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Sinoorbital mucormycosis due to Apophysomyces elegans in immunocompetent individuals--an increasing trend

Sridhara Suryanarayan Rao1, Naresh K Panda, Gilbert Pragache

  • 1Department of Otolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

American Journal of Otolaryngology
|August 29, 2006
PubMed
Abstract

Insights

Apophysomyces elegans can cause fatal mucormycosis in healthy individuals. Early surgical debridement and antifungal treatment are crucial for successful outcomes in these rare cases.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Ophthalmology

Background:

  • Mucormycosis is a severe fungal infection typically affecting immunocompromised individuals.
  • Apophysomyces elegans is an uncommon cause of mucormycosis.
  • Infection in immunocompetent individuals is rare.

Purpose of the Study:

  • To report five cases of mucormycosis caused by Apophysomyces elegans in immunocompetent patients.
  • To highlight the clinical presentation, diagnosis, and management of these unusual infections.
  • To review existing literature on A. elegans infections in healthy individuals affecting the orbit, nose, and paranasal sinuses.

Main Methods:

  • A retrospective case review was conducted at a tertiary referral center.
  • Five cases of mucormycosis caused by A. elegans in healthy patients between 1999 and 2004 were analyzed.
  • Evaluation included clinical presentation, imaging, mycological and surgical findings, and postoperative outcomes. Literature review was also performed.

Main Results:

  • All five patients were immunocompetent with no history of trauma or invasive procedures.
  • Histopathology revealed broad, aseptate hyphae with angioinvasion and thrombosis.
  • Fungal cultures consistently identified Apophysomyces elegans.

Conclusions:

  • Mucormycosis, including that caused by A. elegans, should be considered in the differential diagnosis of severe sinusitis, orbital cellulitis, or acute headache, even in immunocompetent individuals.
  • Prompt surgical debridement is essential for successful treatment.
  • Systemic antifungal therapy, particularly amphotericin B, is a critical component of management.

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