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Benchetrit A, Messina F, Matteo M, Vázquez M, Paul R, Gil Zbinden G, Costa N, Santiso G. Microsporum canis pseudomycetoma and disseminated Mycobacterium genavense infection in an HIV/AIDS patient, an unusual combination. Rev Argent Microbiol 2024:S0325-7541(24)00037-3. [PMID: 38644065 DOI: 10.1016/j.ram.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/27/2023] [Accepted: 02/23/2024] [Indexed: 04/23/2024] Open
Abstract
Pseudomycetomas are rare fungal subcutaneous infections caused by dermatophytes, which are mainly observed in immunocompromised patients. Mycobacterium genavense is considered an opportunistic pathogen in people living with HIV/AIDS (PLWHA), clinically resembling the presentation of Mycobacterium avium complex (MAC). Here, we describe the case of a 26-year-old PLWHA with a 3-month history of a 4cm tumoral, duroelastic and painful lesion located on the back. Histopathology of the tumoral lesion revealed chronic granulomatous inflammation with grains composed of PAS-positive and Grocott-positive septate hyphae, as well as acid-fast bacilli (AFB). Culture on Sabouraud and lactrimel agar developed colonies that were later identified as Microsporum canis. In successive samples, the AFB were identified as M. genavense by restriction analysis of PCR products. Immunocompromised PLWHA not only suffer increased susceptibility to diseases due to unusual pathogens but also atypical clinical presentation of frequently encountered pathogens.
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Affiliation(s)
- Andrés Benchetrit
- Sala 21, Hospital de Infecciosas Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina
| | - Fernando Messina
- Unidad Micología, Hospital de Infecciosas Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mario Matteo
- Sección de Bacteriología de la Tuberculosis, Hospital de Infecciosas Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariana Vázquez
- Sección de Bacteriología de la Tuberculosis, Hospital de Infecciosas Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina
| | - Roxana Paul
- Instituto Nacional de Enfermedades Infecciosas-ANLIS Carlos Malbrán, Buenos Aires, Argentina
| | - Germán Gil Zbinden
- Servicio de Anatomía Patológica, Hospital de Infecciosas Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina
| | - Nora Costa
- Sección de Bacteriología de la Tuberculosis, Hospital de Infecciosas Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriela Santiso
- Unidad Micología, Hospital de Infecciosas Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina.
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Song Y, Wang X, Li Q, Zhang R, de Hoog S, Li R. Fatal dermatophytic pseudomycetoma in a patient with non-HIV CD4 lymphocytopenia. Emerg Microbes Infect 2023; 12:2208685. [PMID: 37128909 DOI: 10.1080/22221751.2023.2208685] [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: 05/03/2023]
Abstract
Dermatophytic pseudomycetoma is a rare invasive infection, involving both immunocompetent and immunocompromised individuals. Since the discovery of inherited immune disorders such as the impairment of CARD9 gene, extended dermatophyte infections are mostly ascribed to any of these host factors. This study is to present and explore the potential causes in a fatal dermatophytic pseudomycetoma patient. We present a chronic and deep pseudomycetoma caused by the common dermatophyte Microsporum canis which ultimately led to the death of the patient. Mycological examination, genetic studies and host immune responses against fungi were performed to explore the potential factors. The patient had decreased lymphocyte counts with significantly reduced CD4+ T cells, although all currently known genetic parameters proved to be normal. Through functional studies, we demonstrated that peripheral blood mononuclear cells from the patient showed severe impairment of adaptive cytokine production upon fungus-specific stimulation, whereas innate immune responses were partially defective. This is, to our knowledge, the first report of fatal dermatophytic pseudomycetoma in a patient with non-HIV CD4 lymphocytopenia, which highlights the importance of screening for immune deficiencies in patients with deep dermatophytosis.
