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Zheng M, Zhou X, Pang J, Yang Z, Zou Y, Zhang L, Xu Y, Yin R. New methylene blue-mediated photodynamic inactivation of multidrug-resistant Fonsecaea nubica infected chromoblastomycosis in vitro. Braz J Microbiol 2023; 54:873-883. [PMID: 37145297 PMCID: PMC10234991 DOI: 10.1007/s42770-023-00974-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/10/2023] [Indexed: 05/06/2023] Open
Abstract
Chromoblastomycosis is a fungal disease presented with local warty papule, plaque, and verrucous nodules. In addition, the incidence and drug resistance of chromoblastomycosis are increasing each year worldwide. Photodynamic therapy is a promising method to treat mycoses. The purpose of this study was to evaluate the effect of new methylene blue (NMB)-induced PDT on multidrug-resistant chromoblastomycosis in vitro. We isolated one wild-type strain pathogen from one clinical patient diagnosed with chromoblastomycosis for over 27 years. The pathogen was identified by histopathology, the morphology of fungal culture, and genetic testing. Drug susceptibility testing was performed on the isolate. It was cultured with logarithmic growth phase spore in vitro and incubated with different concentrations of NMB for 30 min, and received illumination by red light-emitted diode with different light doses. After photodynamic treatment, the scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were conducted. The pathogen was Fonsecaea nubica, and it was resistant to itraconazole, terbinafine, amphotericin B, voriconazole andcaspofungin. At the same NMB concentration, the sterilization efficiency of NMB-photodynamic therapy (PDT) on F. nubica increased with increasing light intensity; F. nubica was completely killed at 25 µmol/L NMB with a light dose of 40 J/cm2 or 50 µmol/L NMB and light doses of ≥ 30 J/cm2. SEM and TEM observed ultrastructural changes after PDT. NMB-PDT inactivates the survival of multidrug-resistant F. nubica in vitro; it therefore has the potential to become an alternative or adjuvant treatment for refractory chromoblastomycosis.
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Affiliation(s)
- Mengxue Zheng
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Xiaoqing Zhou
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Jiayin Pang
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Zengjun Yang
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yongzhen Zou
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Lian Zhang
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yan Xu
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Rui Yin
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
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Luo J, Feng P, Hu Y, Yang Y, Zhou S, Huang S, Jadad A, Zhong Z, Zheng Y, Liu K, Lu Y, Hu Y, Zhou X. [Long-pulsed 1064 nm Nd: YAG laser combined with terbinafine against chromoblastomycosis caused by Fonsecaea nubica and the effect of laser therapy in a Wistar rat model]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:712-717. [PMID: 31270051 DOI: 10.12122/j.issn.1673-4254.2019.06.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We report a case of chromoblastomycosis caused by Fonsecaea nubica, which was successfully treated by long-pulsed 1064 nm Nd: YAG laser combined with terbinafine. A 60-year-old man was admitted for the presence of a 30 mm×40 mm erythematous plaque on the dorsum of his right hand for about 10 months without any subjective symptoms. Both microscopic examination and tissue biopsy of the lesion showed characteristic sclerotic bodies of chromoblastomycosis. Lesion tissue culture on SDA at 26 ℃ for 2 weeks resulted in a black colony, and slide culture identified the isolate as Fonsecaea species. ITS sequence analysis of the isolate showed a 99% homology with F. nubica strain KX078407. The in vitro susceptibility of the isolate to 9 antifungal agents was determined using the microdilution method according to the guidelines of CLSI M38-A2 protocol, and terbinafine showed the lowest MIC (0.125 μg/ml). We subsequently established a Wistar rat model of chromoblastomycosis using the clinical isolate F. nubica and treated the rats with long-pulsed 1064 nm Nd: YAG laser (pulse width of 3.0 ms, fluence of 24 J/cm2, spot size of 3 mm, frequency of 4 Hz, repeated 3 times at an interval of 30 s) twice a week for a total of 8 sessions. Although the laser treatment alone was not able to eliminate the fungi, histopathological examination showed the aggregation of numerous lymphocytes in the local affected tissue, indicating an immune response that consequently facilitate the regression of the lesion. The patient was successfully treated by long-pulsed 1064 nm Nd: YAG laser once a week combined with terbinafine (0.25 /bid) for 8 weeks, and follow-up for 20 months did not reveal any signs of recurrence.
