|Year : 2019 | Volume
| Issue : 1 | Page : 1-9
Gastrointestinal basidiobolomycosis: An emerging potentially lethal fungal infection
M Ezzedien Rabie1, Abdulla Saad Al Qahtani1, Salim Jamil2, Nabil Tadros Mikhail3, Ismail El Hakeem1, Abdelellah Hummadi1, Khaled Elsayed Elshaar4, Ibrahim Abdelraheem5, Dib Saudi6
1 Department of Surgery, Armed Forces Hospital, Southern Region, Khamis Mushait, Saudi Arabia
2 Department of Pathology, Armed Forces Hospital, Southern Region, Khamis Mushait, Saudi Arabia
3 Department of Pathology, King Fahad Hospital, Jazan, Saudi Arabia; Department of Pathology, Alexandria University, Alexandria, Egypt
4 Department of Surgery, King Fahad Hospital, Jazan, Saudi Arabia
5 Department of Paediatric Surgery, Armed Forces Hospital, Southern Region, Khamis Mushait, Saudi Arabia; Department of Paediatric Surgery, Al Galaa Teaching Hospital, Cairo, Egypt
6 Department of Gastroenterology, Armed Forces Hospital, Southern Region, Khamis Mushait, Saudi Arabia
|Date of Web Publication||14-Mar-2019|
Dr. M Ezzedien Rabie
Department of Surgery, Armed Forces Hospital, Southern Region, P. O. Box 101, Khamis Mushait
Source of Support: None, Conflict of Interest: None
Background: Gastrointestinal basidiobolomycosis (GIB) is a newly emerging rare tropical fungal infection which affects immunocompetent individuals.
Patients and Methods: Our database was reviewed to identify patients with biopsy-proven gastrointestinal basidiobolomycosis.
Results: Six patients were recognized, two females and four males, with a median age of 23.5 years (range 11–70). All patients came from the same region and all had eosinophilia and they were all immunocompetent. The clinical and radiological features simulated colorectal malignancy in four patients, inflammatory bowel disease in one patient, and left iliac fossa mass in another patient. The diagnosis was established after extensive colonic surgery in four patients, after open biopsy in one patient and after ultrasound-guided biopsy in another. All patients received prolonged antifungal treatment. In those who received extensive colonic surgery, one patient died, two patients recovered, and one is still receiving antifungal treatment. Patients in whom the diagnosis was established by biopsy only, one patient recovered while the other is showing steady improvement.
Conclusion: GIB is a potentially lethal fungal infection, which affects immunocompetent individuals in temperate and hot arid regions of the world, including Saudi Arabia, Iraq, Iran, and Arizona desert in the United States. The patient usually presents with features suggestive of colonic malignancy, inflammatory bowel disease, or abdominal mass. Establishing the diagnosis by endoscopic- or radiology-guided biopsy, serological tests, fungal cultures, or molecular techniques enables the institution of antifungal treatment, which may lead to complete cure without surgery. With or without surgery prolonged antifungal therapy is always required.
Keywords: Antifungal agents, Arizona, basidiobolomycosis, colonoscopy, Saudi Arabia, surgery
|How to cite this article:|
Rabie M E, Al Qahtani AS, Jamil S, Mikhail NT, El Hakeem I, Hummadi A, Elshaar KE, Abdelraheem I, Saudi D. Gastrointestinal basidiobolomycosis: An emerging potentially lethal fungal infection. Saudi Surg J 2019;7:1-9
|How to cite this URL:|
Rabie M E, Al Qahtani AS, Jamil S, Mikhail NT, El Hakeem I, Hummadi A, Elshaar KE, Abdelraheem I, Saudi D. Gastrointestinal basidiobolomycosis: An emerging potentially lethal fungal infection. Saudi Surg J [serial online] 2019 [cited 2020 Sep 25];7:1-9. Available from: http://www.saudisurgj.org/text.asp?2019/7/1/1/254116
| Introduction|| |
Gastrointestinal fungal infections are an uncommon encounter for the surgeon, gastroenterologist, and radiologist alike. The unfamiliarity with this entity, usually leads to much confusion and diagnostic delay.
