Review articleZygomycosis
Section snippets
Epidemiology
The organisms of the class Zygomycetes are ubiquitous in soil and are commonly found in decaying organic matter, such as fruit and bread [1], [2], [9], [10]. The human pathogens grow rapidly on virtually any carbohydrate substrate and produce large numbers of hyphae and asexual sporangiospores, which permit the organism to propagate into the environment. Many of the Zygomycetes are able to grow at temperatures above 37°C. These properties of wide ecologic distribution, rapid growth, and
Pathogenesis and host defense
Healthy humans have a strong natural immunity against Zygomycetes. Most commonly, the infection presents as an opportunistic disease in patients with underlying risk factors [6], [8], [13], [18], [19], [20], [24], [29], [33], [34], [35], [50]. Predisposing conditions to zygomycosis include the following:
Immunosuppression
Neutropenia
Corticosteroid therapy
Organ transplantation
HIV infection
Metabolic
Diabetic ketoacidosis
Uncontrolled diabetes
Deferoxamine therapy
Chronic metabolic acidosis
Skin or soft
Clinical manifestations
Clinical manifestations of zygomycosis can be classified by the tissue site affected (eg, rhinocerebral, sinus, pulmonary, cutaneous, disseminated, abdominopelvic and gastric, and miscellaneous). There are no specific signs or symptoms of the disease; however, suggestive clinical manifestations in the right clinical setting should alert physicians for the possibility of zygomycosis (Table 2).
Laboratory diagnosis
Diagnosis of zygomycosis relies on direct morphologic identification of mycotic elements and recovery of Zygomycetes in culture from specimens obtained on the site of presumed involvement. Examination of wet mounts of sputum, paranasal sinuses secretions, or bronchoalveolar lavage is frequently negative [75]. The recovery of Zygomycetes from these specimens, however, should not be dismissed as a contaminant [24], [108], [109]. Rather, it should be considered a strong evidence for invasive
Treatment and prevention
Successful therapy for zygomycosis involves a combined approach. As depicted in Fig. 2, it is based on early diagnosis, which leads to both prompt institution of medical therapy and extensive surgical debridement of all devitalized tissue. The overall survival rate in zygomycosis has been about 50% and in the last 10 years about 80%. This number, however, represents a composite of the proportion of different predisposing conditions, treatment approaches, and extent of zygomycotic disease
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