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Li DM, Lun LD. Rhino-Orbital-Cerebral Mycosis and Extranodal Natural Killer or/and T-Cell Lymphoma, Nasal Type. Front Med (Lausanne) 2022; 9:851208. [PMID: 35783622 PMCID: PMC9248758 DOI: 10.3389/fmed.2022.851208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Extranodal natural killer/T-cell lymphoma, nasal type is a syndrome of middle face destruction with an association to Epstein-Barr virus. Fungi have been recovered from the diseased tissue now and then but were often seen as a lymphoma-associated secondary infection. However, there are ENKTL-NT cases with the recoveries of fungi and complete recovery with antifungal therapy, which are quite similar to rhino-orbital-cerebral mycosis (ROCM) that often confuses the physicians. Methods We searched Medline for English-language manuscripts limited to “human” and “case reports,” “letters,” “reviews,” and “clinical conferences” from 1966 to 2022. We used MeSH terms “lymphoma, extranodal nk-t-cell” [MeSH Terms] or “lethal midline granuloma” [MeSH Terms], in combination with MeSH terms “microbiology” [subheading] or “microbiology” [all fields] or “fungi” [all fields] or “fungi” [MeSH Terms] for ENKTL-NT with infections. We used MeSH terms “Mycoses” in combination with “Nose” [Mesh] OR “Orbital Diseases” [Mesh] for rhino-orbital-cerebral fungal infections. Results We appraised 149 included articles and extracted references related to ENKTL-NT and/or ROCM. Themes and subcategories were subsequently derived. Our findings revealed that ROCM and ENKTL-NT are characterized by progressive and destructive ulcers in the midline face or rhino-orbital structures. ROCM is mainly caused by fungi in the order of Mucorales, and ENKTL-NT is usually associated with Epstein-Barr virus and sometimes fungi. Radiologically, both are characterized by non-specific features of sinusitis, soft tissue infection, and necrosis. Pathologically, ROCM and ENKTL-NT share the same characteristics of inflammation, necrosis, and granuloma. ROCM is characterized by the detection of fungi in tissue, while ENKTL-NT is typically positive for NK/T-cell markers and cytotoxic granule-associated proteins, proliferation, and vascular damage of angioinvasion, which could be incited by Mucor irregularis and Rhizopus arrhizus in patients and mice. Conclusion ENKTL-NT and ROCM share many similarities in clinical presentations, radiology, and histopathology, and might have the same etiology. This may explain why the two diseases are tangled together in the reported cases, and suggests the role that the fungi may play in the development of these ENKTL-NT/ROCM diseases. The reason why ENKTL-NT and ROCM are sometimes confused is that the main pathogens of ROCM, Mucor irregularis and Rhizopus arrhizus, are the fungal causative agents of ENKTL-NT.
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Affiliation(s)
- Dong Ming Li
- Division of Dermatology and Mycological Lab, Peking University Third Hospital, Beijing, China
- *Correspondence: Dong Ming Li, ,
| | - Li De Lun
- Division of Nephrology and Rheumatism, Air Force General Hospital PLA, Beijing, China
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Tian L, Mu Y, Zhang H, Su X, Yang C, Shu X, Qing D. First report on cutaneous infectious granuloma caused by Schizophyllum commune. BMC Infect Dis 2018; 18:286. [PMID: 29940940 PMCID: PMC6019233 DOI: 10.1186/s12879-018-3187-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Schizophyllum commune, a basidiomycetous fungus, is a common invader of rotten wood. This fungus rarely causes mycotic disease in humans, especially cutaneous infection. In this paper, we describe the first case of cutaneous granuloma caused by S. commune in a Chinese woman. Case presentation A 25-year-old female with a two-year history of erythema, papules, nodules, and scales on her sole of left foot was presented to our outpatient center. Samples were obtained by the scraping of lesion and for light microscopy. Hyphae were observed by microscopic examination. We carried out a skin tissue biopsy, which showed multiple granulomatous nodules. Biopsy specimens were also inoculated onto media. After being cultured on SDA at 27 °C for 7 days, spreading-woolly-white colonies grew on the inoculation sites of media containing chloramphenicol only and there,s no other colonies grew. S. commune was identified by morphology methods, biochemical tests, and PCR sequencing. Pathological findings also aided in diagnosing cutaneous fungal granuloma. Oral itraconazole was applied. After 1 month of therapy, rashes on her left foot and pain were improved. Conclusion We describe the first case of cutaneous granuloma caused by Schizophyllum commune, which illustrates the importance of recognizing uncommon pathogenic fungal infections.
