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Bocca AL, Siqueira IM. An Experimental Model of Chromoblastomycosis Caused by Fonsecaea sp. Species. Methods Mol Biol 2023; 2667:129-138. [PMID: 37145281 DOI: 10.1007/978-1-0716-3199-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The experimental rodent models for the fungal disease are a handy tool for understanding host-fungus interactions. To Fonsecaea sp., one of the causative agents of chromoblastomycosis, there is an extra challenge because the animals preferably used show a spontaneous cure; so until now, there is no model to reproduce the long-term disease similar to human chronic disease. In this chapter, we described an experimental model using rats and mice with a subcutaneous route, with the checkpoints of acute-like and chronic-like lesion analysis comparable with human lesions, the fungal burden, and the lymphocytes investigation.
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Affiliation(s)
- Anamelia L Bocca
- Department of Cell Biology, Institute of Biological Sciences, University of Brasilia, Brasilia, DF, Brazil.
| | - Isaque Medeiros Siqueira
- Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renováveis, IBAMA, Brasília, DF, Brazil
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2
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Pereira JAL, de Moraes LS, de Sena CBC, do Nascimento JLM, Rodrigues APD, da Silva SHM, Silva EO. Inhibition of Melanization by Kojic Acid Promotes Cell Wall Disruption of the Human Pathogenic Fungus Fonsecaea sp. Pathogens 2022; 11:pathogens11080925. [PMID: 36015045 PMCID: PMC9414132 DOI: 10.3390/pathogens11080925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Chromoblastomycosis (CBM) is a chronic human subcutaneous mycosis caused by various aetiologic agents. CBM does not have an established treatment but may be managed using antifungal agents, surgical removal of the lesions, or cryotherapy. Kojic acid (KA), a known tyrosinase inhibitor with a variety of biological actions, including fungistatic action against the fungus Cryptococcus neoformans, mediated by inhibiting melanin production, seems to be an alternative to improve the treatment of CBM. The aim of the present study was to analyze the action of KA against the pathogenic fungus Fonsecaea sp., an aetiological agent of CBM. The fungal culture was incubated with KA, and the amount of melanin was assessed, followed by cytochemical detection. Subsequently, the samples were analyzed by light microscopy, transmission and scanning electron microscopy. Culture analysis revealed that 100 g/mL KA significantly decreased the melanization of the fungus and the exocytosis of melanin into the culture supernatant. Additionally, KA induced less growth of biofilm formation and intense disruption of the cell wall, and decreased the number of melanin-containing vesicles in the culture supernatant. Finally, KA inhibited fungal filamentation in culture and the subsequent phagocytosis process. Thus, KA may be a promising substance to help in the treatment of CBM.
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Affiliation(s)
- Jorge Augusto Leão Pereira
- Laboratory of Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil
| | - Lienne Silveira de Moraes
- Laboratory of Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil
- National Institute of Science and Technology in Structural Biology and Bioimaging, Rio de Janeiro 21040-900, RJ, Brazil
- Pharmaceutical Sciences Post Graduation Program, Health and Biological Sciences Department, Federal University of Amapa (UNIFAP), Macapá 68903-329, AP, Brazil
| | - Chubert Bernardo Castro de Sena
- Laboratory of Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil
- National Institute of Science and Technology in Neuroimmunomodulation (INCT—NIM), Rio de Janeiro 21040-900, RJ, Brazil
| | - José Luiz Martins do Nascimento
- Pharmaceutical Sciences Post Graduation Program, Health and Biological Sciences Department, Federal University of Amapa (UNIFAP), Macapá 68903-329, AP, Brazil
- National Institute of Science and Technology in Neuroimmunomodulation (INCT—NIM), Rio de Janeiro 21040-900, RJ, Brazil
- Laboratory of Molecular and Cellular Neurochemistry, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil
| | - Ana Paula D. Rodrigues
- National Institute of Science and Technology in Structural Biology and Bioimaging, Rio de Janeiro 21040-900, RJ, Brazil
- Laboratory of Electron Microscopy, Evandro Chagas Institute, Ministry of Health, Belém 66093-020, PA, Brazil
| | - Silvia Helena Marques da Silva
- Laboratory of Superficial and Systemic Mycoses, Evandro Chagas Institute, Department of Mycology and Bacteriology, Ministry of Health, Ananindeua 67030-000, PA, Brazil
| | - Edilene O. Silva
- Laboratory of Structural Biology, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil
- National Institute of Science and Technology in Structural Biology and Bioimaging, Rio de Janeiro 21040-900, RJ, Brazil
- Correspondence: ; Tel.: +055-9132-0175-46
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Does DHN-Melanin Always Protect Fungi against Antifungal Drugs? The Fonsecaea/Micafungin Paradigm. MICROBIOLOGY RESEARCH 2022. [DOI: 10.3390/microbiolres13020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Several human pathogenic fungi produce melanin. One of its properties during parasitism is the protection against antifungal drugs. This occurs with the agents of chromoblastomycosis, in which DHN-melanin reduces antifungal susceptibility to terbinafine and itraconazole. Since these agents are resistant to some antifungal drugs, we investigated the role of DHN-melanin on the Fonsecaea susceptibility to amphotericin B, micafungin, fluconazole, and flucytosine, drugs that usually present high minimal inhibitory concentrations (MIC) to this genus. Seven strains from three Fonsecaea human pathogenic species were treated with tricyclazole, a DHN-melanin inhibitor, and the MIC of the treated and untreated cells were compared. A survival assay was performed to confirm the alterations in the susceptibility of strains with reduced melanization, and the chitin levels of the strains were estimated by fluorescence. Tricyclazole did not affect fluconazole and flucytosine MIC, while melanin inhibition increased susceptibility to amphotericin B. Surprisingly, DHN-melanin inhibition decreased the susceptibility to micafungin. Survival assays confirmed this result on five strains. Cell wall chitin levels of the strains were not associated with the decrease in micafungin susceptibility. The results show that DHN-melanin does not have a role in the intrinsic resistance of Fonseacaea spp. to amphotericin B, fluconazole, and flucytosine, and its inhibition may promote micafungin resistance.
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Climate Change Impact on Chromoblastomycosis. Fungal Biol 2022. [DOI: 10.1007/978-3-030-89664-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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Lima ACDC, Santos DWDCL, Hirata SH, Nishikaku AS, Enokihara MMSES, Ogawa MM. Therapeutic management of subcutaneous phaeohyphomycosis and chromoblastomycosis in kidney transplant recipients: a retrospective study of 82 cases in a single center. Int J Dermatol 2021; 61:346-351. [PMID: 34633082 DOI: 10.1111/ijd.15948] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 09/01/2021] [Accepted: 09/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Melanized fungi are a distinct group of pathogens that cause infections like chromoblastomycosis and phaeohyphomycosis, especially in a state of immunosuppression including solid organ transplant recipients. Guidelines for the treatment of these infections are lacking, and there is no available standard recommendation. OBJECTIVE To evaluate the therapeutic aspects of subcutaneous melanized fungal infections in kidney transplant recipients. METHODS A retrospective medical record was performed for kidney transplant recipients with melanized fungal infection evaluated in a single institution from January 1996 to December 2018. RESULTS Eighty-two episodes were noticed in our series. The treatment of subcutaneous phaeohyphomycosis was managed by surgical excision without antifungal therapy in 34 cases (34/68; 50%), and the association of both methods occurred in 18 cases (18/68; 26.5%). A complete surgical excision without antifungal therapy was observed in six (6/14; 42.9%) episodes of chromoblastomycosis, and combined treatment was possible in three (3/14; 21.4%) cases. Five episodes of chromoblastomycosis and 16 episodes of phaeohyphomycosis were managed only with antifungal therapy. CONCLUSION Management depends on the dermatologic lesion, immunosuppression condition, and anatomical cleavage plane. The sample size is still small in order to dictate a guideline, but it can be hard to execute a larger study given the rarity of this group of infections.
