Advertisement

Mycopathologia

, Volume 184, Issue 1, pp 159–167 | Cite as

Cutaneous Mucormycosis by Saksenaea vasiformis: An Unusual Case Report and Review of Literature

  • Ioannis D. GkegkesEmail author
  • Ioannis Kotrogiannis
  • Filitsa Konstantara
  • Athina Karetsou
  • Sofia Tsiplakou
  • Eleftherios Fotiou
  • Sotiria Stamopoulou
  • Christos Papazacharias
  • Ioannis A. Paraskevopoulos
Case Report
  • 118 Downloads

Abstract

Background

Saksenaea vasiformis is one of the numerous fungi of the Order Mucorales. Rapid progression and invasion of neighboring tissues are the most characteristic features of S. vasiformis mucormycosis.

Aim

The objective of this review is the management of this type of infections.

Methods

Case report and literature review.

Results

A 62-year old woman, without a history of immunocompromisation, developed a localized cutaneous infection at her right thigh. No trauma, skin laceration or insect bite was reported at the side of infection. The initial treatment was surgical debridements and intravenous administration of amphotericin B/posaconazole. In order to avoid the further rapid progression of the infection and save her life, it was decided to proceed to amputation of the patient’s right leg. This is the first case of S. vasiformis cutaneous infection in an immunocompetent patient, in Greece.

Conclusion

Early diagnosis of S. vasiformis mucormycosis is of paramount importance. Clinical suspicion, based on the rapid progression of the infection and on the medical history of the patient, is sufficient to start antifungal treatment. Broad, aggressive, and repeated surgical debridement of the infection site together with systemic antifungal agents administration is the key point for successful treatment.

Keywords

Cutaneous zygomycosis Saksenaea vasiformis Zygomycosis Amphotericin B Posaconazole Mucormycosis 

Notes

Acknowledgements

The authors would like to thank Dr M. Lelekis and Prof. A. Velegraki for their significant clinical support and advice.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from the patient included in the study.