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Affiliation(s)
- Lidi Tian
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yunzhu Mu
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hao Zhang
- Department of Dermatology, Shenzhen Baoan Central Hospital and the 5th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China.
| | - Xiaocui Su
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chuan Yang
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xianzhu Shu
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Defu Qing
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Liu X, Zou H, Chen QJ, Lu CM. Allergic fungal sinusitis caused by Schizophyllum commune. World J Otorhinolaryngol Head Neck Surg 2017; 3:59-63. [PMID: 29204581 PMCID: PMC5683597 DOI: 10.1016/j.wjorl.2017.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 02/28/2017] [Indexed: 11/15/2022] Open
Abstract
A case of allergic fungal sinusitis (AFS) due to Schizophyllum commune was reported. The pathogen was identified using molecular bioanalysis. The patient underwent the functional endoscopic sinus surgery followed by the radical maxillary sinusotomy with canine fossa trephine. This case suggested that complete surgery allowed optimal disease clearance for AFS caused by Schizophyllum commune.
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Affiliation(s)
- Xiang Liu
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 West YanJiang Rd, GuangZhou, GuangDong, 510120, PR China
| | - Hua Zou
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 West YanJiang Rd, GuangZhou, GuangDong, 510120, PR China
| | - Qiu-Jian Chen
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 West YanJiang Rd, GuangZhou, GuangDong, 510120, PR China
| | - Chang-Ming Lu
- Mycological Laboratory, Department of Dermatology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 West YanJiang Rd, GuangZhou, GuangDong, 510120, PR China
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4
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Schizophyllum radiatum, an Emerging Fungus from Human Respiratory Tract. J Clin Microbiol 2016; 54:2491-7. [PMID: 27440814 DOI: 10.1128/jcm.01170-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/13/2016] [Indexed: 11/20/2022] Open
Abstract
Schizophyllum is an important genus of basidiomycetes that, apart from being of genetic and biotechnological interest, is also reported to be a plant and animal pathogen. Schizophyllum commune is the best-known species and the only one reported from clinical specimens thus far, being recovered mainly from the respiratory tract. The aim of this study was to determine the species diversity of 23 clinical isolates of Schizophyllum from the United States using multilocus phylogenetic analysis and their in vitro susceptibilities to six drugs. The markers used for sequencing were the internal transcribed spacer (ITS), a portion of the nuclear large subunit (LSU) of ribosomal DNA, the RNA polymerase II second-largest subunit (RPB2), and the translation elongation factor 1α (EF-1α) gene. The analyses revealed that 22 of the clinical isolates were in the Schizophyllum radiatum clade with high support values and 1 isolate was in the S. commune clade. This is the first report of this species in clinical samples. The two species mentioned above showed very similar morphological features in culture (i.e., white, cottony, unsporulated colonies composed of hyphae with clamp connections), making morphological discrimination between the two impossible. An epitype is designed for S. radiatum, and its sequences have been deposited in GenBank. The antifungal that showed the greatest in vitro activity against the strains tested was shown to be amphotericin B. In general, the strains of S. radiatum showed higher MICs than S. commune.
