P157 Entomophthoromycosis: a rare fungal infection case series

POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM: OBJECTIVES: To present a case series of entomophthoromycosis (a rare fungal infection of the skin and subcutaneous tissue with a protracted and chronic clinical evolution), which would aid in the early recognition and management of this condition. MATERIALS AND METHODS: A total of 7 laboratory-confirmed cases of entomophthoromycosis, diagnosed and treated between May 2018 and March 2022 at our center, were included in the series. Diagnostic criteria were based on the results of conventional mycological diagnostic methods, including direct epifluorescence microscopy and visual identification of isolates obtained by culture on solid media. Clinical histories were collected retrospectively by chart review and correlated with laboratory findings. RESULTS: Of the seven patients, six were male and one was female, with ages ranging from 2.5 to 42 years. Most of the patients presented with chronic progressive nasal or rhinofacial swelling and nasal obstruction. Aseptate or pauciseptate hyphae were observed in direct epifluorescence microscopy of tissue samples from all the patients. Conidiobolus spp was isolated from samples from five patients, and Basidiobolus spp from the remaining two. Although growth in culture was obtained several days after sample inoculation, specific antifungal treatment for entomophthoromycosis (using a combination of potassium iodide and itraconazole) was initiated early based on concurrence between clinical features, typical fungal elements seen in direct microscopy and histopathological findings. All the patients improved rapidly and made full recoveries. CONCLUSION: Entomophthoromycosis is a rare condition whose identification requires a high index of clinical suspicion. The treatment for this condition is specific and different from the treatment for other clinically significant invasive fungal infections, but confirmation of diagnosis by culture may take weeks. Therefore, early diagnosis supported by a combination of suggestive clinical features as well as mycological and histopathological evidence, is vital to ensure successful outcomes.