Absidia corymbifera

Absidia corymbifera on gypsum boardAbsidia corymbifera on woodAbsidia corymbifera on a ceiling tileAbsidia corymbifera on EM agarAbsidia corymbifera on RB agarAbsidia corymbifera - StereoscopyAbsidia corymbifera - Microscopy (EM Culture)

Basics

There are 12 to 21 named species of Absidia, depending on the taxonomy followed; most are soil-borne species {431}. Few are mentioned regularly as found in the indoor environment {2694; 1056; 470}. Absidia corymbifera, also named Absidia ramosa or Mycocladus corymbiferus, is of particular interest as this species can be found in the indoor environment and is linked to many adverse health effects.

Taxonomy

Kingdom Fungi/Metazoa group Order Mucorales
Phylum Mucoromycotina Family Mucoraceae (Mycocladiaceae)
Class Zygomycetes Genus Absidia (Mycocladus)

Even if this species has been placed in an other genus (Mycocladus) by certain taxonomists, it will be treated here as anAbsidia and as an example of other species of Absidia.  Absidia corymbifera is the most commonly isolated species and is the only recognized pathogen among the genus causing zygomycosis (mucoromycosis) in immune compromised individuals. 
One must note that these zygomyses are often considered as one entity as full identification of the agent is rarely confirmed. 

Some of the other important Absidia species are A. coerulea, A. cylindrospora, A. glauca and A. spinosa.

Habitat/Ecology

Most members of Zygomycetes are saprobic, though some attack other fungi as well as animals and plants {1056}; they are found all over the world in decaying vegetation and soil, growing very rapidly and releasing large numbers of spores {3723; 1942; 3727}. They often cause food spoilage like on decaying vegetables in cold storage and on mouldy bread  {431}.

Absidia corymbifera is found worldwide in soil and decaying organic matter. Absidia species are also found in spices {2050}, nuts {3699} and grain products : a study found Absidia spp in 16 % of 100 samples of poultry feed mixtures studied  {1778} .

Absidia corymbifera is ubiquitous and is considered common to the indoor environment.  There are few reports on the occurrence and prevalence of Absidia species in natural or human environments. A Brazilian study showed that Absidiaspecies are only a minor contaminant in outdoor air samples with a prevalence of 2.2% and  was more frequent during the dry season  {1973}. Absidia was also identified in outdoor air samples in Turkey  {3541}.

Growth requirements

Absidia corymbifera is a psychrotolerant and thermophilic fungus growing more rapidly at 37 °C than at 25 °C. Its’ maximum growth temperature is as high as 48 to 52 °C. however the growth of A. corymbifera is optimum at 35-37°C, at a pH value of 3.0 to 8.0 {431; 415}. A. corymbifera may grow on damp building materials {1056}.   The minimum aw for spore germination and growth in vitro for A. corymbifera is 0.88 {3724}. 

Growth on building materials or indoor environment

Absidia corymbifera is ubiquitous and is considered common to the indoor environment  {62; 856; 1056} , contaminating building materials with high cellulose content {3729}.  In indoor environments it has also been isolated from carpet and mattress dust, potted plant soil and bird droppings {3729}.

More details

Samples of wall scrapings collected from damp dwellings in Zagreb (Croatia) revealed that 8% of them were contaminated with Absidia, the third most abundant fungus (with Ulocladium and Mucor) after Aspergillus, Penicillium{1589}.  In Poland, Absidia was found in 5% of mouldy homes {856}.

Absidia is known to be associated with hay, grain of feed mixture in agriculture. Consequently, Absidia may be found in the rural indoor environment: in fact it is one of the microorganisms involved recently in farmer’s lung disease (see adverse health effects). Labuda and Tancinova {1778}  recovered A. corymbifera in 20% of poultry feed mixtures. In an other study of industrial and agricultural facilities, A. coerulea was also recovered in few air samples: 1,7% of samples in a swinery and 2,7% in a feed preparing and storing facility {854}.

