RESUMO
PURPOSE: To describe an aggressive, refractory case of Veronaea botryosa-associated mycokeratitis progressing to endophthalmitis. METHODS: Observational case report and review of relevant literature. RESULTS: An 80-year-old man with a history of lung cancer and diabetes mellitus type 2 presented as an emergent referral to the corneal service with a corneal ulcer and associated endothelial plaque that responded initially to topical steroid and antiviral therapy but subsequently progressed to fungal endophthalmitis. The patient underwent an emergent penetrating keratoplasty and pars plana vitrectomy. Despite multiple negative Grocott methenamine silver smears, gram stains, eye cultures (aerobic, anaerobic, and fungal), and inconclusive confocal microscopy, the host corneal tissue pathology revealed melanin-containing fungi (phaeohyphomycosis). Further speciation of the pathology specimen revealed mold and phenotypic characterization and DNA sequencing confirmed V. botryose. CONCLUSIONS: Veronaea botryose is a rare fungal infection with previously reported human cutaneous, subcutaneous, and submucosal infections. This is the first documented case of phaeohyphomycosis caused by V. botryosa infection in human ocular tissue.
Assuntos
Ascomicetos/isolamento & purificação , Úlcera da Córnea/microbiologia , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/microbiologia , Feoifomicose/microbiologia , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Ascomicetos/genética , Terapia Combinada , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/terapia , DNA Fúngico/genética , Endoftalmite/diagnóstico , Endoftalmite/terapia , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/terapia , Humanos , Masculino , Microscopia Acústica , Microscopia Confocal , Procedimentos Cirúrgicos Oftalmológicos , Feoifomicose/diagnóstico , Feoifomicose/terapia , Reação em Cadeia da Polimerase , Corpo Vítreo/microbiologiaRESUMO
Invasive fungal infections are becoming increasingly more prevalent in clinical practice. This corresponds with more patients living with immunosuppression and improved techniques to identify fungal infections. Subcutaneous fungal masses can often masquerade and imitate common dermatological lesions such as cysts. Querying a fungal aetiology of a mass is important, as fungal elements can be missed on histological examination, and special stains may be needed to identify spores and hyphae to make the diagnosis. Skin trauma with inoculation of fungal elements contained in soil and vegetable matter is the most common source of subcutaneous fungal masses. While traditionally considered a disease of the tropics, subcutaneous fungal masses can present worldwide in both immunosuppressed and immunocompetent patients. This case study describes a subcutaneous knee mass in a 53-year-old immunosuppressed farmer in Australia. A subcutaneous phaeohyphomycosis was diagnosed with a black pigmented mould, Rhytidhysteron species. A latent period of 12 years was observed between traumatic inoculation with farm soil and wheat dust in north-western New South Wales and development of the knee mass. Rhytidhysteron is considered a disease of the tropics, most commonly reported in India. This case, to the author's knowledge, is the first case report of pathogenic Rhytidhysteron from Australia. Surgery and antifungal therapy are recommended to treat Rhytidhysteron infection. This patient's recommended antifungal treatment was shortened due to severe hepatic disease. The clinical course was complicated by three localised recurrences in the patient's knee over 14 months. At the time of the third localised recurrence, this patient could tolerate posaconazole therapy for a month only. Surgical excision using general anaesthesia, use of diathermy for excision and wound lavage with iodine, hydrogen peroxide and saline has coincided in remission of clinical disease for 3 years at the time of writing.