References

  1. 1.
    Ajello L, Dean DF, Irwin RS. The zygomycete Saksenaea vasiformis as a pathogen of humans with a critical review of the etiology of zygomycosis. Mycologia. 1976;68:52–62.CrossRefGoogle Scholar
  2. 2.
    Gomes MZ, Lewis RE, Kontoyiannis DP. Mucormycosis caused by unusual mucormycetes, non-Rhizopus, -Mucor, and -Lichtheimia species. Clin Microbiol Rev. 2011;24:411–45.CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev. 2000;13:236–301.CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Solano T, Atkins B, Tambosis E, et al. Disseminated mucormycosis due to Saksenaea vasiformis in an immunocompetent adult. Clin Infect Dis. 2000;30:942–3.CrossRefGoogle Scholar
  5. 5.
    Spellberg B, Edwards J Jr, Ibrahim A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev. 2005;18:556–69.CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Wilson PA. Zygomycosis due to Saksenaea vasiformis caused by a magpie peck. Med J Aust. 2008;189:521–2.Google Scholar
  7. 7.
    Alvarez E, García-Hermoso D, Sutton DA, et al. Molecular phylogeny and proposal of two new species of the emerging pathogenic fungus Saksenaea. J Clin Microbiol. 2010;48:4410–6.CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Rodriguez-Tudela JL, Donnelly JP, Arendrup MC, et al. EUCAST Technical Note on the method for the determination of broth dilution minimum inhibitory concentrations of antifungal agents for conidia-forming moulds—subcommittee on antifungal susceptibility testing (AFST) of the ESCMID European committee for antimicrobial susceptibility testing (EUCAST). Clin Microbiol Infect. 2008;14:982–4.CrossRefGoogle Scholar
  9. 9.
    Al-Hedaithy M. Cutaneous zygomycosis due to Saksenaea vasiformis: case report and literature review. Ann Saudi Med. 1998;18:428–31.CrossRefGoogle Scholar
  10. 10.
    Bearer EA, Nelson PR, Chowers MY, et al. Cutaneous zygomycosis caused by Saksenaea vasiformis in a diabetic patient. J Clin Microbiol. 1994;32:1823–4.PubMedCentralGoogle Scholar
  11. 11.
    Dean DF, Ajello L, Irwin RS, et al. Cranial zygomycosis caused by Saksenaea vasiformis. Case report. J Neurosurg. 1977;46:97–103.CrossRefGoogle Scholar
  12. 12.
    Ellis DH, Kaminski GW. Laboratory identification of Saksenaea vasiformis: a rare cause of zygomycosis in Australia. Sabouraudia. 1985;23:137–40.CrossRefGoogle Scholar
  13. 13.
    Farmer AR, Murray CK, Driscoll IR, et al. Combat-related pythium aphanidermatum invasive wound infection: case report and discussion of utility of molecular diagnostics. J Clin Microbiol. 2015;53:1968–75.CrossRefPubMedCentralGoogle Scholar
  14. 14.
    Kompoti M, Michalia M, Kallitsi G, et al. Fatal cutaneous Saksenaea vasiformis infection in a critically ill trauma patient. Mycoses. 2011;54:e599–601.CrossRefGoogle Scholar
  15. 15.
    Mayayo E, Stchigel AM, Cano JF, et al. Necrotising fasciitis caused by Saksenaea vasiformis in an immunocompetent patient after a car accident. Rev Iberoam Micol. 2013;30:57–60.CrossRefGoogle Scholar
  16. 16.
    Shatriah I, Mohd-Amin N, Tuan-Jaafar TN, et al. Rhino-orbito-cerebral mucormycosis in an immunocompetent patient: case report and review of literature. Middle East Afr J Ophthalmol. 2012;19:258–61.CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Stewardson AJ, Holmes NE, Ellis DH, et al. Cutaneous zygomycosis caused by Saksenaea vasiformis following water-related wound in a 24-year-old immunocompetent woman. Mycoses. 2009;52:547–9.CrossRefGoogle Scholar
  18. 18.
    Baradkar VP, Mathur M, Taklikar S, et al. Fatal rhino-orbito-cerebral infection caused by Saksenaea vasiformis in an immunocompetent individual: first case report from India. Indian J Med Microbiol. 2008;26:385–7.CrossRefGoogle Scholar
  19. 19.
    Blanchet D, Dannaoui E, Fior A, et al. Saksenaea vasiformis infection, French Guiana. Emerg Infect Dis. 2008;14:342–4.CrossRefPubMedCentralGoogle Scholar
  20. 20.
    Hay RJ, Campbell CK, Marshall WM, et al. Disseminated zygomycosis (mucormycosis) caused by Saksenaea vasiformis. J Infect. 1983;7:162–5.CrossRefGoogle Scholar
  21. 21.
