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Coelho RA, Almeida-Silva F, Figueiredo-Carvalho MHG, Rabello VBDS, de Souza GR, Lourenço MCDS, Rodrigues ML, Almeida-Paes R. Comparison of the antifungal activity of the pyrimidine analogs flucytosine and carmofur against human-pathogenic dematiaceous fungi. Med Mycol 2024; 62:myae029. [PMID: 38533658 PMCID: PMC11008743 DOI: 10.1093/mmy/myae029] [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: 11/28/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 03/28/2024] Open
Abstract
Chromoblastomycosis (CBM) and pheohyphomycosis (PHM) are the most common implantation mycoses caused by dematiaceous fungi. In the past, flucytosine (5-FC) has been used to treat CBM, but development of resistance is common. Carmofur belongs to the same class as 5-FC and has in vitro inhibitory activity against the main agents of CBM and PHM. The aim of this study was to compare the action of these two pyrimidine analog drugs against CBM and PHM agents. The minimum inhibitory concentration (MIC) and the selectivity index based on cytotoxicity tests of these two drugs against some agents of these mycoses were determined, with carmofur presenting a higher selectivity index than 5-FC. Carmofur demonstrated here synergistic interactions with itraconazole and amphotericin B against Exophiala heteromorpha, Fonsecaea pedrosoi, Fonsecaea monophora, and Fonsecaea nubica strains. Additionally, carmofur plus itraconazole demonstrated here synergism against a Phialophora verrucosa strain. To evaluate the development of carmofur resistance, passages in culture medium containing subinhibitory concentrations of this pyrimidine analog were carried out, followed by in vitro susceptibility tests. Exophiala dermatitidis quickly developed resistance, whereas F. pedrosoi took seven passages in carmofur-supplemented medium to develop resistance. Moreover, resistance was permanent in E. dermatitidis but transient in F. pedrosoi. Hence, carmofur has exhibited certain advantages, albeit accompanied by limitations such as the development of resistance, which was expected as with 5-FC. This underscores its therapeutic potential in combination with other drugs, emphasizing the need for a meticulous evaluation of its application in the fight against dematiaceous fungi.
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Affiliation(s)
- Rowena Alves Coelho
- Mycology Laboratory, National Institute of Infectious Diseases Evandro Chagas, INI/Fiocruz, Rio de Janeiro, Brazil
| | - Fernando Almeida-Silva
- Mycology Laboratory, National Institute of Infectious Diseases Evandro Chagas, INI/Fiocruz, Rio de Janeiro, Brazil
| | | | | | - Gabriela Rodrigues de Souza
- RPT 11B Bioassay Platform, National Institute of Infectious Diseases Evandro Chagas, INI/Fiocruz, Rio de Janeiro, Brazil
| | | | - Marcio L Rodrigues
- Carlos Chagas Institute, Fiocruz, Paraná, Brazil
- Institute of Microbiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Rodrigo Almeida-Paes
- Mycology Laboratory, National Institute of Infectious Diseases Evandro Chagas, INI/Fiocruz, Rio de Janeiro, Brazil
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Potenciano da Silva KL, Moraes D, Lechner B, Lindner H, Haas H, Almeida Soares CM, Silva-Bailão MG, Bailão AM. Fonsecaea pedrosoi produces ferricrocin and can utilize different host iron sources. Fungal Biol 2023; 127:1512-1523. [PMID: 38097325 DOI: 10.1016/j.funbio.2023.07.002] [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: 02/01/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 12/18/2023]
Abstract
The survival of living organisms depends on iron, one of the most abundant metals in the Earth's crust. Nevertheless, this micronutrient is poorly available in our aerobic atmosphere as well as inside the mammalian host. This problem is circumvented by the expression of high affinity iron uptake machineries, including the production of siderophores, in pathogenic fungi. Here we demonstrated that F. pedrosoi, the causative agent of the neglected tropical disease chromoblastomycosis, presents gene clusters for siderophore production. In addition, ten putative siderophore transporters were identified. Those genes are upregulated under iron starvation, a condition that induces the secretion of hydroxamates, as revealed by chrome azurol S assays. RP-HPLC and mass spectrometry analysis allowed the identification of ferricrocin as an intra- and extracellular siderophore. F. pedrosoi can grow in different iron sources, including the bacterial ferrioxamine B and the host proteins ferritin, hemoglobin and holotransferrin. Of note, addition of hemoglobin, lactoferrin and holotransferrin to the growth medium of macrophages infected with F. pedrosoi enhanced significantly fungal survival. The ability to produce siderophores in iron limited conditions added to the versatility to utilize different sources of iron are strategies that certainly may contribute to fungal survival inside the host.
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Affiliation(s)
| | - Dayane Moraes
- Instituto de Ciências Biológicas, Universidade Federal de Goiás, Goiânia, Goiás, Brazil.
| | - Beatrix Lechner
- Institute of Molecular Biology/ Biocenter, Medical University of Innsbruck, Innsbruck, Austria.
| | - Herbert Lindner
- Institute of Medical Biochemistry/Biocenter, Medical University of Innsbruck, Innsbruck, Austria.
| | - Hubertus Haas
- Institute of Molecular Biology/ Biocenter, Medical University of Innsbruck, Innsbruck, Austria.
| | | | | | - Alexandre Melo Bailão
- Instituto de Ciências Biológicas, Universidade Federal de Goiás, Goiânia, Goiás, Brazil.
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Belda W, Passero LFD, de Carvalho CHC, Mojica PCR, Vale PA. Chromoblastomycosis: New Perspective on Adjuvant Treatment with Acitretin. Diseases 2023; 11:162. [PMID: 37987273 PMCID: PMC10660773 DOI: 10.3390/diseases11040162] [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: 10/04/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
Chromoblastomycosis (CBM) is a neglected human disease, caused by different species of pigmented dematiaceous fungi that cause granulomatous and suppurative dermatosis. This infection is difficult to treat and there are limited therapeutic options, including terbinafine, itraconazole, and tioconazole. Classic treatment is administered for a long period of time, but some patients do not respond properly, and therefore, such therapeutic approaches possess low cure rates. Therefore, it is vital to develop new strategies for the treatment of CBM. In this regard, it has been observed that the association of immunomodulatory molecules such as glucan with therapy carried out with antifungal drugs improves cutaneous lesions in comparison to treatment with antifungal drugs alone, suggesting that drug association may be an interesting and significant approach to incorporate into CBM therapy. Thus, the aim of this work was to associate classical antifungal therapy with the adjuvants imiquimod and acitretin. In the present case, we reported a patient with extensive CBM caused by Fonsaecae pedrosoi, that affected an extensive area of the right leg, that was left without treatment for 11 years. He was treated with a classical combination of itraconazole and terbinafine via the oral route plus topical imiquimod and oral acitretin, as an adjuvant therapy. After five months of treatment, a significant regression of verrucous plaques was observed, suggesting that the use of these adjuvants combined with the classical antifungal drugs, intraconazole plus terbinafine, can reduce treatment time and rapidly improve the patient's quality of life. This result confirms that the use of coadjuvant drugs may be effective in the treatment of this infectious disease.
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Affiliation(s)
- Walter Belda
- Dermatology Department, Medical School, University of São Paulo, Sao Paulo 05403-000, Brazil; (C.H.C.d.C.); (P.C.R.M.); (P.A.V.)
- Laboratory of Pathology of Infectious Diseases, Medical School, University of São Paulo, Sao Paulo 01246-000, Brazil
| | - Luiz Felipe Domingues Passero
- Institute of Biosciences, São Paulo State University (UNESP), Sao Vicente 11330-900, Brazil;
- Institute for Advanced Studies of Ocean, São Paulo State University (UNESP), Sao Vicente 11350-011, Brazil
| | | | - Paula Celeste Rubiano Mojica
- Dermatology Department, Medical School, University of São Paulo, Sao Paulo 05403-000, Brazil; (C.H.C.d.C.); (P.C.R.M.); (P.A.V.)
| | - Pablo Andrade Vale
- Dermatology Department, Medical School, University of São Paulo, Sao Paulo 05403-000, Brazil; (C.H.C.d.C.); (P.C.R.M.); (P.A.V.)
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Falgout L, Hilton D. Clinical presentation and management of chromoblastomycosis: A case report and review. Med Mycol Case Rep 2023; 41:8-10. [PMID: 37288321 PMCID: PMC10242489 DOI: 10.1016/j.mmcr.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023] Open
Affiliation(s)
| | - Deborah Hilton
- Corresponding author. 2021 Perdido St. New Orleans, LA, 70112, USA.
