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Aljundi M, Brun S, Akhoundi M, Didier M, Jabbour R, Izri A, Caux F, Bohelay G. Recurrent Subcutaneous Phaeohyphomycosis Due to Medicopsis romeroi: A Case Report in a Dermatomyositis Patient and Review of the Literature. Microorganisms 2022; 11:microorganisms11010003. [PMID: 36677294 PMCID: PMC9867221 DOI: 10.3390/microorganisms11010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Medicopsis romeroi phaeohyphomycosis is increasingly reported in immunocompromised patients living in or originating from tropical and subtropical areas. We report a case of subcutaneous phaeohyphomycosis caused by M. romeroi in a 56-year-old Malian woman residing in France for 20 years. She developed a small nodule on her dominant hand's ring finger 15 months after starting immunosuppressive medications for paraneoplastic dermatomyositis. A first surgical debridement was followed by a local recurrence. Despite a second surgical excision combined with posaconazole treatment, the infection recurred one year after antifungal therapy discontinuation. A wide excision was performed again, and antifungal therapy was resumed and maintained for six months, resulting in the absence of relapse during the 18 months following the surgery. This case highlighted the high risk of relapse in immunocompromised patients, suggesting the need for long-term follow-up and prolonged antifungal treatment following surgical excision in cases with sustained immunosuppression. The literature review was performed according to PRISMA guidelines and included 51 scientific publications. A noteworthy predominance of the subcutaneous phaeohyphomycosis presentation was found in immunocompromised patients, whereas eumycetoma had been reported in apparently healthy individuals. A combination of complete excision with antifungal treatment seemed to confer the best outcome.
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Affiliation(s)
- Mohanad Aljundi
- Department of Dermatology, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires de Paris Seine-Saint-Denis (HUPSSD), 93000 Bobigny, France
- Correspondence: ; Tel.: +33-1-48-95-51-89; Fax: +33-1-48-95-51-87
| | - Sophie Brun
- Department of Parasitology-Mycology, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires de Paris Seine-Saint-Denis (HUPSSD), 93000 Bobigny, France
- Inserm UMR 1125 Li2P, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord (USPN), 93000 Bobigny, France
| | - Mohammad Akhoundi
- Department of Parasitology-Mycology, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires de Paris Seine-Saint-Denis (HUPSSD), 93000 Bobigny, France
| | - Morgane Didier
- Department of Pneumology, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 93000 Bobigny, France
| | - Roula Jabbour
- Department of Pathology, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 93000 Bobigny, France
| | - Arezki Izri
- Department of Parasitology-Mycology, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires de Paris Seine-Saint-Denis (HUPSSD), 93000 Bobigny, France
- Inserm UMR 1125 Li2P, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord (USPN), 93000 Bobigny, France
| | - Frédéric Caux
- Department of Dermatology, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires de Paris Seine-Saint-Denis (HUPSSD), 93000 Bobigny, France
- Inserm UMR 1125 Li2P, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord (USPN), 93000 Bobigny, France
| | - Gérôme Bohelay
- Department of Dermatology, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires de Paris Seine-Saint-Denis (HUPSSD), 93000 Bobigny, France
- Inserm UMR 1125 Li2P, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord (USPN), 93000 Bobigny, France
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Ganduri B, Sujith R, Tirlangi P, Nalla R, Veturi SY, Singh G, Xess I, Keithi-Reddy SR. Disseminated Medicopsis Romeroi Infection in a Kidney Transplant Recipient. J Mycol Med 2022; 33:101355. [PMID: 36529086 DOI: 10.1016/j.mycmed.2022.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/14/2022] [Accepted: 12/02/2022] [Indexed: 12/07/2022]
Abstract
Medicopsis romeroi is a rare, dematiaceous fungus that is difficult to identify using conventional fungal tests. Although uncommon, immunocompromised patients are particularly susceptible to this opportunistic fungus. Here, we report the case of a renal transplant recipient who presented with painful disseminated subcutaneous and soft tissue lesions. Sequencing of the Internal transcribed spacer (ITS) region of the ribosomal DNA identified the fungus as Medicopsis romeroi. Additionally, tissue samples from a non-healing wound on the left forearm grew Rhizopus spp. on Sabouraud dextrose agar, indicating a Mucormycosis superinfection. The patient's condition improved with surgical intervention and antifungal therapy with Posaconazole and Terbinafine. This case demonstrates the need for a high index of suspicion in order to facilitate early diagnosis and treatment and thus reduce the risk of dissemination.
