1
|
Garinet S, Tourret J, Barete S, Arzouk N, Meyer I, Frances C, Datry A, Mazier D, Barrou B, Fekkar A. Invasive cutaneous Neoscytalidium infections in renal transplant recipients: a series of five cases. BMC Infect Dis 2015; 15:535. [PMID: 26586129 PMCID: PMC4653896 DOI: 10.1186/s12879-015-1241-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/21/2015] [Indexed: 11/26/2022] Open
Abstract
Background Neoscytalidium species (formerly Scytalidium species) are black fungi that usually cause cutaneous infections mimicking dermatophytes lesions. Very few publications have reported invasive or disseminated infections. Case presentation In this paper, we report the clinical presentations, treatments and outcomes of five cases of invasive Neoscytalidium infections with cutaneous involvement, including two cases with disseminated infection, in five renal transplant recipients. To our knowledge, this is the first report of a series—albeit small—of renal transplant patients in whom this infection was identified. All cases occurred in a single hospital in Paris, France, between 2001 and 2011. Patients all originate from tropical area. Conclusion Treatments of Neoscytalidium infection varied greatly, underlining the lack of a recommendation for a standardized treatment. All patients were cured after long-term antifungal therapy and/or surgical excision. Interestingly, one patient with disseminated infection involving the left elbow, the right leg, the lungs and the nasal septum was cured by medical therapy only without surgery. This may suggest that in contrast to others mycoses (such as mucormycosis), an adequate medical treatment could be sufficient for treating Neoscytalidium. We also point out the difficulties we had in diagnosing two patients with Kaposi’s sarcoma because of the similarity of the lesions. Furthermore, our report underlines the need to check for this rare infection in immunocompromised kidney transplant recipients originating from tropical areas.
Collapse
Affiliation(s)
- Simon Garinet
- AP-HP, Groupe hospitalier La Pitié-Salpêtrière, Service de Parasitologie Mycologie, F-75013, Paris, France.
| | - Jérôme Tourret
- Département d'urologie, néphrologie et transplantation, AP-HP, Groupe hospitalier Pitié-Salpêtrière, F-75013, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, F-75005, Paris, France.
| | - Stéphane Barete
- Sorbonne Universités, UPMC Univ Paris 06, F-75005, Paris, France. .,AP-HP, Groupe hospitalier Pitié-Salpêtrière, Unité fonctionnelle de Dermatologie F-75013, Université Paris Sorbonne-UPMC, Paris, France.
| | - Nadia Arzouk
- Département d'urologie, néphrologie et transplantation, AP-HP, Groupe hospitalier Pitié-Salpêtrière, F-75013, Paris, France.
| | - Isabelle Meyer
- AP-HP, Groupe hospitalier La Pitié-Salpêtrière, Service de Parasitologie Mycologie, F-75013, Paris, France.
| | - Camille Frances
- Sorbonne Universités, UPMC Univ Paris 06, F-75005, Paris, France. .,AP-HP, Groupe hospitalier Pitié-Salpêtrière, Unité fonctionnelle de Dermatologie F-75013, Université Paris Sorbonne-UPMC, Paris, France.
| | - Annick Datry
- AP-HP, Groupe hospitalier La Pitié-Salpêtrière, Service de Parasitologie Mycologie, F-75013, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, F-75005, Paris, France.
| | - Dominique Mazier
- AP-HP, Groupe hospitalier La Pitié-Salpêtrière, Service de Parasitologie Mycologie, F-75013, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, F-75005, Paris, France. .,Centre d'Immunologie et des Maladies Infectieuses, CIMI-Paris, F-75013, Paris, France.
| | - Benoit Barrou
- Département d'urologie, néphrologie et transplantation, AP-HP, Groupe hospitalier Pitié-Salpêtrière, F-75013, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, F-75005, Paris, France.
| | - Arnaud Fekkar
- AP-HP, Groupe hospitalier La Pitié-Salpêtrière, Service de Parasitologie Mycologie, F-75013, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, F-75005, Paris, France. .,Centre d'Immunologie et des Maladies Infectieuses, CIMI-Paris, F-75013, Paris, France.
| |
Collapse
|
2
|
Abstract
Onychomycoses represent about 30% of superficial mycosis that are encountered in Dermatology consults. Fungi such as dermatophytes, which are mainly found on the feet nails, cause nearly 50% of these onychopathies. Yeasts are predominantly present on hands, whereas non-dermatophytic moulds are very seldom involved in both foot and hand nails infections. According to literature, these moulds are responsible for 2 to 17% of onychomycoses. Nevertheless, we have to differentiate between onychomycoses due to pseudodermatophytes such as Neoscytalidium (ex-Scytalidium) and Onychocola canadensis, which present a high affinity for keratin, and onychomycoses due to filamentous fungi such as Aspergillus, Fusarium, Scopulariopsis, Acremonium... These saprophytic moulds are indeed most of the time considered as colonizers rather than real pathogens agents. Mycology and histopathology laboratories play an important role. They allow to identify the species that is involved in nail infection, but also to confirm parasitism by the fungus in the infected nails. Indeed, before attributing any pathogenic role to non-dermatophytic moulds, it is essential to precisely evaluate their pathogenicity through samples and accurate mycological and/or histological analysis. The treatment of onychomycoses due to non-dermatophytic moulds is difficult, as there is today no consensus. The choice of an antifungal agent will first depend on the species that is involved in the infection, but also on the severity of nail lesions and on the patient himself. In most cases, the onychomycosis will be cured with chemical or mechanical removing of the infected tissues, followed by a local antifungal treatment. In some cases, a systemic therapy will be discussed.
Collapse
Affiliation(s)
- D Chabasse
- Institut de biologie en santé, laboratoire de parasitologie-mycologie, centre hospitalier universitaire, 4, rue Larrey, 49933 Angers cedex 9, France.
| | - M Pihet
- Institut de biologie en santé, laboratoire de parasitologie-mycologie, centre hospitalier universitaire, 4, rue Larrey, 49933 Angers cedex 9, France
| |
Collapse
|