An emerging fungal infection is gastrointestinal basidiobolomycosis (GIB) caused by Basidiobolus species, which belong to the order Entomophthorales. Entomophthorales and Mucoralesare the two orders of the fungal class Zygomycete. The pathogenic potentials of both orders are totally different, with the first affecting the immunocompetent patients and the later affecting immunocompromised individuals, causing a mortality of >60%. In the order Entomophthorales, two genera are included, namely, Basidiobolus and Conidiobolus.
Of emerging surgical significance is the fungus Basidiobolus ranarum, which is present in soil and inhabits the intestine of reptiles, amphibians, and insectivorous bats., Surprisingly, it has been detected as a part of the mycobiota, normally inhabiting the gastrointestinal tract of the humans.
| Patients and Methods|| |
Our histopathology records were reviewed to identify patients with biopsy-proven GIB. Patients' records were retrieved and their demographic features, geographic residence, clinical course, and antifungal treatment were extracted. Data missing from the records were obtained through telephone communication with the patients.
This research has been conducted in accordance with the International Standards of Ethics as stated in the Helsinki Declaration and its various modifications, and it has been approved by the research ethics committee, xxxxx: code: AFHSRMREC/2015/GEN. SURGERY/062. Date: 7-6-2015.
All patients or patient's guardians gave their informed consent for the study.
As a small case series encompassing 6 cases, no advanced statistical analysis was necessary.
| Results|| |
We identified six patients with GIB, two females and four males, with a median age of 23.5 years (range 11–70). All patients came from the hot zone in the Southwestern region of Saudi Arabia (the hot zone of Aseer and Jazan). Three patients came from Jazan, two from Tohama, and one from Mohayel. They were all immunocompetent and eosinophilia was present in all of them except the 6th patient, in whom the differential white blood count was not requested.
The diagnosis was established after extensive colonic surgery in four patients, after open biopsy in one patient and after ultrasound (US)-guided biopsy in another [Table 1]. After establishing the diagnosis, all patients received prolonged antifungal treatment. In those who received extensive colonic surgery, one patient died, two patients recovered, and one is still receiving antifungal treatment. The patient in whom the diagnosis was established by open biopsy recovered under antifungal treatment only, while that in whom the diagnosis was established with US-guided biopsy no surgery was recommended and is showing steady improvement under antifungal treatment.
The site of the disease as well as its presentation, treatment given, and its result are shown in [Table 2]. The antifungal regimen is shown in [Table 3].
|Table 2: Site of the disease, presentation, treatment provided, positive biopsy modality, and outcome|
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A 22-year-old male, referred with a bleeding rectal mass, discovered on colonoscopy [Figure 1]. As malignancy was suspected, multiple biopsies were taken.
|Figure 1: Colonoscopic view of the anorectal mass with ulcerating surface|
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On examination, the patient looked well and rectal examination revealed multiple nodular masses in the upper part of the anal canal and lower rectum.
His blood picture showed low haemoglobin (10.2 g/dl, reference range 14–18) and eosinophilia (22%, reference range <7). Computed tomography (CT) scan showed diffuse thickening of the rectal wall with multiple paraaortic and pelvic lymphadenopathy. Histopathology of colonoscopic biopsies showed an inflammatory process with no malignant cells detected, and the histopathologist advised for deeper biopsy. Multiple deep proctoscopic biopsies were taken for histopathology examination and culture for acid–fast bacilli (AFB). The histopathology reported eosinophilic proctitis and the culture for AFB came negative.
Due to the high clinical suspicious of rectal malignancy, we decided to repeat the tissue biopsy, where a nodule along with the deeper tissues of the rectal wall was excised [Figure 2]. Meanwhile, serological tests for schistosomiasis and amoebiasis were requested and came negative.
