Evidence implicating Thamnostylum lucknowense as an etiological agent of rhino-orbital mucormycosis.

In this report, we present a case of rhino-orbital mucormycosis in a 57-year-old female with poorly controlled diabetes mellitus. The only mold cultured at 25°C, 37°C, and 40°C from a specimen of the nasal crust was identified phenotypically and independently using nuclear ribosomal DNA sequence data as Thamnostylum lucknowense. To our knowledge, this report presents the first data implicating this mucoraceous fungus as a mycotic agent of human infection.

Chronic rhinofacial mucormycosis caused by Mucor irregularis (Rhizomucor variabilis) in India.

In this article, we describe a chronic case of rhinofacial mucormycosis caused by Mucor irregularis, formerly known as Rhizomucor variabilis var. variabilis, a rare mycotic agent in humans. The infection caused progressive destruction of the nasal septum and soft and hard palate, leading to collapse of the nose bridge and an ulcerative gaping hole. The mucoralean mold cultured from a nasal biopsy specimen was determined by multilocus DNA sequence data to be conspecific with M. irregularis.

Clinical Spectrum, Molecular Characterization, Antifungal Susceptibility Testing of Exophiala spp. From India and Description of a Novel Exophiala Species, E. arunalokei sp. nov.

Introduction: Exophiala spp. are important opportunist pathogens causing subcutaneous or even fatal disseminated infections in otherwise both immunosuppressed and healthy individuals but there are no systematic studies on the isolates of Exophiala species from India. Methods: Twenty-four isolates of Exophiala species were retrieved from the National Culture Collection of Pathogenic Fungi (NCCPF) and identified phenotypically and by molecular methods (ITS region sequencing) followed by antifungal susceptibility testing (AFST) as per CLSI-M38A3 guidelines. A review of the literature of cases from India was performed up to 1st January 2021 using the Medline and Cochrane database. Results: E. dermatitidis (n = 8), E. jeanselmei (n = 6), E. spinifera (n = 6), E. mesophila (n = 1), E. oligosperma (n = 1), E. xenobiotica (n = 1) were identified and the sequencing of ITS, ß-tubulin and ß-actin revealed a novel species, E. arunalokei sp. nov. (n = 1). The ITS sequence phylogram of E. jeanselmei revealed that the majority (83%) formed a separate cluster close to type A while majority (75%) of E. dermatitidis were type B. The MIC50 (mg/L) of amphotericin, itraconazole, voriconazole, micafungin, caspofungin, anidulafungin, and posaconazole, was 1, 0.25, 0.125, 0.12, 0.125, 0.062, and 0.062, respectively. Sixteen more cases were identified on the literature review and a significant association of E. dermatitidis with history of surgical procedures (p = 0.013), invasive disease (p = 0.032) and of E. mesophila with tuberculosis (p = 0.026) was seen. Conclusion: This, to the best of our knowledge is the first study from India elucidating the molecular and clinical characteristics of Exophiala species and the first Indian report of human infection due to E. xenobiotica and E. arunalokei.

Cavitary pulmonary zygomycosis caused by Rhizopus homothallicus.

We report the first two proven cases of cavitary pulmonary zygomycosis caused by Rhizopus homothallicus. The diagnosis in each case was based on histology, culture of the causal agent, and the nucleotide sequence of the D1/D2 region of the 28S ribosomal DNA.

Concurrent double infections of the skin: phaeohyphomycosis and nocardiosis in a patient with idiopathic thrombocytopenic purpura.

We describe a case of concurrent double infection with phaeohyphomycosis and lymphocutaneous nocardiosis in an immunocompromised host. The episode occurred almost simultaneously with an incident of insect bites. Exophiala spinifera was isolated from lesions on the left arm and Nocardia asteroides was isolated from lesions on the right hand. Clinical resolution occurred within 5 months after initiation of antimicrobial treatment with oral itraconazole and minocycline. We believe that this case represents a novel episode of previously unreported concurrent infections with phaeohyphomycosis and lymphocutaneous nocardiosis in human beings.

Granulomatous lymphadenitis and splenitis associated with Monocillium indicum infection in a dog.

