51
|
Belda W, Criado PR, Domingues Passero LF. Case Report: Treatment of Chromoblastomycosis with Combinations including Acitretin: A Report of Two Cases. Am J Trop Med Hyg 2020; 103:1852-1854. [PMID: 32815507 DOI: 10.4269/ajtmh.20-0471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Chromoblastomycosis is a cutaneous fungal infection caused by dematiaceous fungi that belong to the order Chaetothyriales and family Herpotrichiellaceae. This infection is prevalent in tropical and subtropical areas and has been designated as a neglected tropical disease according to the WHO. Chromoblastomycosis infection is difficult to treat, and there are limited therapeutic options, making urgent the characterization of new medicines or approaches to treat such infection. In the present case report, two patients with extensive chromoblastomycosis lesions were treated with the combination of itraconazole, acitretin, and imiquimod. In the fourth month of treatment, both patients showed improvement of verrucous plates, suggesting that acitretin combined with drugs already used in chromoblastomycosis therapy can decrease the time of treatment, improving patient's quality of life.
Collapse
Affiliation(s)
- Walter Belda
- Laboratory of Pathology of Infectious Diseases, Medical School, University of São Paulo, São Paulo, Brazil.,Dermatology Department, Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Paulo Ricardo Criado
- ABC School of Medicine, Fundação Universitária do ABC (FUABC), Santo André, Brazil.,Laboratory of Pathology of Infectious Diseases, Medical School, University of São Paulo, São Paulo, Brazil
| | - Luiz Felipe Domingues Passero
- Institute for Advanced Studies of Ocean, São Paulo State University (UNESP), São Vicente, Brazil.,Institute of Biosciences, São Paulo State University (UNESP), São Vicente, Brazil
| |
Collapse
|
52
|
Skin Fungal Infections in Children: Diagnostic Challenges. CURRENT FUNGAL INFECTION REPORTS 2020. [DOI: 10.1007/s12281-020-00407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
53
|
Carcamo PM, Schwalb A, Seas C. Chromoblastomycosis: A Case of a Verrucous Plaque from the Tropics. Am J Trop Med Hyg 2020; 103:547-548. [PMID: 32758344 PMCID: PMC7410413 DOI: 10.4269/ajtmh.20-0243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Paloma M Carcamo
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos Seas
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
54
|
Breda LCD, Breda CNDS, de Almeida JRF, Paulo LNM, Jannuzzi GP, Menezes IDG, Albuquerque RC, Câmara NOS, Ferreira KS, de Almeida SR. Fonsecaeapedrosoi Conidia and Hyphae Activate Neutrophils Distinctly: Requirement of TLR-2 and TLR-4 in Neutrophil Effector Functions. Front Immunol 2020; 11:540064. [PMID: 33193308 PMCID: PMC7609859 DOI: 10.3389/fimmu.2020.540064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022] Open
Abstract
Chromoblastomycosis is a chronic and progressive subcutaneous mycosis caused mainly by the fungus Fonsecaea pedrosoi. The infection is characterized by erythematous papules and histological sections demonstrating an external layer of fibrous tissue and an internal layer of thick granulomatous inflammatory tissue containing mainly macrophages and neutrophils. Several groups are studying the roles of the innate and adaptive immune systems in F. pedrosoi infection; however, few studies have focused on the role of neutrophils in this infection. In the current study, we verify the importance of murine neutrophils in the killing of F. pedrosoi conidia and hyphae. We demonstrate that phagocytosis and reactive oxygen species during infection with conidia are TLR-2- and TLR-4-dependent and are essential for conidial killing. Meanwhile, hyphal killing occurs by NET formation in a TLR-2-, TLR-4-, and ROS-independent manner. In vivo experiments show that TLR-2 and TLR-4 are also important in chromoblastomycosis infection. TLR-2KO and TLR-4KO animals had lower levels of CCL3 and CXCL1 chemokines and impaired neutrophil migration to the infected site. These animals also had higher fungal loads during infection with F. pedrosoi conidia, confirming that TLR-2 and TLR-4 are essential receptors for F. pedrosoi recognition and immune system activation. Therefore, this study demonstrates for the first time that neutrophil activation during F. pedrosoi is conidial or hyphal-specific with TLR-2 and TLR-4 being essential during conidial infection but unnecessary for hyphal killing by neutrophils.
