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Samaddar A, Mendonsa JM, Sudhaharan S, S N, Kindo AJ, Shetty A, Pamidimukkala U. In vitro evaluation of antifungal combinations against neurotropic dematiaceous fungi associated with primary cerebral phaeohyphomycosis. Microbiol Spectr 2024:e0078124. [PMID: 38920376 DOI: 10.1128/spectrum.00781-24] [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: 03/25/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
Primary cerebral phaeohyphomycosis is a life-threatening disease caused by neurotropic dematiaceous fungi. At present, there are no consensus guidelines regarding optimal antifungal therapy in such cases. Generally, a combination of antifungal agents is recommended for treatment. However, the activities of antifungal combinations against these fungi have not been investigated. In this study, we evaluated the in vitro activities of 13 double and five triple antifungal combinations against clinical isolates of Cladophialophora bantiana (n = 7), Fonsecaea monophora (n = 2), and Cladosporium cladosporioides (n = 1), using a simplified checkerboard procedure. The minimum inhibitory concentrations (MICs) of nine antifungal drugs were determined by the broth microdilution method, and the interaction between antifungal agents in each combination was assessed by the fractional inhibitory concentration index. Excellent activity was observed for posaconazole and itraconazole. Flucytosine had potent activity against C. bantiana but was ineffective against F. monophora, and C. cladosporioides. The echinocandins demonstrated high MICs for all the isolates. Synergistic interactions were observed for all the double combinations, except when itraconazole was combined with either amphotericin B or flucytosine. The combination of amphotericin B with caspofungin showed synergistic interactions against 40% of the isolates. Antagonism was observed with isavuconazole-flucytosine combination against two C. bantiana isolates. The triple combinations of caspofungin and flucytosine with amphotericin B or posaconazole were synergistic against one isolate of F. monophora. For C. cladosporioides, synergy was observed for the triple combination of amphotericin B with caspofungin and flucytosine. Our results indicate that combination of caspofungin with amphotericin B or a triazole, with or without 5-flucytosine has great potential against neurotropic dematiaceous fungi.IMPORTANCEThis research uses a modified version of the checkerboard assay to standardize the in vitro testing of double and triple combinations of antifungal agents against neurotropic dematiaceous fungi. Antifungal combination therapy is associated with improved outcomes in cerebral phaeohyphomycosis. In this study, we demonstrate that posaconazole is the single most active antifungal drug against this group of fungi. The double combination of amphotericin B with caspofungin or a trizole, and the triple combinations of caspofungin and flucytosine with amphotericin B or posaconazole might hold promise in the treatment of cerebral phaeohyphomycosis. Our findings will guide in developing optimal therapeutic strategies for these refractory infections.
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Affiliation(s)
- Arghadip Samaddar
- Department of Neuromicrobiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Jenevi Margaret Mendonsa
- Department of Neuromicrobiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sukanya Sudhaharan
- Department of Microbiology, ICMR-Advanced Mycology Diagnostic and Research Centre, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Nagarathna S
- Department of Neuromicrobiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Anupma Jyoti Kindo
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Anjali Shetty
- Department of Microbiology, ICMR-Advanced Mycology Diagnostic and Research Centre, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Umabala Pamidimukkala
- Department of Microbiology, ICMR-Advanced Mycology Diagnostic and Research Centre, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Herman TS, da Silva Goersch C, Bocca AL, Fernandes L. Resazurin to determine the minimum inhibitory concentration on antifungal susceptibility assays for Fonsecaea sp. using a modified EUCAST protocol. Braz J Microbiol 2024; 55:1349-1357. [PMID: 38438831 PMCID: PMC11153478 DOI: 10.1007/s42770-024-01293-2] [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: 11/07/2023] [Accepted: 02/27/2024] [Indexed: 03/06/2024] Open
Abstract
Chromoblastomycosis is a fungal chronic disease, which affects humans, especially in cutaneous and subcutaneous tissues. There is no standard treatment for Chromoblastomycosis, and it is a therapeutic challenge, due natural resistance of their causative agents, inadequate response of patients and common cases of relapse. Protocols for determination of antifungal drugs susceptibility are not standardized for chromoblastomycosis agents and endpoint definition is usually based on visual inspection, which depends on the analyst, making it sometimes inaccurate. We presented a colorimetric and quantitative methodology based on resazurin reduction to resofurin to determine the metabolic status of viable cells of Fonsecaea sp. Performing antifungal susceptibility assay by a modified EUCAST protocol allied to resazurin, we validated the method to identify the minimum inhibitory concentrations of itraconazole, fluconazole, amphotericin B, and terbinafine for eight Fonsecaea clinical isolates. According to our data, resazurin is a good indicator of metabolic status of viable cells, including those exposed to antifungal drugs. This work aimed to test resazurin as an indicator of the metabolic activity of Fonsecaea species in susceptibility assays to antifungal drugs. Species of this genus are the main causative agents of Chromoblastomycosis, which affects humans.
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Affiliation(s)
- Tatiana Sobianski Herman
- Postgraduate Program in Molecular Pathology, Faculty of Medicine, University of Brasília, UnB, Brasília, DF, Brazil
- Laboratory of Applied Immunology, Department of Cell Biology, Institute of Biological Sciences, University of Brasília, UnB, Room J1 28/8, Brasília, DF, 70910-900, Brazil
| | - Camila da Silva Goersch
- Laboratory of Applied Immunology, Department of Cell Biology, Institute of Biological Sciences, University of Brasília, UnB, Room J1 28/8, Brasília, DF, 70910-900, Brazil
- Postgraduate Program in Microbial Biology, Institute of Biological Science, University of Brasília, UnB, Brasília, DF, Brazil
| | - Anamelia Lorenzetti Bocca
- Postgraduate Program in Molecular Pathology, Faculty of Medicine, University of Brasília, UnB, Brasília, DF, Brazil
- Laboratory of Applied Immunology, Department of Cell Biology, Institute of Biological Sciences, University of Brasília, UnB, Room J1 28/8, Brasília, DF, 70910-900, Brazil
| | - Larissa Fernandes
- Laboratory of Applied Immunology, Department of Cell Biology, Institute of Biological Sciences, University of Brasília, UnB, Room J1 28/8, Brasília, DF, 70910-900, Brazil.
- Postgraduate Program in Microbial Biology, Institute of Biological Science, University of Brasília, UnB, Brasília, DF, Brazil.
- Faculty of Ceilândia, University of Brasília, UnB, Brasília, DF, Brazil.
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Gourav S, Singh G, Pandey M, Rana B, Gupta S, Mishra H, Xess I. Molecular Identification of Fonsecaea monophora, Novel Agent of Fungal Brain Abscess. Emerg Infect Dis 2024; 30:1232-1235. [PMID: 38782016 PMCID: PMC11138971 DOI: 10.3201/eid3006.240077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
A 3-year-old patient in India experiencing headaches and seizures was diagnosed with a fungal infection, initially misidentified as Cladophialophora bantiana. Follow-up sequencing identified the isolate to be Fonsecaea monophora fungus. This case demonstrates the use of molecular methods for the correct identification of F. monophora, an agent of fungal brain abscess.