Assuntos
Ascomicetos/isolamento & purificação , Cistos/microbiologia , Cistos/terapia , Feoifomicose/diagnóstico , Feoifomicose/terapia , Tela Subcutânea/microbiologia , Feminino , Humanos , Pessoa de Meia-Idade , Feoifomicose/microbiologia , Resultado do Tratamento , Clima TropicalAssuntos
Ascomicetos/genética , DNA Fúngico/genética , DNA Espaçador Ribossômico/genética , Dermatomicoses/microbiologia , Proteínas Fúngicas/genética , Infecções Oportunistas/microbiologia , Feoifomicose/microbiologia , Tubulina (Proteína)/genética , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Ascomicetos/isolamento & purificação , Dermatomicoses/diagnóstico , Dermatomicoses/imunologia , Dermatomicoses/terapia , Feminino , Glucocorticoides/efeitos adversos , Humanos , Hipertermia Induzida , Hospedeiro Imunocomprometido , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Infecções Oportunistas/terapia , Feoifomicose/diagnóstico , Feoifomicose/imunologia , Feoifomicose/terapia , Prednisolona/efeitos adversos , Recidiva , Terbinafina/uso terapêuticoRESUMO
BACKGROUND: Deep cutaneous fungal infections (DCFIs) are varied in immunosuppressed patients, with few data for such infections in solid-organ transplant recipients (s-OTRs). OBJECTIVE: To determine DCFI diagnostic characteristics and outcome with treatments in s-OTRs. METHODS: A 20-year retrospective observational study in France was conducted in 8 primary dermatology-dedicated centers for s-OTRs diagnosed with DCFIs. Relevant clinical data on transplants, fungal species, treatments, and outcomes were analyzed. RESULTS: Overall, 46 s-OTRs developed DCFIs (median delay, 13 months after transplant) with predominant phaeohyphomycoses (46%). Distribution of nodular lesions on limbs and granulomatous findings on histopathology were helpful diagnostic clues. Treatments received were systemic antifungal therapies (48%), systemic antifungal therapies combined with surgery (28%), surgery alone (15%), and modulation of immunosuppression (61%), leading to complete response in 63% of s-OTRs. LIMITATIONS: Due to the retrospective observational design of the study. CONCLUSIONS: Phaeohyphomycoses are the most common DCFIs in s-OTRs. Multidisciplinary teams are helpful for optimal diagnosis and management.
Assuntos
Dermatomicoses/epidemiologia , Hospedeiro Imunocomprometido , Transplante de Órgãos/efeitos adversos , Feoifomicose/epidemiologia , Transplantados/estatística & dados numéricos , Adolescente , Adulto , Idoso , Antifúngicos/uso terapêutico , Procedimentos Cirúrgicos Dermatológicos , Dermatomicoses/imunologia , Dermatomicoses/microbiologia , Dermatomicoses/terapia , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Humanos , Hifas/isolamento & purificação , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Feoifomicose/imunologia , Feoifomicose/microbiologia , Feoifomicose/terapia , Prevalência , Estudos Retrospectivos , Pele/imunologia , Pele/microbiologia , Adulto JovemAssuntos
Ascomicetos/isolamento & purificação , Micoses/microbiologia , Feoifomicose/microbiologia , Feoifomicose/patologia , Adulto , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Ascomicetos/genética , Mãos/microbiologia , Mãos/patologia , Humanos , Hospedeiro Imunocomprometido/imunologia , Itraconazol/administração & dosagem , Itraconazol/uso terapêutico , Transplante de Rim/efeitos adversos , Masculino , Micoses/diagnóstico , Micoses/patologia , Feoifomicose/diagnóstico , Feoifomicose/terapia , Transplantados , Resultado do TratamentoRESUMO
PURPOSE: In the past decade, an increasing number of otherwise healthy individuals suffered from invasive fungal infections due to inherited CARD9 mutations. Herein, we present a patient with a homozygous CARD9 mutation who was suffering from localized subcutaneous phaeohyphomycosis caused by the phytopathogenic fungus Pallidocercospora crystallina which has not been reported to cause infections in humans. METHODS: The medical history of our patient was collected. P. crystallina was isolated from the biopsied tissue. To characterize this novel pathogen, the morphology was analyzed, whole-genome sequencing was performed, and the in vivo immune response was explored in mice. Whole-exome sequencing was carried out with samples from the patient's family. Finally, the expression and function of mutated CARD9 were investigated. RESULTS: A dark red plaque was on the patient's left cheek for 16 years and was diagnosed as phaeohyphomycosis due to a P. crystallina infection. Whole-genome sequencing suggested that that this strain had a lower pathogenicity. The in vivo immune response in immunocompetent or immunocompromised mice indicated that P. crystallina could be eradicated within a few weeks. Whole-exome sequencing revealed ahomozygous missense mutation in CARD9 (c.1118G>C p.R373P). The mRNA and protein expression levels were similar among cells carrying homozygous (C/C), heterozygous (G/C), and wild-type (G/G) CARD9 alleles. Compared to PBMCs or neutrophils with heterozygous or wild-type CARD9 alleles, however, PBMCs or neutrophils with homozygous CARD9 alleles showed impaired anti-P. crystallina effects. CONCLUSION: Localized subcutaneous phaeohyphomycosis caused by P. crystallina was reported in a patient with a homozygous CARD9 mutation. Physicians should be aware of the possibility of a CARD9 mutation in seemingly healthy patients with unexplainable phaeohyphomycosis.