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Affiliation(s)
| | | | - Sérgio Henrique Hirata
- Department of Dermatology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | - Marilia Marufuji Ogawa
- Department of Dermatology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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6
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Breda LCD, Breda CNDS, de Almeida JRF, Paulo LNM, Jannuzzi GP, Menezes IDG, Albuquerque RC, Câmara NOS, Ferreira KS, de Almeida SR. Fonsecaeapedrosoi Conidia and Hyphae Activate Neutrophils Distinctly: Requirement of TLR-2 and TLR-4 in Neutrophil Effector Functions. Front Immunol 2020; 11:540064. [PMID: 33193308 PMCID: PMC7609859 DOI: 10.3389/fimmu.2020.540064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022] Open
Abstract
Chromoblastomycosis is a chronic and progressive subcutaneous mycosis caused mainly by the fungus Fonsecaea pedrosoi. The infection is characterized by erythematous papules and histological sections demonstrating an external layer of fibrous tissue and an internal layer of thick granulomatous inflammatory tissue containing mainly macrophages and neutrophils. Several groups are studying the roles of the innate and adaptive immune systems in F. pedrosoi infection; however, few studies have focused on the role of neutrophils in this infection. In the current study, we verify the importance of murine neutrophils in the killing of F. pedrosoi conidia and hyphae. We demonstrate that phagocytosis and reactive oxygen species during infection with conidia are TLR-2- and TLR-4-dependent and are essential for conidial killing. Meanwhile, hyphal killing occurs by NET formation in a TLR-2-, TLR-4-, and ROS-independent manner. In vivo experiments show that TLR-2 and TLR-4 are also important in chromoblastomycosis infection. TLR-2KO and TLR-4KO animals had lower levels of CCL3 and CXCL1 chemokines and impaired neutrophil migration to the infected site. These animals also had higher fungal loads during infection with F. pedrosoi conidia, confirming that TLR-2 and TLR-4 are essential receptors for F. pedrosoi recognition and immune system activation. Therefore, this study demonstrates for the first time that neutrophil activation during F. pedrosoi is conidial or hyphal-specific with TLR-2 and TLR-4 being essential during conidial infection but unnecessary for hyphal killing by neutrophils.
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Affiliation(s)
- Leandro Carvalho Dantas Breda
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | | | - José Roberto Fogaça de Almeida
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Larissa Neves Monteiro Paulo
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Grasielle Pereira Jannuzzi
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Isabela de Godoy Menezes
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Renata Chaves Albuquerque
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Niels Olsen Saraiva Câmara
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Karen Spadari Ferreira
- Departamento de Ciências Farmacêuticas, Instituto de Ciências Naturais, Universidade Federal de São Paulo, Diadema, Brazil
| | - Sandro Rogério de Almeida
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
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Siqueira IM, Wüthrich M, Li M, Wang H, Las-Casas LDO, de Castro RJA, Klein B, Bocca AL. Early immune response against Fonsecaea pedrosoi requires Dectin-2-mediated Th17 activity, whereas Th1 response, aided by Treg cells, is crucial for fungal clearance in later stage of experimental chromoblastomycosis. PLoS Negl Trop Dis 2020; 14:e0008386. [PMID: 32542003 PMCID: PMC7316354 DOI: 10.1371/journal.pntd.0008386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/25/2020] [Accepted: 05/12/2020] [Indexed: 01/26/2023] Open
Abstract
Chromoblastomycosis (CBM) is a chronic worldwide subcutaneous mycosis, caused by several dimorphic, pigmented dematiaceous fungi. It is difficult to treat patients with the disease, mainly because of its recalcitrant nature. The correct activation of host immune response is critical to avoid fungal persistence in the tissue and disease chronification. CD4+ T cells are crucial for the development of protective immunity to F. pedrosoi infection. Here, we investigated T helper cell response dynamics during experimental CBM. Following footpad injection with F. pedrosoi hyphae and conidia, T cells were skewed towards a Th17 and Th1 phenotype. The Th17 population was the main Th cell subset found in the infected area during the early stages of experimental murine CBM, followed by Th1 predominance in the later stages, coinciding with the remission phase of the disease in this experimental model. Depletion of CD25+ cells, which leads to a reduction of Treg cells in the draining lymph node, resulted in decline in fungal burden after 14 days of infection. However, fungal cells were not cleared in the later stages of the disease, prolonging CBM clinical features in those animals. IL-17A and IFN-γ neutralization hindered fungal cell elimination in the course of the disease. Similarly, in dectin-2 KO animals, Th17 contraction in the course of experimental CBM was accompanied by fungal burden decrease in the first 14 days of infection, although it did not affect disease resolution. In this study, we gained insight into T helper subsets' dynamics following footpad injections of F. pedrosoi propagules and uncovered their contribution to disease resolution. The Th17 population proved to be important in eliminating fungal cells in the early stages of infection. The Th1 population, in turn, closely assisted by Treg cells, proved to be relevant not only in the elimination of fungal cells at the beginning of infection but also essential for their complete elimination in later stages of the disease in a mouse experimental model of CBM.
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Affiliation(s)
- Isaque Medeiros Siqueira
- Molecular Pathology Post-Graduate Program, School of Medicine, University of Brasília, Brasília, Brazil
| | - Marcel Wüthrich
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
| | - Mengyi Li
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
| | - Huafeng Wang
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
| | | | | | - Bruce Klein
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
- Department of Internal Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
- Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
| | - Anamelia Lorenzetti Bocca
- Department of Cell Biology, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
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8
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Yang W, Zhang W, Luo J, Chen J, Tan Y, Lei X. 5-aminolevulinic acid-based photodynamic therapy associated with Itraconazole successfully treated a case of chromoblastomycosis. Photodiagnosis Photodyn Ther 2020; 29:101589. [PMID: 31689509 DOI: 10.1016/j.pdpdt.2019.101589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 11/17/2022]
Abstract
Chromoblastomycosis (CBM) is a prevalent implantation fungal infection. Patients with CBM show chronic granulomatous hyperplasia with ulcers and exudation. It may cause incapacity for labor in some severe clinical forms and it is often refractory to antifungal therapies. There is no optimal treatment. Here we report a case of a 71-year-old male farmer with refractory CBM who was successfully treated with 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) and Itraconazole in 2 months. Clinical cure was achieved with no obvious side effects.
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Affiliation(s)
- Weijiang Yang
- Department of Dermatology, Daping Hospital, The Army Medical University, Chongqing 400042, China
| | - Wentao Zhang
- Department of Dermatology, Daping Hospital, The Army Medical University, Chongqing 400042, China
| | - Jiefu Luo
- Department of Dermatology, Daping Hospital, The Army Medical University, Chongqing 400042, China
| | - Jinyi Chen
- Department of Dermatology, Daping Hospital, The Army Medical University, Chongqing 400042, China
| | - Yang Tan
- Department of Dermatology, Daping Hospital, The Army Medical University, Chongqing 400042, China
| | - Xia Lei
- Department of Dermatology, Daping Hospital, The Army Medical University, Chongqing 400042, China.
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9
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Khan S, Kumar A, Bhaskaran V, Chandran S, Dinesh K. Chronic fungal osteomyelitis of the tibia due to Acremonium curvulum: a rare case. Pan Afr Med J 2019; 34:173. [PMID: 32153713 PMCID: PMC7046102 DOI: 10.11604/pamj.2019.34.173.13737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 07/09/2019] [Indexed: 11/29/2022] Open
Abstract
Fungal osteomyelitis is a rare disease which usually presents in an indolent manner. Opportunistic infections due to other non-aspergillus moulds are an emerging entity. We report a case of fungal osteomyelitis due to Acremonium spp in an immunocompetent adult which showed a chronic, indolent course but responded well to treatment with voriconazole. This case highlights the importance of diagnosing the causative agent in fungal osteomyelitis as species specific susceptibility can aid in the treatment of fungal osteomyelitis.
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Affiliation(s)
- Sadia Khan
- Department of Microbiology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Anil Kumar
- Department of Microbiology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Vadakekoottu Bhaskaran
- Department of Orthopaedics, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Sabthami Chandran
- Department of Microbiology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Kavitha Dinesh
- Department of Microbiology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
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Kumbhakar R, Miko BA. Chromoblastomycosis in Solid Organ Transplant Recipients. CURRENT FUNGAL INFECTION REPORTS 2019. [DOI: 10.1007/s12281-019-00351-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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11
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Qiu Y, Zhang J, Tang Y, Zhong X, Deng J. Case report: Fever- pneumonia- lymphadenectasis- osteolytic- subcutaneous nodule: Disseminated chromoblastomycosis caused by phialophora. J Infect Chemother 2019; 25:1031-1036. [PMID: 31229375 DOI: 10.1016/j.jiac.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/05/2019] [Accepted: 05/07/2019] [Indexed: 11/26/2022]
Abstract
Chromoblastomycosis (CBM) is a chronic cutaneous and subcutaneous fungal infection caused by certain dematiaceous fungi (usually Fonsecaea, Phialophora, or Cladophialophora). Histologically, CBM is characterized by the presence of medlar bodies. However, the diagnosis is difficult because of the rarity of these pathognomonic presentations and the wide variety of presentations. Treatment of these infections is challenging as it lacks standardization. Herein, we report a case of chromoblastomycosis caused by Phialophora, in a 42-year-old immunocompetent male agriculturist from the humid and subtropical region of southern China. He had a 3-month history of pneumonia with intermittent fever, coughing, and expectoration. The infection subsequently spread to the bone and lymph nodes forming deep lesions and eventually resulting in osteolysis and lymphadenectasis. These subcutaneous nodules were observed after 9 months. Antifungal treatment was administered for 20 months leading to clinical improvement before the patient was lost to follow-up. This case is unique because such deep lesions are rare in immunocompetent individuals and because the initial onset was associated with pneumonia.
