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Lee SJ, Kwon KH. Current therapeutic insights regarding problematic fingernails and toenails in the Republic of Korea. J Cosmet Dermatol 2022; 21:5341-5345. [PMID: 36153799 DOI: 10.1111/jocd.14384] [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: 07/07/2021] [Accepted: 07/30/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Problematic nails and toenails are infected by germs and increasingly have many causes. AIMS To investigate the types and treatment of problematic nails and toenails, we focused on bacteria that may appear in problematic nail toenail symptoms. METHODS We have searched for PubMed and Google Scholar and correlated the words Onychomycosis, Tinea ungium, Melanonychia, and ingrown toenail related to symptoms. RESULTS To measure onychomycosis, KOH tests and fungal culture tests will be used. Treatment can be treated with full-body treatment using anti-fungal agents and local treatment (laser therapy) that can minimize the side effects. A biopsy should be performed when Melanonychia is diagnosed with brown or black pigments on the patient's fingernail plate. Moreover, ingrown toenail surgical treatment can be improved by acquired lifestyle. CONCLUSIONS There are many different types of treatments, but many studies show that problematic nail and toenail improvement periods are long and treatment success rates are low.
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Affiliation(s)
- Soo Jin Lee
- Division of Beauty Arts Care, Department of Beauty Arts Care, Graduate School, Dongguk University, Seoul, Korea.,Nail Bam Co., Wonju, Gangwon-do, Korea
| | - Ki Han Kwon
- College of General Education, Kookmin University, Seoul, Korea
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2
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Gupta AK, Summerbell RC, Venkataraman M, Quinlan EM. Nondermatophyte mould onychomycosis. J Eur Acad Dermatol Venereol 2021; 35:1628-1641. [PMID: 33763903 DOI: 10.1111/jdv.17240] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/09/2021] [Indexed: 01/21/2023]
Abstract
Nondermatophyte moulds (NDMs) onychomycosis is often difficult to diagnose as NDMs have been considered contaminants of nails. There are several diagnostic methods used to identify NDMs, however, repeated laboratory isolation is recommended to validate pathogenicity. With NDM and mixed infection (dermatophytes plus NDM) onychomycosis on the rise, accurate clinical diagnosis along with mycological tests is recommended. Systemic antifungal agents such as itraconazole and terbinafine (e.g. pulse regimen: 1 pulse = every day for one week, followed by no treatment for three weeks) have shown efficacy in treating onychomycosis caused by various NDMs such as Aspergillus spp., Fusarium spp., Scopulariopsis brevicaulis, and Onychocola canadensis. Studies investigating topical therapy and devices for NDM onychomycosis are limited. The emergence of antifungal resistance necessitates the incorporation of antifungal susceptibility testing into diagnosis when possible, for the management of recalcitrant infections. Case studies documented in the literature show newer azoles such as posaconazole and voriconazole as sometimes effective in treating resistant NDM onychomycosis. Treatment with broad-spectrum antifungal agents (e.g. itraconazole and efinaconazole) and other combination therapy (oral + oral and/or oral + topical) may be considerations in the management of NDM onychomycosis.
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Affiliation(s)
- A K Gupta
- Mediprobe Research Inc., London, ON, Canada.,Department of Dermatology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - R C Summerbell
- Sporometrics, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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3
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Yang SJ, Ng CY, Wu TS, Huang PY, Wu YM, Sun PL. Deep Cutaneous Neoscytalidium dimidiatum Infection: Successful Outcome with Amphotericin B Therapy. Mycopathologia 2018; 184:169-176. [PMID: 30515655 DOI: 10.1007/s11046-018-0308-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/24/2018] [Indexed: 11/29/2022]
Abstract
Phaeohyphomycosis is a term used to describe a heterogenous group of cutaneous and systemic mycotic infections caused by melanized fungi. Many fungi have been reported as pathogens of this disease. The disease spectrum ranges from superficial cutaneous infections, deep cutaneous infections, to systemic infections with internal organ involvement. We report two cases of deep cutaneous phaeohyphomycosis on the foot clinically presenting as cellulitis with abscess formation. The pathogens were isolated from the lesion and both were identified as Neoscytalidium dimidiatum by their colony morphology, microscopic features, and sequences of internal transcribed spacers of ribosomal DNA. Both patients did not respond to the therapy with voriconazole and itraconazole, but improved after intravenous amphotericin B.
