RESUMO
Cutaneous mucormycosis in children is an opportunistic fungal infection associated with significant morbidity and mortality. We describe characteristics of 12 patients with healthcare-associated cutaneous mucormycosis at Texas Children's Hospital and results of an outbreak investigation. A definitive source was not identified. Skin lesions near medical device securement sites should raise concern for mucormycosis in patients with underlying medical conditions.
Assuntos
Infecção Hospitalar/complicações , Infecção Hospitalar/microbiologia , Dermatomicoses/etiologia , Dermatomicoses/microbiologia , Mucormicose/etiologia , Mucormicose/microbiologia , Adolescente , Criança , Pré-Escolar , Infecção Hospitalar/terapia , Dermatomicoses/terapia , Surtos de Doenças , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Controle de Infecções , Masculino , Mucormicose/terapia , Estudos Retrospectivos , Rhizopus/isolamento & purificação , Texas/epidemiologiaRESUMO
Mucormycosis is an invasive fungal infection (IFI) due to several species of saprophytic fungi, occurring in patients with underlying co-morbidities (including organ transplantation). During the ongoing Coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal co-infections occurring in COVID-19 patients, including COVID-19 associated pulmonary aspergillosis (CAPA). We describe a case of mucormycosis occurring after COVID-19, in an individual who received a recent heart transplant for severe heart failure. Two months after heart transplant, our patient developed upper respiratory and systemic symptoms and was diagnosed with COVID-19. He was managed with convalescent plasma therapy and supportive care. Approximately three months after COVID-19 diagnosis, he developed cutaneous mucormycosis at an old intravascular device site. He underwent extensive surgical interventions, combined with broad-spectrum antifungal therapy. Despite the aggressive therapeutic measures, he died after a prolonged hospital stay. In this case report, we also review the prior well-reported cases of mucormycosis occurring in COVID-19 patients and discuss potential mechanisms by which COVID-19 may predispose to IFIs. Similar to CAPA, mucormycosis with COVID-19 may need to be evaluated as an emerging disease association. Clinicians should be vigilant to evaluate for invasive fungal infections such as mucormycosis in patients with COVID-19 infection.
Assuntos
COVID-19/complicações , Transplante de Coração , Infecções Fúngicas Invasivas/complicações , Mucormicose/complicações , Complicações Pós-Operatórias/etiologia , Rhizopus/isolamento & purificação , Idoso , Anti-Infecciosos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , COVID-19/terapia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/etiologia , Coinfecção/tratamento farmacológico , Coinfecção/microbiologia , Terapia Combinada , Contraindicações de Medicamentos , Desbridamento , Dermatomicoses/tratamento farmacológico , Dermatomicoses/etiologia , Suscetibilidade a Doenças , Evolução Fatal , Insuficiência Cardíaca/cirurgia , Humanos , Hidroxicloroquina/uso terapêutico , Imunização Passiva , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Balão Intra-Aórtico/instrumentação , Infecções Fúngicas Invasivas/tratamento farmacológico , Masculino , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Tratamento de Ferimentos com Pressão Negativa , Infecções Oportunistas/complicações , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/virologia , Infecção da Ferida Cirúrgica/complicações , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/cirurgia , Soroterapia para COVID-19RESUMO
In recent years, the frequency of infections due to saprophytic fungi has increased. Cryptococcus laurentii, recently classified as Papiliotrema laurentii, is responsible for fungemia, meningitis, and superficial infections. Here, we report the first case of cutaneous Papiliotrema (Cryptococcus) laurentii infection in a 23-year-old Caucasian woman affected by an autoimmune thyroiditis with hypothyroidism. Impairments of the immune system are often associated with unusual fungal infections, which cannot be neglected. The isolate strain was susceptible to Amphotericin B while resistant to fluconazole, itraconazole, voriconazole, and terbinafine. The patient was successfully treated with Amphotericin B.
