Subcutaneous phaeohyphomycosis due to Phaeoacremonium venezuelense: The first clinical case report in Costa Rica.

Phaeoacremonium is a genus of dematiaceous fungi that rarely causes human infections. We describe a case of subcutaneous infection in a 70-year-old diabetic man with lesions on the dorsum of the one foot. The agent was isolated, and for the final identification we performed matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and DNA sequencing. After diagnosis, the patient underwent curettage of the cyst and received 100mg of Itraconazole, twice daily for 6 months. Clinical resolution of the lesion was observed after treatment. This is the first case of infection by Phaeoacremonium venezuelense reported in Costa Rica.

Identification of Chromoblastomycosis and Phaeohyphomycosis Agents through ITS-RFLP.

Chromoblastomycosis (CBM) and phaeohyphomycosis (FEO) are infections caused by melanized filamentous fungal agents, primarily found in tropical and subtropical regions. Both infections pose significant challenges for the correct identification of the causative agent due to their morphological similarity, making conventional methods of morphological analysis highly subjective. Therefore, molecular techniques are necessary for the precise determination of these species. In this regard, this study aimed to contribute to a new methodology based on PCR-RFLP for the identification of agents causing CBM and FEO. Sequences from the Internal Transcribed Spacer (ITS) region were used to identify potential restriction enzyme sites in silico, followed by in vitro validation using the selected restriction enzymes. The obtained results were compared with species identification through morphological analyses and sequencing. The results demonstrated that the PCR-RFLP applied in this study accurately identified two major agents of chromoblastomycosis, Fonsecaea pedrosoi and Fonsecaea monophora, as well as Cladophialophora bantiana and Exophiala dermatitidis, both causative agents of phaeohyphomycosis. In this context, the proposed assay can complement current methods for identifying these species, aiding in diagnosis, and contributing to the proper management of these infections.

Misleading subcutaneous mycosis: a case report of subsequent clinical mycetoma-like and histological chromoblastomycosis-like lesions

ABSTRACT Hyalohyphomycosis and phaeohyphomycosis are groups of mycoses caused by several agents and show different clinical manifestations. We report a case of an immunocompromised patient who presented rare manifestations of opportunistic mycoses: mycetoma-like hyalohyphomycosis on his right foot caused by Colletotrichum gloeosporioides, followed by cutaneous phaeohyphomycosis on his right forearm caused by Exophiala oligosperma. Further to the rarity of this case, the patient's lesion on the foot shows that the clinical aspects of mycetomas could falsely appear in other fungal infections similar to hyalohyphomycosis. We also show that the muriform cells that were seen in the direct and anatomopathological examination of the skin are not pathognomonic of chromoblastomycosis, as observed in the lesion of the patient's forearm.

First case of subcutaneous cystic phaeohyphomycosis due to Phialophora chinensis in a kidney transplant recipient in Martinique.

We report a case of subcutaneous mycosis in the form of a subcutaneous cyst of the index finger, successfully treated by surgery and posaconazole in an 84-year-old female kidney transplant patient. Intra-operative mycological analysis enabled the diagnosis of Phialophora chinensis phaeohyphomycosis. Phialophora chinensis is an environmental mold recently described in human pathology in cases of chromoblastomycosis. This is the first case of subcutaneous phaeohyphomycosis due to Phialophora chinensis in an immunocompromised patient.

Rhinitis in goat by Exserohilum rostratum (Setosphaeria rostrata) / Rinite em caprino por Exserohilum rostratum (Setosphaeria rostrata)

ABSTRACT: We described a case of rhinitis case caused by Exserohilum rostratum in a 3-year-old, mixed breed, afemale goat, presenting with decreased appetite, dyspnea, and face deformity, with evolution of approximately 2 months. Necropsy revealed an extensive brownish yellow, irregular, ulcerated, and friable focal lesion in the nasal cavity. Purulent secretion drained from the lesion, affecting the nasal vestibule and extending the caudal portion of the dorsal concha, associated with nasal meatus obstruction, destruction of the nasal septum, and nasal bone palatine and vomer. Histologically, the lesion was characterized as rhinitis and pyogranulomatous and necrotizing osteomyelitis (multifocal to coalescent, sharp, and chronic) and associated with a myriad of fungal structures. Morphologically, the hyphae were characterized by thin, slightly tortuous, and rarely septate walls (2-6 μm diameter), multiple chains of individual conidia or in groups (8-10 μm diameter), and pigmented chlamydoconidia (7.5-15 μm diameter). They showed positive results for the special histochemical techniques such as Fontana Masson, methenamine silver nitrate by Grocott, and periodic acid by Schiff. E. rostratum was identified as the causative agent using microbiological isolation associated with molecular identification. Pyrogranulomatous rhinitis caused by E. rostratum in goats is unprecedented, being the first isolation of the agent in animals in Brazil and the first case of nasal phaeohyphomycosis in the goats.