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Bailão AM, Silva KLPD, Moraes D, Lechner B, Lindner H, Haas H, Soares CMA, Silva-Bailão MG. Iron Starvation Induces Ferricrocin Production and the Reductive Iron Acquisition System in the Chromoblastomycosis Agent Cladophialophora carrionii. J Fungi (Basel) 2023; 9:727. [PMID: 37504717 PMCID: PMC10382037 DOI: 10.3390/jof9070727] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
Iron is a micronutrient required by almost all living organisms. Despite being essential, the availability of this metal is low in aerobic environments. Additionally, mammalian hosts evolved strategies to restrict iron from invading microorganisms. In this scenario, the survival of pathogenic fungi depends on high-affinity iron uptake mechanisms. Here, we show that the production of siderophores and the reductive iron acquisition system (RIA) are employed by Cladophialophora carrionii under iron restriction. This black fungus is one of the causative agents of chromoblastomycosis, a neglected subcutaneous tropical disease. Siderophore biosynthesis genes are arranged in clusters and, interestingly, two RIA systems are present in the genome. Orthologs of putative siderophore transporters were identified as well. Iron starvation regulates the expression of genes related to both siderophore production and RIA systems, as well as of two transcription factors that regulate iron homeostasis in fungi. A chrome azurol S assay demonstrated the secretion of hydroxamate-type siderophores, which were further identified via RP-HPLC and mass spectrometry as ferricrocin. An analysis of cell extracts also revealed ferricrocin as an intracellular siderophore. The presence of active high-affinity iron acquisition systems may surely contribute to fungal survival during infection.
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Affiliation(s)
- Alexandre Melo Bailão
- Instituto de Ciências Biológicas, Universidade Federal de Goiás, Goiânia 74690-900, Brazil
| | | | - Dayane Moraes
- Instituto de Ciências Biológicas, Universidade Federal de Goiás, Goiânia 74690-900, Brazil
| | - Beatrix Lechner
- Institute of Molecular Biology/Biocenter, Medical University of Innsbruck, 795J+RF Innsbruck, Austria
| | - Herbert Lindner
- Institute of Medical Biochemistry/Biocenter, Medical University of Innsbruck, 795J+RF Innsbruck, Austria
| | - Hubertus Haas
- Institute of Molecular Biology/Biocenter, Medical University of Innsbruck, 795J+RF Innsbruck, Austria
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Grassi A, Gambini M, Pantoli M, Toscano S, Albertetti A, Del Frassino DM, Ugochukwu ICI, Romeo O, Otranto D, Cafarchia C. A Lethal Case of Disseminated Cladosporium allicinum Infection in a Captive African Bullfrog. J Fungi (Basel) 2023; 9:jof9020191. [PMID: 36836306 PMCID: PMC9967566 DOI: 10.3390/jof9020191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Cladosporium infections have a poor prognosis in animals, most likely due to a lack of knowledge about diagnosis and treatment. In this study, we described a case of a lethal Cladosporium allicinum infection in a captive bullfrog (Pyxicephalus adspersus) in Europe. One adult male bullfrog was referred with clinical signs of lethargy and a cutaneous nodule. Fungal infection was suspected on cytology and confirmed by histology and cultural isolation. The mold was identified by molecular methods using partial sequencing of the TEF1α gene and the ITS region of rDNA. Climbazole antifungal treatment was started but the frog died after 30 days, and necropsy was done. Pigmented hyphae and structures consistent with muriform bodies were found on a background of diffuse granulomatous inflammation at cytological and histopathological examinations. Fungal culture revealed the presence of pigmented fungi identified as Cladosporium allicinum only by partial sequencing of the TEF1α gene. A focally extensive granuloma with intralesional hyphae and muriform bodies effacing the architecture of head, liver, kidneys, lungs, and large intestine were retrieved after necropsy. This study is the first Italian report of the occurrence of lethal C. allicinum infection in a frog and highlights the role of this Cladosporium sp. in chromoblastomycosis.
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Affiliation(s)
- Andrea Grassi
- I-Vet Diagnostica Veterinaria, 25020 Brescia, Italy
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna, 27100 Pavia, Italy
| | | | | | | | | | | | - Iniobong Chukwuebuka Ikenna Ugochukwu
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari Aldo Moro, 70124 Bari, Italy
- Department of Veterinary Pathology and Microbiology, University of Nigeria, Nsukka 400001, Nigeria
| | - Orazio Romeo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Domenico Otranto
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari Aldo Moro, 70124 Bari, Italy
- Faculty of Veterinary Sciences, Bu-Ali Sina University, Hamedan 6517833131, Iran
| | - Claudia Cafarchia
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari Aldo Moro, 70124 Bari, Italy
- Correspondence:
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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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8
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Las-Casas LDO, Marina CLF, de Castro RJA, Coelho LC, Báo SN, de Hoog GS, Vicente VA, Fernandes L, Bocca AL. Pathogenicity and Growth Conditions Modulate Fonsecaea Extracellular Vesicles' Ability to Interact With Macrophages. Front Cell Infect Microbiol 2022; 12:879018. [PMID: 35755848 PMCID: PMC9218254 DOI: 10.3389/fcimb.2022.879018] [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: 02/18/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Chromoblastomycosis (CBM) is a chronic cutaneous and subcutaneous mycosis caused by black, dimorphic, and filamentous fungi of the Herpothrichiellaceae family, such as species of the genus Fonsecaea. These fungi can switch between the saprophytic forms (conidia and hyphae) and the pathogenic form, the muriform cells (MCs), which is considered an essential mechanism for fungal virulence. Nearly all types of cells can produce membranous structures formed by a lipid bilayer that communicate extracellularly with other cells, known as “extracellular vesicles” (EVs), which may act as virulence factors, as observed for several species of pathogenic fungi. Our findings demonstrated for the first time that F. pedrosoi, F. nubica, and F. erecta produce EVs in response to nutritional conditions. The EVs varied in sterol and protein contents, size, and morphology. Moreover, the EVs induced different cytokine and nitric oxide release patterns by bone marrow-derived macrophages (BMDMs). The EVs activated IL-1β production, possibly acting as the first signal in inflammasome activation. Unlike the pathogenic species, the EVs isolated from F. erecta did not significantly stimulate TNF and IL-10 production in general. Overall, these results demonstrated that different species of Fonsecaea produce EVs capable of modulating pro- and anti-inflammatory cytokine and nitric oxide production by BMDMs and that growth conditions affected the immunomodulatory capacities of the EVs as well as their size, content, and morphology.
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Affiliation(s)
| | | | | | | | - Sônia Nair Báo
- Department of Cell Biology, University of Brasília, Brasília, Brazil
| | - G Sybren de Hoog
- Department of Pathology, Federal University of Paraná, Curitiba, Brazil.,Center of Expertise in Mycology of Radboud, University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, Netherlands
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Wu X, Hu Y. Photodynamic Therapy for the Treatment of Fungal Infections. Infect Drug Resist 2022; 15:3251-3266. [PMID: 35761978 PMCID: PMC9233483 DOI: 10.2147/idr.s369605] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
Cutaneous fungal infections are common in humans and are associated with significant physical and psychological distress to patients. Although conventional topical and/or oral anti-fungal medications are commonly recommended treatments, drug resistance has emerged as a significant concern in this patient population, and safer, more efficacious, and cost-effective alternatives are warranted. Recent studies have reported effectiveness of photodynamic therapy (PDT) against fungal infections without severe adverse effects. In this review, we briefly discuss the mechanisms underlying PDT, current progress, adverse effects, and limitations of this treatment in the management of superficial and deep fungal infections.
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Affiliation(s)
- Xuelin Wu
- Department of Dermatology and Venereology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, People's Republic of China
| | - Yongxuan Hu
- Department of Dermatology and Venereology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, People's Republic of China
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10
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Borges JR, Ximenes BÁS, Miranda FTG, Peres GBM, Hayasaki IT, Ferro LCDC, Ianhez M, Garcia-Zapata MTA. Accuracy of direct examination and culture as compared to the anatomopathological examination for the diagnosis of chromoblastomycosis: a systematic review. An Bras Dermatol 2022; 97:424-434. [PMID: 35643736 PMCID: PMC9263652 DOI: 10.1016/j.abd.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background Chromoblastomycosis is a skin infection caused by dematiaceous fungi that take the form of muriform cells in the tissue. It mainly manifests as verrucous plaques on the lower limbs of rural workers in tropical countries. Objectives The primary objective of this review is to evaluate the accuracy of diagnostic methods for the identification of chromoblastomycosis, considering the histopathological examination as the reference test. Methods MEDLINE, LILACS and Scielo databases were consulted using the terms “chromoblastomycosis” AND “diagnosis”. The eligibility criteria were: studies that evaluated the accuracy of tests for the diagnosis of chromoblastomycosis. Eleven studies were selected. Statistical analysis included the calculation of sensitivity and specificity of the diagnostic methods. Results Considering the histopathological examination as the reference test, the culture showed a sensitivity (S) of 37.5% - 90.9% and a specificity (Sp) of 100%; while direct mycological examination showed S = 50% - 91.6% and Sp of 100% . Considering the culture as the reference test, the serology (precipitation techniques) showed S of 36% - 99%; and Sp of 80% - 100%; while the intradermal test showed S of 83.3% - 100% and Sp of 99.4% - 100%. Study limitations The small number of studies and very discrepant sensitivity results among them do not allow the calculation of summary measures through a meta-analysis. Conclusions Direct mycological examination, culture, intradermal test and serology show sensitivity and specificity values for the diagnosis of chromoblastomycosis with no significant difference between the studies.