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Affiliation(s)
| | - R Sujith
- AIG Hospitals, Hyderabad and AIIMS, New Delhi.
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Fungal Infections of Implantation: More Than Five Years of Cases of Subcutaneous Fungal Infections Seen at the UK Mycology Reference Laboratory. J Fungi (Basel) 2022; 8:jof8040343. [PMID: 35448574 PMCID: PMC9028115 DOI: 10.3390/jof8040343] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 01/20/2023] Open
Abstract
Subcutaneous fungal infections, which typically result from traumatic introduction (implantation) of fungal elements into the skin or underlying tissues, can present as a range of different clinical entities including phaeohyphomycosis, chromoblastomycosis, subcutaneous nodules or masses, and genuine eumycetoma. Here, we mined our laboratory information management system for such infections in humans and domestic animals for the period 2016–2022, including (i) fungal isolates referred for identification and/or susceptibility testing; (ii) infections diagnosed at our laboratory using panfungal PCR approaches on infected tissue; and (iii) organisms cultured in our laboratory from biopsies. In total, 106 cases were retrieved, involving 39 fungal species comprising 26 distinct genera. Subcutaneous infections with Alternaria species were the most frequent (36 cases), which possibly reflects the ubiquitous nature of this common plant pathogen. A substantial proportion of Alternaria spp. isolates exhibited reduced in vitro susceptibility to voriconazole. Notably, a significant number of subcutaneous infections were diagnosed in renal and other solid organ transplant recipients post transplantation, suggesting that humans may harbour “inert” subcutaneous fungal elements from historical minor injuries that present as clinical infections upon later immunosuppression. The current study underscores the diversity of fungi that can cause subcutaneous infections. While most organisms catalogued here were responsible for occasional infections, several genera (Alternaria, Exophiala, Phaeoacremonuim, Scedosporium) were more frequently recovered in our searches, suggesting that they possess virulence factors that facilitate subcutaneous infections and/or inhabit natural niches that make them more likely to be traumatically inoculated.
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Radcliffe C, Radcliffe AJ, Azar MM, Grant M. Dematiaceous fungal infections in solid organ transplantation: systematic review and bayesian meta-analysis. Transpl Infect Dis 2022; 24:e13819. [PMID: 35253959 DOI: 10.1111/tid.13819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/03/2022] [Accepted: 02/19/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Dematiaceous fungi cause a number of infectious syndromes referred to as phaeohyphomycosis among both immunocompetent and immunocompromised hosts. We performed a systematic review to characterize these infections in solid organ transplant recipients (SOTR). METHODS We searched PubMed database (last searched 1/6/2022) for English-language reports on dematiaceous fungal infections in SOTR. Included reports needed individualized demographic, treatment, and outcome data; pediatric reports were excluded. A universally applicable bias assessment was performed on reports. Models for infection type and outcome were created using the Bayesian paradigm. RESULTS We included 149 reports on 201 cases of dematiaceous fungal infections in SOTR. The mean age was 54 years, 72% were men, and kidney recipients accounted for 61% of cases. Skin and soft tissue infection (SSTI) was the most common infectious syndrome (73%). Death from infection occurred in 7% of cases (14/201), with disseminated (32%) cases having the highest mortality. Our model for infection type predicted the relative probability of central nervous system infection to be highest in liver recipients. Across all transplant types, higher relative probabilities of disseminated and pulmonary infections occur in the early post-transplant period, and the predicted probabilities for these infection types decreased after 100 months post-transplantation. DISCUSSION We identified SSTI as the most common dematiaceous fungal infections in SOTR. Disseminated infections carried the worst prognosis. The evidence in this review is limited by the heterogeneity of included cases. No funding source was used, and this review's protocol was not registered. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Marwan M Azar
- Yale University School of Medicine, New Haven, CT, USA.,Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew Grant
- Yale University School of Medicine, New Haven, CT, USA.,Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
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