Phaeohyphomycosis: Cytomorphologic Evaluation in Eleven Cases

Phaeohyphomycosis: A 10-Year Study From a Tertiary Care Centre in South India

Background Phaeohyphomycosis, a fungal infection caused by dematiaceous fungi, presents a significant health challenge affecting both immunocompromised and immunocompetent individuals. Despite its clinical importance, phaeohyphomycosis remains underrepresented in epidemiological studies, leading to gaps in our understanding of its prevalence, clinical manifestations, and associated risk factors. This retrospective study conducted in South India aims to address these gaps by examining the incidence, diverse clinical presentations, and other relevant epidemiological aspects of phaeohyphomycosis in patients referred for pathological examination. Objective To investigate the epidemiological trends, clinicopathological characteristics, and microbiological spectrum of phaeohyphomycosis in patients at a tertiary care center in South India over 10 years. Materials and methods This comprehensive study was conducted at Employees State Insurance Corporation Medical College & Post Graduate Institute of Medical Sciences and Research (ESIC Medical College and PGIMSR), Chennai, embodying a retrospective observational approach. Over a decade, researchers meticulously reviewed cases diagnosed with phaeohyphomycosis. This involved an in-depth analysis of patients' medical records to gather detailed information on presenting symptoms, history of thorn pricks, diabetic status, and other pertinent epidemiological data. Additionally, culture samples were selectively obtained from patients exhibiting abscesses or cystic swellings, followed by a thorough assessment of the culture reports. Results In the ten-year study period, a total of 46 cases were identified. Most lesions were solid or cystic and located on extremities, predominantly affecting the digits. Eight cases (17%) had a history of thorn prick injuries, and six cases (13%) were associated with diabetes mellitus. Microscopic examination revealed necrosis, granulomas, varying degrees of inflammatory infiltrates, giant cells, and pigmented fungal hyphae. In some cases, biopsies revealed pseudoepitheliomatous hyperplasia. Among the 19 cases where culture was performed, Alternaria was the most commonly isolated pathogen (42%). Conclusion The study brings to light the diagnostic challenges inherent in phaeohyphomycosis cases, which often eluded clinical diagnosis and were only conclusively identified via pathological examinations. While this research was primarily focused on outpatients presenting with minor symptoms, it underscores the potential for more severe clinical presentations in immunocompromised patients. Our findings emphasize the need for increased clinical awareness and the pivotal role of histopathological examination in accurately diagnosing phaeohyphomycosis, particularly in cases with extremity lesions. This study contributes significantly to the understanding of phaeohyphomycosis and advocates for ongoing research to better understand its epidemiology and clinical diversity.

Not all black fungus is mucormycosis: A challenging case of Medicopsis romeroi

In this case of phaeohyphomycosis, fine needle aspiration cytology enabled a rapid diagnosis and emergent treatment. This infection is quite prevalent in immunocompromised individuals; however, the Medicopsis romeroi species is a rare causative agent. These cases are associated with inadequate response to standard antifungal therapy and require discussion.

Novel cases of cutaneous phaeohyphomycosis by Alternaria alstromeriae, Epicoccum tritici and Phialemonium obovatum from North India

BACKGROUND

A growing number of non-dermatophytic moulds and yeasts with the ability to act as human pathogens are reported every year. Dematiaceous fungi cause phaeohyphomycosis which encompasses a broad spectrum of diseases ranging from superficial (cutaneous and subcutaneous) to disseminated infections. Such fungal infections are responsible for causing significant morbidity and mortality, frequently in immunocompromised patients and rarely in immunocompetent patients.

OBJECTIVES

To investigate the prevalence of cutaneous mycosis in Jammu district (India) and to isolate and identify the recovered causal agents from the affected skin of the patients.

METHODS

For direct microscopy, 10% KOH was used. Skin samples were collected carefully from the affected areas of suspected patients, followed by the isolation and identification of the causal agents by cultural examination, morphological examination and ITS sequencing.

RESULTS

Herein, we report and describe three new cases of cutaneous phaeohyphomycosis from District Jammu of Union Territory Jammu and Kashmir, India. The age of the patients under study ranged from 17 to 42 years and the duration of infection from 1 to 2 years. The etiological agents that were recovered from the patients under study were Alternaria alstromeriae, Epicoccum tritici and Phialemonium obovatum. These dematiaceous fungal species were isolated from the skin specimen of immunocompetent hosts.

CONCLUSION

Among the three isolated etiological agents, two (Alternaria alstromeriae, Epicoccum tritici) represent new global records and one (Phialemonium obovatum) new record to India as causal agents of cutaneous phaeohyphomycosis. Careful microscopic and mycological examination form the basis of correct diagnosis of such fungal infections in the absence of simple and reliable laboratory tests (serologic or antigen tests).