Assuntos
Ascomicetos , Proteínas Adaptadoras de Sinalização CARD/genética , Dermatomicoses/genética , Dermatomicoses/microbiologia , Homozigoto , Mutação , Feoifomicose/genética , Feoifomicose/microbiologia , Adulto , Animais , Ascomicetos/ultraestrutura , Biópsia , Dermatomicoses/terapia , Feminino , Dosagem de Genes , Predisposição Genética para Doença , Genoma Fúngico , Interações Hospedeiro-Patógeno , Humanos , Imuno-Histoquímica , Camundongos , Feoifomicose/terapia , Sequenciamento do ExomaRESUMO
BACKGROUND: Phaeoacremonium parasiticum is considered a rare infectious agent that is part of a heterogeneous group of fungi causing phaeohyphomycosis. This organism is capable of producing subcutaneous infections, eumycetomas, osteomyelitis, arthritis, myositis and also disseminated diseases, such as fungemia and endocarditis. CASE REPORT: We describe a case of cutaneous infection by P. parasiticum in a kidney transplant patient. The identification of this microorganism was performed by microbiological and histopathological studies and confirmed with the sequence of the gene encoding ß-tubulin and a real time panfungal PCR targeting 18S ribosomal RNA gene. The microorganism was correctly identified by phenotypic and molecular methods. The patient was treated with oral antifungal therapy and a debulking surgery and evolved without any complication. CONCLUSIONS: The diagnosis of this infection is difficult and usually affects kidney transplant patients, but the reasons of this association are still unknown.
Assuntos
Ascomicetos/isolamento & purificação , Dermatomicoses/microbiologia , Rim , Feoifomicose/microbiologia , Transplantados , Ascomicetos/genética , Dermatomicoses/terapia , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Feoifomicose/terapia , Fenótipo , RNA Ribossômico 18S/genética , Tubulina (Proteína)/genéticaRESUMO
BACKGROUND: The incidence of cutaneous infections by dematiaceous fungi is rising in our environment due to the high number of solid organ transplant recipients (SOTR). OBJECTIVE: To review our experience in the management of cutaneous phaeohyphomycoses in a Spanish reference centre for dermatological care of SOTR. METHODS: Retrospective clinical, histopathological and microbiological review of all SOTR diagnosed of a phaeohyphomycosis in a 7-year period. RESULTS: Eleven SOTR were identified (8 lung and 3 kidney). The lesions were solitary in six patients and multiple in five, affecting mostly the lower extremities. Early lesions showed epidermal hyperplasia and a diffuse dermal suppurative granulomatous infiltrate that was progressively substituted by fibrosis when the lesions were treated. Septated fungal structures with refractile walls were identified. DNA sequencing confirmed the presence of Alternaria spp (8 cases), Cladosporium cladosporioides, Microsphaeropsis arundinis and Exophiala oligosperma. Three patients with single lesions were treated with surgery, while the other 8 required long-term antifungal therapy, including itraconazole, voriconazole and/or terbinafine, combined with surgery and reduction in tacrolimus doses. CONCLUSION: A clinical, histopathological and microbiological correlation is essential to corroborate this diagnosis. Solitary lesions are easily treated with surgery, but larger or multiple lesions may require long medical treatments combined with surgery and modification of immunosuppressive medication. The list of dematiaceous fungi implicated in cutaneous infections is expanding, in line with the availability of more sophisticated identification methods and the increasing number of immunosuppressed patients.
Assuntos
Gerenciamento Clínico , Feoifomicose/diagnóstico , Feoifomicose/terapia , Transplantados , Adulto , Idoso , Antifúngicos/uso terapêutico , Ascomicetos/classificação , Ascomicetos/genética , Ascomicetos/isolamento & purificação , Desbridamento , Feminino , Histocitoquímica , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Feoifomicose/epidemiologia , Feoifomicose/patologia , Estudos Retrospectivos , Pele/microbiologia , Pele/patologia , Espanha/epidemiologia , TransplantesRESUMO
We report a case of a 59-year-old male patient with a postoperative fungal infection of the left eye. A dark-pigmented yeast, Exophiala dermatitidis (previously known as Wangiella dermatitidis), was identified from the culture of the biopsy taken from the posterior capsule. The infection was successfully eradicated by a combination of surgical and medical (i.e., voriconazole and fluconazole) treatment. This is the first report of successfully treated E. dermatitidis endophthalmitis, which demonstrates that a prompt and aggressive antifungal therapy combined with surgical intervention is necessary to prevent vision loss in cases of endophthalmitis due to Exophiala species. Beside the case description, we also aim to provide a literature review of previously reported eye infections caused by Exophiala species in order to help the future diagnosis and management of the disease.