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Affiliation(s)
- Ye Qiu
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jianquan Zhang
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
| | - Yanping Tang
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaoning Zhong
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jingmin Deng
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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12
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Fornari G, Gomes RR, Degenhardt-Goldbach J, Dos Santos SS, de Almeida SR, Dos Santos GD, Muro MD, Bona C, Scola RH, Trindade ES, Bini IH, Ferreira-Maba LS, Kestring DR, do Nascimento MMF, Lima BJFDS, Voidaleski MF, Steinmacher DA, Soley BDS, Deng S, Bocca AL, da Silva MB, Salgado CG, de Azevedo CMPES, Vicente VA, de Hoog S. A Model for Trans-Kingdom Pathogenicity in Fonsecaea Agents of Human Chromoblastomycosis. Front Microbiol 2018; 9:2211. [PMID: 30356683 PMCID: PMC6189323 DOI: 10.3389/fmicb.2018.02211] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 08/29/2018] [Indexed: 12/17/2022] Open
Abstract
The fungal genus Fonsecaea comprises etiological agents of human chromoblastomycosis, a chronic implantation skin disease. The current hypothesis is that patients acquire the infection through an injury from plant material. The present study aimed to evaluate a model of infection in plant and animal hosts to understand the parameters of trans-kingdom pathogenicity. Clinical strains of causative agents of chromoblastomycosis (Fonsecaea pedrosoi and Fonsecaea monophora) were compared with a strain of Fonsecaea erecta isolated from a living plant. The clinical strains of F. monophora and F. pedrosoi remained concentrated near the epidermis, whereas F. erecta colonized deeper plant tissues, resembling an endophytic behavior. In an invertebrate infection model with larvae of a beetle, Tenebrio molitor, F. erecta exhibited the lowest survival rates. However, F. pedrosoi produced dark, spherical to ovoidal cells that resembled muriform cells, the invasive form of human chromoblastomycosis confirming the role of muriform cells as a pathogenic adaptation in animal tissues. An immunologic assay in BALB/c mice demonstrated the high virulence of saprobic species in animal models was subsequently controlled via host higher immune response.
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Affiliation(s)
- Gheniffer Fornari
- Microbiology, Parasitology and Pathology Post-graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Renata Rodrigues Gomes
- Microbiology, Parasitology and Pathology Post-graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | | | - Suelen Silvana Dos Santos
- Department of Clinical and Pharmacological Analysis, College of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Sandro Rogério de Almeida
- Department of Clinical and Pharmacological Analysis, College of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Germana Davila Dos Santos
- Microbiology, Parasitology and Pathology Post-graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Marisol Dominguez Muro
- Support and Diagnosis Unit, Mycology Laboratory, Hospital of Clinics, Federal University of Paraná, Curitiba, Brazil
| | - Cleusa Bona
- Department of Botany, Federal University of Paraná, Curitiba, Brazil
| | | | - Edvaldo S Trindade
- Department of Cell Biology, Federal University of Paraná, Curitiba, Brazil
| | | | | | - Daiane Rigoni Kestring
- Embrapa Forestry, Brazilian Agricultural Research Corporation (EMBRAPA), Colombo, Brazil
| | | | | | - Morgana F Voidaleski
- Microbiology, Parasitology and Pathology Post-graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | | | | | - Shuwen Deng
- Department of Medical Microbiology, People's Hospital of Suzhou National New & Hi-Tech Industrial Development Zone, Jiangsu, China
| | - Anamelia Lorenzetti Bocca
- Dermato-Immunology Laboratory, Institute of Biological Sciences, Federal University of Para, Marituba, Brazil
| | - Moises B da Silva
- Department of Cell Biology, University of Brasília (UnB), Brasília, Brazil, 13 Department of Medicine, Federal University of Maranhão, São Luís, Brazil
| | - Claudio G Salgado
- Dermato-Immunology Laboratory, Institute of Biological Sciences, Federal University of Para, Marituba, Brazil
| | | | - Vania Aparecida Vicente
- Microbiology, Parasitology and Pathology Post-graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Sybren de Hoog
- Microbiology, Parasitology and Pathology Post-graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil.,Department of Medical Microbiology, People's Hospital of Suzhou National New & Hi-Tech Industrial Development Zone, Jiangsu, China.,Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands.,Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, Netherlands
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13
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Coelho RA, Brito-Santos F, Figueiredo-Carvalho MHG, Silva JVDS, Gutierrez-Galhardo MC, do Valle ACF, Zancopé-Oliveira RM, Trilles L, Meyer W, Freitas DFS, Almeida-Paes R. Molecular identification and antifungal susceptibility profiles of clinical strains of Fonsecaea spp. isolated from patients with chromoblastomycosis in Rio de Janeiro, Brazil. PLoS Negl Trop Dis 2018; 12:e0006675. [PMID: 30048450 PMCID: PMC6080783 DOI: 10.1371/journal.pntd.0006675] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/07/2018] [Accepted: 07/09/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Chromoblastomycosis (CBM) is a difficult-to-treat chronic subcutaneous mycosis. In Brazil, the main agent of this disease is Fonsecaea pedrosoi, which is phenotypically very similar to other Fonsecaea species, differing only genetically. The correct species identification is relevant since different species may differ in their epidemiologic aspects, clinical presentation, and treatment response. METHODOLOGY/PRINCIPAL FINDINGS Partial sequencing of the internal transcribed spacer (ITS) was used to identify twenty clinical isolates of Fonsecaea spp. Their in vitro antifungal susceptibility was determined using the broth microdilution method, according to the M38-A2 protocol. Amphotericin B (AMB), flucytosine (5FC), terbinafine (TRB), fluconazole (FLC), itraconazole (ITC), ketoconazole (KTC), posaconazole (POS), voriconazole (VRC), ravuconazole (RVC), caspofungin (CAS), and micafungin (MFG) were tested. The association between ITC/TRB, AMB/5FC, and ITC/CAS was studied by the checkerboard method to check synergism. The available patients' data were correlated with the obtained laboratory results. Fonsecaea monophora (n = 10), F. pedrosoi (n = 5), and F. nubica (n = 5) were identified as CBM' agents in the study. TRB and VRC were the drugs with the best in vitro activity with minimal inhibitory concentrations (MIC) lower than 0.25 mg/L. On the other hand, FLC, 5FC, AMB, and MFG showed high MICs. The AMB/5FC combination was synergistic for three F. monophora strains while the others were indifferent. Patients had moderate or severe CBM, and ITC therapy was not sufficient for complete cure in most of the cases, requiring adjuvant surgical approaches. CONCLUSIONS/SIGNIFICANCE F. monophora, the second most frequent Fonsecaea species in South America, predominated in patients raised and born in Rio de Janeiro, Brazil, without cerebral involvement in these cases. TRB, VRC, and the AMB/5FC combination should be further investigated as a treatment option for CBM.
