Curso clínico de micosis producidas por Exophiala xenobiotica en paciente trasplantado renal en el Hospital Universitario de Burgos / Clinical course of micosis produced by exophiala xenobiotica in renal transplanted patient at the University Hospital of Burgos

Resumen Las micosis por Exophiala xenobiotica comprenden un amplio espectro clínico en pacientes inmunosuprimidos, desde infecciones localizadas, hasta diseminadas. Son incluidas como etiología de las feohifomicosis, actualmente consideradas como infecciones fúngicas emergentes en pacientes trasplantados de órgano sólido. Presentamos 2 casos de micosis por Eexophiala xenobiotica en paciente trasplantado renal, una micosis cutánea localizada y una infección sistémica con afectación del sistema nervioso central.

Abstract Mycosis by exophiala xenobiotica comprise a broad clinical spectrum in immunosuppressed patients, from localized to disseminated infections. They are a recognized etiology of phaeohyphomycosis, currently considered as emerging fungal infections in transplanted solid organ recipients. We present 2 cases of mycosis by exophiala xenobiotica in kidney transplant recipients, a localized cutaneous mycosis and a systemic infection with central nervous system involvement.

Tiña negra: reporte de tres casos pediátricos / Tinea nigra: report of three pediatrics cases

Resumen: Introducción: La tiña negra es una micosis superficial causada por Hortaea werneckii. Su caracte rística clínica es la aparición de una mácula café negruzca de rápido crecimiento, producto del pig mento sintetizado por el mismo hongo. Sus características pigmentarias y de rápido crecimiento, de localización preferentemente acral, genera preocupación en los pacientes y en sus médicos tratantes por la sospecha de una lesion névica en evolución. Objetivos: Presentar 3 casos clínicos de pacientes pediátricos con esta patología y dar a conocer las herramientas para su diagnóstico diferencial. Casos clínicos: Tres pacientes, edades 3 y 5 años, con lesión macular pigmentada en palmas o plantas, cuyos padres referían habían crecido en forma rápida en poco tiempo. Dos de los casos tenían antecedentes de viajes previos al Caribe. Ante la sospecha clínica y dermatoscópica de una tiña negra, se realizó exámen micológico que confirmó el diagnóstico. En todos los casos, el tratamiento con antimicóticos tópicos llevó a la resolución completa de las lesiones. Conclusión: Aunque la tiña negra es rara en un clima seco, los viajes cada vez más frecuentes de los pacientes a países tropicales, probablemente aumentarán el número de casos. La dermatoscopía y el examen micológico son las herramientas que permiten realizar un correcto diagnóstico, evitando biopsias y/o cirugías innecesarias.

Abstract: Introduction: Tinea nigra is a superficial mycosis caused by Hortaea werneckii. Its clinical characte ristic is the appearance of a blackish brown macula of rapid growth, caused by the pigment produced by the fungus itself. The presence of a dark, fast growing, acral pigmentary lesion causes concern among patients and their treating physician about the possibility of a malignant pigmentary lesion. Objective: To present a series of three clinical cases in pediatric patients with this pathology and to show the tools that help to make a differential diagnosis. Clinical cases: Three patients between three and five years of age, which present a macular pigmented lesion on palms or soles, whose parents reported a rapid growth over a short period of time. Two of the patients reported previous trips to the Caribbean. Clinical and dermatoscopy suspicion of tinea nigra lead to a direct mycological exa mination, which confirmed the diagnosis. In all three cases, treatment with topical antifungals led to complete healing of the lesions. Conclusions: Although tinea nigra is rare in a dry climate, increasing travel of patients to tropical countries will increase the number of cases. Dermatoscopy and direct mycological examination are the tools that allow performing a correct diagnosis and avoiding unne cessary biopsies and/or surgeries.

A Case of Phaeohyphomycosis on the Wrist: Identification of Exophiala spinifera in Korea

No abstract available.

