1
|
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.
Collapse
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
| |
Collapse
|
2
|
Liu S, Zhi H, Shen H, Lv W, Sang B, Li Q, Zhong Y, Liu Z, Xia X. Chromoblastomycosis: A case series from Eastern China. PLoS Negl Trop Dis 2022; 16:e0010800. [PMID: 36155495 PMCID: PMC9536625 DOI: 10.1371/journal.pntd.0010800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/06/2022] [Accepted: 09/07/2022] [Indexed: 11/22/2022] Open
Abstract
Chromoblastomycosis (CBM) is a chronic fungal infection of the cutaneous and subcutaneous tissues caused by brown pigmented fungi. Fonsecaea monophora is one of the most common pathogens of CBM in China. Most formal cases have been reported from Southern China, however, the infection is not uncommon in Eastern China where very few case series are available. To describe the clinical aspects of CBM, we report a series of 11 cases between 2018 and 2021 at a single medical center in Eastern China. The patients were predominately male (n = 9) and the disease duration ranged from 3 months to 20 years. Plaque type lesions were the most common clinical manifestations. There were 7 cases of mild forms and 3 cases of severe forms. Among the 3 severe cases, one case gave up treatment due to economic poverty; one case did not respond to a 1-year systemic treatmen; one case was cured by combination therapy of 10 months. Other cases were cured by treatment with antifungal agents. All cases of direct mycological examination were positive. All isolates were identified by morphology and sequencing of the the ITS regions of ribosomal DNA, Ten were F. monophora and 1 was Cladophialophora carrionii. All cases had been evaluated at other clinics, where 8 cases were misdiagnosed as other diseases. As a neglected tropical disease (NTD), CBM is still a major challenge in the field of dermatology, especially in its severe clinical forms. As an effective and simple diagnostic method of CBM, direct microscopic examination should be further promoted in rural hospitals. Chromoblastomycosis is a neglected fungal disease that mainly affects low-income agricultural workers and rural population. The high misdiagnosis rate of chromoblastomycosis is a major challenge in dermatology, especially for rural hospitals. With the increase in the disease severity, infections may bring significant limitations to labor activities. Severe lesions tend to respond slowly or even become non-responding to antifungal drugs. A direct microscopic examination can find pathogens with typical characteristics; so, this technology must be promoted and mastered through short-term training in rural hospitals. The disease is an implantation mycosis, and therefore, wearing protective clothing and shoes are effective measures to prevent these diseases. The treatment choice and results depend on the patients’ lesion grade. Mild cases respond well to systemic agents, whereas high doses and a long treatment and combination therapy are the first treatment choices for severe forms. This study presents clinical features, mycological findings, pathogens, treatments, and outcomes of CBM from Zhejiang, Eastern China.
Collapse
Affiliation(s)
- Sujun Liu
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huilin Zhi
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Shen
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenwen Lv
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bo Sang
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiuping Li
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Zhong
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zehu Liu
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiujiao Xia
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
- * E-mail:
| |
Collapse
|
3
|
Xiao X, Li Y, Lan Y, Zhang J, He Y, Cai W, Chen Z, Xi L, Zhang J. Deletion of pksA attenuates the melanogenesis, growth and sporulation ability and causes increased sensitivity to stress response and antifungal drugs in the human pathogenic fungus Fonsecaea monophora. Microbiol Res 2020; 244:126668. [PMID: 33359842 DOI: 10.1016/j.micres.2020.126668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 11/03/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022]
Abstract
Fonsecaea monophora, which is very similar to Fonsecaea pedrosoi in morphological features, has been commonly misdiagnosed as F. pedrosoi. Like F. pedrosoi, F. monophora has been also identified as a predominant pathogen of Chromoblastomycosis (CBM). Melanin has been recognized as a virulence factor in several fungi, however, it is still largely unknown about the biological role of melanin and how melanin is synthesized in F. monophora. In this study, we identified two putative polyketide synthase genes (pks), AYO21_03016 (pksA) and AYO21_10638, by searching against the genome of F. monophora. AYO21_03016 and AYO21_10638 were further targeted disrupted by Agrobacterium tumefaciens-mediated transformation (ATMT). We discovered that pksA gene was the major polyketide synthase required for melanin synthesis in F. monophora, rather than AYO21_10638. Phenotypic analysis showed that, knocking out of the pksA gene attenuated melanogenesis, growth rate, sporulation ability and virulence of F. monophora, as compared with wild-type and complementation strain (pksA-C). Furthermore, the ΔpksA mutant was confirmed to be more sensitive to the oxidative stress, extreme pH environment, and antifungal drugs including itraconazole (ITC), terbinafine (TER), and amphotericin B (AMB). Taken together, these findings enabled us to comprehend the role of pksA in regulating DHN-melanin pathway and its effect on the biological function of F. monophora.
