Cytological Dilemma Of A Rare Subcutaneous Fungal Infection: Phaeoacremonium Griseorubrum

Human disease caused by Phaeoacremonium species is rare. It was first reported in 1974 to cause subcutaneous tissue infection in the renal transplant recipient.Since then, only a few cases have been reported in the literature; however, underreporting is common in such cases due to incomplete or incorrect identification.Furthermore, some cases of subcutaneous infection in otherwise healthy patients may be asymptomatic and definitive identification of the etiological agent is not pursued. Identification of fungi at the species level is challenging by conventional methods; hence, final identification of fungi is based on culture. Phaeoacremoniumhas a very wide spectrum of presentation ranging from subcutaneous infections to fungemia and disseminated disease. We report a case of subcutaneous tissue swelling in an immunocompetent 55-year-old male, in whom etiology was traced to Phaeoacremonium griseorubrum. To the best of our knowledge, this report of P. griseorubrum causing human infection is second of its kind and the first from India. The patient did not respond well to oral itraconazole therapy and was advised surgical debridement with amphotericin B therapy.

Mycobacterial infections in human immuno-deficiency virus seropositive patients: role of non-tuberculous mycobacteria.

BACKGROUND: There is high prevalence of tuberculosis in patients with HIV infection; hence the role of non-tuberculous mycobacteria (NTM) in HIV patients has always been undermined. NTM may be responsible for clinical disease in a substantial number of immuno-compromised HIV sero-positive individuals even in a country endemic for Mycobacterium tuberculosis (M. tuberculosis). The study was designed to look for the contribution of NTM to morbidity in HIV seropositive patients. MATERIAL AND METHODS: In a prospective study of ninety-four HIV seropositive individuals presenting with pulmonary or extra-pulmonary symptoms suggestive of mycobacterial infection, appropriate samples were collected and processed. Detailed clinical history was utilized to differentiate colonization or contamination by NTM from true lung disease. RESULTS: Fourteen samples grew mycobacterial species, 8(57.2%) being NTM. The distribution of NTM was--3 M. avium complex, 2 M. fortuitum, 2 M. vaccae, 1 M. phlei. 6 isolates were M. tuberculosis. CONCLUSION: NTM may be responsible for a significant proportion of mycobacterial infections in HIV seropositive individuals. Despite the high endemicity of tuberculosis in developing countries like India, the presence of NTM should be ruled out; especially in immuno-compromised HIV seropositive individuals before instituting anti-tubercular therapy empirically. In addition, non-response of NTM to ATT may be wrongly attributed to multi-drug resistant tuberculosis.