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1.
J Neuroophthalmol ; 41(3): 399-403, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-33630777

RESUMEN

ABSTRACT: A 9-year-old girl presented with morning headaches associated with vomiting, gait ataxia, and facial and ocular motor nerve palsies. Her initial imaging was concerning for demyelinating disease. After extensive infectious and rheumatologic workup returned negative, she was treated twice with intravenous immunoglobulin and intravenous steroids with near-complete resolution each time. She returned, however, with worsening neurologic deficits and imaging revealing focal ischemic infarction in the brainstem as well as new-onset hydrocephalus. A multispecialty workup was initiated without conclusive diagnosis. A novel, noninvasive test for plasma cell-free DNA established a diagnosis of Cladophialophora bantiana that was confirmed and validated by a brain biopsy taken during a clinical decompensation. Treatment was initiated with systemic voriconazole and intraventricular amphotericin B.


Asunto(s)
Absceso Encefálico/complicaciones , Encéfalo/patología , Diplopía/etiología , Ataxia de la Marcha/etiología , Huésped Inmunocomprometido , Feohifomicosis/complicaciones , Ascomicetos/aislamiento & purificación , Biopsia , Encéfalo/microbiología , Absceso Encefálico/diagnóstico , Absceso Encefálico/microbiología , Niño , Diagnóstico Diferencial , Diplopía/fisiopatología , Femenino , Ataxia de la Marcha/fisiopatología , Humanos , Feohifomicosis/diagnóstico , Feohifomicosis/microbiología
6.
J Am Acad Dermatol ; 80(4): 869-880.e5, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30102951

RESUMEN

Angioinvasive fungal infections cause significant morbidity and mortality because of their propensity to invade blood vessel walls, resulting in catastrophic tissue ischemia, infarct, and necrosis. While occasionally seen in immunocompetent hosts, opportunistic fungi are emerging in immunosuppressed hosts, including patients with hematologic malignancy, AIDS, organ transplant, and poorly controlled diabetes mellitus. The widespread use of antifungal prophylaxis has led to an "arms race" of emerging fungal resistance patterns. As the at-risk population expands and new antifungal resistance patterns develop, it is critical for dermatologists to understand and recognize angioinvasive fungal pathogens, because they are often the first to encounter the cutaneous manifestations of these diseases. Rapid clinical recognition, histopathologic, and culture confirmation can help render a timely, accurate diagnosis to ensure immediate medical and surgical intervention. Superficial dermatophyte infections and deep fungal infections, such as blastomycosis and histoplasmosis, have been well characterized within the dermatologic literature, and therefore this article will focus on the severe infections acquired by angioinvasive fungal species, including an update on new and emerging pathogens. In the first article in this continuing medical education series, we review the epidemiology and cutaneous manifestations. The second article in the series focuses on diagnosis, treatment, and complications of these infections.


Asunto(s)
Dermatomicosis/patología , Piel/irrigación sanguínea , Aspergilosis/complicaciones , Aspergilosis/diagnóstico , Aspergilosis/epidemiología , Aspergilosis/patología , Vasos Sanguíneos/patología , Candidiasis Cutánea/complicaciones , Candidiasis Cutánea/diagnóstico , Candidiasis Cutánea/epidemiología , Candidiasis Cutánea/patología , Dermatomicosis/complicaciones , Dermatomicosis/diagnóstico , Dermatomicosis/epidemiología , Farmacorresistencia Fúngica , Humanos , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Mucormicosis/epidemiología , Mucormicosis/patología , Infecciones Oportunistas/complicaciones , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/epidemiología , Infecciones Oportunistas/patología , Feohifomicosis/complicaciones , Feohifomicosis/diagnóstico , Feohifomicosis/epidemiología , Feohifomicosis/patología
7.
BMC Infect Dis ; 18(1): 255, 2018 06 04.
Artículo en Inglés | MEDLINE | ID: mdl-29866071