This report describes severe generalized granulomatous lymphadenitis and splenitis in a 5-year-old, spayed female, Rottweiler dog with anorexia and diarrhea. There was replacement or effacement of much of the parenchyma of the lymph nodes and spleen by sheets of macrophages, multinucleated giant cells, and myriad nonpigmented fungal organisms, most of which appeared to be intracellular. These organisms were very pleomorphic, including large chlamydospore-like cells, small round yeast-like cells, and septate hyphae. A fungus identified as Monocillium indicum was isolated from lymph node tissue. To the authors' knowledge, this is the first report of infection with Monocillium in either humans or other animals.

Canine Subcutaneous Zygomycosis Caused by Conidiobolus sp.: A Case Report and Review of Conidiobolus Infections in other Species.

Résumé- Un chien, jeune adulte, a été présenté pour une masse sous-cutanée évoluant depuis un mois sur la partie droite du thorax et une masse ulcérée sous-cutanée sur la cuisse droite. L'examen histo-pathologique a révélé une inflammation pyogranulomateuse du derme et du tissu sous-cutané avec de larges hyphes fongiques. De nouvelles lésions sont apparues. Un traitement à base d'itraconazole pendant 2 semaines a été inefficace. L'euthanasie a été pratiquée 10 semaines après la première consultation. La culture fongique faite à partir de prélèvements chirurgicaux a permis d'isoler un Conidiobolus sp. Des infections àConidiobolus sp. ont été rapportées chez l'homme, le cheval, le mouton et le lama. Histologiquement, les hyphes sont difficiles à différencier de ceux d'autres zygomycètes ou de Pythium insidiosum. La culture est nécessaire pour une identification définitive. Une discussion sur les aspects comparés des infections cutanées àConidiobolus sp. est développée. [Hiller, A., Kunkle, G. A., Ginn, P. E., Padhye, A. A. Canine subcutaneous zygomycosis caused by Conidiobolus sp.: a case report and review of Conidibolus infections in other species. (Zygomycose sous-cutanée àConidiobolus sp. chez un chien: cas clinique et revue des infections àConidiobolus dans les autres espèces). Resumen- Un perro adulto joven presentaba una masa subcutánea en la región torácica derecha y otra ulcerada en la parte proximal de la extremidad posterior derecha, ambas de un mes de duración. El exámen histopatológico mostró una inflamación piogranulomatosa de la dermis y del tejido subcutáneo con grandes hifas füngicas. A pesar de que la enfermedad cutánea presentó un curso oscilante, aparecieron nuevas lesiones. Un tratamiento de dos semanas con itraconazol no alteró el curso de la enfermedad. El animal fue eutanasiado a las 10 semanas de la primera visita. Se ais lóConidiobolus sp. a partir de las muestras quirúrjicas. Las infecciones por Conidiobolus sp. estan descritas en la especie humana, la equina, la ovina y en las llamas. Las hifas no se diferencian fácilmente a nivel histológico de otros cigomicetales o de Pythium insidiosum y es necesaria la identificatión mediante un cultivo fúngico para establecer un diagnóstico definitive Se discuten las caracteristicas de la infección cutánea por Conidiobolus sp. y se describen las caracteristicas de la pitiosis cutánea. [Hillier, A., Kunkle, G. A., Ginn, P. E. and Padhye, A. A. Canine subcutaneous zygomycosis caused by Conidiobolus sp.: a case report and review of Conidibolus infections in other species (Cigomcosis subcutánea canina causada por Conidibolus sp.: un caso clinico y revisién de las infecciones por Conidibolus sp. en otras especies). Zusammenfassung- Ein junger ausgewachsener Hund wurde vorgestellt, der seit einem Monat an der rechten Thoraxwand ein subkutanes Gebilde und proximal an der rechten Hintergliedmaße eine ulzer-ierende, subkutane Masse aufwies. Bei der histopathologischen Untersuchung wurde eine pyogranulomatöse Entzündung der Dermis und Subkutis mit breiten Pilzhyphen entdeckt. Trotz des "Auf und Ab" der Hautkrankheit erschionon laufend neue Hautveränderungen. Eine zweiwöchige Behandlung mit Itrakonazol veränderte den Verlauf der Krankheit nicht. 10 Wochen nach der Erstvorstellung des Patienten wurde en euthenesiert. In der Kultur von chrirugischen Proben wurde Conidiobolus sp. isoliert. Conidiobolus sp.-Infektionen sind bei Menschen, Pferden, Schafen und Lamas beschrieben. Die Hyphen können histologisch schlecht von denen anderen Zygomyzeten oder von Pythium insidiosum unterschieden werden. Für die endgültige Diagnose ist eine Identifizierung mittels Pilzkultur notwendig. Die Erscheinungsbilder von kutanen Conidiobolus sp.-Infektionen werdon diskutiert und mit denen kutaner Phytiosis verglichen. [Canine subcutaneous zygomycosis caused by Conidiobolus sp.: a case report and reviews of Conidiobolus infections in other species (Subkutane Zygomykose des Hundes durch Conidiobolus sp.: Fallbericht und übersicht über Conidioblus-Infektionen bie anderen Tierarten). Abstract- A young adult dog was presented with a 1-month history of a subcutaneous mass on the right thoracic wall and an ulcerative, subcutaneous mass of the proximal right hindlimb. Pyogranulomatous inflammation of the dermis and subcutis with broad fungal hyphae were found on histopathologic examination. Despite some waxing and waning of the skin disease, new lesions continued to appear. A 2-week course of itraconazole did not alter the course of the disease. Euthanasia was performed 10 weeks after initial presentation. Conidiobolus sp. was isolated in culture from surgical specimens. Conidiobolus sp. infection has been reported in humans, horses, sheep and llamas. The hyphae cannot be easily distinguished histologically from those of some other zygomycetes or Pythium insidiosum and fungal culture identification of the organism is required for definitive diagnosis. A discussion of the features of cutaneous Conidiobolus sp. infection is given and comparative features of cutaneous pythiosis are presented.