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Fungal Infections of Implantation: More Than Five Years of Cases of Subcutaneous Fungal Infections Seen at the UK Mycology Reference Laboratory. J Fungi (Basel) 2022; 8:jof8040343. [PMID: 35448574 PMCID: PMC9028115 DOI: 10.3390/jof8040343] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 01/20/2023] Open
Abstract
Subcutaneous fungal infections, which typically result from traumatic introduction (implantation) of fungal elements into the skin or underlying tissues, can present as a range of different clinical entities including phaeohyphomycosis, chromoblastomycosis, subcutaneous nodules or masses, and genuine eumycetoma. Here, we mined our laboratory information management system for such infections in humans and domestic animals for the period 2016–2022, including (i) fungal isolates referred for identification and/or susceptibility testing; (ii) infections diagnosed at our laboratory using panfungal PCR approaches on infected tissue; and (iii) organisms cultured in our laboratory from biopsies. In total, 106 cases were retrieved, involving 39 fungal species comprising 26 distinct genera. Subcutaneous infections with Alternaria species were the most frequent (36 cases), which possibly reflects the ubiquitous nature of this common plant pathogen. A substantial proportion of Alternaria spp. isolates exhibited reduced in vitro susceptibility to voriconazole. Notably, a significant number of subcutaneous infections were diagnosed in renal and other solid organ transplant recipients post transplantation, suggesting that humans may harbour “inert” subcutaneous fungal elements from historical minor injuries that present as clinical infections upon later immunosuppression. The current study underscores the diversity of fungi that can cause subcutaneous infections. While most organisms catalogued here were responsible for occasional infections, several genera (Alternaria, Exophiala, Phaeoacremonuim, Scedosporium) were more frequently recovered in our searches, suggesting that they possess virulence factors that facilitate subcutaneous infections and/or inhabit natural niches that make them more likely to be traumatically inoculated.
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12
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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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Guevara A, Siqueira NP, Nery AF, Cavalcante LRDS, Hagen F, Hahn RC. Chromoblastomycosis in Latin America and the Caribbean: epidemiology over the past 50 years. Med Mycol 2021; 60:6391503. [PMID: 34637525 DOI: 10.1093/mmy/myab062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/30/2021] [Accepted: 10/09/2021] [Indexed: 01/19/2023] Open
Abstract
Chromoblastomycosis is a chronic disease caused by melanized fungi that mainly affect individuals performing soil-related labour. The objective of this study was to analyse the epidemiological and clinical characteristics of chromoblastomycosis in Latin America and the Caribbean by an extensive literature review. An integrative review was performed of English, French, Portuguese, and Spanish publications in LILACS, SciELO, PubMed, SCOPUS and Web of Science databases covering the period 1969-2019. A total of 1,211 articles were identified, of which 132 were included in the review, covering 2,081 patients, 80.3% were male, the mean age was 56.1 years. The mean duration of the disease was 10.8 years. The lesions were mainly described in the lower limbs (60%). The most frequent clinical forms were verrucous (46.4%) and tumorous (21.7%). Major disease symptoms and signs consisted of itching and pain. Bacterial infection and functional limitation were important complications. Immunosuppression post-kidney transplantation was the most frequent comorbidity while leprosy was the main concomitant infectious disease. Fonsecaea pedrosoi and Cladophialophora carrionii were the predominant etiological agents. Majority of the cured cases were treated with itraconazole as monotherapy or in combination with other antifungals, surgery or cryosurgery. Chromoblastomycosis affects hundreds of rural workers in Latin America and the Caribbean, causing disability and personal, family and economic losses. It is important to prioritize epidemiological surveillance and early diagnosis of this disease in order to reveal its real prevalence and direct resources to preventive actions, diagnosis and early treatment. LAY SUMMARY Chromoblastomycosis is a slowly progressing chronic disease caused by melanized fungi. We collected data from South America and the Caribbean covering 1969-2019, the 132 articles included 2 081 patients, mean disease duration was 10.8 years. Fonsecaea pedrosoi and Cladophialophora carrionii predominated.
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Affiliation(s)
- Armando Guevara
- Mycology/Research Laboratory, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Nathan Pereira Siqueira
- Mycology/Research Laboratory, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Andreia Ferreira Nery
- Department of Internal Medicine, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.,Júlio Muller University Hospital, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | | | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, Utrecht, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Utrecht The Netherlands
| | - Rosane Christine Hahn
- Mycology/Research Laboratory, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.,Júlio Muller University Hospital, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
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Tirado-Sánchez A, Franco-Paredes C, Bonifaz A. Subcutaneous Mycoses in Travelers. CURRENT TROPICAL MEDICINE REPORTS 2020; 7:141-152. [PMID: 35665217 PMCID: PMC9162435 DOI: 10.1007/s40475-020-00216-z] [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] [Accepted: 10/24/2020] [Indexed: 01/19/2023]
Abstract
Purpose of Review The increase in international travel in recent decades has contributed to the risk of acquiring diseases considered endemic to a region or country and the change in the epidemiology of these diseases. Endemic mycoses that may be acquired by travelers in the short or long term are endemic subcutaneous mycoses such as sporotrichosis and lobomycosis, while endemic systemic mycoses are a group of serious diseases including histoplasmosis and coccidioidomycosis. Herein, we review the current knowledge and highlight the most important aspects of these fungal infections in travelers. Recent Findings The most relevant advances in the study of these mycoses involve the epidemiological distribution; human mycoses can be fatal and there are few antifungal drugs available, increasing drug resistance, and a risk of emerging fungal diseases associated with climate change, as well as the increasing virulence, and the diagnostic strategies that may be limited in many countries. Summary Although endemic mycoses are relatively rare, they should be considered as potentially travel-related illnesses. A recent or late trip to an endemic country may guide the clinical suspicion, an early diagnosis, and the institution of effective therapy.
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Affiliation(s)
- Andrés Tirado-Sánchez
- Dermatology Service & Micology Department, Hospital General de México “Dr Eduardo Liceaga”, Dr. Balmis 148, colonia Doctores, PZ: 06720 Mexico City, Mexico
| | - Carlos Franco-Paredes
- Department of Medicine, Division of Infectious Diseases, Anschutz Medical Center, University of Colorado, Aurora, CO, USA
- Instituto Nacional de Salud, Hospital Infantil de México, Federico Gómez, Mexico City, Mexico
| | - Alexandro Bonifaz
- Dermatology Service & Micology Department, Hospital General de México “Dr Eduardo Liceaga”, Dr. Balmis 148, colonia Doctores, PZ: 06720 Mexico City, Mexico
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Environmental Screening of Fonsecaea Agents of Chromoblastomycosis Using Rolling Circle Amplification. J Fungi (Basel) 2020; 6:jof6040290. [PMID: 33212756 PMCID: PMC7712894 DOI: 10.3390/jof6040290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 12/15/2022] Open
Abstract
Chromoblastomycosis is a chronic, cutaneous or subcutaneous mycosis characterized by the presence of muriform cells in host tissue. Implantation disease is caused by melanized fungi related to black yeasts, which, in humid tropical climates, are mainly members of the genus Fonsecaea. In endemic areas of Brazil, F. pedrosoi and F. monophora are the prevalent species. The current hypothesis of infection is traumatic introduction via plant materials, especially by plant thorns. However, isolation studies have demonstrated a low frequency of the agents in environmental substrates. The present study aimed to detect F. pedrosoi and F. monophora in shells of babassu coconuts, soil, plant debris, and thorns from endemic areas of chromoblastomycosis in Maranhão state, northern Brazil, using Rolling Circle Amplification (RCA) with padlock probes as a new environmental screening tool for agents of chromoblastomycosis. In addition to molecular screening, the environmental samples were analyzed by fungal isolation using mineral oil flotation. The limit of detection of the RCA method was 2.88 × 107 copies of DNA per sample for the used padlock probes, indicating that this represents an efficient and sensitive molecular tool for the environmental screening of Fonsecaea agents. In contrast, with isolation from the same samples using several selective methods, no agents of chromoblastomycosis were recovered.
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A comparative study of extracellular enzymes from chromoblastomycosis agents reveals the potential association of phospholipase with the severity of the lesions. Microb Pathog 2020; 147:104367. [PMID: 32649963 DOI: 10.1016/j.micpath.2020.104367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 12/14/2022]
Abstract
Chromoblastomycosis is a chronic, progressive subcutaneous mycosis that is endemic in tropical and subtropical countries. Cladophialophora carrionii and Fonsecaea pedrosoi are prevalent etiological agents. The potential role of the proteolytic activity of extracellular enzymes in these fungi and its relationship with the pathogenesis of the disease has not been proven. Some phenotypic traits have been associated with the virulence of other fungi; i.e., their different rate of protease, phospholipase, and esterase excretion, melanin, and thermotolerance. The aim of this study was the identification of extracellular enzymes that could be considered virulence markers of chromoblastomycosis agents. Therefore, we tested 29 C. carrionii and 11 F. pedrosoi clinical isolates to determine their hydrolytic and physiologic characteristics. All the tested isolates grew at a range of 30°-37 °C; except 2 strains of F. pedrosoi that grew slowly at 40 °C. We noticed that the hydrolytic capabilities of the tested isolates were positive for urea hydrolysis in almost all, while both strains were negative for DNase, hemolysin, and gelatin. C. carrionii and F. pedrosoi had phospholipase and esterase activity. These findings were similar for most isolates. All strains showed an association between phospholipase activity and moderate to severe lesions. However, only in F. pedrosoi isolates, the association remains significant. We conclude that the different enzymatic production reported here may be linked to the clinical manifestations of these pathologies. Notwithstanding, the influence of other virulence factors is not excluded.
