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Ditsios K, Katsimentzas T, Pitsilos C, Koukourikos I, Christidis P, Ditsios T, Konstantinou P, Varitimidis S. Deep Fungal Infections of the Upper Extremity - A Review. Orthop Rev (Pavia) 2024; 16:94570. [PMID: 38469579 PMCID: PMC10927313 DOI: 10.52965/001c.94570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 02/05/2024] [Indexed: 03/13/2024] Open
Abstract
Deep fungal infections are rare in the upper extremity. Vessel and nerve infection, synovitis, tenosynovitis, myofasciitis, arthritis and osteomyelitis have been discovered in literature. Treatment in most cases includes surgical procedure and antifungal agent use. Amputation is the final, most devastating for patient's functionality, solution. Intravenous antifungal drugs, frequently followed by oral administration, are important ancillary agents both for the initial treatment and the prevention of recurrence. We therefore performed a review of the current literature, in order to assemble the dispersed results of different studies and clarify the various aspects of upper extremity fungal infections.
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Affiliation(s)
- Konstantinos Ditsios
- 2nd Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Triantafyllos Katsimentzas
- 2nd Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Charalampos Pitsilos
- 2nd Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Ilias Koukourikos
- 2nd Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | | | | | - Panagiotis Konstantinou
- 2nd Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Sokrates Varitimidis
- Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, University of Thessaly, Larisa, Greece
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Leung AKC, Barankin B, Lam JM, Leong KF, Hon KL. Tinea pedis: an updated review. Drugs Context 2023; 12:2023-5-1. [PMID: 37415917 PMCID: PMC10321471 DOI: 10.7573/dic.2023-5-1] [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: 05/06/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
Background Tinea pedis is one of the most common superficial fungal infections of the skin, with various clinical manifestations. This review aims to familiarize physicians with the clinical features, diagnosis and management of tinea pedis. Methods A search was conducted in April 2023 in PubMed Clinical Queries using the key terms 'tinea pedis' OR 'athlete's foot'. The search strategy included all clinical trials, observational studies and reviews published in English within the past 10 years. Results Tinea pedis is most often caused by Trichophyton rubrum and Trichophyton interdigitale. It is estimated that approximately 3% of the world population have tinea pedis. The prevalence is higher in adolescents and adults than in children. The peak age incidence is between 16 and 45 years of age. Tinea pedis is more common amongst males than females. Transmission amongst family members is the most common route, and transmission can also occur through indirect contact with contaminated belongings of the affected patient. Three main clinical forms of tinea pedis are recognized: interdigital, hyperkeratotic (moccasin-type) and vesiculobullous (inflammatory). The accuracy of clinical diagnosis of tinea pedis is low. A KOH wet-mount examination of skin scrapings of the active border of the lesion is recommended as a point-of-care testing. The diagnosis can be confirmed, if necessary, by fungal culture or culture-independent molecular tools of skin scrapings. Superficial or localized tinea pedis usually responds to topical antifungal therapy. Oral antifungal therapy should be reserved for severe disease, failed topical antifungal therapy, concomitant presence of onychomycosis or in immunocompromised patients. Conclusion Topical antifungal therapy (once to twice daily for 1-6 weeks) is the mainstay of treatment for superficial or localized tinea pedis. Examples of topical antifungal agents include allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate and amorolfine. Oral antifungal agents used for the treatment of tinea pedis include terbinafine, itraconazole and fluconazole. Combined therapy with topical and oral antifungals may increase the cure rate. The prognosis is good with appropriate antifungal treatment. Untreated, the lesions may persist and progress.
