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He Y, Zheng HL, Mei H, Lv GX, Liu WD, Li XF. Phaeohyphomycosis in China. Front Cell Infect Microbiol 2022; 12:895329. [PMID: 35770068 PMCID: PMC9235401 DOI: 10.3389/fcimb.2022.895329] [Citation(s) in RCA: 6] [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: 03/13/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDue to more attentions paid to melanized fungi over the past few decades and under the background of the global coronavirus disease 2019 pandemic (COVID-19) the fact that the virus itself and the immunosuppressive agents such as glucocorticoids can further increase the risk of infections of deep mycoses, the number of patients with phaeohyphomycosis (PHM) has a substantial increase. Their spectrum is broad and the early diagnosis and treatments are extremely sticky. This study aims to more comprehensively understand the clinical features of phaeohyphomycosis in China over 35 years and to establish a more applicable systematical classification and severity grades of lesions to guide treatments and prognosis.MethodsWe reviewed 174 cases of proven phaeohyphomycosis reported in Chinese and English language literature from 1987 to 2021 and we also made the accurate classification definitions and detailed information about the epidemiology, species of clinical dematiaceous fungi, minimum inhibitory concentration values, clinical features, treatments, and prognosis.ResultsThe mortality of cerebral, disseminated and pulmonary phaeohyphomycosis are 55%, 36%, and 25%. Nearly 19% of patients had poor quality of life caused by the complications such as disability, disfigurements, and blindness. The overall misdiagnosis rate of phaeohyphomycosis was 74%. Moderate to severe rashes are accounting for 82% of subcutaneous phaeohyphomycosis. The areas of the head and face are mostly affected accounting for 16% of severe rashes. Nearly 30% of invasive infections of phaeohyphomycosis are triggered by recurrent lesions. Voriconazole, itraconazole, amphotericin B deoxycholate (AmB-DOC), and terbinafine were most commonly used but diagnosis and treatments of phaeohyphomycosis remain challenging in reality.ConclusionsOur classifications are likely to be more practical and easier to popularize, and there are still also plenty of characteristics in these non-specific lesions. There’re no significant variations in cure rates, or death rates between three grades of lesions. But patients with severe rashes have longer courses and lower effective rates.
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Affiliation(s)
- Yun He
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Science, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
- Skin Disease Prevention and Treatment Institute of Yixing, Yixing, China
| | - Hai-lin Zheng
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Science, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Huan Mei
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Science, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Gui-xia Lv
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Science, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Wei-da Liu
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Science, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
- *Correspondence: Wei-da Liu, ; Xiao-fang Li,
| | - Xiao-fang Li
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, China
- Institute of Dermatology, Chinese Academy of Medical Science, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
- *Correspondence: Wei-da Liu, ; Xiao-fang Li,
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Mercier V, Bastides F, Bailly É, Garcia-Hermoso D, Miquelestorena-Standley E, El Baz Z, Marteau E, Vermes E, De Muret A, Bernard L, Desoubeaux G. Successful Terbinafine Treatment for Cutaneous Phaeohyphomycosis Caused by Trematosphaeria grisea in a Heart Transplanted Man: Case Report and Literature Review. Mycopathologia 2020; 185:709-716. [PMID: 32562177 DOI: 10.1007/s11046-020-00467-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/06/2020] [Indexed: 01/19/2023]
Abstract
Phaeohyphomycosis is a chronic infectious disease caused by dematiaceous fungi. It is characterized by the presence of pigmented septate mycelia within tissues. In the case of superficial infection, the lesion(s) chronically evolve(s) toward painless pseudo-tumor(s) of the soft parts. We report herein the original case of a heart transplanted man who exhibited phaeohyphomycosis of the left hand, with no mention of travels in endemic areas. Trematosphaeria grisea was identified as the causative agent, which is quite innovative since this species has been rather described in mycetoma. The antifungal treatment initially based on isavuconazole alone was not sufficient to cure the patient. In contrast, its association with local terbinafine ointment allowed total clinical improvement. This finding is unusual as diagnosis of phaeohyphomycosis caused by T. grisea is uncommon in nontropical countries, and as the outcome appeared successful by the means of add-on therapeutic strategy with terbinafine.