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Ali GA, Goravey W, Taj-Aldeen SJ, Petkar M, Al-Bozom I, Hadi HA. A case of mycetoma-like chromoblastomycosis in Qatar. IDCases 2020; 21:e00853. [PMID: 32528848 PMCID: PMC7283144 DOI: 10.1016/j.idcr.2020.e00853] [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: 05/24/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/03/2022] Open
Abstract
Chromoblastomycosis is one of the neglected tropical mycoses associated with chronic infection of the skin and subcutaneous tissues. We report a case of 49-year-old patient originally from India presented with a mycetoma-like lesion in his right foot which was slowly progressing over three-year period. The diagnosis of chromoblastomycosis was confirmed following surgical excision and identification of the unique histological pathology of muriform bodies. The patient was subsequently treated with a prolonged course of oral itraconazole with a favorable outcome. The clinical presentations, assessment and management of the disease are outlined.
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Affiliation(s)
| | | | - Saad J Taj-Aldeen
- Department of Laboratory Medicine and Pathology Hamad Medical Corporation, Doha, Qatar
| | - Mahir Petkar
- Department of Laboratory Medicine and Pathology Hamad Medical Corporation, Doha, Qatar
| | - Issam Al-Bozom
- Department of Laboratory Medicine and Pathology Hamad Medical Corporation, Doha, Qatar
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18
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Coelho RA, Joffe LS, Alves GM, Figueiredo-Carvalho MHG, Brito-Santos F, Amaral ACF, Rodrigues ML, Almeida-Paes R. A screening of the MMV Pathogen Box® reveals new potential antifungal drugs against the etiologic agents of chromoblastomycosis. PLoS One 2020; 15:e0229630. [PMID: 32401759 PMCID: PMC7219733 DOI: 10.1371/journal.pone.0229630] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/27/2020] [Indexed: 12/17/2022] Open
Abstract
Chromoblastomycosis (CBM) is a chronic subcutaneous mycosis caused by traumatic implantation of many species of black fungi. Due to the refractoriness of some cases and common recurrence of CBM, a more effective and less time-consuming treatment is mandatory. The aim of this study was to identify compounds with in vitro antifungal activity in the Pathogen Box® compound collection against different CBM agents. Synergism of these compounds with drugs currently used to treat CBM was also assessed. An initial screening of the drugs present in this collection at 1 μM was performed with a Fonsecaea pedrosoi clinical strain according to the EUCAST protocol. The compounds with activity against this fungus were also tested against other seven etiologic agents of CBM (Cladophialophora carrionii, Phialophora verrucosa, Exophiala jeanselmei, Exophiala dermatitidis, Fonsecaea monophora, Fonsecaea nubica, and Rhinocladiella similis) at concentrations ranging from 0.039 to 10 μM. The analysis of potential synergism of these compounds with itraconazole and terbinafine was performed by the checkerboard method. Eight compounds inhibited more than 60% of the F. pedrosoi growth: difenoconazole, bitertanol, iodoquinol, azoxystrobin, MMV688179, MMV021013, trifloxystrobin, and auranofin. Iodoquinol produced the lowest MIC values (1.25-2.5 μM) and MMV688179 showed MICs that were higher than all compounds tested (5 - >10 μM). When auranofin and itraconazole were tested in combination, a synergistic interaction (FICI = 0.37) was observed against the C. carrionii isolate. Toxicity analysis revealed that MMV021013 showed high selectivity indices (SI ≥ 10) against the fungi tested. In summary, auranofin, iodoquinol, and MMV021013 were identified as promising compounds to be tested in CBM models of infection.
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Affiliation(s)
- Rowena Alves Coelho
- Mycology Laboratory at the Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Luna Sobrino Joffe
- Department of Microbiology and Immunology, Stony Brook University, New York, NY, United States of America
| | - Gabriela Machado Alves
- Mycology Laboratory at the Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | | | - Fábio Brito-Santos
- Mycology Laboratory at the Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | | | - Marcio L. Rodrigues
- Carlos Chagas Institute, Fiocruz, Paraná, Brazil
- Microbiology Institute, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Rodrigo Almeida-Paes
- Mycology Laboratory at the Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
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Sendrasoa FA, Rakotoarisaona MF, Ranaivo IM, Razanakoto NH, Sata M, Raharolahy O, Andrianarison M, Ratovonjanahary V, Rasamoelina T, Rapelanoro Rabenja F, Ramarozatovo LS. [Management of chromoblastomycosis, a challenge for limited-resource countries such as Madagascar]. Ann Dermatol Venereol 2020; 147:377-382. [PMID: 32220474 DOI: 10.1016/j.annder.2020.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/18/2019] [Accepted: 01/16/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Chromoblastomycosis (CBM) is a chronic fungal infection of the skin and subcutaneous tissue caused by dematiaceous fungi. CBM lesions are recalcitrant and extremely difficult to eradicate. We report three cases of CBM with difficulties in therapeutic management. OBSERVATION Three men aged 36, 50 and 67 years, all farmers, presented for between three and ten years with hyperkeratotic, scaly plaques with black dots on the right thigh and left leg, respectively. For all patients, mycological examination showed fumagoid cells, all of which were pathognomonic for CBM. PCR identified Fonsecaeanubica in one patient and Cladophialophoracarrionii in two patients. All patients received itraconazole 200mg/day for over 18 months. Two patients required combined therapy with terbinafine for seven months, which improved lesions; however, relapse occurred in one patient during the 5th month of this combined therapy and five months after the end of this treatment in the other. The patient on monotherapy (itraconazole) also presented recurrence of lesions five months after the end of treatment. DISCUSSION Itraconazole is the standard therapy for CBM, with cure rates ranging from 15 to 80%. Success with itraconazole after eight to twelve months was reported by several authors. Fonsecaea and Cladophialophora are the most common species found in Madagascar, and while these organisms are susceptible to triazoles in vitro, clinical response is not so clear-cut. CONCLUSION Although unavailable in Madagascar, posaconazole and isavoconazole appear to be effective in treating chromoblastomycosis.
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Affiliation(s)
- F-A Sendrasoa
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar.
| | - M-F Rakotoarisaona
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - I-M Ranaivo
- USFR dermatologie, hôpital universitaire Morafeno Toamasina, Toamasina, Madagascar
| | - N-H Razanakoto
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - M Sata
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - O Raharolahy
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - M Andrianarison
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - V Ratovonjanahary
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - T Rasamoelina
- Centre d'infectiologie Charles Mérieux, Antananarivo, Madagascar
| | - F Rapelanoro Rabenja
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - L-S Ramarozatovo
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
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An optimized Agrobacterium tumefaciens-mediated transformation system for random insertional mutagenesis in Fonsecaea monophora. J Microbiol Methods 2020; 170:105838. [DOI: 10.1016/j.mimet.2020.105838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 01/01/2023]
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Marques SG, Bomfim MRQ, Azevedo CDMPS, Martins CVB, Marques ACG, Gonçalves AG, Vicente VA, Dos Santos AM, Costa MC, Freitas GJC, Santos DA, de Resende-Stoianoff MA. Mixed secondary bacterial infection is associated with severe lesions of chromoblastomycosis in a neglected population from Brazil. Diagn Microbiol Infect Dis 2019; 95:201-207. [PMID: 31262546 DOI: 10.1016/j.diagmicrobio.2019.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/16/2019] [Accepted: 05/27/2019] [Indexed: 11/16/2022]
Abstract
Chromoblastomycosis (CBM) is a chronic subcutaneous infection caused by melanotic fungi, affecting mainly rural workers in tropical and subtropical regions. Secondary bacterial infections (SBIs) in CBM lesions bring complications to the disease, but little is known about the agents involved. Fungal and bacterial identification and epidemiological profile of 50 patients with CBM were analyzed in this study. Bacteria were tested for susceptibility to antibacterial drugs. Fonseacea pedrosoi and Rhinocladiella aquaspersa were the fungal agents isolated. 88% of the patients presented SBI. Gram-positive bacteria coinfected mainly upper limbs, and Gram-negative bacteria were more isolated from lower limbs. Streptococcus pyogenes and mixed bacterial microbiota were associated with severe lesions. Staphylococcus aureus was associated with mixed infections and consequently with the severity of the infection. Resistance to β-lactams and methicillin was detected. Our results emphasize the necessity of bacterial culture and susceptibility testing as part of routine monitoring CBM cases.
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Affiliation(s)
- Sirlei G Marques
- Hospital Universitário da Universidade Federal do Maranhão, São Luiz, MA, Brazil; Laboratório Cedro, São Luiz, MA, Brazil; Universidade Federal de Minas Gerais, Departamento de Microbiologia, Belo Horizonte, MG, Brazil
| | | | - Conceição de Maria P S Azevedo
- Universidade Federal de Minas Gerais, Departamento de Microbiologia, Belo Horizonte, MG, Brazil; Universidade Federal do Maranhão, São Luis, MA, Brazil
| | | | | | | | | | | | - Marliete C Costa
- Universidade Federal de Minas Gerais, Departamento de Microbiologia, Belo Horizonte, MG, Brazil
| | - Gustavo J C Freitas
- Universidade Federal de Minas Gerais, Departamento de Microbiologia, Belo Horizonte, MG, Brazil
| | - Daniel A Santos
- Universidade Federal de Minas Gerais, Departamento de Microbiologia, Belo Horizonte, MG, Brazil.
