Mucormycosis caused by Syncephalastrum spp.: Clinical profile, molecular characterization, antifungal susceptibility and review of literature. (July 2021)

• Record Type: Journal Article
• Authors: Singh, Shreya; Pal, Nupur; Chander, Jagdish; Sardana, Raman; Mahajan, Bella; Joseph, Noyal; Chakrabarti, Arunaloke; Rudramurthy, Shivaprakash M.; Hariprasath, P.; Paul, Saikat; Kaur, Harsimran; Ghosh, Anup
• Is Part Of: Clinical infection in practice. Volume 11(2021)
• Publication Date: 2021-07
• Subjects: Syncephalastrum racemosum -- Syncephalastrum monosporum -- MALDI -TOF MS -- Molecular -- Clinical infections -- Antifungal susceptibility; Communicable diseases -- Periodicals; Infection -- Periodicals; Communicable Diseases; Infections; Communicable diseases; Infection; Electronic journals; Periodical; Electronic journals; Periodicals; 616.905
• DOI: 10.1016/j.clinpr.2021.100074
• Languages: English
• ISSNs: 2590-1702

Abstract

Highlights: MALDI-TOF, sequencing and AFLP can differentiate S. racemosum from S. monosporum. We report clinical isolates of S. monosporum for the first time. Syncephalastrum spp are uniformly susceptible to amphotericin B and terbinafine. Cutaneous mucormycosis is the most common presentation of Syncephalastrum spp infection. Trauma is associated with Syncephalastrum spp skin infection. Immunosuppression/steroid use and neutropenia are associated with Syncephalastrum spp pulmonary infection. Abstract: Objectives: The clinical profile, molecular characteristics and antifungal susceptibility patterns of the Mucoraceous mould, Syncephalastrum spp are poorly characterized. The present study provides a comprehensive overview of these aspects of this rare fungus. Methods: We characterized 8 clinical isolates of Syncephalestrum spp by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF), 28S rDNA sequencing, Amplified Fragment Length Polymorphism (AFLP, n = 7) and in-vitro antifungal susceptibility testing. Clinical details of these eight cases were reviewed with all cases of Syncephalestrum infections reported in the literature till August 2020. Results: S. racemosum (n = 4) and S. monosporum (n = 4) were identified by MALDI-TOF, sequencing and AFLP also clearly differentiated the two. All isolates were uniformly susceptible to amphotericin B and terbinafine. Analysis of clinical details in our eight patients with 43 more cases reported in the literature revealed that most of the reports were (78.4%) from India and cutaneous mucormycosis was the most common (37.3%) presentation followed by rhino-orbito-cerebral (23.5%) and pulmonary(17.6%) infection. Association of trauma with skin infection (p:0.042); immunosuppression/steroid use (p:0.005) and neutropenia (p:0.000) with pulmonary infection was seen. Conclusion: S. racemosum, S. monosporum give rise to human infections. The improved database of MALDI-TOF could distinguish the two species . Such rare and emerging infections merit careful consideration and clinical attention.