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Affiliation(s)
- Rowena Alves Coelho
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Fábio Brito-Santos
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Juliana Vitoria dos Santos Silva
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Maria Clara Gutierrez-Galhardo
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Antonio Carlos Francesconi do Valle
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Rosely Maria Zancopé-Oliveira
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Luciana Trilles
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Westmead Clinical School-Sydney Medical School, Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead Institute for Medical Research, Sydney, Australia
| | - Dayvison Francis Saraiva Freitas
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Rodrigo Almeida-Paes
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
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Thomas E, Bertolotti A, Barreau A, Klisnick J, Tournebize P, Borgherini G, Zemali N, Jaubert J, Jouvion G, Bretagne S, Picot S. From phaeohyphomycosis to disseminated chromoblastomycosis: A retrospective study of infections caused by dematiaceous fungi. Med Mal Infect 2018; 48:278-285. [PMID: 29656841 DOI: 10.1016/j.medmal.2017.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/30/2016] [Accepted: 09/12/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Infections caused by dematiaceous fungi are more common in tropical and subtropical areas. We aimed to describe the clinical, microbiological and therapeutic aspects of case patients diagnosed at a University Hospital located on an Indian Ocean island. PATIENTS AND METHODS We performed an observational retrospective study of infections caused by dematiaceous fungi diagnosed at the University Hospital of Saint-Pierre, Reunion, from 2000 to 2015. Mycological identifications were performed at the National Reference Center for Invasive Mycosis and Antifungal Agents (Paris). RESULTS The review of clinical and microbiological data of 11 patients identified revealed that five were infected by dematiaceous fungi. Two had cutaneous phaeohyphomycosis, two had cerebral phaeohyphomycosis and one had cutaneous chromoblastomycosis with brain and potentially medullary dissemination. Skin lesions and cerebral abscesses were quite varied. CONCLUSION Infections caused by dematiaceous fungi are rare. Medullary and brain localizations are extremely rare, especially for chromoblastomycosis. Cutaneous manifestations of phaeohyphomycosis are varied; diagnosis is thus more difficult. It is therefore important, when confronted with a chronic tumor-like lesion in endemic areas, to perform a biopsy for pathology and fungal culture. While surgical excision is not always sufficient, medical treatment of these infections is not standardized, but relies on an azole, which can be associated with another antifungal agent.
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Affiliation(s)
- E Thomas
- Service de bactériologie, virologie, parasitologie, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - A Bertolotti
- Service de maladies infectieuses, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - A Barreau
- Service de bactériologie, virologie, parasitologie, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - J Klisnick
- Service de maladies infectieuses, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - P Tournebize
- Service de neurologie, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - G Borgherini
- Service de maladies infectieuses, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - N Zemali
- Service de bactériologie, virologie, parasitologie, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - J Jaubert
- Service de bactériologie, virologie, parasitologie, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - G Jouvion
- Institut Pasteur, histopathologie humaine et modèles animaux, 28, rue du Docteur-Roux, 75015 Paris, France
| | - S Bretagne
- Institut Pasteur, centre national de référence des mycoses invasives et des antifongiques, 28, rue du Docteur-Roux, 75015 Paris, France
| | - S Picot
- Service de bactériologie, virologie, parasitologie, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion.
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15
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Abstract
Chromoblastomycosis (CBM), also known as chromomycosis, is one of the most prevalent implantation fungal infections, being the most common of the gamut of mycoses caused by melanized or brown-pigmented fungi. CBM is mainly a tropical or subtropical disease that may affect individuals with certain risk factors around the world. The following characteristics are associated with this disease: (i) traumatic inoculation by implantation from an environmental source, leading to an initial cutaneous lesion at the inoculation site; (ii) chronic and progressive cutaneous and subcutaneous tissular involvement associated with fibrotic and granulomatous reactions associated with microabscesses and often with tissue proliferation; (iii) a nonprotective T helper type 2 (Th2) immune response with ineffective humoral involvement; and (iv) the presence of muriform (sclerotic) cells embedded in the affected tissue. CBM lesions are clinically polymorphic and are commonly misdiagnosed as various other infectious and noninfectious diseases. In its more severe clinical forms, CBM may cause an incapacity for labor due to fibrotic sequelae and also due to a series of clinical complications, and if not recognized at an early stage, this disease can be refractory to antifungal therapy.
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16
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Ramírez Soto MC, Malaga G. Subcutaneous mycoses in Peru: a systematic review and meta-analysis for the burden of disease. Int J Dermatol 2017; 56:1037-1045. [PMID: 28670680 DOI: 10.1111/ijd.13665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 03/10/2017] [Accepted: 05/03/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a worrying lack of epidemiological data on the geographical distribution and burden of subcutaneous mycoses in Peru, hindering the implementation of surveillance and control programs. OBJECTIVES This study aimed to estimate the disease burden of subcutaneous mycoses in Peru and identify which fungal species were commonly associated with these mycoses. METHODS We performed a meta-analysis after a systematic review of the published literature in PubMed, LILACS, and SciELO to estimate the burden of subcutaneous mycoses in 25 regions in Peru. The disease burden was determined in terms of prevalence (number of cases per 100,000 inhabitants) and the number of reported cases per year per region. RESULTS A total of 26 studies were eligible for inclusion. Results showed that sporotrichosis was the most common subcutaneous mycosis (99.7%), whereas lobomycosis, chromoblastomycosis, and subcutaneous phaeohyphomycosis were rare. Cases of eumycetoma and subcutaneous zygomycosis were not found. Of the 25 regions, the burden of sporotrichosis was estimated for four regions classified as endemic; in nine regions, only isolated cases were reported. The highest burden of sporotrichosis was in Apurimac (15 cases/100,000 inhabitants; 57 cases/year), followed by Cajamarca (3/100,000 inhabitants; 30/year), Cusco (0.5/100,000 inhabitants; 4/year), and La Libertad (0.2/100,000 inhabitants; 2/year). In two regions, the mycoses predominantly affected children. CONCLUSIONS Sporotrichosis is the most common subcutaneous mycosis in Peru, with a high disease burden in Apurimac. Chromoblastomycosis, lobomycosis, and subcutaneous phaeohyphomycosis are rare mycoses in Peru.
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Affiliation(s)
| | - German Malaga
- Medicine School, Universidad Peruana Cayetano Heredia, Lima, Peru
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17
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Siqueira IM, de Castro RJA, Leonhardt LCDM, Jerônimo MS, Soares AC, Raiol T, Nishibe C, Almeida N, Tavares AH, Hoffmann C, Bocca AL. Modulation of the immune response by Fonsecaea pedrosoi morphotypes in the course of experimental chromoblastomycosis and their role on inflammatory response chronicity. PLoS Negl Trop Dis 2017; 11:e0005461. [PMID: 28355277 PMCID: PMC5391973 DOI: 10.1371/journal.pntd.0005461] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 04/14/2017] [Accepted: 03/06/2017] [Indexed: 02/03/2023] Open
Abstract
A common theme across multiple fungal pathogens is their ability to impair the establishment of a protective immune response. Although early inflammation is beneficial in containing the infection, an uncontrolled inflammatory response is detrimental and may eventually oppose disease eradication. Chromoblastomycosis (CBM), a cutaneous and subcutaneous mycosis, caused by dematiaceous fungi, is capable of inducing a chronic inflammatory response. Muriform cells, the parasitic form of Fonsecaea pedrosoi, are highly prevalent in infected tissues, especially in long-standing lesions. In this study we show that hyphae and muriform cells are able to establish a murine CBM with skin lesions and histopathological aspects similar to that found in humans, with muriform cells being the most persistent fungal form, whereas mice infected with conidia do not reach the chronic phase of the disease. Moreover, in injured tissue the presence of hyphae and especially muriform cells, but not conidia, is correlated with intense production of pro-inflammatory cytokines in vivo. High-throughput RNA sequencing analysis (RNA-Seq) performed at early time points showed a strong up-regulation of genes related to fungal recognition, cell migration, inflammation, apoptosis and phagocytosis in macrophages exposed in vitro to muriform cells, but not conidia. We also demonstrate that only muriform cells required FcγR and Dectin-1 recognition to be internalized in vitro, and this is the main fungal form responsible for the intense inflammatory pattern observed in CBM, clarifying the chronic inflammatory reaction observed in most patients. Furthermore, our findings reveal two different fungal-host interaction strategies according to fungal morphotype, highlighting fungal dimorphism as an important key in understanding the bipolar nature of inflammatory response in fungal infections.
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Affiliation(s)
- Isaque Medeiros Siqueira
- Molecular Pathology Post-Graduate Program, School of Medicine; University of Brasília, Brasília, Brazil
| | | | | | - Márcio Sousa Jerônimo
- Department of Cell Biology, Institute of Biological Sciences; University of Brasília, Brasília, Brazil
| | | | - Tainá Raiol
- Institute Leônidas and Maria Deane, Oswaldo Cruz Foundation, Manaus, Brazil
| | - Christiane Nishibe
- School of Computing Sciences, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Nalvo Almeida
- School of Computing Sciences, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Aldo Henrique Tavares
- Department of Cell Biology, Institute of Biological Sciences; University of Brasília, Brasília, Brazil
| | - Christian Hoffmann
- Department of Cell Biology, Institute of Biological Sciences; University of Brasília, Brasília, Brazil
- Department of Food Sciences and Experimental Nutrition, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Anamelia Lorenzetti Bocca
- Department of Cell Biology, Institute of Biological Sciences; University of Brasília, Brasília, Brazil
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18
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Abstract
Chromoblastomycosis (CMB) is a chronic fungal infection of the skin and the
subcutaneous tissue caused by a transcutaneous traumatic inoculation of a specific
group of dematiaceous fungi occurring mainly in tropical and subtropical zones
worldwide. If not diagnosed at early stages, patients with CBM require long term
therapy with systemic antifungals, sometimes associated with physical methods. Unlike
other neglected endemic mycoses, comparative clinical trials have not been performed
for this disease. Nowadays, therapy is based on a few open trials and on expert
opinion. Itraconazole either as monotherapy or associated with other drugs, or with
physical methods, is widely used. Recently, photodynamic therapy has been
successfully employed in combination with antifungals in patients presenting with
CBM. In the present revision the most used therapeutic options against CBM are
reviewed as well as the several factors that may have impact on the patient's
outcome.