Finally, the histopathological examination showed fungal proctitis with transmural acute inflammatory cells, mainly neutrophils and many eosinophils and chronic granulomatous inflammation with foreign body type multinucleated giant cells, some of which are engulfing fungal hyphae. The free fungi were surrounded by intense eosinophilic material that clearly demonstrates the presence of the fungus (Splendore–Hoeppli phenomenon). The fungi have thin wall and irregular outline and can be seen collapsed or twisted forming enlargement like small balls. They are pauciseptate and branches at acute angles. They stain with hematoxylin and eosin, Periodic acid–Schiff, and Gomori methenamine silver stains very well, features highly suggestive of basidiobolomycosis [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7].
|Figure 3: Fungal form surrounded by dense eosinophilic reaction (yellow oval, H and E ×40)|
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|Figure 6: Multinucleated foreign body giant cells engulfing fungi (H and E, ×400)|
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|Figure 7: Eosinophils and neutrophils around fungi as well as chronic inflammatory cells (H and E, ×100)|
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The patient was started on itraconazole 200 mg IV for 2 weeks, then shifted to voriconazole 200 mg IV for 4 weeks, and then oral voriconazole 200 mg BID was started to complete 1 year of antifungal treatment, with regular monitoring of blood picture, liver, and renal functions.
In his last OPD visit, few months later, the patient looked in good health with complete disappearance of the anorectal masses.
A 17-year-old previously healthy female presented with extensive bilateral perianal and gluteal brawny swellings. She underwent incision and drainage of perianal abscess twice in the preceding 2 months.
Her laboratory investigations were normal apart from leukocytosis and eosinophilia. Crohn's disease was suspected and colonoscopy was performed, but colonoscopic biopsy showed chronic nonspecific inflammation. CT scan showed extensive perianal collection extending up in the retroperitoneum with the right perinephric collection. Incision and drainage of both the gluteal regions and perinephric collections were done. The general condition of the patient continued to deteriorate with progressive muscle wasting, which culminated into hemiparesis. Locally, the skin overlying the sacrum sloughed exposing the underlying unhealthy looking muscles [Figure 8].
|Figure 8: Skin sloughing, exposing the underlying partially necrotic gluteal muscles and sacrum|
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Diagnostic laparoscopy showed a mass involving the ileocecal region, for which ileocecal resection with end ileostomy was performed to divert the stools away from the perianal and gluteal regions.
Histopathological examination showed features suggestive of basidiobolomycosis [Figure 9]. Upon this, intravenous fluconazole 200 mg OD, then voriconazole 100 mg PO BD were added to the antibiotics agents. Repeated debridement of the perianal and gluteal regions was carried out, with a seemingly favourable response [Figure 10].
|Figure 9: Splendore–Hoeppli phenomenon (yellow circle): central fungal forms surrounded by a thick eosinophilic cuff (H and E, ×40)|
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Unfortunately, after 3 months of her hospital stay, heavy trickling of blood from the gluteal region started and the patient was shifted immediately to the operation theater. On exploration, profuse bleeding from an unrecognized source deep in the pelvis started. The infection appeared to excavate and destroy the region, including the vessels and nerves, under the apparently intact gluteal muscles. Control of bleeding failed due to extensive tissue maceration and despite the surgical efforts and massive transfusions, the patient expired.
| Discussion|| |
Basidiobolomycosis is a known, though rare, infection caused by the fungus B. ranarum. Seen mainly in the tropics, it affects the skin and subcutaneous tissue of the limbs and trunk of immunocompetent individuals, following minor trauma or insect bites., Relatively recently, GIB has been reported and new cases were discovered, probably due to increased awareness of the condition.
