1
|
Zhu X, Ma J, Zheng B, Cai W, Li J, Lin L, Xi L, Li X, Lu S. Combination therapy with itraconazole and terbinafine for phaeohyphomycosis caused by Exophiala spinifera: A case report and literature review. Mycoses 2023; 66:1012-1017. [PMID: 37553547 DOI: 10.1111/myc.13642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023]
Abstract
Exophiala spinifera is a rare dematiaceous fungus causing cutaneous, subcutaneous and disseminated phaeohyphomycosis (PHM). Standard antifungal therapy for PHM is still uncertain. Here, we report a case of a Chinese male with PHM caused by E. spinifera, who received significant clinical improvement after the treatment with oral itraconazole and terbinafine. With the aim of evaluating the antifungal therapy for PHM caused by E. spinifera, a detailed review was performed.
Collapse
Affiliation(s)
- Xianzhong Zhu
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Dermatology and Venereology, The Second Affiliated Hospital of Guangzhou Medical University
| | - Jianchi Ma
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bowen Zheng
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenying Cai
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiahao Li
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Lin
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liyan Xi
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Xiqing Li
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sha Lu
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
2
|
Sharma B, Nonzom S. Mucormycosis and Its Upsurge During COVID-19 Epidemic: An Updated Review. Curr Microbiol 2023; 80:322. [PMID: 37592083 DOI: 10.1007/s00284-023-03430-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 07/26/2023] [Indexed: 08/19/2023]
Abstract
Although mucormycosis may have reached an epidemic situation during the COVID-19 pandemic, the term was much more familiar even before the COVID-19 period. The year 2020 showed an outbreak of novel coronavirus (SARS-CoV-2) which affected millions of people all over the world. One of the noticeable complications observed to be associated with this disease is mucormycosis. It is an opportunistic infection caused by members of the Order Mucorales existing worldwide and has been commonly reported as a laboratory contaminant for a long time. However, nowadays due to the changes in the host environment, they have been emerging as potent opportunistic pathogens responsible for causing primary infections or coinfections with other diseases eventually resulting in morbidity and even mortality in severe cases. Although immunocompromised patients are more susceptible to this infection, few cases have been reported in immunocompetent individuals. Various risk factors which are responsible for the acquisition of mucormycosis include diabetes mellitus type 2, ketoacidosis, hematological malignancies, organ transplants, and chemotherapy recipients. Among the various etiological agents, Rhizopus is found to be the most common, and rhino-cerebral to be the most frequent clinical presentation. As far as pathogenesis is concerned, host cell invasion, thrombosis, and necrosis are the main events in the progression of this disease. The aim of the present review is to address a complete spectrum of mucormycosis and COVID-19-associated mucormycosis (CAM) in a single article. Both global and Indian scenarios of mucormycosis are taken into account while framing this review.
Collapse
Affiliation(s)
- Bharti Sharma
- Department of Botany, University of Jammu, Jammu, Jammu and Kashmir, 180006, India
| | - Skarma Nonzom
- Department of Botany, University of Jammu, Jammu, Jammu and Kashmir, 180006, India.
| |
Collapse
|
3
|
Kondratjeva J, Pressanti C, Reynolds BS, Trumel C, Delverdier M, Normand AC, Soetart N, Guillot J, Cadiergues MC. Multifocal cutaneous phaeohyphomycosis caused by Exophiala spinifera with clinical resolution in an immunocompromised cat. JFMS Open Rep 2023; 9:20551169231164610. [PMID: 37123554 PMCID: PMC10141254 DOI: 10.1177/20551169231164610] [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] [Accepted: 03/02/2023] [Indexed: 05/02/2023] Open
Abstract
Case summary A 3-year-old neutered domestic shorthair cat with a long history of idiopathic immune-mediated haemolytic anaemia and thrombocytopenia treated with ciclosporin and prednisolone was referred 2 months after the appearance of nodular dermatitis. A single pigmented nodule was present in the lateral carpal region of the right foreleg. The lesion was 7 mm in diameter, non-exudative and cutaneous to subcutaneous. Fine-needle aspiration of the mass revealed the presence of pigmented fungal elements. Excisional surgery was planned; in the meantime, a plaque-like lesion developed in the interorbital region. Histopathological examination confirmed the presumptive diagnosis of phaeohyphomycosis, and Exophiala spinifera was identified as the aetiological agent. Itraconazole, given orally at a dose of 10 mg/kg for 8 weeks following surgery, enabled clinical resolution despite continued use of immunosuppressants. The follow-up was carried out over 14 weeks. Relevance and novel information This case report provides the first evidence of multifocal cutaneous phaeohyphomycosis caused by E spinifera with clinical resolution after combined surgical and itraconazole treatment in an immunocompromised cat.