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Affiliation(s)
- Shih-Jyun Yang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fushin Street, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chau-Yee Ng
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fushin Street, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Shu Wu
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Yen Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Mu Wu
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Lun Sun
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fushin Street, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Research Laboratory of Medical Mycology, Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
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4
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In vitro susceptibilities of Neoscytalidium spp. sequence types to antifungal agents and antimicrobial photodynamic treatment with phenothiazinium photosensitizers. Fungal Biol 2017; 122:436-448. [PMID: 29801787 DOI: 10.1016/j.funbio.2017.08.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 11/21/2022]
Abstract
Neoscytalidium spp. are ascomycetous fungi consisting of pigmented and hyaline varieties both able to cause skin and nail infection. Their color-based identification is inaccurate and may compromise the outcome of the studies with these fungi. The aim of this study was to genotype 32 isolates morphologically identified as Neoscytalidiumdimidiatum or N. dimidiatum var. hyalinum by multilocus sequence typing (MLST), differentiate the two varieties by their sequence types, evaluate their susceptibility to seven commercial antifungal drugs [amphotericin B (AMB), voriconazole (VOR), terbinafine (TER), 5-flucytosine (5FC), ketoconazole (KET), fluconazole (FLU), and caspofungin (CAS)], and also to the antimicrobial photodynamic treatment (APDT) with the phenothiazinium photosensitizers (PS) methylene blue (MB), new methylene blue (NMBN), toluidine blue O (TBO) and the pentacyclic derivative S137. The efficacy of each PS was determined, initially, based on its minimal inhibitory concentration (MIC). Additionally, the APDT effects with each PS on the survival of ungerminated and germinated arthroconidia of both varieties were evaluated. Seven loci of Neoscytalidium spp. were sequenced on MLST revealing eight polymorphic sites and six sequence types (ST). All N. dimidiatum var. hyalinum isolates were clustered in a single ST. AMB, VOR and TER were the most effective antifungal agents against both varieties. The hyaline variety isolates were much less tolerant to the azoles than the isolates of the pigmented variety. APDT with S137 showed the lowest MIC for all the isolates of both varieties. APDT with all the PS killed both ungerminated and germinated arthroconidia of both varieties reducing the survival up to 5 logs. Isolates of the hyaline variety were also less tolerant to APDT. APDT with the four PS also increased the plasma membrane permeability of arthroconidia of both varieties but only NMBN and S137 caused peroxidation of the membrane lipids.
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5
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Chiewchanvit S, Chongkae S, Mahanupab P, Nosanchuk JD, Pornsuwan S, Vanittanakom N, Youngchim S. Melanization of Fusarium keratoplasticum (F. solani Species Complex) During Disseminated Fusariosis in a Patient with Acute Leukemia. Mycopathologia 2017; 182:879-885. [PMID: 28616680 DOI: 10.1007/s11046-017-0156-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 06/06/2017] [Indexed: 12/22/2022]
Abstract
Fusarium spp. are recognized as the second most frequently filamentous fungi causing opportunistic infections and particularly important due to the increasing number of immunocompromised patients. F. keratoplasticum (a member of F. solani species complex) is one of the Fusarium species commonly associated with human infection, and therefore, studies on the virulence of this fungus are needed. This study aimed to confirm the presence of melanin in F. keratoplasticum from a patient with systemic fusariosis. Immunofluorescence labeling with anti-melanin monoclonal antibody (MAb) was used to examine an expression of melanin in F. keratoplasticum in vitro and during infection. Electron spin resonance identified the particles extracted from F. keratoplasticum as stable free radical consistent with melanin. Lesional skin from the sites with fusariosis contained hyphal structures that could be labeled by melanin-binding MAb, while digestion of the tissue yielded dark particles that were reactive. These findings suggest that F. keratoplasticum hyphae and chlamydospores can produce melanin in vitro and that hyphae can synthesize pigment in vivo. Given the potential role of melanin in virulence of other fungi, this pigment in F. keratoplasticum may play a role in the pathogenesis of fusariosis.
