1
|
Bonifaz A, Tirado-Sánchez A, Vazquez-Gonzalez D, Araiza J, Hernández-Castro R. Actinomycetoma by Actinomadura madurae: Clinical Characteristics and Treatment of 47 Cases. Indian Dermatol Online J 2021; 12:285-289. [PMID: 33959526 PMCID: PMC8088182 DOI: 10.4103/idoj.idoj_474_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/17/2020] [Accepted: 09/05/2020] [Indexed: 12/02/2022] Open
Abstract
Context: Mycetoma is a chronic, granulomatous disease caused by fungi (eumycetoma) or aerobic filamentous actinomycetes (actinomycetoma). Actinomadura madurae is one of the most frequent actinomycetes. Aim: The study aims to provide an update on clinical, diagnostic, therapeutic, and outcome data for patients with actinomycetoma in a single center in Mexico. Settings and Design: This was a retrospective study of 47 cases diagnosed with actinomycetoma. Subjects and Methods: The cases were selected from a total of 536 mycetoma obtained during 35 years (from 1985 to 2019). Clinical data were retrieved from the clinical records of our department. Microbiological data were obtained from our Mycology laboratory. Statistical Analysis: Frequencies and percentages were used for categorical variables. Normality was determined with the Kolmogorov–Smirnov test. We used means and medians to describe the variables. Results: Forty-seven patients with actinomycetoma were included; female:male ratio 1.9:1; median age 38 years. The foot was the most affected region in 76.5% of cases. The bone invasion was observed in 89%. The time between symptoms onset and diagnosis was 5.5 years. Grain detection by direct examination was positive in 95% of cases. The most commonly used, as well as the most effective treatment scheme was streptomycin + sulfamethoxazole-trimethoprim with dapsone. Sixty-three percent (30 patients) achieved clinical and mycological cure, and 10.6% (5 patients) had treatment failure. Conclusions: We highlight the importance of designing therapeutic strategies to standardize treatments and gain more experience to improve the care of these patients.
Collapse
Affiliation(s)
- Alexandro Bonifaz
- Department of Dermatology, Hospital General de México, Mexico City, Mexico.,Mycology Service, Hospital General de México, Mexico City, Mexico
| | - Andrés Tirado-Sánchez
- Department of Dermatology, Hospital General de México, Mexico City, Mexico.,Department of Internal Medicine, Hospital General de Zona 29, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Javier Araiza
- Department of Dermatology, Hospital General de México, Mexico City, Mexico.,Mycology Service, Hospital General de México, Mexico City, Mexico
| | | |
Collapse
|
2
|
Sow D, Ndiaye M, Sarr L, Kanté MD, Ly F, Dioussé P, Faye BT, Gaye AM, Sokhna C, Ranque S, Faye B. Mycetoma epidemiology, diagnosis management, and outcome in three hospital centres in Senegal from 2008 to 2018. PLoS One 2020; 15:e0231871. [PMID: 32330155 PMCID: PMC7182189 DOI: 10.1371/journal.pone.0231871] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/29/2020] [Indexed: 02/04/2023] Open
Abstract
Mycetoma is a neglected tropical disease caused by various actinomycetes or fungi. The disease is characterized by the formation of tumor like-swellings and grains. Senegal is an endemic country where mycetoma cases are under-or misdiagnosed due to the lack of capacities and knowledge among health workers and the community; and where the management of eumycetoma, burdened by a high amputation rate, is currently inadequate. This study aimed to update data on the epidemiology of mycetoma cases diagnosed in three hospital centres in Senegal over a 10 years-period. A total of 193 patients, diagnosed from 2008 to 2018, were included in the study. The most frequent presentation was eumycetoma (47.2%); followed by actinomycetoma (36.8%); it remained undetermined in 16.1% of the patients. The mean age was 38.3 years (68.4% of the patients were between 15 and 45 years-old); the male: female ratio was a 2.94; and most were farmers. One hundred fifty-six (80.8%) patients had used phytotherapy before attending the hospital. Mycetoma was mainly located to the lower limbs (91.2%). Grains were observed in 85% of the patients; including white (25.6%) and yellow (4.3%) grains. The etiological diagnosis was complex, resulting in negative direct microscopy, culture and/or histopathology findings, which explains that 16.1% remained uncharacterized. In most of cases, actinomycetoma were treated with a combination of cotrimoxazole, amoxicillin/clavulanic acid, and streptomycin; whereas eumycetoma cases were treated with terbinafine. The surgery was done in 100 (51.8%) of the patients including 9 in actinomycetoma, 78 in eumycetoma and 13 in undetermined form. The high number of uncharacterized mycetoma in this study, the delay in attending a qualified health-care facility, and the lack of available adequate antifungal drug, point out the need to strengthen mycetoma management capacities in Senegal.