Collapse
Affiliation(s)
- Xing Xiao
- Department of Dermatology and Venerology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Department of Dermatology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yu Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yu Lan
- Department of Dermatology and Venerology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jing Zhang
- Department of Dermatology and Venerology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ya He
- Department of Dermatology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Wenying Cai
- Department of Dermatology and Venerology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhiwen Chen
- Department of Dermatology and Venerology, The Liwan Hospital of The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Liyan Xi
- Department of Dermatology and Venerology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Junmin Zhang
- Department of Dermatology and Venerology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
| |
Collapse
|
4
|
Villena CIF, Gomes RR, Fernandes L, Florencio CS, Bombassaro A, Grisolia ME, da Silva Trindade E, de Hoog S, Vicente VA. Agrobacterium tumefaciens-Mediated Transformation of Fonsecaea monophora and Fonsecaea erecta for Host-Environment Interaction Studies. J Fungi (Basel) 2020; 6:jof6040325. [PMID: 33265950 PMCID: PMC7711947 DOI: 10.3390/jof6040325] [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: 10/16/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022] Open
Abstract
The fungal genus Fonsecaea contains etiological agents of human chromoblastomycosis, a (sub)tropical, (sub)cutaneous implantation disease caused by plant contact. The invasive potential differs significantly between species. Infections by Fonsecaea monophora are believed to originate from the environment and the species has been reported as one of the main causative agents of the disease, but also of cases of primary brain infection. The epidemiology of the disease has not been fully elucidated and questions related to its infection route and virulence are still to be clarified. The environmental species Fonsecaea erecta was isolated from organic material and living plants in endemic areas for chromoblastomycosis in Brazil. The present paper describes Agrobacteriumtumefaciens-mediated transformation (AMT) of the environmental species F. erecta and the pathogenic species F. monophora. We propose the use of Agrobacterium transformation for future gene function studies related to Fonsecaea virulence and pathogenicity. We evaluated the co-cultivation ratios 1:1, 10:1 and 100:1 (Agrobacterium:conidia) at 28 °C during 72 h. pAD1625 and pCAMDsRed plasmids were inserted into both species. Confirmation of transformation was realized by hph gene amplification and Southern blot determined the amount of foreign DNA integrated into the genome. In order to evaluate a potential link between environmental and clinical strains, we obtained red fluorescent transformants after pCAMDsRed insertion. We observed by confocal fluorescence microscopy that both F. monophora and F. erecta were able to colonize the palm Bactris gasipaes, penetrating the epidermis. These results contribute to understanding the ability of Fonsecaea species to adapt to different environmental and host conditions.
Collapse
Affiliation(s)
- Cristina Isabel Ferrer Villena
- Engineering Bioprocess and Biotechnology Graduate Program, Department of Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba 81530-000, Brazil; (C.I.F.V.); (M.E.G.)
| | - Renata Rodrigues Gomes
- Microbiology, Parasitology and Pathology Graduate Program, Department of Pathology, Federal University of Paraná, Curitiba 81530-000, Brazil; (R.R.G.); (A.B.)
| | - Larissa Fernandes
- Microbial Biology Graduate Program, Department of Cell Biology, University of Brasília, Brasilia 70910-900, Brazil; (L.F.); (C.S.F.)
| | - Camille Silva Florencio
- Microbial Biology Graduate Program, Department of Cell Biology, University of Brasília, Brasilia 70910-900, Brazil; (L.F.); (C.S.F.)
| | - Amanda Bombassaro
- Microbiology, Parasitology and Pathology Graduate Program, Department of Pathology, Federal University of Paraná, Curitiba 81530-000, Brazil; (R.R.G.); (A.B.)
- Department of Medical Microbiology, Center of Expertise in Mycology of Radboud University Medical Center/Canisius Wilhelmina Hospital, 6525GA Nijmegen, The Netherlands
| | - Maria Eduarda Grisolia
- Engineering Bioprocess and Biotechnology Graduate Program, Department of Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba 81530-000, Brazil; (C.I.F.V.); (M.E.G.)
| | | | - Sybren de Hoog
- Microbiology, Parasitology and Pathology Graduate Program, Department of Pathology, Federal University of Paraná, Curitiba 81530-000, Brazil; (R.R.G.); (A.B.)
