Clinical Characteristics and Pathogen Spectrum of Male Genital Fungal Infections in Nanchang Area, South China.

The cutaneous fungal infections in male genitalia are relatively rare, and often present with various atypical clinical symptoms. It was mainly reported in a small number of case reports, while data with large number of patients were rarely reported. In this study, we reported 79 male patients with cutaneous fungal infections on scrotum or penis. The fungal infections were confirmed by microscopic examination directly and fungus culture. Clinical characteristics and predisposing factors were also collected. Of these 79 patients, 72 has lesions on scrotum, 5 on penis and 2 on both scrotum and penis. Trichophyton (T.) rubrum is the most common pathogen, found in 50 (67.6%) patients, which presented diverse clinical manifestation such as majorly erythematous, dry diffused scaly lesions without a clear border, slightly powdery and scutular scalings. Candida (C.) albicans is the secondly common pathogen, found in 21 (28.4%) patients, which also presented diverse lesions such as erythematous with dry whitish scaly lesions and erythematous erosion. The predisposing factors mainly included concomitant fungal infections on sites other than genitalia, especially inguinal region (tinea cruris), application of corticosteroid and high moisture. In conclusion, cutaneous fungal infections in male genitalia could be caused by different fungi, showed atypical or mild clinical appearances in most cases and might be a fungus reservoir, emphasizing the necessity to timely perform the fungi examinations and corresponding therapy.

Dermatopathology and the Diagnosis of Fungal Infections.

Diagnosis of superficial/cutaneous fungal infections from skin, hair and nail samples is generally achieved using microscopy and culture in a microbiology laboratory, however, any presentation that is unusual or subcutaneous is sampled by taking a biopsy. Using histological techniques a tissue biopsy enables a pathologist to perform a full examination of the skin structure, detect any inflammatory processes or the presence of an infectious agent or foreign body. Histopathological examination can give a presumptive diagnosis while a culture result is pending, and may provide valuable diagnostic information if culture fails. This review demonstrates how histopathology contributes to the diagnosis of fungal infections from the superficial to the life threatening.

Fungal Skin Disease Classification Using the Convolutional Neural Network.

Skin is the outer cover of our body, which protects vital organs from harm. This important body part is often affected by a series of infections caused by fungus, bacteria, viruses, allergies, and dust. Millions of people suffer from skin diseases. It is one of the common causes of infection in sub-Saharan Africa. Skin disease can also be the cause of stigma and discrimination. Early and accurate diagnosis of skin disease can be vital for effective treatment. Laser and photonics-based technologies are used for the diagnosis of skin disease. These technologies are expensive and not affordable, especially for resource-limited countries like Ethiopia. Hence, image-based methods can be effective in reducing cost and time. There are previous studies on image-based diagnosis for skin disease. However, there are few scientific studies on tinea pedis and tinea corporis. In this study, the convolution neural network (CNN) has been used to classify fungal skin disease. The classification was carried out on the four most common fungal skin diseases: tinea pedis, tinea capitis, tinea corporis, and tinea unguium. The dataset consisted of a total of 407 fungal skin lesions collected from Dr. Gerbi Medium Clinic, Jimma, Ethiopia. Normalization of image size, conversion of RGB to grayscale, and balancing the intensity of the image have been carried out. Images were normalized to three sizes: 120 × 120, 150 × 150, and 224 × 224. Then, augmentation was applied. The developed model classified the four common fungal skin diseases with 93.3% accuracy. Comparisons were made with similar CNN architectures: MobileNetV2 and ResNet 50, and the proposed model was superior to both. This study may be an important addition to the very limited work on the detection of fungal skin disease. It can be used to build an automated image-based screening system for dermatology at an initial stage.

Development, preparation, and evaluation of a novel non-adjuvanted polyvalent dermatophytes vaccine.