RESUMEN

BACKGROUND: Exophiala dermatitidis is a melanized fungus isolated from many environmental sources. Infections caused by Exophiala species are typically seen in immunocompromised hosts and manifest most commonly as cutaneous or subcutaneous disease. Systemic infections are exceedingly rare and associated with significant morbidity and mortality CASE PRESENTATION: A 28-year-old female originally from India presented with fevers, chills, weight loss and increasing back pain. She had a recent diffuse maculopapular rash that resulted in skin biopsy and a tentative diagnosis of sarcoidosis, leading to administration of azathioprine and prednisone. An MRI of her spine revealed a large paraspinal abscess requiring surgical intervention and hardware placement. Cultures from the paraspinal abscess grew a colony of dark pigmented mold. Microscopy of the culture revealed a melanized fungus, identified as Exophiala dermatitidis. Voriconazole was initially utilized, but due to relapse of infection involving the right iliac crest and left proximal humerus, she received a prolonged course of amphotericin B and posaconazole in combination and required 7 separate surgical interventions. Prolonged disease stability following discontinuation of therapy was achieved. CONCLUSIONS: Described is the first identified case of disseminated Exophiala dermatitidis causing osteomyelitis and septic arthritis in a patient on immunosuppressive therapy. A positive outcome was achieved through aggressive surgical intervention and prolonged treatment with broad-spectrum antifungal agents.


Asunto(s)
Antifúngicos/uso terapéutico , Artritis Infecciosa/microbiología , Exophiala/patogenicidad , Osteomielitis/microbiología , Adulto , Anfotericina B/uso terapéutico , Artritis Infecciosa/diagnóstico por imagen , Artritis Infecciosa/terapia , Exophiala/aislamiento & purificación , Femenino , Humanos , Huésped Inmunocomprometido , Imagen por Resonancia Magnética , Osteomielitis/diagnóstico por imagen , Osteomielitis/terapia , Feohifomicosis/complicaciones , Triazoles/uso terapéutico , Voriconazol/uso terapéutico
10.
Rev Chilena Infectol ; 34(3): 280-286, 2017 Jun.
Artículo en Español | MEDLINE | ID: mdl-28991328

RESUMEN

There are very few reports of pediatric patients with infections by dematiaceous filamentous fungi. In this publication we report a case of invasive fungal infection of the nasal septum by Curvularia spicifera in a pediatric patient with acute myeloid leukemia. The patient presented with a painful scabby wound in the nasal vestibule. Culture and universal PCR were consistent with Curvularia spicifera. Early management with surgical debridement and bi-associated antifungal therapy achieved complete resolution of the lesions, with no evidence of dissemination and relapses. Clinical management of these fungal infections represents a challenge as the antifungal selection and duration of therapy is not yet well stablished.


Asunto(s)
Ascomicetos/aislamiento & purificación , Leucemia Mieloide Aguda/complicaciones , Neutropenia/complicaciones , Enfermedades Nasales/complicaciones , Infecciones Oportunistas/complicaciones , Feohifomicosis/complicaciones , Niño , Humanos , Leucemia Mieloide Aguda/microbiología , Masculino , Neutropenia/microbiología , Enfermedades Nasales/microbiología , Infecciones Oportunistas/microbiología , Feohifomicosis/microbiología
11.
Infect Disord Drug Targets ; 17(3): 223-226, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28558644

RESUMEN

BACKGROUND: Subcutaneous phaeohyphomycosis is an infection caused by melanized fungi and is increasingly reported among immunosuppressive patients. The most commonly cited etiologic agent is Exophiala jeanselmei, followed by Alternaria spp. We present a case of subcutaneous phaeohyphomycosis in a 48-yearold woman, with a history of lepromatous leprosy, using corticosteroid in immunosuppressive doses due to a type 2 repetitive reaction leprosy outbreak. RESULT AND DISCUSSION: The diagnosis was confirmed by fine-needle aspiration of the secretion, with subsequent direct mycological observations, culture and molecular analysis. The species agent was identified by culture and nucleotide sequences of ribosomal DNA as Exophiala dermatitidis.


Asunto(s)
Exophiala/aislamiento & purificación , Lepra Lepromatosa/complicaciones , Feohifomicosis/complicaciones , Feohifomicosis/microbiología , Corticoesteroides/uso terapéutico , Biopsia con Aguja Fina , ADN Ribosómico , Exophiala/genética , Femenino , Humanos , Huésped Inmunocomprometido , Lepra Lepromatosa/microbiología , Persona de Mediana Edad , Feohifomicosis/diagnóstico
12.
Rev. chil. infectol ; 34(3): 280-286, jun. 2017. ilus, tab
Artículo en Español | LILACS | ID: biblio-899713

RESUMEN

There are very few reports of pediatric patients with infections by dematiaceous filamentous fungi. In this publication we report a case of invasive fungal infection of the nasal septum by Curvularia spicifera in a pediatric patient with acute myeloid leukemia. The patient presented with a painful scabby wound in the nasal vestibule. Culture and universal PCR were consistent with Curvularia spicifera. Early management with surgical debridement and bi-associated antifungal therapy achieved complete resolution of the lesions, with no evidence of dissemination and relapses. Clinical management of these fungal infections represents a challenge as the antifungal selection and duration of therapy is not yet well stablished.