Assuntos
Endoftalmite/diagnóstico , Endoftalmite/patologia , Exophiala/isolamento & purificação , Feoifomicose/diagnóstico , Feoifomicose/patologia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/patologia , Antifúngicos/administração & dosagem , Biópsia , Desbridamento , Endoftalmite/microbiologia , Endoftalmite/terapia , Humanos , Masculino , Técnicas Microbiológicas , Pessoa de Meia-Idade , Feoifomicose/microbiologia , Feoifomicose/terapia , Pigmentos Biológicos/análise , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/terapia , Resultado do TratamentoAssuntos
Antifúngicos/uso terapêutico , Ascomicetos/isolamento & purificação , Linfoma de Células T/complicações , Infecções Oportunistas/complicações , Feoifomicose/complicações , Idoso de 80 Anos ou mais , Ascomicetos/genética , DNA Fúngico/isolamento & purificação , Humanos , Japão , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/microbiologia , Infecções Oportunistas/terapia , Feoifomicose/diagnóstico , Feoifomicose/microbiologia , Feoifomicose/terapia , Tela Subcutânea/microbiologia , Tela Subcutânea/patologia , Tela Subcutânea/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Phaeohyphomycosis is an infrequent infection in human beings. However, in recent years, its prevalence has augmented in immunosuppressed patients (mostly in solid organ transplanted patients). Infection can be mucocutaneous or disseminated. In the former, the fungus inoculation occurs mainly through traumatism. Lesions may be polymorphic and asymptomatic, isolated or multiple, and are usually localized in exposed areas of the limbs and head. Treatment is not standardized. When possible, surgical resection of the lesion is combined with systemic antifungals. METHODS: We communicate three phaeohyphomycosis cases with cutaneous compromise. RESULTS: The cases we present show diverse clinical characteristics and varied severity and evolution. CONCLUSION: It is important for dermatologists to recognize this cutaneous fungus infection because the diagnosis using microscopic examination and mycological culture depends on the clinical suspicion.
Assuntos
Dermatomicoses/microbiologia , Dermatomicoses/terapia , Fasciite Necrosante/microbiologia , Hospedeiro Imunocomprometido , Feoifomicose/imunologia , Feoifomicose/terapia , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Dermatomicoses/diagnóstico , Evolução Fatal , Feminino , Humanos , Itraconazol/uso terapêutico , Pneumopatias/microbiologia , Masculino , Pessoa de Meia-Idade , Feoifomicose/microbiologia , Feoifomicose/patologiaAssuntos
Alternariose/patologia , Doenças Transmissíveis Emergentes/diagnóstico , Hospedeiro Imunocomprometido/imunologia , Transplante de Rim/métodos , Feoifomicose/patologia , Feoifomicose/terapia , Idoso , Alternariose/imunologia , Alternariose/terapia , Antifúngicos/uso terapêutico , Biópsia por Agulha , Terapia Combinada , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/terapia , Procedimentos Cirúrgicos Dermatológicos/métodos , Europa (Continente) , Feminino , Humanos , Imuno-Histoquímica , Extremidade Inferior , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Prognóstico , Resultado do TratamentoAssuntos
Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/imunologia , Feoifomicose/terapia , Tenossinovite/etiologia , Voriconazol/uso terapêutico , Articulação do Punho/microbiologia , Terapia Combinada , Drenagem/métodos , Seguimentos , Humanos , Hospedeiro Imunocomprometido , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Feoifomicose/diagnóstico , Prednisona/uso terapêutico , Tenossinovite/microbiologia , Tenossinovite/terapia , Resultado do Tratamento , Articulação do Punho/fisiopatologiaRESUMO
Infections are Achilles heel of kidney transplant recipients. Opportunistic fungal infections are increasingly recognized in these patients. We report a case of kidney transplant recipient with skin and soft tissue infection caused by Pyrenochaeta romeroi, a dematiaceous fungi. Infection by this organism is rare.
