ARS | Publication request: Evidence implicating Thamnostylum lucknowense as an etiological agent of Rhino-orbital Mucormycosis

Submitted to: Journal of Clinical Microbiology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: January 26, 2012
Publication Date: February 1, 2012
Citation: Xess, I., Mohapatra, S., Shivaprakash, M.R., Chakrabarti, A., Benny, G.L., O Donnell, K., Padhye, A.A. 2012. Evidence implicating Thamnostylum lucknowense as an etiological agent of Rhino-orbital Mucormycosis . Journal of Clinical Microbiology. 50(4):1491-1494.

Interpretive Summary: This study describes a case report of a fatal infection caused by the mucor-like filamentous mold Thamnostylum lucknowense (fungal order Mucorales). The patient was an Indian female with uncontrolled diabetes mellitus who was hospitalized with fever, vomiting and itching in the right eye, with intermittent episodes of altered response to sensory stimuli. A contrast enhanced computed tomographic (CT) scan of her face revealed evidence of infection of her sinuses and eye. A fast growing mold grew from a biopsy taken from her nasal cavity on microbiological media. The patient was treated over the course of one week with the antifungal amphotericin B, but this therapy was discontinued because the patient experienced kidney failure, and subsequently died on the tenth day of hospitalization due to cardiac arrest and multiorgan failure. Pure cultures of the fungus produced diagnostic morphological features that allowed it to be identified as T. lucknowense. Independent confirmation of the identification was obtained using DNA sequence data. This case report is unique in that it is the first known opportunistic infection caused by this fungus. The results of this study should be of interest to infectious disease specialists and microbiologists charged with diagnosing and treating infections caused by these highly aggressive molds in patients with predisposing conditions such as uncontrolled diabetes mellitus as well as immunologically healthy individuals.

Technical Abstract: In this report, we present a case of rhino-orbital mucormycosis in a 57-year-old female with poorly controlled diabetes mellitus. The causal agent was cultured from a specimen of the nasal crust and identified phenotypically and independently using nuclear ribosomal DNA sequence data as Thamnostylum lucknowense. To our knowledge, this is the first mycotic infection caused by this mucoraceous fungus.