Existen pocos reportes de infecciones por hongos dematiáceos en pediatría. Comunicamos el caso de una infección fúngica invasora del tabique nasal en un niño con una leucemia mieloide aguda, que se presentó como una lesión costrosa dolorosa en el vestíbulo nasal. Se realizó desbridamiento quirúrgico precoz y recibió tratamiento antifúngico biasociado, lográndose resolución completa de las lesiones, sin diseminación ni recaídas. El cultivo y la RPC universal fueron compatibles con Curvularia spicifera. El manejo de estas infecciones fúngicas representa un desafío, considerando que la elección del agente antifúngico y la duración de la terapia no están completamente establecidas.


Asunto(s)
Humanos , Masculino , Niño , Ascomicetos/aislamiento & purificación , Infecciones Oportunistas/complicaciones , Leucemia Mieloide Aguda/complicaciones , Enfermedades Nasales/complicaciones , Feohifomicosis/complicaciones , Neutropenia/complicaciones , Infecciones Oportunistas/microbiología , Leucemia Mieloide Aguda/microbiología , Enfermedades Nasales/microbiología , Feohifomicosis/microbiología , Neutropenia/microbiología
13.
Ann Clin Lab Sci ; 46(4): 439-42, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27466308

RESUMEN

Bipolaris is a dematiaceous fungus seen in the skin, nasal sinuses, and occasionally in the central nervous system. We present an immunocompetent female with bilateral dural-based abscesses caused by a Bipolaris species. The patient had no involvement of the sinuses with the fungus but was later found to have a significant Bipolaris infection of her biliary tree.


Asunto(s)
Sistema Biliar/microbiología , Sistema Biliar/patología , Absceso Encefálico/complicaciones , Absceso Encefálico/microbiología , Inmunocompetencia , Hongos Mitospóricos/fisiología , Feohifomicosis/complicaciones , Feohifomicosis/microbiología , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética
14.
Artículo en Inglés | MEDLINE | ID: mdl-26261143

RESUMEN

Cladophialophora bantiana is a neurotropic dematiaceous fungus which only rarely affects the skin. We report a case of disseminated cutaneous phaeohyphomycosis caused by Cladophialophora bantiana in an immunocompromised female who presented with multiple pyogenic granuloma-like nodules, dermatophytosis-like plaque, and subcutaneous cysts on the upper and lower extremities without systemic involvement. Biopsy revealed black yeasts resembling sclerotic bodies and culture yielded irregular, velvety, grey colonies with black reverse. Excision of the nodules and treatment with oral itraconazole 100 mg twice daily resulted in complete clinical resolution within two months, following which itraconazole was administered for another 4 months.


Asunto(s)
Ascomicetos/aislamiento & purificación , Dermatomicosis/diagnóstico , Feohifomicosis/diagnóstico , Adulto , Dermatomicosis/complicaciones , Dermatomicosis/inmunología , Femenino , Humanos , Huésped Inmunocomprometido/inmunología , Feohifomicosis/complicaciones , Feohifomicosis/inmunología
15.
Rev. argent. microbiol ; 47(1): 54-6, Mar. 2015.
Artículo en Español | LILACS, BINACIS | ID: biblio-1171806

RESUMEN

We here report a clinical case of a female patient presenting with a three-month history of a white onychodystrophic lesion of both hallux. The infection was due to a mold, identified as Curvularia lunata var aeria. The Curvularia gender is related to the production of phaeohyphomycosis, Curvularia lunata cause onychomycosis occasionally. The patient was treated with itraconazole 200mg/day, during six month with complete remission of the lesions. In conclusion, it is important to consider these fungi as causative agent of nail mycosis since the initial site of infection may be a pathway for systemic dissemination in inmunocompromised patients