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Bi W, Xu L, Zong L, Zhu Z, Xia X. Antifungal Susceptibility and Biological Characteristics of Fonsecaea monophora Causing Cerebral Phaeohyphomycosis in Jinhua, China. Infect Drug Resist 2023; 16:7187-7195. [PMID: 37965207 PMCID: PMC10642484 DOI: 10.2147/idr.s425961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/04/2023] [Indexed: 11/16/2023] Open
Abstract
Background The management of cerebral abscesses caused by dark-pigmented Fonsecaea monophora in healthy individuals continues to be challenging due to no consensus on the therapeutic regimen. Due to the absence of an accurate identification method, Fonsecaea species are often misidentified due to indistinct morphology features. Materials and Methods An F. monophora strain from an immunocompetent host with cerebral abscess was collected and identified by ITS rDNA molecular sequencing. The ITS sequences of the isolate were compared with that of the other ten Chinese F. monophora isolates obtained from GenBank for difference comparison and phylogenetic analysis. Fluorescence, Gram stains, and medan lactate were used to observe the colonial morphology. Antifungal susceptibility testing was implemented to demonstrate the antibiotic susceptibility profile. Galleria mellonella larvae were used as a model to study virulence of F. monophora. Medical records and clinical data of the patient were collected and analyzed. Results Antifungal susceptibility testing indicated that triazole antifungal drugs possess remarkable antifungal effect against F. monophora, and satisfactory antifungal effect of itraconazole was corresponding to the drug susceptibility results. Compared with the GM test, the serum G test was found to be more sensitive. The virulence and melanization in G. mellonella models for F. monophora were observed, and the death rates of infected larvae were positively related to injected concentrations of fungus. The phylogenetic tree was constructed from the ITS sequences of the clinical isolate along with ten Chinese F. monophora isolates, revealing that there is high relatedness in F. monophora strains collected from China. Conclusion F. monophora is an important neurotropic dematiaceous fungus and increasingly causing disease in immunocompetent individuals by means of noninvasive ways. Fungal culture, stainings, and molecular methods could be utilized to identify the etiologic agent. Triazole antifungal drugs can be applied as empiric therapeutic agents for phaeohyphomycosis.
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Affiliation(s)
- Wenzi Bi
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
| | - Licheng Xu
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
| | - Laibin Zong
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
| | - Zhiqiang Zhu
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
| | - Xiaoping Xia
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China
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Coelho RA, Figueiredo-Carvalho MHG, Almeida-Silva F, de Souza Rabello VB, de Souza GR, Sangenito LS, Joffe LS, Santos ALSD, da Silva Lourenço MC, Rodrigues ML, Almeida-Paes R. Repurposing Benzimidazoles against Causative Agents of Chromoblastomycosis: Albendazole Has Superior In Vitro Activity Than Mebendazole and Thiabendazole. J Fungi (Basel) 2023; 9:753. [PMID: 37504741 PMCID: PMC10381309 DOI: 10.3390/jof9070753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
Chromoblastomycosis (CBM) is a neglected human implantation mycosis caused by several dematiaceous fungal species. Currently available therapy is usually associated with physical methods, especially surgery, and with high refractoriness. Therefore, drug discovery for CBM is essential. Drug repositioning is a strategy used to facilitate the discovery of new treatments for several diseases. The aim of this study was to discover substances with antifungal activity against CBM agents from a collection of drugs previously approved for use in human diseases. A screening was performed with the NIH Clinical Collection against Fonsecaea pedrosoi. Ten substances, with clinical applicability in CBM, inhibited fungal growth by at least 60%. The minimum inhibitory concentration (MIC) of these substances was determined against other CBM agents, and the benzimidazoles albendazole, mebendazole and thiabendazole presented the lowest MIC values. The selectivity index, based on MIC and cytotoxicity of these substances, revealed albendazole to be more selective. To investigate a possible synergism of this benzimidazole with itraconazole and terbinafine, the chequerboard method was used. All interactions were classified as indifferent. Our current results suggest that benzimidazoles have repositioning potential against CBM agents. Albendazole seems to be the most promising, since it presented the highest selectivity against all dematiaceous fungi tested.
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Affiliation(s)
- Rowena Alves Coelho
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, INI/Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil
| | | | - Fernando Almeida-Silva
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, INI/Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil
| | - Vanessa Brito de Souza Rabello
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, INI/Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil
| | - Gabriela Rodrigues de Souza
- Plataforma de Bioensaios RPT 11B, Instituto Nacional de Infectologia Evandro Chagas, INI/Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil
| | - Leandro Stefano Sangenito
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goés, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
- Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Nilópolis 26530-060, RJ, Brazil
| | - Luna Sobrino Joffe
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, NY 11792, USA
| | - André Luis Souza Dos Santos
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goés, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
- Rede Micologia RJ, Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Rio de Janeiro 21941-901, RJ, Brazil
| | - Maria Cristina da Silva Lourenço
- Plataforma de Bioensaios RPT 11B, Instituto Nacional de Infectologia Evandro Chagas, INI/Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil
| | - Marcio L Rodrigues
- Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba 81350-010, PR, Brazil
- Instituto de Microbiologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-902, RJ, Brazil
| | - Rodrigo Almeida-Paes
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, INI/Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil
- Rede Micologia RJ, Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Rio de Janeiro 21941-901, RJ, Brazil
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The origin of human pathogenicity and biological interactions in Chaetothyriales. FUNGAL DIVERS 2023. [DOI: 10.1007/s13225-023-00518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
AbstractFungi in the order Chaetothyriales are renowned for their ability to cause human infections. Nevertheless, they are not regarded as primary pathogens, but rather as opportunists with a natural habitat in the environment. Extremotolerance is a major trend in the order, but quite different from black yeasts in Capnodiales which focus on endurance, an important additional parameter is advancing toxin management. In the ancestral ecology of rock colonization, the association with metabolite-producing lichens is significant. Ant-association, dealing with pheromones and repellents, is another mainstay in the order. The phylogenetically derived family, Herpotrichiellaceae, shows dual ecology in monoaromatic hydrocarbon assimilation and the ability to cause disease in humans and cold-blooded vertebrates. In this study, data on ecology, phylogeny, and genomics were collected and analyzed in order to support this hypothesis on the evolutionary route of the species of Chaetothyriales. Comparing the ribosomal tree with that of enzymes involved in toluene degradation, a significant expansion of cytochromes is observed and the toluene catabolism is found to be complete in some of the Herpotrichiellaceae. This might enhance human systemic infection. However, since most species have to be traumatically inoculated in order to cause disease, their invasive potential is categorized as opportunism. Only in chromoblastomycosis, true pathogenicity might be surmised. The criterion would be the possible escape of agents of vertebrate disease from the host, enabling dispersal of adapted genotypes to subsequent generations.
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Guevara A, Nery AF, de Souza Carvalho Melhem M, Bonfietti L, Rodrigues AM, Hagen F, de Carvalho J, de Camargo ZP, de Souza Lima B, Vicente VA, Hahn RC. Molecular epidemiology and clinical-laboratory aspects of chromoblastomycosis in Mato Grosso, Brazil. Mycoses 2022; 65:1146-1158. [PMID: 35869803 PMCID: PMC9828117 DOI: 10.1111/myc.13505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Chromoblastomycosis is a disease caused by melanized fungi, primarily belonging to the genera Fonsecaea and Cladophialophora, mainly affecting individuals who are occupationally exposed to soil and plant products. This research aimed to determine the clinical, epidemiological and laboratory characteristics of chromoblastomycosis in the state of Mato Grosso, Brazil. MATERIALS AND METHODS Patients diagnosed with chromoblastomycosis treated at the Júlio Müller University Hospital, Cuiabá, Brazil, from January 2015 to December 2020, whose isolates were preserved in the Research Laboratory of the Faculty of Medicine of the Federal University of Mato Grosso. Isolates were identified by partly sequencing the Internal Transcribed Spacer (ITS) and β-tubulin (BT2) loci. AFLP fingerprinting was used to explore the genetic diversity. Susceptibility to itraconazole, voriconazole, 5-fluorocytosine, terbinafine and amphotericin B was determined by the broth microdilution technique. RESULTS Ten patients were included, nine were male (mean age = 64.1 years). Mean disease duration was 8.6 years. Lesions were mainly observed in the lower limbs. Predominant clinical forms were verrucous and scarring. Systemic arterial hypertension and type II diabetes mellitus were the predominant comorbidities. Leprosy was the main concomitant infectious disease. Fonsecaea pedrosoi was the unique aetiological agent identified with moderate genetic diversity (H = 0.3934-0.4527; PIC = 0.3160-0.3502). Antifungal agents with the highest activity were terbinafine, voriconazole and itraconazole. CONCLUSION Chromoblastomycosis is affecting the poor population in rural and urban areas, mainly related to agricultural activities, with F. pedrosoi being the dominant aetiologic agent. All isolates had low MICs for itraconazole, voriconazole and terbinafine, confirming their importance as therapeutic alternatives for chromoblastomycosis.