Assuntos
Ascomicetos/isolamento & purificação , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Infecções Oportunistas/microbiologia , Feoifomicose/microbiologia , Adulto , Antifúngicos/uso terapêutico , Ascomicetos/classificação , Desbridamento , Humanos , Hospedeiro Imunocomprometido , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Infecções Oportunistas/terapia , Feoifomicose/diagnóstico , Feoifomicose/imunologia , Feoifomicose/terapia , Resultado do TratamentoAssuntos
Alternariose/patologia , Transplante de Rim/efeitos adversos , Úlcera da Perna/etiologia , Feoifomicose/patologia , Alternariose/etiologia , Alternariose/terapia , Humanos , Hospedeiro Imunocomprometido , Úlcera da Perna/patologia , Masculino , Pessoa de Meia-Idade , Feoifomicose/etiologia , Feoifomicose/terapiaRESUMO
Rhino-sinusal infections are serious diseases and possibly lethal. When they are invasive, we easily discuss apergilloses and mucormycoses. The confirmation of the diagnosis of mucormycosis need an extensive surgery for precise histopathological and mycological evaluation. The pathologist may be faced to other rare mycoses such as phaeohyphomycoses, which present different morphological features than mucormycoses and Aspergillus. Once the diagnosis is established, an appropriate antifungal treatment is quickly started. The aim of our work is to report two observations of phaeohyphomycoses, to describe their histopathological features, to discuss complementary diagnostic methods and to present the main differential diagnoses.
Assuntos
Alternaria/isolamento & purificação , Alternariose/microbiologia , Feoifomicose/microbiologia , Rinite/microbiologia , Sinusite/microbiologia , Adulto , Alternaria/ultraestrutura , Alternariose/diagnóstico , Alternariose/patologia , Alternariose/terapia , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Terapia Combinada , Desbridamento , Diagnóstico Diferencial , Diagnóstico Precoce , Evolução Fatal , Feminino , Humanos , Lipossomos , Mastoidite/tratamento farmacológico , Mastoidite/microbiologia , Mastoidite/cirurgia , Feoifomicose/diagnóstico , Feoifomicose/patologia , Feoifomicose/terapia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Rinite/diagnóstico , Rinite/patologia , Rinite/terapia , Choque Séptico/etiologia , Sinusite/diagnóstico , Sinusite/patologia , Sinusite/terapiaRESUMO
Phaeohyphomycosis is an infection caused by a filamentous fungus that contains pigment melanin in its cell wall. We report two cases caused by Exophiala sp. emphasizing the clinical variability of the disease, as well as diagnostic and therapeutic difficulties of this opportunistic infection in immunosuppressed patients (kidney transplant).
Assuntos
Exophiala/isolamento & purificação , Transplante de Rim/efeitos adversos , Feoifomicose/patologia , Antifúngicos/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/imunologia , Infecções Oportunistas/patologia , Infecções Oportunistas/terapia , Feoifomicose/imunologia , Feoifomicose/terapia , Pele/patologiaRESUMO
Abstract Phaeohyphomycosis is an infection caused by a filamentous fungus that contains pigment melanin in its cell wall. We report two cases caused by Exophiala sp. emphasizing the clinical variability of the disease, as well as diagnostic and therapeutic difficulties of this opportunistic infection in immunosuppressed patients (kidney transplant).
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Exophiala/isolamento & purificação , Transplante de Rim/efeitos adversos , Feoifomicose/patologia , Antifúngicos/uso terapêutico , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Infecções Oportunistas/imunologia , Infecções Oportunistas/patologia , Infecções Oportunistas/terapia , Feoifomicose/imunologia , Feoifomicose/terapia , Pele/patologiaRESUMO
Phaeohyphomycosis is a heterogeneous group of opportunistic infections caused by dematiaceous molds, which are distributed worldwide as plant pathogens but rarely cause human diseases. However, due to the growing populations of immunocompromised patients, these fungi are frequently recognized as important human pathogens. We are reporting this very rare, unique case for the first time from Islamabad, Pakistan, describing the association of visceral Phaeohyphomycosis caused by the opportunistic fungus Alternaria alternata, affecting the left kidney, with the immunocompromised state in a young incidentally detected patient with insulin-dependent type I diabetes. The case was diagnosed on the basis of a high index of clinical suspicion, microbial cultures, microscopy, imaging studies and endourological procedures. The patient did not respond well to the highly sensitive Amphotericin B, resulting in loss of the kidney. Therefore, we suggest that clinicians involved in treating immunocompromised patients should have a high degree of clinical suspicion for such opportunistic pathogens to allow timely initiation of the correct diagnostic and therapeutic work-up.