Zygomycetes
[Aseptate filamentous fungi]
Yimtubezinash Woldeamanuel
(CHS-AAU)
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Outline of presentation
• Introduction
• Taxonomy
• Genera of medical importance
• Infections and clinical forms
• Laboratory diagnosis
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Introduction
Zygomycetes
• mostly fast-growing fungi
• common as saprophytes in wet environments like food, plants, dung
• spoilage organisms in fruit, food and beverages
• important as fermentation agent for food
• used extensively in the biotechnology for enzymes
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Introduction (cont’d)
• Widely distributed
• Fast growing
• All medically important species grow at 37° C
• Have several species which are thermophilic
• Hyphae – mostly aseptate
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• Two orders (species of medical importance)
• the Mucorales
• the Entomopthorales
• Class Zygomycetes
• Disease:- Zygomycosis (mucormycosis)
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• The majority of cases of zygomycosis in humans are caused
by members of the order Mucorales.
• Organisms of the genus Rhizopus are by far the most
common clinical isolates, with R. oryzae being the most
frequently recovered species.
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Order Mucorales
o Includes members of the genera Abisidia, Apophysomces, Mucor,
Rhizomucor & Rhizopus
• Rhizopus oryzae (arrhizus) most frequent infectious agent
reported (nearly 90% of the rhinocerebral form of infection)
o Most common species (> 80% of culture proven zygomycosis)
:- Rhizopus oryzae, R. microsporus var. rhizopodiformis,
Abisida corymbifera and Rhizimucor pusillus
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Culture, sporangia,
sporangiophores and
rhizoids of R.oryzae.
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Mucorales
• ubiquitous in nature and a common laboratory contaminant,
• Most of the Mucor spp. are unable to grow at 37°C
• the strains isolated from human infections are usually one of the few
thermotolerant Mucor spp.
• Mucor indicus may grow at temperatures as high as 40°C. Mucor racemosus
and Mucor ramosissimus, on the other hand, grow poorly or do not grow at all
at 37°C.
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The genus Mucor can be differentiated from Absidia, Rhizomucor and
Rhizopus by:- the absence of stolons and rhizoids
Sporangia, columella
with a conspicuous
collarette and
sporangiospores of
Mucor.
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• Members of Mucorales
• cause severe form of zygomycosis
• Reproduce asexually by means of sporangiospores
• Rapid growth rate, filling a petri dish within 3-5 days
• Colonies loosely floccose, grey or brownish-grey color
• several species also develop stolons and rhizoids
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Order Entomophthorales
▪
cause chronic disease of the nasal mucosa & subcutaneous tissue
Lack of vascular invasion or infarction
many members require a complex nutrient medium to stimulates
sporulation
only three species known to cause human disease
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EPIDEMIOLOGY
• ubiquitous in soil and can be isolated from decaying organic matter including hay,
decaying vegetation, and a variety of food items.
• Human infection :-
• acquired through inhalation of sporangiospores from environmental
sources.
• Acquisition via the cutaneous or percutaneous route is also common,
(traumatic disruption of skin barriers or with the use of catheters and
injections.
• Less commonly, through the GI route
• A clear male predisposition has been observed, as demonstrated by an
approximate 2:1 male to female ratio among cases
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• cause disease in a wider and more heterogeneous population
• Mucorales mainly affect patients with underlying immuno-
suppression or other medical conditions
• the Entomophthorales largely afflict immunocompetent hosts in
tropical and subtropical areas of developing countries.
• most common underlying condition
• diabetes, both type I and type II.
• hematological malignancy, solid organ or bone marrow
transplantation, deferoxamine therapy, and injection drug use
• Less commonly, renal failure, diarrhea, and malnutrition in low
birth weight infants and in HIV patients.
• Occasionally in patients with persistent metabolic acidosis
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Pathogenesis and Immunology
• an effective immune response following inoculation of
sporangiospores requires
• the presence of adequate phagocytic activity of the host
effector cells,
• including tissue macrophages and neutrophils.
• growth of Rhizopus species is promoted in the presence of increased
iron uptake.