Collapse
Affiliation(s)
- Leandro Carvalho Dantas Breda
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | | | - José Roberto Fogaça de Almeida
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Larissa Neves Monteiro Paulo
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Grasielle Pereira Jannuzzi
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Isabela de Godoy Menezes
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Renata Chaves Albuquerque
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Niels Olsen Saraiva Câmara
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Karen Spadari Ferreira
- Departamento de Ciências Farmacêuticas, Instituto de Ciências Naturais, Universidade Federal de São Paulo, Diadema, Brazil
| | - Sandro Rogério de Almeida
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
55
|
A comparative study of extracellular enzymes from chromoblastomycosis agents reveals the potential association of phospholipase with the severity of the lesions. Microb Pathog 2020; 147:104367. [PMID: 32649963 DOI: 10.1016/j.micpath.2020.104367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 12/14/2022]
Abstract
Chromoblastomycosis is a chronic, progressive subcutaneous mycosis that is endemic in tropical and subtropical countries. Cladophialophora carrionii and Fonsecaea pedrosoi are prevalent etiological agents. The potential role of the proteolytic activity of extracellular enzymes in these fungi and its relationship with the pathogenesis of the disease has not been proven. Some phenotypic traits have been associated with the virulence of other fungi; i.e., their different rate of protease, phospholipase, and esterase excretion, melanin, and thermotolerance. The aim of this study was the identification of extracellular enzymes that could be considered virulence markers of chromoblastomycosis agents. Therefore, we tested 29 C. carrionii and 11 F. pedrosoi clinical isolates to determine their hydrolytic and physiologic characteristics. All the tested isolates grew at a range of 30°-37 °C; except 2 strains of F. pedrosoi that grew slowly at 40 °C. We noticed that the hydrolytic capabilities of the tested isolates were positive for urea hydrolysis in almost all, while both strains were negative for DNase, hemolysin, and gelatin. C. carrionii and F. pedrosoi had phospholipase and esterase activity. These findings were similar for most isolates. All strains showed an association between phospholipase activity and moderate to severe lesions. However, only in F. pedrosoi isolates, the association remains significant. We conclude that the different enzymatic production reported here may be linked to the clinical manifestations of these pathologies. Notwithstanding, the influence of other virulence factors is not excluded.
Collapse
|
56
|
Siqueira IM, Wüthrich M, Li M, Wang H, Las-Casas LDO, de Castro RJA, Klein B, Bocca AL. Early immune response against Fonsecaea pedrosoi requires Dectin-2-mediated Th17 activity, whereas Th1 response, aided by Treg cells, is crucial for fungal clearance in later stage of experimental chromoblastomycosis. PLoS Negl Trop Dis 2020; 14:e0008386. [PMID: 32542003 PMCID: PMC7316354 DOI: 10.1371/journal.pntd.0008386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/25/2020] [Accepted: 05/12/2020] [Indexed: 01/26/2023] Open
Abstract
Chromoblastomycosis (CBM) is a chronic worldwide subcutaneous mycosis, caused by several dimorphic, pigmented dematiaceous fungi. It is difficult to treat patients with the disease, mainly because of its recalcitrant nature. The correct activation of host immune response is critical to avoid fungal persistence in the tissue and disease chronification. CD4+ T cells are crucial for the development of protective immunity to F. pedrosoi infection. Here, we investigated T helper cell response dynamics during experimental CBM. Following footpad injection with F. pedrosoi hyphae and conidia, T cells were skewed towards a Th17 and Th1 phenotype. The Th17 population was the main Th cell subset found in the infected area during the early stages of experimental murine CBM, followed by Th1 predominance in the later stages, coinciding with the remission phase of the disease in this experimental model. Depletion of CD25+ cells, which leads to a reduction of Treg cells in the draining lymph node, resulted in decline in fungal burden after 14 days of infection. However, fungal cells were not cleared in the later stages of the disease, prolonging CBM clinical features in those animals. IL-17A and IFN-γ neutralization hindered fungal cell elimination in the course of the disease. Similarly, in dectin-2 KO animals, Th17 contraction in the course of experimental CBM was accompanied by fungal burden decrease in the first 14 days of infection, although it did not affect disease resolution. In this study, we gained insight into T helper subsets' dynamics following footpad injections of F. pedrosoi propagules and uncovered their contribution to disease resolution. The Th17 population proved to be important in eliminating fungal cells in the early stages of infection. The Th1 population, in turn, closely assisted by Treg cells, proved to be relevant not only in the elimination of fungal cells at the beginning of infection but also essential for their complete elimination in later stages of the disease in a mouse experimental model of CBM.