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Affiliation(s)
- Siri Chiewchanvit
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Siriporn Chongkae
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Pongsak Mahanupab
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Joshua D Nosanchuk
- Department of Medicine (Infectious Diseases), Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Soraya Pornsuwan
- Department of Physical Chemistry, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
| | - Nongnuch Vanittanakom
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Sirida Youngchim
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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6
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Counterfeit Pennies: Distinguishing Chromoblastomycosis From Phaeohyphomycotic Infections. Am J Dermatopathol 2017; 39:485-487. [PMID: 28525909 DOI: 10.1097/dad.0000000000000679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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James JE, Santhanam J, Lee MC, Wong CX, Sabaratnam P, Yusoff H, Tzar MN, Razak MFA. In Vitro Antifungal Susceptibility of Neoscytalidium dimidiatum Clinical Isolates from Malaysia. Mycopathologia 2016; 182:305-313. [DOI: 10.1007/s11046-016-0085-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/24/2016] [Indexed: 11/29/2022]
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8
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Garinet S, Tourret J, Barete S, Arzouk N, Meyer I, Frances C, Datry A, Mazier D, Barrou B, Fekkar A. Invasive cutaneous Neoscytalidium infections in renal transplant recipients: a series of five cases. BMC Infect Dis 2015; 15:535. [PMID: 26586129 PMCID: PMC4653896 DOI: 10.1186/s12879-015-1241-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/21/2015] [Indexed: 11/26/2022] Open
Abstract
Background Neoscytalidium species (formerly Scytalidium species) are black fungi that usually cause cutaneous infections mimicking dermatophytes lesions. Very few publications have reported invasive or disseminated infections. Case presentation In this paper, we report the clinical presentations, treatments and outcomes of five cases of invasive Neoscytalidium infections with cutaneous involvement, including two cases with disseminated infection, in five renal transplant recipients. To our knowledge, this is the first report of a series—albeit small—of renal transplant patients in whom this infection was identified. All cases occurred in a single hospital in Paris, France, between 2001 and 2011. Patients all originate from tropical area. Conclusion Treatments of Neoscytalidium infection varied greatly, underlining the lack of a recommendation for a standardized treatment. All patients were cured after long-term antifungal therapy and/or surgical excision. Interestingly, one patient with disseminated infection involving the left elbow, the right leg, the lungs and the nasal septum was cured by medical therapy only without surgery. This may suggest that in contrast to others mycoses (such as mucormycosis), an adequate medical treatment could be sufficient for treating Neoscytalidium. We also point out the difficulties we had in diagnosing two patients with Kaposi’s sarcoma because of the similarity of the lesions. Furthermore, our report underlines the need to check for this rare infection in immunocompromised kidney transplant recipients originating from tropical areas.
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Affiliation(s)
- Simon Garinet
- AP-HP, Groupe hospitalier La Pitié-Salpêtrière, Service de Parasitologie Mycologie, F-75013, Paris, France.
| | - Jérôme Tourret
- Département d'urologie, néphrologie et transplantation, AP-HP, Groupe hospitalier Pitié-Salpêtrière, F-75013, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, F-75005, Paris, France.
| | - Stéphane Barete
- Sorbonne Universités, UPMC Univ Paris 06, F-75005, Paris, France. .,AP-HP, Groupe hospitalier Pitié-Salpêtrière, Unité fonctionnelle de Dermatologie F-75013, Université Paris Sorbonne-UPMC, Paris, France.
| | - Nadia Arzouk
- Département d'urologie, néphrologie et transplantation, AP-HP, Groupe hospitalier Pitié-Salpêtrière, F-75013, Paris, France.
| | - Isabelle Meyer
- AP-HP, Groupe hospitalier La Pitié-Salpêtrière, Service de Parasitologie Mycologie, F-75013, Paris, France.
| | - Camille Frances
- Sorbonne Universités, UPMC Univ Paris 06, F-75005, Paris, France. .,AP-HP, Groupe hospitalier Pitié-Salpêtrière, Unité fonctionnelle de Dermatologie F-75013, Université Paris Sorbonne-UPMC, Paris, France.
| | - Annick Datry
- AP-HP, Groupe hospitalier La Pitié-Salpêtrière, Service de Parasitologie Mycologie, F-75013, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, F-75005, Paris, France.
| | - Dominique Mazier
- AP-HP, Groupe hospitalier La Pitié-Salpêtrière, Service de Parasitologie Mycologie, F-75013, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, F-75005, Paris, France. .,Centre d'Immunologie et des Maladies Infectieuses, CIMI-Paris, F-75013, Paris, France.
| | - Benoit Barrou
- Département d'urologie, néphrologie et transplantation, AP-HP, Groupe hospitalier Pitié-Salpêtrière, F-75013, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, F-75005, Paris, France.
| | - Arnaud Fekkar
- AP-HP, Groupe hospitalier La Pitié-Salpêtrière, Service de Parasitologie Mycologie, F-75013, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, F-75005, Paris, France. .,Centre d'Immunologie et des Maladies Infectieuses, CIMI-Paris, F-75013, Paris, France.