Collapse
Affiliation(s)
- Doudou Sow
- Service de Parasitologie-Mycologie, UFR Sciences de la Santé, Université Gasbon Berger de Saint Louis, Saint Louis, Sénégal
- Service de Parasitologie-Mycologie, Faculté de médecine, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
- UMR VITROME, Campus International IRD-UCAD de l’IRD, Dakar, Sénégal
- * E-mail:
| | - Maodo Ndiaye
- Service de Dermatologie, Hôpital Aristide Le Dantec, Dakar, Sénégal
| | - Lamine Sarr
- Service d’Orthopédie, Hôpital Aristide Le Dantec, Dakar, Sénégal
| | - Mamadou D. Kanté
- Service de Dermatologie, Hôpital Aristide Le Dantec, Dakar, Sénégal
| | - Fatoumata Ly
- Service de Dermatologie, Institut d’Hygiène Sociale, Dakar, Sénégal
| | - Pauline Dioussé
- Service de Dermatologie, Centre Hospitalier Régional de Thiès, Thiès, Sénégal
| | - Babacar T. Faye
- Service de Parasitologie-Mycologie, Faculté de médecine, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Abdou Magip Gaye
- Service d’anatomie pathologie, Hôpital Aristide Le Dantec, Dakar, Sénégal
| | - Cheikh Sokhna
- UMR VITROME, Campus International IRD-UCAD de l’IRD, Dakar, Sénégal
| | - Stéphane Ranque
- Aix Marseille Univ, IRD, APHM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - Babacar Faye
- Service de Parasitologie-Mycologie, Faculté de médecine, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| |
Collapse
|
3
|
Cárdenas-de la Garza JA, Welsh O, Cuéllar-Barboza A, Suarez-Sánchez KP, De la Cruz-Valadez E, Cruz-Gómez LG, Gallardo-Rocha A, Ocampo-Candiani J, Vera-Cabrera L. Clinical characteristics and treatment of actinomycetoma in northeast Mexico: A case series. PLoS Negl Trop Dis 2020; 14:e0008123. [PMID: 32097417 PMCID: PMC7059949 DOI: 10.1371/journal.pntd.0008123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 03/06/2020] [Accepted: 02/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background Mycetoma is a neglected tropical disease characterized by nodules, scars, abscesses, and fistulae that drain serous or purulent material containing the etiological agent. Mycetoma may be caused by true fungi (eumycetoma) or filamentous aerobic bacteria (actinomycetoma). Mycetoma is more frequent in the so-called mycetoma belt (latitude 15° south and 30° north around the Tropic of Cancer), especially in Sudan, Nigeria, Somalia, India, Mexico, and Venezuela. The introduction of new antibiotics with fewer side effects, broader susceptibility profiles, and different administration routes has made information on actinomycetoma treatment and outcomes necessary. The objective of this report was to provide an update on clinical, therapeutic, and outcome data for patients with actinomycetoma attending a reference center in northeast Mexico. Methodology/principal findings This was a retrospective, cross-sectional, descriptive study of 31 patients (male to female ratio 3.4:1) diagnosed with actinomycetoma by direct grain examination, histopathology, culture, or serology from January 2009 to September 2018. Most lesions were caused by Nocardia brasiliensis (83.9%) followed by Actinomadura madurae (12.9%) and Actinomadura pelletieri (3.2%). About 50% of patients had bone involvement, and the right leg was the most commonly affected region in 38.7% of cases. Farmers/agriculture workers were most commonly affected, representing 41.9% of patients. The most commonly used treatment regimen was the Welsh regimen (35.5% of cases), a combination of trimethoprim/sulfamethoxazole (TMP/SMX) plus amikacin, which had a 90% cure rate, followed by TMP/SMX plus amoxicillin/clavulanic acid in 19.4% of cases with a cure rate of 100%. In our setting, 28 (90.3%) patients were completely cured and three (9.7%) were lost to follow-up. Four patients required multiple antibiotic regimens due to recurrences and adverse effects. Conclusions/significance In our sample, actinomycetoma was predominantly caused by N. brasiliensis. Most cases responded well to therapy with a combination of TMP/SMX with amikacin or TMP/SMX and amoxicillin/clavulanic acid. Four patients required multiple antibiotics and intrahospital care. Mycetoma is a chronic skin disease that can invade bone or underlying organs. Inadequate treatment may lead to long-lasting disability. Information about treatment is scarce. We report the outcomes of 31 patients with a diagnosis of bacterial actinomycetoma attending a tertiary care hospital in northeast Mexico. Most cases were treated with a combination of antibiotics including TMP/SMX plus amikacin or TMP/SMX plus amoxicillin/clavulanic acid. Cure was achieved in 90% of patients and only one required surgery.
