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de Carvalho Sugai JB, Di Rito NP, Lourenço A, Mamoni RL, Da Mota Falleiros AC, de Moraes Alves CAX, Paraluppi GR. White piedra on pediatric scalp: A case report. IDCases 2024; 37:e02002. [PMID: 38966283 PMCID: PMC11222930 DOI: 10.1016/j.idcr.2024.e02002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 07/06/2024] Open
Abstract
This case report describes a rare fungal infection, piedra alba, in a 5-year-old female initially misdiagnosed. Treatment with 2 % ketoconazole shampoo led to significant regression within a week, without the need for hair cutting. We discuss the importance of early and accurate diagnosis, highlighting potential hair damage and complications in immunocompromised cases. Dermatoscopy aided diagnosis, and 2 % ketoconazole demonstrated efficacy, emphasizing the need for a multidisciplinary approach and dermatological follow-up.
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Affiliation(s)
| | - Nayara Pelizaro Di Rito
- Faculdade de Medicina de, Jundiai, Dermatology, Rua Francisco Telles, 250, 13202-550, Brazil
| | - Alexandre Lourenço
- Faculdade de Medicina de, Jundiai, Dermatology, Rua Francisco Telles, 250, 13202-550, Brazil
| | - Ronei Luciano Mamoni
- Faculdade de Medicina de, Jundiai, Dermatology, Rua Francisco Telles, 250, 13202-550, Brazil
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Guerrero-Ponce AE, Araiza J, Tirado-Sánchez A, Bonifaz A. Review Article White Piedra: Review of 131 cases. Mycoses 2024; 67:e13668. [PMID: 37907831 DOI: 10.1111/myc.13668] [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] [Received: 07/10/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023]
Abstract
This study analyzes the clinical characteristics of patients diagnosed with White Piedra through a systematic review of cases in the literature. A sample of 131 subjects was considered, of which 91.6% were female and most were 18 years of age or younger. Most studies were conducted in Brazil, followed by India, and Mexico. The most common etiologic agent found was Trichosporon spp (34.3%). Most affected patients were asymptomatic (94.6%) and predisposing factors included long hair, use of a hair band or hair accessories, and wet hair. The most common clinical feature was the presence of nodules. The evaluation of treatment effectiveness was hindered by the scarcity of follow-up information in the majority of the studies. It is concluded that White Piedra infection is more common in young women and is associated with hair-related factors.
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Affiliation(s)
| | - Javier Araiza
- Mycology Department, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Andrés Tirado-Sánchez
- Internal Medicine Department, Hospital General de Zona 29, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Alexandro Bonifaz
- Dermatology Service, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
- Mycology Department, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
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Zapata-Zapata C, Giraldo-Galeano AM, Rojo-Uribe C, Campo-Polanco L, Gómez-Velásquez JC, Mesa-Arango AC. Antifungal susceptibility profile of Trichosporon inkin: About three cases of White Piedra. Med Mycol Case Rep 2023; 40:8-11. [PMID: 36879844 PMCID: PMC9984918 DOI: 10.1016/j.mmcr.2023.02.007] [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: 01/19/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Trichosporon spp. usually cause systemic or superficial infections. Three cases of White Piedra produced by Trichosporon inkin are described. The in vitro antifungal activity to fluconazole, amphotericin B, ketoconazole and caspofungin against the three clinical isolates were evaluated. Sensitivity to fluconazole and ketoconazole was evidenced. However, the treatment of this mycosis is still a challenge.