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Affiliation(s)
- Flavio Queiroz-Telles
- Departamento de Saúde Pública, Universidade Federal do Paraná, Curitiba, PR, Brasil,
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19
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Taj-Aldeen SJ, Rammaert B, Gamaletsou M, Sipsas NV, Zeller V, Roilides E, Kontoyiannis DP, Miller AO, Petraitis V, Walsh TJ, Lortholary O. Osteoarticular Infections Caused by Non-Aspergillus Filamentous Fungi in Adult and Pediatric Patients: A Systematic Review. Medicine (Baltimore) 2015; 94:e2078. [PMID: 26683917 PMCID: PMC5058889 DOI: 10.1097/md.0000000000002078] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Osteoarticular mycoses due to non-Aspergillus moulds are uncommon and challenging infections. A systematic literature review of non-Aspergillus osteoarticular mycoses was performed using PUBMED and EMBASE databases from 1970 to 2013. Among 145 patients were 111 adults (median age 48.5 [16-92 y]) and 34 pediatric patients (median age 7.5 [3-15 y]); 114 (79.7%) were male and 88 (61.9%) were immunocompromised. Osteomyelitis was due to direct inoculation in 54.5%. Trauma and puncture wounds were more frequent in children (73.5% vs 43.5%; P = 0.001). Prior surgery was more frequent in adults (27.7% vs 5.9%; P = 0.025). Vertebral (23.2%) and craniofacial osteomyelitis (13.1%) with neurological deficits predominated in adults. Lower limb osteomyelitis (47.7%) and knee arthritis (67.8%) were predominantly seen in children. Hyalohyphomycosis represented 64.8% of documented infections with Scedosporium apiospermum (33.1%) and Lomentospora prolificans (15.8%) as the most common causes. Combined antifungal therapy and surgery was used in 69% of cases with overall response in 85.8%. Median duration of therapy was 115 days (range 5-730). When voriconazole was used as single agent for treatment of hyalohyphomycosis and phaeohyphomycosis, an overall response rate was achieved in 94.1% of cases. Non-Aspergillus osteoarticular mycoses occur most frequently in children after injury and in adults after surgery. Accurate early diagnosis and long-course therapy (median 6 mo) with a combined medical-surgical approach may result in favorable outcome.
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Affiliation(s)
- Saad J Taj-Aldeen
- From the Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar (SJT-A); Center for Osteoarticular Mycoses, Hospital for Special Surgery (SJT-A, BR, MG, NVS, ER, AOM, VP, TJW, OL); International Osteoarticular Mycoses Study Consortium, NY (SJT-A, BR, MG, NVS, ER, AOM, VP, TJW, OL); Weill Cornell Medical College, Doha, Qatar (SJT-A); Université Paris-Descartes, Sorbonne Paris Cité, APHP, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, Institut Imagine (BR, OL); Institut Pasteur, Mycology Molecular Unit, Paris, France (BR, OL); Transplantation-Oncology Infectious Diseases Program, Department of Medicine, Weill Cornell Medical Center of Cornell University (MG, AOM, VP, TJW); Pediatrics, and Microbiology & Immunology, Weill Cornell Medical Center of Cornell University, New York, NY (MG, NVS, TJW); National and Kapodistrian University of Athens, Athens, Greece (MG, NVS); Osteoarticular Reference Center, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France (VZ); Infectious Diseases Unit, Department of Pediatrics, Faculty of Medicine, Aristotle University, School of Health Sciences, and Hippokration Hospital, Thessaloniki, Greece (ER); and MD Anderson Cancer Center, Houston, TX (DPK)
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20
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Wüthrich M, Wang H, Li M, Lerksuthirat T, Hardison SE, Brown GD, Klein B. Fonsecaea pedrosoi-induced Th17-cell differentiation in mice is fostered by Dectin-2 and suppressed by Mincle recognition. Eur J Immunol 2015; 45:2542-52. [PMID: 26140582 PMCID: PMC4562893 DOI: 10.1002/eji.201545591] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/08/2015] [Accepted: 06/29/2015] [Indexed: 12/11/2022]
Abstract
Chromoblastomycosis is a chronic skin infection caused by the pigmented saprophytic mould Fonsecaea pedrosoi. Chronicity of infection can be broken by a coordinated innate recognition of the spores by pattern recognition receptors. While Mincle signaling via the Syk/Card9 pathway is required for fungal recognition by host cells, it is not sufficient for host control. Exogenously applied TLR agonists are necessary to promote the induction of proinflammatory cytokines and clearance of infection in vivo. Here, we investigated whether costimulation by TLR agonists fosters the development of adaptive immune responses, by examining the development of fungus‐specific T cells. Subcutaneous infection of mice with F. pedrosoi spores induced the activation, expansion, and differentiation of Ag‐specific CD4+ T cells but TLR costimulation did not further augment these T‐cell responses. The Dectin‐2/FcRγ/Card9 signaling pathway promoted the differentiation of fungus‐specific CD4+ T cells into Th17 cells, whereas Mincle inhibited the development of this T‐helper subset in infected mice. These results indicate differential roles for Dectin‐2 and Mincle in the generation of adaptive immune responses to F. pedrosoi infection.
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Affiliation(s)
- Marcel Wüthrich
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA
| | - Huafeng Wang
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA
| | - Mengyi Li
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA
| | - Tassanee Lerksuthirat
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA
| | - Sarah E Hardison
- Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA
| | - Gordon D Brown
- Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA
| | - Bruce Klein
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA.,Department of Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA.,Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
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21
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Black yeasts and their filamentous relatives: principles of pathogenesis and host defense. Clin Microbiol Rev 2015; 27:527-42. [PMID: 24982320 DOI: 10.1128/cmr.00093-13] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Among the melanized fungi, the so-called "black yeasts" and their filamentous relatives are particularly significant as agents of severe phaeohyphomycosis, chromoblastomycosis, and mycetoma in humans and animals. The pathogenicity and virulence of these fungi may differ significantly between closely related species. The factors which probably are of significance for pathogenicity include the presence of melanin and carotene, formation of thick cell walls and meristematic growth, presence of yeast-like phases, thermo- and perhaps also osmotolerance, adhesion, hydrophobicity, assimilation of aromatic hydrocarbons, and production of siderophores. Host defense has been shown to rely mainly on the ingestion and elimination of fungal cells by cells of the innate immune system, especially neutrophils and macrophages. However, there is increasing evidence supporting a role of T-cell-mediated immune responses, with increased interleukin-10 (IL-10) and low levels of gamma interferon (IFN-γ) being deleterious during the infection. There are no standardized therapies for treatment. It is therefore important to obtain in vitro susceptibilities of individual patients' fungal isolates in order to provide useful information for selection of appropriate treatment protocols. This article discusses the pathogenesis and host defense factors for these fungi and their severity, chronicity, and subsequent impact on treatment and prevention of diseases in human or animal hosts.
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22
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Azevedo CMPS, Marques SG, Santos DWCL, Silva RR, Silva NF, Santos DA, Resende-Stoianoff MA. Squamous cell carcinoma derived from chronic chromoblastomycosis in Brazil. Clin Infect Dis 2015; 60:1500-4. [PMID: 25681378 DOI: 10.1093/cid/civ104] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/04/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chromoblastomycosis (CBM) is a chronic fungal infection caused mainly by the melanized fungi Fonsecaea species. The chronic lesions may be predisposed to develop into cancer, the most serious complication of the disease. METHODS In this report, 7 cases of squamous cell carcinoma (SCC) resulting from chronic CBM in patients from Maranhão in the Brazilian Amazon are described. RESULTS The 7 patients presented with SCC that resulted from chronic CBM, caused by Fonsecaea species >10 years' duration. The malignant lesions occurred independent of the antifungal therapy and all patients underwent curative amputation, except for 1 patient who developed metastases in the inguinal and intra-abdominal lymph nodes and thigh muscles. A majority of previous reports have focused on the malignant transformation of CBM described in only 1 patient each. This is a first report describing a group of patients from a single Brazilian state. CONCLUSIONS Here, we provide new epidemiologic data on malignant CBM lesions, an endemic disease that is seemingly neglected worldwide. We reinforce the idea that typically chronic lesions may be predisposed to turn malignant.