Collapse
Affiliation(s)
- Jesús Alberto Cárdenas-de la Garza
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Oliverio Welsh
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Adrián Cuéllar-Barboza
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Karina Paola Suarez-Sánchez
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Estephania De la Cruz-Valadez
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Luis Gerardo Cruz-Gómez
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Anabel Gallardo-Rocha
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jorge Ocampo-Candiani
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Lucio Vera-Cabrera
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
- * E-mail:
| |
Collapse
|
4
|
Abushouk A, Nasr A, Masuadi E, Allam G, Siddig EE, Fahal AH. The Role of Interleukin-1 cytokine family (IL-1β, IL-37) and interleukin-12 cytokine family (IL-12, IL-35) in eumycetoma infection pathogenesis. PLoS Negl Trop Dis 2019; 13:e0007098. [PMID: 30946748 PMCID: PMC6483278 DOI: 10.1371/journal.pntd.0007098] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/25/2019] [Accepted: 03/18/2019] [Indexed: 12/12/2022] Open
Abstract
Mycetoma is a neglected tropical disease, endemic in many tropical and subtropical regions, characterised by massive deformity and disability and can be fatal if untreated early and appropriately. Interleukins (IL) -35 and IL-37 are newly discovered cytokines that play an important role in suppressing the immune system. However, the expression of these interleukins in patients with Madurella mycetomatis (M. mycetomatis) induced eumycetoma has not yet been explored. The aim of this study is to determine the levels of IL-1 family (IL-1β, IL-37) and IL-12 family (IL-12, IL-35) in a group of these patients and the association between these cytokines levels and the patients’ demographic characteristics. The present, case-control study was conducted at the Mycetoma Research Centre, Soba University Hospital, University of Khartoum, Sudan and it included 140 individuals. They were divided into two groups; group I: healthy controls [n = 70; median age 25 years (range 12 to 70 years)]. Group II: mycetoma patients [n = 70 patients; median age 25 (range 13 to 70 years)]. Cytokines levels were measured in sera using enzyme linked immunosorbent assay (ELISA). There was a significant negative correlation between IL-1β and IL-12 levels and lesion size and disease duration, while IL-37 and IL-35 levels were significantly positively correlated with both lesion size and disease duration. The analysis of the risk factors of higher circulatory levels of IL-37 in patients of mycetoma showed a negative significant association with IL-1β cytokine, where a unit increment in IL-1β will decrease the levels of IL-37 by 35.28 pg/ml. The levels of IL-37 among the patients with a duration of mycetoma infection ≤ 1 year were significantly low by an average of 18.45 pg/ml compared to patients with a mycetoma infection’s duration of ≥ 5years (reference group). Furthermore, the risk factors of higher levels of IL-35 in mycetoma patients revealed a negative significant association with IL-12, as a unit increment in IL-12 decreases the levels of IL-35 by 8.99 pg/ml (p < 0.001). Levels of IL-35 among the patients with duration of mycetoma infection ≤ one year were significantly low on average by 41.82 pg/ml (p value = 0.002) compared to patients with a duration of mycetoma infection ≥ 5 years (reference group). In conclusion, this study indicates that both IL-35 and IL-37 are negatively associated with the levels of IL-1β and IL-12 in eumycetoma mycetoma infection; and high levels of IL-37 and IL-35 may have a negative impact on disease progression. Mycetoma is a progressive chronic granulomatous fungal or bacterial infection that may result in massive destruction of subcutaneous tissues, muscles and bones. Mycetoma is a neglected disease which is endemic in many tropical and subtropical areas. If the disease is not treated properly, eventually it ends up with amputation and adverse medical, health and socioeconomic effects on patients and the community. Previous data suggested a crucial role of adaptive immunity in host resistance to causative agents and in the disease progress. The recently identified IL-35 and IL-37 cytokines revealed an important role in immune suppression. Nevertheless, the expression of these interleukins in patients with mycetoma has not yet been investigated. Therefore, the present case-control study aimed to determine the levels of IL-1 family (IL-1β, IL-37) and IL-12 family (IL-12, IL-35) in these patients and the association between these cytokines levels and the patients’ demographic characteristics. The results of this study showed that, the levels of IL-37 and IL-35 were consistently positively correlated with different diameters of mycetoma lesions as well as its duration. However, the levels of IL-1β and IL-12 were consistently negatively correlated with different diameters of lesions and the duration of mycetoma infection. The analysis of the risk factors of higher circulatory levels of IL-37 in patients of mycetoma showed a negative significant association with IL-1β cytokine Furthermore, the risk factors of higher levels of IL-35 in patients of mycetoma revealed a negative significant association with IL-12. These findings uncover a possible the role of IL-35 and IL-37 in the pathogenesis of mycetoma, and may declare their potential value in treatment of mycetoma.