RESUMO: Descreve-se um caso de rinite por Exserohilum rostratum em um caprino, sem raça definida, fêmea, três anos, com diminuição do apetite, dispneia e deformidade facial, com evolução de aproximadamente dois meses. Durante a necropsia, observou-se que na cavidade nasal havia área focal extensa, amarelo acastanhada, irregular, ulcerada e friável, que drenava secreção purulenta acometendo o vestíbulo nasal e estendendo-se da porção caudal da concha dorsal, associada a obstrução do meato nasal, destruição do septo nasal e osso nasal palatino e vômer. Histologicamente, a lesão foi caracterizada como rinite e osteomielite piogranulomatosa e necrosante, multifocal a coalescente, aguda, crônica, associada a uma miríade de estruturas fúngicas. Morfologicamente, as hifas foram caracterizadas por paredes finas, discretamente tortuosas e septadas medindo 2 a 6 μm de diâmetro. Observamos algumas cadeias de conídios ou grupos com 8 a 10 μm de diâmetro e clamidoconídios pigmentados medindo de 7,5 a 15 μm de diâmetro. Foram positivos na histoquímica especial de Fontana Masson, Nitrato de Metenamina de Prata de Grocott e Ácido Periódico de Schiff. O agente foi determinado por meio de isolamento microbiológico associado à identificação molecular. A rinite piogranulomatosa causada por E. rostratum em caprinos é inédita, sendo o primeiro isolamento do agente em animais no Brasil e o primeiro caso de feo-hifomicose nasal na espécie caprina.

Rhinitis in goat by Exserohilum rostratum (Setosphaeria rostrata) / Rinite em caprino por Exserohilum rostratum (Setosphaeria rostrata)

We described a case of rhinitis case caused by Exserohilum rostratum in a 3-year-old, mixed breed, afemale goat, presenting with decreased appetite, dyspnea, and face deformity, with evolution of approximately 2 months. Necropsy revealed an extensive brownish yellow, irregular, ulcerated, and friable focal lesion in the nasal cavity. Purulent secretion drained from the lesion, affecting the nasal vestibule and extending the caudal portion of the dorsal concha, associated with nasal meatus obstruction, destruction of the nasal septum, and nasal bone palatine and vomer. Histologically, the lesion was characterized as rhinitis and pyogranulomatous and necrotizing osteomyelitis (multifocal to coalescent, sharp, and chronic) and associated with a myriad of fungal structures. Morphologically, the hyphae were characterized by thin, slightly tortuous, and rarely septate walls (2-6 µm diameter), multiple chains of individual conidia or in groups (8-10 µm diameter), and pigmented chlamydoconidia (7.5-15 µm diameter). They showed positive results for the special histochemical techniques such as Fontana Masson, methenamine silver nitrate by Grocott, and periodic acid by Schiff. E. rostratum was identified as the causative agent using microbiological isolation associated with molecular identification. Pyrogranulomatous rhinitis caused by E. rostratum in goats is unprecedented, being the first isolation of the agent in animals in Brazil and the first case of nasal phaeohyphomycosis in the goats.