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9
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Wanitphakdeedecha R, Thanomkitti K, Bunyaratavej S, Manuskiatti W. Efficacy and safety of 1064-nm Nd:YAG laser in treatment of onychomycosis. J DERMATOL TREAT 2015; 27:75-9. [DOI: 10.3109/09546634.2015.1034078] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Scytalidium dimidiatum associated invasive fungal sinusitis in an immunocompetent patient. The Journal of Laryngology & Otology 2014; 128:1018-21. [PMID: 25273969 DOI: 10.1017/s002221511400214x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Scytalidium dimidiatum is a soil and plant pathogen that frequently affects fruit trees, but can also cause human infection. There are only two reported cases of invasive fungal sinusitis involving this rare micro-organism. OBJECTIVE This paper reports the first case of invasive fungal sinusitis caused by Scytalidium dimidiatum occurring in a young immunocompetent patient from a non-endemic region, and discusses potential sources of exposure and relevance of local factors. METHOD Case report. RESULTS The patient was treated successfully with a combination of functional endoscopic sinus surgery, and antifungal and corticosteroid treatment. CONCLUSION This paper describes the first reported case of invasive fungal sinusitis secondary to Scytalidium dimidiatum in a young immunocompetent patient from a non-endemic region. Importance is placed on following a systematic process of investigation and management, and adhering to well-defined basic surgical principles.
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Successful identification of clinical dermatophyte and Neoscytalidium species by matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol 2012; 50:2277-81. [PMID: 22535981 DOI: 10.1128/jcm.06634-11] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Dermatophytes are keratinolytic fungi responsible for a wide variety of diseases of glabrous skin, nails, and hair. Their identification, currently based on morphological criteria, is hindered by intraspecies morphological variability and the atypical morphology of some clinical isolates. The aim of this study was to evaluate matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) as a routine tool for identifying dermatophyte and Neoscytalidium species, both of which cause dermatomycoses. We first developed a spectral database of 12 different species of common and unusual dermatophytes and two molds responsible for dermatomycoses (Neoscytalidium dimidiatum and N. dimidiatum var. hyalinum). We then prospectively tested the performance of the database on 381 clinical dermatophyte and Neoscytalidium isolates. Correct identification of the species was obtained for 331/360 dermatophytes (91.9%) and 18/21 Neoscytalidium isolates (85.7%). The results of MALDI-TOF MS and standard identification disagreed for only 2 isolates. These results suggest that MALDI-TOF MS could be a useful tool for routine and fast identification of dermatophytes and Neoscytalidium spp. in clinical mycology laboratories.