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Affiliation(s)
- Armando Guevara
- Laboratory of Mycology/Research, Faculty of MedicineFederal University of Mato GrossoCuiabáMato GrossoBrazil
| | - Andréia Ferreira Nery
- Júlio Muller University HospitalFederal University of Mato GrossoCuiabáMato GrossoBrazil
| | - Márcia de Souza Carvalho Melhem
- Health DepartmentMycology Nucleus of Instituto Adolfo LutzSão PauloSPBrazil,School of MedicineFederal University of Mato Grosso do SulCampo Grande, MSBrazil
| | - Lucas Bonfietti
- Health DepartmentMycology Nucleus of Instituto Adolfo LutzSão PauloSPBrazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular BiologyFederal University of São Paulo (UNIFESP)São PauloBrazil,Department of Medicine, Discipline of Infectious DiseasesFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Ferry Hagen
- Westerdijk Fungal Biodiversity InstituteUtrechtThe Netherlands,Institute for Biodiversity and Ecosystem Dynamics (IBED)University of AmsterdamThe Netherlands,Department of Medical MicrobiologyUtrecht University Medical CenterUtrechtThe Netherlands
| | - Jamile Ambrósio de Carvalho
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular BiologyFederal University of São Paulo (UNIFESP)São PauloBrazil,Department of Medicine, Discipline of Infectious DiseasesFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular BiologyFederal University of São Paulo (UNIFESP)São PauloBrazil,Department of Medicine, Discipline of Infectious DiseasesFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Bruna Jacomel F. de Souza Lima
- Microbiology, Parasitology and Pathology Post‐Graduation Program, Department of PathologyFederal University of ParanáCuritibaParanáBrazil
| | | | - Rosane Christine Hahn
- Laboratory of Mycology/Research, Faculty of MedicineFederal University of Mato GrossoCuiabáMato GrossoBrazil,Júlio Muller University HospitalFederal University of Mato GrossoCuiabáMato GrossoBrazil
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Lim W, Verbon A, van de Sande W. Identifying novel drugs with new modes of action for neglected tropical fungal skin diseases (fungal skinNTDs) using an Open Source Drug discovery approach. Expert Opin Drug Discov 2022; 17:641-659. [PMID: 35612364 DOI: 10.1080/17460441.2022.2080195] [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: 01/19/2023]
Abstract
INTRODUCTION The three fungal skin neglected tropical diseases (NTD) mycetoma, chromoblastomycosis and sporotrichosis currently lack prioritization and support to establish drug discovery programs in search for novel treatment options. This has made the efforts to identify novel drugs for these skinNTDs fragmented. AREAS COVERED To help escalate the discovery of novel drugs to treat these fungal skinNTDs, the authors have prepared an overview of the compounds with activity against fungal skinNTDs by analyzing data from individual drug discovery studies including those performed on the Medicines for Malaria Venture (MMV) open access boxes. EXPERT OPINION The authors were unable to identify studies in which causative agents of all three skinNTDs were included, indicating that an integrated approach is currently lacking. From the currently available data, the azoles and iodoquinol were the only compounds with activity against causative agents from the three different fungal skinNTDs. Fungal melanin inhibition enhanced the activity of antifungal agents. For mycetoma, the fenarimols, aminothiazoles and benzimidazole carbamates are currently being investigated in the MycetOS initiative. To come to a more integrated approach to identify drugs active against all three fungal skinNTDs, compounds made in the MycetOS initiative could also be explored for chromoblastomycosis and sporotrichosis.
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Affiliation(s)
- Wilson Lim
- Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annelies Verbon
- Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wendy van de Sande
- Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Liu H, Sun J, Li M, Cai W, Chen Y, Liu Y, Huang H, Xie Z, Zeng W, Xi L. Molecular Characteristics of Regional Chromoblastomycosis in Guangdong, China: Epidemiological, Clinical, Antifungal Susceptibility, and Serum Cytokine Profiles of 45 Cases. Front Cell Infect Microbiol 2022; 12:810604. [PMID: 35252030 PMCID: PMC8894709 DOI: 10.3389/fcimb.2022.810604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/24/2022] [Indexed: 11/20/2022] Open
Abstract
Chromoblastomycosis (CBM) is a chronic disease caused by several species of dematiaceous fungi. In this study, a regional collection of 45 CBM cases was conducted in Guangdong, China, a hyper-endemic area of CBM. Epidemiology findings indicated that the mean age of cases was 61.38 ± 11.20 years, long duration ranged from 3 months to 30 years, and the gender ratio of male to female was 4.6:1. Thirteen cases (29%) declared underlying diseases. Verrucous form was the most common clinical manifestation (n = 19, 42%). Forty-five corresponding clinical strains were isolated, and 28 of them (62%) were identified as F. monophora; the remaining 17 (38%) were identified as F. nubica through ITS rDNA sequence analysis. Antifungal susceptibility tests in vitro showed low MICs in azoles (PCZ 0.015–0.25 μg/ml, VCZ 0.015–0.5 μg/ml, and ITZ 0.03–0.5 μg/ml) and TRB (0.015–1 μg/ml). Itraconazole combined with terbinafine was the main therapeutic strategy used for 31 of 45 cases, and 68% (n = 21) of them improved or were cured. Cytokine profile assays indicated upregulation of IL-4, IL-7, IL-15, IL-11, and IL-17, while downregulation of IL-1RA, MIP-1β, IL-8, and IL-16 compared to healthy donors (p < 0.05). The abnormal cytokine profiles indicated impaired immune response to eliminate fungus in CBM cases, which probably contributed to the chronic duration of this disease. In conclusion, we investigated the molecular epidemiological, clinical, and laboratory characteristics of CBM in Guangdong, China, which may assist further clinical therapy, as well as fundamental pathogenesis studies of CBM.
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Affiliation(s)
- Hongfang Liu
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Guangdong Dermatology Hospital of Anhui Medical University, Guangzhou, China
| | - Jiufeng Sun
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Minying Li
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Wenying Cai
- Sun Yat-sen Memorial Hospital of Zhongshan University, Guangzhou, China
| | - Yangxia Chen
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Yinghui Liu
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Huan Huang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Zhenmou Xie
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Weiying Zeng
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Liyan Xi
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Sun Yat-sen Memorial Hospital of Zhongshan University, Guangzhou, China
- Department of Dermatology and Venerology, Guangzhou First People’s Hospital, Guangzhou, China
- *Correspondence: Liyan Xi,
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10
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Reviewing the Etiologic Agents, Microbe-Host Relationship, Immune Response, Diagnosis, and Treatment in Chromoblastomycosis. J Immunol Res 2021; 2021:9742832. [PMID: 34761009 PMCID: PMC8575639 DOI: 10.1155/2021/9742832] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/30/2021] [Indexed: 01/19/2023] Open
Abstract
Chromoblastomycosis (CBM) is a neglected human disease, caused by different species of pigmented dematiaceous fungi that cause subcutaneous infections. This disease has been considered an occupational disease, occurring among people working in the field of agriculture, particularly in low-income countries. In 1914, the first case of CBM was described in Brazil, and although efforts have been made, few scientific and technological advances have been made in this area. In the field of fungi and host cell relationship, a very reduced number of antigens were characterized, but available data suggest that ectoantigens bind to the cell membrane of host cells and modulate the phagocytic, immunological, and microbicidal responses of immune cells. Furthermore, antigens cleave extracellular proteins in tissues, allowing fungi to spread. On the contrary, if phagocytic cells are able to present antigens in MHC molecules to T lymphocytes in the presence of costimulation and IL-12, a Th1 immune response will develop and a relative control of the disease will be observed. Despite knowledge of the resistance and susceptibility in CBM, up to now, no effective vaccines have been developed. In the field of chemotherapy, most patients are treated with conventional antifungal drugs, such as itraconazole and terbinafine, but these drugs exhibit limitations, considering that not all patients heal cutaneous lesions. Few advances in treatment have been made so far, but one of the most promising ones is based on the use of immunomodulators, such as imiquimod. Data about a standard treatment are missing in the medical literature; part of it is caused by the existence of a diversity of etiologic agents and clinical forms. The present review summarizes the advances made in the field of CBM related to the diversity of pathogenic species, fungi and host cell relationship, antigens, innate and acquired immunity, clinical forms of CBM, chemotherapy, and diagnosis.