Descreve-se um caso de rinite por Exserohilum rostratum em um caprino, sem raça definida, fêmea, três anos, com diminuição do apetite, dispneia e deformidade facial, com evolução de aproximadamente dois meses. Durante a necropsia, observou-se que na cavidade nasal havia área focal extensa, amarelo acastanhada, irregular, ulcerada e friável, que drenava secreção purulenta acometendo o vestíbulo nasal e estendendo-se da porção caudal da concha dorsal, associada a obstrução do meato nasal, destruição do septo nasal e osso nasal palatino e vômer. Histologicamente, a lesão foi caracterizada como rinite e osteomielite piogranulomatosa e necrosante, multifocal a coalescente, aguda, crônica, associada a uma miríade de estruturas fúngicas. Morfologicamente, as hifas foram caracterizadas por paredes finas, discretamente tortuosas e septadas medindo 2 a 6 µm de diâmetro. Observamos algumas cadeias de conídios ou grupos com 8 a 10 µm de diâmetro e clamidoconídios pigmentados medindo de 7,5 a 15 µm de diâmetro. Foram positivos na histoquímica especial de Fontana Masson, Nitrato de Metenamina de Prata de Grocott e Ácido Periódico de Schiff. O agente foi determinado por meio de isolamento microbiológico associado à identificação molecular. A rinite piogranulomatosa causada por E. rostratum em caprinos é inédita, sendo o primeiro isolamento do agente em animais no Brasil e o primeiro caso de feo-hifomicose nasal na espécie caprina.

First report of phaeohyphomycosis caused by Phialophora americana in a domestic cat from Argentina.

Case summary: A 10-year-old male neutered domestic shorthair cat from Quilmes (Province of Buenos Aires, Argentina) presented at the Infectious Diseases and Parasitology Unit with a hyperpigmented nodule of 5 cm diameter on the nasal plane with a small ulceration of more than 1 year's evolution. A scaly and hyperpigmented alopecic lesion of 3 cm in diameter was found on the lower edge of the tail. The patient was under immunosuppressive therapy with corticosteroids for lymphoplasmacytic duodenitis. Samples of the lesion present on the nasal plane were taken under a surgical procedure. In the wet mount preparations, pigmented irregular hyphae were observed. They developed dark colonies when cultured on Sabouraud medium. On micromorphology, structures compatible with Phialophora species were identified. PCR and sequencing of ITS (ITS1-5.8S-ITS2) confirmed Phialophora americana as the etiologic agent. A therapeutic scheme that included a combination of itraconazole oral solution (1.5 mg/kg PO q12h) with terbinafine (30 mg/kg PO q24h) was indicated for a period of 10 months. The patient died of complications resulting from its underlying disease. Relevance and novel information: As far as the authors are aware, this is the first study to report P americana as an etiologic agent of phaeohyphomycosis in cats. In this case study, the species was identified using molecular tests.

A case of cutaneous phaeohyphomycosis caused by Biatriospora mackinnonii.

Phaeohyphomycosis is a fungal infection common in immunocompromised patients such as those with hematologic malignancies, transplant recipients or under prolonged corticosteroid use. Here we describe a rare case of phaeohyphomycosis due to Biatriospora mackinnonii in a kidney transplant patient. We confirmed B. mackinnonii identity by sequencing of the internal transcribed spaces (ITS) region of ribosomal DNA (rDNA) and achieved a satisfactory therapeutic response with itraconazole administration.

Granulomatous tracheitis and dermatitis due to Curvularia sp. in a horse: case report / [Traqueíte e dermatite granulomatosas associadas a Curvularia sp. em um equino: relato de caso]

Tracheal fungal infections in horses are rare. This case report describes surgical and clinical management of a filly with a Curvularia sp. infection within the trachea and skin that caused severe intraluminal granulomas and cutaneous nodules, respectively. The patient was successfully treated with itraconazole and surgical excision.(AU)

Infecções fúngicas traqueais em equinos são raras. Este relato de caso descreve condutas clínicas e cirúrgicas em uma égua com infecção por Curvularia sp. na traqueia e na pele, causando granulomas intraluminais severos e nódulos cutâneos, respectivamente. O animal foi tratado com sucesso com itraconazol e exérese cirúrgica.(AU)

Absceso frío en una mano por un hongo dematiáceo. Primera comunicación en Chile de Pleurostomophora richardsiae / Hand cold abscess by a dematiaceous fungus. First report in Chile of Pleurostomophora richardsiae