Ringworm is a worldwide distributed contagious disease infecting both man and animals that constitute an economic, zoonotic, and health problem concern all over the world. During the last decade, attention has been directed to vaccination as an ideal approach to the control of such diseases. In the present study, non-adjuvanted polyvalent vaccines were prepared from locally isolated hot and virulent dermatophyte species, namely Trichophyton verrucosum (T. verrucosum), Trichophyton mentagrophytes (T. mentagrophytes), and Microsporum canis (M. canis) were immunologically evaluated. The prepared vaccine evaluation was focused on the aspects of immunogenicity and protective efficacy using guinea pigs. Both in its living or inactivated forms, the vaccine-induced significant humoral and cell-mediated immune responses and achieve proper protection of guinea pigs against challenging infections with homologous and heterologous dermatophyte strains. On the other hand, investigations on dermatophyte exo-keratinases showed that it was better produced and more expressed in a mineral-based medium containing pure keratin (3 g/L) than in the same medium with human hair supplementation (2.6 g/L). The maximum dermatophyte productivity of exo-keratinases was found to be between 18 and 21 days post-incubation. Using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), two fractions with molecular weights of 40 kDa (fraction I) and 28 kDa (fraction II) have been identified in the culture filtrate of the three involved dermatophyte species. Both fractions demonstrated keratinolytic activity. The specific activity of the isolated keratinases (number of Keratinase units (KU)/mg protein) was stronger in fraction I, where it reached 18.75, 15.38, and 14 KU/mg protein as compared to 12.9, 8.74, and 12 KU/mg protein in fraction II of T. verrucosum, T. mentagrophytes, and M. canis, respectively. The dermatophyte exo-keratinases proved to be immunogenic as they stimulated high keratinase-specific antibody titers and induced strong delayed skin hypersensitivity reactions in vaccinated animals. Anti-keratinase-specific IgG was detected in sera of guinea pigs immunized with the inactivated or living polyvalent dermatophyte vaccines by a homemade enzyme-linked immunosorbent assay (ELISA) using dermatophyte exo-keratinases as coating antigen. The intradermal injection of dermatophyte exo-keratinases induced specific delayed skin reactions in guinea pigs immunized with the inactivated or the living polyvalent dermatophyte vaccines. The intradermal injection of dermatophyte exo-keratinases in the control non-sensitized guinea pigs was associated with itching, swelling, and bloody scar formation, however, no skin indurations were formed. The development of those post-exo-keratinases injection reactions in the control non-sensitized apparently healthy guinea pigs group, suggests an exo-keratinases possible role in the pathogenesis of dermatophytosis.

Altered skin fungal and bacterial community compositions in tinea capitis.

BACKGROUND: Tinea capitis is an infection of the scalp and hair shaft caused by dermatophytes that predominantly occurs in children. Skin fungal infections have been found to be associated with alterations in the overall bacterial and fungal communities. However, the scalp microbiome in tinea capitis have not been fully investigated. OBJECTIVES: To investigate and compare the scalp bacterial and fungal microbiomes between children with tinea capitis and healthy children and between children and adults. METHODS: Skin samples were collected from the scalp. Bacterial and fungal community compositions were analysed by amplification sequencing of the V3-V4 of 16S rDNA and ITS1-5F, respectively. RESULTS: The predominant fungi detected using amplicon sequencing were consistent with the culture- or real-time PCR-positive pathogens in most samples. Children with tinea capitis had lower fungal and higher bacterial Shannon diversity than healthy children. A higher relative abundance of pathogenic fungi and significant alterations in the bacterial community in the lesional sites of tinea capitis than healthy scalps. Compared with adults, healthy children were characterised by higher Shannon diversities with significantly lower relative abundances of Malassezia and Cutibacterium and higher relative abundances of Candida and Streptococcus. CONCLUSIONS: We demonstrated that tinea capitis was characterised by significant alterations in both fungal and bacterial communities and amplicon sequencing could be a complementary method for pathogen identification.

Gout-like hands.

A 65-year-old man presented to our hospital with a 1-year history of multiple nodules on his arms and hands without itching or pain.

Histoplasma capsulatum var. duboisii: A KwaZulu-Natal, South Africa public sector perspective.