A Case of Subcutaneous Phaeohyphomycosis Caused by Exophiala oligosperma Showing Multiple Cysts / 대한피부과학회지

Exophiala species are dark pigmented fungi associated with phaeohyphomycosis that exhibit yeast-like or hyphal forms of the fungus in superficial subcutaneous locations or systemic disease. The incidence of subcutaneous tissue infection of Exophiala species has recently increased, particularly in immunocompromised hosts. In Korea, E. jeanselmei, E. dermatitidis, and E. salmonis were isolated from patients with phaeohyphomycosis. However, there have been no case reports of phaeohyphomycosis caused by E. oligosperma. Here we report the first case of phaeohyphomycosis caused by E. oligosperma in Korea. An 82-year-old female with competent immune function presented with multiple subcutaneous masses on the dorsum of the left hand and wrist. A histopathological examination of the skin specimen revealed granulomatous inflammation with fungal hyphae and yeast. Molecular identification was performed using internal transcribed spacer sequences analysis. The sequence showed 100% identity with the E. oligosperma strains. She was treated with oral itraconazole and showed improvement.

Phaeohyphomycosis in renal transplantation: report of two cases

Abstract Phaeohyphomycosis is an infection caused by a filamentous fungus that contains pigment melanin in its cell wall. We report two cases caused by Exophiala sp. emphasizing the clinical variability of the disease, as well as diagnostic and therapeutic difficulties of this opportunistic infection in immunosuppressed patients (kidney transplant).

A Case of Phaeohyphomycosis Caused by Exophiala lecanii-corni

No abstract available.

A Case of Phaeohyphomycosis from Exophiala Species Mimicking Facial Cutaneous Tumor / 대한의진균학회지

Phaeohyphomycosis is an infection of humans and other animals caused by a number of phaeoid fungi. It is characterized by the development of dark-colored hyphae and other types of fungal elements in invaded tissues. Phaeohyphomycosis caused by Exophiala species is an unusual infection, but it has been reported with increasing frequency as laboratory methods for diagnosis have improved. A 68-year-old woman presented with yellowish round crusted plaque which is similar to actinic keratosis or keratoacanthoma on her right cheek. Histopathologic examination showed mononuclear cell infiltrate and dark-brown hyphae. The nucleotide sequence of internal transcribed spacer-2 was identical to that of Exophiala species. We report a case of phaeohyphomycosis mimicking skin cancer.

Central nervous system infection caused by Exophiala dermatitidis in a case and literature review / 中华儿科杂志

<p><b>OBJECTIVE</b>To summarize the clinical features, imaging characteristics, diagnosis and treatment of a case with central nervous system infection caused by Exophiala dermatitidis, as well as to review the related literature.</p><p><b>METHOD</b>Associated literature and clinical data of an 8-year-old boy who was diagnosed as central nervous system infection caused by Exophiala dermatitidis in Beijing Children's Hospital Affiliated to Capital Medical University and hospitalized twice from 2012 to 2014 were analyzed retrospectively.</p><p><b>RESULT</b>The boy was 8 years old with the chief complaint of dizziness for 2 months, intermittent fever for 1 month accompanied with spasm twice. He was diagnosed as bile ducts space-occupying lesions 2 years ago, when the pathological diagnosis was fungal infection. The boy was treated with irregular anti-fungal therapy. Then the boy developed nervous symptoms, impaired consciousness and abnormal physical activity that developed gradually. After hospitalization the cerebral MRI of the boy showed space-occupying lesions accompanied with edema of surrounding area. Filamentous fungi was found by brain biopsy, which was culture positive for Exophiala dermatitidis. After diagnosis the boy was treated with amphotericin B (AMB), voriconazole and 5-Fu, as well as symptomatic treatment. The state of the boy was improved gradually. Two months later, the boy could communicate with others normally and move personally. The lesions and edema seen on the MRI was decreased moderately. Accordingly, the boy was treated with oral voriconazole maintenance treatment for about 1 year and 4 months after discharge. During this period, the state of him was stable without symptoms. The lesions shown by MRI did not disappear but decreased on regular examination. However, recently the disease of the boy progressed again, with dizziness, neck pain, headache and progressive nervous symptoms (intermittent spasm, inability to cough, and impaired consciousness). The boy died at last, even with the active treatment at the second hospitalization. Exophiala dermatitidis was culture-positive again in his CSF, and was confirmed by PCR successfully.</p><p><b>CONCLUSION</b>The central nervous system infection caused by Exophiala dermatitidis is rare. Clinical features of this disease were similar to those of other fungal CNS infection, cerebral MRI of which could show the similar lumpy lesions. Diagnosis of the disease should be based on pathology and culture.</p>

Diversidad y polimorfismo en el género Exophiala: manejo de las especies comunes en el laboratorio de baja complejidad / Diversity and polimorphism in the genus Exophiala: handling of common species in the low complexity laboratory