• Presence of extensive angio-invasion associated with thrombosis and
ischemic necrosis
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Clinical manifestations
• largely depend on the causative agent and the patient’s condition
• Mucorales cause rapidly progressive disease characterized by
angioinvasion, thrombosis, tissue necrosis, and dissemination
• Entomophthorales induce a chronic inflammatory response
• Symptoms develop rapidly depending on site of infection, immune status of
host and degree of pathology
• Predilection for invading blood vessels –causing thrombosis and
subsequent necrosis of surrounding tissue
• Rapid diagnosis crucial for successful therapy
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Infections caused by mucoraceous fungi
• first case of zygomycosis in humans was reported in 1885
• Members of mucorales cause the most severe forms of zygomycosis
• Infections rare in the immunocompetent host
• Traumatic implantation, leading to cutaneous lesions, localized ,
respond to treatment
• In debilitated patients the most acute and fulminate fungal infection
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Infections caused by the Mucorales
• sinus disease, localized or extended to the orbit and/or brain
• pulmonary
• cutaneous
• gastrointestinal
• disseminated
• miscellaneous infection.
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Clinical forms
Rhinocerebral - the most common, associted with uncontrolled DM
/acidosis, several species etiologic agents, most commonly by R.oryzae
Pulmonary- progressive and fatal within 2-3 weeks, pulmonary
infarction and cavitations, associate with hematological malignancies,
severe neutropenia
Gastrointestinal- rare, associated with severe malnutrition ,fatal
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• Cutaneous – typically single, nonspecific and include plaques,
pustules, ulcerations, deep abscesses, caused by traumatic
implantation
• Disseminated – may originate from any of the other clinical
forms, usually seen in neutropenic patients, most common site
of spread is the brain with abscess formation and infarction
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Fig. 12.3. Development of zygomycosis in the skin and subcutaneous
tissues of the right lower extremity in a patient with cutaneous T-cell
lymphoma.
Adopted from: Diagnosis and treatment of human mycoses, 2008: Duane R.
Hospenthal, MD, PhDMichael G. Rinaldi, PhD
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Adopted from: Diagnosis and treatment of human mycoses, 2008: Duane R.
Hospenthal, MD, PhDMichael G. Rinaldi, PhD
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Infection by Entomophthorales
• A chronic subcutaneous disease
• characterized by slowly enlarging subcutaneous nodules that eventually ulcerate
• typically caused by B. ranarum. C. coronatus
• infections commonly present as chronic sinusitis (usually does not extend to the
central nervous system )
• Less commonly, involvement of other body sites or even aggressive disseminated
infection has been reported for immunocompromised and immunocompetent patients
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Diagnosis
• Can rapidly be fatal, therefore timely diagnosis is crucial to
avoid treatment delay
• Diagnosis is based on :-
• high index of suspicion
• assessment of presenting signs and symptoms
• imaging studies, cultures of clinical specimens, and
histopathology
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Adopted from :-Diagnosis and
management of human mycoses
6/4/2025 YWA-DMIP-CHS-2025 DR Hospenthal, MG Rinaldi , 2008
oLaboratory diagnosis
o Direct demonstration of
ribbon like aseptate
hyphae in tissue and
culture
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specimen :-
• Skin biopsy, Sputum,Needle biopsy, Nasal discharge
• keep moist (with saline or BHI broth)
Direct microscopy
• broad , mostly aseptate, thin walled hyphae, rhizoids
Histopathology
• hyphae, necrosis, infiltrates & involvement of blood vessels
Culture
• Routine media without cycloheximide (SDA at 30°C) + antibiotics
• Fast growing, profuse sporulation
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Absidia corymbifera
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Diagnostic Imaging
Adopted from: Diagnosis and treatment of human mycoses, 2008: Duane R.
6/4/2025 YWA-DMIP-CHS-2025
Hospenthal, MD, PhDMichael G. Rinaldi, PhD
Management of patients
• successful management of zygomycosis depends on:-
• Rapid initiation of therapy,
• reversal of the patient’s underlying predisposing condition
• administration of appropriate antifungal agents, and
• surgical débridement of infected tissues
• Antifungal agents
• Amphotericin B –drug of choice
• Azoles
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