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Affiliation(s)
- Carolina Zapata-Zapata
- Escuela de Microbiología, Universidad de Antioquia, Medellín, 050010, Colombia.,Grupo de Epidemiología Clínica, Facultad de Medicina, Universidad de Antioquia, Medellín, 050010, Colombia
| | | | - Cris Rojo-Uribe
- Escuela de Microbiología, Universidad de Antioquia, Medellín, 050010, Colombia
| | - Laura Campo-Polanco
- Escuela de Microbiología, Universidad de Antioquia, Medellín, 050010, Colombia
| | | | - Ana Cecilia Mesa-Arango
- Grupo de Epidemiología Clínica, Facultad de Medicina, Universidad de Antioquia, Medellín, 050010, Colombia
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Shakshouk H, Tosti A. Trichoscopy beyond scalp. A narrative review. Int J Dermatol 2023; 62:416-427. [PMID: 35511549 DOI: 10.1111/ijd.16226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/03/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022]
Abstract
Dermoscopy is becoming an indispensable tool in everyday practice, with an expanding range of applications. Trichoscopy is effective not only in establishing the diagnosis of scalp disorders but also in the follow-up of treatment. The MEDLINE database was searched using the terms "dermoscopy" and "trichoscopy" in combination with each of the following: "axilla," "pubic area," "beard," "eyebrows," "eyelashes," and "body hairs." We included case reports, case series, and review articles mentioning the previous terms. By providing an updated review from the literature, we aimed to emphasize the potential uses of trichoscopy in detecting diseases in hairy locations other than the scalp. Various inflammatory conditions, infections, and infestations are discussed.
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Affiliation(s)
- Hadir Shakshouk
- Department of Dermatology, Alexandria University, Alexandria, Egypt
| | - Antonella Tosti
- Department of Dermatology, University of Miami, Coral Gables, Florida, USA
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Dermoscopy of Bacterial, Viral, and Fungal Skin Infections: A Systematic Review of the Literature. Dermatol Ther (Heidelb) 2022; 13:51-76. [PMID: 36417086 PMCID: PMC9823193 DOI: 10.1007/s13555-022-00855-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
Over the last three decades, the use of dermoscopy has been extended to inflammatory and infectious dermatoses. Regarding the latter, while the first applications concerned skin parasitoses, there has been a significant increase in the publication trend regarding nonparasitic dermatoses over recent years, yet data on this topic are sparse and often lack a standardized analytical approach. This systematic literature review summarizes published data on dermoscopy of bacterial, viral, and fungal dermatoses (dermoscopic findings, used setting, pathological correlation, and level of evidence of studies) and provides a homogeneous terminology of reported dermoscopic features according to a standardized methodology. A total of 152 papers addressing 43 different dermatoses and describing 184 different dermoscopic findings were included in the analysis. The majority of them displayed a level of evidence of V (107 single case reports and 40 case series), with only 5 studies showing a level of evidence of IV (case-control studies). Moreover, our analysis also underlined a high variability in the terminology used in published articles (even for the same dermatosis). Therefore, despite significant potential, future studies designed according to a systematic and standardized approach are required for a better characterization of dermoscopy of nonparasitic skin infections.
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Sprute R, Bethe U, Chen SCA, Cornely OA. OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1779-1784. [PMID: 35325146 PMCID: PMC9155625 DOI: 10.1093/jac/dkac085] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background Invasive infections due to Trichosporon spp. are life-threatening opportunistic fungal infections that require complex clinical management. Guidelines assist clinicians but can be challenging to comply with. Objectives To develop a scoring tool to facilitate and quantify adherence to current guideline recommendations for invasive trichosporonosis. Methods We reviewed the current guideline for managing rare yeast infections (ECMM, ISHAM and ASM). The most important recommendations for diagnosis, treatment and follow-up were assembled and weighted according to their strength of recommendation and level of evidence. Additional items considered highly relevant for clinical management were also included. Results The resulting EQUAL Trichosporon Score 2022 comprises 18 items, with a maximum score of 39 points. For diagnostics, seven or eight items, depending on whether organ involvement is present or not, apply, resulting in a maximum of 18 or 21 points. Recommendations on diagnostics include imaging, infectious diseases expert consultation, culture, microscopy, molecular techniques, histopathology, and susceptibility testing. For treatment, six recommendations with a maximum of ten points were identified, with two additional points for organ involvement and one point for second-line treatment in uncontrolled disease. Treatment recommendations include immediate initiation, source control, pharmacological treatment, therapeutic drug monitoring, treatment duration and surgical intervention. Follow-up comprises two items with five points maximum, covering follow-up blood cultures and imaging. Conclusions The EQUAL Trichosporon Score weighs and aggregates factors recommended for optimal management of Trichosporon infections. It provides a tool for antifungal stewardship as well as for measuring guideline adherence, but remains to be correlated with patient outcomes.
