Department of Biotechnology, University of Madras, Chennai, Tamil Nadu, 600025, India.
Department of Surgical Oncology, Arignar Anna Memorial Cancer Hospital, Kancheepuram, Tamil Nadu, India.
Infection. 2020 Oct;48(5):791-797. doi: 10.1007/s15010-020-01455-y. Epub 2020 Jun 6.
Mucormycosis is a serious and often fatal mycotic infection caused by members of class Mucormycetes in populations with immunologic or metabolic disorders. Though several clinical manifestations are associated with mucormycetes, gastrointestinal involvement is quite rare.
We described a rare case of invasive fungal infection due to Syncephalastrum racemosum associated with gastric adenocarcinoma in a 48-year-old male patient with type II Diabetes mellitus. He presented with complaints of abdominal pain, nausea, vomiting, dyspepsia, dysphagia, loss of appetite, and weight. Histopathological examination showed broad and aseptate hyphae and culture of endoscopic biopsy tissue from pylorus and antrum yielded the fungal pathogen S. racemosum. The species was confirmed by molecular sequencing of D1/D2 region of the ribosomal DNA. The in vitro susceptibility of S. racemosum was tested by broth microdilution assay as per CLSI guidelines. The MICs suggest that the isolate was susceptible to Amphotericin B (0.25 µg/ml), Itraconazole (0.25 µg/ml) and Posaconazole (0.06 µg/ml) and showed resistance to Micafungin (>16 µg/ml). The patient was successfully treated with radical subtotal gastrectomy with lymphadenectomy and Amphotericin B antifungal therapy. There was a dilemma in concluding the pathogenicity of the isolate since; the symptoms noted were common for both gastric adenocarcinoma and mucormycosis. A review of previously reported cases on Syncephalastrum was presented in the paper with their clinical manifestations, treatment, and outcome.
To the best of our knowledge, this is the first report from India on the gastrointestinal involvement of S. racemosum. Patients with immunocompromised status are more prone to mucormycotic infections, and any typical presentations should be carefully examined for their etiological agent, and appropriate species directed therapy would help in a better outcome.
毛霉病是一种严重且常致命的真菌感染，由类毛霉目中的成员引起，常见于免疫或代谢紊乱的人群。尽管有几种临床表现与毛霉病相关，但胃肠道受累相当罕见。
我们描述了一例罕见的侵袭性真菌感染病例，由 Syncephalastrum racemosum 引起，与一位 48 岁患有 2 型糖尿病的男性患者的胃腺癌相关。他出现了腹痛、恶心、呕吐、消化不良、吞咽困难、食欲不振和体重减轻等症状。组织病理学检查显示广泛的无隔菌丝，经内窥镜活检从幽门和胃窦培养出真菌病原体 S. racemosum。该物种通过核糖体 DNA 的 D1/D2 区域的分子测序得到确认。根据 CLSI 指南，通过肉汤微量稀释法对 S. racemosum 的体外药敏性进行了测试。MIC 表明该分离株对两性霉素 B（0.25µg/ml）、伊曲康唑（0.25µg/ml）和泊沙康唑（0.06µg/ml）敏感，对米卡芬净（>16µg/ml）表现出耐药性。该患者通过根治性胃大部切除术加淋巴结清扫术和两性霉素 B 抗真菌治疗成功治愈。由于患者的症状既常见于胃腺癌又常见于毛霉病，因此在确定分离株的致病性方面存在困境。本文回顾了之前报道的关于 Syncephalastrum 的病例，介绍了其临床表现、治疗和结局。
据我们所知，这是印度首例关于 S. racemosum 胃肠道受累的报告。免疫功能低下的患者更容易发生毛霉病感染，任何典型表现都应仔细检查其病因，并进行适当的靶向物种治疗，以获得更好的结果。
