Onicomicosis en paciente inmunocompetente por Aspergillus sección Candidi / Onychomycosis in immunocompetent patient by Aspergillus section Candidi

Introducción: los hongos miceliales no dermatofitos (HMND) pueden causar un gran número de infecciones, entre ellas, la onicomicosis. Su implicancia como agentes patógenos y su significado clínico en esta afección, se encuentran sujetos al cumplimiento de los criterios de Walshe y Mary P. English. Presentamos un caso de onicomicosis causada por un hongo hifomiceto poco frecuente, del género Asper-gillus sección Candidi, en una paciente inmunocompetente y su estrategia terapéutica. Materiales y métodos: se estudió una paciente inmunocompetente, de 43 años de edad, con lesión en uña de primer dedo del pie derecho, de 10 años de evolución. Se realizó toma de muestra para examen micológico. Resultados: el examen directo reveló la presencia de hifas hialinas irregulares, ramificadas y tabica-das, compatibles con HMND. En muestras seriadas, desarrollaron colonias blanco algodonosas, cuya micromorfología fue concordante con Aspergillus sección Candidi. La identificación fue confirmada en la Unidad de Micología del Hospital de Infecciosas Francisco Javier Muñiz de la Ciudad Autónoma de Buenos Aires, Argentina. Allí también se realizaron pruebas de sensibilidad a antifúngicos, resultando sensible a itraconazol y terbinafina. Conclusión: exponemos un caso de onicomicosis causada por Aspergillus sección Candidi, HMND no queratinolítico, de escasa frecuencia de aparición, siendo el primer caso descripto y publicado en Argentina. También se planteó una estrategia terapéutica efectiva, que condujera a la cura clínica y microbiológica, de la uña de la paciente.

Introduction: non-dermatophyte mycelial fungi (HMND) can cause a large number of infections, including onychomycosis. Its implica-tion as pathogens and its clinical significance in this condition are subject to compliance with Walshe's and Mary P. English's criteria. We present a case of onychomycosis caused by hyphomycete rare fungus, of the genus Aspergillus section Candidi, in an immunocompetent patient and its therapeutic strategy. Materials and methods: a 43-year-old immunocompetent patient with a 10-year-old right-toe nail lesion was studied. Samples were taken for mycological examination. Results: the direct examination revealed the presence of irregu-lar, branched and tabulated hyaline hyphae, compatible with HMND. In serial samples, they developed white cotton colonies, whose micromorphology was consistent with Aspergillus, section Candidi. The identification was confirmed at the Mycology Unit of Francisco Javier Muñiz Infectious Hospital in the Autonomous City of Buenos Aires, Argentina. Susceptibility to antifungals was also tested there, resulting in susceptibility to itraconazole and terbinafine. Conclusion: we present a case of onychomycosis caused by Aspergillus section Candidi, non-keratinolytic HMND, of rare occurrence, being the first case described and published in Argentina. An effective therapeutic strategy was also proposed that led to the patient's toenail's clinical and microbiological cure.

A Clinical and Etiological Analysis of Subcutaneous Mycoses / 대한의진균학회지

BACKGROUND: There have been many studies about sporotrichosis in Korean dermatological literature. However, a few studies have reported on subcutaneous mycoses other than sporotrichosis. OBJECTIVE: The purpose of this study was to investigate the clinical and etiological aspects of subcutaneous mycoses. METHODS: In the 20-year-period 1996-2015, we reviewed seventeen patients with subcutaneous mycoses with in regards to the age, gender, occupation, trauma history and associated diseases. The patients with subcutaneous mycoses were further evaluated concerning the clinical manifestations, histopathology, culture of organisms and treatment. RESULTS: Age of the subcutaneous mycosis was most prevalent in the sixties (35.2%). The male-tofemale ratio was 1:1.8. Most patients were farmers (52.8%), although preceding trauma was noted in seven patients (41.2%). The most common skin lesion was erythematous plaque (58.7%), followed by abscess, ulcer, papule and nodule. The most frequently involved area was upper extremities (58.8%), followed by face, and lower extremities. Hyalohyphomycosis was the most common infection in 6 cases (35.2%), followed by sporotrichosis (5 cases, 29.4%), chromoblastomycosis (4 cases, 23.5%), phaeohyphomycosis (2 cases, 11.8%). Sporothrix species was the most common etiological agent (29.4%), followed by Fonsecaea (23.5%), Scedosporium (17.6%), Exophiala (11.8%), Fusarium, Paecilomyces, and Cephalotheca (5.9%), respectively. Most patients responded well to therapy. CONCLUSION: Because of the increase in subcutaneous mycoses other than sporotrichosis, there is a the need for careful mycological examination in patients with subcutaneous mycoses.

