Conidiobolomycosis | |
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Other names | Rhinoentomophthoromycosis [1] |
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Conidiobolus coronatus [2] | |
Specialty | Infectious disease [3] |
Symptoms | Firm painless swelling in nose, sinuses, cheeks and upper lips, blocked nose, runny nose, nose bleed [4] |
Complications |
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Usual onset | Slowly progressive [6] |
Duration | Long term [4] |
Causes | fungi of the genus Conidiobolus [4] |
Diagnostic method | Medical imaging, biopsy, microscopy, culture [5] |
Differential diagnosis | Soft tissue tumors, [4] Mucormycosis |
Treatment | Antifungals, surgical debridement [6] |
Medication | oral Itraconazole, topical Potassium iodide [6] Severe disease: intravenous Amphotericin B [5] |
Prognosis | Longterm morbidity: facial disfigurement, [4] good response to treatment [7] |
Frequency | Rare, M>F [4] adults>children [5] |
Deaths | Rare [6] |
Conidiobolomycosis is a rare long-term fungal infection that is typically found just under the skin of the nose, sinuses, cheeks and upper lips. [3] [4] It may present with a nose bleed or a blocked or runny nose. [4] Typically there is a firm painless swelling which can slowly extend to the nasal bridge and eyes, sometimes causing facial disfigurement. [6]
Most cases are caused by Conidiobolus coronatus, a fungus found in soil and in the environment in general, which can infect healthy people. [4] 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. [3] [4]
The extent of disease may be seen using medical imaging such as CT scanning of the nose and sinus. [4] Diagnosis may be confirmed by biopsy, microscopy, culture and histopathology. [4] [5] Treatment is with long courses of antifungals and sometimes cutting out infected tissue. [6] The condition has a good response to antifungal treatment, [7] but can recur. [8] The infection is rarely fatal. [6]
The condition occurs more frequently in adults working or living in the tropical forests of South and Central America, West Africa and Southeast Asia. [4] [5] Males are affected more than females. [4] The first case in a human was described in Jamaica in 1965. [4]
The infection presents with firm lumps just under the skin of the nose, sinuses, upper lips, mouth and cheeks. [4] The swelling is painless and may feel "woody". [8] Sinus pain may occur. [6] Infection may extend to involve the nasal bridge, face and eyes, sometimes resulting in facial disfigurement. [4] The nose may feel blocked or have a discharge, and may bleed. [4]
Conidiobolomycosis is a type of Entomophthoromycosis, the other being basidiobolomycosis, and is caused by mainly Conidiobolus coronatus, but also Conidiobolus incongruus and Conidiobolus lamprauges [4]
Conidiobolomycosis chiefly affects the central face, usually beginning in the nose before extending onto paranasal sinuses, cheeks, upper lip and pharynx. [5] 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. [4] It can attach to underlying tissues, but not bone. [4] [5] It can be acquired by direct infection through a small cut in the skin such as an insect bite. [3] Thrombosis, infarction of tissue and spread into blood vessels does not occur. [4] Deep and systemic infection is possible in people with a weakened immune system. [4] Infection causes a local chronic granulomatous reaction. [6]
The condition is typically diagnosed after noticing facial changes. [6] The extent of disease may be seen using medical imaging such as CT scanning of the nose and sinus. [4] Diagnosis can be confirmed by biopsy, microscopy, and culture. [4] Histology reveals wide but thin-walled fungal filaments with branching at right-angles. [5] There are only a few septae. [5] The fungus is fragile and hence rarely isolated. [1] An immunoallergic reaction might be observed, where a local antigen–antibody reaction causes eosinophils and hyaline material to surround the organism. [5] Molecular methods may also be used to identify the fungus. [5]
Differential diagnosis includes soft tissue tumors. [4] Other conditions that may appear similar include mucormycosis, cellulitis, rhinoscleroma and lymphoma. [6]
Treatment is with long courses of antifungals and sometimes cutting out infected tissue. [6] Generally, treatment is with triazoles, preferably itraconazole. [5] A second choice is potassium iodide, either alone or combined with itraconazole. [5] In severe widespread disease, amphotericin B may be an option. [5] The condition has a good response to antifungal treatment, [7] but can recur. [8] The infection is rarely fatal but often disfiguring. [6]
The disease is rare, occurring mainly in those working or living in the tropical forests of West Africa, Southeast Asia, South and Central America, [4] as well India, Saudi Arabia and Oman. [5] Conidiobolus species have been found in areas of high humidity such as the coasts of the United Kingdom, eastern United States and West Africa. [6]
Adults are affected more than children. [5] Males are affected more than females. [4]
The condition was first reported in 1961 in horses in Texas. [4] The first case in a human was described in 1965 in Jamaica. [4] Previously this genus was thought to only infect insects. [4]
Conidiobolomycosis affects spiders, termites and other arthropods. [4] The condition has been described in dogs, horses, sheep and other mammals. [9] Affected mammals typically present with irregular lumps in one or both nostrils that cause obstruction, bloody nasal discharge and noisy abnormal breathing. [9]