Itraconazole in human medicine and veterinary practice.

Diagnosis and management of fungal infections are challenging in both animals and humans, especially in immunologically weakened hosts. Due to its broad spectrum and safety profile when compared to other antifungals, itraconazole (ITZ) has been widely used in the treatment and prophylaxis of fungal infections, both in human and veterinary medicine. The dose and duration of management depend on factors such as the type of fungal pathogen, the site of infection, sensitivity to ITZ, chronic stages of the disease, the health status of the hosts, pharmacological interactions with other medications and the therapeutic protocol used. In veterinary practice, ITZ doses generally vary between 3 mg/kg and 50 mg/kg, once or twice a day. In humans, doses usually vary between 100 and 400 mg/day. As human and veterinary fungal infections are increasingly associated, and ITZ is one of the main medications used, this review addresses relevant aspects related to the use of this drug in both clinics, including case reports and different clinical aspects available in the literature.

A taxonomic review of the genus Paracoccidioides, with focus on the uncultivable species.

Paracoccidioides species have always been surrounded by taxonomic uncertainties. The continuing nomenclatoral muddle was caused in part by the failure of Adolfo Lutz and Jorge Lôbo to name the etiologic agents of human paracoccidioidomycosis and Jorge Lôbo's diseases, respectively. Early in their history, it was postulated that the cultivable species causing systemic infections belonged in the genus Paracoccidioides, whereas the uncultivable species, causing skin disease, were not part of the genus. The taxonomy of these pathogens was further complicated when a similar skin disease with numerous yeast-like cells in infected dolphins was also reported. Due to its phenotypic similarities with that described by Jorge Lôbo in human and its uncultivable nature, it was assumed that the disease in dolphins was caused by the same fungus. Recent molecular and population genetic analysis, however, found the DNA extracted from the uncultivable yeast-like cells affecting dolphins shared common phylogenetic traits with cultivable Paracoccidioides species. The study revealed that the uncultivable pathogens comprised 2 different Paracoccidioides species, now known as P. ceti and P. loboi, correspondingly. To validate P. loboi binomial, a comprehensive historical critical review of Jorge Lôbo etiology was performed. This review showed the proposed binomial P. loboi was previously used, and, thus, a replacement name is introduced, Paracoccidioides lobogeorgii nom. nov. In addition, in this review, several cultivable human Paracoccidioides species are validated, and the generic type species, P. brasiliensis, is neotypified as the original material could not be traced.

Detection of Heavy Metals, Their Distribution in Tilapia spp., and Health Risks Assessment.

Concentrations of heavy metals (HMs) were assessed in Tilapia spp. from selected communities in Calapan City, Philippines. Eleven (11) inland farmed tilapia samples were collected and analyzed for HMs concentration using X-ray fluorescence (XRF). The 11 fish samples were cut into seven pieces, according to the fish body parts, constituting a total of 77 samples. These fish samples were then labeled as bone, fins, head, meat, skin, and viscera. Results showed that the mean concentration of Cd in all parts of tilapia exceeded the Food and Agriculture Organization/World Health Organization (FAO/WHO) limits. The highest concentration was recorded in the fins, which was sevenfold higher than the limit. The trend of the mean concentration of Cd in different parts of tilapia was fins > viscera > skin > tail > head > meat > bone. The target hazard quotient (THQ) recorded a value less than 1. This means that the population exposed to tilapia, within the area where fish samples originated, were not at risk to non-carcinogens. The concentrations of Cu, Pb, Mn, Hg, and Zn in different parts, particularly in skin, fins, and viscera, also exceeded the FAO/WHO limits. The calculated cancer risk (CR) in consuming the fish skin, meat, fins, bone, viscera, and head was higher than the USEPA limit. This indicated a possible carcinogenic risk when consumed regularly. Most of the correlations observed between HMs in various parts of the tilapia had positive (direct) relationships, which were attributed to the HM toxicity target organ characteristics. Results of the principal component analysis (PCA) showed that most of the dominating HMs recorded in tilapia were attributable to anthropogenic activities and natural weathering within the watershed of agricultural areas. The agriculture area comprises about 86.83% of the overall land area of Calapan City. The identified carcinogenic risks were associated with Cd. Therefore, regular monitoring of HMs in inland fishes, their habitat, and surface water quality shall be carried out. This information is useful in creating strategies in metals concentration monitoring, health risks reduction program, and relevant guidelines that would reduce the accumulation of HM in fish.