Assuntos
Basidiomycota/patogenicidade , Dermatomicoses/etiologia , Hipotireoidismo/complicações , Tireoidite Autoimune/complicações , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Basidiomycota/efeitos dos fármacos , Dermatomicoses/tratamento farmacológico , Dermatomicoses/microbiologia , Farmacorresistência Fúngica Múltipla , Feminino , Humanos , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/microbiologia , Tireoidite Autoimune/tratamento farmacológico , Tireoidite Autoimune/microbiologia , Resultado do Tratamento , Adulto JovemRESUMO
Superficial dermatomycosis are prevalent pathologies in the medical field and their diagnosis is fundamentally clinical. Histopathology is not considered part of his study, however, the diagnosis is exceptionally obtained by biopsy, when dermatomycosis was not suspected. Unpublished retrospective work is carried out on patients who had the histopathological diagnosis of superficial dermatomycosis between the years 2000-2019 at the HCUCH, based on selection criteria, obtaining 19 patients, in which the following were analyzed: age, gender, clinical characteristics, location, presumptive diagnosis and mycological and histological examinations. He stressed, as was our hypothesis, that dermatomycosis was not clinically suspected, since the presumptive diagnoses were various dermatoses. The most suspected dermatosis was psoriasis, as a result that 57.8% of the dermatoses studied had erythematous scaly plaques on examination. Another relevant fact is that only 21% of the cases underwent a direct mycological prior to the biopsy, which was negative ('' false negative''). It is concluded, then, that superficial dermatomycosis should be considered clinical simulators of other dermatoses, so clinical suspicion and support of mycological examination and fungal culture is essential. (AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Dermatomicoses/diagnóstico , Tinha/epidemiologia , Dermatomicoses/classificação , Dermatomicoses/etiologia , Dermatomicoses/epidemiologiaRESUMO
BACKGROUND: In China, the prevalence of superficial fungal infections of the foot is high and recurrence is common. However, a prospective, large-scale and multicentre study on the aetiology of superficial fungal infections of the foot is still lacking. OBJECTIVES: To study the epidemiology of aetiological agents of superficial fungal infections of the foot in urban outpatients in mainland China, as well as to understand the aetiology features of the pathogenic agent. METHODS: The study was designed as a multicentre, prospective epidemiological survey. A total of 1704 subjects were enrolled from seven geographical areas in mainland China. For each subject, one mycological sample and one bacterial sample were collected. KOH wet mount examination and culture were performed at local laboratories. The bacterial results were only reported in those with positive mycology. Further morphological identification and, if necessary, molecular biological identification were conducted in a central laboratory. RESULTS: Of 1704 enrolled subjects, 1327 (77.9%) subjects had positive fungal culture results. The incidence of dermatophytes, yeasts and moulds was 90.1%, 8.1% and 1.1%, respectively. The most frequently isolated aetiological agent (fungus) was Trichophyton rubrum. Moccasin form was the most commonly reported clinical diagnosis of superficial fungal infections. The most frequently isolated bacterial genus in patients was Staphylococcus. CONCLUSION: This study prospectively investigated the clinical and mycological features of human dermatophytosis in mainland China. T rubrum was the most frequently isolated fungus, and moccasin form was the most commonly reported clinical diagnosis of superficial fungal infections.
Assuntos
Dermatomicoses , Pé/microbiologia , Adulto , Arthrodermataceae/isolamento & purificação , Arthrodermataceae/patogenicidade , China/epidemiologia , Dermatomicoses/epidemiologia , Dermatomicoses/etiologia , Dermatomicoses/patologia , Feminino , Pé/patologia , Fungos/isolamento & purificação , Fungos/patogenicidade , Humanos , Incidência , Masculino , Micoses/epidemiologia , Micoses/etiologia , Micoses/patologia , Pacientes Ambulatoriais , Prevalência , Estudos Prospectivos , Leveduras/isolamento & purificação , Leveduras/patogenicidadeRESUMO
The use of biological drugs in psoriasis is replacing traditional therapies due to their specific mechanism and limited side effects. However, the use of Interleukin 17 inhibitors and the modification of its cytokine pathway could favor the risk of fungal infections. All-trans retinoic acid is an active metabolite of vitamin A with anti-inflammatory and immunoregulatory properties through its capacity to stimulate both innate and adaptive immunity and to its effects on proliferation, differentiation and apoptosis in a variety of immune cells. Furthermore, it has been recently discovered that All-trans retinoic acid has a direct fungistatic effect against Candida and Aspergillus Fumigatus. On the basis of these new insights, in the current review, we suggest that the evaluation of serum level of All-trans retinoic acid or vitamin A should be considered as a predictive marker for the development of fungal infections among psoriatic patients treated with Interleukin 17 inhibitors. In clinical practice, vitamin A test could be added in the routine hospital diagnostic management for a better selection of psoriatic patients eligible to Interleukin 17 inhibitors.
Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Candidíase/diagnóstico , Candidíase/etiologia , Dermatomicoses/diagnóstico , Dermatomicoses/etiologia , Interleucina-17/antagonistas & inibidores , Micoses/diagnóstico , Micoses/etiologia , Psoríase/tratamento farmacológico , Psoríase/imunologia , Vitamina A/sangue , Biomarcadores/sangue , Candidíase/prevenção & controle , Citocinas/metabolismo , Dermatomicoses/prevenção & controle , Humanos , Interleucina-17/metabolismo , Micoses/prevenção & controle , Seleção de Pacientes , Valor Preditivo dos Testes , Risco , Transdução de Sinais/efeitos dos fármacos , Tretinoína/sangueRESUMO
BACKGROUND: Curvularia is a filamentous dematiaceous fungus increasingly recognized as a pathogen in immunocompromised patients. The most common clinical entities associated with this fungus are allergic sinusitis, cutaneous infection and keratitis. In this article, a report on the first clinical case of Curvularia pallescens cutaneous infection in Spain and its treatment is described. CASE REPORT: A 68 year-old man with a history of lung transplantation presented to Dermatology Unit due to a skin lesion in the knee that had been evolving for 6 months. A skin biopsy was performed for its study. In the histopathological study, an intense and non-specific inflammatory reaction in the dermis was observed, and with Grocott stain and periodic acid Schiff abundant septate hyphae and spores were found in the dermis. The culture of the sample revealed a filamentous fungus whose microscopic examination allowed to identify the genus as Curvularia. Using MALDI-TOF mass spectrometry and molecular identification, the fungus was finally identified as Curvularia pallescens. The patient underwent surgical resection of the lesion and was treated with posaconazole, evolving favorably. CONCLUSIONS: The species of Curvularia should be considered causal agents of fungal skin infections in immunosuppressed patients. This clinical case, which showed good clinical response after surgical resection and treatment with posaconazole, is the first described in Spain due to this species.
Assuntos
Ascomicetos/isolamento & purificação , Dermatomicoses/microbiologia , Transplante de Pulmão , Complicações Pós-Operatórias/microbiologia , Idoso , Antifúngicos/uso terapêutico , Biópsia , Terapia Combinada , Desbridamento , Dermatomicoses/tratamento farmacológico , Dermatomicoses/etiologia , Dermatomicoses/cirurgia , Humanos , Hospedeiro Imunocomprometido , Úlcera da Perna/tratamento farmacológico , Úlcera da Perna/etiologia , Úlcera da Perna/microbiologia , Úlcera da Perna/cirurgia , Masculino , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Espanha/epidemiologia , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Triazóis/uso terapêuticoAssuntos
Cianoacrilatos/efeitos adversos , Dermatomicoses/complicações , Tórax em Funil/cirurgia , Técnicas de Sutura/instrumentação , Adesivos Teciduais/efeitos adversos , Cicatrização , Adolescente , Dermatomicoses/diagnóstico , Dermatomicoses/etiologia , Diagnóstico Diferencial , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologiaRESUMO
A red swollen face can be a skin sign of a potentially life-threatening condition. We present in detail the main clinical presentations, diagnostic tests, and management of some of the most severe conditions that can frequently present as a red and swollen face: acute or recurrent angioedema, mast cell-driven or bradykinin-mediated angioedema, nonhereditary and hereditary angioedema, allergic or photoallergic facial contact dermatitis, contact urticaria, severe adverse drug reactions (particularly drug reaction with eosinophilia and systemic symptoms [DRESS]), skin infections (erysipelas, cellulitis, necrotizing fasciitis), and autoimmune diseases (dermatomyositis). There are many other conditions that also have to be considered in the differential diagnosis of a red swollen face.