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Affiliation(s)
| | - Sirlei G Marques
- Departamento de Patologia, Universidade Federal do Maranhão, São Luiz
| | | | - Raimunda R Silva
- Departamento de Patologia, Universidade Federal do Maranhão, São Luiz
| | - Nayara F Silva
- Departamento de Patologia, Universidade Federal do Maranhão, São Luiz
| | - Daniel Assis Santos
- Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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23
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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.
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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
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A case of nasal chromoblastomycosis causing epistaxis. The Journal of Laryngology & Otology 2014; 128:1117-9. [PMID: 25382114 DOI: 10.1017/s0022215114002655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue that most commonly affects the feet and lower limbs. It is rare for this infection to occur on the face, and it is exceptionally rare for it to involve the nose and sinuses. This paper reports a rare case of nasal chromoblastomycosis in a 50-year-old Malaysian male. CASE REPORT The patient, who was a rubber plantation worker in the southern state of Johor, presented to the ENT clinic with a history of epistaxis. He did not recall any history of injury to the nose. Nasal endoscopy showed a pale yellowish lesion at the inferior edge of the left middle turbinate. Histology revealed that this was a case of chromoblastomycosis. CONCLUSION Chromoblastomycosis of the nasal cavity is very rare and can be mistaken for other granulomatous conditions in the nose. It progresses very slowly over many years. Our patient was managed conservatively, as he was not keen on undergoing surgical intervention. Lesion size remained the same at five months' follow up, with no recurrence of epistaxis.
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Abstract
Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue. The infection usually results from a traumatic injury and inoculation of microorganism from a specific group of dematiaceous fungi (usually Fonsecaea pedrosoi, Phialophora verrucosa, Cladophialophora carrionii). In the tissues fungi produce characteristic sclerotic cells or muriform cells. Dermal lesions can range from small nodules to large papillary-like eruptions. The disease has been described worldwide but the prevalence is higher in rural populations in countries with a tropical or subtropical climate, such as Madagascar in Africa and Brazil in South America. Diagnostic techniques are based on direct examination, culture and histopathology. Despite a variety of treatment modalities, which include long courses of antifungals, surgical excision and destructive physical therapies, the disease remains one of the most difficult deep mycotic infections to eradicate.
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Castro LGM, de Andrade TS. Chromoblastomycosis: still a therapeutic challenge. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.10.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Challenges in the therapy of chromoblastomycosis. Mycopathologia 2013; 175:477-88. [PMID: 23636730 DOI: 10.1007/s11046-013-9648-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
Abstract
Chromoblastomycosis (CBM) is an implantation mycosis mainly occurring in tropical and subtropical zones worldwide. If not diagnosed at early stages, patients with CBM require long-term therapy with systemic antifungals flanked by various physical treatment regimens. As in other neglected endemic mycoses, comparative clinical trials have not been performed for this disease; nowadays, therapy is mainly based on a few open trials and on expert opinions. Itraconazole, either as monotherapy or associated with other drugs, or with physical methods, is widely used. Recently, photodynamic therapy has been employed successfully in combination with antifungals in patients presenting with CBM. In the present paper, the most used therapeutic options against CBM are reviewed as well as the several factors that may have impact on the patient's outcome.
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Queiroz-Telles F, Santos DWCL. Chromoblastomycosis in the Clinical Practice. CURRENT FUNGAL INFECTION REPORTS 2012. [DOI: 10.1007/s12281-012-0116-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Subcutaneous mycoses are common in tropical and subtropical regions of the world. These infections have multiple features in common, including similar epidemiology, mode of transmission, indolent chronic presentation with low potential for dissemination in immunocompetent hosts, and pyogranulomatous lesions on histopathology. Herein, we provide up-to-date epidemiologic, clinical, diagnostic, and therapeutic data for three important subcutaneous mycoses: chromoblastomycosis, mycetoma, and sporotrichosis.
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Affiliation(s)
- Ricardo M La Hoz
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Boulevard, Tinsley Harrison Tower 229, Birmingham, AL, 35294-0006, USA
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Rangel LP, Moreira OC, Livramento GN, Britto C, Alviano DS, Alviano CS, Ferreira-Pereira A. Putative role of an ABC transporter in Fonsecaea pedrosoi multidrug resistance. Int J Antimicrob Agents 2012; 40:409-15. [PMID: 22999764 DOI: 10.1016/j.ijantimicag.2012.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 07/10/2012] [Accepted: 07/16/2012] [Indexed: 10/27/2022]
Abstract
Fonsecaea pedrosoi, a dematiaceous fungus, is the main agent responsible for chromoblastomycosis, a chronic and progressive mycosis of the skin and subcutaneous tissues. This disease can cause different types of lesions depending on the immune status of the host. Its treatment is complicated by the toxicity of available antifungal agents as well as drug resistance. In this work, an ATP-binding cassette (ABC) transporter in this fungus was characterised, with the degree of expression related to the drug resistance of two strains (a patient isolated strain and a laboratory strain). A 150 kDa protein was detected by western blotting. The ATPase activity of membrane preparations was also evaluated. The F. pedrosoi transporter appears to behave like Pdr5p, a well-studied multidrug resistance transporter in Saccharomyces cerevisiae with the ability to hydrolyse different triphosphate nucleotides, as well as its response to classical inhibitors tested. Finally, a reverse transcription polymerase chain reaction (RT-PCR) approach was used and a 400 bp product was detected, corresponding to the highly conserved ATP-binding domain of ABC transporters. We suggest that an ABC transporter must be involved in F. pedrosoi multidrug resistance, and a complete understanding of this protein could bring an important contribution to antifungal treatment of this disease.
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Affiliation(s)
- Luciana P Rangel
- Departamento de Microbiologia Geral, Laboratório de Bioquímica Microbiana/IMPPG, CCS, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Cidade Universitária, CEP 21941902, Rio de Janeiro, Brazil
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Calvo E, Pastor FJ, Salas V, Mayayo E, Capilla J, Guarro J. Histopathology and antifungal treatment of experimental murine chromoblastomycosis caused by Cladophialophora carrionii. J Antimicrob Chemother 2011; 67:666-70. [PMID: 22190608 DOI: 10.1093/jac/dkr537] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES A murine model of chromoblastomycosis caused by Cladophialophora carrionii was used to compare the efficacy of posaconazole and voriconazole with that of terbinafine and itraconazole, the currently used drugs in the management of chromoblastomycosis. METHODS Athymic nude mice were infected with 2 × 10(7) cfu of a clinical isolate of C. carrionii. When typical lesions were established, treatments with posaconazole at 20 mg/kg/day, voriconazole at 20 mg/kg/day, itraconazole at 50 mg/kg/day or terbinafine at 250 mg/kg/day were initiated. Treatment efficacy was evaluated for 4 months by measuring the size of the lesions, observing any histopathological changes and culturing the excised tissue. RESULTS Posaconazole was the only drug that reduced the initial lesion size, while voriconazole and terbinafine reduced growth relative to controls. CONCLUSIONS This study suggests that the newer triazoles have potential in the treatment of chromoblastomycosis caused by C. carrionii.
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Affiliation(s)
- Enrique Calvo
- Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, IISPV, Universitat Rovira i Virgili, Reus, Spain
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Machado AP, Silva MRR, Fischman O. Local phagocytic responses after murine infection with different forms of Fonsecaea pedrosoi and sclerotic bodies originating from an inoculum of conidiogenous cells. Mycoses 2011; 54:202-11. [PMID: 19925569 DOI: 10.1111/j.1439-0507.2009.01792.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Fonsecaea pedrosoi is an important causative agent of chromoblastomycosis (CBM) especially in humid areas of the world; however, little is known about the infective forms of this agent that cause CBM. The aim of this study was to investigate the murine tissue response to inoculation with different forms of F. pedrosoi and the morphological changes of the fungal cells in vivo. BALB/c mice were inoculated intraperitoneally with hyphae, conidia or conidiogenous cells and conidia (CCC) at a single site. In addition, the abdomen and footpads were infected subcutaneously with CCC. Fungal forms were inoculated at a final concentration of 1 × 10(6) cells. Hyphae and ungerminated conidia inocula could not be transformed into parasitic forms. In tissue, a great number of conidiogenous cells underwent transformation into sclerotic bodies, which were more resistant to phagocytes in vivo than conidia and hyphae. Clinical and mycological cure of animals infected with CCC was observed from the fourth to the sixth week of infection, while conidia and hyphae infections were faster and generally lasted 2 to 3 weeks. A high number of destructed conidia was observed intracellularly in macrophages. The migration of neutrophils to the inflammatory site seems important for microbicidal activity, particularly against hyphae. Our observations suggest that inocula with conidiogenous cells are associated with in vivo transformation into sclerotic bodies and that local immune response involved with host resistance to experimental F. pedrosoi-infection is primarily mediated by neutrophils as observed in histological sections.