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Najafzadeh MJ, Dolatabadi S, Vicente VA, de Hoog GS, Meis JF. In vitro activities of 8 antifungal drugs against 126 clinical and environmental Exophiala isolates. Mycoses 2021; 64:1328-1333. [PMID: 34411353 DOI: 10.1111/myc.13364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Exophiala is the main genus of black fungi comprising numerous opportunistic species. Data on antifungal susceptibility of Exophiala isolates are limited, while infections are potentially fatal. MATERIALS AND METHODS In vitro activities of eight antifungal drugs (AMB, five azoles, two echinocandins) against 126 clinical (n = 76) and environmental (n = 47) isolates from around the world were investigated. E. oligosperma (n = 58), E. spinifera (n = 33), E. jeanselmei (n = 14) and E. xenobiotica (n = 21) were included in our dataset. RESULTS The resulting MIC90 s of all strains were as follows, in increasing order: posaconazole 0.063 μg/ml, itraconazole 0.125 μg/ml, voriconazole and amphotericin B 1 μg/ml, isavuconazole 2 μg/ml, micafungin and caspofungin 4 μg/ml, and fluconazole 64 μg/ml. Posaconazole, itraconazole and micafungin were the drugs with the best overall activity against Exophiala species. Fluconazole could not be considered as a treatment choice. No significant difference could be found among antifungal drug activities between these four species, neither in clinical nor in environmental isolates. CONCLUSION Antifungal susceptibility data for Exophiala spp. are crucial to improve the management of this occasionally fatal infection and the outcome of its treatment.
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Affiliation(s)
- Mohammad Javad Najafzadeh
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Vania Aparecida Vicente
- Bioprocess Engineering and Biotechnology Graduate Program, Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Gerrit Sybren de Hoog
- Center of Expertise in Mycology, Radboudumc/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jacques F Meis
- Bioprocess Engineering and Biotechnology Graduate Program, Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil.,Center of Expertise in Mycology, Radboudumc/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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Effect of Melanin Biosynthesis Inhibition on the Antifungal Susceptibility of Chromoblastomycosis Agents. Antimicrob Agents Chemother 2021; 65:e0054621. [PMID: 33972246 DOI: 10.1128/aac.00546-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Chromoblastomycosis (CBM) is a chronic subcutaneous infection caused by genera of melanized fungi: Fonsecaea, Cladophialophora, Phialophora, Exophiala, and Rhinocladiella. Melanin is a virulence factor known to influence antifungal susceptibility. A specific inhibitor of melanin biosynthesis is tricyclazole. The aim of this study was to evaluate the effect of melanin inhibition on antifungal susceptibility of chromoblastomycosis agents and describe the susceptibility profiles of some unusual CBM agents. Seventy-six clinical isolates, representing 13 species of the five main genera of CBM agents, were studied. The antifungal susceptibility testing was performed according to the M38-A2 protocol of CLSI (Reference Method for Broth Dilution Antifungal Susceptibility Testing of Filamentous Fungi, 3rd ed., CLSI Standard M38, 2017). In the melanin inhibition test, 16 mg/liter of tricyclazole was added to the medium used in the inoculum preparation and the susceptibility assay. CBM agents were less susceptible to amphotericin B than azoles and terbinafine. The unusual species showed similar susceptibility profiles to those of other species of the same genera. With tricyclazole exposure, MICs of terbinafine, posaconazole, and itraconazole for Fonsecaea spp. significantly decreased (P < 0.05). For Phialophora spp., this reduction was significant for posaconazole and itraconazole. For the other genera, there was a reduction in MICs of terbinafine and itraconazole; however, the statistical tests were not significant. Melanin inhibition can increase the antifungal susceptibility of most CBM agents to itraconazole and terbinafine, the main drugs used in the disease treatment. This increased susceptibility may open up new possibilities for therapy in refractory cases of CBM and/or cases caused by resistant fungal strains. Further studies are needed to confirm the same results in vivo.
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de Andrade TS, de Almeida AMZ, Basano SDA, Takagi EH, Szeszs MW, Melhem MSC, Albuquerque M, Camargo JDSAA, Gambale W, Camargo LMA. Chromoblastomycosis in the Amazon region, Brazil, caused by Fonsecaea pedrosoi, Fonsecaea nubica, and Rhinocladiella similis: Clinicopathology, susceptibility, and molecular identification. Med Mycol 2020; 58:172-180. [PMID: 31329924 DOI: 10.1093/mmy/myz034] [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: 04/13/2018] [Revised: 02/28/2019] [Accepted: 04/10/2019] [Indexed: 02/02/2023] Open
Abstract
Chromoblastomycosis is a chronic subcutaneous disease caused by human contact with melanized fungi occurring mainly in tropical and subtropical zones worldwide. This study assessed 12 patients with chromoblastomycosis from Rondônia, Brazil, Amazon region. In sum, 83.3% were men, 41.6% were from Monte Negro city, median age was 52.9 years, and median time to disease progression was 12.2 years. Lesions were located on the lower limbs (75%), and verruciform was prevalent form (66.6%). After 3 years of treatment with itraconazole, two patients were considered cured. The etiological agents were identified by the molecular sequence of the ribosomal internal transcribed spacer ITS1, 5.8S, and ITS2 region and β-tubulin genes. Eight strains were identified as Fonsecaea pedrosoi, two were F. nubica, and two were Rhinocladiella similis. The antifungal activity of five drugs was evaluated, and the most active drug was terbinafine (range minimal inhibitory concentration [MIC] 0.015-0.12 μg/ml), itraconazole (range MIC 0.03-0.5 μg/ml) and voriconazole (range MIC 0.06-0.5 μg/ml). The highest MIC was 5-fluorocytosine (range MIC 2-32 μg/ml), and amphotericin B (range MIC 0.25-2 μg/ml). In conclusion, the present study expanded the epidemiological disease database and described for the first time F. nubica and R. similis as chromoblastomycosis agents in the Brazilian Amazon region. Our results confirmed the importance of using molecular methods to identify the melanized fungi and stimulate the recognition of the disease in other places where no cases have been reported.
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Affiliation(s)
- Tânia Sueli de Andrade
- Department of Culture Collection, Adolfo Lutz Institute, Secretary of Health, São Paulo, Brazil
| | | | - Sergio de Almeida Basano
- Department of Medicine, Faculty of São Lucas, Rondônia, Brazil.,Centre of Tropical Medicine of Rondônia, Brazil
| | | | | | - Marcia S C Melhem
- Mycology Unit, Adolfo Lutz Institute, Secretary of Health, São Paulo, Brazil
| | | | | | | | - Luís Marcelo Aranha Camargo
- Department of Medicine, Faculty of São Lucas, Rondônia, Brazil.,Institute of Biomedical Sciences 5, University of São Paulo, Monte Negro, Rondônia, Brazil.,Centre of Tropical Medicine Research, Secretary of Health of the State of Rondônia.,National Institute of Science and Research -Epidemiology of Amazônia, Brazilian Government
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Silva Zatti M, Domingos Arantes T, Cordeiro Theodoro R. Isothermal nucleic acid amplification techniques for detection and identification of pathogenic fungi: A review. Mycoses 2020; 63:1006-1020. [PMID: 32648947 DOI: 10.1111/myc.13140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Fungal infections have increased during the last years due to the AIDS epidemic and immunosuppressive therapies. The available diagnostic methods, such as culture, histopathology and serology, have several drawbacks regarding sensitivity, specificity and time-consuming, while molecular methods are still expensive and dependent on many devices. In order to overcome these challenges, isothermal nucleic acid amplification techniques (INAT) arose as promising diagnostic methods for infectious diseases. OBJECTIVE This review aimed to present and discuss the main contributions of the isothermal nucleic acid amplification techniques applied in medical mycology. METHODS Papers containing terms for each INAT (NASBA, RCA, LAMP, CPA, SDA, HAD or PSR) and the terms 'mycoses' or 'disease, fungal' were obtained from National Center for Biotechnology Information database until August 2019. RESULTS NASBA, RCA, LAMP and PSR are the INAT reported in the literature for detection and identification of pathogenic fungi. Despite the need of a previous conventional PCR, the RCA technique might also be used for genotyping or cryptic species differentiation, which may be important for the treatment of certain mycoses; nevertheless, LAMP is the most used INAT for pathogen detection. CONCLUSION Among all INATs herein reviewed, LAMP seems to be the most appropriate method for fungal detection, since it is affordable, sensitive, specific, user-friendly, rapid, robust, equipment-free and deliverable to end-users, fulfilling all ASSURED criteria of the World Health Organization for an ideal diagnostic method.