- Department of Medical Microbiology, Center of Expertise in Mycology of Radboud University Medical Center/Canisius Wilhelmina Hospital, 6525GA Nijmegen, The Netherlands
- Correspondence: (S.d.H.); (V.A.V.); Tel.: +31-683-087-882 (S.d.H.); +55-413-361-1704 (V.A.V.)
| | - Vania Aparecida Vicente
- Engineering Bioprocess and Biotechnology Graduate Program, Department of Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba 81530-000, Brazil; (C.I.F.V.); (M.E.G.)
- Microbiology, Parasitology and Pathology Graduate Program, Department of Pathology, Federal University of Paraná, Curitiba 81530-000, Brazil; (R.R.G.); (A.B.)
- Correspondence: (S.d.H.); (V.A.V.); Tel.: +31-683-087-882 (S.d.H.); +55-413-361-1704 (V.A.V.)
| |
Collapse
|
5
|
Hu Y, Qi X, Sun H, Lu Y, Hu Y, Chen X, Liu K, Yang Y, Mao Z, Wu Z, Zhou X. Photodynamic therapy combined with antifungal drugs against chromoblastomycosis and the effect of ALA-PDT on Fonsecaea in vitro. PLoS Negl Trop Dis 2019; 13:e0007849. [PMID: 31671098 PMCID: PMC6850556 DOI: 10.1371/journal.pntd.0007849] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/12/2019] [Accepted: 10/16/2019] [Indexed: 01/06/2023] Open
Abstract
Background Chromoblastomycosis is a chronic skin and subcutaneous fungal infection caused by dematiaceous fungi and is associated with low cure and high relapse rates. In southern China, Fonsecaea monophora and Fonsecaea pedrosoi are the main causative agents. Principal findings We treated 5 refractory and complex cases of chromoblastomycosis with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with oral antifungal drugs. The lesions improved after 4 to 9 sessions of ALA-PDT treatment at an interval of one or two weeks, and in some cases, mycological testing results became negative. The isolates were assayed for susceptibility to antifungal drugs and ALA-PDT in vitro, revealing sensitivity to terbinafine, itraconazole and voriconazole, with ALA-PDT altering the cell wall and increasing reactive oxygen species production. Conclusions These results provide the basis for the development of a new therapeutic approach, and ALA-PDT combined with oral antifungal drugs constitutes a promising alternative method for the treatment of refractory and complex cases of chromoblastomycosis. Chromoblastomycosis, a neglected tropical disease, is one of the most frequently encountered subcutaneous mycoses. The disease is usually caused by traumatic inoculation of a specific group of dematiaceous fungi. Chromoblastomycosisis characterized by slowly expanding skin lesions and is associated with low cure and high relapse rates. In recent years, effective methods, such as photodynamic therapy (PDT), have been employed for inhibiting the pathogen’s activity. The authors treated 5 refractory and complex cases of chromoblastomycosis with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with oral antifungal drugs. The lesions improved after 4 to 9 sessions of ALA-PDT treatment at an interval of one or two weeks, and in some cases, mycological testing results became negative. The authors also found that ALA-PDT alter the fungi cell wall and increase reactive oxygen species production. This research provides the basis for the development of a new therapeutic approach, and ALA-PDT combined with oral antifungal drugs constitutes a promising alternative method for the treatment of refractory and complex cases of chromoblastomycosis.