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Queiroz-Telles F, Nucci M, Colombo AL, Tobón A, Restrepo A. Mycoses of implantation in Latin America: an overview of epidemiology, clinical manifestations, diagnosis and treatment. Med Mycol 2011; 49:225-36. [DOI: 10.3109/13693786.2010.539631] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dos Santos ALS. Protease expression by microorganisms and its relevance to crucial physiological/pathological events. World J Biol Chem 2011; 2:48-58. [PMID: 21537490 PMCID: PMC3083995 DOI: 10.4331/wjbc.v2.i3.48] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 02/21/2011] [Accepted: 02/28/2011] [Indexed: 02/05/2023] Open
Abstract
The treatment of infections caused by fungi and trypanosomatids is difficult due to the eukaryotic nature of these microbial cells, which are similar in several biochemical and genetic aspects to host cells. Aggravating this scenario, very few antifungal and anti-trypanosomatidal agents are in clinical use and, therefore, therapy is limited by drug safety considerations and their narrow spectrum of activity, efficacy and resistance. The search for new bioactive agents against fungi and trypanosomatids has been expanded because progress in biochemistry and molecular biology has led to a better understanding of important and essential pathways in these microorganisms including nutrition, growth, proliferation, signaling, differentiation and death. In this context, proteolytic enzymes produced by these eukaryotic microorganisms are appointed and, in some cases, proven to be excellent targets for searching novel natural and/or synthetic pharmacological compounds, in order to cure or prevent invasive fungal/trypanosomatid diseases. With this task in mind, our research group and others have focused on aspartic-type proteases, since the activity of this class of hydrolytic enzymes is directly implicated in several facets of basic biological processes of both fungal and trypanosomatid cells as well as due to the participation in numerous events of interaction between these microorganisms and host structures. In the present paper, a concise revision of the beneficial effects of aspartic protease inhibitors, with emphasis on the aspartic protease inhibitors used in the anti-human immunodeficiency virus therapy, will be presented and discussed using our experience with the following microbial models: the yeast Candida albicans, the filamentous fungus Fonsecaea pedrosoi and the protozoan trypanosomatid Leishmania amazonensis.
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Affiliation(s)
- André Luis Souza Dos Santos
- André Luis Souza dos Santos, Laboratory of Multidisciplinary Studies on Microbial Biochemistry, Department of General Microbiology, Institute of Microbiology Prof. Paulo de Góes, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-902, Brazil
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França K, Villa RT, de Azevedo Bastos VR, Almeida ACC, Massucatti K, Fukumaru D, Bedin V. Auricular Chromoblastomycosis: A Case Report and Review of Published Literature. Mycopathologia 2011; 172:69-72. [DOI: 10.1007/s11046-011-9396-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 02/01/2011] [Indexed: 11/28/2022]
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Wu PA, Turner ML, Cowen EW, Wilson E, Shea YR, Jancel T, Freeman AF. Sixty-year-old man with slowly expanding nodular plaque on the thigh. J Am Acad Dermatol 2010; 63:1083-7. [PMID: 21093663 DOI: 10.1016/j.jaad.2010.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 06/06/2010] [Accepted: 06/21/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Peggy A Wu
- Division of Dermatology, Washington University, St Louis, Missouri, USA
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Muñoz Estrada VF, Valenzuela Paz GA, Rochín Tolosa M. [Chromomycosis: report of a case with unusual topography]. Rev Iberoam Micol 2010; 28:50-2. [PMID: 21167297 DOI: 10.1016/j.riam.2010.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 10/23/2010] [Accepted: 11/03/2010] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chromomycosis is a subcutaneous mycosis caused by dematiaceous fungi. It is characterized by the presence of nodules, verrucous and atrophic lesions, and is prevalent in tropical and subtropical areas. Mexico ranks third among the subcutaneous mycoses, mainly affecting the lower limbs. The verrucous lesions are the most common clinical presentation. AIMS We present a case of chromomycosis located in the helix and the left earlobe in a 29 year-old male, with unusual morphology and topography. METHOD Samples from the affected ear were taken for direct examination, and cultured in Sabouraud dextrose agar and mycobiotic agar. RESULTS Fumagoid cells were found when examining the lesion scrapings under direct microscopic examination. The Sabouraud dextrose agar and mycobiotic agar developed a colony of black fungus, which in the microscopic study was identified as Fonsecaea pedrosoi. The definitive diagnosis was chromomycosis, a pathology that was treated with itraconazole 200mg daily for 10 weeks, with a complete resolution of the dermatosis. CONCLUSIONS This is a case of chromomycosis with unusual clinical features, with an appropriate response to treatment with itraconazole.
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Badali H, Bonifaz A, Barrón-Tapia T, Vázquez-González D, Estrada-Aguilar L, Cavalcante Oliveira NM, Sobral Filho JF, Guarro J, Meis JFGM, De Hoog GS. Rhinocladiella aquaspersa, proven agent of verrucous skin infection and a novel type of chromoblastomycosis. Med Mycol 2010; 48:696-703. [DOI: 10.3109/13693780903471073] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Criado PR, Careta MF, Valente NYS, Martins JEC, Rivitti EA, Spina R, Belda W. Extensive long-standing chromomycosis due to Fonsecaea pedrosoi: three cases with relevant improvement under voriconazole therapy. J DERMATOL TREAT 2010; 22:167-74. [PMID: 20666671 DOI: 10.3109/09546630903585074] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate voriconazole in the treatment of extensive cases of chromomycosis. Chromomycosis is a chronic infection, which is extremely difficult to eradicate, and is caused by dematiaceous (dark-colored) fungi which affect the skin and subcutaneous tissues, with Fonsecaea pedrosoi being the major etiologic agent. Drugs such as itraconazole, terbinafine, posaconazole and amphotericin B have been employed with variable results. METHODS We treated three Caucasian male patients (ages 44, 57 and 77 years), two were farmers and one a trash collector, with long-standing (20, 10 and 21 years of disease, respectively) and extensive chromomycosis (one lower limb affected, at least) due to Fonsecaea pedrosoi. All patients had received previous therapy with the formerly indicated drugs itraconazole and terbinafine for several months either without or with incomplete response. After that, we started treatment with voriconazole per os 200 mg twice a day. RESULTS The patients were treated with voriconazole for 12 months until there was clinical and mycological improvement. Clinical response was evident after 30-50 days. One patient developed visual abnormalities and tremors, and the voriconazole was reduced to 200 mg/day without impairment of the clinical and mycological response. The same patient presented photosensitive dermatitis after 12 months of therapy and the voriconazole was stopped. All patients showed elevations of serum gamma-glutamyl transpeptidase (GGT) during the treatment without clinical relevance. Moreover, our three patients obtained partial response with this therapy. CONCLUSIONS This is the first report with a case series of chromomycosis treated with voriconazole. Despite its high cost, voriconazole is a safe and possibly promising drug for use on extensive chromomycosis refractory to conventional treatment.