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12
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Moutran R, Maatouk I, Wehbé J, Abadjian G, Obeid G. Infection sous-cutanée disséminée par Scytalidium (Neoscytalidium) dimidiatum. Ann Dermatol Venereol 2012; 139:204-8. [DOI: 10.1016/j.annder.2011.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 10/06/2011] [Accepted: 12/14/2011] [Indexed: 11/28/2022]
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13
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Urán ME, Nosanchuk JD, Restrepo A, Hamilton AJ, Gómez BL, Cano LE. Detection of antibodies against Paracoccidioides brasiliensis melanin in in vitro and in vivo studies during infection. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2011; 18:1680-8. [PMID: 21813659 PMCID: PMC3187017 DOI: 10.1128/cvi.05099-11] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 07/26/2011] [Indexed: 12/18/2022]
Abstract
Several cell wall constituents, including melanins or melanin-like compounds, have been implicated in the pathogenesis of a wide variety of microbial diseases caused by diverse species of pathogenic bacteria, fungi, and helminthes. Among these microorganisms, the dimorphic fungal pathogen Paracoccidioides brasiliensis produces melanin in its conidial and yeast forms. In the present study, melanin particles from P. brasiliensis were injected into BALB/c mice in order to produce monoclonal antibodies (MAbs). We identified five immunoglobulin G1 (IgG1) κ-chain and four IgM melanin-binding MAbs. The five IgG1 κ-chain isotypes are the first melanin-binding IgG MAbs ever reported. The nine MAbs labeled P. brasiliensis conidia and yeast cells both in vitro and in pulmonary tissues. The MAbs cross-reacted with melanin-like purified particles from other fungi and also with commercial melanins, such as synthetic and Sepia officinalis melanin. Melanization during paracoccidioidomycosis (PCM) was also further supported by the detection of IgG antibodies reactive to melanin from P. brasiliensis conidia and yeast in sera and bronchoalveolar lavage fluids from P. brasiliensis-infected mice, as well as in sera from human patients with PCM. Serum specimens from patients with other mycoses were also tested for melanin-binding antibodies by enzyme-linked immunosorbent assay, and cross-reactivities were detected for melanin particles from different fungal sources. These results suggest that melanin from P. brasiliensis is an immunologically active fungal structure that activates a strong IgG humoral response in humans and mice.
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Affiliation(s)
- Martha E Urán
- Medical and Experimental Mycology Unit, Corporación para Investigaciones Biológicas, Carrera 72A No. 78B-141, A.A. 73-78, Medellín, Colombia.
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Padhi S, Uppin SG, Uppin MS, Umabala P, Challa S, Laxmi V, Prasad VBN. Mycetoma in South India: retrospective analysis of 13 cases and description of two cases caused by unusual pathogens: Neoscytalidium dimidiatum and Aspergillus flavus. Int J Dermatol 2011; 49:1289-96. [PMID: 20964650 DOI: 10.1111/j.1365-4632.2010.04610.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mycetoma is a chronic suppurative and/or granulomatous inflammatory lesion of skin, subcutaneous tissue, fascia, and tendons caused by the traumatic inoculation of either fungal (eumycotic) or bacterial (actinomycotic) organisms present in the soil. The disease is characterized by triad of tumefaction, discharging sinuses, and grains. MATERIAL AND METHODS Thirteen new cases of biopsy proven mycetomas were analyzed, retrospectively, from January 2000 to October 2009. Clinical parameters, bone involvement, microbiological properties, and histopathological features were evaluated. Categorization into eumycotic or actinomycotic was based upon features on hematoxylin and eosin stained sections with special stains. Therapeutic outcome was presented wherever available. RESULTS There were eight actinomycetomas and five eumycetoma cases including 11 men and two women. Foot and lower extremities were the most common site of involvement (9 of 13, 69%). Culture results were available in 8 of 13 cases (61.5%). Madurella mycetomatis, Neoscytalidium dimidiatum, and Aspergillus flavus were the isolates among eumycetomas whereas Acinomadura madurae, Actinomadura pelletieri, and Nocardia species were the isolates among actinomycetomas. Two cases had underlying bone involvement. On follow-up, four of five eumycetoma cases showed partial improvement following surgery and antifungal therapy, one had amputation of the lower leg. Of the actinomycetomas, six of eight had dramatic improvement following sulfamethoxazole-trimethoprim based therapy, one had complete cure, and one was lost to follow-up. CONCLUSION Strong clinical suspicion, exact categorization of lesion into eumycotic or actinomycotic along with culture correlation, is essential for prognosis and effective therapy.
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Affiliation(s)
- Somanath Padhi
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
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Abstract
Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes, including chromoblastomycosis, mycetoma, and phaeohyphomycosis. [corrected]. Many are soil organisms and are generally distributed worldwide, though certain species appear to have restricted geographic ranges. Though they are uncommon causes of disease, melanized fungi have been increasingly recognized as important pathogens, with most reports occurring in the past 20 years. The spectrum of diseases with which they are associated has also broadened and includes allergic disease, superficial and deep local infections, pneumonia, brain abscess, and disseminated infection. For some infections in immunocompetent individuals, such as allergic fungal sinusitis and brain abscess, they are among the most common etiologic fungi. Melanin is a likely virulence factor for these fungi. Diagnosis relies on careful microscopic and pathological examination, as well as clinical assessment of the patient, as these fungi are often considered contaminants. Therapy varies depending upon the clinical syndrome. Local infection may be cured with excision alone, while systemic disease is often refractory to therapy. Triazoles such as voriconazole, posaconazole, and itraconazole have the most consistent in vitro activity. Further studies are needed to better understand the pathogenesis and optimal treatment of these uncommon infections.