Laboratory section

Normal laboratory precautions should be exercised in handling cultures of this species within Biosafety Level 2 practices and containment facilities.

Colony, macroscopic morphology

Absidia corymbifera grows rapidly and colonies mature within 4 days {412}. Colonies cover the whole Petri dish within a week (5-7 mm to 15 mm in thickness): they are floccose, light grey at first and then rapidly olive gray {1056}. On potato glucose agar, the diameter of the colony is 3-9 cm following incubation at 25 °C for 7 days. The reverse is uncoloured or white and there is no diffused pigment production {412; 431}.

Like any Zygomycetes, Absidia should be studied under low magnification to determine the general form of growth in order to recognised the main identification criteria {1056}.

Microscopic morphology

Absidia species, like all Zygomycetes, are characterized by primitive coenocytic (non septate) wide hyphae (6-15 mm wide) {412}. The reproduction structures are the main Absidia    identification criteria.  Absidia reproduces sexually and asexually.  

Sexual reproduction is isogamous and occurs by fusion of two multinucleate gametangia resulting in thick-walled brown or black zygospores that are borne in the aerial mycelium; they are globose to slightly flattened (40-85 mm in diameter), slightly roughened, thick-walled with one or several equatorial ridges {1056}. Because zygospores are usually absent in routine cultures, identification is based primarily on the asexual reproduction structures morphology, i.e., on sporangial arrangement and number, shape, color, etc. {814}.

Asexual reproduction structures include clamydoconidia, conidia and sporangiospores.  The later are formed within a globose or pyriform sporangia which is mounted on a sporangiophore; the part of the sporangiophore that extend within the sporangia is called the columella {414; 1056}. Absidia spp typically produces sporangia with a columella and a distinct apophysis;  the sporangia are faintly coloured or hyaline, frequently branched and measure 10-40 µm or up to 80 µm when the sporangium is in terminal apical position on a stolon  {1056}.

More details

Morphological criteria specific to Absidia corymbifera are the following.  Stolons measure5-20 mm in diameter and up to 370 mm long; theyare hyaline to brownish, smooth-walled, with an occasional septum often terminating in a large sporangium.  Rhizoids are borne on a swollen area of the stolon.  Sporangiophores, subglobose to oblong-ellipsoidal, are hyaline to faintly pigmented, simple or sometimes branched, arising solitary, in groups of three, or in whorls of up to seven.  Sporangia are more or less pyriform (10- 40 mm in diameter), hyaline at first, becoming grey to greyish-brown when mature; the sporangium wall is transparent, smooth to slightly roughened.  Columellas (10-30 mm in diameter) are hyaline to greyish, globose to short ovoid {1056}.  Sporangiospores are small, spherical to oval and colourless (3-4 mm x 2-3 mm in size), released following rupture of the sporangial walls {814}.

The following criteria can tell apart the genus Absidia from the other Zygomycetes. The genus Absidia is characterized by a differentiation of the hyphae into arched stolons bearing more or less verticillate sporangiophores at the internode, and rhizoids formed at the point of contact with the substrate (at the node). That is to say that the sporangiospores of Absidiaarise at a point of the stolon that is between the rhizoids and not opposite them, a feature which differentiate this genus from Rhizopus where the sporangia arise from the nodes and are therefore found opposite the rhizoids {412}. The sporangia are supported by a characteristic funnel-shaped apophysis which distinguishes Absidia from the generaMucor and Rhizomucor, which have large, globose sporangia without an apophysis {431}.

Specific metabolites

Organics compounds (including VOCs)

In the indoor environment of damp buildings, many organic compounds, including microbial volatile organic compounds (mCOVs), have been identified associated with several fungal species. Some of these compounds are common to most fungal species and probably contribute to different health problems associated with indoor air quality,
However many of the fungal metabolites identified are non reactive and are in low concentrations in indoor air {594}.

The specific mVOC profile of A. corymbifera is not known.