Collapse
Affiliation(s)
- Amir Abushouk
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul-Aziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Centre, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Amre Nasr
- King Abdullah International Medical Research Centre, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Emad Masuadi
- Research Unit, Department of Medical Education, College of Medicine-Riyadh, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Gamal Allam
- Department of Microbiology and Immunology, College of Medicine, Taif University, Taif, Saudi Arabia
- Immunology Section, Department of Zoology, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
| | | | - Ahmed H. Fahal
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- * E-mail: ,
| |
Collapse
|
5
|
Liang JY, Wang JQ, Tian X, Ruan JB, Zhang XB, Zhang SQ. The superficial structure of neurofibroma was cleared in Fonsecaea monophora infected skin area. Int J Infect Dis 2018; 73:67-68. [DOI: 10.1016/j.ijid.2018.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022] Open
|
6
|
Leeyaphan C, Hau C, Takeoka S, Tada Y, Bunyaratavej S, Pattanaprichakul P, Sitthinamsuwan P, Chaiprasert A, Sasajima Y, Makimura K, Watanabe S. Immune response in human chromoblastomycosis and eumycetoma - focusing on human interleukin-17A, interferon-gamma, tumour necrosis factor-alpha, interleukin-1 beta and human beta-defensin-2. Mycoses 2016; 59:751-756. [PMID: 27402133 DOI: 10.1111/myc.12526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/24/2016] [Accepted: 05/28/2016] [Indexed: 02/06/2023]
Abstract
Knowledge regarding host immune response to chromoblastomycosis and eumycetoma is limited, particularly concerning cytokines and antimicrobial peptides production. This was a retrospective study of 12 paraffin-embedded tissue samples from patients diagnosed with chromoblastomycosis or eumycetoma from histological findings and tissue culture. DNA extraction and polymerase chain reaction (PCR) from tissues were done to evaluate human interleukin-17A (IL-17A), interferon-gamma (IFN-γ), tumour necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β) and human beta-defensin-2 (HBD-2) expressions. Human beta-actin primer was used for confirming DNA detection, and DNA extracted from psoriasis lesional skin samples was used as positive controls. The twelve paraffin-embedded sections used in this study consisted of five chromoblastomycosis and seven eumycetoma tissues. All PCR reactions showed beta-actin band at 51 bp in all clinical specimens, confirming adequate DNA levels in each reaction. As positive control, the psoriasis skin samples revealed bands for IL-17A at 174 bp, IFN-γ at 273 bp, TNF-α at 360 bp, IL-1β at 276 bp and HBD-2 at 255 bp. For the chromoblastomycosis and eumycetoma tissues, PCR analyses showed IL-17A band at 174 bp in two eumycetoma tissues and HBD-2 band at 255 bp in a chromoblastomycosis tissue. This study demonstrated IL-17A expression in human eumycetoma and HBD-2 expression in human chromoblastomycosis for the first time. However, their role in immune response remains to be elucidated.