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Comacle P, Belaz S, Jegoux F, Ruaux C, Le Gall F, Gangneux JP, Robert-Gangneux F. Contribution of molecular tools for the diagnosis and epidemiology of fungal chronic rhinosinusitis. Med Mycol 2016; 54:794-800. [PMID: 27335058 DOI: 10.1093/mmy/myw041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/21/2016] [Indexed: 11/13/2022] Open
Abstract
Chronic rhinosinusitis (CRS) rank second at chronic inflammatory diseases in industrialized countries and are an important public health concern. Diagnosis relies on a set of arguments including clinical signs, imaging, histopathologic and mycological analyses of sinus specimens, collected during nasal endoscopy. The sensitivity of fungal cultures is reported to be poor, even when direct examination is positive, thus the epidemiology of fungal chronic sinusitis is ill-known. This study evaluated the sensitivity of molecular diagnosis in 70 consecutive samples (61 patients with CRS) analysed at the University Hospital of Rennes during a 3-year period. DNA detection was performed using a conventional PCR method targeting the ITS1/ITS2 sequence and the resulting amplification products were sequenced. Fungal CRS was proven in 42 patients (69%), of which only 20 (48%) had a positive culture. 37/42 (88%) patients were diagnosed with a fungus ball, 3 with allergic fungal CRS and 2 with undetermined fungal CRS. PCR was positive in all 42 cases and direct sequencing allowed to identify fungi in all cases but one, and detected multiple infection in 3. Aspergillus fumigatus was present in 69% of patients; Cladosporium cladosporoides in 9.5%, Scedosporium sp., A. nidulans and A. flavus in 7% each. In 2/19 patients with negative direct examination, sequencing analysis revealed the presence of Capnobotryella sp. and C. cladosporoides, in clinical settings compatible with fungal sinusitis. In conclusion, ITS1/ITS2 PCR had a twice better sensitivity than culture, and combined sequencing provides accurate epidemiological data on fungal CRS.
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Affiliation(s)
- Pauline Comacle
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sorya Belaz
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Rennes, Rennes, France Inserm U1085-IRSET, Université Rennes 1, Rennes, France
| | - Franck Jegoux
- Service d'Otorhino-laryngologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | | | - François Le Gall
- Service d'Anatomo-Pathologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Jean-Pierre Gangneux
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Rennes, Rennes, France Inserm U1085-IRSET, Université Rennes 1, Rennes, France
| | - Florence Robert-Gangneux
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Rennes, Rennes, France Inserm U1085-IRSET, Université Rennes 1, Rennes, France
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Michel J, Maubon D, Varoquaux DA, Boulze C, Normand AC, Righini CA, Piarroux R, Dessi P, Ranque S. Schizophyllum commune: an emergent or misdiagnosed fungal pathogen in rhinology? Med Mycol 2015; 54:301-9. [PMID: 26613704 DOI: 10.1093/mmy/myv084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/10/2015] [Indexed: 11/14/2022] Open
Abstract
Schizophyllum commune is a common basidiomycete fungus that is rarely involved in human disease. The medical records of patients operated on for fungal rhinosinusitis (FRS) in two University Hospitals between 2012 and 2014 were reviewed. Within the two-year survey, six female, and notably no male, patients were diagnosed with S. commune rhinosinusitis. Mean age was 44.6 years at diagnosis (30 to 68 years). Mean time between onset of symptoms and diagnosis was 8.5 months (2 to 12 months). All six patients were immunocompetent and had no particular host factor for FRS. S. commune was identified using MALDI-TOF mass spectrometry and identifications were confirmed via DNA sequence analysis. Chronic invasive fungal rhinosinusitis was diagnosed in three of our six patients. Based on histological findings, antifungal treatment was delivered in association with surgery. The basidiomycete fungus S. commune is an emerging cause of rhinosinusitis probably as a direct consequence of the recent technological progress in fungal identification methods (DNA sequencing and MALDI-TOF mass spectrometry).
