zachee P, Verhoef GE, Vandenberghe P, et al. Mucormycosis in allogeneic bone marrow transplant recipients: report of five cases and review of the role of iron overload in the pathogenesis. Bone Marrow Transplant 1999;24(3):307-12.
Ingram CW, Sennesh J, Cooper JN, Perfect JR. Disseminated zygomycosis: report of four cases and review. Rev Infect Dis 1989;11(5):741-54.
Herbrecht R, Letscher-Bru V, Bowden RA. Treatment of 21 cases of invasive mucormycosis with amphotericin B colloidal dispersion. Eur J Clin Microbiol Infect Dis 2001;20:460-6.
Baddley JW, Stroud TP, Salzman D, Pappas PG. Invasive mold infections in allogeneic bone marrow transplant recipients. Clin Infect Dis 2001;32:1319-24.
Morrison VA, McGlave PB. Mucormycosis in the BMT population. Bone Marrow Transplant 1993; 11(5):383-8.
Nosari A, Oreste P, Montillo M. Mucormycosis in hematologic malignancies: an emerging fungal infection. Haematologica 2000;85(10):1068-71.
Baraia J, Munoz P, Bernaldo de Quiros JC, Bouza E. Cutaneous mucormycosis in a heart transplant patient associated with a peripheral catheter. Eur J Clin Microbiol Infect Dis 1995;14(9):813-5.
Marr KA, Carter RA, Crippa F, Wald A, Corey L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis 2002;34:909-17.
Jiménez C, Lumbreras C, Aguado JM, Loinaz C, Paseiro G, Andrés A, et al. Successful treatment of mucor infection after liver or pancreas–kidney transplantation. Transplantation 2002;73(3):476-80.
Nampoory MR, Khan ZU, Johny KV, Constandi JN, Gupta RK, Al-Muzairi I, et al. Invasive fungal infections in renal transplant recipients. J Infect 1996;33(2):95-101.
Morduchowicz G, Shmueli D, Shapira Z. Rhinocerebral mucormycosis in renal transplant recipients: report of three cases and review of the literature. Rev Infect Dis 1986;8:441-6.
Sehgal A, Raghavendran M, Kumar D, Srivastava A, Dubey D, Kumar A. Rhinocerebral mucormycosis causing basilar artery aneurysm with concomitant fungal colonic perforation in renal allograft recipient: a case report. Transplantation 2004;78(6):949-50.
Sehgal A, Raghavendran M, Kumar D, Srivastava A, Dubey D, Kumar A et al. Zygomycosis caused by Cunninghamella bertholletiae in a kidney transplant recipient. Med Mycol. 2004;42:177-80.
Mattner F, Weissbrodt H, Strueber M. Two case reports: fatal Absidia corymbifera pulmonary tract infection in the first postoperative phase of a lung transplant patient receiving voriconazole prophylaxis, and transient bronchial Absidia corymbifera colonization in a lung transplant patient. Scand J Infect Dis 2004;36(4):312-4.
Kerbaul F, Guidon C, Collart F, Lépidi H, Cayatte B, Bonnet M, et al. Abdominal wall mucormycosis after heart transplantation. J Cardiothorac Vasc Anesth 2004;18(6):822-3.
Tobon AM, Arango M, Fernandez D, Restrepo A. Mucormycosis (zygomycosis) in a heart–kidney transplant recipient: recovery after posaconazole therapy. Clin Infect Dis 2003;36(11):1488-91.
Minz M, Sharma A, Kashyap R et al. Isolated renal allograft arterial mucormycosis: an extremely rare complication. Nephrol Dial Transplant 2003; 18: 1034–1035.
Ladurner R, Brandacher G, Steurer W et al. Lessons to be learned from a complicated case of rhino-cerebral mucormycosis in a renal allograft recipient. Transpl Int 2003;16:885-9.
Zhang R, Zhang JW, Szerlip HM. Endocarditis and hemorrhagic stroke caused by Cunninghamella bertholletiae infection after kidney transplantation. Am J Kidney Dis 2002;40(4):842-6.
Vera A, Hubscher SG, McMaster P, Buckels JA. Invasive gastrointestinal zygomycosis in a liver transplant recipient: case report. Transplantation 2002;73(1):145-7.
Warnock DW. Fungal complications of transplantation: diagnosis, treatment and prevention. J Antimicrob Chemother 1995; 36 (suppl B):73-90.
Bertocchi M, Thevenet F, Bastien O. Fungal infections in lung transplant recipients. Transplant Proc 1995;27:1695.