In their review of the English literature from 1964 to 2013, Geramizadeh et al. were able to identify only 71. Most of them came from the US (23 cases), Saudi Arabia (23 cases), Iran (17 cases), Iraq (6 cases), Kuwait, and the Nederland (one case each). In another report from Mayo Clinic published in 2015, 73 cases were identified worldwide. The disease affects the adult as well as the pediatric populations and most pediatric cases came from Saudi Arabia. Out of 27 reported pediatric cases, 19 came from Saudi Arabia.
The rarity of this disease, added to the unfamiliarity of the concerned physicians with it and its clinical, endoscopic, and radiologic similarity to the more common abdominal malignancy, inflammatory bowel disease or tuberculosis,,,,,, often delays the diagnosis and lead to an extensive and probably unnecessary surgery. In this series, the diagnosis was established after extensive colonic resection in three cases, the 2nd, 3rd, and 4th patient, while it was established by transanal incisional biopsy, after failure of repeated colonoscopic biopsies, in the 1st patient, and by US-guided biopsy in the 5th patient. In only one patient in this series, the 6th patient, was the diagnosis established by colonoscopic biopsy.
Obviously, the identification of basidiobolomycosis on biopsy specimens may avoid an unnecessary and often major surgery as the organism responds well to the antifungal treatment., This was the case in our 1st and 5th patient. However, despite that, the diagnosis was established by colonoscopic biopsy in the 6th patient, the fear of imminent colonic obstruction led us to perform right hemicolectomy. In this regard, colonoscopic biopsy may only show nonspecific inflammation or granulomatous reaction, as seen in the 1st, 2nd, and 4th patient in this series. Only exceptionally may it reveal fungal forms, as seen in our 6th patient. This failure of endoscopic biopsy to establish the diagnosis has been reported in the majority of published cases., It is probable that the fungi reside deep to the mucosa, rendering its retrieval within the biopsy specimen difficult.
Although histopathological examination of biopsy specimens is currently the major diagnostic modality, other ancillary means exist. These include fungal cultures, serological tests, and molecular techniques which, when available, may establish the diagnosis with certainty. On histopathology, thin-walled irregularly branching hyphae with occasional septae may be seen surrounded by dense eosinophilic reaction (Splendore–Hoeppli phenomenon).,, These morphologic characters were seen in all our cases as well as all those reported. It is to be noted that this picture differs from the picture of other invasive gastrointestinal fungi like mucormycosis.,, Once seen, these features enable an almost certain diagnosis to be made, although some authors have argued that the unequivocal diagnosis requires fungal cultures and/or specific serological tests and molecular techniques. However, in practice, the finding of hyphae showing the morphological features already mentioned may be the only available means as the diagnosis is rarely suspected for tissue cultures to be performed, before immersing the biopsy material in formalin, which destroys all fungal forms. Moreover, fungal culture may be falsely negative in as much as 50% of cases. However, their main value emerges when the tiny biopsy material, whether colonoscopic or CT guided, contain few fungal forms. In these conditions, tissue cultures enable a more detailed study of the fungus to conducted. This recently happened in one of our patients, not included in this series, where the colonoscopic biopsy showed only one fungal form. Fortunately, in anticipation of the diagnosis, part of the specimen was used for tissue culture, which came positive. It must also be mentioned that serological tests including immunodiffusion tests with its reported high sensitivity and specificity,, and molecular techniques for identifying fungal DNA,, are unavailable in the majority of centers dealing with this rare infection. This leaves the histopathologic examination as the mainstay diagnostic tool.
In any case, with or without surgery, a prolonged antifungal treatment should follow.,, In this series, the shortest period of antifungal therapy was 6 months and the longest is not known yet, as some patients are still on prolonged antifungal therapy (the 1st, 5th and 6th patient). However, the longest completed course was 18 months (the 3rd patient). In this regard, the choice and duration of the antifungal therapy was at the hands of the physicians in conjunction with the clinical pharmacist, and as the disease is rare with no previous local experience exists, different drugs were chosen without a clear indication of the superiority of one over the other. However, in any circumstance, regular follow-up with periodic liver and renal functions is mandatory, as was customary in this series.