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Affiliation(s)
- Rosanne Sprute
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, NRW, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, NRW, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, NRW, Germany
| | - Ullrich Bethe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, NRW, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, NRW, Germany
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead, Sydney, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, The University of Sydney, Sydney, Australia
| | - Oliver A. Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, NRW, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, NRW, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, NRW, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, NRW, Germany
- University of Cologne, Faculty of Medicine and University Hospital MC), Cologne, Germany
- Corresponding author. E-mail:
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Bieber AK, Pomeranz MK, Kim RH. White Piedra. JAMA Dermatol 2021; 157:339. [PMID: 33471028 DOI: 10.1001/jamadermatol.2020.4266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amy Kalowitz Bieber
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Miriam Keltz Pomeranz
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Randie H Kim
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
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Arastehfar A, de Almeida Júnior JN, Perlin DS, Ilkit M, Boekhout T, Colombo AL. Multidrug-resistant Trichosporon species: underestimated fungal pathogens posing imminent threats in clinical settings. Crit Rev Microbiol 2021; 47:679-698. [PMID: 34115962 DOI: 10.1080/1040841x.2021.1921695] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Species of Trichosporon and related genera are widely used in biotechnology and, hence, many species have their genome sequenced. Importantly, yeasts of the genus Trichosporon have been increasingly identified as a cause of life-threatening invasive trichosporonosis (IT) in humans and are associated with an exceptionally high mortality rate. Trichosporon spp. are intrinsically resistant to frontline antifungal agents, which accounts for numerous reports of therapeutic failure when echinocandins are used to treat IT. Moreover, these fungi have low sensitivity to polyenes and azoles and, therefore, are potentially regarded as multidrug-resistant pathogens. However, despite the clinical importance of Trichosporon spp., our understanding of their antifungal resistance mechanisms is quite limited. Furthermore, antifungal susceptibility testing is not standardized, and there is a lack of interpretive epidemiological cut-off values for minimal inhibitory concentrations to distinguish non-wild type Trichosporon isolates. The route of infection remains obscure and detailed clinical and environmental studies are required to determine whether the Trichosporon infections are endogenous or exogenous in nature. Although our knowledge on effective IT treatments is rather limited and future randomized clinical trials are required to identify the best antifungal agent, the current paradigm advocates the use of voriconazole, removal of central venous catheters and recovery from neutropenia.