Resumen Los hongos dematiáceos son un grupo heterogéneo de microorganismos capaces de sintetizar melanina. Las infecciones de este grupo que producen hifas en tejidos se denominan feohifomicosis y generalmente afectan la piel y tejidos vecinos. Presentamos el caso de un varón de 86 años con un tumor quístico blando progresivo en su mano y muñeca derecha, no asociado a dolor o signos inflamatorios. Se demostró una tenosinovitis de los flexores con pseudocapsula y sinovitis adherida a los tendones. El cultivo demostró un hongo dematiáceo compatible con Pleurostomophora richardsiae que se confirmó por secuenciación de la región ITS. La biopsia mostró una inflamación crónica granulomatosa e hifas. Después del drenaje quirúrgico, el paciente fue dado de alta sin terapia antifúngica, pero falleció por causas no relacionadas, tres meses después. Esta es la primera descripción de P. richardsiae como causa de feohifomicosis en Chile. Esta patología se puede sospechar cuando una lesión quística cutánea crónica involucra extremidades sin signos inflamatorios. Puede afectar a pacientes inmunocompetentes o inmunocomprometidos. El tratamiento contempla la escisión quirúrgica con o sin terapia antifúngica.

Abstract Dematiaceous fungi are a heterogeneous group of microorganisms able to synthesize melanin. Infections by this group that provoke tissular hyphae are called phaeohyphomycosis and usually involve skin and neighbor tissues. We present the case of a 86 years old men with a progressive soft cystic tumor in his right hand and wrist not associated to pain or inflammatory signs. A surgical intervention demonstrated flexor tenosynovitis with serous secretion, pseudocapsule and synovitis. Fungal culture demonstrated a dematiaceous fungi compatible with Pleurostomophora richardsiae that was confirmed by sequencing of the ITS region. Biopsy showed chronic inflammation with granuloma and hyphae. After surgical drainage, the patient was discharged without antifungal therapy but died of unrelated causes three month later. This is the first description of P. richardsiae as a cause of phaeohyphomycosis in Chile, a country with a template climate. Phaeohyphomycosis can be suspected when a chronic skin cystic lesion involves extremities without inflammatory signs, sometimes with an associated fistula. It may affect immunocompetent or immunosuppressed patients. Treatment involves surgical excision with or without antifungal therapy and prognosis is favorable.

Feohifomicosis por Exserohilum rostratum en un paciente pediátrico con leucemia linfoblástica aguda postransplante de médula ósea / Phaeohyphomycosis by Exserohilum rostratum in a pediatric patient with acute lymphoblastic leukemia after bone marrow transplantation

Resumen El género Exserohilum corresponde a hongos dematiáceos, la mayoría fitopatógenos, saprobios, de los cuales solo tres especies serían patógenas para el hombre: Exserohilum rostratum, Exserohilum longirostratum y Exserohilum mcginnisii. Se han reportado infecciones localizadas y sistémicas causadas por estos agentes, tanto en pacientes inmunocompetentes como inmunosuprimidos. Se presenta un caso de infección cutánea por E. rostratum en un paciente pediátrico con inmunocompromiso.

Abstract The genus Exserohilum consists of dematiaceous or darkly pigmented fungi. Most of the species included in this genus are phytopathogens, saprobes and only three of these species would be pathogenic to humans: Exserohilum rostratum, Exserohilum longirostratum and Exserohilum mcginnisii. Localized and systemic infections have been reported both in immunocompetent and immunosuppressed patients. A clinical case of cutaneous infection by E. rostratum in an immunocompromised pediatric patient is presented in this study.

Inherited CARD9 Deficiency in a Patient with Both Exophiala spinifera and Aspergillus nomius Severe Infections.

PURPOSE: Caspase-associated recruitment domain-9 (CARD9) deficiency is an inborn error of immunity that typically predisposes otherwise healthy patients to single fungal infections and the occurrence of multiple invasive fungal infections is rare. It has been described as the first known condition that predisposes to extrapulmonary Aspergillus infection with preserved lungs. We present a patient that expands the clinical variability of CARD9 deficiency. MATERIALS AND METHODS: Genetic analysis was performed by Sanger sequencing. Neutrophils and mononuclear phagocyte response to fungal stimulation were evaluated through luminol-enhanced chemiluminescence and whole blood production of the proinflammatory mediator interleukin (IL)-6, respectively. RESULTS: We report a 56-year-old Argentinean woman, whose invasive Exophiala spinifera infection at the age of 32 years was unexplained and reported in year 2004. At the age of 49 years, she presented with chronic pulmonary disease due to Aspergillus nomius. After partial improvement following treatment with caspofungin and posaconazole, right pulmonary bilobectomy was performed. Despite administration of multiple courses of antifungals, sustained clinical remission could not be achieved. We recently found that the patient's blood showed an impaired production of IL-6 when stimulated with zymosan. We also found that she is homozygous for a previously reported CARD9 loss-of-function mutation (Q289*). CONCLUSIONS: This is the first report of a patient with inherited CARD9 deficiency and chronic invasive pulmonary aspergillosis (IPA) due to A. nomius. Inherited CARD9 deficiency should be considered in otherwise healthy children and adults with one or more invasive fungal diseases.