Fungal species form part of the gastrointestinal microflora and contrary to the microbiome, with its known physiologic significance, the function of the mycobiome, if any, remains unknown. This mycobiome includes 390 fungal species living on the skin, vagina, and orodigestive tract and Basidiomycota and Zygomycot a phyla are represented here. Although no sex difference regarding the predominant species was observed, B. ranarum is much more prevalent in male individuals. In this regard, factors which lead to the establishment of this devastating infection remains unknown, and it is notable that all our patients as well as all other reported cases, were immunocompetent.
A notable finding in this study is the area of residence of the patients. The Southwestern region of Saudi Arabia is composed of two provinces, Aseer region and Jazan. Both contain mountainous areas and lowlands, with the lowlands having a hot climate. In this series, three patients came from the lowlands of Jazan and three from the lowlands of Aseer: two from Tohama and the other from Mohayel. The endemicity of these regions with Basidiobolus has been previously reported. This underscores the importance of considering GIB in relevant cases hailing from these areas. Moreover, as eosinophilia was seen in five patients presented here, it might serve as an additional sign to heighten the suspicion. However, as the disease is rare, the significance of knowing its geographical distribution may remain limited.
For completion, we conducted a literature search for published cases till date. Our PubMed search utilizing the term gastrointestinal basidiobolomycosis, yielded 44 reports. Due to the fact that few cases may have been reported more than once, probably in a trial to address the topic from a different angle, the exact number of cases could not be easily known. The results of the search are summarized in [Table 4], [Table 5], [Table 6], where [Table 4] shows reported cases in the pediatric population,,,,,,,,,,,,,,,,,, [Table 5] shows reported cases in the adult population,,,,,,,,,,,,,,,,,,,,,, and [Table 6] shows mixed reports in pediatric and adult populations.,
| Conclusion|| |
GIB is a potentially lethal fungal infection, which affects immunocompetent individuals in temperate and hot arid regions of the world, including Saudi Arabia, Iraq, Iran, and Arizona desert in the United States. The patient usually presents with features suggestive of colonic malignancy, inflammatory bowel disease, or abdominal mass. Although difficult, establishing the diagnosis by endoscopic- or radiology-guided biopsy, serological tests, fungal cultures, or molecular techniques enables the institution of antifungal treatment, which may lead to complete cure without surgery. Whether surgery is performed or not, prolonged antifungal therapy is always required.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Prabhu RM, Patel R. Mucormycosis and entomophthoramycosis: A review of the clinical manifestations, diagnosis and treatment. Clin Microbiol Infect 2004;10 Suppl 1:31-47.
Gugnani HC. A review of zygomycosis due to Basidiobolus ranarum
. Eur J Epidemiol 1999;15:923-9.
Gouba N, Drancourt M. Digestive tract mycobiota: A source of infection. Med Mal Infect 2015;45:9-16.
Anaparthy UR, Deepika G. A case of subcutaneous zygomycosis. Indian Dermatol Online J 2014;5:51-4.
] [Full text]
Kumar Verma R, Shivaprakash MR, Shanker A, Panda NK. Subcutaneous zygomycosis of the cervicotemporal region: Due to Basidiobolus ranaram
. Med Mycol Case Rep 2012;1:59-62.
Geramizadeh B, Heidari M, Shekarkhar G. Gastrointestinal basidiobolomycosis, a rare and under-diagnosed fungal infection in immunocompetent hosts: A review article. Iran J Med Sci 2015;40:90-7.
Flicek KT, Vikram HR, De Petris GD, Johnson CD. Abdominal imaging findings in gastrointestinal basidiobolomycosis. Abdom Imaging 2015;40:246-50.