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Affiliation(s)
- Alexander KC Leung
- Department of Pediatrics, The University of Calgary and The Alberta Children’s Hospital, Calgary, Alberta, Canada
| | | | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia and BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, Chinese University of Hong Kong Medical Centre, The Chinese University of Hong Kong, Shatin, Hong Kong
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Ugalde-Trejo NX, Delgado Moreno KP, Alfaro-Sánchez A, Tirado-Sánchez A, Bonifaz Trujillo JA. Two Feet-One Hand Syndrome: Tinea Pedis and Tinea Manuum. CURRENT FUNGAL INFECTION REPORTS 2022. [DOI: 10.1007/s12281-022-00447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Jordens Q, De Maeseneer H, De Crem C, Fölster-Holst R, Van Gysel D. Acral manifestations associated with infection. Pediatr Dermatol 2021; 38:1475-1487. [PMID: 34713504 DOI: 10.1111/pde.14831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acral lesions are well-known physical findings in various infectious disorders. Although they are often overlooked, they can be the key to the diagnosis of the underlying disease. Considering this, we present an overview of various infectious causes of acral lesions in childhood. In addition, we discuss their characteristic presentation, evolution, and appropriate treatment. To our knowledge, this is the first review covering viral, bacterial and mycotic causes.
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Affiliation(s)
- Quentin Jordens
- Department of Pediatrics, O.L.Vrouw Hospital Aalst, Aalst, Belgium.,Department of Pediatrics, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Charlotte De Crem
- Department of Pediatrics, O.L.Vrouw Hospital Aalst, Aalst, Belgium.,Department of Pediatrics, Universiteit Gent, Gent, Belgium
| | - Regina Fölster-Holst
- Clinic for Dermatology, Venerology and Allergology, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Dirk Van Gysel
- Department of Pediatrics, O.L.Vrouw Hospital Aalst, Aalst, Belgium.,Interdisciplinary Unit of Pediatric Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
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Bonifaz A, Tirado-Sánchez A, Araiza J, Treviño-Rangel R, González GM. Deep mycoses and pseudomycoses of the foot: a single-center retrospective study of 160 cases, in a tertiary-care center in Mexico. Foot (Edinb) 2021; 46:101770. [PMID: 33453613 DOI: 10.1016/j.foot.2020.101770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/12/2020] [Accepted: 11/21/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Deep mycoses and pseudomycoses (DMP) may cause significant disability and even death; however, the reports regarding these diseases, mainly affecting the foot, are scarce. OBJECTIVE To describe the epidemiological, clinical, and diagnostic characteristics of DMP of the foot in 160 patients. METHODS A retrospective and observational study of DMP affecting the foot was carried out in a tertiary-care center in Mexico for 20 years (from January 2000 to December 2019). Cases with confirmatory microbiological studies were included; the identification of the isolated fungi was based on the forms of reproduction. For actinomycetes, morphological analysis in an automated system ATB Vitek® 1574 (Biomèrieux) was used. The fungi were identified by PCR, using several primers from the ITS regions and for actinomycetes in the 16S rRNA region. Data from histopathological studies were also collected. RESULTS One hundred and sixty proven cases of DMP of the foot were included. The cases were categorized into nine types of infections including mycetoma (actinomycetoma and eumycetoma) in 102 cases (63.7%); sporotrichosis in 21 cases (13.1%); chromoblastomycosis, 18 cases (11.2%); phaeohyphomycosis, 3 cases (1.8%); histoplasmosis, 12 cases (7.5%); coccidioidomycosis 2 cases (1.2%) and botryomycosis and nocardiosis with one case respectively (0.6%). Most cases developed after traumatic implantation (147 cases, 91.8%). One hundred fifteen cases (71.8%) were men. The evolution was chronic in 125 cases (78.2%); bone involvement was observed in 64 cases (40%). Parasitic forms were observed In 139 cases (86.8%). The isolation and identification of the etiological agents were confirmed in all cases. CONCLUSION The main DMP affecting the foot were infections due to traumatic implantation; most were endemic mycoses. The clinical characteristics and the evolution of the diseases are easily misdiagnosed, and thus, diagnostic tests are usually required.