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Affiliation(s)
- Matheus Silva Zatti
- Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Thales Domingos Arantes
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiás, Brazil
| | - Raquel Cordeiro Theodoro
- Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte, Natal, Brazil
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Shen XC, Dai XN, Xie ZM, Li P, Lu S, Li JH, Zhang Y, Ye XD. A Case of Chromoblastomycosis Caused by Fonsecaea pedrosoi Successfully Treated by Oral Itraconazole Together with Terbinafine. Dermatol Ther (Heidelb) 2020; 10:321-327. [PMID: 32086748 PMCID: PMC7090106 DOI: 10.1007/s13555-020-00358-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Indexed: 12/03/2022] Open
Abstract
Patients with chromoblastomycosis (CBM) usually have a history of local skin damage related to outdoor activities, mainly manifested as chronic refractory proliferative pathologic changes. We report a case of a 56-year-old man with CBM, identified as Fonsecaea pedrosoi infection by fungal culture and gene sequencing. This patient was successfully treated with a regimen of oral itraconazole (ITZ) and terbinafine lasting 7 months. Through in vitro drug sensitivity tests, minimum inhibitory concentrations of amphotericin, ITZ, and terbinafine were 1 μg/ml, 0.25 μg/ml, and 1 μg/ml, respectively. In this case, terbinafine was found to be more effective than ITZ.
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Affiliation(s)
- Xu-Cheng Shen
- Department of Dermatology, Dermatology Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510182, China
| | - Xiang-Nong Dai
- Department of Dermatology, Dermatology Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510182, China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, 510095, China
| | - Zhi-Min Xie
- Department of Dermatology, Dermatology Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510182, China
| | - Ping Li
- Department of Dermatology, Dermatology Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510182, China
| | - Sha Lu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Jia-Hao Li
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Yi Zhang
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, 510095, China
| | - Xing-Dong Ye
- Department of Dermatology, Dermatology Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510182, China.
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, 510095, China.
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Sun L, Wan Z, Li R, Yu J. In vitro activities of nine antifungal agents against rare pathogenic fungi. J Med Microbiol 2019; 68:1664-1670. [PMID: 31553302 DOI: 10.1099/jmm.0.001083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose. To assess in vitro activities of nine antifungal agents (amphotericin B, fluconazole, voriconazole, itraconazole, posaconazole, caspofungin, micafungin, terbinafine and 5-flucytosine) against 93 strains of rare pathogenic fungi and the combined effects of drug combinations against several multidrug-resistant fungi.Methodology. The broth microdilution method M38-A3 and M27-A4 from the Clinical and Laboratory Standards Institute and the checkerboard method were performed in this study.Results. Low MICs for fluconazole were observed in moulds including Tritirachium oryzae, Exophiala attenuata and yeasts. MICs for amphotericin B>2 µg ml-1 were found among Aspergillus nidulans, Fusarium napiforme, Trichoderma longibrachiatum, Tritirachium oryzae, Cunninghamella bertholletiae, Cunninghamella phaeospora, Conidiobolus coronatus, Exophiala attenuata, Ochroconis mirabilis and Rhinocladiella basitona. Multidrug resistance was observed in Microascus spp., Lomentospora prolificans and Pythium insidiosum.Conclusion. Our study illustrated in vitro drug susceptibilities of some rare pathogenic fungi, which provide data to guide clinical treatment of fungal infections.
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Affiliation(s)
- Lingyue Sun
- Department of Dermatology and Venereology, Peking University First Hospital, Research Center for Medical Mycology, Peking University, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, PR China
| | - Zhe Wan
- Department of Dermatology and Venereology, Peking University First Hospital, Research Center for Medical Mycology, Peking University, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, PR China
| | - Ruoyu Li
- Department of Dermatology and Venereology, Peking University First Hospital, Research Center for Medical Mycology, Peking University, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, PR China
| | - Jin Yu
- Department of Dermatology and Venereology, Peking University First Hospital, Research Center for Medical Mycology, Peking University, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, PR 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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Cornely OA, Mullane KM, Ostrosky-Zeichner L, Maher RM, Croos-Dabrera R, Lu Q, Lademacher C, Perfect JR, Oren I, Schmitt-Hoffmann AH, Giladi M, Marty FM, Rahav G. Isavuconazole for treatment of rare invasive fungal diseases. Mycoses 2018; 61:518-533. [PMID: 29611246 DOI: 10.1111/myc.12778] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/29/2022]
Abstract
Data regarding treatment of rare invasive fungal diseases (IFDs) are scarce. We documented the efficacy and safety of isavuconazole for treatment of uncommonly diagnosed IFDs. VITAL was a single-arm, international, open-label study evaluating the efficacy and safety of isavuconazole (200 mg orally or intravenously every 8 hours for 48 hours, then once daily). The primary outcome was overall response at Day 42; key secondary outcomes were overall responses at Day 84 and end of treatment (EOT), mortality at Days 42 and 84, and safety. This analysis includes patients with IFD caused by rare or unidentified pathogens. Twenty-six patients with IFDs caused by rare moulds (n = 17), non-Candida yeasts (n = 2), or unidentified moulds (n = 7) were enrolled (median treatment duration [range], 114.5 [1-496]) days. Overall treatment success was observed in 11/26 (42.3%), 10/26 (38.5%), and 15/26 (57.7%) patients at Days 42, 84, and EOT, respectively. All-cause mortality rates were 2/26 patients (7.7%) at Day 42 and 4/26 patients (15.4%) at Day 84; another two patients died after Day 84. All patients had ≥1 treatment-emergent adverse event (TEAE); 15 patients (57.7%) had serious TEAEs, and TEAEs led to discontinuation of isavuconazole in four patients (15.4%). Isavuconazole may be efficacious for treatment of a range of rare IFDs.
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Affiliation(s)
- Oliver A Cornely
- Department I of Internal Medicine, Clinical Trials Centre Cologne, ZKS Köln, and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Kathleen M Mullane
- Department of Medicine/Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA
| | - Luis Ostrosky-Zeichner
- University of Texas Medical School at Houston and Memorial Hermann Texas Medical Center, University of Texas, Houston, TX, USA
| | | | | | - Qiaoyang Lu
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | | | - John R Perfect
- Department of Medicine/Division of Infectious Diseases, Duke University, Durham, NC, USA
| | - Ilana Oren
- Unit of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | | | - Michael Giladi
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center, and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Galia Rahav
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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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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20
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Marty FM, Cornely OA, Mullane KM, Ostrosky-Zeichner L, Maher RM, Croos-Dabrera R, Lu Q, Lademacher C, Oren I, Schmitt-Hoffmann AH, Giladi M, Rahav G, Perfect JR. Isavuconazole for treatment of invasive fungal diseases caused by more than one fungal species. Mycoses 2018; 61:485-497. [PMID: 29611227 DOI: 10.1111/myc.12777] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
Abstract
The optimal approach to treat invasive fungal disease (IFD) caused by more than one fungal species is unknown. We documented the efficacy and safety of isavuconazole for treatment of IFDs caused by more than one fungal species. VITAL was a single-arm, international, open-label study evaluating the efficacy and safety of isavuconazole (200 mg orally or intravenously every 8 hours for 48 hours, then once daily) for treatment of rare IFDs. The primary outcome was the overall response at Day 42; key secondary outcomes were overall responses at Day 84 and end of treatment (EOT), mortality at Days 42 and 84, and safety. This analysis includes patients with IFD caused by multiple fungal species. Fifteen patients were included in this analysis (including Aspergillus spp., n = 11; without Aspergillus spp., n = 4); median treatment duration was 97 days [range, 6-544] days). Overall treatment success was observed in 2/15 patients (13.3%) at Days 42 and 84, and 2/14 (14.3%) at EOT. All-cause mortality was 2/15 (13.3%) at Day 42 and 4/15 (26.7%) at Day 84. All patients had ≥1 treatment-emergent adverse event (TEAE); 12 patients (80.0%) had serious TEAEs; TEAEs led to discontinuation of isavuconazole in two patients (13.3%). Isavuconazole may be useful to treat some IFDs caused by multiple fungal species.