Mucocutaneous nasal histoplasmosis in an immunocompetent young adult.

A case of mucocutaneous nasal histoplasmosis in an immunocompetent host is described below. A 30-year-old male had a broadened nose with swelling and repeated blockage of nasal passages for the past six months. Diagnosis was made on the basis of histological demonstration of characteristic yeast cells of Histoplasma capsulatum var. capsulatum occurring within histiocytes and extracellularly in stained smears of fine needle aspirates and biopsy from the lesions in ala of the nose and perioral region. The patient showed appreciable regression of lesions after three weeks of itraconazole therapy but was not available for re-assessment.

Members of the Fusarium solani species complex that cause infections in both humans and plants are common in the environment.

Members of the Fusarium solani species complex (FSSC) are increasingly implicated as the causative agents of human mycoses, particularly in the expanding immunocompromised and immunosuppressed patient populations. Best known as ubiquitous plant pathogens and saprotrophs, the FSSC comprises over 45 phylogenetically distinct species distributed among three major clades. To identify which species are associated with human infections, we generated multilocus haplotypes based on four partial gene sequences from 471 isolates. Of these, 278 were from human patients, 21 were from hospital environments, and 172 were from other sources. Phylogenetic trees inferred from an ergosterol biosynthesis gene (erg-3) were highly discordant with those inferred from the three other partial gene sequences; therefore, this partition was analyzed separately. Multilocus analysis showed that isolates from humans were restricted to but spread throughout clade 3 of the FSSC phylogeny, comprising at least 18 phylogenetically distinct species. The majority (74.5%) of the clinical isolates, however, were associated with four major lineages, designated groups 1 to 4. Groups 1 and 2 were strongly supported as phylogenetic species, whereas groups 3 and 4 were not. Although isolates from ocular infections were found in all four groups, they had a significant tendency to belong to group 3 (P < 0.001). Human clinical isolates shared identical multilocus haplotypes with isolates from plants, other animals, and from hospital environments, suggesting potential nosocomiality. The major finding of this study is that FSSC-associated mycoses of humans and other animals have origins in a broad phylogenetic spectrum, indicating widespread ability to cause infection in this diverse species complex.

Species of Phaeoacremonium associated with infections in humans and environmental reservoirs in infected woody plants.

To date, three species of Phaeoacremonium have been associated with phaeohyphomycosis. These are P. parasiticum (formerly Phialophora parasitica), P. inflatipes, and P. rubrigenum. Numerous unknown isolates resembling Phaeoacremonium spp. have in recent years been isolated from human patients as well as from woody plants that appear to be the main environmental source of these fungi. Nine new Phaeoacremonium species, of which six were obtained as etiologic agents of human opportunistic infection, are reported. They can be identified based on their cultural and morphological characters, and the identifications are strongly supported in phylogenetic analyses of partial sequences of the actin, beta-tubulin, and calmodulin genes. A multiple-entry electronic key based on morphological, cultural, and beta-tubulin sequence data was developed to facilitate routine species identification. Reexamination of all isolates of P. inflatipes associated with human disease showed them to be misidentified and to belong to the new taxa described here.