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Affiliation(s)
- Justin Michel
- Department of Otorhinolaryngology, Head and Neck Surgery, APHM CHU Timone, and Aix-Marseille University, 13385 Marseille Cedex 5, France
| | - Danièle Maubon
- Parasitologie-Mycologie, Département des Agents Infectieux, CHU Grenoble and Université Grenoble Alpes, Grenoble, France
| | | | - Carole Boulze
- Department of Otorhinolaryngology, Head and Neck Surgery, APHM CHU Timone, and Aix-Marseille University, 13385 Marseille Cedex 5, France
| | - Anne Cécile Normand
- Parasitologie-Mycologie, Assistance Publique-Hôpitaux de Marseille, CHU Timone-Adultes, Marseilles, France
| | - Christian Adrien Righini
- Department of Otorhinolaryngology, Head and Neck Surgery CHU Grenoble and Université Grenoble Alpes, Grenoble, France
| | - Renaud Piarroux
- Parasitologie-Mycologie, Assistance Publique-Hôpitaux de Marseille, CHU Timone-Adultes, Marseilles, France Aix-Marseille University, IP-TPT UMR MD3, 13885 Marseilles, France
| | - Patrick Dessi
- Department of Otorhinolaryngology, Head and Neck Surgery, APHM CHU Timone, and Aix-Marseille University, 13385 Marseille Cedex 5, France
| | - Stéphane Ranque
- Parasitologie-Mycologie, Assistance Publique-Hôpitaux de Marseille, CHU Timone-Adultes, Marseilles, France Aix-Marseille University, IP-TPT UMR MD3, 13885 Marseilles, France
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Schizophillum commune causing sinusitis with nasal polyposis in the sub-Himalayan region: first case report and review. Mycopathologia 2013; 177:103-10. [PMID: 24318775 DOI: 10.1007/s11046-013-9717-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 11/03/2013] [Indexed: 10/25/2022]
Abstract
Schizophillum commune is an environmental fungus rarely causing human infections of diverse nature. Sinusitis occurs in immunocompromised persons and seldom in healthy subjects. Though easily isolated, the lack of awareness of its virulence is a bottleneck in the diagnosis of this infection. We report the first case of S. commune sinusitis with nasal polyps in an immunocompetent male from the sub-Himalayan region. The computerized tomography scan findings established the clinical diagnosis, and causative agent was confirmed as S. commune. A white, woolly mold with septate, hyaline hyphae and characteristic spicules but unclamped connections suggested a monokaryotic isolate. Patient was treated successfully with fiberoptic endoscopic sinus surgery, and no antifungal therapy was instituted. There was no recurrence at review after 1 year.
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8
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Molecular characterization and in vitro antifungal susceptibility profile of Schizophyllum commune, an emerging basidiomycete in bronchopulmonary mycoses. Antimicrob Agents Chemother 2013; 57:2845-8. [PMID: 23507274 DOI: 10.1128/aac.02619-12] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Schizophyllum commune (n = 30) showed lowest geometric mean MICs of isavuconazole (0.19 μg/ml), itraconazole (0.2 μg/ml), voriconazole (0.24 μg/ml), and amphotericin B (0.29 μg/ml) and high geometric mean MICs of fluconazole (19.39 μg/ml) and flucytosine (17.28 μg/ml). Five cases (of 8) of allergic bronchopulmonary mycosis that were treated with itraconazole had no recrudescence after 6 to 24 months of follow-up. One case each of invasive pulmonary mycosis and fungal ball were treated successfully with voriconazole and itraconazole.
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9
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Chowdhary A, Agarwal K, Kathuria S, Gaur SN, Randhawa HS, Meis JF. Allergic bronchopulmonary mycosis due to fungi other than Aspergillus: a global overview. Crit Rev Microbiol 2013; 40:30-48. [PMID: 23383677 DOI: 10.3109/1040841x.2012.754401] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Allergic bronchopulmonary mycosis (ABPM) is a hypersensitivity-mediated disease of worldwide distribution. We reviewed 143 reported global cases of ABPM due to fungi other than aspergilli. The commonest etiologic agent was Candida albicans, reported in 60% of the cases, followed by Bipolaris species (13%), Schizophyllum commune (11%), Curvularia species (8%), Pseudallescheria boydii species complex (3%) and rarely, Alternaria alternata, Fusarium vasinfectum, Penicillium species, Cladosporium cladosporioides, Stemphylium languinosum, Rhizopus oryzae, C. glabrata, Saccharomyces cerevisiae and Trichosporon beigelii. India accounted for about 47% of the globally reported cases of ABPM, attributed predominantly to C. albicans, followed by Japan (16%) where S. commune predominates, and the remaining one-third from the USA, Australia and Europe. Notably, bronchial asthma was present in only 32% of ABPM cases whereas its association with development of allergic bronchopulmonary aspergillosis (ABPA) is known to be much more frequent. The cases reviewed herein revealed a median IgE value threefold higher than that of ABPA, suggesting that the etiologic agents of ABPM incite a stronger immunological response than that by aspergilli in ABPA. ABPM is currently underdiagnosed, warranting comprehensive basic and clinical studies in order to elucidate its epidemiology and to devise a more effective therapy.