Mycotoxins

Absidia corymbifera is not known to produce mycotoxins.  No toxin was reported by Labuda and Tancinova {1778}  who studied the toxins produced by moulds found in poultry feed mixtures.  No report concerning mycotoxin production by Absidia ssp has been found in the literature.

Some Absidia species have been incorrectly reported to produce aflatoxins including Absidia butleri and Absidia glauca . {3726}.

Adverse health reactions

Organisms of the Zygomycetes class were the first fungi noted to cause diseases in humans in the 1800’s.  Absidia, Mucorand Rhizopus are the main Zygomycetes pathogens most often reported causing disease to humans {1943; 452}.

Irritation and inflammation

It is generally accepted that many fungal structural components, common to all moulds, can induce irritation and inflammation.

No specific study on irritation or inflammation due to Absidia has been reported.

Allergic reactions

Absidia sp is considered common to indoor environment and is reported to cause allergic reactions in some people {1420; 1399; 3047; 3840; 2019; 1973; 3561; 3839} .

Allergic components and mechanism

Specific allergenic components of Absidia have not been studied.

Hypersensitivity pneumonitis

Type III hypersensitivity pneumonites due to Absidia spp  are well known in rural settings: it has recently been associated with farmers lung disease {1103; 2026; 3670; 1091}.

More details

Farmer’s lung disease (FLD) is a granulomatous pneumonitis, also referred to as «extrinsic allergic alveolitis», caused by exposure to microorganisms from mouldy hay: most often FLD is associated with thermophilic actinomycetes such asSaccharopolyspora, Thermoactinomyces and Micropolyspora and  Aspergillus fumigatus, but Absidia corymbifera is now also implicated {1091}. To identify microbiological etiological agents of this disease in France, Reboux et al {1103} selected 11 patients and 11 controls: they found that A. corymbifera was present in the air, hay, straw, ensilage and flour on the farms of the subjects with farmer’s lung disease. Despite the fact that the concentration of this species was low as compared to some other fungus identified, the presence of A. corymbifera was the only criteria able to discriminate subjects with FLD from controls, both in terms of exposure and of sensitization: this fungus could thus be considered as an etiological agent of the disease. This finding was confirmed by Roussel et al {1091} reported that the prevalence of A. corymbifera in hay handled in FLD farms was 19%, as compared to 0,7% in control hays. In Finland, FLD patients had significantly higher median IgG antibodies levels against A. corymbifera as compared to controls; the prevalence of IgG was 20% in FLD patients and 4% in control farmers; A. corymbifera is thus considered as a new contributor to FLD {227} .

Toxic effects (mycotoxicosis)

No mycotoxicosis has been attributed to Absidia spp.

Infections and colonisations

Absidia corymbifera is a saprophytic organism, with worldwide distribution. Absidia corymbifera is an uncommon pathogen representing only 2 to 3% of all zygomycetes infections in humans. The organism is opportunistic, rarely infecting the immunocompetent subject although such cases have been reported {3697}.  A. corymbifera is more likely to be involved as an infectious agent in immunocompromised subjects. The usual sites of infection are lung, nasal sinuses, brain, eyes, gastrointestinal tract and skin. Infection may happen in multiple sites {3215}.  Absidia corymbifera can be an invasive infectious agent in HIV-AIDS and neutropenic patients {3698}.   

Host risk factors include diabetes mellitus, neutropenia, sustained immunosuppressive therapy, chronic prednisone use, iron chelation therapy, broad-spectrum antibiotic use, severe malnutrition, and primary breakdown in the integrity of the cutaneous barrier such as trauma, surgical wounds, needle sticks, or burns. 

In veterinary medicine, Absidia corymbifera has been reported, as an agent of bovine mycotic abortions and feline subcutaneous abscesses.   

More details

The usual mode of transmission for the Zygomycetes is presumed to be via inhalation of sporangiospores released into the environment {1955}, but can also be transmitted by percutaneous routes or by ingestion of spores. Experimentally, rabbits infected by nasal instillation developed upper and lower respiratory disease with subsequent spread to the central nervous system. Inhalation thus causes the major clinical infections (rhinocerebral and pulmonary) with dissemination from the respiratory tract accounting for other infections {1955}. Inhalation of spores in dust provides also the exposure seen in the allergic interstitial pneumonitis or alveolitis syndrome (see Hypersensitivity pneumonitis section).