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Affiliation(s)
- Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
| | - João N de Almeida Júnior
- Laboratorio de Micologia Medica (LIM 53), Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil.,Laboratório Central (LIM 03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - David S Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
| | - Macit Ilkit
- Division of Mycology, University of Çukurova, Adana, Turkey
| | - Teun Boekhout
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands.,Institute of Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, The Netherlands
| | - Arnaldo Lopes Colombo
- Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Lan Y, Lu S, Zheng B, Tang Z, Li J, Zhang J. Combinatory Effect of ALA-PDT and Itraconazole Treatment for Trichosporon asahii. Lasers Surg Med 2020; 53:722-730. [PMID: 33164224 DOI: 10.1002/lsm.23343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/11/2020] [Accepted: 10/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Trichosporiosis is an opportunistic infection that includes superficial infections, white piedra, hypersensitivity pneumonitis, and invasive trichosporonosis. The effect of antifungal agents against these infections is largely weakened by drug resistance and biofilms-related virulence. Photodynamic therapy (PDT) is a new therapeutic approach developed not only to combat cancerous lesions but also to treat infectious diseases such as fungal infections. However, there are few studies on the antimicrobial mechanism of 5-aminolevulinic acid PDT (ALA-PDT) in treating Trichosporon. In this work, we explored the possibility of combining ALA-PDT with an antifungal agent to enhance the therapeutic efficacy of Trichosporon asahii (T. asahii) in a clinical setting and in vitro. STUDY DESIGN/MATERIALS AND METHODS The biofilms of T. asahii were constructed by a 96-well plate-based method in vitro. The planktonic and adherent T. asahii were exposed to different concentrations of photosensitizers and different light doses. After PDT treatment, counting colony-forming units and tetrazolium (XTT) reduction assay were used to estimate the antifungal efficacy. The minimal inhibitory concentration of itraconazole before and after PDT treatment was determined by the broth dilution method, and XTT viability assay was used to detect and evaluate the synergistic potential of ALA-PDT and itraconazole combinations in inhibiting biofilms. Scanning electron microscopy (SEM) was performed to assess the disruption of biofilms. RESULTS Using combination therapy, we have successfully treated a patient who had a T. asahii skin infection. Further in vitro studies showed that the antifungal effect of ALA-PDT on planktonic and adherent T. asahii was dependent on the concentration of ALA and light dosages used. We also found that the sensitivity of both planktonic and biofilm cells to itraconazole were increased after ALA-PDT. Synergistic effect were observed for biofilms in ALA-PDT and itraconazole-combined treatment. The disruption of biofilms was confirmed by SEM, suggesting that ALA-PDT effectively damaged the biofilms and the destruction was further enhanced by ALA-PDT combination of antifungal agents. CONCLUSIONS In conclusion, these data suggest that ALA-PDT could be an alternative strategy for controlling infections caused by Trichosporon. The combination therapy of ALA-PDT with itraconazole could result in increased elimination of planktonic cells and biofilms compared with single therapy. All these findings indicate that it could be a promising treatment against trichosporonosis. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Yu Lan
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, 510120, China.,Department of Dermatology, The Eighth Affiliated Hospital, Sun Yat-sen University, 3025 Shennan Road Central, Shenzhen, 518033, China
| | - Sha Lu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, 510120, China
| | - Bowen Zheng
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, 510120, China.,Department of Plastic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, China
| | - Zengqi Tang
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, 510120, China
| | - Jiahao Li
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, 510120, China
| | - Junmin Zhang
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, 510120, China
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El Attar Y, Atef Shams Eldeen M, Wahid RM, Alakad R. Efficacy of topical vs combined oral and topical antifungals in white piedra of the scalp. J Cosmet Dermatol 2020; 20:1900-1905. [PMID: 33031603 DOI: 10.1111/jocd.13769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Topical antifungals are the most commonly used therapy in white piedra of the scalp. However, persistence and relapse of infection still pose a significant challenge. Systemic antifungals have been recommended to enhance the therapeutic response. AIMS To compare the efficacy of topical antifungal alone versus combined topical and oral antifungals in the treatment of white piedra of the scalp. METHODS Sixty patients with white piedra of the scalp were divided into 3 groups, each containing 20 patients. Group A received topical clotrimazole, group B received combined topical clotrimazole and oral itraconazole, and group C received combined topical clotrimazole and oral terbinafine. The treatment was continued until clearance of infection was confirmed by dermoscopic and mycological examination. Positive responders were followed up for 3 months after treatment. RESULTS All the patients achieved complete clearance of infection. The median treatment time in group B was significantly shorter than group A (P < .001) and group C (P < .001), respectively. In addition, the median treatment time in group C was significantly shorter than group A (P = .002). No recurrence of infection was noted during follow-up period. CONCLUSION The three modalities were effective in the treatment of white piedra of the scalp. The most rapid response was observed with the combined use of topical and oral azoles.
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Affiliation(s)
- Yasmina El Attar
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Maii Atef Shams Eldeen
- Microbiology and Immunology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Reham M Wahid
- Physiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rania Alakad
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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