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Affiliation(s)
- Yinggai Song
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- Centre of Expertise for Mycology of Radboud University Medical Centre / Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Xiaowen Wang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Qian Li
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
| | - Ruijun Zhang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
| | - Sybren de Hoog
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Centre of Expertise for Mycology of Radboud University Medical Centre / Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Ruoyu Li
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
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3
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Wang R, Huang C, Zhang Y, Li R. Invasive dermatophyte infection: A systematic review. Mycoses 2020; 64:340-348. [PMID: 33217082 DOI: 10.1111/myc.13212] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022]
Abstract
Dermatophyte infections usually present as various types of superficial cutaneous mycoses; on very rare occasions, dermatophytes enter deep into the dermis and cause invasive infections. In this study, we aimed to perform a systematic review of all reported invasive dermatophytosis cases over the past 20 years. We performed systematic searches in PubMed/Medline, EMBASE and Web of Science and identified 123 papers reporting 160 individual cases of invasive dermatophytosis between 2000 and 2020. Our study included 103 (64.4%) males, and the mean age at diagnosis was 43.0 years (range: 3-87 years). The most common predisposing factor was superficial dermatophytosis (56.9%), followed by solid organ transplantation (26.9%), the use of topical immunosuppressants (15.6%), gene mutations (14.4%), diabetes (14.4%) and trauma (6.9%). Trichophyton (T.) rubrum was the most prevalent pathogen (53.1%) responsible for invasive dermatophytosis, followed by T. mentagrophytes (7.5%), Microsporum canis (6.9%), T. tonsurans (5.6%), T. interdigitale (5.0%) and T. violaceum (3.8%). Patients with CARD9 or STAT3 mutations were prone to have mixed infection of two or more dermatophytes, present with eosinophilia and high IgE, and develop disseminated infections. Overall mortality was 7.9%, and the mortality in patients with and without gene mutations was 17.4% and 5.5%, respectively. Most of the normal host patients responded well to oral antifungal agents, while gene-deficient patients usually required lifelong treatment to stabilise their infection status. Our review indicated the importance of preventive treatment of superficial tinea in patients with immunosuppression and gene deficiencies to avoid the development of invasive dermatophytosis.
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Affiliation(s)
- Ruojun Wang
- Department of Dermatology, Peking University First Hospital, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China
| | - Chen Huang
- Department of Dermatology, Jiangsu Province Hospital, Nanjing, China
| | - Yi Zhang
- Department of Dermatology, Peking University First Hospital, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China
| | - Ruoyu Li
- Department of Dermatology, Peking University First Hospital, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China
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Ruiz LRB, Zaitz C, Lellis RF, Veasey JV. Pseudomycetoma of the scalp caused by Microsporum canis. An Bras Dermatol 2020; 95:372-375. [PMID: 32278631 PMCID: PMC7253879 DOI: 10.1016/j.abd.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/22/2019] [Indexed: 10/25/2022] Open
Abstract
Pseudomycetoma is an extremely rare deep mycosis, caused by dermatophytic fungi that penetrate the tissue from infected follicles of tinea capitis. Both clinically and histopathology are similar to eumycetoma, being distinguished through the isolation of the fungus, which in the case of pseudomycetoma can be Microsporum spp. or Trichophyton spp. genre. We present a 24-year-old man with an exuberant tumor in the occipital region with fistula, whose histopathological examination evidenced grains composed of hyaline hyphae and the culture for fungi isolated the agent Microsporum canis. Combined treatment of surgical excision followed by oral griseofulvin for two years was performed, with resolution of the condition.
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Affiliation(s)
- Ligia Rangel Barboza Ruiz
- Clinic of Dermatology, Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Clarisse Zaitz
- Clinic of Dermatology, Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Rute Facchini Lellis
- Pathology Laboratory, Hospital da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - John Verrinder Veasey
- Clinic of Dermatology, Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
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Changing Concepts and Current Definition of Majocchi's Granuloma. Mycopathologia 2019; 185:187-192. [PMID: 31297666 DOI: 10.1007/s11046-019-00358-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/01/2019] [Indexed: 01/13/2023]
Abstract
Dermatophytic granuloma characterized by perifollicular granulomatous inflammation was first described by Domenico Majocchi and was later named after him, Majocchi's granuloma (MG). Although the initial description was related to a dermatophyte Trichophyton tonsurans, later reports linked MG to non-dermatophytes (Phoma, Aspergillus, Malbranchea), which led to a confusion of disease patterns caused by cutaneous pathogens and general opportunistic microorganisms. Furthermore, several causative agents of MG described in the literature were not confirmed as such. Our review addressed the following aspects: (1) significance of histopathological finding for MG diagnosis, (2) dermatophytes as exclusive agents of MG, (3) spectrum of etiological agents causing different types of invasive dermatophytic infections, and (4) treatment options.