    Oberle AD, Penn RL. Nosocomial invasive Saksenaea vasiformis infection. Am J Clin Pathol. 1983;80:885–8.CrossRefGoogle Scholar
  22. 22.
    Padmaja IJ, Ramani TV, Kalyani S. Cutaneous zygomycosis: necrotising fascitis due to Saksenaea vasiformis. Indian J Med Microbiol. 2006;24:58–60.CrossRefGoogle Scholar
  23. 23.
    Baradkar VP, Kumar S. Cutaneous zygomycosis due to Saksenaea vasiformis in an immunocompetent host. Indian J Dermatol. 2009;54:382–4.CrossRefPubMedCentralGoogle Scholar
  24. 24.
    Gonis G, Starr M. Fatal rhinoorbital mucormycosis caused by Saksenaea vasiformis in an immunocompromised child. Pediatr Infect Dis J. 1997;16:714–6.CrossRefGoogle Scholar
  25. 25.
    Nitinawarat J, Putcharoen O, Chindamporn A, et al. Subcutaneous Saksenaea vasiformis infection presenting as disfiguring facial plaques. Indian J Dermatol Venereol Leprol. 2017;83:346–8.CrossRefGoogle Scholar
  26. 26.
    Trotter DJ, Gonis G, Cottrill E, et al. Disseminated Saksenaea vasiformis in an immunocompetent host. Med J Aust. 2008;189:519–20.Google Scholar
  27. 27.
    Koren G, Polacheck I, Kaplan H. Invasive mucormycosis in a non-immunocompromised patient. J Infect. 1986;12:165–7.CrossRefGoogle Scholar
  28. 28.
    Torell J, Cooper BH, Helgeson NG. Disseminated Saksenaea vasiformis infection. Am J Clin Pathol. 1981;76:116–1121.CrossRefGoogle Scholar
  29. 29.
    Tanphaichitr VS, Chaiprasert A, Suvatte V, et al. Subcutaneous mucormycosis caused by Saksenaea vasiformis in a thalassaemic child: first case report in Thailand. Mycoses. 1990;33:303–9.CrossRefGoogle Scholar
  30. 30.
    Taj-Aldeen SJ, Falamarzi A, AlMuzrkchi A, et al. Rare pediatric rhino-orbital infection caused by Saksenaea vasiformis. Infection. 2012;40:703–7.CrossRefGoogle Scholar
  31. 31.
    Gomez-Camarasa C, Rojo-Martin MD, Miranda-Casas C, et al. Disseminated infection due to Saksenaea vasiformis secondary to cutaneous mucormycosis. Mycopathologia. 2014;177:97–101.CrossRefGoogle Scholar
  32. 32.
    Kaushik R, Chander J, Gupta S, et al. Fatal primary cutaneous zygomycosis caused by Saksenaea vasiformis: case report and review of literature. Surg Infect (Larchmt). 2012;13:125–9.CrossRefGoogle Scholar
  33. 33.
    Kaufman L, Padhye AA, Parker S. Rhinocerebral zygomycosis caused by Saksenaea vasiformis. J Med Vet Mycol. 1988;26:237–41.CrossRefGoogle Scholar
  34. 34.
    Wilson M, Robson J, Pyke CM, et al. Saksenaea vasiformis breast abscess related to gardening injury. Aust N Z J Med. 1998;28:845–6.CrossRefGoogle Scholar
  35. 35.
    Chakrabarti A, Kumar P, Padhye AA, et al. Primary cutaneous zygomycosis due to Saksenaea vasiformis and Apophysomyces elegans. Clin Infect Dis. 1997;24:580–3.CrossRefGoogle Scholar
  36. 36.
    Lechevalier P, Hermoso DG, Carol A, et al. Molecular diagnosis of Saksenaea vasiformis cutaneous infection after scorpion sting in an immunocompetent adolescent. J Clin Microbiol. 2008;46:3169–72.CrossRefPubMedCentralGoogle Scholar
  37. 37.
    Lye GR, Wood G, Nimmo G. Subcutaneous zygomycosis due to Saksenaea vasiformis: rapid isolate identification using a modified sporulation technique. Pathology. 1996;28:364–5.CrossRefGoogle Scholar
  38. 38.
    Padhye AA, Koshi G, Anandi V, et al. First case of subcutaneous zygomycosis caused by Saksenaea vasiformis in India. Diagn Microbiol Infect Dis. 1988;9:69–77.CrossRefGoogle Scholar
  39. 39.
    Parker C, Kaminski G, Hill D. Zygomycosis in a tattoo, caused by Saksenaea vasiformis. Australas J Dermatol. 1986;27:107–11.CrossRefGoogle Scholar
  40. 40.
    Patino JF, Mora R, Guzman MA, et al. Mucormycosis: a fatal case by Saksenaea vasiformis. World J Surg. 1984;8:419–22.CrossRefGoogle Scholar
  41. 41.
    Pierce PF, Wood MB, Roberts GD, et al. Saksenaea vasiformis osteomyelitis. J Clin Microbiol. 1987;25:933–5.PubMedCentralGoogle Scholar
  42. 42.
    Pritchard RC, Muir DB, Archer KH, et al. Subcutaneous zygomycosis due to Saksenaea vasiformis in an infant. Med J Aust. 1986;145:630–1.Google Scholar
  43. 43.
    Cefai C, Elliott TS, Nutton RW, et al. Zygomycetic gangrenous cellulitis. Lancet. 1987;2:1337–8.CrossRefGoogle Scholar
