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Llinas J, Rozmanec M, Hyndman TH. Diagnosis and management of Cryptococcus neoformans var. grubii detected in an oral mass in a pink-tongued skink (Cyclodomorphus gerarrdii). Aust Vet J 2024; 102:416-422. [PMID: 38653559 DOI: 10.1111/avj.13337] [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: 12/06/2023] [Revised: 03/01/2024] [Accepted: 04/01/2024] [Indexed: 04/25/2024]
Abstract
Cryptococcus is an encapsulated yeast that is found in both yeast and hyphal forms. Cryptococcus neoformans and C. gattii are the most medically important species, causing disease in both immunocompromised and immunocompetent individuals. A large, friable, sublingual mass was surgically resected from the oral cavity of a pink-tongued skink (Cyclodomorphus gerarrdii). Histopathology, fungal culture and PCR testing with Sanger sequencing confirmed granulomatous inflammation containing large numbers of yeasts identified as Cryptococcus neoformans var. grubii. Surgical excision and treatment with oral amphotericin B and terbinafine was unsuccessful in managing the infection. On Day 67 after surgery, Cryptococcus DNA was detected by PCR in the blood but not oral, cloacal or skin swabs. The skink was euthanised 72 days after surgery due to anorexia, weight loss and progressive neurological signs of disease. Necropsy results showed disseminated cryptococcosis, including meningoencephalitis and ventriculitis. Two in-contact pink-tongued skinks remained asymptomatic and PCR-negative during 198 days of observation. This case suggests Cryptococcus infections should be considered for oral masses presenting with or without neurological signs in skinks. Further investigation is required to determine the best treatment options for disseminated cryptococcosis in reptiles. This report describes the third reported case of Cryptococcus in a reptile and the first case of cryptococcosis in a pink-tongued skink. It is also the first report of Cryptococcus in a reptile identified to the variety level using PCR, including in whole blood samples.
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Affiliation(s)
- J Llinas
- The Unusual Pet Vets Jindalee, Jindalee, Queensland, Australia
| | - M Rozmanec
- QML Vetnostics, SVS Pathology Network, Murarrie, Queensland, Australia
| | - T H Hyndman
- School of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, Australia
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Zheng M, Zhou X, Pang J, Yang Z, Zou Y, Zhang L, Xu Y, Yin R. New methylene blue-mediated photodynamic inactivation of multidrug-resistant Fonsecaea nubica infected chromoblastomycosis in vitro. Braz J Microbiol 2023; 54:873-883. [PMID: 37145297 PMCID: PMC10234991 DOI: 10.1007/s42770-023-00974-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/10/2023] [Indexed: 05/06/2023] Open
Abstract
Chromoblastomycosis is a fungal disease presented with local warty papule, plaque, and verrucous nodules. In addition, the incidence and drug resistance of chromoblastomycosis are increasing each year worldwide. Photodynamic therapy is a promising method to treat mycoses. The purpose of this study was to evaluate the effect of new methylene blue (NMB)-induced PDT on multidrug-resistant chromoblastomycosis in vitro. We isolated one wild-type strain pathogen from one clinical patient diagnosed with chromoblastomycosis for over 27 years. The pathogen was identified by histopathology, the morphology of fungal culture, and genetic testing. Drug susceptibility testing was performed on the isolate. It was cultured with logarithmic growth phase spore in vitro and incubated with different concentrations of NMB for 30 min, and received illumination by red light-emitted diode with different light doses. After photodynamic treatment, the scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were conducted. The pathogen was Fonsecaea nubica, and it was resistant to itraconazole, terbinafine, amphotericin B, voriconazole andcaspofungin. At the same NMB concentration, the sterilization efficiency of NMB-photodynamic therapy (PDT) on F. nubica increased with increasing light intensity; F. nubica was completely killed at 25 µmol/L NMB with a light dose of 40 J/cm2 or 50 µmol/L NMB and light doses of ≥ 30 J/cm2. SEM and TEM observed ultrastructural changes after PDT. NMB-PDT inactivates the survival of multidrug-resistant F. nubica in vitro; it therefore has the potential to become an alternative or adjuvant treatment for refractory chromoblastomycosis.