Cutaneous phaeohyphomycosis caused by Exophiala xenobiotica: A case report.

We report a case of phaeohyphomycosis that affected the leg of a 45-year-old Brazilian man, car mechanic and renal transplanted. The direct mycological examination evidenced dematiaceous septated hyphae. The pathogenic fungal species was identified as Exophiala xenobiotica. Antifungal activity in vitro revealed terbinafine as the best antifungal. For treatment, it was chosen surgical excision of the entire lesion and used systemic itraconazole. Phaeohyphomycosis caused by Exophiala xenobiotica is extremely rare and is closely related to transplant patients.

Cerebral phaeohyphomycosis caused by Alternaria spp.: A case report.

Phaeohyphomycosis is a group of infections caused by pigmented, black, dematiaceous fungi and is responsible for cutaneous, superficial and deep mycoses, disseminated infection and brain abscesses. The primary agents involved include Alternaria spp., Exophiala spp. and Cladophialophora spp. Invasive systemic presentation is rare and in most cases is associated with immunosuppression; for this reason, reported cases of Alternaria spp. infection are scarce. This report describes the case of a 66-year-old man with a history of renal transplantation from a cadaveric donor 1 year ago, which was considered as the primary risk factor. The characteristics of the infection, procedures performed, microbiological findings and treatment provided are described.

[Phaeohyphomycosis by Exserohilum rostratum in a pediatric patient with acute lymphoblastic leukemia after bone marrow transplantation]. / Feohifomicosis por Exserohilum rostratum en un paciente pediátrico con leucemia linfoblástica aguda postransplante de médula ósea.

The genus Exserohilum consists of dematiaceous or darkly pigmented fungi. Most of the species included in this genus are phytopathogens, saprobes and only three of these species would be pathogenic to humans: Exserohilumrostratum, Exserohilumlongirostratum and Exserohilummcginnisii. Localized and systemic infections have been reported both in immunocompetent and immunosuppressed patients. A clinical case of cutaneous infection by E. rostratum in an immunocompromised pediatric patient is presented in this study.'

Brain abscess caused by Cladophialophora bantiana after renal allograft loss: A case report / Absceso cerebral por Cladophialophora bantiana en un paciente con trasplante renal: reporte de un caso

Cerebral feohifomycosis are severe infections caused by dematiaceous fungi. Cladophialophora bantiana is one of the most commonly isolated species; it has central nervous system tropism and it often manifests as a brain abscess in immunocompetent patients. In immunocompromised patients, it can lead to brain abscesses and disseminated infections. Despite the availability of broad-spectrum antifungal drugs, it is a must to perform surgical management, in addition to drug therapy. However, mortality is high. The diagnostic approach must be invasive to establish a timely diagnosis and direct treatment based on culture and susceptibility tests. We report a case of brain abscess caused by C. bantiana in an immunosuppressed patient who was treated with surgical resection and voriconazole with an adequate response to therapy and without neurological sequels.

Las feohifomicosis cerebrales son infecciones graves causadas por mohos dematiáceos, entre los cuales Cladophialophora bantiana es una de las especies más comúnmente aislada. Esta tiene tropismo por el sistema nervioso central y frecuentemente produce abscesos cerebrales en pacientes inmunocompetentes; además, en los inmunocomprometidos también puede ocasionar infección diseminada. Pese a la disponibilidad de medicamentos antifúngicos de amplio espectro, a menudo se requiere también la intervención quirúrgica; de todas maneras, la mortalidad es elevada. El diagnóstico debe hacerse interviniendo para tomar la muestra y hacer el cultivo y las pruebas de sensibilidad. Se presenta aquí el caso de un paciente con trasplante renal que presentó un absceso cerebral por C. bantiana, el cual se extrajo mediante resección quirúrgica. El paciente recibió tratamiento con voriconazol, con adecuada respuesta, mejoría y sin secuelas neurológicas.