Exophiala es un género fúngico poco común, conocido como integrante de las levaduras negras y sus respectivas formas filamentosas que pertenece al orden Chaetothyriales. Estos hongos son causantes de cromoblastomicosis o diferentes tipos de faeohifomicosis en pacientes sanos o con compromiso inmune (cutáneas, subcutáneas, diseminadas y quistes de faeohifomicosis). Sus miembros son a menudo difíciles de clasificar a nivel de especie solo por métodos fenéticos, debido a su polimorfismo en cultivo y la gran diversidad molecular que exhiben, la cual se confirma en la revisión de la literatura en estos últimos 15 años. El objetivo de este estudio, se basa en la descripción y recopilación de las especies más comunes del género, presente en ambientes diversos y específicos, con especial atención a los principales aportes morfo fisiológicos útiles en su diagnóstico en un laboratorio de baja complejidad, sin olvidar que debido a su alto polimorfismo y la aparente similitud entre especie, el micólogo debe confirmar su hallazgo mediante el envío de su cepa a un laboratorio de referencia internacional para evitar el subdiagnóstico.

Exophiala is an uncommon fungic genus, known as integrant of black yeast and its filamentous relatives that belong to the Chaetothyriales order. This fungi produce cromoblastomicosis or different kinds of phaeohyfomycosis in healthy patients or immunocompromissed patients (cutaneous, subcutaneous, scattered and phaeohyfomycosis’s cysts). Its members are often hard to classify to species by only using phenetics methods, because they present polimorfisms in culture and shows great molecular diversity, wich is confirmed in the review of literature in the last 15 years. The aim of this study is the description and recopilation of the most common species of the genus, that is present in a variety or specific enviroments, with special enphasis onto the principal morfophysiologic contributions that are usefull to diagnose in a low complexity laboratory, given its high polymorfism and similar look between species, the mycologist must confirm its strain by sending it to an international reference laboratory in order to avoid underdiagnosis.

Cutaneous and subcutaneous phaeohyphomycosis caused by Exophiala jeanselmei after renal transplantation: a case report / 南方医科大学学报

We report a case of cutaneous and subcutaneous phaeohyphomycosis caused by Exophiala jeanselmei after renal transplantation in Guangdong. A 66-year-old man who had a renal transplantation 6 years ago was admitted in October 2011 for the presence of 16 nodules (0.5-1.5 cm) found on his right middle finger, wrist and forearm for 5 months. Microscopic examination of the purulent exudate showed segmented and branched brown mycelium, and tissue biopsy and PAS staining showed fungal hyphae. The isolate was processed for morphological identification and molecular sequence analysis. A black colony was found after culture of the isolate on SDA at 26 degrees Celsius;, and small culture identified the isolate as Exophiala jeanselmei. ITS sequence analysis of the isolate showed a 100% homology with Exophiala jeanselmei. E-test strip was used in drug sensitivity test, and the isolate was sensitive to amphotericin B, voriconazole, itraconazole and fluconazole, but resistant to 5-flucytosine and caspofungin. Good response was obtained with surgical intervention, local injection and systemic antifungal treatment.

Molecular Phylogenetics of Exophiala Species Isolated from Korea

BACKGROUND: Recently, identification of fungi have been supplemented by molecular tools, such as ribosomal internal transcribed spacer (ITS) sequence analysis. According to these tools, morphological Exophiala species was newly introduced or redefined. OBJECTIVE: This study was designed to investigate the phylogenetics based on ribosomal ITS sequence analysis from clinical Exophiala species isolated in Korea. METHODS: The strains of Exophiala species were 4 clinical isolates of phaeohyphomycosis agents kept in the department of dermatology, Dongguk University Medical Center(DUMC), Gyeongju, Korea. The DNAs of total 5 strains of Exophiala species were extracted by bead-beating method. Polymerase chain reaction of ITS region using the primer pairs ITS1-ITS4, was done and phylogenetic tree contributed from sequences of ITS region from 5 Korean isolates including E. dermatitidis CBS 109154 and comparative related strains deposited in GenBank. RESULTS: The strains of Exophiala species were 3 strains of E. dermatitidis, 1 strain of E. jeanselmei and 1 strain of Exophiala new species. Among the 3 subtypes (type A, B, C) of E. jeanselmei, E. jeanselmei DUMC 9901 belonged to type B. Of the 2 main types of E. dermatitidis (type A, B) and 3 subtypes of E. dermatitidis type A (A0, A1 and A2), two strains (E. dermatitidis CBS 709.95, E. dermatitidis CBS 109154) belonged to A0 subtypes, 1 strain (E. dermatitidis DUMC 9902) A1 subtype, respectively. CONCLUSION: Phylogenetic analysis of ITS region sequence provided useful information not only for new species identification but for the subtyping and origin of Exophiala species.