El-Shabrawi MH, Kamal NM, Jouini R, Al-Harbi A, Voigt K, Al-Malki T, et al.
Gastrointestinal basidiobolomycosis: An emerging fungal infection causing bowel perforation in a child. J Med Microbiol 2011;60:1395-402.
Al-Maani AS, Paul G, Jardani A, Nayar M, Al-Lawati F, Al-Baluishi S, et al.
Gastrointestinal basidiobolomycosis:First case report from Oman and literature review. Sultan Qaboos Univ Med J 2014;14:e241-4.
Rabie ME, El Hakeem I, Al-Shraim M, Al Skini MS, Jamil S. Basidiobolomycosis of the colon masquerading as stenotic colon cancer. Case Rep Surg 2011;2011:685460.
Saadah OI, Farouq MF, Daajani NA, Kamal JS, Ghanem AT. Gastrointestinal basidiobolomycosis in a child; an unusual fungal infection mimicking fistulising Crohn's disease. J Crohns Colitis 2012;6:368-72.
Al Jarie A, Al Azraki T, Al Mohsen I, Al Jumaah S, Almutawa A, Mohd Fahim Y, et al.
Basidiobolomycosis: Case series. J Mycol Med 2011;21:37-45.
Vikram HR, Smilack JD, Leighton JA, Crowell MD, De Petris G. Emergence of gastrointestinal basidiobolomycosis in the United States, with a review of worldwide cases. Clin Infect Dis 2012;54:1685-91.
Nemenqani D, Yaqoob N, Khoja H, Al Saif O, Amra NK, Amr SS, et al.
Gastrointestinal basidiobolomycosis: An unusual fungal infection mimicking colon cancer. Arch Pathol Lab Med 2009;133:1938-42.
Lyon GM, Smilack JD, Komatsu KK, Pasha TM, Leighton JA, Guarner J, et al.
Gastrointestinal basidiobolomycosis in Arizona: Clinical and epidemiological characteristics and review of the literature. Clin Infect Dis 2001;32:1448-55.
Yousef OM, Smilack JD, Kerr DM, Ramsey R, Rosati L, Colby TV, et al.
Gastrointestinal basidiobolomycosis. Morphologic findings in a cluster of six cases. Am J Clin Pathol 1999;112:610-6.
Hussein MR, Musalam AO, Assiry MH, Eid RA, El Motawa AM, Gamel AM, et al.
Histological and ultrastructural features of gastrointestinal basidiobolomycosis. Mycol Res 2007;111:926-30.
Do GW, Jung SW, Jun JB, Seo JH, Nah YW. Colonic mucormycosis presented with ischemic colitis in a liver transplant recipient. World J Gastroenterol 2013;19:3508-11.
Roussy JF, Allard C, St. Germain G, Pépin J. Gastrointestinal mucormycosis following a streptococcus pyogenes toxic shock syndrome in a previously healthy patient: A case report. Case Rep Infect Dis 2012;2012:476719.
Morton J, Nguyen V, Ali T. Mucormycosis of the intestine: A rare complication in Crohn's disease. Gastroenterol Hepatol (N Y) 2012;8:137-40.
Zabolinejad N, Naseri A, Davoudi Y, Joudi M, Aelami MH. Colonic basidiobolomycosis in a child: Report of a culture-proven case. Int J Infect Dis 2014;22:41-3.
Imwidthaya P, Srimuang S. Immunodiffusion test for diagnosing basidiobolomycosis. Mycopathologia 1992;118:127-31.
Kaufman L, Mendoza L, Standard PG. Immunodiffusion test for serodiagnosing subcutaneous zygomycosis. J Clin Microbiol 1990;28:1887-90.
El-Shabrawi MH, Kamal NM, Kaerger K, Voigt K. Diagnosis of gastrointestinal basidiobolomycosis: A mini-review. Mycoses 2014;57 Suppl 3:138-43.