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Affiliation(s)
- Mengxue Zheng
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Xiaoqing Zhou
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Jiayin Pang
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Zengjun Yang
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yongzhen Zou
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Lian Zhang
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yan Xu
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Rui Yin
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
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Coelho RA, Alves GM, Figueiredo-Carvalho MHG, Almeida-Silva F, de Souza GR, Lourenço MCDS, Brito-Santos F, Amaral ACF, Almeida-Paes R. New possibilities for chromoblastomycosis and phaeohyphomycosis treatment: identification of two compounds from the MMV Pathogen Box® that present synergism with itraconazole. Mem Inst Oswaldo Cruz 2022; 117:e220089. [PMID: 36102413 PMCID: PMC9467274 DOI: 10.1590/0074-02760220089] [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: 04/19/2022] [Accepted: 08/23/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Black fungi of the Herpotrichiellaceae family are agents of chromoblastomycosis and phaeohyphomycosis. There are few therapeutic options for these infections and it is common to associate antifungal drugs in their treatment. OBJECTIVES To investigate the Medicines for Malaria Venture (MMV) Pathogen Box® for possible compounds presenting synergism with antifungal drugs used to treat black fungal infections. METHODS An initial screening of the Pathogen Box® compounds was performed in combination with itraconazole or terbinafine at sub-inhibitory concentrations against Fonsecaea pedrosoi. Hits were further tested against eight Herpotrichiellaceae using the checkerboard method. FINDINGS No synergism was observed with terbinafine. MMV687273 (SQ109) and MMV688415 showed synergism with itraconazole against F. pedrosoi. Synergism of these compounds was confirmed with some black fungi by the checkerboard method. SQ109 and itraconazole presented synergism for Exophiala dermatitidis, F. pedrosoi, F. monophora and F. nubica, with fungicidal activity for F. pedrosoi and F. monophora. MMV688415 presented synergism with itraconazole only for F. pedrosoi, with fungicidal activity. The synergic compounds had high selectivity index values when combined with itraconazole. MAIN CONCLUSIONS These compounds in combination, particularly SQ109, are promising candidates to treat Fonsecaea spp. and E. dermatitidis infections, which account for most cases of chromoblastomycosis and phaeohyphomycosis.
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Affiliation(s)
- Rowena Alves Coelho
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Rio de Janeiro, RJ, Brasil
| | - Gabriela Machado Alves
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Rio de Janeiro, RJ, Brasil
| | | | - Fernando Almeida-Silva
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Rio de Janeiro, RJ, Brasil
| | - Gabriela Rodrigues de Souza
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Plataforma de Bioensaios RPT 11B, Rio de Janeiro, RJ, Brasil
| | - Maria Cristina da Silva Lourenço
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Plataforma de Bioensaios RPT 11B, Rio de Janeiro, RJ, Brasil
| | | | - Ana Claudia Fernandes Amaral
- Fundação Oswaldo Cruz-Fiocruz, Farmanguinhos, Laboratório de Produtos Naturais e Derivados, Rio de Janeiro, RJ, Brasil
| | - Rodrigo Almeida-Paes
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Rio de Janeiro, RJ, Brasil
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Ranawaka RR. Treatment of chromoblastomycosis with a combination of debulking surgery, intralesional amphotericin B, and oral terbinafine. Int J Dermatol 2021; 60:1040-1041. [PMID: 33826140 DOI: 10.1111/ijd.15567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 11/28/2022]
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Granato MQ, Sousa IS, Rosa TLSA, Gonçalves DS, Seabra SH, Alviano DS, Pessolani MCV, Santos ALS, Kneipp LF. Aspartic peptidase of Phialophora verrucosa as target of HIV peptidase inhibitors: blockage of its enzymatic activity and interference with fungal growth and macrophage interaction. J Enzyme Inhib Med Chem 2020; 35:629-638. [PMID: 32037904 PMCID: PMC7034032 DOI: 10.1080/14756366.2020.1724994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Phialophora verrucosa causes several fungal human diseases, mainly chromoblastomycosis, which is extremely difficult to treat. Several studies have shown that human immunodeficiency virus peptidase inhibitors (HIV-PIs) are attractive candidates for antifungal therapies. This work focused on studying the action of HIV-PIs on peptidase activity secreted by P. verrucosa and their effects on fungal proliferation and macrophage interaction. We detected a peptidase activity from P. verrucosa able to cleave albumin, sensitive to pepstatin A and HIV-PIs, especially lopinavir, ritonavir and amprenavir, showing for the first time that this fungus secretes aspartic-type peptidase. Furthermore, lopinavir, ritonavir and nelfinavir reduced the fungal growth, causing remarkable ultrastructural alterations. Lopinavir and ritonavir also affected the conidia-macrophage adhesion and macrophage killing. Interestingly, P. verrucosa had its growth inhibited by ritonavir combined with either itraconazole or ketoconazole. Collectively, our results support the antifungal action of HIV-PIs and their relevance as a possible alternative therapy for fungal infections.