Collapse
Affiliation(s)
- Isaque Medeiros Siqueira
- Molecular Pathology Post-Graduate Program, School of Medicine, University of Brasília, Brasília, Brazil
| | - Marcel Wüthrich
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
| | - Mengyi Li
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
| | - Huafeng Wang
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
| | | | | | - Bruce Klein
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
- Department of Internal Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
- Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
| | - Anamelia Lorenzetti Bocca
- Department of Cell Biology, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| |
Collapse
|
57
|
Melo ED, Morais PMD, Fernandes DCDL, Rebello PFB. Case for diagnosis. Pruritic erythematosquamous lesion in the auricle. An Bras Dermatol 2020; 95:521-523. [PMID: 32473772 PMCID: PMC7335870 DOI: 10.1016/j.abd.2019.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/24/2019] [Indexed: 10/28/2022] Open
Abstract
Chromoblastomycosis is a subcutaneous mycosis with chronic evolution that mainly affects the lower limbs and, less frequently, the auricles. Clinically, it presents with papillary verrucous, nodular, and/or tumoral lesions, whether isolated or infiltrated, forming plaques and, sometimes, atrophic in some areas. Histopathologically, it is characterized by a dermal granulomatous inflammatory infiltrate, and the diagnosis can be confirmed by the presence of fumagoid bodies in anatomopathological or direct mycological exams. The treatment to be indicated will depend on the extent and location of the lesions, using systemic antifungals, surgical removal, cryotherapy, thermotherapy, and immunoadjuvants. The present study reports an atypical presentation of chromoblastomycosis on the auricle.
Collapse
Affiliation(s)
- Elaine Dias Melo
- Teaching and Research Department, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil.
| | - Patrícia Motta de Morais
- Department of Histopathology, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
| | | | | |
Collapse
|
58
|
Ali GA, Goravey W, Taj-Aldeen SJ, Petkar M, Al-Bozom I, Hadi HA. A case of mycetoma-like chromoblastomycosis in Qatar. IDCases 2020; 21:e00853. [PMID: 32528848 PMCID: PMC7283144 DOI: 10.1016/j.idcr.2020.e00853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/03/2022] Open
Abstract
Chromoblastomycosis is one of the neglected tropical mycoses associated with chronic infection of the skin and subcutaneous tissues. We report a case of 49-year-old patient originally from India presented with a mycetoma-like lesion in his right foot which was slowly progressing over three-year period. The diagnosis of chromoblastomycosis was confirmed following surgical excision and identification of the unique histological pathology of muriform bodies. The patient was subsequently treated with a prolonged course of oral itraconazole with a favorable outcome. The clinical presentations, assessment and management of the disease are outlined.