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Diongue K, Boye A, Bréchard L, Diallo M, Dione H, Ndoye N, Diallo M, Ranque S, Ndiaye D. Dermatophytic mycetoma of the scalp due to an atypical strain of Microsporum audouinii identified by MALDI-TOF MS and ITS sequencing. J Mycol Med 2019; 29:185-188. [DOI: 10.1016/j.mycmed.2019.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/28/2019] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
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Lam ATH, Krone LM, Ferrer L. Pathology in Practice. J Am Vet Med Assoc 2018; 253:287-290. [PMID: 30020009 DOI: 10.2460/javma.253.3.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Majocchi’s granuloma (MG) is a rare fungal infection of the dermis that is mainly caused by dermatophytes (in ≥95% of cases); the most frequently identified cause is anthropophilic Trichophyton rubrum. In the rest of the cases, the causes are non-dermatophytic fungi such as Aspergillus species. This review aimed to provide information about the current perspectives on MG regarding its clinical characteristics, predisposing factors, laboratory diagnosis, and treatment strategies. Although the lower extremities were reported to be the most common site of infection, facial involvement has been predominant in the past 5 years. Our literature research showed that the most common predisposing factor (55%) is the use of topical steroid creams without potassium hydroxide examination during treatment of erythematous squamous dermatoses. A reliable diagnosis of MG is based on histopathological examination, including fungal culture and molecular analyses. MG should be treated not only with topical agents but also with systemic antifungal agents that are continued until the lesions are completely resolved. In systemic treatment, the most preferred drug is terbinafine, because of its efficacy, side effects, and safety.
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Affiliation(s)
- Hazal Boral
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Murat Durdu
- Department of Dermatology, Faculty of Medicine, Başkent University Adana Hospital, Adana, Turkey
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
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Wang R, Wang X, Li R. Image Gallery: Dermatophytic pseudomycetoma caused by Microsporum canis. Br J Dermatol 2018; 178:e228. [PMID: 29595227 DOI: 10.1111/bjd.16243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R. Wang
- Department of Dermatology; Peking University First Hospital; Beijing China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses; Beijing China
- Research Center for Medical Mycology; Peking University; Beijing China
| | - X. Wang
- Department of Dermatology; Peking University First Hospital; Beijing China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses; Beijing China
- Research Center for Medical Mycology; Peking University; Beijing China
| | - R. Li
- Department of Dermatology; Peking University First Hospital; Beijing China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses; Beijing China
- Research Center for Medical Mycology; Peking University; Beijing China
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Wang H, Yu C, Lu X, Wang S, Liu H, Zhang F. A case of subcutaneous infection caused by Microsporum gypseum. DERMATOL SIN 2017. [DOI: 10.1016/j.dsi.2017.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Silva KVS, Lima MIO, Cardoso GN, Santos AS, Silva GS, Pereira FO. Inibitory effects of linalool on fungal pathogenicity of clinical isolates ofMicrosporum canisandMicrosporum gypseum. Mycoses 2017; 60:387-393. [DOI: 10.1111/myc.12606] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/08/2016] [Accepted: 01/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Kaltz V. S. Silva
- Laboratory of Biochemistry; Academic Unit of Health, Education and Health Center; Federal University of Campina Grande; Cuité Brazil
| | - Maria I. O. Lima
- Laboratory of Biochemistry; Academic Unit of Health, Education and Health Center; Federal University of Campina Grande; Cuité Brazil
| | - Gustavo N. Cardoso
- Laboratory of Biochemistry; Academic Unit of Health, Education and Health Center; Federal University of Campina Grande; Cuité Brazil
| | - Aldeir S. Santos
- Laboratory of Biochemistry; Academic Unit of Health, Education and Health Center; Federal University of Campina Grande; Cuité Brazil
| | - Gezaíldo S. Silva
- Laboratory of Biochemistry; Academic Unit of Health, Education and Health Center; Federal University of Campina Grande; Cuité Brazil
| | - Fillipe O. Pereira
- Laboratory of Biochemistry; Academic Unit of Health, Education and Health Center; Federal University of Campina Grande; Cuité Brazil
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Severe Dermatophytosis and Acquired or Innate Immunodeficiency: A Review. J Fungi (Basel) 2015; 2:jof2010004. [PMID: 29376922 PMCID: PMC5753085 DOI: 10.3390/jof2010004] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/16/2015] [Accepted: 12/14/2015] [Indexed: 12/14/2022] Open
Abstract
Dermatophytes are keratinophilic fungi responsible for benign and common forms of infection worldwide. However, they can lead to rare and severe diseases in immunocompromised patients. Severe forms include extensive and/or invasive dermatophytosis, i.e., deep dermatophytosis and Majocchi’s granuloma. They are reported in immunocompromised hosts with primary (autosomal recessive CARD9 deficiency) or acquired (solid organ transplantation, autoimmune diseases requiring immunosuppressive treatments, HIV infection) immunodeficiencies. The clinical manifestations of the infection are not specific. Lymph node and organ involvement may also occur. Diagnosis requires both mycological and histological findings. There is no consensus on treatment. Systemic antifungal agents such as terbinafine and azoles (itraconazole or posaconazole) are effective. However, long-term outcome and treatment management depend on the site and extent of the infection and the nature of the underlying immunodeficiency.