Current Nomenclature of Paracoccidioides lobogeorgii's Disease Name. Comment on Grotta et al. Fungal Density in Lobomycosis in French Guiana: A Proposal for a New Clinico-Histological and Therapeutic Classification. J. Fungi 2023, 9, 1005.

We have read the article by Grotta and collaborators [...].

Pythium insidiosum complex hides a cryptic novel species: Pythium periculosum.

Early phylogenetic analysis of Pythium insidiosum, the etiologic agent of pythiosis in mammals, showed the presence of a complex comprising three monophyletic clusters. Two included isolates recovered from cases of pythiosis in the Americas (Cluster I) and Asia (Cluster II), whereas the third cluster included four diverged isolates three from humans in Thailand and the USA, and one isolate from a USA spectacled bear (Cluster III). Thereafter, several phylogenetic analyses confirmed the presence of at least three monophyletic clusters, with most isolates placed in clusters I and II. Recent phylogenetic analyses using isolates from environmental sources and from human cases in India, Spain, Thailand, and dogs in the USA, however, showed the presence of two monophyletic groups each holding two sub-clusters. These studies revealed that P. insidiosum possesses different phylogenetic patterns to that described by early investigators. In this study, phylogenetic, population genetic and protein MALDI-TOF analyses of the P. insidiosum isolates in our culture collection, as well as those available in the database, showed members in the proposed cluster III and IV are phylogenetically different from that in clusters I and II. Our analyses of the complex showed a novel group holding two sub-clusters the USA (Cluster III) and the other from different world regions (Cluster IV). The data showed the original P. insidiosum cluster III is a cryptic novel species, now identified as P. periculosum. The finding of a novel species within P. insidiosum complex has direct implications in the epidemiology, diagnosis, and management of pythiosis in mammalian hosts.

Geographic distribution of Pythium insidiosum infections in the United States.

OBJECTIVE: To describe the geographic distribution of infections caused by Pythium insidiosum in dogs, horses, and other animal species in the US. ANIMALS: For the last 20 years, we have collected data from cases of pythiosis in 1,150 horses, 467 dogs, and other species (59) from various geographic locations in the US. PROCEDURES: Due to lost data (from 2006 to 2016), the selected cases include years 2000 to 2005 and 2016 to 2020. The selection of cases was based on infected host clinical features, serum samples demonstrating strong positive anti-P insidiosum IgG titers in serologic assays, and positive results on ≥ 1 of the following diagnostic modalities: microbial culture on 2% Sabouraud dextrose agar, histologic evaluation, PCR assay, and wet mount cytologic evaluation (with potassium hydroxide). RESULTS: Most confirmed P insidiosum infections were found in horses and dogs in the southeastern US. Interestingly, in Texas, no cases were found west of longitude 100°W. Few pythiosis cases were diagnosed in west-coast states. Equine cases were more often diagnosed during summer and fall months, but canine cases were more often diagnosed between September and February. Cases in other species were discovered in the same geographic areas as those in dogs and horses. CLINICAL RELEVANCE: To our knowledge, this is the first report providing the ecological distribution of P insidiosum infection in affected species in the US. Results of this study illustrated the importance of including P insidiosum in the differential diagnostic scheme of nonhealing skin lesions or intestinal granulomatous masses, particularly in dogs and horses inhabiting or having visited endemic areas.

The taxonomy of two uncultivated fungal mammalian pathogens is revealed through phylogeny and population genetic analyses.

Ever since the uncultivated South American fungal pathogen Lacazia loboi was first described 90 years ago, its etiology and evolutionary traits have been at the center of endless controversies. This pathogen infects the skin of humans and as long believed, dolphin skin. However, recent DNA analyses of infected dolphins placed its DNA sequences within Paracoccidioides species. This came as a surprise and suggested the human and dolphin pathogens may be different species. In this study, population genetic analyses of DNA from four infected dolphins grouped this pathogen in a monophyletic cluster sister to P. americana and to the other Paracoccidioides species. Based on the results we have emended the taxonomy of the dolphin pathogen as Paracoccidioides cetii and P. loboi the one infecting human. Our data warn that phylogenetic analysis of available taxa without the inclusion of unusual members may provide incomplete information for the accurate classification of anomalous species.

Ichthyophonosis in Peruvian rainbow trout Oncorhynchus mykiss: identification of endemic areas using molecular and histopathological tools.