Carbone KM, Pennington LR, Gimenez LF, Burrow CR, Watson AJ. Mucormycosis in renal transplant patients-a report of two cases and review of the literature. Q J Med 1985;57(3-4):825-31.
Haim S, Better OS, Lichtig C, Erlik D, Barzilai A. Rhinocerebral mucormycosis following kidney transplantation. Isr J Med Sci 1970;6:646-9.
Boelaert JR, de Locht M, Van Cutsem J, Kerrels V, Cantinieaux B, Verdonck A, et al. Mucormycosis during deferoxamine therapy is a siderophoremediated infection. In vitro and in vivo animal studies. J Clin Invest 1993;91(5):1979-86.
Van Cutsem J, Boelaert JR. Effects of deferoxamine, feroxamine and iron on experimental mucormycosis (zygomycosis). Kidney Int 1989;36(6):1061-8.
Kubota N, Miyazawa K, Shoji N, Sumi M, Nakajima A, Kimura Y, et al. A massive intraventricular thrombosis by disseminated mucormycosis in a patient with myelodysplastic syndrome during deferoxamine therapy. Haematologica 2003; 88(9): EIM13.
Venkattaramanabalaji GV, Foster D, Greene JN, Muro-Cacho CA, Sandin RL, et al. Mucormycosis associated with deferoxamine therapy after allogeneic bone marrow transplantation. Cancer Control 1997;4(2):168-71.
Prokopowicz GP, Bradley SF, Kauffman CA. Indolent zygomycosis associated with deferoxamine chelation therapy. Mycoses 1994;37:427-31.
Boelaert JR, Van Cutsem J, de Locht M, Schneider YJ, Crichton RR. Deferoxamine augments growth and pathogenicity of Rhizopus, while hydroxypyridinone chelators have no effect. Kidney Int 1994;4(3)5:667-71.
Boelaert JR, de Locht M, Schneider YJ. The effect of deferoxamine on different zygomycetes. J Infect Dis 1994;169(1):231-2.
Vlasveld LT, Sweder van Asbeck B. Treatment with deferoxamine: a real risk factor for mucormycosis? Nephron 1991;57:487-8.
Slade MP, Mc Nab AA. Fatal mucormycosis therapy associated with deferoxamine. Am J Ophthalmol 1991;112(5):594-5.
Ponz E, Campistol JM, Ribalta T. Mucormicosis diseminada en una paciente hemodializada en tratamiento con deferroxiamina. Rev Clin Esp 1991;188:85-7.
Boelaert JR, Fenves AZ, Coburn JW. Deferoxamine therapy and mucormycosis in dialysis patients: report of an international registry. Am J Kidney Dis 1991;18(6):660-7.
Vandevelde L, Bondewel C, Dubois M, De Vuyst M. Mucorales and deferoxamine: from saprophytic to pathogenic state. Acta Otorhinolaryngol Belg 1990;44(4):429-33.
Sane A, Manzi S, Perfect J, Herzberg AJ, Moore JO. Deferoxamine treatment as a risk factor for zygomycete infection. J Infect Dis 1989;159:151-2.
Eiser AR, Slifkin RF, Neff MS. Intestinal mucormycosis in hemodialysis patients following deferoxamine. Am J Kidney Dis 1987;10(1):71-3.
Goodill JJ, Abuelo JG. Mucormycosis-a new risk of deferoxamine therapy in dialysis patients with aluminum or iron overload? N Engl J Med 1987;317:54.
Veis JH, Contiguglia R, Klein M, Mishell J, Alfrey AC, Shapiro JI. Mucormycosis in deferoxamine-treated patients on dialysis. Ann Intern Med 1987; 107(2):258.
Windus DW, Stokes TJ, Julian BA, Fenves AZ. Fatal Rhizopus infections in hemodialysis patients receiving deferoxamine. Ann Intern Med 1987;107: 678-80.
Rex JH, Ginsberg AM, Fries LF, Pass HI, Kwon-Chung KJ. Cunninghamella bertholletiae infection associated with deferoxamine therapy. Rev Infect Dis 1988;10(6):1187-94.
McNab AA, McKelvie P. Iron overload is a risk factor for zygomycosis. Arch Ophthalmol 1997;115:919-21.
MacDonald ML, Weiss PJ, Deloach-Banta LJ, Comer SW. Primary cutaneous mucormycosis with a Mucor species: is iron overload a factor? Cutis 1994;54:275-8.