Rhinocerebral infections are usually fulminant and frequently fatal {431} : this disease is frequently seen in the uncontrolled diabetic. In this disease the fungus has a tendency to invade blood vessels (particularly arteries) and enters the brain via the blood vessels and by direct extension through the cribiform plate.
Zygomycoses, including Absidia infections, are often associated with a poor prognosis, having high morbidity and mortality (41% in patients without malignancy and 80% in those with malignancy); these infections include pulmonary, rhinocerebral, cutaneous, gastrointestinal and disseminated mycoses {1955}. 
The host risk factors for pediatric zygomycoses are the same as for adults adding type I diabetes and prematurity.  In a meta-analysis of 157 cases, reported risk factors were the following: prematurity (17%), diabetes mellitus (15%), ketoacidosis (10%), and 14 % had no apparent underlying condition {1939}.   Zygomycosis is a life-threatening infection in children and there is high mortality in untreated disease, disseminated infections, and subjects under the ages of one year. In the same study, cerebral, gastrointestinal, disseminated and cutaneous zygomycosis were associated with mortality rates of 100, 100, 88, and 0%, respectively; pediatric infections specifically attributable to Absidia represented 9% of cases, but were not fatal {1939}.

Cases of Absidia infection have been reported in animals. In one study, of the 116 farmed deer (Cervus elaphus) examined on suspicion of tuberculosis, four were diagnosed with pulmonary mycosis: the histopathology showed allergic bronchopulmonary mycosis and the agent was identified as a Zygomycetes, probably Absidia corymbifera, by immunofluorescence staining. {2025}. 

Because little is known about this fungus and its infection, vigorous research is now in serious demand and a crucial point in these studies is the choice of the animal models. Mice are the most commonly used animals, but models using guinea pigs and rabbits are also available. Pre-treatment of animals with cyclophosphamide, corticosteroid, alloxan or streptozocine is frequently done to create an immunocompromised state. Treatment with desferrioxamine, an iron chelator, is also used to make animal models. In terms of the route of infection, the airborne route is used for pathophysiological studies in pulmonary infection models, but sometimes intravenous injection is preferred, particularly for antifungal drug studies.{3661}.

Infections produced by Absidia and other Zygomycetes are referred to by the generic label «zygomycoses» but some literature also refers to mucormycoses; this later term has generally fallen from favour but is still used {816}. Zygomycoses have been considered as emerging mycoses since the 1990’s {1939} but it is worthwhile to mention they are rare, occurring mainly in immunocompromised patients {1942}. Mucorales are thus relatively uncommon causes of invasive infections, falling far behind Aspergillus, Candida or other opportunistic yeasts {452}.

Virulence factors

Absidia corymbifera is able to survive adverse and harsh environmental conditions: it grows readily at temperatures above outdoor environmental températures. Virulence factors associated with A. corymbifera appears to be linked in part to these growth properties. Its pathogenicity is linked to its ability to grow at 37°C and, in vitro, it can even grow at temperature up to 48 to 52 °C. Absidia’s proteolytic properties allows it to penetrate intact skin {452}. The ability to invade intact skin through proteolytic enzymes as well as the organism's angioinvasive propensity is associated with high mortality {3728; 3697; 3215}.

The angioinvasive properties of Zygomycetes are associated with diseases that often lead to thrombosis, infarction of involved tissues, and tissue destruction mediated by a number of fungal proteases, lipases, and, in the case of Rhizopus, mycotoxins. {452}.