BACKGROUND: Histoplasma capsulatum var. duboisii (H. duboisii) causes potentially fatal disease in the immunocompromised patient, and the literature on these cases is limited. The study was undertaken to describe the cases of H. duboisii seen in a resource-limited setting. METHODS: A 5-year retrospective, laboratory-based histopathologic review of all H. duboisii cases. RESULTS: A total of 24 patients were diagnosed with cutaneous H. duboisii infection. The male-to-female ratio was 1.4. All the patients were human immunodeficiency virus (HIV) positive, and 70.83% (17 of 24 patients) were on antiretroviral therapy. The clinically identified lesions were as follows: plaques, nodular plaques, papules, papulo-pustules, and umbilicated papules. Histopathological appraisal revealed organisms typical of H. duboisii. The commonest epidermal alterations were interface change, parakeratosis, spongiosis, ulceration, acanthosis, hyperkeratosis, transepidermal elimination, and exocytosis in decreasing order. The dermal changes included histiocytic pattern (n = 14), neutrophil-rich (n = 13), non-necrotizing granulomatous inflammation (n = 9), and karyorrhexis (n = 6). Histoplasma was confirmed in 53% (8 of 15 samples) of the tissue samples submitted for routine fungal culture. CONCLUSION: This study showed the demographics, clinical and histopathology features of H. duboisii infection in a resource-limited setting. Further research on histopathological features of this rare infection is essential to expand on the knowledge base and support findings in this study.

Automated detection of superficial fungal infections from microscopic images through a regional convolutional neural network.

Direct microscopic examination with potassium hydroxide is generally used as a screening method for diagnosing superficial fungal infections. Although this type of examination is faster than other diagnostic methods, it can still be time-consuming to evaluate a complete sample; additionally, it possesses the disadvantage of inconsistent reliability as the accuracy of the reading may differ depending on the performer's skill. This study aims at detecting hyphae more quickly, conveniently, and consistently through deep learning using images obtained from microscopy used in real-world practice. An object detection convolutional neural network, YOLO v4, was trained on microscopy images with magnifications of 100×, 40×, and (100+40)×. The study was conducted at the Department of Dermatology at Veterans Health Service Medical Center, Seoul, Korea between January 1, 2019 and December 31, 2019, using 3,707 images (1,255 images for training, 1,645 images for testing). The average precision was used to evaluate the accuracy of object detection. Precision recall curve analysis was performed for the hyphal location determination, and receiver operating characteristic curve analysis was performed on the image classification. The F1 score, sensitivity, and specificity values were used as measures of the overall performance. The sensitivity and specificity were, respectively, 95.2% and 100% in the 100× data model, and 99% and 86.6% in the 40× data model; the sensitivity and specificity in the combined (100+40)× data model were 93.2% and 89%, respectively. The performance of our model had high sensitivity and specificity, indicating that hyphae can be detected with reliable accuracy. Thus, our deep learning-based autodetection model can detect hyphae in microscopic images obtained from real-world practice. We aim to develop an automatic hyphae detection system that can be utilized in real-world practice through continuous research.

Invasive Microsporum canis infection as a presenting complaint of late-diagnosed HIV infection.

A 43-year-old male barber presented with 1 year history of a painful, itchy plaque on the dorsal hand. Microsporum canis was recovered from pus of the lesion. Serologic testing for human immunodeficiency virus (HIV) antibody was positive, with a CD4+ count of 81 cells per cubic millimeter. Invasive cutaneous Microsporum canis infection is uncommon and can be suggestive of HIV infection or other conditions of immunocompromise.

Superficial mycoses, a matter of concern: Global and Indian scenario-an updated analysis.

Superficial mycoses of skin, nails and hair are among the common fungal infections. They are caused by dermatophytes, non-dermatophyte moulds, yeasts and yeast-like fungi. Such fungal infections are widespread all over the world and are predominant in tropical as well as subtropical regions. Environmental factors, such as warm, humid and pitiable hygienic conditions, are conducive for their growth and proliferation. Although it does not cause mortality, it is known to be associated with excessive morbidity which may be psychological or physical. This affects the quality of life of the infected individuals which leads to a negative impact on their occupational, emotional and social status. Such infections are increasing on a global scale and, therefore, are of serious concern worldwide. This review article covers the global and Indian scenario of superficial mycoses taking into account the historical background, aetiological agents, prevalence, cultural and environmental factors, risk factors, pathogenesis and hygienic practices for the prevention of superficial mycoses.