Collapse
Affiliation(s)
- Yongxuan Hu
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
- * E-mail: (YH); (XZ)
| | - Xinyu Qi
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Hengbiao Sun
- Department of Clinical Laboratory, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yan Lu
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yanqing Hu
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xuyang Chen
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Kangxing Liu
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yemei Yang
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zuhao Mao
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhong Wu
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xianyi Zhou
- Department of Dermatology and Venerology, The 3rd Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
- * E-mail: (YH); (XZ)
| |
Collapse
|
6
|
Najafzadeh MJ, Gerrits van den Ende AHG, Vicente VA, Dolatabadi S, Sun J, de Hoog GS. Identification of chromoblastomycosis agents by PCR based reverse line blot (PCR-RLB) hybridization assay. Microb Pathog 2018; 125:43-47. [PMID: 30194974 DOI: 10.1016/j.micpath.2018.09.002] [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: 08/05/2018] [Revised: 08/27/2018] [Accepted: 09/01/2018] [Indexed: 11/16/2022]
Abstract
Chromoblastomycosis is one of the most prevalent implantation fungal infections caused by melanized fungi, affecting individuals with certain risk factors with high morbidity due to its recalcitrant nature. It is difficult to identify the etiological agents and thus a suitable reproductive molecular identification method applicable in developing countries has been investigated. We report the identification of four different fungal causative agents of chromoblastomycosis by reverse line blotting hybridization (RLB) based on biotin-labeled PCR products and amine labeled probes to hybridize. Sixty five reference strains, including type strains, i.e. Fonsecaea pedrosoi, F. monophora, F. nubica, and Phialophora verrucosa, obtained from the CBS-KNAW were included in this study. Internal transcribed spacer 1 (ITS1) regions of relevant species were aligned and adjusted using BIONUMERICS v. 4.61 in order to design four specific probes to identify informative nucleotide polymorphisms. The final identification of these species by RLB assay was concordant with ITS sequencing and showed 100% specificity with no cross hybridization, able to identify all tested strains. The time and cost were less compare to other routine identification methods such as sequencing. This assay allows sensitive and specific simultaneous detection and identification of a different fungal species.
Collapse
Affiliation(s)
- M J Najafzadeh
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - V A Vicente
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Basic Pathology, Federal University of Paraná, Brazil
| | - S Dolatabadi
- Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands; Faculty of Engineering, Sabzevar University of New Technology, Sabzevar, Iran.
| | - J Sun
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - G S de Hoog
- Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands; Center of Expertise in Mycology Radboudumc / CWZ, Nijmegen, the Netherlands.
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
Label M, Karayan LC, De Hoog S, Afeltra J, Bustamante T, Vitale RG. Differential distribution patterns of Fonsecaea agents of chromoblastomycosis, exemplified by the first case due to F. monophora from Argentina. Med Mycol Case Rep 2017; 20:35-38. [PMID: 29552459 PMCID: PMC5852295 DOI: 10.1016/j.mmcr.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/04/2017] [Accepted: 11/24/2017] [Indexed: 11/17/2022] Open
Abstract
Chromoblastomycosis is a mutilating infection of the skin and subcutaneous tissues caused by melanized fungi belonging to the order Chaetothyriales. Proven cases of the main agent, Fonsecaea pedrosoi are mainly limited to (sub)tropical, humid climates of Latin and Central America and the Caribbean. Fonsecaea monophora has a global distribution along the equator. Cases outside the (sub)tropics have thus far mostly been considered to have been imported, but here we report the first endemic case by F. monophora from Argentina. Patient was a 82-year-old rural female worker from Corrientes, a province with a dry continental climate.
Collapse
Affiliation(s)
- Marcelo Label
- Dermatology Division, Ramos Mejia Hospital, Buenos Aires C1221ADC, Argentina
| | - Luciana C Karayan
- Ramos Mejia Hospital, Parasitology Unit, Mycology Branch, Buenos Aires C1221ADC, Argentina
| | - Sybren De Hoog
- Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Javier Afeltra
- Ramos Mejia Hospital, Parasitology Unit, Mycology Branch, Buenos Aires C1221ADC, Argentina
| | - Togo Bustamante
- Dermatology Division, Ramos Mejia Hospital, Buenos Aires C1221ADC, Argentina
| | - Roxana G Vitale
- Ramos Mejia Hospital, Parasitology Unit, Mycology Branch, Buenos Aires C1221ADC, Argentina.,Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands.,The National Council of Scientific and Technological Research (CONICET), Buenos Aires, Argentina
| |
Collapse
|
9
|
He L, Ma J, Mei X, Lu S, Li X, Xi L. Successful treatment of chromoblastomycosis of 10-year duration due to Fonsecaea nubica. Mycoses 2017; 61:231-236. [PMID: 29178398 DOI: 10.1111/myc.12732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/19/2017] [Accepted: 11/21/2017] [Indexed: 11/29/2022]
Abstract
We report a case of chromoblastomycosis due to the presence of large plaque and verrucous hyperplasia lesions on the left upper limb, with elbow abnormal activities, in a 56-year-old male. The diagnosis of chromoblastomycosis was based on gross and microscopic morphologies, histopathological examination and clinical manifestation. Molecular tools were applied to identifying the causative agent Fonsecaea nubica, which is rarely reported to be associated with chromoblastomycosis. The patient was initially treated orally with terbinafine (250 mg/day) and itraconazole (200 mg/day), subsequently patient received thermotherapy (45-50°C, 3 h/day) for 1 month. The patient was successfully cured. A literature review was performed to assess general features, treatment and outcome of chromoblastomycosis due to F. nubica. All the 5 reviewed patients were male, over 30 years old and their lesions occurred after traumatic inoculation.