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Pérez-Laguna V, Gilaberte Y, Millán-Lou MI, Agut M, Nonell S, Rezusta A, Hamblin MR. A combination of photodynamic therapy and antimicrobial compounds to treat skin and mucosal infections: a systematic review. Photochem Photobiol Sci 2019; 18:1020-1029. [PMID: 30821303 PMCID: PMC6520109 DOI: 10.1039/c8pp00534f] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/08/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Antimicrobial photodynamic therapy (aPDT) is a growing approach to treat skin and mucosal infections. Despite its effectiveness, investigators have explored whether aPDT can be further combined with antibiotics and antifungal drugs. OBJECTIVE To systematically assess the in vivo studies on the effectiveness of combinations of aPTD plus antimicrobials in the treatment of cutaneous and mucosal infections. MATERIALS AND METHODS Searches were performed in four databases (PubMed, EMBASE, Cochrane library databases, ClinicaTrials.gov) until July 2018. The pooled information was evaluated according to the PRISMA guidelines. RESULTS 11 full-text articles were finally evaluated and included. The best aPDT combinations involved 5-aminolevulinic acid or phenothiazinium dye-based aPDT. In general, the combination shows benefits such as reducing treatment times, lowering drug dosages, decreasing drug toxicity, improving patient compliance and diminishing the risk of developing resistance. The mechanism of action may be that first aPDT damages the microbial cell wall or membrane, which allows better penetration of the antimicrobial drug. LIMITATIONS The number of studies was low, the protocols used were heterogeneous, and there was a lack of clinical trials. CONCLUSIONS The additive or synergistic effect of aPDT combined with antimicrobials could be promising to manage skin and mucosal infections, helping to overcome the microbial drug resistance.
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Shi M, Sun J, Lu S, Qin J, Xi L, Zhang J. Transcriptional profiling of macrophages infected with Fonsecaea monophora. Mycoses 2019; 62:374-383. [PMID: 30656755 DOI: 10.1111/myc.12894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 12/11/2018] [Accepted: 01/10/2019] [Indexed: 01/07/2023]
Abstract
Fonsecaea monophora is a member of dematiaceous fungi capable of causing chromoblastomycosis through traumatic injury. However, little is known about the pathogenesis and early interactions between F. monophora and host. The aim of this study was to explore the potential mechanism of macrophages against F. monophora, especially the role of melanin during the pathogenic process. We carried out RNA sequencing based on the Illumina system. It showed that according to melanin contents, different strains of F. monophora induced different transcriptional profilings in macrophages. Functional analyses suggested the biological functions of differentially expressed genes were closely related to immune response, and the melanin might affect the interactions by regulating the MAPK signalling pathway of macrophages. Our results provide insights into the pathogenesis of infection by F. monophora conidia.
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Affiliation(s)
- Minglan Shi
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiufeng Sun
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Sha Lu
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinglin Qin
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liyan Xi
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junmin Zhang
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Romero-Navarrete M, Ruíz LF, Castillo A, Arenas R, Vega-Memije ME, Xicohtencatl-Cortes J, Espinoza-Rivera M, Hernández-Castro R. An impressive case of chromoblastomycosis due to Fonsecaea pedrosoi in a patient with a long history of fungal infection. J Mycol Med 2018; 28:663-665. [PMID: 30126716 DOI: 10.1016/j.mycmed.2018.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/20/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
Chromoblastomycosis is defined as a chronic cutaneous and subcutaneous fungal infection caused by melanized or brown-pigmented fungi. A 63-year-old man farmer showed on external and internal part of the right arm, a well-delimited verrucous and hyperkeratotic plaque, with atrophic and cicatricial areas. Direct examination of skin scrapings samples showed the presence of muriform cells, a classic feature of chromoblastomycosis. Fungal isolation was performed in Sabouraud dextrose agar, and dark olivaceous colonies were isolated. Skin biopsy samples were obtained for histopathological and molecular diagnosis. DNA extracted from both, paraffin-embedded skin biopsy samples and fungal colonies, was used for molecular identification by 18S-ITS1-5.8S-ITS2-28S rRNA amplification and sequencing. Fonsecaea pedrosoi was identified from paraffin-embedded skin samples and fungal colonies. A combined therapy with terbinafine and itraconazole, plus cryotherapy was applied with an important improvement. Herein, we report an impressive case of chromoblastomycosis due to Fonsecaea pedrosoi with a successful outcome.
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Affiliation(s)
- M Romero-Navarrete
- Hospital General-de-Acapulco, Secretaria de Salud, 39670 Guerrero, Mexico
| | - L F Ruíz
- Servicio de Dermatopatología, Hospital General "Dr. Manuel Gea González", 14080 Tlalpan, Mexico
| | - A Castillo
- Hospital General-de-Acapulco, Secretaria de Salud, 39670 Guerrero, Mexico
| | - R Arenas
- Servicio de Micología, Hospital General Dr. Manuel Gea González, 14080 Tlalpan, Mexico
| | - M E Vega-Memije
- Servicio de Dermatopatología, Hospital General "Dr. Manuel Gea González", 14080 Tlalpan, Mexico
| | - J Xicohtencatl-Cortes
- Laboratorio de Bacteriología Intestinal, Hospital Infantil de México Dr. Federico Gómez, 06720 Cuauhtémoc, Mexico
| | - M Espinoza-Rivera
- Departamento de Ecología de Agentes Patógenos, Hospital General Dr. Manuel Gea González, 14080 Tlalpan, Mexico
| | - R Hernández-Castro
- Departamento de Ecología de Agentes Patógenos, Hospital General Dr. Manuel Gea González, 14080 Tlalpan, Mexico.
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Combination of Amphotericin B and Terbinafine against Melanized Fungi Associated with Chromoblastomycosis. Antimicrob Agents Chemother 2018; 62:AAC.00270-18. [PMID: 29581111 DOI: 10.1128/aac.00270-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/15/2018] [Indexed: 11/20/2022] Open
Abstract
Our in vitro studies showed that a combination of amphotericin B and terbinafine had synergistic effects against the majority of melanized fungi associated with chromoblastomycosis (CBM) and similar infections, including those with Cladophialophora carrionii, Cladophialophora arxii, Exophialadermatitidis, Exophialaspinifera, Fonsecaea monophora, Fonsecaea nubica, Fonsecaea pedrosoi, and Phialophora verrucosa. This drug combination could provide an option for the treatment of severe or unresponsive cases of CBM, particularly in cases due to species of Fonsecaea and Cladophialophora.
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Abstract
Fungi must meet four criteria to infect humans: growth at human body temperatures, circumvention or penetration of surface barriers, lysis and absorption of tissue, and resistance to immune defenses, including elevated body temperatures. Morphogenesis between small round, detachable cells and long, connected cells is the mechanism by which fungi solve problems of locomotion around or through host barriers. Secretion of lytic enzymes, and uptake systems for the released nutrients, are necessary if a fungus is to nutritionally utilize human tissue. Last, the potent human immune system evolved in the interaction with potential fungal pathogens, so few fungi meet all four conditions for a healthy human host. Paradoxically, the advances of modern medicine have made millions of people newly susceptible to fungal infections by disrupting immune defenses. This article explores how different members of four fungal phyla use different strategies to fulfill the four criteria to infect humans: the Entomophthorales, the Mucorales, the Ascomycota, and the Basidiomycota. Unique traits confer human pathogenic potential on various important members of these phyla: pathogenic Onygenales comprising thermal dimorphs such as Histoplasma and Coccidioides; the Cryptococcus spp. that infect immunocompromised as well as healthy humans; and important pathogens of immunocompromised patients-Candida, Pneumocystis, and Aspergillus spp. Also discussed are agents of neglected tropical diseases important in global health such as mycetoma and paracoccidiomycosis and common pathogens rarely implicated in serious illness such as dermatophytes. Commensalism is considered, as well as parasitism, in shaping genomes and physiological systems of hosts and fungi during evolution.
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de Castro RJA, Siqueira IM, Jerônimo MS, Basso AMM, Veloso Junior PHDH, Magalhães KG, Leonhardt LC, de Oliveira SAM, Bürgel PH, Tavares AH, Bocca AL. The Major Chromoblastomycosis Etiologic Agent Fonsecaea pedrosoi Activates the NLRP3 Inflammasome. Front Immunol 2017; 8:1572. [PMID: 29209318 PMCID: PMC5702042 DOI: 10.3389/fimmu.2017.01572] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/01/2017] [Indexed: 12/20/2022] Open
Abstract
Fonsecaea pedrosoi is the main etiologic agent of chromoblastomycosis (CBM), one of the most prevalent subcutaneous mycosis in tropical and subtropical countries. CBM is a poorly characterized chronic infection that commonly starts after transcutaneous inoculation of conidia and saprophytic hyphae of F. pedrosoi. Recently, we have shown that unlike conidia, hyphae and muriform cells (the parasitic morphotype) of F. pedrosoi promotes an intense inflammatory response pattern in vivo, which comprises the production of an inflammasome-derived cytokine, IL-1β. Nonetheless, the mechanisms underlying IL-1β production and maturation upon F. pedrosoi infection and its functional output in the course of CBM remains unknown. We show here that F. pedrosoi hyphae, differently from conidia, induce IL-1β secretion in both bone marrow-derived dendritic cells and macrophages. Using inhibitors and knockout cells, we demonstrated that the mechanisms underlying IL-1β production by hyphae-infected macrophages were dependent on dectin-1, -2, and -3 receptors and the Syk-NF-kB signaling pathway. Furthermore, F. pedrosoi promoted a NLRP3-dependent inflammasome activation, which required potassium efflux, reactive oxygen species production, phagolysosomal acidification, and cathepsin B release as triggers. IL-1β processing and release was mediated primarily by caspase-1 and, to a lesser extent, by caspase-8-dependent cleavage. Finally, we showed using a murine CBM model that F. pedrosoi elicits a NLRP3-regulated IL-1β and interleukin-18 release in vivo, but without NLRP3 inflammasome activation interfering in the course of the experimental infection.