Collapse
Affiliation(s)
| | - Charline Pressanti
- Department of Clinical Sciences, University
of Toulouse, ENVT, Toulouse, France
| | | | - Catherine Trumel
- Department of Clinical Sciences, University
of Toulouse, ENVT, Toulouse, France
- CREFRE (The Regional Centre for Functional
and Experimental Exploration Resources), University of Toulouse, Inserm, UPS, Toulouse,
France
| | - Maxence Delverdier
- Department of Basic Sciences, University of
Toulouse, ENVT, Toulouse, France
- IHAP (Interactions Hôtes-Agents Pathogènes),
University of Toulouse, ENVT, INRAE, Toulouse, France
| | - Anne-Cécile Normand
- AP-HP (Assistance Publique-Hôpitaux de
Paris), Department of Parasitology and Mycology, Hôpital La Pitié-Salpêtrière, Paris,
France
| | | | - Jacques Guillot
- Department of Dermatology, Parasitology and
Mycology, Oniris, Nantes, France
- University of Angers, University of Brest,
IRF, SFR ICAT, Angers, France
| | - Marie Christine Cadiergues
- Department of Clinical Sciences, University
of Toulouse, ENVT, Toulouse, France
- INFINITy (Toulouse Institute for Infectious
and Inflammatory Diseases), University of Toulouse, Inserm, CNRS, UPS, Toulouse,
France
- Marie Christine Cadiergues DrMedVet, PhD, EBVS
Specialist in Veterinary Dermatology, Department of Clinical Sciences, University of
Toulouse, ENVT, 23, Chemin des Capelles, Toulouse 31076, France
| |
Collapse
|
4
|
He Y, Zheng HL, Mei H, Lv GX, Liu WD, Li XF. Phaeohyphomycosis in China. Front Cell Infect Microbiol 2022; 12:895329. [PMID: 35770068 PMCID: PMC9235401 DOI: 10.3389/fcimb.2022.895329] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDue to more attentions paid to melanized fungi over the past few decades and under the background of the global coronavirus disease 2019 pandemic (COVID-19) the fact that the virus itself and the immunosuppressive agents such as glucocorticoids can further increase the risk of infections of deep mycoses, the number of patients with phaeohyphomycosis (PHM) has a substantial increase. Their spectrum is broad and the early diagnosis and treatments are extremely sticky. This study aims to more comprehensively understand the clinical features of phaeohyphomycosis in China over 35 years and to establish a more applicable systematical classification and severity grades of lesions to guide treatments and prognosis.MethodsWe reviewed 174 cases of proven phaeohyphomycosis reported in Chinese and English language literature from 1987 to 2021 and we also made the accurate classification definitions and detailed information about the epidemiology, species of clinical dematiaceous fungi, minimum inhibitory concentration values, clinical features, treatments, and prognosis.ResultsThe mortality of cerebral, disseminated and pulmonary phaeohyphomycosis are 55%, 36%, and 25%. Nearly 19% of patients had poor quality of life caused by the complications such as disability, disfigurements, and blindness. The overall misdiagnosis rate of phaeohyphomycosis was 74%. Moderate to severe rashes are accounting for 82% of subcutaneous phaeohyphomycosis. The areas of the head and face are mostly affected accounting for 16% of severe rashes. Nearly 30% of invasive infections of phaeohyphomycosis are triggered by recurrent lesions. Voriconazole, itraconazole, amphotericin B deoxycholate (AmB-DOC), and terbinafine were most commonly used but diagnosis and treatments of phaeohyphomycosis remain challenging in reality.ConclusionsOur classifications are likely to be more practical and easier to popularize, and there are still also plenty of characteristics in these non-specific lesions. There’re no significant variations in cure rates, or death rates between three grades of lesions. But patients with severe rashes have longer courses and lower effective rates.