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Bonifaz A, Tirado-Sánchez A, Calderón L, Saúl A, Araiza J, Hernández M, González GM, Ponce RM. Mycetoma: experience of 482 cases in a single center in Mexico. PLoS Negl Trop Dis 2014; 8:e3102. [PMID: 25144462 PMCID: PMC4140667 DOI: 10.1371/journal.pntd.0003102] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 07/07/2014] [Indexed: 01/19/2023] Open
Abstract
Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013). A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11%) were actinomycetomas and 38 cases (7.88%) were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3∶1. The mean age was 34.5 years old (most ranged from 21 to 40 years). The main affected localization was lower and upper limbs (70.74% and 14.52% respectively). Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported). The main clinical presentation was as tumor-like soft tissue swelling with draining sinuses (97.1%). Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21%) and Actinomadura madurae (8.7%); meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii) were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico. Mycetoma is a chronic, subcutaneous granulomatous disease that usually begins after traumatic inoculation with causative microorganisms. Based on its etiology, mycetoma is referred to eumycetoma when the infection is caused by filamentous fungi, and actinomycetoma when the infection is due to aerobic actinomycetes (in Mexico predominantly Nocardia brasiliensis). Establishing the etiology is extremely important since it impacts treatment regimens. Mycetoma typically presents around the Tropic of Cancer between latitude 15° South and 30° North (also known as “mycetoma belt”) affecting poor populations in Africa, Asia, and Latin America, including Mexico, which represents a highly endemic area with higher frequencies of actinomycetomas. Mycetoma usually affects males (male∶female ratio of 3∶1), agricultural or rural workers (age range 20–40 years) that typically do not have access to protective equipment. The main clinical presentation is as soft tissue swelling with sinus tract formation draining grains, which leads to diagnosis. The foot is the most commonly affected localization; however, when disease presents in high risk areas, such as the trunk, it can disseminate to the lungs and spinal cord. This report represents a single center study which provides epidemiologic, clinical, and microbiological data of mycetoma cases in different regions of Mexico.
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Affiliation(s)
- Alexandro Bonifaz
- Department of Mycology, Dermatology Service, General Hospital of Mexico, Mexico City, Mexico
- * E-mail:
| | - Andrés Tirado-Sánchez
- Department of Mycology, Dermatology Service, General Hospital of Mexico, Mexico City, Mexico
| | - Luz Calderón
- Department of Mycology, Dermatology Service, General Hospital of Mexico, Mexico City, Mexico
| | - Amado Saúl
- Department of Mycology, Dermatology Service, General Hospital of Mexico, Mexico City, Mexico
| | - Javier Araiza
- Department of Mycology, Dermatology Service, General Hospital of Mexico, Mexico City, Mexico
| | - Marco Hernández
- Department of Mycology, Dermatology Service, General Hospital of Mexico, Mexico City, Mexico
| | - Gloria M. González
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Rosa María Ponce
- Department of Mycology, Dermatology Service, General Hospital of Mexico, Mexico City, Mexico
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