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Affiliation(s)
- Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Oliver A Cornely
- Department of Internal Medicine, Clinical Trials Centre Cologne, ZKS Köln, and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Kathleen M Mullane
- Department of Medicine/Section of Infectious Diseases, University of Chicago, Chicago, IL, USA
| | - Luis Ostrosky-Zeichner
- University of Texas Medical School at Houston and Memorial Hermann Texas Medical Center, University of Texas, Houston, TX, USA
| | | | | | - Qiaoyang Lu
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | | | - Ilana Oren
- Unit of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | | | - Michael Giladi
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Rahav
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John R Perfect
- Department of Medicine/Division of Infectious Diseases, Duke University, Durham, NC, USA
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21
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Denis J, Ledoux MP, Nivoix Y, Herbrecht R. Isavuconazole: A new broad-spectrum azole. Part 1: In vitro activity. J Mycol Med 2018. [DOI: 10.1016/j.mycmed.2018.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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22
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Label M, Karayan LC, De Hoog S, Afeltra J, Bustamante T, Vitale RG. Differential distribution patterns of Fonsecaea agents of chromoblastomycosis, exemplified by the first case due to F. monophora from Argentina. Med Mycol Case Rep 2017; 20:35-38. [PMID: 29552459 PMCID: PMC5852295 DOI: 10.1016/j.mmcr.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/04/2017] [Accepted: 11/24/2017] [Indexed: 11/17/2022] Open
Abstract
Chromoblastomycosis is a mutilating infection of the skin and subcutaneous tissues caused by melanized fungi belonging to the order Chaetothyriales. Proven cases of the main agent, Fonsecaea pedrosoi are mainly limited to (sub)tropical, humid climates of Latin and Central America and the Caribbean. Fonsecaea monophora has a global distribution along the equator. Cases outside the (sub)tropics have thus far mostly been considered to have been imported, but here we report the first endemic case by F. monophora from Argentina. Patient was a 82-year-old rural female worker from Corrientes, a province with a dry continental climate.
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Affiliation(s)
- Marcelo Label
- Dermatology Division, Ramos Mejia Hospital, Buenos Aires C1221ADC, Argentina
| | - Luciana C Karayan
- Ramos Mejia Hospital, Parasitology Unit, Mycology Branch, Buenos Aires C1221ADC, Argentina
| | - Sybren De Hoog
- Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Javier Afeltra
- Ramos Mejia Hospital, Parasitology Unit, Mycology Branch, Buenos Aires C1221ADC, Argentina
| | - Togo Bustamante
- Dermatology Division, Ramos Mejia Hospital, Buenos Aires C1221ADC, Argentina
| | - Roxana G Vitale
- Ramos Mejia Hospital, Parasitology Unit, Mycology Branch, Buenos Aires C1221ADC, Argentina.,Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands.,The National Council of Scientific and Technological Research (CONICET), Buenos Aires, Argentina
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23
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He L, Ma J, Mei X, Lu S, Li X, Xi L. Successful treatment of chromoblastomycosis of 10-year duration due to Fonsecaea nubica. Mycoses 2017; 61:231-236. [PMID: 29178398 DOI: 10.1111/myc.12732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/19/2017] [Accepted: 11/21/2017] [Indexed: 11/29/2022]
Abstract
We report a case of chromoblastomycosis due to the presence of large plaque and verrucous hyperplasia lesions on the left upper limb, with elbow abnormal activities, in a 56-year-old male. The diagnosis of chromoblastomycosis was based on gross and microscopic morphologies, histopathological examination and clinical manifestation. Molecular tools were applied to identifying the causative agent Fonsecaea nubica, which is rarely reported to be associated with chromoblastomycosis. The patient was initially treated orally with terbinafine (250 mg/day) and itraconazole (200 mg/day), subsequently patient received thermotherapy (45-50°C, 3 h/day) for 1 month. The patient was successfully cured. A literature review was performed to assess general features, treatment and outcome of chromoblastomycosis due to F. nubica. All the 5 reviewed patients were male, over 30 years old and their lesions occurred after traumatic inoculation.
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Affiliation(s)
- Liya He
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Research Center of Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianchi Ma
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Research Center of Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin Mei
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sha Lu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiqing Li
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liyan Xi
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Dermatology Hospital of Southern Medical University, Guangzhou, China
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24
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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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25
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Rasamoelina T, Raharolahy O, Rakotozandrindrainy N, Ranaivo I, Andrianarison M, Rakotonirina B, Maubon D, Rakotomalala F, Rakoto Andrianarivelo M, Andriantsimahavandy A, Rapelanoro Rabenja F, Ramarozatovo L, Cornet M. Chromoblastomycosis and sporotrichosis, two endemic but neglected fungal infections in Madagascar. J Mycol Med 2017; 27:312-324. [DOI: 10.1016/j.mycmed.2017.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 01/19/2023]
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26
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Cleinman IB, Gonçalves SS, Nucci M, Quintella DC, Halpern M, Akiti T, Barreiros G, Colombo AL, Santoro-Lopes G. Respiratory Tract Infection Caused by Fonsecaea monophora After Kidney Transplantation. Mycopathologia 2017; 182:1101-1109. [DOI: 10.1007/s11046-017-0168-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 06/17/2017] [Indexed: 12/29/2022]
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27
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Lima AMD, Sacht GL, Paula LZPD, Aseka GK, Goetz HS, Gheller MF, Torraca PDFS. Response of chromoblastomycosis to voriconazole. An Bras Dermatol 2017; 91:679-681. [PMID: 27828652 PMCID: PMC5087237 DOI: 10.1590/abd1806-4841.20165142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/16/2015] [Indexed: 11/22/2022] Open
Abstract
Chromoblastomycosis is a chronic fungal infection of the epidermis, dermis and
subcutaneous tissue, in which the most common etiologic agent in Brazil is
Fonsecaea pedrosoi. In more advanced cases we found many
difficulties in their treatment, and therefore, we report a case of extensive
and severe chromoblastomycosis, with therapeutical failure of first choice
treatments, but good response to voriconazole.
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28
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Ouédraogo MS, Vignon-Pennamen MD, Battistella M, Levy A, Feuilhade de Chauvin M, Petit A. [Chromomycosis acquired in a non-tropical area: A case report]. Ann Dermatol Venereol 2017; 144:438-442. [PMID: 28396061 DOI: 10.1016/j.annder.2017.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 02/07/2017] [Accepted: 02/28/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chromomycosis, or chromoblastomycosis, is caused by cutaneous inoculation of dematiaceous fungi of telluric or plant origin. It is generally seen in tropical or subtropical zones. Treatment of the condition is known to be complex. Herein we report a case of chromomycosis contracted in a temperate region of Eastern Europe/Central Asia that was effectively treated with oral itraconazole and terbinafine in combination with cryotherapy. PATIENTS AND METHODS A 44-year-old immunocompetent male subject consulted for a lesion on the buttocks that he had sustained 16 years earlier, and which, although never previously treated, had only become troublesome within the last few months. The examination revealed a large erythemato-squamous plaque containing a heterogeneous infiltrate. The diagnosis was based upon biopsy, with histological examination revealing sooty mould ; culture of a second sample showed the causative agent to be Fonsecaea pedrosoi. After 30 months of treatment combining oral terbinafine at a very high dose (1000mg/day), topical terbinafine and adjuvant cryotherapy, considerable, though incomplete, improvement was obtained. Finally, combined use of terbinafine (500mg/day) and itraconazole (200mg/day) led to clinical and histological cure. DISCUSSION The possibility of acquiring chromomycosis other than in a tropical zone is slight but has nevertheless been described, particularly in Eastern Europe. In our patient, the exact source of contamination is unknown, although it may have been acquired through frequent horse-riding or use of saunas. This case confirms the efficacy of combined itraconazole and terbinafine against this condition, which is usually difficult to treat.