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Chowdhary A, Randhawa HS, Gaur SN, Agarwal K, Kathuria S, Roy P, Klaassen CH, Meis JF. Schizophyllum commune as an emerging fungal pathogen: a review and report of two cases. Mycoses 2012; 56:1-10. [PMID: 22524529 DOI: 10.1111/j.1439-0507.2012.02190.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We report Schizophyllum commune as the aetiological agent of one case each of allergic broncho-pulmonary mycosis (ABPM) and pulmonary fungal ball, and present a literature review. The fungus was characterised by clamp connections, hyphal spicules, and formation of basidiocarps with basidiospores. The phenotypic identification was confirmed by sequencing of the ITS region. To-date, ABPM and pulmonary fungal ball to S. commune have been reported exclusively from Japan and North America respectively. Of the 71 globally reported cases due to S. commune, 45 (63%) were bronchopulmonary, 22 (31%) sinusitis and 4 extrapulmonary. Taken together, cases of bronchopulmonary disease and sinusitis numbered 67 (94%), indicating the respiratory tract as the primary target of disease. Concerning the country-wise distribution, Japan topped the list with 33 cases (46%), followed by Iran - 7 cases (10%), U.S.A. - 6 cases (9%), and a lower prevalence of 1.4-6% for the remaining 12 countries. The preponderance of the disease in Japan may be attributed to its greater awareness vis-à-vis that in other countries rather than to any geographical/climatic factors. We believe that the burden of S. commune-incited disease is currently underestimated, warranting comprehensive prospective studies to determine its prevalence.
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Affiliation(s)
- A Chowdhary
- Departments of Medical Mycology Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
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Gari-Toussaint M, Lachaud L, Pihet M, Rispail P, Castillo L, Crampette L, Bouchara JP. Sinusite récidivante due à Schizophyllum commune . À propos de deux nouveaux cas. J Mycol Med 2011. [DOI: 10.1016/j.mycmed.2011.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Brockus CW, Myers RK, Crandell JM, Sutton DA, Wickes BL, Nakasone KK. Disseminated Oxyporus corticola infection in a German shepherd dog. Med Mycol 2010; 47:862-8. [PMID: 19468930 DOI: 10.3109/13693780902962267] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The filamentous basidiomycetous fungus, Oxyporus corticola, has not previously been reported in the human or veterinary medical literature. Identification of this organism as the etiologic agent of fungal osteomyelitis and multiorgan dissemination in a German shepherd dog was confirmed by comparison of ITS and D1/D2 sequences with known isolates.
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Affiliation(s)
- C W Brockus
- Charles River Laboratories, Preclinical Services, Reno, Nevada 89511, USA.
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Tullio V, Mandras N, Banche G, Allizond V, Gaido E, Roana J, Cuffini AM, Carlone NA. Schizophyllum commune: an unusual of agent bronchopneumonia in an immunocompromised patient. Med Mycol 2008; 46:735-8. [DOI: 10.1080/13693780802256091] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Baron O, Cassaing S, Percodani J, Berry A, Linas MD, Fabre R, Serrano E, Magnaval JF. Nucleotide sequencing for diagnosis of sinusal infection by Schizophyllum commune, an uncommon pathogenic fungus. J Clin Microbiol 2006; 44:3042-3. [PMID: 16891539 PMCID: PMC1594647 DOI: 10.1128/jcm.00211-06] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Schizophyllum commune, a basidiomycete fungus, is a rare cause of mycotic disease. We report here a case of sinusitis in a 35-year-old woman that underscores the value of molecular biology for the diagnosis of this fungal infection.
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Affiliation(s)
- Olivier Baron
- Department of Parasitology and Mycology, Rangueil University Hospital, Toulouse, France
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