Collapse
Affiliation(s)
- Charussri Leeyaphan
- Department of Dermatology, Graduate School of Medicine, Teikyo University, Tokyo, Japan.,Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Carren Hau
- Department of Dermatology, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Shintaro Takeoka
- Department of Dermatology, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Yayoi Tada
- Department of Dermatology, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Sumanas Bunyaratavej
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Penvadee Pattanaprichakul
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Panitta Sitthinamsuwan
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Angkana Chaiprasert
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yuko Sasajima
- Department of Pathology, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Koichi Makimura
- Laboratory of Space and Environmental Medicine, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| |
Collapse
|
7
|
Shi L, Luo M, Chen WR, Hu C, Zhang G, Zhang F, Chen J, Mo X, Cai Q, Yang L, Wang X. In situ photoimmunotherapy for cutaneous granuloma caused by itraconazole-resistant Candida guilliermondii. Dermatol Ther 2016; 29:353-357. [PMID: 27328828 DOI: 10.1111/dth.12376] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Cutaneous granulomas caused by Candida guilliermondii are difficult to cure. In situ photoimmunotherapy (ISPI) is a novel method composed of local photothermal therapy and immunoadjuvant. In this study, ISPI was used the first time clinically for cutaneous granuloma caused by itraconazole-resistant C.guilliermondii. A 10-week cycle of ISPI was composed of (1) 5% imiquimod applied topically every other day and (2) irradiation of lesions with an 808-nm diode laser at Days 14, 28, 42, and 56. Here we report our first case. A patient was treated with ISPI for four cycles. After the treatment, the lesions were eliminated without recurrence during a 12-month follow-up. Our results demonstrate that ISPI can be used as an effective treatment modality for cutaneous fungal granuloma.
Collapse
Affiliation(s)
- Lei Shi
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Min Luo
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Wei R Chen
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, P. R. China.,Biophotonics Research Laboratory, Center for Interdisciplinary Biomedical Education and Research, University of Central Oklahoma, Edmond, Oklahoma, USA
| | - Chan Hu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Guolong Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Fuhe Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Jia Chen
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Xiaohui Mo
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Qing Cai
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Lianjuan Yang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, P. R. China.
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, P. R. China.
| |
Collapse
|
8
|
Mycetoma: a unique neglected tropical disease. THE LANCET. INFECTIOUS DISEASES 2016; 16:100-112. [PMID: 26738840 DOI: 10.1016/s1473-3099(15)00359-x] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/24/2015] [Accepted: 09/28/2015] [Indexed: 11/23/2022]
Abstract
Mycetoma can be caused by bacteria (actinomycetoma) or fungi (eumycetoma) and typically affects poor communities in remote areas. It is an infection of subcutaneous tissues resulting in mass and sinus formation and a discharge that contains grains. The lesion is usually on the foot but all parts of the body can be affected. The causative microorganisms probably enter the body by a thorn prick or other lesions of the skin. Mycetoma has a worldwide distribution but is restricted to specific climate zones. Microbiological diagnosis and characterisation of the exact organism causing mycetoma is difficult; no reliable serological test exists but molecular techniques to identify relevant antigens have shown promise. Actinomycetoma is treated with courses of antibiotics, which usually include co-trimoxazole and amikacin. Eumycetoma has no acceptable treatment at present; antifungals such as ketoconazole and itraconazole have been used but are unable to eradicate the fungus, need to be given for long periods, and are expensive. Amputations and recurrences in patients with eumycetoma are common.
Collapse
|
9
|
Burjack JR, Santana-Filho AP, Ruthes AC, Riter DS, Vicente VA, Alvarenga LM, Sassaki GL. Glycan analysis of Fonsecaea monophora from clinical and environmental origins reveals different structural profile and human antigenic response. Front Cell Infect Microbiol 2014; 4:153. [PMID: 25401093 PMCID: PMC4215789 DOI: 10.3389/fcimb.2014.00153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 10/11/2014] [Indexed: 11/17/2022] Open
Abstract
Dematiaceous fungi constitute a large and heterogeneous group, characterized by having a dark pigment, the dihydroxynaftalen melanin—DHN, inside their cell walls. In nature they are found mainly as soil microbiota or decomposing organic matter, and are spread in tropical and subtropical regions. The fungus Fonsecaea monophora causes chromoblastomycosis in humans, and possesses essential mechanisms that may enhance pathogenicity, proliferation and dissemination inside the host. Glycoconjugates confer important properties to these pathogenic microorganisms. In this work, structural characterization of glycan structures present in two different strains of F. monophora MMHC82 and FE5p4, from clinical and environmental origins, respectively, was performed. Each one were grown on Minimal Medium (MM) and Czapeck-Dox (CD) medium, and the water soluble cell wall glycoconjugates and exopolysaccharides (EPS) were evaluated by NMR, methylation and principal component analysis (PCA). By combining the methylation and 2D NMR analyses, it was possible to visualize the glycosidic profiles of the complex carbohydrate mixtures. Significant differences were observed in β-D-Galf-(1→5) and (1→6) linkages, α- and β-D-Glcp-(1→3), (1→4), and (1→6) units, as well as in α-D-Manp. PCA from 1H-NMR data showed that MMHC82 from CD medium showed a higher variation in the cell wall carbohydrates, mainly related to O-2 substituted β-D-Galf (δ 106.0/5.23 and δ 105.3/5.23) units. In order to investigate the antigenic response of the glycoconjugates, these were screened against serum from chromoblastomycosis patients. The antigen which contained the cell wall of MMHC82 grown in MM had β-D-Manp units that promoted higher antigenic response. The distribution of these fungal species in nature and the knowledge of how cell wall polysaccharides and glycoconjugates structure vary, may contribute to the better understanding and the elucidation of the pathology caused by this fungus.