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Affiliation(s)
- Raffael Júnio Araújo de Castro
- Laboratory of Applied Immunology, Department of Cellular Biology, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - Isaque Medeiros Siqueira
- Laboratory of Applied Immunology, Department of Cellular Biology, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - Márcio Sousa Jerônimo
- Laboratory of Applied Immunology, Department of Cellular Biology, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - Angelina Maria Moreschi Basso
- Laboratory of Applied Immunology, Department of Cellular Biology, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | | | - Kelly Grace Magalhães
- Laboratory of Immunology and Inflammation, Department of Cellular Biology, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - Luiza Chaves Leonhardt
- Laboratory of Applied Immunology, Department of Cellular Biology, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - Stephan Alberto Machado de Oliveira
- Laboratory of Applied Immunology, Department of Cellular Biology, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - Pedro Henrique Bürgel
- Laboratory of Applied Immunology, Department of Cellular Biology, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - Aldo Henrique Tavares
- Laboratory of Applied Immunology, Department of Cellular Biology, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - Anamélia Lorenzetti Bocca
- Laboratory of Applied Immunology, Department of Cellular Biology, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
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Photodynamic effects on Fonsecaea monophora conidia and RAW264.7 in vitro. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2017; 176:112-117. [DOI: 10.1016/j.jphotobiol.2017.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 08/28/2017] [Accepted: 09/01/2017] [Indexed: 01/10/2023]
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Vicente VA, Weiss VA, Bombassaro A, Moreno LF, Costa FF, Raittz RT, Leão AC, Gomes RR, Bocca AL, Fornari G, de Castro RJA, Sun J, Faoro H, Tadra-Sfeir MZ, Baura V, Balsanelli E, Almeida SR, Dos Santos SS, Teixeira MDM, Soares Felipe MS, do Nascimento MMF, Pedrosa FO, Steffens MB, Attili-Angelis D, Najafzadeh MJ, Queiroz-Telles F, Souza EM, De Hoog S. Comparative Genomics of Sibling Species of Fonsecaea Associated with Human Chromoblastomycosis. Front Microbiol 2017; 8:1924. [PMID: 29062304 PMCID: PMC5640708 DOI: 10.3389/fmicb.2017.01924] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/21/2017] [Indexed: 01/16/2023] Open
Abstract
Fonsecaea and Cladophialophora are genera of black yeast-like fungi harboring agents of a mutilating implantation disease in humans, along with strictly environmental species. The current hypothesis suggests that those species reside in somewhat adverse microhabitats, and pathogenic siblings share virulence factors enabling survival in mammal tissue after coincidental inoculation driven by pathogenic adaptation. A comparative genomic analysis of environmental and pathogenic siblings of Fonsecaea and Cladophialophora was undertaken, including de novo assembly of F. erecta from plant material. The genome size of Fonsecaea species varied between 33.39 and 35.23 Mb, and the core genomes of those species comprises almost 70% of the genes. Expansions of protein domains such as glyoxalases and peptidases suggested ability for pathogenicity in clinical agents, while the use of nitrogen and degradation of phenolic compounds was enriched in environmental species. The similarity of carbohydrate-active vs. protein-degrading enzymes associated with the occurrence of virulence factors suggested a general tolerance to extreme conditions, which might explain the opportunistic tendency of Fonsecaea sibling species. Virulence was tested in the Galleria mellonella model and immunological assays were performed in order to support this hypothesis. Larvae infected by environmental F. erecta had a lower survival. Fungal macrophage murine co-culture showed that F. erecta induced high levels of TNF-α contributing to macrophage activation that could increase the ability to control intracellular fungal growth although hyphal death were not observed, suggesting a higher level of extremotolerance of environmental species.
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Affiliation(s)
- Vania A Vicente
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil.,Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba, Brazil
| | - Vinícius A Weiss
- Laboratory of Bioinformatics, Sector of Technological and Professional Education, Federal University of Paraná, Curitiba, Brazil.,Department of Biochemistry, Federal University of Paraná, Curitiba, Brazil
| | - Amanda Bombassaro
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Leandro F Moreno
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil.,CBS-KNAW Fungal Biodiversity Centre, Utrecht, Netherlands.,Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, Netherlands
| | - Flávia F Costa
- Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba, Brazil
| | - Roberto T Raittz
- Laboratory of Bioinformatics, Sector of Technological and Professional Education, Federal University of Paraná, Curitiba, Brazil
| | - Aniele C Leão
- Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba, Brazil.,Laboratory of Bioinformatics, Sector of Technological and Professional Education, Federal University of Paraná, Curitiba, Brazil.,Department of Biochemistry, Federal University of Paraná, Curitiba, Brazil
| | - Renata R Gomes
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Anamelia L Bocca
- Department of Cell Biology, University of Brasília, Brasilia, Brazil
| | - Gheniffer Fornari
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | | | - Jiufeng Sun
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Helisson Faoro
- Department of Biochemistry, Federal University of Paraná, Curitiba, Brazil
| | | | - Valter Baura
- Department of Biochemistry, Federal University of Paraná, Curitiba, Brazil
| | - Eduardo Balsanelli
- Department of Biochemistry, Federal University of Paraná, Curitiba, Brazil
| | - Sandro R Almeida
- Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, University of São Paulo, Sao Paulo, Brazil
| | - Suelen S Dos Santos
- Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, University of São Paulo, Sao Paulo, Brazil
| | - Marcus de Melo Teixeira
- Department of Cell Biology, University of Brasília, Brasilia, Brazil.,Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| | - Maria S Soares Felipe
- Department of Genomic Sciences and Biotechnology, Catholic University of Brasília, Brasilia, Brazil
| | | | - Fabio O Pedrosa
- Department of Biochemistry, Federal University of Paraná, Curitiba, Brazil
| | - Maria B Steffens
- Laboratory of Bioinformatics, Sector of Technological and Professional Education, Federal University of Paraná, Curitiba, Brazil.,Department of Biochemistry, Federal University of Paraná, Curitiba, Brazil
| | | | - Mohammad J Najafzadeh
- Department of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Flávio Queiroz-Telles
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil.,Clinical Hospital of the Federal University of Paraná, Curitiba, Brazil
| | - Emanuel M Souza
- Laboratory of Bioinformatics, Sector of Technological and Professional Education, Federal University of Paraná, Curitiba, Brazil.,Department of Biochemistry, Federal University of Paraná, Curitiba, Brazil
| | - Sybren De Hoog
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil.,CBS-KNAW Fungal Biodiversity Centre, Utrecht, Netherlands.,Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, Netherlands
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30
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Purim KSM, Peretti MC, Fillus J, Olandoski M. Chromoblastomycosis: tissue modifications during itraconazole treatment. An Bras Dermatol 2017; 92:478-483. [PMID: 28954095 PMCID: PMC5595593 DOI: 10.1590/abd1806-4841.20175466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/28/2016] [Indexed: 11/24/2022] Open
Abstract
Background Histological and mycological changes during itraconazole use have not been
totally established in chromoblastomycosis. Objectives To evaluate tissue modifications in chromoblastomycosis carriers under
itraconazole treatment. Methods A histological retrospective study of 20 cases of chromoblastomycosis seen at
the university hospital at the south of Brazil, during itraconazole 400 mg
daily treatment. Patients were classified into two groups: plaque or tumor
lesions, and underwent periodic evaluations every four months during three
years. Hematoxylin-eosin stain was used to analyze epidermal modifications,
inflammatory infiltrate and fibrosis, and Fontana-Masson stain for parasite
evaluation. Results Fontana-Masson stain was superior to hematoxylin-eosin stain in fungal count
in the epidermis (mean difference=0.14; p<0.05). The most distinct
mycosis tissue responses were registered in the dermis. Epidermal thinning,
granulomatous infiltrate decrease or disappearance, fibrosis increase and
quantitative/morphological changes occurred during treatment. Study limitations Patients could not be located to have their current skin condition
examined. Conclusion Parasitic and tissue changes verified in this study can reflect the
parasite-host dynamics under itraconazole action.