Collapse
Affiliation(s)
- Yun He
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Science, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
- Skin Disease Prevention and Treatment Institute of Yixing, Yixing, China
| | - Hai-lin Zheng
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Science, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Huan Mei
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Science, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Gui-xia Lv
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Science, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Wei-da Liu
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Science, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
- *Correspondence: Wei-da Liu, ; Xiao-fang Li,
| | - Xiao-fang Li
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Science, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
- *Correspondence: Wei-da Liu, ; Xiao-fang Li,
| |
Collapse
|
5
|
Mercier V, Bastides F, Bailly É, Garcia-Hermoso D, Miquelestorena-Standley E, El Baz Z, Marteau E, Vermes E, De Muret A, Bernard L, Desoubeaux G. Successful Terbinafine Treatment for Cutaneous Phaeohyphomycosis Caused by Trematosphaeria grisea in a Heart Transplanted Man: Case Report and Literature Review. Mycopathologia 2020; 185:709-716. [PMID: 32562177 DOI: 10.1007/s11046-020-00467-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/06/2020] [Indexed: 01/19/2023]
Abstract
Phaeohyphomycosis is a chronic infectious disease caused by dematiaceous fungi. It is characterized by the presence of pigmented septate mycelia within tissues. In the case of superficial infection, the lesion(s) chronically evolve(s) toward painless pseudo-tumor(s) of the soft parts. We report herein the original case of a heart transplanted man who exhibited phaeohyphomycosis of the left hand, with no mention of travels in endemic areas. Trematosphaeria grisea was identified as the causative agent, which is quite innovative since this species has been rather described in mycetoma. The antifungal treatment initially based on isavuconazole alone was not sufficient to cure the patient. In contrast, its association with local terbinafine ointment allowed total clinical improvement. This finding is unusual as diagnosis of phaeohyphomycosis caused by T. grisea is uncommon in nontropical countries, and as the outcome appeared successful by the means of add-on therapeutic strategy with terbinafine.
Collapse
Affiliation(s)
- Victor Mercier
- Parasitologie - Mycologie et Médecine Tropicale, Hôpital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37044, Tours, France.
| | - Frédéric Bastides
- Médecine Interne Et Maladies Infectieuses, CHU de Tours, Tours, France
| | - Éric Bailly
- Parasitologie - Mycologie et Médecine Tropicale, Hôpital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37044, Tours, France
| | - Dea Garcia-Hermoso
- CNRS, National Reference Center for Invasive Mycoses and Antifungals (NRCMA), Molecular Mycology Unit, UMR2000, Institut Pasteur, Paris, France
| | | | - Zaki El Baz
- Radiologie, CHU de Tours, Chambray-les-Tours, France
| | - Emilie Marteau
- Chirurgie orthopédique Et Traumatologie, CHU de Tours, Chambray-les-Tours, France
| | | | - Anne De Muret
- Anatomie Et Cytologie Pathologiques, CHU de Tours, Chambray-les-Tours, France
| | - Louis Bernard
- Médecine Interne Et Maladies Infectieuses, CHU de Tours, Tours, France
| | - Guillaume Desoubeaux
- Parasitologie - Mycologie et Médecine Tropicale, Hôpital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37044, Tours, France
| |
Collapse
|
6
|
Song Y, Laureijssen-van de Sande WWJ, Moreno LF, Gerrits van den Ende B, Li R, de Hoog S. Comparative Ecology of Capsular Exophiala Species Causing Disseminated Infection in Humans. Front Microbiol 2017; 8:2514. [PMID: 29312215 PMCID: PMC5742258 DOI: 10.3389/fmicb.2017.02514] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/04/2017] [Indexed: 12/15/2022] Open
Abstract
Exophiala spinifera and Exophiala dermatitidis (Fungi: Chaetothyriales) are black yeast agents potentially causing disseminated infection in apparently healthy humans. They are the only Exophiala species producing extracellular polysaccharides around yeast cells. In order to gain understanding of eventual differences in intrinsic virulence of the species, their clinical profiles were compared and found to be different, suggesting pathogenic strategies rather than coincidental opportunism. Ecologically relevant factors were compared in a model set of strains of both species, and significant differences were found in clinical and environmental preferences, but virulence, tested in Galleria mellonella larvae, yielded nearly identical results. Virulence factors, i.e., melanin, capsule and muriform cells responded in opposite direction under hydrogen peroxide and temperature stress and thus were inconsistent with their hypothesized role in survival of phagocytosis. On the basis of physiological profiles, possible natural habitats of both species were extrapolated, which proved to be environmental rather than animal-associated. Using comparative genomic analyses we found differences in gene content related to lipid metabolism, cell wall modification and polysaccharide capsule production. Despite the fact that both species cause disseminated infections in apparently healthy humans, it is concluded that they are opportunists rather than pathogens.