Collapse
Affiliation(s)
- Liya He
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Research Center of Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianchi Ma
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Research Center of Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin Mei
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sha Lu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiqing Li
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liyan Xi
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Dermatology Hospital of Southern Medical University, Guangzhou, China
| |
Collapse
|
10
|
Abstract
Chromoblastomycosis (CBM), also known as chromomycosis, is one of the most prevalent implantation fungal infections, being the most common of the gamut of mycoses caused by melanized or brown-pigmented fungi. CBM is mainly a tropical or subtropical disease that may affect individuals with certain risk factors around the world. The following characteristics are associated with this disease: (i) traumatic inoculation by implantation from an environmental source, leading to an initial cutaneous lesion at the inoculation site; (ii) chronic and progressive cutaneous and subcutaneous tissular involvement associated with fibrotic and granulomatous reactions associated with microabscesses and often with tissue proliferation; (iii) a nonprotective T helper type 2 (Th2) immune response with ineffective humoral involvement; and (iv) the presence of muriform (sclerotic) cells embedded in the affected tissue. CBM lesions are clinically polymorphic and are commonly misdiagnosed as various other infectious and noninfectious diseases. In its more severe clinical forms, CBM may cause an incapacity for labor due to fibrotic sequelae and also due to a series of clinical complications, and if not recognized at an early stage, this disease can be refractory to antifungal therapy.
Collapse
|
11
|
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.
Collapse
|
12
|
Chromoblastomycosis due to Fonsecaea monophora misdiagnosed as sporotrichosis and cutaneous tuberculosis in a pulmonary tuberculosis patient. Med Mycol Case Rep 2016; 11:57-60. [PMID: 27330937 PMCID: PMC4907037 DOI: 10.1016/j.mmcr.2016.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/03/2016] [Indexed: 11/24/2022] Open
Abstract
Chromoblastomycosis is caused by dematiaceous fungi. It develops after inoculation of the organism into the skin. We report a case of chromoblastomycosis in a pulmonary tuberculosis patient without known history of trauma. The lesions were initially diagnosed as sporotrichosis and skin tuberculosis. Histopathology of scales and skin biopsy specimen revealed sclerotic bodies, the hallmark of chromoblastomycosis. The causative organism was identified as Fonsecaea monophora by rDNA ITS sequencing. The lesions recovered markedly after two month treatment with oral terbinafine 250 mg daily according to drug sensitive test in vitro in combination with local thermotherapy.
Collapse
|
13
|
Ogawa MM, Peternelli MP, Enokihara MMSS, Nishikaku AS, Gonçalves SS, Tomimori J. Spectral Manifestation of Melanized Fungal Infections in Kidney Transplant Recipients: Report of Six Cases. Mycopathologia 2016; 181:379-85. [PMID: 27025729 DOI: 10.1007/s11046-016-0005-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/19/2016] [Indexed: 11/29/2022]
Abstract
Chromoblastomycosis and phaeohyphomycosis are melanized fungal infections, which affect skin and subcutaneous tissues in immunocompetent and immunosuppressed patients, as solid-organ transplant recipients, respectively. In this present study, we report six cases of melanized fungal infection in kidney transplant recipients. In five cases, culture of tissue specimens identified two cases of Exophiala spp. and three cases of Fonsecaea spp. Molecular identification was performed in three cases based on sequencing of rDNA (ITS region) that revealed the following agents: Exophiala xenobiotica, Exophiala bergeri and Fonsecaea monophora. Clinically, they presented verrucous lesion, erythematous-squamous plaque, nodules and lymphangitic distribution. Histopathological aspect was tuberculous granuloma, with concomitant presence of muriform bodies and hyphae. Some patients presented fungal transepithelial elimination. One patient received only terbinafine. Three patients underwent surgery, and two of them received itraconazole. In these four cases, the infection did not relapse. The other two patients were treated only with itraconazole, one of them is still under treatment and the other one was lost to follow-up. These patients presented clinical and histopathological characteristics ranging from resistant to nonresistant forms.