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Affiliation(s)
- Marcela Q. Granato
- Laboratório de Taxonomia, Bioquímica e Bioprospecção de Fungos (LTBBF), Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Ingrid S. Sousa
- Laboratório de Taxonomia, Bioquímica e Bioprospecção de Fungos (LTBBF), Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | | | - Diego S. Gonçalves
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes, Instituto de Microbiologia Paulo de Góes (IMPPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Bioquímica, Instituto de Química, UFRJ, Rio de Janeiro, Brazil
| | - Sergio H. Seabra
- Laboratório de Tecnologia em Cultura de Células, Centro Universitário Estadual da Zona Oeste (UEZO), Rio de Janeiro, Brazil
| | - Daniela S. Alviano
- Laboratório de Estrutura de Microrganismos, IMPPG, UFRJ, Rio de Janeiro, Brazil
| | | | - André L. S. Santos
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes, Instituto de Microbiologia Paulo de Góes (IMPPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Bioquímica, Instituto de Química, UFRJ, Rio de Janeiro, Brazil
| | - Lucimar F. Kneipp
- Laboratório de Taxonomia, Bioquímica e Bioprospecção de Fungos (LTBBF), Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
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Shen XC, Dai XN, Xie ZM, Li P, Lu S, Li JH, Zhang Y, Ye XD. A Case of Chromoblastomycosis Caused by Fonsecaea pedrosoi Successfully Treated by Oral Itraconazole Together with Terbinafine. Dermatol Ther (Heidelb) 2020; 10:321-327. [PMID: 32086748 PMCID: PMC7090106 DOI: 10.1007/s13555-020-00358-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Indexed: 12/03/2022] Open
Abstract
Patients with chromoblastomycosis (CBM) usually have a history of local skin damage related to outdoor activities, mainly manifested as chronic refractory proliferative pathologic changes. We report a case of a 56-year-old man with CBM, identified as Fonsecaea pedrosoi infection by fungal culture and gene sequencing. This patient was successfully treated with a regimen of oral itraconazole (ITZ) and terbinafine lasting 7 months. Through in vitro drug sensitivity tests, minimum inhibitory concentrations of amphotericin, ITZ, and terbinafine were 1 μg/ml, 0.25 μg/ml, and 1 μg/ml, respectively. In this case, terbinafine was found to be more effective than ITZ.
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Affiliation(s)
- Xu-Cheng Shen
- Department of Dermatology, Dermatology Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510182, China
| | - Xiang-Nong Dai
- Department of Dermatology, Dermatology Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510182, China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, 510095, China
| | - Zhi-Min Xie
- Department of Dermatology, Dermatology Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510182, China
| | - Ping Li
- Department of Dermatology, Dermatology Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510182, China
| | - Sha Lu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Jia-Hao Li
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Yi Zhang
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, 510095, China
| | - Xing-Dong Ye
- Department of Dermatology, Dermatology Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510182, China.
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, 510095, China.
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