Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Guangxi Key Laboratory of Mycosis Research and Prevention, Nanning, China.
Mycoses. 2023 Sep;66(9):795-800. doi: 10.1111/myc.13605. Epub 2023 May 25.
Mucormycosis is a rare form of invasive, rapidly progressive and lethal opportunistic fungal infection caused by Mucorales. Although Rhizopus arrhizus (R. arrhizus) is the most commonly isolated Mucorales worldwide, infections caused by Apophysomyces variabilis (A. variabilis) are increasing.
We present a case of necrotizing fasciitis caused by A. variabilis in an immunocompetent woman. In order to further understand the characteristics of the strain isolated from the patient, we identified the strain through ITS sequencing, assessed the ability to tolerate salt concentrations and temperature conditions, in addition to performing in vitro drug susceptibility testing against common antifungal agents.
The strain showed 98.76% identity with A. variabilis in the NCBI database, and it was found to tolerate higher temperatures and salt concentrations than previously reported strains. The strain was sensitive to amphotericin B and posaconazole, but not to voriconazole, itraconazole, 5-fluorocytosine and echinocandins.
This case indicates that Mucorales caused by A. variabilis should be recognised as an emerging pathogen that can cause a high mortality rate in the absence of prompt diagnosis and proper treatment in China, aggressive surgical debridement combined with prompt and appropriate antifungal treatment may improve outcomes.
毛霉病是一种罕见的侵袭性、快速进展和致命的机会性真菌感染，由毛霉目真菌引起。虽然根毛霉（Rhizopus arrhizus）是全球最常分离到的毛霉目真菌，但棘孢瓶霉（Apophysomyces variabilis）引起的感染正在增加。
我们报告了一例免疫功能正常的女性由棘孢瓶霉引起的坏死性筋膜炎。为了进一步了解从患者中分离出的菌株的特征，我们通过 ITS 测序对该菌株进行鉴定，评估其耐受盐浓度和温度条件的能力，并对常见抗真菌药物进行体外药敏试验。
该菌株与 NCBI 数据库中的棘孢瓶霉的相似度为 98.76%，与之前报道的菌株相比，该菌株能耐受更高的温度和盐浓度。该菌株对两性霉素 B 和泊沙康唑敏感，但对伏立康唑、伊曲康唑、5-氟胞嘧啶和棘白菌素类药物不敏感。
本病例表明，棘孢瓶霉引起的毛霉病应被视为一种新兴的病原体，在中国，如果不能及时诊断和恰当治疗，可能导致高死亡率。积极的手术清创术结合及时和适当的抗真菌治疗可能改善预后。