Feline Phaeohyphomycotic Cerebellitis Caused by Cladosporium cladosporioides-complex: Case Report and Review of Literature.

Cerebellar phaeohyphomycosis was diagnosed in an 8-year-old neutered male domestic cat. Gross lesions were limited to the cerebellum, which had a focally extensive dark brown-black, soft, irregular area affecting the cortex and white matter of the left hemisphere and extending to the reticular formation. Microscopically, multifocal pyogranulomatous meningoencephalitis with intralesional pigmented fungal hyphae effaced the cerebellar grey and white matter. Fungal hyphae were 3-6 µm in diameter, septate and non-dichotomously branched, with parallel, thin and slightly bulbous walls. Polymerase chain reaction for the internal transcribed spacer 1-2 ribosomal RNA genes was performed on tissue samples from formalin-fixed and paraffin wax-embedded sections of cerebellum. Nucleotide sequence analysis of the amplified fragment identified the fungal agent as Cladosporium cladosporioides. This is the first confirmed report of cerebellar phaeohyphomycosis attributable to C. cladosporioides-complex in a domestic cat.

Absceso cerebral por Cladophialophora bantiana en un paciente con trasplante renal: reporte de un caso / Brain abscess caused by Cladophialophora bantiana after renal allograft loss: A case report

Resumen Las feohifomicosis cerebrales son infecciones graves causadas por mohos dematiáceos, entre los cuales Cladophialophora bantiana es una de las especies más comúnmente aislada. Esta tiene tropismo por el sistema nervioso central y frecuentemente produce abscesos cerebrales en pacientes inmunocompetentes; además, en los inmunocomprometidos también puede ocasionar infección diseminada. Pese a la disponibilidad de medicamentos antifúngicos de amplio espectro, a menudo se requiere también la intervención quirúrgica; de todas maneras, la mortalidad es elevada. El diagnóstico debe hacerse interviniendo para tomar la muestra y hacer el cultivo y las pruebas de sensibilidad. Se presenta aquí el caso de un paciente con trasplante renal que presentó un absceso cerebral por C. bantiana, el cual se extrajo mediante resección quirúrgica. El paciente recibió tratamiento con voriconazol, con adecuada respuesta, mejoría y sin secuelas neurológicas.

Abstract Cerebral feohifomycosis are severe infections caused by dematiaceous fungi. Cladophialophora bantiana is one of the most commonly isolated species; it has central nervous system tropism and it often manifests as a brain abscess in immunocompetent patients. In immunocompromised patients, it can lead to brain abscesses and disseminated infections. Despite the availability of broad-spectrum antifungal drugs, it is a must to perform surgical management, in addition to drug therapy. However, mortality is high. The diagnostic approach must be invasive to establish a timely diagnosis and direct treatment based on culture and susceptibility tests. We report a case of brain abscess caused by C. bantiana in an immunosuppressed patient who was treated with surgical resection and voriconazole with an adequate response to therapy and without neurological sequels.

Curso clínico de micosis producidas por Exophiala xenobiotica en paciente trasplantado renal en el Hospital Universitario de Burgos / Clinical course of micosis produced by exophiala xenobiotica in renal transplanted patient at the University Hospital of Burgos

Resumen Las micosis por Exophiala xenobiotica comprenden un amplio espectro clínico en pacientes inmunosuprimidos, desde infecciones localizadas, hasta diseminadas. Son incluidas como etiología de las feohifomicosis, actualmente consideradas como infecciones fúngicas emergentes en pacientes trasplantados de órgano sólido. Presentamos 2 casos de micosis por Eexophiala xenobiotica en paciente trasplantado renal, una micosis cutánea localizada y una infección sistémica con afectación del sistema nervioso central.

Abstract Mycosis by exophiala xenobiotica comprise a broad clinical spectrum in immunosuppressed patients, from localized to disseminated infections. They are a recognized etiology of phaeohyphomycosis, currently considered as emerging fungal infections in transplanted solid organ recipients. We present 2 cases of mycosis by exophiala xenobiotica in kidney transplant recipients, a localized cutaneous mycosis and a systemic infection with central nervous system involvement.