Sugar AM. Mucormycosis. Clin Infect Dis 1992; 14 (suppl 1):S126-9.
Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005; 41(5):634-53.
Chakrabarti A, Das A, Sharma A, Panda N, Das S, Gupta KL, et al. Ten years’ experience in zygomycosis at a tertiary care centre in India. J Infect 2001;42(4)261-6.
Parfrey NA. Improved diagnosis and prognosis of mucormycosis. A clinicopathologic study of 33 cases. Medicine (Baltimore) 1986;65:113-23.
Effat KG, Karam M, El-Kabani A. Pott’s puffy tumour caused by mucormycosis. J Laryngol Otol 2005;119:643-5.
Yohai RA, Bullock JD, Aziz AA, Markert RJ. Survival factors in rhino-orbital-cerebral mucormycosis. Surv Ophthalmol 1994;39(1):3-22.
Ferry AP, Abedi S. Diagnosis and management of rhinoorbitocerebral mucormycosis (phycomycosis). A report of 16 personally observed cases. Ophthalmology 1983;90:1096-104.
Nithyanandam S, Jacob MS, Battu RR, Thomas RK, Correa MA, D’Souza O. Rhino-orbito-cerebral mucormycosis. A retrospective analysis of clinical features and treatment outcomes. Ind J Ophthalmol 2003;51(3):231-6.
Gleissner B, Schilling A, Anagnostopolous I, Siehl I, Thiel E. Improved outcome of zygomycosis in patients with hematological diseases? Leuk Lymphoma 2004;45(7):1351-60.
DhiwakarM, Thakar A, Bahadur S. Improving outcomes in rhinocerebral mucormycosis early diagnostic pointers and prognostic factors. J Laryngol Otol 2003;117:861-5.
Van Dam AP, Pruijm MT, Harinck BI, Gelinck LB, Kuijper EJ. Pneumonia involving Aspergillus and Rhizopus spp. after a near-drowning incident with subsequent Nocardia cyriacigeorgici and N. farcinica coinfection as a late complication. Eur J Clin Microbiol Infect Dis 2005;24(1):61-4.
Dobrilovic N, Wait MA. Pulmonary mucormycosis. Ann Thorac Surg. 2005;79:354.
Kim Y, Lee KS, Jung KJ, Han J, Kim JS, Suh JS. Halo sign on high resolution CT: findings in spectrum of pulmonary diseases with pathologic correlation. J Comput Assist Tomogr 1999;23(4):622-6.
Jamadar DA, Kazerooni EA, Daly BD, White CS, Gross BH. Pulmonary zygomycosis: CT appearance. J Comput Assist Tomogr. 1995;19(5):733-8.
Chadli-Chaieb M, Bchir A, Fathallah-Mili A et al. Mucormycosis in the diabetic patient. Presse Med 2005;34(3):218-22.
Thajeb P, Thajeb T, Dai D. Fatal strokes in patients with rhino-orbito-cerebral mucormycosis and associated vasculopathy. Scand J Infect Dis 2004;36:643-8.
Thomas PA, Geraldine P. Rhino-orbito-cerebral mucormycosis. Ind J Ophthalmol 2004;52:171-2.
Dubey A, Patwardhan RV, Sampth S, Santosh V, Kolluri S, Nanda A. Intracranial fungal granuloma: analysis of 40 patients and review of the literature. Surg Neurol 2005;63(3):254-60.
Andresen D, Donaldson A, Choo L, Knox A, Klaassen M, Ursic C, et al. Multifocal cutaneous mucormycosis complicating polymicrobial wound infections in a tsunami survivor from Sri Lanka. Lancet 2005;365(9462):876-8.
Horre R, Jovanić B, Herff S, Marklein G, Zhou H, Heinze I, et al. Wound infection due to Absidia corymbifera and Candida albicans with fatal outcome. Med Mycol 2004;42(4):373-8.
Karim M, Ahmed R, Chishty K. Wound zygomycosis: two cases with unusual manifestations. Int J Infect Dis 2001;5:107-11.
Abter EI, Lutwick SM, Chapnick EK, Chittivelu S, Lutwick LI, Sabado M, et al. Mucormycosis of a median sternotomy wound. Cardiovasc Surg 1994;2(4):474-7.
Paparello SF, Parry RL, MacGillivray DC, Brock N, Mayers DL. Hospital-acquired wound mucormycosis. Clin Infect Dis 1992;14(1):350-2.
