Supplement article Entomophthoromycosis: a challenging emerging disease Mortada H. F. El-Shabrawi, 1 Heba Arnaout, 2 Lamiaa Madkour 2 and Naglaa Mohamed Kamal 1 1 Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt and 2 Department of Medical Microbiology and Immunology, Faculty of Medicine, Cairo University, Cairo, Egypt Summary Entomophthoromycosis is a rare fungal infection that may affect immunocompetent hosts; predominantly in tropical and subtropical regions. Recently, the importance of this emerging mycosis has increased and the scope of its manifestations has been expanded. These manifestations; however, may masquerade as other clinical entities. Prompt diagnosis of this infection requires a high index of suspicion. Although histo- pathological examination and cultures are the gold standard diagnostic tools; molec- ular diagnosis is now available and started to play an important role. The cornerstone treatment is prolonged anti-fungal therapy along with surgical debride- ment. More awareness of this mycosis is warranted for definitive diagnosis and implementation of early proper therapeutic strategies. Key words: Entomophthoromycosis, basidiobolomycosis, condiobolomycosis, zygomycosis, emerging disease, fun- gal infection. Introduction Entomophthoromycosis (or entomophthoramycosis) is caused by fungi belonging to the Entomophthorales including basidiobolomycosis and conidiobolomycosis. 1 This name is derived from the Greek word ‘Entomon’, meaning insect, reflecting their original identification as pathogens infecting insects. 2 Formerly, the two orders; Mucorales and Entomophthorales were classi- fied in the phylum Zygomycota. However; in 2007, Hibbett et al. [3] suggested a comprehensive phyloge- netic classification of the kingdom Fungi. Using data obtained from molecular phylogenetic methods, they found the phylum Zygomycota to be polyphyletic, and subsequently proposed elimination of this phylum. As a result, the taxa belonging to Zygomycota were dis- tributed among the phylum Glomeromycota and four subphyla of uncertain placement (incertae sedis). 4 The Entomophthorales and Mucorales, as well as two other orders (Kickxellales and Zoopagales) were raised to the rank of subphyla: Entomophthoromycotina, Mucoro- mycotina, Kickxellomycotina and Zoopagomycotina. 4 Entomophthoromycotina encompasses two genera that cause human infection; Basidiobolus and Conidiobolus. 5 Both genera are ubiquitous in the environment with high prevalence in tropical and sub-tropical regions, particularly in equatorial Africa, Central America and India. 6 Entomophthoromycosis has a predilection for areas with adipose tissue, possibly because these organisms thrive on fatty substances. 7 The disease presents in two clinically distinct forms; basidiobolomycosis (subcuta- neous zygomycosis) and conidiobolomycosis (rhinofa- cial zygomycosis). Neither of these two forms occurs preferentially in patients with underlying disease or defective immunity. 8 Basidiobolomycosis Basidiobolus was first described by Eidam in 1886. It is a filamentous fungus isolated from amphibians, rep- tiles, horses, dogs and bats, as well as wood lice, plant debris and soil. 9 Basidiobolus is classified into Correspondence: Mortada H. F. El-Shabrawi, MD Pediatrics, Professor of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt. Tel.: +20122 313 3705. Fax: +202 3761 9012. E-mail: melshabrawi@medicine.cu.edu.eg Submitted for publication 10 December 2013 Revised 27 February 2014 Accepted for publication 4 March 2014 © 2014 Blackwell Verlag GmbH Mycoses, 2014, 57 (Suppl. 3), 132–137 doi:10.1111/myc.12248 mycoses Diagnosis,Therapy and Prophylaxis of Fungal Diseases