  44. 44.
    Holland J. Emerging zygomycoses of humans: Saksenaea vasiformis and Apophysomyces elegans. Curr Top Med Mycol. 1997;8:27–34.Google Scholar
  45. 45.
    Garcia-Martinez J, Lopez-Medrano F, Alhambra A, et al. Rhinocerebral zygomycosis caused by Saksenae vasiformis in a diabetic patient. Mycoses. 2008;51:549–53.CrossRefGoogle Scholar
  46. 46.
    Dominguez Mdel C, Sanchez J, Carmona E, et al. Elderly patient with rapidly progressive skin lesions. Enferm Infecc Microbiol Clin. 2012;30:43–5.CrossRefGoogle Scholar
  47. 47.
    Buzacott K, Townell N, Dettrick A, et al. Saksenaeae subcutaneous abscess in an immunocompetent child. Pediatr Infect Dis J. 2016;35:120.CrossRefGoogle Scholar
  48. 48.
    Pilch WT, Kinnear N, Hennessey DB (2017) Saksenaea vasiformis infection in an immunocompetent patient in rural Australia. BMJ Case Rep;2017. pii: bcr-2017-220341.Google Scholar
  49. 49.
    Upton A, Gabriel R, Fougere C, et al. A patient with cutaneous zygomycosis due to Saksenaea vasiformis. Infect Dis Clin Pract. 2002;11:137–9.CrossRefGoogle Scholar
  50. 50.
    Coronel-Pérez IM, Rodríguez-Rey EM, Castilla-Guerra L, et al. Primary cutaneous mucormycosis due to Saksenaea vasiformis in an immunocompetent patient. Actas Dermosifiliogr. 2015;106:516–8.CrossRefGoogle Scholar
  51. 51.
    Aarset H, Aasarod K, Bergan U, et al. Acute renal infarction in a woman with slight asthma. Nephrol Dial Transplant. 2001;16:1711–2.CrossRefGoogle Scholar
  52. 52.
    Goldschmied-Reouven A, Shvoron A, Topaz M, et al. Saksenaea vasiformis infection in a burn wound. J Med Vet Mycol. 1989;27:427–9.CrossRefGoogle Scholar
  53. 53.
    Vega W, Orellana M, Zaror L, et al. Saksenaea vasiformis infections: case report and literature review. Mycopathologia. 2006;162:289–94.CrossRefGoogle Scholar
  54. 54.
    Campelo C, de Miguel S, del Palacio A. Zigomicosis rinocerebral causada por Saksenaea vasiformis en un paciente diabetico. Enferm Infecc Microbiol Clin. 2005;23(Suppl 1):77.Google Scholar
  55. 55.
    Gómez Merino E, Blanch Sancho JJ, Iñiguez de Onzoñoa L, et al. Lesión necrótica en cuero cabelludo tras traumatismo. Rev Clin Esp. 2003;203:451–2.CrossRefGoogle Scholar
  56. 56.
    Tendolkar U, Baradkar V, Baveja S, et al. Cutaneous zygomycosis due to Saksenaea vasiformis in a patient with paraparesis, burns and pressure ulcer. Internet J Infect Dis. 2012;10:1–4.Google Scholar
  57. 57.
    Reynaldi FJ, Giacoboni G, Cordoba SB, et al. kMucormicosys due to Saksenaea vasiformis in a dog. Med Mycol Case Rep. 2017;16:4–7.CrossRefPubMedCentralGoogle Scholar
  58. 58.
    Robeck TR, Dalton LM. Saksenaea vasiformis and Apophysomyces elegans zygomycotic infections in bottlenose dolphins (Tursiops truncatus), a killer whale (Orcinus orca), and pacific white-sided dolphins (Lagenorhynchus obliquidens). J Zoo Wildl Med. 2002;33:356–66.CrossRefGoogle Scholar
  59. 59.
    Hill BD, Black PF, Kelly M, et al. Bovine cranial zygomycosis caused by Saksenaea vasiformis. Aust Vet J. 1992;69:173–4.CrossRefGoogle Scholar
  60. 60.
    Kontoyiannis DP, Lewis RE. Invasive zygomycosis: update on pathogenesis, clinical manifestations, and management. Infect Dis Clin North Am. 2006;20:581–607, vi.CrossRefGoogle Scholar
  61. 61.
    Skiada A, Petrikkos G. Cutaneous zygomycosis. Clin Microbiol Infect. 2009;15(Suppl 5):41–5.CrossRefGoogle Scholar
  62. 62.
    Castrejón-Pérez AD, Welsh EC, Miranda I, et al. Cutaneous mucormycosis. An Bras Dermatol. 2017;92:304–11.CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Ioannis D. Gkegkes
    • 1
    Email author
  • Ioannis Kotrogiannis
    • 1
  • Filitsa Konstantara
    • 1
  • Athina Karetsou
    • 1
  • Sofia Tsiplakou
    • 2
  • Eleftherios Fotiou
    • 1
  • Sotiria Stamopoulou
    • 1
  • Christos Papazacharias
    • 1
  • Ioannis A. Paraskevopoulos
    • 1
  1. 1.First Department of General SurgeryGeneral Hospital of Attica “KAT”AthensGreece
  2. 2.Microbiology DepartmentGeneral Hospital of Attica “KAT”AthensGreece

Personalised recommendations