Conidiobolomycosis
Template:Short description Template:Infobox medical condition (new) Conidiobolomycosis is a rare long-term fungal infection that is typically found just under the skin of the nose, sinuses, cheeks and upper lips.[1][2] It may present with a nose bleed or a blocked or runny nose.[2] Typically there is a firm painless swelling which can slowly extend to the nasal bridge and eyes, sometimes causing facial disfigurement.[3]
Most cases are caused by Conidiobolus coronatus, a fungus found in soil and in the environment in general, which can infect healthy people.[2] It is usually acquired by inhaling the spores of the fungus, but can be by direct infection through a cut in the skin such as an insect bite.[1][2]
The extent of disease may be seen using medical imaging such as CT scanning of the nose and sinus.[2] Diagnosis may be confirmed by biopsy, microscopy, culture and histopathology.[2][4] Treatment is with long courses of antifungals and sometimes cutting out infected tissue.[3] The condition has a good response to antifungal treatment,[5] but can recur.[6] The infection is rarely fatal.[3]
The condition occurs more frequently in adults working or living in the tropical forests of South and Central America, West Africa and Southeast Asia.[2][4] Males are affected more than females.[2] The first case in a human was described in Jamaica in 1965.[2]
Signs and symptoms
The infection presents with firm lumps just under the skin of the nose, sinuses, upper lips, mouth and cheeks.[2] The swelling is painless and may feel "woody".[6] Sinus pain may occur.[3] Infection may extend to involve the nasal bridge, face and eyes, sometimes resulting in facial disfigurement.[2] The nose may feel blocked or have a discharge, and may bleed.[2]
Cause
Conidiobolomycosis is a type of Entomophthoromycosis, the other being basidiobolomycosis, and is caused by mainly Conidiobolus coronatus, but also Conidiobolus incongruus and Conidiobolus lamprauges[2]
Mechanism
Conidiobolomycosis chiefly affects the central face, usually beginning in the nose before extending onto paranasal sinuses, cheeks, upper lip and pharynx.[4] The disease is acquired usually by breathing in the spores of the fungus, which then infect the tissue of the nose and paranasal sinuses, from where it slowly spreads.[2] It can attach to underlying tissues, but not bone.[2][4] It can be acquired by direct infection through a small cut in the skin such as an insect bite.[1] Thrombosis, infarction of tissue and spread into blood vessels does not occur.[2] Deep and systemic infection is possible in people with a weakened immune system.[2] Infection causes a local chronic granulomatous reaction.[3]
Diagnosis
The condition is typically diagnosed after noticing facial changes.[3] The extent of disease may be seen using medical imaging such as CT scanning of the nose and sinus.[2] Diagnosis can be confirmed by biopsy, microscopy, and culture.[2] Histology reveals wide but thin-walled fungal filaments with branching at right-angles.[4] There are only a few septae.[4] The fungus is fragile and hence rarely isolated.[7] An immunoallergic reaction might be observed, where a local antigen–antibody reaction causes eosinophils and hyaline material to surround the organism.[4] Molecular methods may also be used to identify the fungus.[4]
Differential diagnosis
Differential diagnosis includes soft tissue tumors.[2] Other conditions that may appear similar include mucormycosis, cellulitis, rhinoscleroma and lymphoma.[3]
Treatment
Treatment is with long courses of antifungals and sometimes cutting out infected tissue.[3] Generally, treatment is with triazoles, preferably itraconazole.[4] A second choice is potassium iodide, either alone or combined with itraconazole.[4] In severe widespread disease, amphotericin B may be an option.[4] The condition has a good response to antifungal treatment,[5] but can recur.[6] The infection is rarely fatal but often disfiguring.[3]
Epidemiology
The disease is rare, occurring mainly in those working or living in the tropical forests of West Africa, Southeast Asia, South and Central America,[2] as well India, Saudi Arabia and Oman.[4] Conidiobolus species have been found in areas of high humidity such as the coasts of the United Kingdom, eastern United States and West Africa.[3]
Adults are affected more than children.[4] Males are affected more than females.[2]
History
The condition was first reported in 1961 in horses in Texas.[2] The first case in a human was described in 1965 in Jamaica.[2] Previously this genus was thought to only infect insects.[2]
Other animals
Conidiobolomycosis affects spiders, termites and other arthropods.[2] The condition has been described in dogs, horses, sheep and other mammals.[8] Affected mammals typically present with irregular lumps in one or both nostrils that cause obstruction, bloody nasal discharge and noisy abnormal breathing.[8]
References
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External links
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