Collapse
Affiliation(s)
| | | | - Saad J Taj-Aldeen
- Department of Laboratory Medicine and Pathology Hamad Medical Corporation, Doha, Qatar
| | - Mahir Petkar
- Department of Laboratory Medicine and Pathology Hamad Medical Corporation, Doha, Qatar
| | - Issam Al-Bozom
- Department of Laboratory Medicine and Pathology Hamad Medical Corporation, Doha, Qatar
| | | |
Collapse
|
59
|
Chromoblastomycosis caused by Cladophialophora carrionii. Infection 2020; 49:567-568. [PMID: 32451738 DOI: 10.1007/s15010-020-01437-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
|
60
|
Coelho RA, Joffe LS, Alves GM, Figueiredo-Carvalho MHG, Brito-Santos F, Amaral ACF, Rodrigues ML, Almeida-Paes R. A screening of the MMV Pathogen Box® reveals new potential antifungal drugs against the etiologic agents of chromoblastomycosis. PLoS One 2020; 15:e0229630. [PMID: 32401759 PMCID: PMC7219733 DOI: 10.1371/journal.pone.0229630] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/27/2020] [Indexed: 12/17/2022] Open
Abstract
Chromoblastomycosis (CBM) is a chronic subcutaneous mycosis caused by traumatic implantation of many species of black fungi. Due to the refractoriness of some cases and common recurrence of CBM, a more effective and less time-consuming treatment is mandatory. The aim of this study was to identify compounds with in vitro antifungal activity in the Pathogen Box® compound collection against different CBM agents. Synergism of these compounds with drugs currently used to treat CBM was also assessed. An initial screening of the drugs present in this collection at 1 μM was performed with a Fonsecaea pedrosoi clinical strain according to the EUCAST protocol. The compounds with activity against this fungus were also tested against other seven etiologic agents of CBM (Cladophialophora carrionii, Phialophora verrucosa, Exophiala jeanselmei, Exophiala dermatitidis, Fonsecaea monophora, Fonsecaea nubica, and Rhinocladiella similis) at concentrations ranging from 0.039 to 10 μM. The analysis of potential synergism of these compounds with itraconazole and terbinafine was performed by the checkerboard method. Eight compounds inhibited more than 60% of the F. pedrosoi growth: difenoconazole, bitertanol, iodoquinol, azoxystrobin, MMV688179, MMV021013, trifloxystrobin, and auranofin. Iodoquinol produced the lowest MIC values (1.25-2.5 μM) and MMV688179 showed MICs that were higher than all compounds tested (5 - >10 μM). When auranofin and itraconazole were tested in combination, a synergistic interaction (FICI = 0.37) was observed against the C. carrionii isolate. Toxicity analysis revealed that MMV021013 showed high selectivity indices (SI ≥ 10) against the fungi tested. In summary, auranofin, iodoquinol, and MMV021013 were identified as promising compounds to be tested in CBM models of infection.
Collapse
Affiliation(s)
- Rowena Alves Coelho
- Mycology Laboratory at the Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Luna Sobrino Joffe
- Department of Microbiology and Immunology, Stony Brook University, New York, NY, United States of America
| | - Gabriela Machado Alves
- Mycology Laboratory at the Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | | | - Fábio Brito-Santos
- Mycology Laboratory at the Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | | | - Marcio L. Rodrigues
- Carlos Chagas Institute, Fiocruz, Paraná, Brazil
- Microbiology Institute, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Rodrigo Almeida-Paes
- Mycology Laboratory at the Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| |
Collapse
|
61
|
Sendrasoa FA, Rakotoarisaona MF, Ranaivo IM, Razanakoto NH, Sata M, Raharolahy O, Andrianarison M, Ratovonjanahary V, Rasamoelina T, Rapelanoro Rabenja F, Ramarozatovo LS. [Management of chromoblastomycosis, a challenge for limited-resource countries such as Madagascar]. Ann Dermatol Venereol 2020; 147:377-382. [PMID: 32220474 DOI: 10.1016/j.annder.2020.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/18/2019] [Accepted: 01/16/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Chromoblastomycosis (CBM) is a chronic fungal infection of the skin and subcutaneous tissue caused by dematiaceous fungi. CBM lesions are recalcitrant and extremely difficult to eradicate. We report three cases of CBM with difficulties in therapeutic management. OBSERVATION Three men aged 36, 50 and 67 years, all farmers, presented for between three and ten years with hyperkeratotic, scaly plaques with black dots on the right thigh and left leg, respectively. For all patients, mycological examination showed fumagoid cells, all of which were pathognomonic for CBM. PCR identified Fonsecaeanubica in one patient and Cladophialophoracarrionii in two patients. All patients received itraconazole 200mg/day for over 18 months. Two patients required combined therapy with terbinafine for seven months, which improved lesions; however, relapse occurred in one patient during the 5th month of this combined therapy and five months after the end of this treatment in the other. The patient on monotherapy (itraconazole) also presented recurrence of lesions five months after the end of treatment. DISCUSSION Itraconazole is the standard therapy for CBM, with cure rates ranging from 15 to 80%. Success with itraconazole after eight to twelve months was reported by several authors. Fonsecaea and Cladophialophora are the most common species found in Madagascar, and while these organisms are susceptible to triazoles in vitro, clinical response is not so clear-cut. CONCLUSION Although unavailable in Madagascar, posaconazole and isavoconazole appear to be effective in treating chromoblastomycosis.