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Affiliation(s)
- M S Ouédraogo
- Service de dermatologie, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - M-D Vignon-Pennamen
- Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Battistella
- Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - A Levy
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Feuilhade de Chauvin
- Service de mycologie parasitologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - A Petit
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
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29
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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.
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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.
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30
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Answer to May 2016 Photo Quiz. J Clin Microbiol 2016; 54:1409. [PMID: 27114568 DOI: 10.1128/jcm.01250-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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31
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32
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de J. Treviño-Rangel R, González GM. Susceptibility Testing Agents of Subcutaneous Mycoses (Sporotrichosis and Chromoblastomycosis). CURRENT FUNGAL INFECTION REPORTS 2015. [DOI: 10.1007/s12281-015-0232-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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33
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Fonsecaea pugnacius, a Novel Agent of Disseminated Chromoblastomycosis. J Clin Microbiol 2015; 53:2674-85. [PMID: 26085610 DOI: 10.1128/jcm.00637-15] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/03/2015] [Indexed: 11/20/2022] Open
Abstract
We report a fatal case of a chromoblastomycosis-like infection caused by a novel species of Fonsecaea in a 52-year-old immunocompetent Caucasian male from an area of chromoblastomycosis endemicity in Brazil. The patient had a 30-year history of slowly evolving, verrucous lesions on the right upper arm which gradually affected the entire arm, the left hemifacial area, and the nose. Subsequent dissemination to the brain was observed, which led to death of the patient. The internal transcribed spacer (ITS) and partial large subunit (LSU), BT2, and CDC42 genes of the isolates recovered from skin and brain were sequenced, confirming the novelty of the species. The species is clinically unique in causing brain abscesses secondary to chromoblastomycosis lesions despite the apparent intact immunity of the patient. Histopathologic appearances were very different, showing muriform cells in skin and hyphae in brain.
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34
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Chromoblastomycosis due to Fonsecaea monophora in a man with nephritic syndrome. Mycopathologia 2015; 179:447-52. [PMID: 25575792 DOI: 10.1007/s11046-014-9856-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
Chromoblastomycosis is a chronic subcutaneous mycosis caused by dematiaceous fungi. Fonsecaea monophora, a new species segregated from F. pedrosoi, may be the most prevalent pathogen of chromoblastomycosis in southern China. Herein, we report a rare case of chromoblastomycosis in a man with nephritic syndrome. He presented with an asymptomatic red plaque on the back of his left wrist that had appeared and enlarged over a period of 1.5 years, without any prior trauma. He was initially diagnosed with sporotrichosis. However, he did not respond to a 6-month course of potassium iodide treatment. The lesion slowly enlarged and became verrucous instead. Concurrently, a similar maculopapule appeared on his left forearm. Histopathological examination of a biopsy specimen indicated the presence of sclerotic bodies in the dermis. The fungus was identified as Fonsecaea spp. based on the results of a slide culture; in addition, the agent was confirmed to be F. monophora by using molecular methods. The patient demonstrated marked improvement after receiving appropriate antifungal therapy for 3 months. To our knowledge, this is the first case of chromoblastomycosis caused by F. monophora in an immunosuppressed patient. The identification of the agent by molecular techniques is important for epidemiological purposes. Thus, we believe that combination therapy with itraconazole and terbinafine would be a suitable option for infections caused by F. monophora.
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35
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Chowdhary A, Perfect J, de Hoog GS. Black Molds and Melanized Yeasts Pathogenic to Humans. Cold Spring Harb Perspect Med 2014; 5:a019570. [PMID: 25384772 DOI: 10.1101/cshperspect.a019570] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A review is given of melanized fungi involved in human infection, including species forming budding cells and strictly filamentous representatives. Classically, they are known as "phaeoid" or "dematiaceous" fungi, and, today, agents are recognized to belong to seven orders of fungi, of which the Chaetothyriales and Pleosporales are the most important. Infections range from cutaneous or pulmonary colonization to systemic or disseminated invasion. Subcutaneous involvement, either primary or after dissemination, may lead to host tissue proliferation of dermis or epidermis. Particularly in the Chaetothyriales, subcutaneous and systemic infections may occur in otherwise apparently healthy individuals. Infections are mostly chronic and require extended antifungal therapy and/or surgery.
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Affiliation(s)
- Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India
| | - John Perfect
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center Durham, North Carolina 27710
| | - G Sybren de Hoog
- CBS-KNAW Fungal Biodiversity Centre, 3508 AD Utrecht, The Netherlands
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36
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Systematic review of severe acute liver injury caused by terbinafine. Int J Clin Pharm 2014; 58:5609-12. [PMID: 24986266 DOI: 10.1128/aac.02875-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Terbinafine is an effective antimicrobial agent against dermatophytes, cryptococcus and other fungi. It is the preferred drug to treat onychomycosis. However, severe acute hepatitis from oral terbinafine administration has been recently reported. AIM To describe a representative case, and review the literature regarding the best evidence on treatment and prognosis of severe acute hepatitis caused by oral terbinafine. METHODS The literature was searched for publications on severe hepatitis caused by terbinafine using MEDLINE, China Biology Medicine Disc, and the VIP Medical Information Resource System. Related references were searched manually. RESULTS Seventeen English and three Chinese references of case reports were included after eliminating duplicate publications. No randomized control studies were found. Liver enzyme levels were found to have been increased significantly. Abdominal ultrasound demonstrated cholestasis. CONCLUSIONS Severe acute liver injury is a known, but unusual complication of terbinafine exposure. The prognosis is often good with appropriate treatment. Liver function assessment before treatment and periodic monitoring 4-6 weeks after initiation of treatment is recommended.
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Chowdhary A, Meis J, Guarro J, de Hoog G, Kathuria S, Arendrup M, Arikan-Akdagli S, Akova M, Boekhout T, Caira M, Guinea J, Chakrabarti A, Dannaoui E, van Diepeningen A, Freiberger T, Groll A, Hope W, Johnson E, Lackner M, Lagrou K, Lanternier F, Lass-Flörl C, Lortholary O, Meletiadis J, Muñoz P, Pagano L, Petrikkos G, Richardson M, Roilides E, Skiada A, Tortorano A, Ullmann A, Verweij P, Cornely O, Cuenca-Estrella M. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi. Clin Microbiol Infect 2014; 20 Suppl 3:47-75. [DOI: 10.1111/1469-0691.12515] [Citation(s) in RCA: 216] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 12/13/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022]
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38
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Yang YP, Li W, Huang WM, Zhou Y, Fan YM. Chromoblastomycosis caused by Fonsecaea: clinicopathology, susceptibility and molecular identification of seven consecutive cases in southern China. Clin Microbiol Infect 2013; 19:1023-8. [DOI: 10.1111/1469-0691.12067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 10/03/2012] [Accepted: 10/04/2012] [Indexed: 12/01/2022]
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39
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In vitro activities of eight antifungal drugs against 106 waterborne and cutaneous exophiala species. Antimicrob Agents Chemother 2013; 57:6395-8. [PMID: 24100491 DOI: 10.1128/aac.01629-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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 106 clinical and environmental isolates of waterborne and cutaneous Exophiala species were tested. The MICs and minimum effective concentrations for 90% of the strains tested (n = 106) were, in increasing order, as follows: posaconazole, 0.063 μg/ml; itraconazole, 0.25 μg/ml; micafungin, 1 μg/ml; voriconazole, 2 μg/ml; isavuconazole, 4 μg/ml; caspofungin, 8 μg/ml; amphotericin B, 16 μg/ml; fluconazole, 64 μg/ml.