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Affiliation(s)
- Victor Mercier
- Parasitologie - Mycologie et Médecine Tropicale, Hôpital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37044, Tours, France.
| | - Frédéric Bastides
- Médecine Interne Et Maladies Infectieuses, CHU de Tours, Tours, France
| | - Éric Bailly
- Parasitologie - Mycologie et Médecine Tropicale, Hôpital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37044, Tours, France
| | - Dea Garcia-Hermoso
- CNRS, National Reference Center for Invasive Mycoses and Antifungals (NRCMA), Molecular Mycology Unit, UMR2000, Institut Pasteur, Paris, France
| | | | - Zaki El Baz
- Radiologie, CHU de Tours, Chambray-les-Tours, France
| | - Emilie Marteau
- Chirurgie orthopédique Et Traumatologie, CHU de Tours, Chambray-les-Tours, France
| | | | - Anne De Muret
- Anatomie Et Cytologie Pathologiques, CHU de Tours, Chambray-les-Tours, France
| | - Louis Bernard
- Médecine Interne Et Maladies Infectieuses, CHU de Tours, Tours, France
| | - Guillaume Desoubeaux
- Parasitologie - Mycologie et Médecine Tropicale, Hôpital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37044, Tours, France
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Ramasamy I, Sahoo AK, Medapati HG, Elamurugan TP, Nelamangala Ramakrishnaiah VP. Unwanted Diagnosis of a Subcutaneous Swelling. Cureus 2020; 12:e8141. [PMID: 32550061 PMCID: PMC7294882 DOI: 10.7759/cureus.8141] [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] [Indexed: 01/19/2023] Open
Abstract
Subcutaneous swelling is one of the common cases seen in surgical practice. The pathology of the subcutaneous swellings is varied ranging from epidermal inclusion cyst to malignant swelling. Fungal infections producing subcutaneous swelling are relatively rare. They occur in immunocompromised patients. We report a case of phaeohyphomycosis (PHM) which is characterized by the presence of pseudohyphae, hyphae, brown yeast-like cells, and melanin in their cell walls, presenting as subcutaneous swelling. A 34-year-old male presented with a swelling over the anterior aspect of left knee joint for three months, which was initially painless. He gave a history of purulent discharge from the swelling 20 days back. He was a known case of myasthenia gravis on regular treatment with steroids. On examination, the swelling was firm, nontender, and mobile in subcutaneous plane. The skin over the swelling showed a healed puckered scar, fine needle aspiration cytology (FNAC) of the swelling showed slender, septate hyphae with variable branching bulbous ends, and few of the hyphae showed pigmentation morphologically suggestive of PHM. The swelling was excised with clear margin. Subcutaneous mycosis is common in tropical and subtropical countries like India. Strong suspicion of this diagnosis is warranted especially in immunocompromised patients. Surgical excision is the treatment of choice to achieve early cure.
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Affiliation(s)
- Indira Ramasamy
- Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Ashok Kumar Sahoo
- Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Harish Goutham Medapati
- Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND.,Surgical Gastroenterology, Government Medical College, Srinagar, IND
| | - T P Elamurugan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Lu PD, Zhao YH. Targeting NF-κB pathway for treating ulcerative colitis: comprehensive regulatory characteristics of Chinese medicines. Chin Med 2020; 15:15. [PMID: 32063999 PMCID: PMC7011253 DOI: 10.1186/s13020-020-0296-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/30/2020] [Indexed: 12/15/2022] Open
Abstract
Nuclear factor-kappa B (NF-κB) is a kind of multi-functional nuclear transcription factor involved in regulating gene transcription to influence pathological evolution of inflammatory and immune diseases. Numerous literature evidence that NF-κB pathway plays an essential role in pathogenic development of ulcerative colitis (UC). UC is a chronic non-specific inflammatory bowel disease, and until now, therapeutic agents for UC including aminosalicylates, corticosteroids and immune inhibitors still cannot exert satisfied effects on patients. In recent years, Chinese medicines suggest the advantages of alleviating symptoms and signs, decreasing side-effects and recurrence, whose one of mechanisms is related to regulation of NF-κB pathway. In this review, we categorize Chinese medicines according to their traditional therapeutic functions, and summarize the characteristics of Chinese medicines targeting NF-κB pathway in UC treatment. It indicates that 85 kinds of Chinese medicines’ compounds and formulae can directly act on NF-κBp65; while 58 Chinese medicines’ ingredients and formulae indirectly suppress NF-κBp65 by regulation of its upstream or other related pathways. Moreover, by the analysis of Chinese medicines’ category based on their traditional functions, we conclude the category of dampness-drying and detoxificating medicine targeting NF-κB pathway accounts for primary status for amelioration of UC. Simultaneously, this review also contributes to the choices of Chinese medicine category and provides curative potential of Chinese medicines for clinical UC treatment.
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Affiliation(s)
- Peng-De Lu
- 1School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong-Hua Zhao
- 2State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, 999078 Macao, Special Administrative Region of China
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