Collapse
Affiliation(s)
- F-A Sendrasoa
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar.
| | - M-F Rakotoarisaona
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - I-M Ranaivo
- USFR dermatologie, hôpital universitaire Morafeno Toamasina, Toamasina, Madagascar
| | - N-H Razanakoto
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - M Sata
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - O Raharolahy
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - M Andrianarison
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - V Ratovonjanahary
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - T Rasamoelina
- Centre d'infectiologie Charles Mérieux, Antananarivo, Madagascar
| | - F Rapelanoro Rabenja
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - L-S Ramarozatovo
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| |
Collapse
|
62
|
Hu Y, Qi X, Sun H, Lu Y, Hu Y, Chen X, Liu K, Yang Y, Mao Z, Wu Z, Zhou X. Photodynamic therapy combined with antifungal drugs against chromoblastomycosis and the effect of ALA-PDT on Fonsecaea in vitro. PLoS Negl Trop Dis 2019; 13:e0007849. [PMID: 31671098 PMCID: PMC6850556 DOI: 10.1371/journal.pntd.0007849] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/12/2019] [Accepted: 10/16/2019] [Indexed: 01/06/2023] Open
Abstract
Background Chromoblastomycosis is a chronic skin and subcutaneous fungal infection caused by dematiaceous fungi and is associated with low cure and high relapse rates. In southern China, Fonsecaea monophora and Fonsecaea pedrosoi are the main causative agents. Principal findings We treated 5 refractory and complex cases of chromoblastomycosis with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with oral antifungal drugs. The lesions improved after 4 to 9 sessions of ALA-PDT treatment at an interval of one or two weeks, and in some cases, mycological testing results became negative. The isolates were assayed for susceptibility to antifungal drugs and ALA-PDT in vitro, revealing sensitivity to terbinafine, itraconazole and voriconazole, with ALA-PDT altering the cell wall and increasing reactive oxygen species production. Conclusions These results provide the basis for the development of a new therapeutic approach, and ALA-PDT combined with oral antifungal drugs constitutes a promising alternative method for the treatment of refractory and complex cases of chromoblastomycosis. Chromoblastomycosis, a neglected tropical disease, is one of the most frequently encountered subcutaneous mycoses. The disease is usually caused by traumatic inoculation of a specific group of dematiaceous fungi. Chromoblastomycosisis characterized by slowly expanding skin lesions and is associated with low cure and high relapse rates. In recent years, effective methods, such as photodynamic therapy (PDT), have been employed for inhibiting the pathogen’s activity. The authors treated 5 refractory and complex cases of chromoblastomycosis with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with oral antifungal drugs. The lesions improved after 4 to 9 sessions of ALA-PDT treatment at an interval of one or two weeks, and in some cases, mycological testing results became negative. The authors also found that ALA-PDT alter the fungi cell wall and increase reactive oxygen species production. This research provides the basis for the development of a new therapeutic approach, and ALA-PDT combined with oral antifungal drugs constitutes a promising alternative method for the treatment of refractory and complex cases of chromoblastomycosis.