Collapse
Affiliation(s)
- Marilia M Ogawa
- Department of Dermatology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 508, São Paulo, SP, CEP 04038-001, Brazil.
| | - Marcella P Peternelli
- Department of Dermatology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 508, São Paulo, SP, CEP 04038-001, Brazil
| | - Milvia M S S Enokihara
- Department of Pathology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Angela S Nishikaku
- Special Laboratory of Mycology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Jane Tomimori
- Department of Dermatology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 508, São Paulo, SP, CEP 04038-001, Brazil
| |
Collapse
|
14
|
Carolina Rojas O, León-Cachón RBR, Pérez-Maya AA, Aguirre-Garza M, Moreno-Treviño MG, González GM. Phenotypic and molecular identification ofFonsecaea pedrosoistrains isolated from chromoblastomycosis patients in Mexico and Venezuela. Mycoses 2015; 58:267-72. [DOI: 10.1111/myc.12308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 01/20/2015] [Accepted: 02/05/2015] [Indexed: 11/29/2022]
Affiliation(s)
- O. Carolina Rojas
- División Ciencias de la Salud; Departamento de Ciencias Básicas; Universidad de Monterrey; San Pedro Garza García Nuevo León México
- Departamento de Microbiología; Facultad de Medicina; Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Rafael B. R. León-Cachón
- División Ciencias de la Salud; Departamento de Ciencias Básicas; Universidad de Monterrey; San Pedro Garza García Nuevo León México
| | - Antonio Alí Pérez-Maya
- Departamento de Bioquímica y Medicina Molecular; Facultad de Medicina; Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Marcelino Aguirre-Garza
- División Ciencias de la Salud; Departamento de Ciencias Básicas; Universidad de Monterrey; San Pedro Garza García Nuevo León México
| | - María G. Moreno-Treviño
- División Ciencias de la Salud; Departamento de Ciencias Básicas; Universidad de Monterrey; San Pedro Garza García Nuevo León México
| | - Gloria M. González
- Departamento de Microbiología; Facultad de Medicina; Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| |
Collapse
|
15
|
Black yeasts and their filamentous relatives: principles of pathogenesis and host defense. Clin Microbiol Rev 2015; 27:527-42. [PMID: 24982320 DOI: 10.1128/cmr.00093-13] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Among the melanized fungi, the so-called "black yeasts" and their filamentous relatives are particularly significant as agents of severe phaeohyphomycosis, chromoblastomycosis, and mycetoma in humans and animals. The pathogenicity and virulence of these fungi may differ significantly between closely related species. The factors which probably are of significance for pathogenicity include the presence of melanin and carotene, formation of thick cell walls and meristematic growth, presence of yeast-like phases, thermo- and perhaps also osmotolerance, adhesion, hydrophobicity, assimilation of aromatic hydrocarbons, and production of siderophores. Host defense has been shown to rely mainly on the ingestion and elimination of fungal cells by cells of the innate immune system, especially neutrophils and macrophages. However, there is increasing evidence supporting a role of T-cell-mediated immune responses, with increased interleukin-10 (IL-10) and low levels of gamma interferon (IFN-γ) being deleterious during the infection. There are no standardized therapies for treatment. It is therefore important to obtain in vitro susceptibilities of individual patients' fungal isolates in order to provide useful information for selection of appropriate treatment protocols. This article discusses the pathogenesis and host defense factors for these fungi and their severity, chronicity, and subsequent impact on treatment and prevention of diseases in human or animal hosts.