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Affiliation(s)
- Kátia Sheylla Malta Purim
- Discipline of Dermatology of the Medical School - Universidade Positivo (UP) - Curitiba (PR), Brazil
| | - Murilo Calvo Peretti
- Dermatology Service of theHospital das Clínicas - Universidade Federal do Paraná (HC-UFPR) - Curitiba (PR), Brazil
| | - José Fillus
- Dermatology Service of the Hospital Evangélico de Curitiba - Universidade Evangélica do Paraná - Curitiba (PR), Brazil
| | - Marcia Olandoski
- Discipline of Biostatistics of the Medical School - Pontifícia Universidade Católica do Paraná (PUC-PR) - Curitiba (PR), Brazil
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Abstract
Chromoblastomycosis (CBM) is a chronic, progressive, cutaneous and subcutaneous fungal infection following the traumatic implantation of certain dematiaceous fungi. The disease has worldwide prevalence with predominant cases reported from humid tropical and subtropical regions of America, Asia, and Africa. Diagnosis is often delayed or misdirected either due to poor degree of clinical suspicions or clinical simulation of dermatological conditions. The infection is not uncommon in India and several case reports from the sub-Himalayan belt and western and eastern coasts of India have been published; however, very few have reviewed the cases. We reviewed 169 cases published in English literature from India during 1957 through May 2016, including 2 recent cases from our institute. A tremendous increase in the number of reported cases was noticed since 2012, since which, more than 50% of the cases had been published. A majority of the patients (74.1%) were involved in various agricultural activities directly or indirectly. The mean age at presentation was 43.3 years ± 16.0, with male to female ratio of 4.2:1. The duration of disease at the time of presentation varied from 20 days to 35 years. Any history of trauma was recalled only in 33.8% of the studied cases. The lower extremity was the most common site afflicted, followed by the upper extremity. The culture was positive in 80.3% of the cases with Fonsecaea pedrosoi, isolated as the most common fungal pathogen, followed by Cladophialophora carrionii. Although all the commercially available antifungals were prescribed in these cases, itraconazole and terbinafine were the most commonly used, either alone or in combination with other drugs/physical methods, with variable degrees of outcome. Combinations of different treatment modalities (chemotherapy and physical methods) yielded a cure rate of 86.3%. CBM is refractory to treatment and no single antifungal agent or regimen has demonstrated satisfactory results. Increased awareness with early clinical suspicion of the disease and adequate therapy are necessary to improve the outcome. However, depending upon the causative agent, disease severity, and the choice of antifungals, variable outcomes can be observed.
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Ramírez Soto MC, Malaga G. Subcutaneous mycoses in Peru: a systematic review and meta-analysis for the burden of disease. Int J Dermatol 2017; 56:1037-1045. [PMID: 28670680 DOI: 10.1111/ijd.13665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 03/10/2017] [Accepted: 05/03/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a worrying lack of epidemiological data on the geographical distribution and burden of subcutaneous mycoses in Peru, hindering the implementation of surveillance and control programs. OBJECTIVES This study aimed to estimate the disease burden of subcutaneous mycoses in Peru and identify which fungal species were commonly associated with these mycoses. METHODS We performed a meta-analysis after a systematic review of the published literature in PubMed, LILACS, and SciELO to estimate the burden of subcutaneous mycoses in 25 regions in Peru. The disease burden was determined in terms of prevalence (number of cases per 100,000 inhabitants) and the number of reported cases per year per region. RESULTS A total of 26 studies were eligible for inclusion. Results showed that sporotrichosis was the most common subcutaneous mycosis (99.7%), whereas lobomycosis, chromoblastomycosis, and subcutaneous phaeohyphomycosis were rare. Cases of eumycetoma and subcutaneous zygomycosis were not found. Of the 25 regions, the burden of sporotrichosis was estimated for four regions classified as endemic; in nine regions, only isolated cases were reported. The highest burden of sporotrichosis was in Apurimac (15 cases/100,000 inhabitants; 57 cases/year), followed by Cajamarca (3/100,000 inhabitants; 30/year), Cusco (0.5/100,000 inhabitants; 4/year), and La Libertad (0.2/100,000 inhabitants; 2/year). In two regions, the mycoses predominantly affected children. CONCLUSIONS Sporotrichosis is the most common subcutaneous mycosis in Peru, with a high disease burden in Apurimac. Chromoblastomycosis, lobomycosis, and subcutaneous phaeohyphomycosis are rare mycoses in Peru.
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Affiliation(s)
| | - German Malaga
- Medicine School, Universidad Peruana Cayetano Heredia, Lima, Peru
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33
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Diversity of opportunistic black fungi on babassu coconut shells, a rich source of esters and hydrocarbons. Fungal Biol 2017; 121:488-500. [DOI: 10.1016/j.funbio.2017.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 11/18/2022]
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Tourret J, Benabdellah N, Drouin S, Charlotte F, Rottembourg J, Arzouk N, Fekkar A, Barrou B. Unique case report of a chromomycosis and Listeria in soft tissue and cerebellar abscesses after kidney transplantation. BMC Infect Dis 2017; 17:288. [PMID: 28427354 PMCID: PMC5397669 DOI: 10.1186/s12879-017-2386-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 04/06/2017] [Indexed: 01/23/2023] Open
Abstract
Background Chromomycosis is a rare mycotic infection encountered in tropical and subtropical regions. The disease presents as a slowly-evolving nodule that can become infected with bacteria. Here, we describe a unique association of abscesses caused by a chromomycosis and Listeria monocytogenes in a kidney transplant recipient, and didactically expose how the appropriate diagnosis was reached. Case presentation A 49-year old male originating from the Caribbean presented a scalp lesion which was surgically removed in his hometown where it was misdiagnosed as a sporotrichosis on histology, 3 years after he received a kidney transplant. He received no additional treatment and the scalp lesion healed. One year later, an abscess of each thigh due to both F. pedrosoi and L. monocytogenes was diagnosed in our institution. A contemporary asymptomatic cerebellar abscess was also found by systematic MRI. An association of amoxicillin and posaconazole allowed a complete cure of the patient without recurring to surgery. Histological slides from the scalp lesion were re-examined in our institution and we retrospectively concluded to a first localisation of the chromomycosis. We discuss the possible pathophysiology of this very unusual association. Conclusion In this case of disseminated listeriosis and chromomycosis, complete cure of the patients could be reached with oral anti-infectious treatment only.
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Affiliation(s)
- J Tourret
- Département d'Urologie, Néphrologie et Transplantation, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix. 47-83, Bd de l'Hôpital, 75013, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, Paris, France. .,Sorbonne Paris Cité, Univ Paris Nord, IAME, INSERM UMR 1137, Paris, France.
| | - N Benabdellah
- Département d'Urologie, Néphrologie et Transplantation, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix. 47-83, Bd de l'Hôpital, 75013, Paris, France
| | - S Drouin
- Département d'Urologie, Néphrologie et Transplantation, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix. 47-83, Bd de l'Hôpital, 75013, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - F Charlotte
- Service d'Anatomie Cytologie Pathologique, Paris, France
| | - J Rottembourg
- Département d'Urologie, Néphrologie et Transplantation, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix. 47-83, Bd de l'Hôpital, 75013, Paris, France
| | - N Arzouk
- Département d'Urologie, Néphrologie et Transplantation, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix. 47-83, Bd de l'Hôpital, 75013, Paris, France
| | - A Fekkar
- Service de Parasitologie Mycologie, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Paris, France.,INSERM U1135, CNRS ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - B Barrou
- Département d'Urologie, Néphrologie et Transplantation, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix. 47-83, Bd de l'Hôpital, 75013, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Paris, France
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Diallo A, Michaud C, Tabibou S, Raz M, Fernandez C, Lepidi H, Fournier PE, Stein A, Ranque S, Seng P. Arthrocladium fulminans Arthritis and Osteomyelitis. Am J Trop Med Hyg 2017; 96:698-700. [PMID: 28070004 DOI: 10.4269/ajtmh.16-0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Arthrocladium fulminans is the only species in the Arthrocladium genus that has been involved in a previous human infection. To date, only one case of A. fulminans infection in a patient with GATA-2 immunodeficiency has been reported. We here report the second human case and the first case of septic arthritis and osteomyelitis due to A. fulminans in an immunocompetent patient, living in Mayotte, a French island in western Indian Ocean. He was successfully treated with surgical debridement and 6 months of antifungal treatment. This second observation of human invasive disease caused by A. fulminans is an additional argument for the pathogenicity of this rare species.