Ichthyophonus infection was first detected in Peruvian Oncorhynchus mykiss in 1986, but the occurrence of ichthyophonosis disease in the region is unknown. This study investigated the presence and distribution of Ichthyophonus sp. in Peruvian rainbow trout using traditional and DNA sequencing tools. Between 2007 and 2008, 205 rainbow trout from 13 hatcheries in the Mantaro river basin were examined for the presence of Ichthyophonus, and at that time only 3 farms were positive. This early study confirmed the presence of Ichthyophonus sp. in the Tranca Grande lagoon for the first time, at a prevalence of 50%. In 2012, examination of 240 trout from 24 fish farms in 2 Peruvian Departments found 9 infected farms. More recently, in 2018, Ichthyophonus sp. was found in Lake Titicaca, infecting a trout in the Ichu area (in the Department of Puno). Our molecular analysis of the infected trout showed that ichthyophonosis disease in the Peruvian trout was caused by Ichthyophonus sp. Clade C. The finding of this pathogen in Lake Titicaca should be an alert for nearby farms and entities dealing with fish of economic importance in the rivers of Peru.

Serological tests using Sporothrix species antigens for the accurate diagnosis of sporotrichosis: a meta-analysis.

Some species of the fungus Sporothrix cause a chronic granulomatous infection in humans and animals called sporotrichosis. In the last decades, some research into serological tests has been carried out by different groups for the rapid detection of this infection. We performed a systematic review of the literature with meta-analysis to evaluate studies using Sporothrix spp. antigens and to evaluate their accuracy for sporotrichosis diagnostic. We searched Scopus, MEDLINE, Web of Science, GALE, Technology Research Database, DOA, Elsevier, SciELO, and Google Scholar Databases. The united results of sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio with their corresponding 95% confidence intervals (CI) were assessed. A total of 15 assays from 8 studies using 7 different serological methods and 8 different antigens were analyzed. The studies were performed in the USA, Brazil, and Venezuela from 1973 until 2015 and presented good quality. A high heterogeneity for sensitivity [I2 = 90.7%; 87% CI = (84-89), P < 0.001] and specificity [I2 = 89.2%; 93% CI = (92-95), P < 0.001] was observed. The performance of diagnostic tests was 0.93. Enzyme-linked immunosorbent assay was the main tool used, and the ConA-binding fraction antigen of the strain 1099-18 appears as a promising diagnostic biomarker candidate.

An unusual case of cutaneous feline pythiosis.

Pythiosis is frequently reported in dogs and horses inhabiting tropical, subtropical and temperate areas of the USA, but the disease is rare in domestic cats. The clinical presentation of feline pythiosis includes subcutaneous masses without ulcerated tissue and involvement of the intestinal tract. Here in we report an eight-week-old female unvaccinated stray kitten with an unusual extensive circular ulcerated lesion on her left flank. The lesion did not respond favorably to administration of systemic antibiotics. Clinical specimens submitted for culture demonstrated submerged fungal-like flat colonies later identified as Pythium insidiosum, a finding also confirmed by histopathology, serology, and DNA sequencing and thus, treated with itraconazole. Since no improvement was observed, Pythium-immunotherapy was initiated. The cat responded to the latter approach and in less than 10 days, the lesion had contracted around the edges and was crusting off to reveal healthy granulation tissue. Twenty-three days after immunotherapy was initiated the original wound had shrunken significantly to a small scabbed area. However, the cat acutely developed tachypnea, lung and intestinal complications and due to her rapid deterioration, humane euthanasia was elected. Unfortunately, necropsy was not conducted. The clinical presentation reported here suggests large ulcerative cutaneous lesions caused by P. insidiosum can also occur in domestic cats. Despite reports of unsuccessful treatment results of feline pythiosis using Pythium-immunotherapy, this report suggests this approach might be helpful in similar feline cases.

Phylogenetic and physiological traits of oomycetes originally identified as Lagenidium giganteum from fly and mosquito larvae.

We studied phylogenetic and taxonomic features of isolates identified as Lagenidium giganteum recovered from six different species of mosquito larvae. The isolates grew vigorously at 25 C, moderately at 30 C, and not at all at 37 C and developed submerged, white colonies with few short, hyaline, aerial hyphae. Cultures displayed phenotypic plasticity, with broad, hyaline hyphae strongly constricted at septa that developed oval, spherical, or amorphous segments. These developed into sporangia producing one or two exit tubes, from which evanescent gelatinous vesicles containing zoospores developed. Three isolates developed oogonia consistent with features previously described for L. giganteum. Phylogenetic analysis of nuc rDNA internal transcribed spacer (ITS1-5.8S-ITS = ITS) and cytochrome c oxidase subunit II (COXII) sequences of L. giganteum consistently grouped into eight clusters. Four of the investigated isolates grouped with sequences of an unnamed Lagenidium species infecting nematodes. Based on phenotypic and phylogenetic data, we describe the latter isolates as L. juracyae, sp. nov. In addition, we also investigated a species of Paralagenidium from a dog with lagenidiosis and describe it as new, Paralagenidium ajellopsis, sp. nov.