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Affiliation(s)
- Juan Luo
- Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - Peiying Feng
- Department of Dermatology and Venerology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Yongxuan Hu
- Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - Yemei Yang
- Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - Sitong Zhou
- Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - Songgen Huang
- Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - Abdulla Jadad
- Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - Zemin Zhong
- Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - Yushi Zheng
- Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - Kangxing Liu
- Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - Yan Lu
- Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - Yanqing Hu
- Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - Xianyi Zhou
- Department of Dermatology and Venerology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
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Zhang J, Wu X, Li M, Huang J, Yin S, Huang H, Lu C, Xi L. Synergistic effect of terbinafine and amphotericin B in killing Fonsecaea nubica in vitro and in vivo. Rev Inst Med Trop Sao Paulo 2019; 61:e31. [PMID: 31241660 PMCID: PMC6592013 DOI: 10.1590/s1678-9946201961031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/02/2019] [Indexed: 12/26/2022] Open
Abstract
Chromoblastomycosis is a chronic fungal infection. Itraconazole and terbinafine are the most recommended antifungal drugs for chromoblastomycosis, while amphotericin B is not usually recommended. A patient with chromoblastomycosis in our hospital showed poor clinical responses to itraconazole and terbinafine. The fungus isolated from the lesions of this patient was identified as Fonsecaea nubica and numbered zssy0803. In vitro antifungal susceptibilities of F. nubica zssy0803 to terbinafine, amphotericin B, itraconazole, voriconazole and caspofungin were evaluated, as well as the combinations of terbinafine with the other four antifungals. The combined effect of terbinafine and amphotericin B on other 20 clinical F. nubica strains was also evaluated. The minimal inhibitory concentrations of terbinafine, amphotericin B, itraconazole, voriconazole and caspofungin on F. nubica zssy0803 were 0.25 μg/mL, 2 μg/mL, 1 μg/mL, 4 μg/mL and 8 μg/mL, respectively. The combination of terbinafine and amphotericin B showed the lowest fractional inhibitory concentration index of 0.28 to F. nubica zssy0803 in comparison with combinations of terbinafine and the other four antifungal drugs. The combination of terbinafine and amphotericin B was also synergistic for all the other 20 F. nubica strains. Then, the combination of oral terbinafine (500 mg/day) and intralesional injections of amphotericin B (1 mg/mL) was used to treat this patient. After this combined therapy for 25 weeks and terbinafine monotherapy for additional 12 weeks, the patient was cured. These findings indicate for the first time that terbinafine and amphotericin B are synergistic in killing F. nubica both in vitro and in vivo.
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Affiliation(s)
- Jing Zhang
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China.,Yat-sen University, Sun Yat-sen Memorial Hospital, Department of Dermatology and Venereology, Guangzhou, China.,Sun Yat-sen University, Sun Yat-sen Memorial Hospital, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China
| | - Xiaoyan Wu
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Meirong Li
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Jiamin Huang
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Songchao Yin
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Huaiqiu Huang
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Chun Lu
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Liyan Xi
- Yat-sen University, Sun Yat-sen Memorial Hospital, Department of Dermatology and Venereology, Guangzhou, China
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You Z, Yang X, Yu J, Zhang J, Ran Y. Chromoblastomycosis Caused by Fonsecaea nubica: First Report in Northern China and Literature Review. Mycopathologia 2018; 184:97-105. [PMID: 30547378 DOI: 10.1007/s11046-018-0307-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 11/19/2018] [Indexed: 02/05/2023]
Abstract
Chromoblastomycosis is found worldwide with higher incidence in tropical and subtropical regions. Fonsecaea spp. is one of the major causative agents of this disease. First case of chromoblastomycosis due to Fonsecaea nubica in Northern China is reported in a 75-year-old Chinese male. We firstly summarized molecular identification methods of Fonsecaea spp. and all the strains of F. nubica reported in the literature. Sequencing of internal transcribed spacer alone and/or combined with actin (ACT1), partial cell division cycle (CDC42) and partial beta-tubulin (BT2) were most commonly used to identify species, while lactase (Lac), homogentisate (HmgA) and polyketide synthase (PKS1) were also used in some cases. Most strains were isolated from South America and Eastern China. Five clinical cases of chromoblastomycosis due to F. nubica from Asia and Europe were also reviewed. All the five patients were male, over 30 years old, and their lesions occurred after trauma.
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Affiliation(s)
- Zimeng You
- Department of Dermatovenereology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Xiaoxiao Yang
- Department of Dermatology, First Affiliated Hospital, Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Jianbin Yu
- Department of Dermatology, First Affiliated Hospital, Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Jiangan Zhang
- Department of Dermatology, First Affiliated Hospital, Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, 450052, Henan Province, China.
| | - Yuping Ran
- Department of Dermatovenereology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Wuhou District, Chengdu, 610041, Sichuan Province, China.
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