Gómez-Muñoz MT, Fernández-Barredo S, Martínez-Díaz RA, Pérez-Gracia MT, Ponce-Gordo F. Development of a specific polymerase chain reaction assay for the detection of Basidiobolus
. Mycologia 2012;104:585-91.
Al Jarie A, Al-Mohsen I, Al Jumaah S, Al Hazmi M, Al Zamil F, Al Zahrani M, et al.
Pediatric gastrointestinal basidiobolomycosis. Pediatr Infect Dis J 2003;22:1007-14.
Arjmand R, Karimi A, Sanaei Dashti A, Kadivar M. A child with intestinal basidiobolomycosis. Iran J Med Sci 2012;37:134-6.
Sanaei Dashti A, Nasimfar A, Hosseini Khorami H, Pouladfar G, Kadivar MR, Geramizadeh B, et al.
Gastro-intestinal basidiobolomycosis in a 2-year-old boy: Dramatic response to potassium iodide. Paediatr Int Child Health 2018;38:150-3.
Al-Shanafey S, AlRobean F, Bin Hussain I. Surgical management of gastrointestinal basidiobolomycosis in pediatric patients. J Pediatr Surg 2012;47:949-51.
AlSaleem K, Al-Mehaidib A, Banemai M, Bin-Hussain I, Faqih M, Al Mehmadi A, et al.
Gastrointestinal basidiobolomycosis: Mimicking Crohn's disease case report and review of the literature. Ann Saudi Med 2013;33:500-4.
Zahir ST, Sharahjin NS, Kargar S. Basidiobolomycosis a mysterious fungal infection mimic small intestinal and colonic tumour with renal insufficiency and ominous outcome. BMJ Case Rep 2013;2013. pii: bcr2013200244.
Al-Qahtani AM, Alsuheel AA, Shati NI, Mirza AA, Al-Qahtani AA, Al-Hanshani AA, et al
. Case reports: Gastrointestinal basidiobolomycosis in children. Curr Pediatr Res 2013;17:1-6.
Al Asmi MM, Faqeehi HY, Alshahrani DA, Al-Hussaini AA. A case of pediatric gastrointestinal basidiobolomycosis mimicking Crohn's disease. A review of pediatric literature. Saudi Med J 2013;34:1068-72.
Albaradi BA, Babiker AM, Al-Qahtani HS. Successful treatment of gastrointestinal basidiobolomycosis with voriconazole without surgical intervention. J Trop Pediatr 2014;60:476-9.
Saeed MA, Al Khuwaitir TS, Attia TH. Gastrointestinal basidiobolomycosis with hepatic dissemination: A case report. JMM Case Rep 2014;1:e003269.
Mandhan P, Hassan KO, Samaan SM, Ali MJ. Visceral basidiobolomycosis: An overlooked infection in immunocompetent children. Afr J Paediatr Surg 2015;12:193-6.
] [Full text]
Geramizadeh B, Sanai Dashti A, Kadivar MR, Kord S. Isolated hepatic basidiobolomycosis in a 2-year-old girl: The first case report. Hepat Mon 2015;15:e30117.
Krishnamurthy S, Singh R, Chandrasekaran V, Mathiyazhagan G, Chidambaram M, Deepak Barathi S, et al.
Basidiobolomycosis complicated by hydronephrosis and a perinephric abscess presenting as a hypertensive emergency in a 7-year-old boy. Paediatr Int Child Health 2018;38:146-9.
Shreef K, Saleem M, Saeedd MA, Eissa M. Gastrointestinal basidiobolomycosis: An emerging, and A confusing, disease in children (A multicenter experience). Eur J Pediatr Surg 2018;28:194-9.
Pasha TM, Leighton JA, Smilack JD, Heppell J, Colby TV, Kaufman L, et al.
Basidiobolomycosis: An unusual fungal infection mimicking inflammatory bowel disease. Gastroenterology 1997;112:250-4.