Identification of Pythium insidiosum complex by matrix-assisted laser desorption ionization-time of flight mass spectrometry.

PURPOSE: Pythiosis is an infection of humans and other animals caused by the fungal-like pathogen Pythium insidiosum. This pathogen causes life-threatening infection in the infected hosts. Culture, histopathology, serology and molecular tools are used to diagnose its infections. Successful management of pythiosis is directly linked to an early diagnosis. Thus, a rapid identification of putative cultures developing submerged sparsely septate hyphae is of extreme importance. However, few laboratories are familiar with the culture identification of this unique pathogen and its differential diagnosis with similar filamentous fungi. METHODOLOGY: We have evaluated the use of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) on 53 isolates of P. insidiosum collected from cases of human and animal pythiosis in the USA and around the world. To assess the specificity of the approach, 18 pathogenic and saprotrophic filamentous fungal and fungal-like microbes were also tested. RESULTS: MALDI-TOF in-house spectra correctly identified the 53 P. insidiosum isolates (score range 1.93-2.51). MALDI-TOF based identification within P. insidiosum isolates showed protein spectra variation between geographical diverse isolates. A mass spectrometry approach was able to discriminate P. insidiosum from the 18 filamentous fungal and fungal-like microbes in this study, including four Pythium spp. and Phytopythium litorale plant pathogenic species. CONCLUSION: The data showed MALDI-TOF could be used for the accurate and rapid culture identification of P. insidiosum in the clinical laboratory.

Pythium insidiosum and Acanthamoeba keratitis in a contact lens user.

The oomycete Pythium and the protozoan Acanthamoeba can cause fulminant and recalcitrant keratitis, respectively. These infections are not only sight-threatening but can also threaten the structural integrity of the eye. A high index of suspicion is required to identify Pythium keratitis given its uncommon occurrence. Acanthamoeba keratitis is most commonly associated with contact lens wear. However, its coexistence with Pythium has not been reported. We present the successful management of a case of contact lens-related keratitis, coinfected with Pythium and Acanthamoeba.

Human Pathogenic Entomophthorales.

The pathogenic entomophthoralean fungi cause infection in insects and mammalian hosts. Basidiobolus and Conidiobolus species can be found in soil and insect, reptile, and amphibian droppings in tropical and subtropical areas. The life cycles of these fungi occur in these environments where infecting sticky conidia are developed. The infection is acquired by insect bite or contact with contaminated environments through open skin. Conidiobolus coronatus typically causes chronic rhinofacial disease in immunocompetent hosts, whereas some Conidiobolus species can be found in immunocompromised patients. Basidiobolus ranarum infection is restricted to subcutaneous tissues but may be involved in intestinal and disseminated infections. Its early diagnosis remains challenging due to clinical similarities to other intestinal diseases. Infected tissues characteristically display eosinophilic granulomas with the Splendore-Höeppli phenomenon. However, in immunocompromised patients, the above-mentioned inflammatory reaction is absent. Laboratory diagnosis includes wet mount, culture serological assays, and molecular methodologies. The management of entomophthoralean fungi relies on traditional antifungal therapies, such as potassium iodide (KI), amphotericin B, itraconazole, and ketoconazole, and surgery. These species are intrinsically resistant to some antifungals, prompting physicians to experiment with combinations of therapies. Research is needed to investigate the immunology of entomophthoralean fungi in infected hosts. The absence of an animal model and lack of funding severely limit research on these fungi.

Taxonomic and phylogenetic analysis of the Oomycota mosquito larvae pathogen Crypticola clavulifera.

Beside the taxonomic features displayed by Crypticola clavulifera in culture and unpublished data on its phylogeny, little is known about the main phylogenetic features of this unusual mosquito pathogen. We have PCR amplified the 18S SSU rDNA, ITS, and the partial coding regions of COXII and COXI to study the phylogenetic features of this pathogen within the tree of life. Our phylogenetic data showed C. clavulifera clustered among homologous DNA sequences of the Oomycota class Saprolegniomycetes. Our study support previous taxonomic and unpublished molecular analysis, placing this unusual mosquito larvae pathogen as part of the earliest diverging cluster within the Saprolegniomycetes.