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Ruíz-Cendoya M, Madrid H, Pastor FJ, Mayayo E, Mariné M, Guarro J. Development of murine models of disseminated infection byNeoscytalidium dimidiatum. Med Mycol 2010; 48:681-6. [DOI: 10.3109/13693780903452917] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Ruíz-Cendoya M, Madrid H, Pastor J, Guarro J. Evaluation of antifungal therapy in a neutropenic murine model of Neoscytalidium dimidiatum infection. Int J Antimicrob Agents 2010; 35:152-5. [DOI: 10.1016/j.ijantimicag.2009.09.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 09/29/2009] [Indexed: 11/26/2022]
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18
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Khan Z, Ahmad S, Joseph L, Chandy R. Cutaneous phaeohyphomycosis due to Neoscytalidium dimidiatum : First case report from Kuwait. J Mycol Med 2009. [DOI: 10.1016/j.mycmed.2009.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Scytalidium dimidiatum, a dematiaceous fungus, has been well established as an agent of dermatomycosis. There are few reports of invasive infection caused by S. dimidiatum; most infections occurred in immunocompromised hosts. We present an immunocompetent patient with pleural S. dimidiatum infection and review nine other published cases of invasive S. dimidiatum infections.
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Successful Treatment of Subcutaneous Scytalidium hyalinum Infection With Voriconazole and Topical Terbinafine in a Cardiac Transplant Patient. Transplantation 2008; 85:780-2. [DOI: 10.1097/tp.0b013e3181664ecb] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dunand J, Paugam A. [In vitro susceptibility of isolates of Scytalidium spp. from superficial lesions against posaconazole]. ACTA ACUST UNITED AC 2008; 56:268-71. [PMID: 18325689 DOI: 10.1016/j.patbio.2007.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 12/14/2007] [Indexed: 11/27/2022]
Abstract
Scytalidium spp. is a dematiaceous fungi that has been frequently reported from tropical to semi subtropical regions. We distinguish two pathogenic species: S. dimidiatum and S. hyalinum which is an homologous non-pigmented mutant of S. dimidiatum. This keratinophilic mold may produce superficial disease (skin, nails) indistinguishable from dermatophytes. In Martinique, this pseudodermatophyte could represent more than 50 % of onychomycosis. Contrary to dermatophytes, the clinical response of Scytalidium spp. are typically very poor and topical treatment or systemic agents ineffective. To evaluate the potential efficacy of the new antifungal agent posaconazole, we tested in vitro 12 clinical isolates of Scytalidium spp. (seven S. dimidiatum and five S. hyalinum) against posaconazole by Etest method. For the totality of the isolates, the minimum inhibitory concentrations (MICs) were low: MICs less or equal to 0.25 microg/ml (maximum MICs of 0.25 microg/ml for S. dimidiatum and 0.032 microg/ml for S. hyalinum). These in vitro efficacy suggest that the new agent posaconazole may be a future alternative treatment.
