Entomophthoromycosis: A Systematic Analysis of 405 cases

Entomophthoromycosis is a chronic fungal granulomatous disease caused by Basidiobolus and Conidiobolus species. This disease is associated with significant morbidity and prolonged treatment. This systematic review aims to address the epidemiology, clinical features, diagnostic methods, therapeutic strategies, and clinical outcomes of entomophthoromycosis. Medline, Embase, Scopus and Web of Science databases were searched using appropriate keywords for entomophthoromycosis from 1 January 2000 to 31 December 2023. A total of 405 cases of entomophthoromycosis were included; of those, Basidiobolomycosis (n=241/405, 59.5%) was the most common, followed by conidiobolomycosis (n=123/405, 30.4%) and unclassified entomophthoromycosis (n=41/405, 10.1%). Distinct epidemiological patterns were observed: basidiobolomycosis was most commonly reported from Middle Eastern countries (n=139/241, 57.7%), whereas conidiobolomycosis was most commonly reported from Southeast Asian countries (n=97/123, 78.9%). The common clinical forms seen in basidiobolomycosis were gastrointestinal (n=164/241, 68%) and cutaneous (n=64/241, 26.6%) disease, and rhino-facial disease (n=114/123, 92.7%) in conidiobolomycosis. Demonstration of fungal hyphae by histopathology or by direct microscopy is the most common diagnostic method (n=377/405, 93.1%). Culture positivity was higher in conidiobolomycosis (n=94/123, 76.4%) than in basidiobolomycosis (n=108/241, 44.8%). Antifungal treatment with surgery (n=129/231, 55.8%) was the common treatment strategy for basidiobolomycosis. Antifungal therapy alone (n=77/112, 68.8%) was the most commonly used treatment for conidiobolomycosis. Itraconazole was the most common antifungal used in treatment (n=228/357, 63.9%), followed by potassium iodide (n=104/357, 29.1%). Overall mortality of the cohort is 10.93% (n=40/366). Gastrointestinal basidiobolomycosis has a higher mortality (n=28/150, 18.7%). Both these diseases exhibit different geographic patterns and clinical forms. The disease mimics malignancies and other inflammatory diseases; high clinical suspicion is essential for prompt diagnosis and initiation of therapy to improve clinical outcomes.