NEW YORK, Aug 20 (Reuters Health) -- Six cases of a rare, fungal illness usually found in Africa or South America have been reported in Arizona in the last 5 years. Three cases were reported between January and March of this year, say experts at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.
Basidiobolomycosis can involve the skin, but it can also affect the stomach or large intestine, where the fungal infection may be mistaken as inflammatory bowel disease or cancer. The fungus responsible, Basidiobolus ranarum, is found in decaying vegetation and in the intestinal tracts of reptiles, amphibians, fish, and bats.
"(This) unusual fungal infection causes severe illness and may be misdiagnosed initially," note the CDC authors.
In the report released Thursday, the CDC team describes the circumstances surrounding two of the Arizona cases.
In one case, a 37-year-old woman presented to an emergency department in November 1998 with abdominal pain. The presumed initial diagnosis, based on her medical history and presenting signs, was peptic ulcer disease. However, treatment with traditional ulcer medications proved largely ineffective.
Doctors then switched their diagnosis to one of gastric cancer, and the woman underwent partial gastrectomy (removal of a portion of the stomach). Tissue biopsy showed a non-cancerous lesion, however, leading the doctors to the correct diagnosis of basidiobolomycosis. The patient was started on antifungal therapy and is now recovering.
In another case, a 59-year-old man consulted physicians after suffering from abdominal pain and abnormal stools for 3 weeks. Physicians first suspected colon cancer, and the patient had surgery to remove part of his intestine. Examination of the removed tissue revealed the fungal infection. The man has improved on antifungal therapy.
CDC editors commenting on the report say that how these patients became infected with the fungus remains "unclear." Possible exposure routes include "unintentional ingestion of (fungus-) contaminated soil, especially near rivers or lakes, or eating fruits or vegetables contaminated with soil or feces from reptiles or amphibians."
CDC officials are urging all healthcare providers to "consider basidiobolomycosis when caring for patients with gastrointestinal disease that doesn't respond to the usual treatment, or when a patient is diagnosed with an unusual, non-cancerous abdominal tumor."
SOURCE: Morbidity and Mortality Weekly Report 1999;48:710-713.