Infecções causadas por fungos demácios e suas correlações anátomo-clinicas / Infections caused by dematiaceous fungi and their anatomoclinical correlations

O gênero Exophiala é composto por fungos melanizados dimórficos, responsáveis por um espectro de doenças, incluindo feohifomicoses, micetomas, cromoblastomicoses e fungemia. A espécie E. jeanselmei é a predominante nestas infecções, seguida de E. dermatitidis. Este trabalho tem como objetivo relatar quatro casos e discutir aspectos clínicos, histológicos, micológicos e epidemiológicos para o seu diagnóstico.

The Exophiala genus comprises dimorphic melanized fungi responsible for a spectrum of diseases including phaeohyphomycosis, mycetoma, chromoblastomycosis and fungemia. The E. jeanselmei species is predominant in such infections, followed by E. dermatitidis. This paper aims at reporting four cases and at discussing clinical, histologycal, mycologycal and epidemiologycal aspects for its diagnosis.

Feoifomicose subcutânea / Subcutaneous phaeohyphomycosis

São apresentadas imagens ilustrativas de um caso de feoifomicose subcutânea causada pela Exophiala jeanselmei num paciente transplantado renal. Breves comentários sobre a doença encontram-se no texto. Ressalta-se a necessidade de essa micose entrar no diagnóstico diferencial de outras dermatoses, inclusive as não infecciosas.

This report shows images of a case of subcutaneous phaeohyphomycosis caused by Exophiala jeanselmei in a patient who has undergone renal transplantation. The paper comments briefly on the disease and emphasizes the need to take this mycosis into account in the differential diagnosis of other dermatoses, including non-infectious dermatoses.

Feo-hifomicose subcutânea por Exophiala jeanselmei localizada na bolsa escrotal: relato de caso / Subcutaneous phaeohyphomycosis on the scrotum caused by Exophiala jeanselmei: case report

A feo-hifomicose subcutânea é uma doença causada por fungos demáceos que acomete principalmente indivíduos imunocomprometidos e geralmente cursa com lesões localizadas nos membros inferiores. Os autores relatam um caso de feo-hifomicose subcutânea em um paciente imunocompetente, com localização atípica - na hemibolsa escrotal esquerda -, tratado com sucesso com fluconazol sistêmico associado à excisão cirúrgica.

Subcutaneous phaeohyphomycosis is a disease caused by dematiaceous fungi that develops mainly in immunocompromised patients. Lesions are generally located on the lower limbs. The present report describes a case of phaeohyphomycosis in an immunocompetent patient in whom a subcutaneous abscess was located in an unusual site, on the left hemiscrotum. The abscess was treated successfully with oral fluconazole associated with surgical excision.

Feohifomicosis subcutánea / Subcutaneous phaeohyphomycosis

La feohifomicosis subcutánea es una infección de la piel y tejido celular subcutáneo causada por hongos dematiáceos. Se presenta el caso de una paciente inmunosuprimida que al examen físico mostró una lesión quística supurativa. En el estudio histológico se hallo granulomas supurativos y necrosis; el estudio micológico evidenció Exophiala dermatitidis. El tratamiento consistió en exéresis de la lesión y administración de itraconazol.

Subcutaneous phaeohyphomycosis is an infection of the skin and subcutaneous tissue caused by fungi demateaceos. We present the case of an inmunosuppressed woman whose physical examination showed a cystic suppurative lesion. Histological study evidenced suppurative granulomas and necrosis; mycological study demonstrated Exophiala dermatitidis. Treatment consisted on oral itraconazole and surgical excision.

Fungemia due to Exophiala dermatitidis / 대한임상미생물학회지

We report a rare case of fungemia due to Exophiala (Wangiella) dermatitidis in a 4-month-old female infant who was admitted to an intensive care unit with sudden infant death syndrome (SIDS). E. dermatitidiswas repeatedly isolated from blood cultures (on the 28th and 32nd day of hospitalization) of the patient, who died on the 44th day of hospitalization. The fungus was identified by its morphological characteristics and DNA sequencing of both the D1/D2 domain and the ITS region of rDNA. To our knowledge, this is the first reported case of E. dermatitidis fungemia in Korea.