Collapse
|
16
|
Photodynamic therapy combined with terbinafine against chromoblastomycosis and the effect of PDT on Fonsecaea monophora in vitro. Mycopathologia 2014; 179:103-9. [PMID: 25366276 DOI: 10.1007/s11046-014-9828-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
Chromoblastomycosis, a chronic fungal infection of skin and subcutaneous tissue caused by dematiaceous fungi, is associated with low cure and high relapse rates. Among all factors affecting clinical outcome, etiological agents have an important position. In southern China, Fonsecaea pedrosoi and Fonsecaea monophora are main causative agents causing Chromoblastomycosis. We treated one case of chromoblastomycosis by photodynamic therapy (PDT) of 5-aminolevulinic acid (ALA) irradiation combined with terbinafine 250 mg a day. The lesions were improved after two sessions of ALA-PDT treatment, each including nine times, at an interval of 1 week, combined with terbinafine 250 mg/day oral, and clinical improvement could be observed. In the following study, based on the clinical treatment, the effect of PDT and antifungal drugs on this isolate was detected in vitro. It showed sensitivity to terbinafine, itraconazole or voriconazole, and PDT inhibited the growth. Both the clinic and experiments in vitro confirm the good outcome of ALA-PDT applied in the inhibition of F. monophora. It demonstrated that combination of antifungal drugs with ALA-PDT arises as a promising alternative method for the treatment of these refractory cases of chromoblastomycosis.
Collapse
|
17
|
Chowdhary A, Meis J, Guarro J, de Hoog G, Kathuria S, Arendrup M, Arikan-Akdagli S, Akova M, Boekhout T, Caira M, Guinea J, Chakrabarti A, Dannaoui E, van Diepeningen A, Freiberger T, Groll A, Hope W, Johnson E, Lackner M, Lagrou K, Lanternier F, Lass-Flörl C, Lortholary O, Meletiadis J, Muñoz P, Pagano L, Petrikkos G, Richardson M, Roilides E, Skiada A, Tortorano A, Ullmann A, Verweij P, Cornely O, Cuenca-Estrella M. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi. Clin Microbiol Infect 2014; 20 Suppl 3:47-75. [DOI: 10.1111/1469-0691.12515] [Citation(s) in RCA: 216] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 12/13/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022]
|
18
|
Chromoblastomycosis as an endemic disease in temperate Europe: first confirmed case and review of the literature. Eur J Clin Microbiol Infect Dis 2013; 33:391-8. [PMID: 24048727 DOI: 10.1007/s10096-013-1969-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
This study reports a case of a 56-year-old white male, retired coal-miner, diagnosed with chromoblastomycosis lasting 20 years. The infection site was the burnt skin of the back. For many years the patient had not undertaken any treatment believing that the lesion had been a burn scar. A gradual increase in lesion size prompted the patient to start therapy. The diagnosis was made by histopathological examination and mycological culture. Identification of the causative agent at the species level was achieved by sequence analysis of the internal transcribed spacer (ITS) region and D1/D2 domains of the 26S rDNA. To our knowledge, this is the first documented case of chromoblastomycosis caused by Fonsecaea monophora in temperate Europe, outside the endemic area for the disease. This finding is highly significant for understanding the routes of infection of chromoblastomycosis and radically revises the traditional view of the natural ecology of the etiological agents of the disease.
Collapse
|
19
|
Abstract
Emerging fungal diseases due to black yeasts and relatives in domestic or wild animals and in invertebrates or cold- and warm-blooded vertebrates are continually being reported, either as novel pathogens or as familiar pathogens affecting new species of hosts. Different epidemiological situations can be distinguished, i.e., occurrence as single infections or as zoonoses, and infection may occur sporadically in otherwise healthy hosts. Such infections are found mostly in mammals but also in cold-blooded animals, are frequently subcutaneous or cerebral, and bear much similarity to human primary disorders. Infections of the nervous system are mostly fatal, and the source and route of infection are currently unknown. A third epidemiological situation corresponds to pseudoepidemics, i.e., infection of a large host population due to a common source. It is often observed and generally hypothesized that the susceptible animals are under stress, e.g., due to poor housing conditions of mammals or to a change of basins in the case of fishes. The descriptions in this article represent an overview of the more commonly reported and recurring black fungi and the corresponding diseases in different types of animals.