Se presenta el caso clínico de una paciente que consultó por una lesión onicodistrófica blanquecina en ambos hallux, de 3 meses de evolución. El examen micológico determinó que el agente causal de la infección era un moho, Curvularia lunata var. aeria. El género Curvularia se asocia a la producción de feohifomicosis. Curvularia lunata es una especie que ocasionalmente puede producir onicomicosis. Se administró tratamiento por pulsos con itraconazol 200mg/día durante 6 meses, con remisión completa de las lesiones. Es importante tener en cuenta a estos hongos como agentes oportunistas causales de micosis ungueales, ya que el lugar inicial de infección puede significar una vía para la diseminación sistémica en pacientes inmunodeprimidos


Asunto(s)
Humanos , Femenino , Adulto , Onicomicosis/tratamiento farmacológico , Feohifomicosis/diagnóstico , Onicomicosis/diagnóstico , Técnicas de Cultivo/métodos , Feohifomicosis/complicaciones
16.
J Cyst Fibros ; 13(4): 391-9, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24439251

RESUMEN

BACKGROUND: The clinical importance of airway colonisation by the fungus Exophiala dermatitidis in patients with cystic fibrosis (CF) is unclear. We have previously shown that E. dermatitidis frequently colonises the airways of patients with CF. The aims of the present study were to determine whether patients who are colonised by E. dermatitidis have detectable fungal antigens in the circulation, develop anti-fungal antibodies, and show signs of inflammation and impaired respiratory function. METHODS: We collected sputum and serum samples consecutively from 98 sputum-producing patients with CF aged more than 12 years. The serum samples were subjected to bacterial and fungal culturing and analyses for fungal antigens and inflammatory factors. RESULTS: E. dermatitidis was recovered from 17 (17%) patients, the same isolation rate as for Aspergillus fumigatus. There were no difference regarding the levels of ß-glucan in the sera from E. dermatitidis culture-positive and culture-negative patients with CF. Serological analysis revealed significantly higher levels of IgG antibodies to E. dermatitidis cell wall fragments in the E. dermatitidis culture-positive patients. Patients with higher level of E. dermatitidis IgG antibodies were more often colonised with non-tuberculous Mycobacteria, and less often with Staphylococcus aureus. The increased levels of IgG antibodies directed against E. dermatitidis were positively associated with higher white blood cell counts, increased erythrocyte sedimentation rate, pancreatic insufficiency, intravenous antibiotic treatment, and they were negatively associated with respiratory function (FEV1 % predicted). Overall, 4/17 Exophiala-positive patients were diagnosed as having symptomatic infection with E. dermatitidis and were treated with broad-spectrum azoles. CONCLUSION: E. dermatitidis triggers antibody production and may cause significant airway infection in patients with cystic fibrosis.


Asunto(s)
Anticuerpos Antiidiotipos/inmunología , Anticuerpos Antifúngicos/inmunología , Fibrosis Quística/inmunología , Exophiala/inmunología , Inmunoglobulina G/inmunología , Feohifomicosis/inmunología , Adolescente , Adulto , Antígenos Fúngicos/sangre , Antígenos Fúngicos/inmunología , Niño , Estudios Transversales , Fibrosis Quística/sangre , Fibrosis Quística/complicaciones , Exophiala/aislamiento & purificación , Femenino , Estudios de Seguimiento , Humanos , Técnicas para Inmunoenzimas , Inflamación/inmunología , Inflamación/patología , Masculino , Feohifomicosis/complicaciones , Feohifomicosis/microbiología , Estudios Retrospectivos , Esputo/inmunología , Esputo/microbiología , Adulto Joven
18.
Med Mycol J ; 55(4): J151-6, 2014.
Artículo en Japonés | MEDLINE | ID: mdl-25742995

RESUMEN

In black fungal infections, Exophiala species are frequently encountered as causative agents of human mycosis, particularly in immunocompromised patients. Among them, Exophiala jenselmei was previously reported as the most common etiological agent. Advances in molecular taxonomy proved this taxon to be heterogeneous, and led to newly introduced or redefined species. Exophiala xenobiotica is one of the novel species differentiated from E. jenselmei on the basis of molecular phylogeny.Here, we report a case of pheomycotic cyst caused by E. xenobiotica, which was well controlled via drainage and local thermotherapy. A 70-year-old man developed a cystic nodular lesion on the dorsum of his right thumb over the previous 3 months. He had been treated with prednisolone and methotrexate for 4 years for rheumatoid arthritis. The patient also had lung cancer with vertebral bone metastasis. Direct microscopic examination of the greenish pus aspirated from the cyst revealed mycelial elements. Culture of the pus on blood and Sabouraud dextrose agar yielded numerous black colonies multiple times. Histopathological examination of a biopsy specimen showed subcutaneous abscess formation surrounded by granulomatous tissues. Faintly pigmented pseudohyphae were seen within the abscess. The presence of melanin in the fungal cells was determined by Fontana-Masson staining. Initial microscopic examination of the isolate revealed annellidic conidiogenous cells, suggestive of E. jenselmei. This strain was further identified as E. xenobiotica by sequence analysis of the internal transcribed spacer (ITS) region of ribosomal RNA, showing a 100% sequence homology with the strain type.Pheomycotic cysts should be considered on identifying a slowly developing chronic subcutaneous abscess in immunocompromised patients. Sequencing is recommended for accurate species identification of causative pathogens.