Vainrub B, Macareno A, Mandel S, Musher DM. Wound zygomycosis (mucormycosis) in otherwise healthy adults. Am J Med 1988;84(3):546-8.
Codish SD, Sheridan ID, Monaco AP. Mycotic wound infections. A new challenge of the surgeon. Arch Surg 1979;114(7):831-5.
Tang D, Wang W. Successful cure of an extensive burn injury complicated with mucor wound sepsis. Burns 1998;24(1):72-3.
Kraut EJ, Jordan MH, Steiner CR 3rd. Arterial occlusion and progressive gangrene caused by mucormycosis in a patient with burns. J Burn Care Rehabil 1993;14(5):552-6.
Cooter RD, Lim IS, Ellis DH, Leitch IO. Burn wound zygomycosis caused by Apophysomyces elegans. J Clin Microbiol 1990;28:2151-3.
Goldschmied-Reouven A, Shvoron A, Topaz M, Block C. Saksenaea vasiformis infection in a burn wound. J Med Vet Mycol 1989;27:427-9.
Chuntrasakul C, Chantarakul N. Mucormycosis in severely burned patients. Report of two cases with extensive destructive lesions. J Med Assoc Thai 1983;66(2):132-8.
Rabin ER, Lundberg GD, Mitchell ET. Mucormycosis in severely burned patients. Report of two cases with extensive destruction of the face and nasal cavity. N Engl J Med 1961;264:1286-9.
Legouge C, Caillot D, Chrétien ML, Lafon I, Ferrant E, Audia S, et al. The reversed halo sign: pathognomonic pattern of pulmonary mucormycosis in leukemic patients with neutropenia? Clin Infect Dis 2014;58(5):672.
Perez-Uribe A, Molina de Soschin D, Arenas R, Reyes M. Mucormicosis cuta´nea primaria en un paciente infectado con el virus de la inmunodeficiencia humana. Rev Iberoam Micol 2005;22(2):118-21.
Kapadia S, Polenakovik H. Cutaneous zygomycosis following attempted radial artery cannulation. Skin Med 2004;3(6):336-8.
Rubin AI, Grossman ME. Bull’s-eye cutaneous infarct of zygomycosis: a bedside diagnosis confirmed by touch preparation. J Am Acad Dermatol 2004;51(6):996-1001.
Everett ED, Pearson S, Rogers W. Rhizopus surgical wound infection with elasticized adhesive tape dressings. Arch Surg 1979;114(6):738-9.
Jain JK, Markowitz A, Khilanani PV, Lauter CB. Localized mucormycosis following intramuscular corticosteroid. Case report and review of the literature. Am J Med Sci 1978;275(2):209-16.
Stamm B. Mucormycosis of the stomach in a patient with multiple trauma. Histopathology 2005;47(2):222-3.
Virk SS, Singh RP, Arora AS, Grewal JS, Puri H. Gastric zygomycosis an unusual cause of massive upper gastrointestinal bleed. Ind J Gastroenterol 2004;23(4):146-7.
Maraví-Poma E, Rodríguez-Tudela JL, de Jalón JG, Manrique-Larralde A, Torroba L, Urtasun J, et al. Outbreak of gastric mucormycosis associated with the use of wooden tongue depressors in critically ill patients. Intens Care Med 2004;30(4):724-8.
Shahapure AG, Patankar RV, Bhatkhande R. Gastric mucormycosis. Ind J Gastroenterol 2002;21(6):231-2.
Paulo De Oliveira JE, Milech A. A fatal case of gastric mucormycosis and diabetic ketoacidosis. Endocr Pract 2002;8(1):44-6.
Park YS, Lee JD, Kim TH, Joo YH, Lee JH, Lee TS, et al. Gastric mucormycosis. Gastrointest Endosc 2002;56(6):904-5.
Pickeral JJ 3rd, Silverman JF, Sturgis CD. Gastric zygomycosis diagnosed by brushing cytology. Diagn Cytopathol 2000;23(1):51-4.
Al-Rikabi AC, Al-Dohayan AD, Al-Boukai AA. Invasive mucormycosis in benign gastric ulcer. Saudi Med J 2000;21(3):287-90.
Cherney CL, Chutuape A, Fikrig MK. Fatal invasive gastric mucormycosis occurring with emphysematous gastritis: case report and literature review. Am J Gastroenterol 1999;94(1):252-6.
Barroso F, Forcelledo JL, Mayorga M, Pena F, Marques FF, de la Pena J. A fatal case of gastric mucormyosis in a heart transplant recipient. Endoscopy 1999;31(2):S2.