Collapse
|
20
|
Daboit TC, Magagnin CM, Heidrich D, Castrillón MR, Mendes SDC, Vettorato G, Valente P, Scroferneker ML. A case of relapsed chromoblastomycosis due to Fonsecaea monophora: antifungal susceptibility and phylogenetic analysis. Mycopathologia 2013; 176:139-44. [PMID: 23645135 DOI: 10.1007/s11046-013-9660-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/19/2013] [Indexed: 11/25/2022]
Abstract
Chromoblastomycosis is a chronic cutaneous and subcutaneous mycosis. The management of this infection continues to be challenging because there is no consensus on the therapeutic regimen. We report here a case of a 69-year-old male patient with cauliflower-like lesions on his left leg and foot. He had already been treated with itraconazole at a dose of 200 mg/day for 5 months, with mycological cure for all the affected areas. However, the lesions relapsed at both sites, and treatment with itraconazole was resumed at the dose previously used. Initially, direct mycological examination, cultural, and microculture slide observation were performed. Afterward, sequencing of the ITS1-5.8S rDNA-ITS2 region of the fungal DNA and evaluation of its susceptibility to antifungal agents alone and in combination were performed. In direct mycological examination, the presence of sclerotic cells was verified, and the fungus was identified as Fonsecaea based on cultural and microscopic examinations. Identification as Fonsecaea monophora was confirmed after sequencing of the ITS region and phylogenetic analysis. The isolate was susceptible to itraconazole and terbinafine. The combinations of amphotericin B and terbinafine and terbinafine and voriconazole were synergistic. The use of drugs for which the causative agent is susceptible to singly or in combination may be an alternative for the treatment of mycosis. Furthermore, the identification of the agent by molecular techniques is important for epidemiological purposes. To the best of our knowledge, this is the first case of relapsed chromoblastomycosis caused by F. monophora in Brazil.
Collapse
Affiliation(s)
- Tatiane Caroline Daboit
- Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400-2º andar, Porto Alegre, Rio Grande do Sul, CEP 90035-003, Brazil,
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Severe Disseminated Phaeohyphomycosis in an Immunocompetent Patient Caused by Veronaea botryosa. Mycopathologia 2013; 175:497-503. [DOI: 10.1007/s11046-013-9632-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
|
22
|
Badali H, Fernández-González M, Mousavi B, Illnait-Zaragozi MT, González-Rodríguez JC, de Hoog GS, Meis JF. Chromoblastomycosis due to Fonsecaea pedrosoi and F. monophora in Cuba. Mycopathologia 2013; 175:439-44. [DOI: 10.1007/s11046-013-9634-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
|
23
|
Veronaea botryosa: Molecular Identification with Amplified Fragment Length Polymorphism (AFLP) and In vitro Antifungal Susceptibility. Mycopathologia 2013; 175:505-13. [DOI: 10.1007/s11046-013-9631-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
|
24
|
Yang Y, Hu Y, Zhang J, Li X, Lu C, Liang Y, Xi L. A refractory case of chromoblastomycosis due to Fonsecaea monophora with improvement by photodynamic therapy. Med Mycol 2012; 50:649-53. [DOI: 10.3109/13693786.2012.655258] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
25
|
Najafzadeh M, Vicente V, Sun J, Meis J, de Hoog G. Fonsecaea multimorphosa sp. nov, a new species of Chaetothyriales isolated from a feline cerebral abscess. Fungal Biol 2011; 115:1066-76. [DOI: 10.1016/j.funbio.2011.06.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 06/08/2011] [Accepted: 06/13/2011] [Indexed: 11/29/2022]
|
26
|
Najafzadeh MJ, Sun J, Vicente VA, de Hoog GS. Rapid identification of fungal pathogens by rolling circle amplification using Fonsecaea as a model. Mycoses 2011; 54:e577-82. [DOI: 10.1111/j.1439-0507.2010.01995.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
27
|
Najafzadeh MJ, Sun J, Vicente VA, Klaassen CHW, Bonifaz A, Gerrits van den Ende AHG, Menken SBJ, de Hoog GS. Molecular epidemiology of Fonsecaea species. Emerg Infect Dis 2011; 17:464-9. [PMID: 21392438 DOI: 10.3201/eid1703.100555] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To assess population diversities among 81 strains of fungi in the genus Fonsecaea that had been identified down to species level, we applied amplified fragment-length polymorphism (AFLP) technology and sequenced the internal transcribed spacer regions and the partial cell division cycle, beta-tubulin, and actin genes. Many species of the genus Fonsecaea cause human chromoblastomycosis. Strains originated from a global sampling of clinical and environmental sources in the Western Hemisphere, Asia, Africa, and Europe. According to AFLP fingerprinting, Fonsecaea isolates clustered in 5 groups corresponding with F. pedrosoi, F. monophora, and F. nubica: the latter 2 species each comprised 2 groups, and F. pedrosoi appeared to be of monophyletic origin. F. pedrosoi was found nearly exclusively in Central and South America. F. monophora and F. nubica were distributed worldwide, but both showed substantial geographic structuring. Clinical cases outside areas where Fonsecaea is endemic were probably distributed by human migration.
Collapse
|