Alternate week and combination itraconazole and terbinafine therapy for chromoblastomycosis caused by Fonsecaea pedrosoi in Brazil.

Patients with long-standing chromoblastomycosis may respond poorly to standard treatments such as amphotericin B, oral antifungals, surgical measures or thermotherapy. The objective of this study was to determine the potential of alternate week and combination therapy with itraconazole and terbinafine in the treatment of poorly responsive, or non-responsive, chromoblastomycosis. Four patients with longstanding chromoblastomycosis (8-23 years) caused by Fonsecaea pedrosoi had responded poorly to standard therapies including monotherapy with the oral antifungal agents. In order to try and improve the response to oral itraconazole and terbinafine, alternate week or combination therapy with itraconazole and terbinafine was initiated. Bloodwork including complete blood count and liver function tests were performed every 3-8 weeks to ensure patient safety. Reduction or resolution of lesions of chromoblastomycosis was noted with alternate week or combination treatment using oral itraconazole and terbinafine. Three of four patients experienced no clinical side-effects; the third reported mild, transient gastric discomfort which responded to antacids. Bloodwork generally remained within normal limits throughout the entire course of treatment with no clinically significant changes. The combination therapy was considered effective in treating the poorly responsive chromoblastomycosis of all four patients. Some success with alternative week therapy was also noted in one patient. The favorable response and lack of significant adverse effects suggests that these regimens may be an option for some patients with chromoblastomycosis.

Zoonotic sporotrichosis. Transmission to humans by infected domestic cat scratching: report of four cases in São Paulo, Brazil.

BACKGROUND: Sporotrichosis is a chronic, granulomatous, deep mycosis caused by the dimorphic fungus Sporothrix schenckii that usually results in indolent cutaneous lesions. OBJECTIVE: To describe four cases of human sporotrichosis transmitted by domestic cats in south-eastern Brazil. METHODS: Confirmation of the diagnosis was performed by histopathology, culture, and/or inoculation of hamsters. RESULTS: In all cases, the clinical findings in both cat and human groups were highly distinctive of the disease. In all human cases, there was a previous history of cat scratching before the development of lymphocutaneous lesions. Histopathology of the human lesions demonstrated the classical granulomatous and exudative pattern with scarce or absent fungal elements. Conversely, in cats, the cutaneous lesions were multiple, extensive, necrotic, exudative, and ulcerated. Histopathology revealed a widespread histiocytic reaction with a large number of fungal organisms. Disseminated lymphatic and visceral mycotic infection was observed in two necropsied cats. CONCLUSIONS: Domestic cats may be an important carrier of agents of sporotrichosis to humans.

Phylogenetic analysis of Lacazia loboi places this previously uncharacterized pathogen within the dimorphic Onygenales.

Lacazia loboi is the last of the classical fungal pathogens to remain a taxonomic enigma, primarily because it has resisted cultivation and only causes cutaneous and subcutaneous infections in humans and dolphins in the New World tropics. To place it in the evolutionary tree of life, as has been done for the other enigmatic human pathogens Pneumocystis carinii and Rhinosporidium seeberi, we amplified its 18S small-subunit ribosomal DNA (SSU rDNA) and 600 bp of its chitin synthase-2 gene. Our phylogenetic analysis indicated that L. loboi is the sister taxon of the human dimorphic fungal pathogen Paracoccidioides brasiliensis and that both species belong with the other dimorphic fungal pathogens in the order Onygenales. The low nucleotide variation among three P. brasiliensis 18S SSU rDNA sequences contrasts with the surprising amount of nucleotide differences between the two sequences of L. loboi used in this study, suggesting that the nucleic acid epidemiology of this hydrophilic pathogen will be rewarding.

Constitutive melanin in the cell wall of the etiologic agent of Lobo's disease.

Lobo's disease is a chronic granulomatous disease caused by the obligate pathogenic fungus, whose cell walls contain constitutive melanin. In contrast, melanin does not occur in the cell walls of Paracoccidioides brasiliensis when stained by the Fontana-Masson stain.

Lacazia loboi gen. nov., comb. nov., the etiologic agent of lobomycosis.

The new genus Lacazia P. Taborda, V. Taborda, et McGinnis is proposed to accommodate Lacazia loboi (O. M. Fonseca et Lacaz) P. Taborda, V. Taborda, et McGinnis, the obligate pathogen that causes lobomycosis in mammals. The continued placement of that fungus in the genus Paracoccidioides Almeida as Paracoccidioides loboi is taxonomically inappropriate. Loboa loboi Ciferri et al. is a synonym of Paracoccidioides brasiliensis.