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40
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Daboit TC, Massotti Magagnin C, Heidrich D, Czekster Antochevis L, Vigolo S, Collares Meirelles L, Alves K, Scroferneker ML. In vitrosusceptibility of chromoblastomycosis agents to five antifungal drugs and to the combination of terbinafine and amphotericin B. Mycoses 2013; 57:116-20. [DOI: 10.1111/myc.12111] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 06/24/2013] [Accepted: 06/26/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Tatiane C. Daboit
- Postgraduate Program in Medicine: Medical Sciences; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Department of Microbiology, Immunology and Parasitology; ICBS; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Cibele Massotti Magagnin
- Postgraduate Program in Medicine: Medical Sciences; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Department of Microbiology, Immunology and Parasitology; ICBS; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Daiane Heidrich
- Postgraduate Program in Medicine: Medical Sciences; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Department of Microbiology, Immunology and Parasitology; ICBS; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Laura Czekster Antochevis
- Department of Microbiology, Immunology and Parasitology; ICBS; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Suelen Vigolo
- Department of Microbiology, Immunology and Parasitology; ICBS; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Lúcia Collares Meirelles
- Department of Microbiology, Immunology and Parasitology; ICBS; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Karine Alves
- Department of Microbiology, Immunology and Parasitology; ICBS; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Maria L. Scroferneker
- Postgraduate Program in Medicine: Medical Sciences; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Department of Microbiology, Immunology and Parasitology; ICBS; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
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41
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Detection and identification of opportunistic Exophiala species using the rolling circle amplification of ribosomal internal transcribed spacers. J Microbiol Methods 2013; 94:338-42. [PMID: 23872449 DOI: 10.1016/j.mimet.2013.06.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 06/25/2013] [Accepted: 06/26/2013] [Indexed: 11/23/2022]
Abstract
Deep infections by melanized fungi deserve special attention because of a potentially fatal, cerebral or disseminated course of disease in otherwise healthy patients. Timely diagnostics are a major problem with these infections. Rolling circle amplification (RCA) is a sensitive, specific and reproducible isothermal DNA amplification technique for rapid molecular identification of microorganisms. RCA-based diagnostics are characterized by good reproducibility, with few amplification errors compared to PCR. The method is applied here to species of Exophiala known to cause systemic infections in humans. The ITS rDNA region of five Exophiala species (E. dermatitidis, E. oligosperma, E. spinifera, E. xenobiotica, and E. jeanselmei) was sequenced and aligned in view of designing specific padlock probes to be used for the detection of single nucleotide polymorphisms (SNPs) of the Exophiala species concerned. The assay proved to successfully amplify DNA of the target fungi at the level of species; while no cross-reactivity was observed. Amplification products were visualized on 1% agarose gels to verify the specificity of probe-template binding. Amounts of reagents were minimized to avoid the generation of false positive results. The sensitivity of RCA may help to improve early diagnostics of these difficult to diagnose infections.
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Abstract
Emerging fungal diseases due to black yeasts and relatives in domestic or wild animals and in invertebrates or cold- and warm-blooded vertebrates are continually being reported, either as novel pathogens or as familiar pathogens affecting new species of hosts. Different epidemiological situations can be distinguished, i.e., occurrence as single infections or as zoonoses, and infection may occur sporadically in otherwise healthy hosts. Such infections are found mostly in mammals but also in cold-blooded animals, are frequently subcutaneous or cerebral, and bear much similarity to human primary disorders. Infections of the nervous system are mostly fatal, and the source and route of infection are currently unknown. A third epidemiological situation corresponds to pseudoepidemics, i.e., infection of a large host population due to a common source. It is often observed and generally hypothesized that the susceptible animals are under stress, e.g., due to poor housing conditions of mammals or to a change of basins in the case of fishes. The descriptions in this article represent an overview of the more commonly reported and recurring black fungi and the corresponding diseases in different types of animals.
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Daboit TC, Magagnin CM, Heidrich D, Castrillón MR, Mendes SDC, Vettorato G, Valente P, Scroferneker ML. A case of relapsed chromoblastomycosis due to Fonsecaea monophora: antifungal susceptibility and phylogenetic analysis. Mycopathologia 2013; 176:139-44. [PMID: 23645135 DOI: 10.1007/s11046-013-9660-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/19/2013] [Indexed: 11/25/2022]
Abstract
Chromoblastomycosis is a chronic cutaneous and subcutaneous mycosis. The management of this infection continues to be challenging because there is no consensus on the therapeutic regimen. We report here a case of a 69-year-old male patient with cauliflower-like lesions on his left leg and foot. He had already been treated with itraconazole at a dose of 200 mg/day for 5 months, with mycological cure for all the affected areas. However, the lesions relapsed at both sites, and treatment with itraconazole was resumed at the dose previously used. Initially, direct mycological examination, cultural, and microculture slide observation were performed. Afterward, sequencing of the ITS1-5.8S rDNA-ITS2 region of the fungal DNA and evaluation of its susceptibility to antifungal agents alone and in combination were performed. In direct mycological examination, the presence of sclerotic cells was verified, and the fungus was identified as Fonsecaea based on cultural and microscopic examinations. Identification as Fonsecaea monophora was confirmed after sequencing of the ITS region and phylogenetic analysis. The isolate was susceptible to itraconazole and terbinafine. The combinations of amphotericin B and terbinafine and terbinafine and voriconazole were synergistic. The use of drugs for which the causative agent is susceptible to singly or in combination may be an alternative for the treatment of mycosis. Furthermore, the identification of the agent by molecular techniques is important for epidemiological purposes. To the best of our knowledge, this is the first case of relapsed chromoblastomycosis caused by F. monophora in Brazil.
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Affiliation(s)
- Tatiane Caroline Daboit
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400-2º andar, Porto Alegre, Rio Grande do Sul, CEP 90035-003, Brazil,
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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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Najafzadeh MJ, Suh MK, Lee MH, Ha GY, Kim JR, Kim TH, Lee HJ, Choi JS, Meis JF, De Hoog GS. Subcutaneous phaeohyphomycosis caused by Exophiala equina, with susceptibility to eight antifungal drugs. J Med Microbiol 2013; 62:797-800. [DOI: 10.1099/jmm.0.057406-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A case of subcutaneous phaeohyphomycosis caused by Exophiala equina is reported in a 75-year-old female, who showed subcutaneous abscesses on both forearms for 8 months. A lesion was initiated by inoculation with a spine from a tree. Histopathologically, suppurative granulomatous inflammation was present and short hyphal elements were observed. Upon culture greyish–black, velvety colonies of a black yeast were obtained after 3 weeks. The strain grew well at 25 °C, but poorly at 37 °C. After sequencing the internal transcribed spacer domain and the partial β-tubulin gene, the fungus was identified as E. equina. The patient was successfully treated with fluconazole for 3 months.
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Affiliation(s)
- Mohammad Javad Najafzadeh
- Department of Parasitology and Mycology, and Cancer Molecular Pathology Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Moo Kyu Suh
- Departments of Dermatology, Dongguk University, Gyeongju, South Korea
| | - Myung Hoon Lee
- Departments of Dermatology, Dongguk University, Gyeongju, South Korea
| | - Gyoung Yim Ha
- Laboratory Medicine, Dongguk University, Gyeongju, South Korea
| | - Jung Ran Kim
- Pathology, College of Medicine, Dongguk University, Gyeongju, South Korea
| | | | - Hyo Jin Lee
- Department of Dermatology, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Jong Soo Choi
- Department of Dermatology, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Jacques F. Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - G. Sybren De Hoog
- Peking University Health Science Center, Research Center for Medical Mycology, Beijing, PR China
- Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, The Netherlands
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
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First Case of Tritirachium oryzae as Agent of Onychomycosis and Its Susceptibility to Antifungal Drugs. Mycopathologia 2013; 176:119-22. [DOI: 10.1007/s11046-013-9653-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
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Badali H, Fernández-González M, Mousavi B, Illnait-Zaragozi MT, González-Rodríguez JC, de Hoog GS, Meis JF. Chromoblastomycosis due to Fonsecaea pedrosoi and F. monophora in Cuba. Mycopathologia 2013; 175:439-44. [DOI: 10.1007/s11046-013-9634-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
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In vitro antifungal susceptibility of Cladophialophora carrionii, an agent of human chromoblastomycosis. Antimicrob Agents Chemother 2013; 57:1974-7. [PMID: 23380718 DOI: 10.1128/aac.02114-12] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A global collection of Cladophialophora carrionii strains (n = 81) was tested against nine antifungal drugs. MIC90s of all strains were as follows in increasing order: itraconazole and posaconazole, 0.063 μg/ml; terbinafine, 0.125 μg/ml; isavuconazole and voriconazole, 0.25 μg/ml; caspofungin, 2 μg/ml; micafungin, 4 μg/ml; amphotericin B, 8 μg/ml; and fluconazole, 64 μg/ml.
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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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