Assuntos
Dermatite/patologia , Exantema/etiologia , Exantema/patologia , Face/patologia , Angioedema/etiologia , Angioedema/patologia , Dermatite/etiologia , Dermatomicoses/etiologia , Dermatomicoses/patologia , Toxidermias/etiologia , Toxidermias/patologia , HumanosRESUMO
Fungal and viral skin infections are common and typically are managed by family physicians. The fungal skin infections commonly seen in family practice include the various forms of tinea: tinea corporis, tinea gladiatorum, tinea cruris, tinea pedis, tinea capitis, and tinea unguium (eg, onychomycosis). Common viral skin infections include herpes simplex virus infection, herpes zoster, cutaneous and genital warts, and molluscum contagiosum. Many fungal and viral skin infections have a classic appearance but variations and atypical manifestations can make patients with these conditions difficult to diagnose definitively. Confirmatory testing often is not required. In complex cases with atypical features, microscopy, culture, or blood tests can help in making a diagnosis. For some infections, treatment may be initiated before confirmatory test results are received. Most fungal skin infections can be managed effectively with topical antifungals. Tinea capitis and onychomycosis should be managed with oral drugs. Oral antiviral drugs are used to manage most viral skin infections but dosages vary based on the condition and phase of the infectious process. Cutaneous warts typically are managed with salicylic acid and/or cryotherapy.
Assuntos
Queimaduras , Dermatomicoses , Dermatopatias Infecciosas , Tinha , Queimaduras/complicações , Queimaduras/microbiologia , Dermatomicoses/diagnóstico , Dermatomicoses/tratamento farmacológico , Dermatomicoses/etiologia , Humanos , Pacientes Ambulatoriais , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/tratamento farmacológico , Dermatopatias Infecciosas/etiologia , Tinha dos PésAssuntos
Dermatomicoses/etiologia , Foliculite/patologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transtornos Linfoproliferativos/terapia , Prurido/etiologia , Administração Tópica , Animais , Fármacos Dermatológicos/uso terapêutico , Dermatomicoses/patologia , Diagnóstico Diferencial , Dermatoses Faciais/etiologia , Dermatoses Faciais/patologia , Feminino , Foliculite/etiologia , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Transtornos Linfoproliferativos/patologia , Ácaros/imunologia , Prurido/patologia , Índice de Gravidade de Doença , Adulto JovemAssuntos
Dermatomicoses/etiologia , Dermatomicoses/microbiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Trichoderma/isolamento & purificação , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Criança , Desbridamento , Dermatomicoses/terapia , Evolução Fatal , Feminino , Humanos , Pulmão/microbiologia , Testes de Sensibilidade Microbiana , Trichoderma/citologia , Trichoderma/efeitos dos fármacos , Trichoderma/genéticaAssuntos
Artrite Reumatoide/complicações , Dermatomicoses/patologia , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Histoplasmose/patologia , Miosite/patologia , Biópsia , Dermatomicoses/etiologia , Eritema/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Técnicas Microbiológicas , Pessoa de Meia-Idade , Miosite/etiologia , Coxa da Perna/diagnóstico por imagem , Coxa da Perna/patologiaRESUMO
Cutaneous mucormycosis due to Saksenaea vasiformis species is exceptional. There have been about 40 reported cases worldwide, with most being fatal. We report an exceptional nonlethal case of mucormycosis due to S. vasiformis following a spider bite. The patient was in an immunosuppressed state owing to previous chemotherapy and diabetes mellitus. The origin of the inoculation was the bite of a Loxosceles laeta spider, which caused loxoscelism. The initial skin injury was quickly progressive, requiring amputation of the right upper limb. After surgical intervention and suitable antifungal treatment, the patient was discharged with resolution of accompanying pulmonary disease. Infections due to S. vasiformis are probably underdiagnosed. To avoid fatal outcomes, a high index of clinical suspicion in patients with quickly progressive necrotic lesions of soft tissues and systemic dissemination is important.