Symmers WS. Imported mycoses: Some diagnostic problems. Postgrad Med J 1979;55:598-602.
Centers for Disease Control and Prevention. Gastrointestinal basidiobolomycosis-Arizona, 1994-1999. MMWR Morb Mortal Wkly Rep 1999;48:710-3.
Nguyen BD. CT features of basidiobolomycosis with gastrointestinal and urinary involvement. AJR Am J Roentgenol 2000;174:878-9.
Khan ZU, Khoursheed M, Makar R, Al-Waheeb S, Al-Bader I, Al-Muzaini A, et al. Basidiobolus ranarum
as an etiologic agent of gastrointestinal zygomycosis. J Clin Microbiol 2001;39:2360-3.
Choonhakarn C, Inthraburan K. Concurrent subcutaneous and visceral basidiobolomycosis in a renal transplant patient. Clin Exp Dermatol 2004;29:369-72.
Bigliazzi C, Poletti V, Dell'Amore D, Saragoni L, Colby TV. Disseminated basidiobolomycosis in an immunocompetent woman. J Clin Microbiol 2004;42:1367-9.
van den Berk GE, Noorduyn LA, van Ketel RJ, van Leeuwen J, Bemelman WA, Prins JM, et al.
A fatal pseudo-tumour: Disseminated basidiobolomycosis. BMC Infect Dis 2006;6:140.
Chetambath R, Deepa Sarma MS, Suraj KP, Jyothi E, Mohammed S, Philomina BJ, et al. Basidiobolus
: An unusual cause of lung abscess. Lung India 2010;27:89-92.
] [Full text]
Rose SR, Lindsley MD, Hurst SF, Paddock CD, Damodaran T, Bennett J, et al.
Gastrointestinal basidiobolomycosis treated with posaconazole. Med Mycol Case Rep 2012;2:11-4.
Ejtehadi F, Anushiravani A, Bananzadeh A, Geramizadeh B. Gastrointestinal basidiobolomycosis accompanied by liver involvement: A case report. Iran Red Crescent Med J 2014;16:e14109.
Pandit V, Rhee P, Aziz H, Jehangir Q, Friese RS, Joseph B, et al.
Perforated appendicitis with gastrointestinal basidiobolomycosis: A rare finding. Surg Infect (Larchmt) 2014;15:339-42.
Cazorla A, Grenouillet F, Piton G, Faure É, Delabrousse É, Mathieu P, et al.
A letal case of gastro-intestinal basidiobolomycosis. Ann Pathol 2014;34:228-32.
Al-Naemi AQ, Khan LA, Al-Naemi I, Amin K, Athlawy YA, Awad A, et al.
A case report of gastrointestinal basidiobolomycosis treated with voriconazole: A rare emerging entity. Medicine (Baltimore) 2015;94:e1430.
Ilyas MI, Jordan SA, Nfonsam V. Fungal inflammatory masses masquerading as colorectal cancer: A case report. BMC Res Notes 2015;8:32.
Sitterlé E, Rodriguez C, Mounier R, Calderaro J, Foulet F, Develoux M, et al.
Contribution of ultra deep sequencing in the clinical diagnosis of a new fungal pathogen species: Basidiobolus meristosporus
. Front Microbiol 2017;8:334.
Geramizadeh B, Foroughi R, Keshtkar-Jahromi M, Malek-Hosseini SA, Alborzi A. Gastrointestinal basidiobolomycosis, an emerging infection in the immunocompetent host: A report of 14 patients. J Med Microbiol 2012;61:1770-4.
Hassan HA, Majid RA, Rashid NG, Nuradeen BE, Abdulkarim QH, Hawramy TA, et al.
Eosinophilic granulomatous gastrointestinal and hepatic abscesses attributable to basidiobolomycosis and fasciolias: A simultaneous emergence in Iraqi Kurdistan. BMC Infect Dis 2013;13:91.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]