Collapse
Affiliation(s)
- Yongxuan Hu
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
- * E-mail: (YH); (XZ)
| | - Xinyu Qi
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Hengbiao Sun
- Department of Clinical Laboratory, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yan Lu
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yanqing Hu
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xuyang Chen
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Kangxing Liu
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yemei Yang
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zuhao Mao
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhong Wu
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xianyi Zhou
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
- * E-mail: (YH); (XZ)
| |
Collapse
|
63
|
Zhang J, Wu X, Li M, Huang J, Yin S, Huang H, Lu C, Xi L. Synergistic effect of terbinafine and amphotericin B in killing Fonsecaea nubica in vitro and in vivo. Rev Inst Med Trop Sao Paulo 2019; 61:e31. [PMID: 31241660 PMCID: PMC6592013 DOI: 10.1590/s1678-9946201961031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/02/2019] [Indexed: 12/26/2022] Open
Abstract
Chromoblastomycosis is a chronic fungal infection. Itraconazole and terbinafine are the most recommended antifungal drugs for chromoblastomycosis, while amphotericin B is not usually recommended. A patient with chromoblastomycosis in our hospital showed poor clinical responses to itraconazole and terbinafine. The fungus isolated from the lesions of this patient was identified as Fonsecaea nubica and numbered zssy0803. In vitro antifungal susceptibilities of F. nubica zssy0803 to terbinafine, amphotericin B, itraconazole, voriconazole and caspofungin were evaluated, as well as the combinations of terbinafine with the other four antifungals. The combined effect of terbinafine and amphotericin B on other 20 clinical F. nubica strains was also evaluated. The minimal inhibitory concentrations of terbinafine, amphotericin B, itraconazole, voriconazole and caspofungin on F. nubica zssy0803 were 0.25 μg/mL, 2 μg/mL, 1 μg/mL, 4 μg/mL and 8 μg/mL, respectively. The combination of terbinafine and amphotericin B showed the lowest fractional inhibitory concentration index of 0.28 to F. nubica zssy0803 in comparison with combinations of terbinafine and the other four antifungal drugs. The combination of terbinafine and amphotericin B was also synergistic for all the other 20 F. nubica strains. Then, the combination of oral terbinafine (500 mg/day) and intralesional injections of amphotericin B (1 mg/mL) was used to treat this patient. After this combined therapy for 25 weeks and terbinafine monotherapy for additional 12 weeks, the patient was cured. These findings indicate for the first time that terbinafine and amphotericin B are synergistic in killing F. nubica both in vitro and in vivo.
Collapse
Affiliation(s)
- Jing Zhang
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China.,Yat-sen University, Sun Yat-sen Memorial Hospital, Department of Dermatology and Venereology, Guangzhou, China.,Sun Yat-sen University, Sun Yat-sen Memorial Hospital, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China
| | - Xiaoyan Wu
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Meirong Li
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Jiamin Huang
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Songchao Yin
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Huaiqiu Huang
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Chun Lu
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Liyan Xi
- Yat-sen University, Sun Yat-sen Memorial Hospital, Department of Dermatology and Venereology, Guangzhou, China
| |
Collapse
|
64
|
Abstract
The endemic mycoses are a group of infections caused by fungi with a distinct geographic distribution, defined by climatic and environmental conditions. The systemic endemic mycoses, namely histoplasmosis, blastomycosis, talaromycosis, coccidioidomycosis and paracoccidioidomycosis, occur after the inhalation of fungal spores. The cutaneous endemic mycoses, including sporotrichosis, mycetoma, entomophthoramycosis and chromoblastomycosis, enter the host via traumatic inoculation of the skin. Clinical presentation varies between these relatively heterogeneous infections, as does the susceptibility of immunosuppressed patients to disease. An understanding of the geographic range, typical manifestations, diagnostic methods, and treatment of the endemic mycoses is key in assessing patients presenting with atypical infections who may have traveled to endemic areas.
Collapse
|