Assuntos
Dermatomicoses/etiologia , Dermatomicoses/patologia , Mucormicose/etiologia , Mucormicose/patologia , Picada de Aranha/complicações , Idoso , Dermatomicoses/terapia , Humanos , Masculino , Mucormicose/terapiaRESUMO
Dandruff is a common scalp condition causing both a discomfort and an undesired social image. Various studies dating from early 1900s have investigated the condition, but understanding of underlying mechanisms and etiology of the condition is still in its infancy. Formation of dandruff is a common but complex event which has been associated with numerous causal factors. Physiological conditions such as pH, water content, or sebum secretion are some of the host-related factors. An imbalance between these factors can disturb the physiological equilibrium of the scalp that can lead to dandruff formation. However, severity of the condition is strongly related to the lipophilic yeast of the skin microbiota, Malassezia spp. On the other hand, there are recent publications highlighting the role of other scalp microbiota members on dandruff formation. This review investigates the processes leading to the formation of dandruff to provide an etiological description of the condition, with a focus on Malassezia spp.
Assuntos
Caspa/etiologia , Caspa/patologia , Dermatomicoses/etiologia , Dermatomicoses/patologia , Malassezia/crescimento & desenvolvimento , HumanosRESUMO
Skin infections caused by Paecilomyces species have been rarely described in patients with solid organ transplantation. Cutaneous manifestations are highly variable and include erythematous macules, nodules, pustules, and vesicular and necrotic lesions. The diagnosis of these infections is generally made by examination of a skin biopsy. Management of these fungal infections is difficult due to the immunocompromised state of the patients. Moreover, antifungal therapy and immunosuppressive drug interactions should be considered during treatment management. Herein, we reported a case of cellulitis caused by Paecilomyces variotii in a 56-year-old man who had undergone a kidney transplantation. Erythematous macular and nodular lesions on the left hand and left foot appeared first; within 2 months the skin lesions became ulcerated, hemorrhagic, and progressively painful and the patient was admitted to our hospital. The diagnosis was made by skin biopsy and tissue culture. The skin lesions resolved by the sixth week of the treatment with voriconazole.
Assuntos
Dermatomicoses/diagnóstico , Transplante de Rim/efeitos adversos , Paecilomyces/isolamento & purificação , Pele/patologia , Transplantados , Antifúngicos/uso terapêutico , Biópsia , Dermatomicoses/tratamento farmacológico , Dermatomicoses/etiologia , Dermatomicoses/microbiologia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Paecilomyces/efeitos dos fármacos , Pele/microbiologia , Resultado do Tratamento , Voriconazol/uso terapêuticoAssuntos
Fasciite Necrosante/etiologia , Dermatopatias Bacterianas/tratamento farmacológico , Dermatopatias Bacterianas/etiologia , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/etiologia , Administração Intravenosa , Toxinas Bacterianas/metabolismo , Dermatomicoses/tratamento farmacológico , Dermatomicoses/etiologia , Exotoxinas/metabolismo , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/tratamento farmacológico , Gangrena Gasosa/tratamento farmacológico , Gangrena Gasosa/etiologia , Humanos , Hospedeiro Imunocomprometido , Imunoglobulinas/administração & dosagem , Leucocidinas/metabolismo , Piomiosite/tratamento farmacológico , Piomiosite/etiologia , Infecções dos Tecidos Moles/diagnóstico , Staphylococcus aureus/metabolismo , Staphylococcus aureus/patogenicidade , Abuso de Substâncias por Via IntravenosaRESUMO
Mucormycosis is a rare and potentially life-threatening infection, typically affecting immunocompromised hosts. We report a case of an adolescent boy who developed primary isolated cutaneous mucormycosis in the early period following kidney transplantation. Surgical excision was performed using intraoperative fungal staining to obtain clear margins, followed by topical and systemic antifungal therapy. A skin graft was then applied to the excised area with good healing, and the patient made a full recovery.