Disseminated Mucor indicus Infection in a Heart Transplant Recipient: Complementary Conventional and Sequencing-Based Diagnostic Approaches
4 affiliations
- 1Institute of Medical Microbiology, Virology and Hygiene, , Martinistrasse 46, 20246 Hamburg, Germany
- 2Institute for Molecular Virology and Tumorvirology, , Martinistrasse 46, 20246 Hamburg, Germany
- 3Institute for Neuropathology, , Martinistrasse 46, 20246 Hamburg, Germany
- 4, Martinistrasse 52, 20246 Hamburg, Germany
Abstract
Background: Mucormycosis is a rapidly progressive and often fatal invasive fungal infection in immunocompromised patients. Diagnosis remains challenging because microscopy and culture have limited sensitivity, while targeted molecular assays may fail to detect uncommon Mucorales species. Case Presentation: We report a fatal case of disseminated Mucor indicus infection with pulmonary and cerebral involvement in a heart transplant recipient receiving immunosuppressive therapy and posaconazole prophylaxis. Initial microscopy of bronchial secretions demonstrated broad pauciseptate hyphae consistent with Mucorales, whereas targeted PCR assays remained negative. Species identification was subsequently achieved by culture, MALDI-TOF mass spectrometry, and internal transcribed spacer (ITS) sequencing. Following neurological deterioration, brain biopsy confirmed cerebral involvement histopathologically, and ITS sequencing detected M. indicus. Comparative DNA- and RNA-based metagenomic sequencing identified Mucorales sequences, although read abundance remained unexpectedly low despite extensive histopathological fungal burden. Nevertheless, independent mapping of metagenomic reads against databases comprising all genomic viral and fungal reference sequences readily identified Mucor indicus as the sole pathogen receiving significant scores. Conclusions: This case illustrates that targeted Mucorales PCR may fail to detect an uncommon species despite evidence of invasive fungal infection. Microscopy, culture, histopathology, ITS sequencing, and comprehensive metagenomic analyses provided complementary evidence for disseminated Mucor indicus infection. Integrated diagnostics combining histopathology, culture, and complementary molecular methods remain essential for accurate diagnosis of invasive mucormycosis.
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BibTeX
@article{tanida2026disseminated,
title = {{Disseminated Mucor indicus Infection in a Heart Transplant Recipient: Complementary Conventional and Sequencing-Based Diagnostic Approaches}},
author = {Konstantin Tanida and Nicole Degel-Broßmann and Alexis Robitaille and Denise Heim and Markus Glatzel and Patrick Blümke and Martin Aepfelbacher and Marc Lütgehetmann and Martin Christner and Adam Grundhoff and Nicole Fischer},
journal = {Journal of fungi (Basel, Switzerland)},
year = {2026},
month = oct,
doi = {10.3390/jof12100767},
url = {https://europepmc.org/article/PMC/PMC13706590},
note = {CC BY},
}
RIS
TY - JOUR
TI - Disseminated Mucor indicus Infection in a Heart Transplant Recipient: Complementary Conventional and Sequencing-Based Diagnostic Approaches
AU - Konstantin Tanida
AU - Nicole Degel-Broßmann
AU - Alexis Robitaille
AU - Denise Heim
AU - Markus Glatzel
AU - Patrick Blümke
AU - Martin Aepfelbacher
AU - Marc Lütgehetmann
AU - Martin Christner
AU - Adam Grundhoff
AU - Nicole Fischer
PY - 2026
DA - 2026/10/01
JO - Journal of fungi (Basel, Switzerland)
DO - 10.3390/jof12100767
UR - https://europepmc.org/article/PMC/PMC13706590
AB - Background: Mucormycosis is a rapidly progressive and often fatal invasive fungal infection in immunocompromised patients. Diagnosis remains challenging because microscopy and culture have limited sensitivity, while targeted molecular assays may fail to detect uncommon Mucorales species. Case Presentation: We report a fatal case of disseminated Mucor indicus infection with pulmonary and cerebral involvement in a heart transplant recipient receiving immunosuppressive therapy and posaconazole prophylaxis. Initial microscopy of bronchial secretions demonstrated broad pauciseptate hyphae consistent with Mucorales, whereas targeted PCR assays remained negative. Species identification was subsequently achieved by culture, MALDI-TOF mass spectrometry, and internal transcribed spacer (ITS) sequencing. Following neurological deterioration, brain biopsy confirmed cerebral involvement histopathologically, and ITS sequencing detected M. indicus. Comparative DNA- and RNA-based metagenomic sequencing identified Mucorales sequences, although read abundance remained unexpectedly low despite extensive histopathological fungal burden. Nevertheless, independent mapping of metagenomic reads against databases comprising all genomic viral and fungal reference sequences readily identified Mucor indicus as the sole pathogen receiving significant scores. Conclusions: This case illustrates that targeted Mucorales PCR may fail to detect an uncommon species despite evidence of invasive fungal infection. Microscopy, culture, histopathology, ITS sequencing, and comprehensive metagenomic analyses provided complementary evidence for disseminated Mucor indicus infection. Integrated diagnostics combining histopathology, culture, and complementary molecular methods remain essential for accurate diagnosis of invasive mucormycosis.
SN - 2309-608X
ER -