Specific settings

Nosocomial infections

Absidia infections are not often acquired within the hospital setting. On the other hand one must be prudent as all the necessary circumstances are found in the hospital setting :  the host factors favouring Absidia infections are the same as those often leading to hospitalisation and both sources and routes of exposure may be found in the hospital setting. One such example of hospital acquired infection was reported when a patient with a risk factor, a leukemic patient, was exposed to a an airborne source of Absidia,  a potted plant in his room {3700}.  In particular, two sets of circumstances must be kept in mind as possible situations leading to opportunistic Absidia infection in the hospital : severe immunosuppression combined with surgery or loss of tissue integrity combined with transcutaneous exposure.    

More details

Mucorales fungi are opportunistic pathogens, usually requiring a breakdown in the immune defences, such as found in disease processes that lead to neutropenia or neutrophil dysfunction during chemotherapy or induced immunosuppression following transplantation.  Consequently, transplant patients are particularly vulnerable to infection such as described in a multiple case report {1942}.

In patients with diabetes mellitus, particularly uncontrolled cases,  Zygomycosis is often a potentially fatal, rapidly destructive, opportunistic infection {1965; 1943} : the presence of diabetes combined with debridement surgery can be sufficient to permit introduction of the fungus.

Surgical patients and those with burns or trauma  are also at a risk {1955; 1939}. Traumatic implantation of spores in dirt has been seen in number of patients. Needle-stick exposures, catheter insertion sites, injection sites for illicit drug use, tattooing and insect bites or stings have also been implicated in disease transmission.  In several large studies in high-risk populations,infections with Zygomycetes represented 5 to 12% of all fungal infections {452}.

Occupational diseases

Type III hypersensitivity pneumonitis due to Absidia spp are well known in the rural occupational setting {1103; 2026; 3670; 1091}. (see section   hypersensitivity pneumonitis ).

The only other report in the literature of Absidia associated with occupational disease is the potential allergenic exposures in furniture factories  {3047} .

Diagnostic tools

Cultures

Even though histopathological examinations of tissue sections often are sufficient to pronounce the diagnosis of zygomycosis, some cases require culture to isolate Absidia or other Mucorales. Such was the case of an invasive necrotizing cellulitis not responding to broad spectrum antimicrobials, and surgical debridement  {3701} for which all tissue examination was negative. Only the culture of the tissue allowed the identification of Absidia corymbifera as the infectious agent.

Culture remains the only routine method enabling the complete identification of the agents of zygomycosis. 

Histopathology

During the infectious process, A. corymbifera grows within the soft tissues in the same fashion as all infectious Zygomycetes.  The fungi within the class Zygomycetes are hyaline organisms that produce wide ribbon-like coenocytic hyphae with wide-angle branching in human tissues while the other filamentous fungi (like Aspergillus) present as septate hyphae. The morphology of the hyphae is important in making identification of Zygomycetes in tissue sections, but one cannot distinguish neither genuses nor species  {452}.  The Mucorales are associated with angioinvasive disease, often leading to thrombosis, infarction of involved tissues, and tissue destruction {452}; visualisation of these histopathology elements are thus complementary to the histological diagnosis.    

More details

Immunohistochemistry has proved to be a powerful tool for the accurate diagnosis of a number of important mycoses in humans and animals, such as zygomycosis (mucormycosis). Apart from the specificity of immunohistochemistry, the application of fluorochromes is highly effective for the localization of typical or atypical fungal elements in lesions with only few cells of the organism present. Occasionally, a dual etiology of fungal infections may be suspected on the basis of morphological study, and dual staining techniques have the capacity for resolving this question by simultaneous and differential staining of two fungal species present in a tissue specimen {3521}.

Immunodiagnosis

In the diagnosis of Absidia HP, the double immunodiffusion and electrosyneresis  test are considered positive if the result is one arc of precipitation or more against Absidia corymbifera extracts {2024}.

In the diagnosis of allergic reactions, Absidia antigens may cross-react with those of Alternaria sp {818}.

Test IgE IgG Antigens Other
Skin Tests X      
RAST-IgE X      
RAST-IgG   X    
ELISA-ELIFA       Experimental
Immunodiffusion   X    
Immunofluorescence       Experimental
Complement fixation        
PCR        
Other        

 

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