A masquerading subcutaneous swelling caused by Scedosporium apiospermum: An emerging pathogen.

Scedosporiasis is an emerging infection in immunocompromised individuals. We report a case of multiple subcutaneous swellings in a diabetic ketoacidotic patient, which was clinically diagnosed as lipoma. On fi ne-needle aspiration cytology, pus was aspirated, which showed septate branching hyphal elements. The pus culture on Sabouraud’s dextrose agar yielded Scedosporium apiospermum, which was identifi ed based on its macroscopic and microscopic features. There are very few reports of scedosporiasis from India. The diagnosis of scedosporiasis is diffi cult and correct etiological diagnosis can help in better management of the patient.

Hialohifomicosis cutánea en un paciente con leucemia linfoblástica / Cutaneous hyalohyphomycosis in a patient with acute lymphoblastic leukemia

Las infecciones fúngicas causadas por Aspergillus sp. y Candida sp. son causa importante de morbilidad y mortalidad en pacientes gravemente inmunodeficientes, especialmente en aquellos con neutropenia o receptores de trasplante de médula ósea o de órganos sólidos. Informamos sobre una hialohifomicosis cutánea en una mujer de 24 años de edad con leucemia linfoblástica.

Invasive fungal infections most frequently caused by Aspergillus sp. and Candida sp. are significant causes of morbidity and mortality in severely immunocompromised patients, especially those who are neutropenic or who have undergone bone marrow or solid-organ transplant. We report a case of cutaneous hyalohyphomycosis in a 24-year-old female with acute lymphoblastic leukemia.

Avaliação da interação in vitro do fungo oportunista, emergente, paecilomyces lilacinus, agente causal da hialohifomicose, com células apresentadoras de antígenos humanas (macrófagos e células dentríticas) / Assessment of in vitro interaction of opportunistic emerging fungus, Paecilomyces lilacinus, causal agent of hyalohyphomycosis with human antigen-presenting cells (macrophages and dendritic cells)

Paecilomyces lilacinus, um dos agentes causais da hialohifomicose, é um fungo filamentoso, assexuado. Está amplamente distribuído pelo mundo e frequentemente é encontrado como contaminante, proveniente do ar, em espécimes clínicos e em soluções consideradas estéreis. Acomete principalmente pacientes comprometidos imunologicamente, porém pacientes imunocompetentes também podem apresentar manifestações clínicas da doença, sendo esse fungo, atualmente, considerado como um importante patógeno oportunista humano. O presente trabalho teve por objetivo a investigação da interação de conídios de P. lilacinus, proveniente de caso clínico de hialohifomicose humana, com células apresentadoras de antígenos (APCs - macrófagos e células dendríticas). Conídios interagiram com macrófagos e células dendritícas de doadores humanos saudáveis, em diferentes concentrações (conídio/APCs) e tempos de incubação para avaliação qualitativa e quantitativa da interação por microscopia óptica e para estudo do percentual de células expressando moléculas de superfície celular que atuam na resposta imune do hospedeiro. Sobrenadantes provenientes da interação das APCs com os conídios foram coletados para o estudo das citocinas IL1-beta e TNF-alfa...

Os resultados demonstraram que o fungo foi capaz de infectar de modo semelhante ambas as APCs e que a concentração de 1:1 (conídio/APCs) foi a melhor proporção entre as células para avaliar o processo de fagocitose e as etapas de desenvolvimento do fungo assim como o tempo de 6 horas de interação foi o melhor tempo para a certificação da internalização dos conídios pelas APCs. Após o processo de internalização dos conídios pelas APCs os mesmos começaram a se dilatar, formar tubos germinativos e hifas septadas que se ramificaram formando um micélio que destruiu as células humanas no período de 24 horas de observação. A avaliação quantitativa da fagocitose dos conídios pelas APCs demonstrou que não houve diferenças significativas entre o percentual fagocítico dos macrófagos e células dendríticas de cada doador como também entre os doadores. A interação do fungo com as APCs na presença de L-Name não modificou o processo de desenvolvimento do conídio no interior das células humanas, quando comparado a interação das células sem L-Name. Em relação aos marcadores de superfície celular a presença dos conídios não aumentou o percentual de macrófagos expressando CD14, porém aumentou as células expressando B7.1 e DC-SIGN. As células dendríticas apresentaram um percentual semelhante de células positivas para B7.1,na ausência e presença do fungo, e um aumento significativo do percentual de células DC-SIGN positivas na presença dos conídios. Os conídios de P. lilacinus foram capazes de estimular a secreção da citocina IL1-beta pelos macrófagos e células dendríticas e é possível que eles tenham inibido a produção de TNF-alfa pelos macrófagos. Então, os dados aqui apresentados demonstram a capacidade invasiva para APCs e de estimulação de moléculas de superfície importantes na resposta imune do hospedeiro por P. lilacinus, até o momento desconhecida...