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Affiliation(s)
- Alexandro Bonifaz
- Dermatology Service, & Mycology Department, Hospital General De México, "Dr. Eduardo Liceaga", Mexico.
| | - Andrés Tirado-Sánchez
- Dermatology Service, & Mycology Department, Hospital General De México, "Dr. Eduardo Liceaga", Mexico
| | - Javier Araiza
- Dermatology Service, & Mycology Department, Hospital General De México, "Dr. Eduardo Liceaga", Mexico
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Pfister J, Summer D, Petrik M, Khoylou M, Lichius A, Kaeopookum P, Kochinke L, Orasch T, Haas H, Decristoforo C. Hybrid Imaging of Aspergillus fumigatus Pulmonary Infection with Fluorescent, 68Ga-Labelled Siderophores. Biomolecules 2020; 10:E168. [PMID: 31979017 PMCID: PMC7072563 DOI: 10.3390/biom10020168] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/14/2020] [Accepted: 01/19/2020] [Indexed: 01/16/2023] Open
Abstract
Aspergillus fumigatus (A. fumigatus) is a human pathogen causing severe invasive fungal infections, lacking sensitive and selective diagnostic tools. A. fumigatus secretes the siderophore desferri-triacetylfusarinine C (TAFC) to acquire iron from the human host. TAFC can be labelled with gallium-68 to perform positron emission tomography (PET/CT) scans. Here, we aimed to chemically modify TAFC with fluorescent dyes to combine PET/CT with optical imaging for hybrid imaging applications. Starting from ferric diacetylfusarinine C ([Fe]DAFC), different fluorescent dyes were conjugated (Cy5, SulfoCy5, SulfoCy7, IRDye 800CW, ATTO700) and labelled with gallium-68 for in vitro and in vivo characterisation. Uptake assays, growth assays and live-cell imaging as well as biodistribution, PET/CT and ex vivo optical imaging in an infection model was performed. Novel fluorophore conjugates were recognized by the fungal TAFC transporter MirB and could be utilized as iron source. Fluorescence microscopy showed partial accumulation into hyphae. µPET/CT scans of an invasive pulmonary aspergillosis (IPA) rat model revealed diverse biodistribution patterns for each fluorophore. [68Ga]Ga-DAFC-Cy5/SufloCy7 and -IRDye 800CW lead to a visualization of the infected region of the lung. Optical imaging of ex vivo lungs corresponded to PET images with high contrast of infection versus non-infected areas. Although fluorophores had a decisive influence on targeting and pharmacokinetics, these siderophores have potential as a hybrid imaging compounds combining PET/CT with optical imaging applications.
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Affiliation(s)
- Joachim Pfister
- Department of Nuclear Medicine, Medical University Innsbruck, A-6020 Innsbruck, Austria; (J.P.); (D.S.); (P.K.); (L.K.)
| | - Dominik Summer
- Department of Nuclear Medicine, Medical University Innsbruck, A-6020 Innsbruck, Austria; (J.P.); (D.S.); (P.K.); (L.K.)
| | - Milos Petrik
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, 772-00 Olomouc, Czech Republic; (M.P.); (M.K.)
| | - Marta Khoylou
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, 772-00 Olomouc, Czech Republic; (M.P.); (M.K.)
| | - Alexander Lichius
- Department of Microbiology, University Innsbruck, A-6020 Innsbruck, Austria;
| | - Piriya Kaeopookum
- Department of Nuclear Medicine, Medical University Innsbruck, A-6020 Innsbruck, Austria; (J.P.); (D.S.); (P.K.); (L.K.)
| | - Laurin Kochinke
- Department of Nuclear Medicine, Medical University Innsbruck, A-6020 Innsbruck, Austria; (J.P.); (D.S.); (P.K.); (L.K.)
| | - Thomas Orasch
- Division of Molecular Biology, Medical University Innsbruck, A-6020 Innsbruck, Austria; (T.O.); (H.H.)
| | - Hubertus Haas
- Division of Molecular Biology, Medical University Innsbruck, A-6020 Innsbruck, Austria; (T.O.); (H.H.)
| | - Clemens Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, A-6020 Innsbruck, Austria; (J.P.); (D.S.); (P.K.); (L.K.)
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