Pythium insidiosum isolated from infected mosquito larvae in central Brazil.

Pythium insidiosum is a straminopilan pathogen causing life threatening infections in mammals inhabiting temperate, tropical and subtropical areas of the world. The concept that P. insidiosum could also infect mosquitoes was mentioned earlier by investigators conducting phylogenetic analysis on available P. insidiosum isolates deposited at different culture collections. However, an official report and details on its pathological features in mosquitoes are not available. We are reporting the isolation of P. insidiosum from infected mosquito larvae during a survey conducted in central Brazil. At least three oomycotan isolates were recovered during the survey. Due to their ability to infect mosquito larvae the isolates were deposited in the U.S. Department of Agriculture, Agricultural Research Service Collection of Entomopathogenic Fungi (ARSEF; Ithaca, New York) as putative Lagenidium species. The investigated isolates developed very well at 37 °C, produced typical Pythium-like vesicles containing numerous biflagellate zoospores, hydrolyzed sucrose, and their cultured extracted proteins were recognized in serological analysis by anti-P. insidiosum antibodies. Phylogenetic analyses using ITS and partial COXII DNA sequences identified the isolates as P. insidiosum within the American Cluster I. This is the first official report of P. insidiosum recovered from infected mosquito larvae, indicating that this mammalian pathogen, in addition to plants, it could also use mosquito larvae to complete its life cycle in nature.

Development of esthetic prosthesis for a patient with severe stigmatizing facial lesions due to cancer: a pilot study.

PURPOSE: Severe physical facial deformities due to surgical interventions can have significant psychosocial consequences to patient's relationships with friends and family and thus, has a considerable impact on their quality of life. We have developed a 3D prosthesis for a 56-year-old woman diagnosed with epidermoid carcinoma at the right hemiface, to improve her quality of life. METHODS: The patient started radiotherapy with modulated intensity. To deal with the advance of the process, a maxilectomy of supra structure with modified radical cervical emptying on the right hemiface was performed. Reconstruction of areas surgically affected by the displacement of islands of skin and muscle (flaps) from healthy regions was initiated. Although the procedure occurred without intercurrences, the patient developed necrosis and loss of the myocutaneous flap. After the removal of the flap, the esthetic result of the treatment was evident causing exposure of subcutaneous and granulation tissues. RESULTS: A computational model was used to develop a 3D structure of the affected area and then used to construct the prosthesis. The prosthesis was applied over the affected area, and the patient was able see her face on the mirror for the first time in years. The patient was grateful and hopeful. CONCLUSION: We have found that the application of this new technology greatly improves the social interaction of patients with deformities due to surgical interventions.

A Leishmania murine model to evaluate the immunomodulatory properties of Pythium insidiosum proteins.

Pythium insidiosum immunomodulatory vaccine (PiV) has been tested in clinical and experimental pythiosis. Previous data showed that P. insidiosum immunogens have the ability to switch the Th2 immune response, normally in place during pythiosis, to a curative Th1 response. Pythiosis cannot be reproduced in experimental rodents with the exception of rabbits, and thus thorough evaluation of PiV´s immunomodulatory properties has been limited by the lack of a compatible inbred mouse model. In this study, we took advantage of the murine BALB/c Leishmania infection model, where infected mice produce a Th2 response, to evaluate the PiV Th2 to Th1 immunomodulatory potential. Twenty-one days following challenge with L. major, large cutaneous granulomas developed in control mice, consistent with the expected Th2 response. In contrast, Leishmania-induced cutaneous lesions in PiV-immunized mice were minimal or absent. Flow cytometry analysis of spleen cells from mice immunized with PiV and subsequently challenged with L. major displayed more CD4+ and CD8+ cells than the control group. Moreover, spleen cells from mice that were immunized with PiV then challenged with L. major secreted high levels of IFN-γ, with a moderate IL-2, IL-4, and IL-10 mixed cytokine profile upon in vitro re-stimulation with PiV. Anti-P. insidiosum IgG1 in immunized animals was present at low titers suggesting a minor immunological role for this Ig isotype in this model. Our preliminary data showed that BALB/c mice challenged with L. major represent an attractive model in which to study PiV´s immunomodulatory properties.