Collapse
Affiliation(s)
- Juliana R Burjack
- Química de Carboidratos, Departamento de Patologia Básica, Universidade Federal do Paraná Curitiba, Brazil
| | | | - Andrea C Ruthes
- Departamento de Bioquímica e Biologia Molecular, Universidade Federal do Paraná Curitiba, Brazil
| | - Daniel S Riter
- Departamento de Bioquímica e Biologia Molecular, Universidade Federal do Paraná Curitiba, Brazil
| | - Vania A Vicente
- Química de Carboidratos, Departamento de Patologia Básica, Universidade Federal do Paraná Curitiba, Brazil
| | - Larissa M Alvarenga
- Química de Carboidratos, Departamento de Patologia Básica, Universidade Federal do Paraná Curitiba, Brazil
| | - Guilherme L Sassaki
- Departamento de Bioquímica e Biologia Molecular, Universidade Federal do Paraná Curitiba, Brazil
| |
Collapse
|
10
|
Gonzalez Santiago TM, Pritt B, Gibson LE, Comfere NI. Diagnosis of deep cutaneous fungal infections: correlation between skin tissue culture and histopathology. J Am Acad Dermatol 2014; 71:293-301. [PMID: 24836547 DOI: 10.1016/j.jaad.2014.03.042] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 03/21/2014] [Accepted: 03/30/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Deep cutaneous fungal infections (DCFIs) are responsible for significant morbidity and mortality, particularly in immunocompromised patients. Although a direct correlation between histopathologic examination and culture is expected, discordant findings may be seen, presenting a unique diagnostic and therapeutic challenge. OBJECTIVES We sought to determine the correlation between skin tissue cultures and histopathologic examination in patients with DCFI. METHODS This is a 10-year retrospective review (2003-2012) of patients with a diagnosis of DCFI seen at a single tertiary care institution. Tissue cultures and histopathologic findings were reviewed. RESULTS In 8 of 33 cases, fungal elements were seen on routine histopathologic sections but skin cultures were negative. Three of 8 of the discordant cases had concurrent positive non-skin tissue cultures that correlated with the pathology interpretation, and 3 of 8 patients in the discordant group died of systemic fungal infection. LIMITATIONS This was a retrospective study design and a single tertiary care institution experience. CONCLUSIONS The histopathologic interpretation of skin tissue specimens is critical for rapid and accurate diagnosis of DCFI. Despite the identification of fungal organisms on histopathologic assessment of skin tissue specimens, skin tissue culture may fail to show fungal growth. A diagnosis of a DCFI and initiation of appropriate treatment should always be considered in spite of discordant results.
Collapse
Affiliation(s)
| | - Bobbi Pritt
- Department of Laboratory Medicine and Pathology, Mayo Clinic, College of Medicine, Rochester, Minnesota
| | - Lawrence E Gibson
- Department of Dermatology, Mayo Clinic, College of Medicine, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, College of Medicine, Rochester, Minnesota
| | - Nneka I Comfere
- Department of Dermatology, Mayo Clinic, College of Medicine, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, College of Medicine, Rochester, Minnesota.
| |
Collapse
|
11
|
Welsh O, Vera-Cabrera L, Salinas-Carmona MC. Current treatment for nocardia infections. Expert Opin Pharmacother 2013; 14:2387-98. [DOI: 10.1517/14656566.2013.842553] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|