Asunto(s)
Artritis Reumatoide/complicaciones , Quistes/complicaciones , Quistes/microbiología , Exophiala/aislamiento & purificación , Exophiala/patogenicidad , Neoplasias Pulmonares/complicaciones , Infecciones Oportunistas/complicaciones , Feohifomicosis/complicaciones , Feohifomicosis/microbiología , Anciano , Exophiala/clasificación , Exophiala/genética , Humanos , Huésped Inmunocomprometido , Masculino , ARN Ribosómico/genética , Análisis de Secuencia de ARN
19.
Indian J Ophthalmol ; 61(12): 763-5, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24413827

RESUMEN

A 67-year-old former gold miner with rheumatoid arthritis, treated with steroids and methotrexate, presented to eye casualty with a painful right eye. Examination revealed an anterior uveitis and despite an initial response to topical steroids, the intraocular inflammation worsened with anterior and posterior uveitis development. Re-examination showed a white mass in the peripheral nasal retina initially suspected of being active Toxoplasmosis infection and anti-toxoplasmosis treatment commenced. After improvement and tapering of this treatment, the intraocular inflammation reoccurred. Cytopathological examination of a pars plana vitrectomy obtained vitreous sample that showed a non-diagnostic non-infectious chronic vitritis. The vitreoretinal surgeons elected to do a direct biopsy of the white subretinal mass in the peripheral nasal area. This revealed, quite unexpectedly, an abscess containing pigmented phaeohyphomycosis fungi. This case report documents the multidisciplinary approach that assisted in clinching a final diagnosis and the role of sub-retinal biopsy in this unprecedented scenario.


Asunto(s)
Absceso/complicaciones , Artritis Reumatoide/complicaciones , Endoftalmitis/complicaciones , Infecciones Fúngicas del Ojo/complicaciones , Feohifomicosis/complicaciones , Retina/microbiología , Tuberculosis Pulmonar/complicaciones , Absceso/diagnóstico , Anciano , Artritis Reumatoide/diagnóstico , Biopsia , Diagnóstico Diferencial , Endoftalmitis/diagnóstico , Infecciones Fúngicas del Ojo/diagnóstico , Humanos , Masculino , Feohifomicosis/diagnóstico , Retina/patología , Tuberculosis Pulmonar/diagnóstico
20.
Med Mycol ; 50(5): 513-7, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22217212

RESUMEN

Black yeasts including Exophiala species are increasingly recognized as agents of human disease. In recent years, progress in molecular phylogeny and taxonomy of the genus Exophiala has led to the description of numerous novel species. The 'classical' but highly variable species Exophiala jeanselmei was split into a number of morphological siblings, which, however, were phylogenetically and clinically remote from each other. E. jeanselmei was restricted to an uncommon species causing subcutaneous infections. Hence only limited information is available on the segregants, among which is E. xenobiotica. We describe a case of an HIV-patient presenting with fungal arthritis and subcutaneous nodules caused by the latter species, which was identified by means of phenotypic and molecular methods.


Asunto(s)
Artritis Infecciosa/microbiología , Exophiala/genética , Exophiala/aislamiento & purificación , Infecciones por VIH/complicaciones , Feohifomicosis/complicaciones , Feohifomicosis/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Artritis Infecciosa/patología , ADN de Hongos/análisis , Exophiala/clasificación , Infecciones por VIH/inmunología , Humanos , Síndrome Inflamatorio de Reconstitución Inmune , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Técnicas de Tipificación Micológica , Fenotipo , Análisis de Secuencia de ADN , Tejido Subcutáneo/patología
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