Pulmonary fungal infection with hyalohyphomycosis associated with zygomycosis and Actinomyces spp. in a patient with ankylosing spondylitis / Infecção fúngica pulmonar por hialo-hifomicose associada a zigomicose e Actinomyces spp. em paciente com espondilite anquilosante

A espondilite anquilosante (EA) pode cursar com manifestações extra-articulares e, dentre elas, as pulmonares. A fibrose nos ápices pulmonares ocorre em até 30 por cento dos casos e as formações císticas são menos frequentes e observadas em casos avançados. A colonização dessas cavidades é uma complicação rara. Um paciente com diagnóstico de EA desde 1998, com comprometimento axial, histórico de tuberculose pulmonar tratada em 2002 e 2007, evoluiu com um quadro de aspergilose bilateral em ápices pulmonares associada à zigomicose e Actinomyces spp. Havia sido internado para investigar queixa de emagrecimento, sudorese noturna, tosse produtiva e lesão nos ápices pulmonares. Foi submetido a tratamento cirúrgico de lobectomia de lobo pulmonar superior direito, após identificação de bola fúngica nos ápices pulmonares nas radiografias e tomografias, comprovados por exames de fibrobroncoscopia e biópsia com exame anatomopatológico. Evoluiu sem expansão pulmonar direita, foi submetido à nova fibrobroncoscopia que sugeriu oclusão do brônquio lobar médio. Uma nova toracotomia não confirmou o achado da fibrobroncoscopia. Permaneceu sem expansão pulmonar direita, evoluiu com choque séptico refratário ao tratamento e ao óbito.

Ankylosing spondylitis (AS) can be associated with extra-articular manifestations, among which we find pulmonary disorders. Fibrosis of the pulmonary apices is seen in up to 30 percent of the cases, and cyst formation is less common, being seen in advanced cases. Colonization of those cavities is a rare complication. A patient with a diagnosis of AS since 1998 with axial involvement and history of pulmonary tuberculosis treated in 2002 and 2007, developed bilateral aspergillosis of the pulmonary apices associated with zygomycosis and Actinomyces spp. The patient had been hospitalized to investigate complaints of weight loss, nocturnal diaphoresis, productive cough, and lesion in both lung apices. He was submitted to right upper pulmonary lobectomy after identification of a fungus ball on chest X-ray and CT scan, which was confirmed by a fibrobronchoscopy and biopsy for anatomopathological exam. The patient evolved without expansion of the right lung and underwent another fibrobronchoscopy that suggested occlusion of the middle lobar bronchus. Repeat thoracotomy did not confirm the findings of the last fibrobronchoscopy, but the right lung failed to expand. The patient developed septic shock refractory to treatment and died.

Foot hyalohyphomycosis caused by Fusarium subglutinans:a case report / 中华皮肤科杂志

Objective To report a case of foot hyalohyphomycosis due to Fusarium subglutinans. Methods Medical history was collected and physical examination performed for this patient.Biopsy samples were obtained from the inner side of right ankle of this patient and subjected to pathological examination. Discharge was collected from the lesions for direct microscopic examination and culture.Results A 72-year-old woman presented with an ulcer on the right foot for 3 years.Physical examination disclosed an ulcer,measuring 3 cm x 1.5 cm,with a moist surface and obvious tenderness,at the inner side of the right ankle.Proliferation of dusky-red granulomatous tissue was observed at the base of the ulcer.Pathological examination revealed necrotic granulomatous tissue and slender,septate and hyaline hypha-like structure in the superficial dermis with scattered infiltration of inflammatory cells.PAS staining showed sausage-like hypha and scattered orbicular-ovate spores.Microscopic examination of lesional discharge exhibited septate, branching and hyaline hypha.The isolated fungus was identified as Fusarium subglutinans by culture,and appeared to be highly sensitive to terbinafine,nystatin and amphotericin B.The lesion completely healed after 2 months of treatment with oral terbinafine (0.25 g,twice a day).Conclusions This is a case of foot hyalohyphomycosis due to Fusarium subglutinans,and terbinafine is effective for this condition.