Collapse
Affiliation(s)
- Yinggai Song
- Department of Dermatology, Peking University First Hospital, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China.,Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | | | | | | | - Ruoyu Li
- Department of Dermatology, Peking University First Hospital, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China
| | - Sybren de Hoog
- Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands.,Center of Expertise in Mycology Radboudumc/CWZ, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| |
Collapse
|
7
|
|
8
|
Abstract
Dematiaceous fungi are the cause of phaeohyphomycosis, a term that encompasses many clinical syndromes, from local infections due to trauma to widely disseminated infection in immunocompromised patients. These fungi are unique owing to the presence of melanin in their cell walls, which imparts the characteristic dark color to their spores and hyphae. Melanin may also be a virulence factor. Local infection may be cured with excision alone, whereas systemic disease is often refractory to therapy. Azoles have the most consistent in vitro activity. Further studies are needed to better understand the pathogenesis and treatment of these uncommon infections.
Collapse
Affiliation(s)
- Eunice H Wong
- Division of Infectious Diseases, Harper University Hospital, Wayne State University, 3990 John R., 5 Hudson, Detroit, MI 48201, USA
| | - Sanjay G Revankar
- Division of Infectious Diseases, Harper University Hospital, Wayne State University, 3990 John R., 5 Hudson, Detroit, MI 48201, USA.
| |
Collapse
|
9
|
Bohelay G, Robert S, Bouges-Michel C, Gerin M, Levy A, Fain O, Caux F. Subcutaneous phaeohyphomycosis caused byExophiala spiniferain a European patient with lymphoma: a rare occurrence case report and literature review. Mycoses 2016; 59:691-696. [DOI: 10.1111/myc.12515] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 03/27/2016] [Accepted: 04/19/2016] [Indexed: 11/28/2022]
Affiliation(s)
- G. Bohelay
- Department of Dermatology; Avicenne Hospital; Assistance Publique des Hôpitaux de Paris (AP-HP); Bobigny France
| | - S. Robert
- Department of General Practice; University Paris Diderot; Sorbonne Paris Cité; Paris France
| | - C. Bouges-Michel
- Laboratory of Mycology; Avicenne Hospital; Assistance Publique des Hôpitaux de Paris (AP-HP); Bobigny France
| | - M. Gerin
- Department of Internal Medicine; Jean Verdier Hospital; Assistance Publique des Hôpitaux de Paris (AP-HP); Bondy France
| | - A. Levy
- Department of Pathology; Avicenne Hospital; Assistance Publique des Hôpitaux de Paris (AP-HP); Bobigny France
| | - O. Fain
- Department of Internal Medicine; Saint-Antoine Hospital; AP-HP; DHU i2B; University Paris 6; Paris France
| | - F. Caux
- Department of Dermatology; Avicenne Hospital; Assistance Publique des Hôpitaux de Paris (AP-HP); Bobigny France
| |
Collapse
|