Reporte de un caso de tiña negra en Medellín / Report a case of tinea nigra in Medellín

Presentamos el caso de un paciente que consultó por una “mancha oscura” en la palma derecha. El examen microbiológico determinó que la infección había sido producida por el hongo pigmentado, Hortaea werneckii, agente etiológico de la tiña negra. Esta es una infección benigna que tiene tratamiento eficaz cuando se hace el diagnóstico adecuado. Mediante una técnica no invasiva es posible establecer un diagnóstico etiológico y descartar otras enfermedades más graves que se pueden confundir en el examen clínico.

Antifungal Susceptibility Testing of Dematiaceous Fungi Using Etest / 대한의진균학회지

BACKGROUND: Despite the increase of infections caused by dematiaceous fungi, the antifungal susceptibility of these fungi has been the little study. It is necessary to perform antifungal susceptibility testing of dematiaceous fungi. Etest (AB Biodisk, Sweden) is a rapid, easy-to-perform in-vitro antifungal susceptibility test. OBJECTIVE: The purpose of the study was to investigate the minimal inhibitory concentration (MICs) of dematiaous fungi isolated from skin lesion using Etest. METHODS: The dematiaceous fungal strains studied were nine clinical isolates of chromoblastomycosis and phaeohyphomycosis agents (3 strains of Exophiala dermatitidis, 4 strains of Fonsecaea pedrosoi, 2 strains of Exophiala jeanselmei) and two standard strains (Aspergillus flavus KCTC 6905, Aspergillus fumigatus KCTC 6145). MIC endpoints of Etest for amphotericin B (AMB) and itraconazole (ITZ) susceptibility were read after 72, 96, and 120 hours incubation for each isolates on RPMI 1640 agar. RESULTS: MIC of AMB was 0.125~1.0 microgram/mL on E. dermatitidis & F. pedrosoi, and 0.19~0.25 microgram/mL on E. jeanselmei. MIC of ITZ was 0.38~1.5 microgram/mL on E. dermatitidis, 0.016~0.125 microgram/mL on F. pedrosoi, and 0.064~0.25 microgram/mL on E. jeanselmei. Two strains of E. dermatitidis isolated from Korean patients with phaeohyphomycosis showed ITZ-resistant. CONCLUSION: This study showed that Etest represented a simple and efficacious method for antifungal susceptibility testing of dematiaceous fungi.

Dermatomicose e ceratite micótica causada por Exophiala sp em um cão / Dermatomycosis and mycotic keratitis caused by Exophiala sp in a dog

Neste trabalho, descreve-se o diagnóstico e a conduta terapêutica aplicada em caso de dermatomicose e ceratite micótica causada por Exophiala sp em um cão com um ano e seis meses de idade. Os sinais clínicos incluíam alopecia, crostas, despigmentação e ulceração do plano nasal e focinho, e ceratite superficial bilateral no canto lateral dos olhos. Na cultura fúngica foi isolado Exophiala sp e o exame histopatológico da biopsia cutânea revelou dermatite nodular superficial e profunda granulomatosa. O tratamento com itraconazol sistêmico promoveu remissão dos sinais clínicos. Conclui-se que a realização de cultura fúngica e biópsia de pele são exames complementares eficazes no diagnóstico de dermatomicoses e que o emprego de itraconazol sistêmico pode ser efetivo no tratamento de dermatite fúngica e ceratite micótica causado por Exophiala sp em cão.

This report describes the diagnosis and the therapeutic conduct applied to the cases of subcutaneous dermatomycosis and mycotic keratitis caused by Exophiala sp in a one and a half year-old dog. The clinical signs included alopecia, crusts, dispigmentation, ulcerations in the nose and superficial bilateral keratitis in the corner of the eyes. In the fungal cultures, Exophiala sp was isolated and the microscopic analysis revealed characteristics of fungal dermatitis. Systemic therapy with itraconazole evidenced remission of clinical signs. The realization of fungal cultures and cutaneous biopsy are efficient complementary procedures in the diagnosis of dermatomycosis and that the usage of oral itraconazole can be effective in the treatment of fungal dermatitis and mycotic keratitis caused by Exophiala sp in dogs.