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Affiliation(s)
- J Dunand
- Laboratoire de microbiologie, hôpital Ambroise-Paré, Boulogne-Billancourt, France
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Paolo WF, Dadachova E, Mandal P, Casadevall A, Szaniszlo PJ, Nosanchuk JD. Effects of disrupting the polyketide synthase gene WdPKS1 in Wangiella [Exophiala] dermatitidis on melanin production and resistance to killing by antifungal compounds, enzymatic degradation, and extremes in temperature. BMC Microbiol 2006; 6:55. [PMID: 16784529 PMCID: PMC1569847 DOI: 10.1186/1471-2180-6-55] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Accepted: 06/19/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Wangiella dermatitidis is a human pathogenic fungus that is an etiologic agent of phaeohyphomycosis. W. dermatitidis produces a black pigment that has been identified as a dihydroxynaphthalene melanin and the production of this pigment is associated with its virulence. Cell wall pigmentation in W. dermatitidis depends on the WdPKS1 gene, which encodes a polyketide synthase required for generating the key precursor for dihydroxynaphthalene melanin biosynthesis. RESULTS We analyzed the effects of disrupting WdPKS1 on dihydroxynaphthalene melanin production and resistance to antifungal compounds. Transmission electron microscopy revealed that wdpks1Delta-1 yeast had thinner cell walls that lacked an electron-opaque layer compared to wild-type cells. However, digestion of the wdpks1Delta-1 yeast revealed small black particles that were consistent with a melanin-like compound, because they were acid-resistant, reacted with melanin-binding antibody, and demonstrated a free radical signature by electron spin resonance analysis. Despite lacking the WdPKS1 gene, the mutant yeast were capable of catalyzing the formation of melanin from L-3,4-dihyroxyphenylalanine. The wdpks1Delta-1 cells were significantly more susceptible to killing by voriconazole, amphotericin B, NP-1 [a microbicidal peptide], heat and cold, and lysing enzymes than the heavily melanized parental or complemented strains. CONCLUSION In summary, W. dermatitidis makes WdPKS-dependent and -independent melanins, and the WdPKS1-dependent deposition of melanin in the cell wall confers protection against antifungal agents and environmental stresses. The biological role of the WdPKS-independent melanin remains unclear.
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Affiliation(s)
- William F Paolo
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, New York University Medical Center, NY, USA
| | - Ekaterina Dadachova
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Nuclear Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Piyali Mandal
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Microbiology, All India Institute of Medical Sciences and Division of Infectious Diseases, New Delhi, India
| | - Arturo Casadevall
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Paul J Szaniszlo
- Section of Molecular Genetics and Microbiology, The University of Texas at Austin, Austin, TX, USA
| | - Joshua D Nosanchuk
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
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Abstract
Candida species rarely cause black pigmentation of infected nails and only a few cases have been reported in the literature. We describe a 53-year-old white man who had diffuse melanonychia of the fourth right fingernail due to C. albicans. A progressive dark pigmentation of his nail appeared over 6 months, following paronychial inflammation. The melanonychia was associated with brittleness. There was no onycholysis or hyperkeratosis. Direct examination with potassium hydroxide demonstrated round yeast cells in the specimen. The samples were cultured on Sabouraud glucose agar containing chloramphenicol at 27 degrees C and showed white growth after a few days. The patient was successfully treated with systemic itraconazole.
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Affiliation(s)
- A H Parlak
- Department of Dermatology, Izzet Baysal Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey.
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Abstract
Onychomycoses have been divided into several categories depending on the site of nail penetration by the fungus. However, not all cases entirely fit with this classification, such as potentially the deep spread of superficial fungi, suggesting alternative penetration routes. A recent European study showed that the prevalence of onychomycosis may be as high as 26.9%. The main causative agent varies according to climate; dermatophyte infections are common worldwide (70% in Europe). Mycological examination is currently the preferred diagnostic method, despite a false-negative rate of 30%. A clinical diagnostic aid that can be used alongside mycological tests is currently being developed. Newer diagnostic approaches include calcofluor, which stains fungi in nails, and molecular genetic techniques for species recognition (e.g. RFLP). Restriction fragment length polymorphism (RFLP) can also distinguish between failed treatment and reinfection. Onychomycosis can be treated with numerous oral and topical agents alone or in combination. In some studies, combination therapy appears more effective than monotherapy.
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Affiliation(s)
- R Hay
- The Faculty of Medicine and Health Sciences, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast BT9 7BL, UK.
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Baran R, McLoone N, Hay RJ. Could proximal white subungual onychomycosis be a complication of systemic spread? The lessons to be learned from Maladie Dermatophytique and other deep infections. Br J Dermatol 2005; 153:1023-5. [PMID: 16225618 DOI: 10.1111/j.1365-2133.2005.06838.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There are several published cases where dermatophyte infections have spread systemically, resulting in widespread internal dissemination as well as spread to local lymphatics and lymph nodes. The best example is provided by the condition known as Maladie Dermatophytique. In this commentary the arguments are discussed for a potential role of lymphatic dissemination in the development of proximal white subungual onychomycosis, where invasion of the nail plate by fungi proceeds from the proximal nail fold.
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Affiliation(s)
- R Baran
- Nail Disease Centre, 42 rue des Serbes, 06400 Cannes, France
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