Saline-filled breast implant contamination with Curvularia species among women who underwent cosmetic breast augmentation.

BACKGROUND: During December 2000-July 2001, black sediment was noted in saline-filled silicone breast implants of women who had undergone revision surgery at facility A. Curvularia fungus was isolated from implant saline. METHODS: To identify risk factors for contamination with Curvularia species, we performed case-control, retrospective cohort, and laboratory studies and conducted procedural reviews. A case patient was defined as any woman who underwent revision surgery at facility A between January 2000 and June 2001 and had black sediment in her implants. RESULTS: Five patients met the case definition. Contamination was associated with having had surgery performed in operating room (OR) 2 (4/88 vs. 1/140; P=.07) and a longer duration of surgery (P<.001). A longer duration spent in the OR was an additional risk factor (P=.005). Curvularia fungus was isolated from the sterile supply room, where saline bottles had been stored under a water-damaged ceiling, and from the corridor outside OR 2; it was also found more commonly from facility A personnel than from non-facility A personnel (12/34 vs. 4/60; P<.001). Saline was warmed in a cabinet opposite OR 2, which was maintained at negative pressure differentials, then was poured into bowls open to the OR 2 environment before injection into implants. CONCLUSION: Surgeons should always use closed systems to inflate breast implants. Surgery center infection control measures must include moisture control and balanced ventilation systems.

Trichosporon loubieri infection in a patient with adult polycystic kidney disease.

A 45-year-old man from Nepal with a 13-year history of polycystic kidney disease was diagnosed as suffering from chronic renal failure with end-stage renal disease. After receiving empirical antituberculosis treatment, he was treated with broad-spectrum antibiotics. A left nephrectomy was performed, and after 4 months, he received a kidney transplant. The left kidney was grossly enlarged, with multiple cystic spaces filled with blackish material. Histologic examination of the excised left kidney tissue stained with hematoxylin and eosin and Gomori's methenamine silver stains showed numerous hyaline, septate, fungal hyphae of various lengths, many broken into rectangular arthroconidia in the cystic spaces. Culture of the kidney tissue yielded white, glabrous, yeast-like colonies. Based on its micromorphology, growth at 42 degrees C, and ribosomal DNA (rDNA) sequence analysis, and also sequence analysis of the internal-transcribed-spacer and D1/D2 rDNA regions, the yeast was identified as Trichosporon loubieri. Postsurgically, the patient was treated with amphotericin B and oral itraconazole, followed by maintenance therapy with fluconazole. He remained afebrile and asymptomatic. At the final follow-up, all parameters were found normal and the patient was doing well, with normal renal function reports. This paper presents the first known case of human infection caused by T. loubieri.

Cryptococcosis in a bottlenose dolphin (Tursiops truncatus) caused by Cryptococcus neoformans var. gattii.

We describe the first case of cryptococcosis caused by Cryptococcus neoformans var. gattii in a male Atlantic bottlenose dolphin (Tursiops truncatus). The dolphin showed clinical signs of tachypnea, transient dyspnea, and mild tachycardia and developed multiple hyperechoic nodules, parenchymal consolidation, and thickening of pleura. A diagnosis of bronchopneumonia with pleuritis was made. Itraconazole therapy was implemented for 120 days, and trough levels in serum were within or above the suggested therapeutic range. Titers of cryptococcal antigen in serum increased eightfold during therapy, and the case had a fatal outcome. Necropsy examination findings included enlarged pulmonary lymph nodes and extensive coalescing granulomatous lesions throughout both lungs. Histologic examination revealed numerous, spherical to ellipsoidal, mucicarmine-positive, 3- to 14-microm, encapsulated, budding cells consistent with C. neoformans. Culture of the lung tissue yielded colonies of C. neoformans. The isolate was urease positive and nitrate negative and exhibited phenoloxidase activity. It was positive on canavanine-glycine-bromothymol blue agar. When tested by the Iatron serodiagnostic reagent kit (Iatron Laboratories, Inc.), it was shown to belong to serotype B.