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Affiliation(s)
- Abdoulahy Diallo
- Service de Médecine Polyvalente, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte
| | - Céline Michaud
- Service de Médecine Polyvalente, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte
| | - Souandou Tabibou
- Service de Médecine Polyvalente, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte
| | - Maxime Raz
- Laboratoire de Biologie Médicale, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte
| | - Carla Fernandez
- Service d'Anatomie Pathologique, CHU Félix-Guyon, Saint-Denis, Réunion
| | - Hubert Lepidi
- Aix Marseille Université, INSERM 1095, CNRS 7278, IRD 198, URMITE, Marseille, France
| | | | - Andreas Stein
- Centre de Référence des Infections Ostéo-Articulaires (CRIOA) Interrégional Sud-Méditerranée, Hôpital de la Conception, Marseille, France.,Assistance Publique-Hôpitaux de Marseille (APHM), Service de Maladies Infectieuses, Centre Hospitalier Universitaire de la Conception, Marseille, France.,Aix Marseille Université, INSERM 1095, CNRS 7278, IRD 198, URMITE, Marseille, France
| | - Stéphane Ranque
- Parasitologie and Mycologie, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,IP-TPT UMR MD3, Aix Marseille Université, Marseille, France
| | - Piseth Seng
- Centre de Référence des Infections Ostéo-Articulaires (CRIOA) Interrégional Sud-Méditerranée, Hôpital de la Conception, Marseille, France.,Assistance Publique-Hôpitaux de Marseille (APHM), Service de Maladies Infectieuses, Centre Hospitalier Universitaire de la Conception, Marseille, France.,Aix Marseille Université, INSERM 1095, CNRS 7278, IRD 198, URMITE, Marseille, France
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36
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Siqueira IM, de Castro RJA, Leonhardt LCDM, Jerônimo MS, Soares AC, Raiol T, Nishibe C, Almeida N, Tavares AH, Hoffmann C, Bocca AL. Modulation of the immune response by Fonsecaea pedrosoi morphotypes in the course of experimental chromoblastomycosis and their role on inflammatory response chronicity. PLoS Negl Trop Dis 2017; 11:e0005461. [PMID: 28355277 PMCID: PMC5391973 DOI: 10.1371/journal.pntd.0005461] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 04/14/2017] [Accepted: 03/06/2017] [Indexed: 02/03/2023] Open
Abstract
A common theme across multiple fungal pathogens is their ability to impair the establishment of a protective immune response. Although early inflammation is beneficial in containing the infection, an uncontrolled inflammatory response is detrimental and may eventually oppose disease eradication. Chromoblastomycosis (CBM), a cutaneous and subcutaneous mycosis, caused by dematiaceous fungi, is capable of inducing a chronic inflammatory response. Muriform cells, the parasitic form of Fonsecaea pedrosoi, are highly prevalent in infected tissues, especially in long-standing lesions. In this study we show that hyphae and muriform cells are able to establish a murine CBM with skin lesions and histopathological aspects similar to that found in humans, with muriform cells being the most persistent fungal form, whereas mice infected with conidia do not reach the chronic phase of the disease. Moreover, in injured tissue the presence of hyphae and especially muriform cells, but not conidia, is correlated with intense production of pro-inflammatory cytokines in vivo. High-throughput RNA sequencing analysis (RNA-Seq) performed at early time points showed a strong up-regulation of genes related to fungal recognition, cell migration, inflammation, apoptosis and phagocytosis in macrophages exposed in vitro to muriform cells, but not conidia. We also demonstrate that only muriform cells required FcγR and Dectin-1 recognition to be internalized in vitro, and this is the main fungal form responsible for the intense inflammatory pattern observed in CBM, clarifying the chronic inflammatory reaction observed in most patients. Furthermore, our findings reveal two different fungal-host interaction strategies according to fungal morphotype, highlighting fungal dimorphism as an important key in understanding the bipolar nature of inflammatory response in fungal infections.
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Affiliation(s)
- Isaque Medeiros Siqueira
- Molecular Pathology Post-Graduate Program, School of Medicine; University of Brasília, Brasília, Brazil
| | | | | | - Márcio Sousa Jerônimo
- Department of Cell Biology, Institute of Biological Sciences; University of Brasília, Brasília, Brazil
| | | | - Tainá Raiol
- Institute Leônidas and Maria Deane, Oswaldo Cruz Foundation, Manaus, Brazil
| | - Christiane Nishibe
- School of Computing Sciences, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Nalvo Almeida
- School of Computing Sciences, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Aldo Henrique Tavares
- Department of Cell Biology, Institute of Biological Sciences; University of Brasília, Brasília, Brazil
| | - Christian Hoffmann
- Department of Cell Biology, Institute of Biological Sciences; University of Brasília, Brasília, Brazil
- Department of Food Sciences and Experimental Nutrition, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Anamelia Lorenzetti Bocca
- Department of Cell Biology, Institute of Biological Sciences; University of Brasília, Brasília, Brazil
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37
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Gomes RR, Vicente VA, de Azevedo CMPS, Salgado CG, da Silva MB, Queiroz-Telles F, Marques SG, Santos DWCL, de Andrade TS, Takagi EH, Cruz KS, Fornari G, Hahn RC, Scroferneker ML, Caligine RB, Ramirez-Castrillon M, de Araújo DP, Heidrich D, Colombo AL, de Hoog GS. Molecular Epidemiology of Agents of Human Chromoblastomycosis in Brazil with the Description of Two Novel Species. PLoS Negl Trop Dis 2016; 10:e0005102. [PMID: 27893750 PMCID: PMC5125572 DOI: 10.1371/journal.pntd.0005102] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 10/11/2016] [Indexed: 12/13/2022] Open
Abstract
The human mutilating disease chromoblastomycosis is caused by melanized members of the order Chaetothyriales. To assess population diversity among 123 clinical strains of agents of the disease in Brazil we applied sequencing of the rDNA internal transcribed spacer region, and partial cell division cycle and β-tubulin genes. Strains studied were limited to three clusters divided over the single family Herpotrichiellaceae known to comprise agents of the disease. A Fonsecaea cluster contained the most important agents, among which F. pedrosoi was prevalent with 80% of the total set of strains, followed by 13% for F. monophora, 3% for F. nubica, and a single isolate of F. pugnacius. Additional agents, among which two novel species, were located among members of the genus Rhinocladiella and Cyphellophora, with frequencies of 3% and 1%, respectively. Chromoblastomycosis, a skin disease found among rural populations in tropical and subtropical regions, is caused by melanized fungi related to the black yeasts. The present study evaluates the species distribution among 123 clinical strains from endemic areas in Brazil based on multilocus sequence data, and describes two new agents of the disease which proved to be affiliated to Rhinocladiella and Cyphellophora.
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Affiliation(s)
- Renata R. Gomes
- Microbiology, Parasitology and Pathology Post-graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, PR, Brazil
- Department of Biological Science, State University of Parana/ Campus Paranaguá, Paranaguá, PR, Brazil
| | - Vania A. Vicente
- Microbiology, Parasitology and Pathology Post-graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, PR, Brazil
- * E-mail: (VAV); (GSdH)
| | | | - Claudio G. Salgado
- Dermato-Immunology Laboratory, Institute of Biological Sciences, Federal University of Para. Marituba, PA, Brazil
| | - Moises B. da Silva
- Dermato-Immunology Laboratory, Institute of Biological Sciences, Federal University of Para. Marituba, PA, Brazil
| | - Flávio Queiroz-Telles
- Microbiology, Parasitology and Pathology Post-graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, PR, Brazil
- Clinical Hospital of the Federal University of Paraná, Curitiba, PR, Brazil
| | - Sirlei G. Marques
- University Hospital of Federal University of Maranhão, Sao Luis, MA, Brazil
- Cedro Laboratories Maranhão, Sao Luis, MA, Brazil
| | | | - Tania S. de Andrade
- Department of Culture Collection, Adolfo Lutz Institute, São Paulo, SP, Brazil
| | - Elizabeth H. Takagi
- Department of Culture Collection, Adolfo Lutz Institute, São Paulo, SP, Brazil
| | - Katia S. Cruz
- National Institute of Amazonian Research, Manaus, Brazil
| | - Gheniffer Fornari
- Microbiology, Parasitology and Pathology Post-graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, PR, Brazil
| | - Rosane C. Hahn
- Veterinary Laboratory of Molecular Biology, Faculty of Agronomy and Veterinary Medicine, Federal University of Mato Grosso, Cuiabá, MT, Brazil
| | - Maria L. Scroferneker
- Department of Microbiology, ICBS, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rachel B. Caligine
- Postgraduate Program in Medicine and Biomedicine, Santa Casa de Belo Horizonte Hospital, MG, Brazil
| | - Mauricio Ramirez-Castrillon
- Postgraduate Program in Cellular and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Daniella P. de Araújo
- Dermato-Immunology Laboratory, Institute of Biological Sciences, Federal University of Para. Marituba, PA, Brazil
| | - Daiane Heidrich
- Postgraduate Program in Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Arnaldo L. Colombo
- Division of Infectious Diseases, Federal University of São Paulo, SP, Brazil
| | - G. S. de Hoog
- Microbiology, Parasitology and Pathology Post-graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, PR, Brazil
- Centraalbureau voor Schimmelcultures KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- * E-mail: (VAV); (GSdH)
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38
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Chen Y, Yin S, Li M, Chen R, Wei L, Ma H, Deng S, de Hoog GS, Lai W, Lu C, Feng P. A case of chromoblastomycosis byFonsecaea nubicaindicating a possible insect route of transmission. Mycoses 2016; 59:662-7. [PMID: 27330038 DOI: 10.1111/myc.12523] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/18/2016] [Accepted: 05/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Yingdan Chen
- Department of Dermatology; Third Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Songchao Yin
- Department of Dermatology; Third Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Meirong Li
- Department of Dermatology; Third Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Rongzhang Chen
- Department of Dermatology; Third Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Ling Wei
- Department of Dermatology; Third Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Han Ma
- Department of Dermatology; Third Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Shuwen Deng
- Shanghai Institute of Medical Mycology; Changzheng Hospital; Second Military Medical University; Shanghai China
| | - Gert Sybren de Hoog
- Shanghai Institute of Medical Mycology; Changzheng Hospital; Second Military Medical University; Shanghai China
- CBS-KNAW Fungal Biodiversity Centre; Utrecht The Netherlands
- Institute for Biodiversity and Ecosystem Dynamics; University of Amsterdam; Amsterdam The Netherlands
- Research Center for Medical Mycology; Peking University Health Science Center; Beijing China
| | - Wei Lai
- Department of Dermatology; Third Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Chun Lu
- Department of Dermatology; Third Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Peiying Feng
- Department of Dermatology; Third Affiliated Hospital; Sun Yat-sen University; Guangzhou China
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