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Affiliation(s)
- Paulo Ricardo Criado
- Dermatology Department, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
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da Silva JP, da Silva MB, Campelo SR, Salgado UI, Diniz JAP, Esterre P, Rozental S, Salgado CG. TGF-beta plasma levels in chromoblastomycosis patients during itraconazole treatment. Cytokine 2010; 51:202-6. [PMID: 20621721 DOI: 10.1016/j.cyto.2010.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 04/27/2010] [Accepted: 05/12/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Chromoblastomycosis (CBM) is a dermal mycosis. The disease evolves to a chronic state, presenting a suppurative granulomatous dermatitis, combined with variable dermal fibrosis. Pathogenesis of the inflammation and tissue repair in CBM are poorly understood. AIM To quantify Transforming Growth Factor-beta (TGF-beta) plasma levels of CBM patients during itraconazole (ITZ) treatment. METHODS Blood plasma of 12 CBM patients was subjected to TGF-beta titration with ELISA at 0, 3, 6 and 12months of 200mg per day of ITZ therapy, and correlated with the clinical aspects. Plasma of 12 healthy individuals were used for control. RESULTS CBM patients present high plasma levels of TGF-beta (7.016+/-1988pg/ml), decreasing after 03months (4.625+/-645pg/ml) of ITZ treatment, which correlates with a rapid clinical improvement. However, after 6 (6.566+/-777pg/ml) and 12months (6.908+/-776) of treatment, TGF-beta levels increase to almost the same levels observed before treatment, which is related to a slow clinical improvement, fungal persistence on the lesion, and fibrotic scars. CONCLUSION TGF-beta plasma levels are high in CBM patients. Fungal destruction by ITZ correlates with TGF-beta downregulation, but tissue remodeling and fungal persistence probably raises its levels again, interfering with cellular immune responses.
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Affiliation(s)
- Jorge Pereira da Silva
- Laboratório de Dermato-Imunologia, Universidade do Estado do Pará (UEPA), Universidade Federal do Pará (UFPA), Unidade de Referência em Dermatologia Sanitária do Estado do Pará Dr. Marcello Candia (MC), Brazil
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Najafzadeh MJ, Rezusta A, Cameo MI, Zubiri ML, Yus MC, Badali H, Revillo MJ, De Hoog GS. Successful treatment of chromoblastomycosis of 36 years duration caused byFonsecaea monophora. Med Mycol 2010. [DOI: 10.3109/13693780903008813] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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In vitro activities of eight antifungal drugs against 55 clinical isolates of Fonsecaea spp. Antimicrob Agents Chemother 2010; 54:1636-8. [PMID: 20086140 DOI: 10.1128/aac.01655-09] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The in vitro activities of eight antifungal drugs against clinical isolates of Fonsecaea pedrosoi (n = 21), Fonsecaea monophora (n = 25), and Fonsecaea nubica (n = 9) were tested. The resulting MIC(90)s for all strains (n = 55) were as follows, in increasing order: posaconazole, 0.063 microg/ml; itraconazole, 0.125 microg/ml; isavuconazole, 0.25 microg/ml; voriconazole, 0.5 microg/ml; amphotericin B, 2 microg/ml; caspofungin, 2 microg/ml; anidulafungin, 2 microg/ml; and fluconazole, 32 microg/ml.
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Difficult mycoses of the skin: advances in the epidemiology and management of eumycetoma, phaeohyphomycosis and chromoblastomycosis. Curr Opin Infect Dis 2010; 22:559-63. [PMID: 19773651 DOI: 10.1097/qco.0b013e328332bbc5] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Eumycetoma, phaeohyphomycosis and chromoblastomycosis are subcutaneous mycoses having in common the fact that they are acquired as a result of penetrating trauma to the skin and may be caused by a large variety of fungi. This article will review recent data regarding the epidemiology and treatment of these infections. RECENT FINDINGS Recent epidemiologic observations in these mycoses include an increased incidence of phaeohyphomycosis in immunosuppressed patients, the association of polymorphisms in genes involved in innate immunity, the occurrence of eumycetoma caused by Madurella mycetomatis and the nosocomial acquisition of phaeohyphomycosis. The management of these infections continues to be challenging. An approach that involves early diagnosis, the use of systemic antifungal agents and local therapies, including surgical removal of lesions, is the basis of the treatment of these diseases. SUMMARY It is crucial that the epidemiology and clinical presentation of these infections are understood if we are to improve their outcomes.
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Queiroz-Telles F, Esterre P, Perez-Blanco M, Vitale RG, Salgado CG, Bonifaz A. Chromoblastomycosis: an overview of clinical manifestations, diagnosis and treatment. Med Mycol 2009; 47:3-15. [DOI: 10.1080/13693780802538001] [Citation(s) in RCA: 169] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Tsianakas A, Pappai D, Basoglu Y, Metze D, Tietz HJ, Luger TA, Bonsmann G. Chromomycosis - successful CO2laser vaporization. J Eur Acad Dermatol Venereol 2008; 22:1385-6. [DOI: 10.1111/j.1468-3083.2008.02649.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Salgado CG, da Silva MB, Yamano SSP, Salgado UI, Diniz JAP, da Silva JP. Cutaneous localized annular chromoblastomycosis. J Cutan Pathol 2008; 36:257-61. [PMID: 18727664 DOI: 10.1111/j.1600-0560.2008.01025.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chromoblastomycosis (CBM) is a difficult-to-treat dermal mycosis characterized by the presence of round, pigmented, sclerotic bodies formed by black fungi found in polymorphic lesions. According to the morphology of a lesion, different clinical types of the disease have been described. We present three patients who each developed a single, 10-cm diameter, 8 to 15-year-old, well-circumscribed, slow-growing, annular, papulosquamous or papulosquamous-verrucous lesion, with no regression despite the use of topical antifungals. Skin scrapings and biopsies confirmed CBM and microculture defined the agent as Fonsecaea pedrosoi. The patients were treated with 200 mg/day of itraconazole for 6-9 months and were discharged after complete regression of the lesions. All were examined after the first and second year of the end of treatment and there were no signs of recurrence. A new clinical type of CBM is described, and itraconazole appears to be effective and safe in curing these patients after no more than 9 months of therapy.
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Affiliation(s)
- Claudio G Salgado
- Dermato-Immunology Laboratory UEPA/UFPA/Marcello Candia, Marituba, Pará, Brazil.
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Abstract
Chromoblastomycosis is an uncommon chronic fungal infection capable of presenting in a variety of clinical guises. Herein, we present the histopathological features of an unusual dermal response engendered by this organism, consisting of dermal effacement by a spindle cell proliferation arranged in sweeping fascicles.
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Santos ALS, Palmeira VF, Rozental S, Kneipp LF, Nimrichter L, Alviano DS, Rodrigues ML, Alviano CS. Biology and pathogenesis of Fonsecaea pedrosoi, the major etiologic agent of chromoblastomycosis. FEMS Microbiol Rev 2007; 31:570-91. [PMID: 17645522 DOI: 10.1111/j.1574-6976.2007.00077.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Fonsecaea pedrosoi is the principal etiologic agent of chromoblastomycosis, a fungal disease whose pathogenic events are poorly understood. Treatment of the disease presents poor effectiveness and serious side effects. The disease is epidemiologically important in several regions, which has stimulated studies focused on the biology and pathogenic potential of its major causative agent. In this review, we summarize the current knowledge on the biological aspects of F. pedrosoi, including cell differentiation and pathogenic mechanisms during the interaction of fungi with different hosts' elements.
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Affiliation(s)
- André L S Santos
- Laboratório de Estudos Integrados em Bioquímica Microbiana, Departamento de Microbiologia Geral, IMPPG/Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Ilha do Fundão, Rio de Janeiro, RJ, Brazil.
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de Andrade TS, Cury AE, de Castro LGM, Hirata MH, Hirata RDC. Rapid identification of Fonsecaea by duplex polymerase chain reaction in isolates from patients with chromoblastomycosis. Diagn Microbiol Infect Dis 2007; 57:267-72. [PMID: 17338941 DOI: 10.1016/j.diagmicrobio.2006.08.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Revised: 08/06/2006] [Accepted: 08/29/2006] [Indexed: 11/26/2022]
Abstract
Fonsecaea pedrosoi is the most common etiologic agent of chromoblastomycosis. F. pedrosoi and other dematiaceous fungi are usually identified by morphologic studies. We have developed a duplex polymerase chain reaction (PCR) targeting the ribosomal DNA for rapid and more specific identification of the genus Fonsecaea. DNA samples from 103 isolates of Fonsecaea species and other dematiaceous fungi were amplified by PCR using universal and specific primers targeting ITS1-5.8S-ITS2 region of the ribosomal DNA. Universal primers were used for detection of non-Fonsecaea DNA. Fonsecaea-specific PCR product was found in 70 (68.0%) isolates including 4 strains that did not develop conidiogenesis. Thirty non-Fonsecaea and 3 Fonsecaea compacta isolates were negative by duplex PCR. These results were confirmed by DNA sequencing analysis indicating the high specificity of the duplex PCR assay. In conclusion, the duplex PCR is a rapid and specific assay for identification of Fonsecaea isolates mainly for the strains that are difficult to identify by morphologic methods.
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Affiliation(s)
- Tânia Sueli de Andrade
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brasil.
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