Sheu BS, Lee PC, Yang HB. A giant gastric ulcer caused by mucormycosis infection in a patient with renal transplantation. Endoscopy 1998;30:S60-1.
Alexander P, Alladi A, Correa M, D’Cruz AJ. Neonatal colonic mucormycosis a tropical perspective. J Trop Pediatr 2005;51(1):54-9.
Gulati S, Barthakur G, Banerjee CK, Singhi S. Zygomycosis of colon. Ind Pediatr 1991;28:940-3.
Agha FP, Lee HH, Boland CR, Bradley SF. Mucormycoma of the colon: early diagnosis and successful management. AJR Am J Roentgenol 1985;145(4):739-41.
De Feo E. Mucormycosis of the colon. Am J Roentgenol Radium Ther Nucl Med 1961;86:86-90.
Sellappan B, Bakhshi S, Safaya R, Gupta AK, Arya LS. Invasive colonic mucormycosis in early induction therapy of childhood acute lymphoblastic leukemia. Ind J Pediatr 2005;72(1):77-9.
Diven SC, Angel CA, Hawkins HK, Rowen JL, Shattuck KE. Intestinal zygomycosis due to Absidia corymbifera mimicking necrotizing enterocolitis in a preterm neonate. J Perinatol 2004;24(12):794-6.
Echo A, Hovsepian RV, Shen GK. Localized cecal zygomycosis following renal transplantation. Transpl Infect Dis 2005;7(2):68-70.
Siu KL, Lee WH. A rare cause of intestinal perforation in an extreme low birth weight infant-gastrointestinal mucormycosis: a case report. J Perinatol 2004;24(5):319-21.
Manchikalapati P, Canon CL, Jhala N, Eloubeidi MA. Gastrointestinal zygomycosis complicating heart and lung transplantation in a patient with Eisenmenger’s syndrome. Dig Dis Sci 2005;50(6):1181-3.
Chen L, Xiao Y, Wang X. Successful treatment of mucormycosis in the pulmonary artery after cardiac surgery. J Card Surg 2005;20(2):186-8.
Mehta NN, Romanelli J, Sutton MG. Native aortic valve vegetative endocarditis with Cunninghamella. Eur J Echocardiogr 2004;5(2):156-8.
Erdos MS, Butt K, Weinstein L. Mucormycotic endocarditis of the pulmonary valve. JAMA 1972;222(8):951-3.
Buchbinder NA, Roberts WC. Active infective endocarditis confined to mural endocardium. A study of six necropsy patients. Arch Pathol 1972;93(5):435-40.
Sanchez-Recalde A, Merino JL, Dominguez F, Mate I, Larrea JL, Sobrino JA. Successful treatment of prosthetic aortic valve mucormycosis. Chest 1999;116(6):1818-20.
Virmani R, Connor DH, McAllister HA. Cardiac mucormycosis. A report of five patients and review of 14 previously reported cases. Am J Clin Pathol 1982;78(1):42-7.
Mishra B, Mandal A, Kumar N. Mycotic prosthetic-valve endocarditis. J Hosp Infect 1992;20:122-5.
Welk B, House AA, Ralph E, Tweedy E, Luke PP. Successful treatment of primary bilateral renal mucormycosis with bilateral nephrectomy. Urology 2004;64(3):590.
Singh SK, Wadhwa P, Sakhuja V. Isolated bilateral renal mucormycosis. Urology 2004;63(5):979-80.
Jianhong L, Xianliang H, Xuewu J. Isolated renal mucormycosis in children. J Urol 2004;171:387-8.
Lin CY, Lee SC, Lin CC, Chan SC, Lee CT. Isolated fatal renal mucormycosis in a patient with chronic obstructive pulmonary disease and tuberculosis. Int J Clin Pract 2003;57(10):916-8.
Chkhotua A, Yussim A, Sobolev V, Bar‐Nathan N, Shaharabani E, Shapir Z, et al. Mucormycosis of the renal allograft: case report and review of the literature. Transpl Int 2001;14(6):438-41.
Chan LL, Singh S, Jones D, Diaz EM Jr, Ginsberg LE. Imaging of mucormycosis skull base osteomyelitis. AJNR Am J Neuroradiol 2000;21(5):828-31.
Stevanovic MV, Mirzayan R, Holtom PD, Schnall SB. Mucormycosis osteomyelitis in the hand. Orthopedics 1999;22(4):449-50.