Cutaneous Histoplasmosis in HIV Seronegative Patients: A Clinicopathological Analysis.

BACKGROUND: Diagnosis of extrapulmonary histoplasmosis in HIV seronegative and immunocompetent patients is often challenging, so a high index of suspicion is required. Cutaneous manifestation of infection shows a wide spectrum of lesions including erythematous plaques; maculopapules; crusted, verrucous, or desquamative papules and nodules; abscesses; and mucocutaneous ulcers among others. Due to the variations in its clinical presentation, histopathology plays a very important role in the detection of spores and the confirmation of diagnosis. OBJECTIVES: The aim of our study was to analyze clinicopathological characteristics of cutaneous manifestations of biopsy-proven histoplasmosis in HIV seronegative individuals. We also examined the utility of Fite stain for the diagnosis of Histoplasma capsulatum on tissue biopsy sections. METHODS: This was a retrospective, observational study on 7 patients who were HIV seronegative and clinically manifested with isolated cutaneous lesions or disseminated disease. Skin biopsy from the lesions was performed on all 7 patients. In addition to H&E staining and special stains for detecting fungus, Fite staining was performed on all of the cases to study its utility in detecting H. capsulatum spores. RESULTS: The skin lesions were widely disseminated in all patients and the most common cutaneous lesions were papules, present in all 7 patients. On review of the H&E-stained slides, the most common pattern was histiocytic lobular panniculitis-like infiltrate observed in 4 cases. Fite stain highlighted the yeast as magenta-colored spores on a blue background in all cases, except for 1 with a granulomatous pattern. CONCLUSION: A primary cutaneous manifestation of H. capsulatum infection in non-HIV-infected individuals is extremely rare. Fite stain could aid in differentiating the spores of H. capsulatum from those of other fungi, Cryptococcus and Candida in particular.

Analysis of Archival Specimens Confirms White-Nose Syndrome in Little Brown Bats (Myotis lucifugus) from New York, USA, in Spring 2007.

White-nose syndrome (WNS), an emerging fungal disease of North American bats, was first diagnosed in January 2008, although mortality and photodocumentation suggest the disease might have been present earlier. Using archived samples, we describe a definitive case of WNS in little brown bats (Myotis lucifugus) from New York, US, in spring 2007.

Cytological clues to Alternaria alternata.

Alternaria alternata is dematiaceous fungi affecting mainly immunocompromised host. It generally causes cutaneous infection in humans, but can cause fatal disease. Fine needle aspiration cytology (FNAC) has not been used widely for the diagnosis of dematiaceous fungi. Here, we present a case of Alternaria alternata in an immunocompetent patient diagnosed on cytology and culture.

Localized cutaneous infection caused by Scedosporium apiospermum: Report of a case diagnosed on cytology.

Scedosporium apiospermum (also known as Pseudallescheria boydii) is a ubiquitous filamentous fungus. This fungus is known as a cause of mycetoma, which may occur in a normal immune host following trauma and nonmycetoma-localized skin infections without grain production which are much rarer. However, in an immunocompromised host, S. apiospermum may cause a life-threatening infection. We describe a case of S. apiospermum infection of the left middle finger in an immunocompetent patient, which was diagnosed on cytology and later confirmed on culture.

Rhinofacial Conidiobolomycosis: A Case Series and Review of the Literature.

Conidiobolomycosis is an uncommon, chronic, localized subcutaneous mycosis primarily affecting rhinofacial region. It is reported mainly from tropical and subtropical countries. The condition is underreported due to the lack of clinical suspicion and usually mismanaged. This rare mycosis is due to the genus Conidiobolus within the order Entomophthorales of class Zygomycetes. Here we present 3 cases of rhinofacial conidiobolomycosis in otherwise healthy adults from different parts of Sri Lanka over 1-year period. All patients had disfiguring subcutaneous lesions in the rhinofacial area. The diagnoses were based on isolation of Conidiobolus coronatus in clinical specimens.