Shaw CJ, Thomason AJ, Spencer JD. Fungal osteomyelitis of the foot. A report of an unusual case. J Bone Joint Surg Br 1994;76(1):137-9.
Chaudhuri R, McKeown B, Harrington D, Hay RJ, Bingham JB, Spencer JD. Mucormycosis osteomyelitis causing avascular necrosis of the cuboid bone: MR imaging findings. AJR Am J Roentgenol 1992;159(5):1035-7.
Meis JF, Kullberg BJ, Pruszczynski M, Veth RP. Severe osteomyelitis due to the zygomycete Apophysomyces elegans. J Clin Microbiol 1994;32(12):3078-81.
Pierce PF, Wood MB, Roberts GD, Fitzgerald RH Jr, Robertson C, Edson RS. Saksenaea vasiformis osteomyelitis. J Clin Microbiol 1987;25(5):933-5.
Echols RM, Selinger DS, Hallowell C, Goodwin JS, Duncan MH, Cushing AH. Rhizopus osteomyelitis. A case report and review. Am J Med 1979;66(1):141-5.
Buruma OJ, Craane H, Kunst MW. Vertebral osteomyelitis and epidural abscess due to mucormycosis, a case report. Clin Neurol Neurosurg 1979;81(1):39-44.
Mostaza JM, Barbado FJ, Fernandez-Martin J, Pena-Yanez J, Vazquez-Rodriguez JJ. Cutaneoarticular mucormycosis due to Cunninghamella bertholletiae in a patient with AIDS. Rev Infect Dis 1989;11(2):316-8.
Nannini EC, Paphitou NI, Ostrosky-Zeichner L. Peritonitis due to Aspergillus and zygomycetes in patients undergoing peritoneal dialysis: report of 2 cases and review of the literature. Diagn Microbiol Infect Dis 2003;46(1):49-54.
Fergie JE, Fitzwater DS, Einstein P, Leggiadro RJ. Mucor peritonitis associated with acute peritoneal dialysis. Pediatr Infect Dis J 1992;11(6):498-500.
Polo JR, Luno J, Menarguez C, Gallego E, Robles R, Hernandez P. Peritoneal mucormycosis in a patient receiving continuous ambulatory peritoneal dialysis. Am J Kidney Dis 1989;13(3):237-9.
Branton MH, Johnson SC, Brooke JD, Hasbargen JA. Peritonitis due to Rhizopus in a patient undergoing continuous ambulatory peritoneal dialysis. Rev Infect Dis 1991;13:19-21.
Nakamura M, Weil WB Jr, Kaufman DB. Fatal fungal peritonitis in an adolescent on continuous ambulatory peritoneal dialysis: association with deferoxamine. Pediatr Nephrol 1989;3(1):80-2.
Machouart M, Larché J, Burton K, Collomb J, Maurer P, Cintrat A, et al. Genetic identification of t he main opportunistic Mucorales by PCR-restriction fragment length polymorphism. J Clin Microbiol 2006;44(3):805.
Hammond SP, Bialek R, Milner DA. Molecular methods to improve diagnosis and identification of mucormycosis. J Clin Microbiol 2011;49(6):2151.
Walsh TJ, Gamaletsou MN, McGinnis MR, Hayden RT, Kontoyiannis DP. Early clinical and labor atory diagnosis of invasive pulmonary, extrapulmonary, and disseminated mucormycosis (zygomycosis). Clin Infect Dis 2012; 54 Suppl 1:S55-60.
Schrödl W, Heydel T, Schwartze VU, Hoffmann K, Große-Herrenthey A, et al. Direct analysis and identification of pathogenic Lichtheimia species by matrix-assisted laser desorption ionizationtime of flight analyzer-mediated mass spectrometry. J Clin Microbiol 2012;50(2):419.
Cassagne C, Ranque S, Normand AC, Fourquet P, Thiebault S, Planard C, et al. Mould routine identification in the clinical laboratory by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. PLoS One 2011;6(12):e28425.
Ling H, Yuan Z, Shen J. Accuracy of matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of clinical pathogenic fungi: a meta-analysis. J Clin Microbiol 2014;52:2573.
Saltoğlu N, Taşova Y, Zorludemir S, Dündar IH. Rhinocerebral zygomycosis treated with liposomal amphotericin B and sur gery. Mycoses 1998;41(1-2):45-9.
DelGaudio JM, Swain RE Jr, Kingdom TT, Hudgins PA. Computed tomographic findings in patients with invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg 2003;129(2):236.