Phaeohyphomycosis: A study from tertiary health care center in North India

Objectives: Phaeohyphomycosis refers to infections caused by phaeoid/dematiaceous or darkly pigmented fungi. This study was undertaken to further increase our knowledge about the incidence of phaeohyphomycosis and its causative agents. Materials and Methods: The present study was conducted over a period of one and a half years (January 2018–June 2019) on specimens received from patients with varied clinical manifestations ranging from superficial infections, subcutaneous cysts, pneumonia, brain abscess to a disseminated infection. These specimens were processed in the Department of Microbiology for potassium hydroxide (KOH) examination and culture and in Pathology for cytology/histopathological examination (HPE). All specimens positive on direct examination for dark grey, brown or black fungi were included in the study. Results: A total of 20 specimens were confirmed as phaeohyphomycosis. Most of the patients belonged to the age group of 41 to 50 years. Male: Female ratio was 2.3:1. Trauma was the most common risk factor. Spectra of the isolated fungal pathogens comprised of Bipolaris species, Exophiala species, Curvularia geniculata, Phialemonium species, Daldinia eschscholtzii, Hypoxylon anthochroum, Phaeoacremonium species, Leptosphaerulina australis, Medicopsis romeroi, Lasiodiplodia theobromae, Eutypella species, Chaetomium globosum, Alternaria species, Cladophialophora bantiana and 2 unidentified dematiaceous fungi. Recovery from phaeohyphomycosis was seen in 12 patients, 7 were lost to follow up and one patient succumbed to the illness. Conclusion: Infections caused by phaeoid fungi can no longer be viewed as rare. In fact, phaeohyphomycosis can have myriad of presentations spanning from mild cutaneous infections to fatal brain disease. Therefore, a high index of clinical suspicion is needed to diagnose such infections. The primary treatment modality remains surgical removal of the lesion in cutaneous or subcutaneous infections however disseminated disease with a guarded prognosis requires aggressive management.

Iatrogenic Phaeohyphomycosis: A Rare and Underrecognized Disease

Summary@#Phaeohyphomycosis refers to a heterogenous group of mycotic infections caused by dematiaceous fungi where unintentional traumatic inoculation accounts for majority of the cases. Herein, we are reporting a rare case of iatrogenic subcutaneous phaeohyphomycosis which is secondary to intravenous cannula placement.

Afectación intestinal por un hongo dematiáceo / Intestinal disease by a dematiaceous fungi

Resumen Introducción: Los hongos dematiáceos se caracterizan por la presencia de abundante melanina en su pared celular. Presentan una distribución mundial, siendo más comunes en climas tropicales y subtropicales. Producen infecciones cutáneas y subcutáneas, además de enfermedades alérgicas, neumonías, abscesos cerebrales o infecciones diseminadas. Caso Clínico: Presentamos el caso de un paciente con adenocarcinoma de recto intervenido quirúrgicamente con hallazgo incidental de divertículo de Meckel y en el cual en el estudio anatomopatológico reveló la presencia de un hongo dematiáceo

Introduction: Dematiaceous fungi are characterized by the presence of brown melanine or melanine like pigments in their cell wall. They are generally distributed worldwide, being more common in tropical and subtropical climates. The clinical syndromes are often cutaneous and subcutaneous infections, but can be also responsible of allergic diseases, pneumonias, cerebral abscesses or disseminated infections. Clinical Case: We present the case of a patient with a diagnosis of rectal adenocarcinoma intervening surgically and with an incidental finding of Meckel's Diverticulum. The anatomopathological study revealed the presence of a dematiaceous fungi.

Causative fungi and treatment outcome of dematiaceous fungal keratitis in North India

Purpose: The aim of the study is to identify risk factors, clinical characteristics, causative fungi, and treatment outcome of dematiaceous fungal keratitis in North India. Methods: Consecutive cases of culture-proven dematiaceous fungal keratitis between January 2012 and June 2017 were retrieved from the medical record department. Risk factors, clinical signs, and outcome were registered. Results: Eighty-three patients were included. Identified dematiaceous fungal organism were Curvularia sp. (n = 55/83; 66.3%), Alternaria sp. (n = 12/83; 14.5%), Ulocladium sp. (n = 5/83; 6%), Bipolaris sp. (n = 5/83; 6.1%), Scedosporium sp. (n = 3/83; 3.6%), Acremonium sp. (n = 2/83; 2.4%), and Epicoccum sp. (n = 1/83; 1.2%). Male preponderance was reported. The most common predisposing factor was corneal trauma (67.4%). In cases associated with corneal trauma due to vegetative matter, sugarcane was the most common cause. In all, 89% of the patients were more than 30 years of age. The median infiltrate size was 8 mm2. The median time of antifungal therapy was 4.2 weeks (interquartile range [IQR]: 1-25 weeks). Complications were seen in 14 (n = 14/65; 21.5%) patients. Complete resolution of dematiaceous fungal keratitis was present in 27 (n = 27/65; 41.5%) eyes. Conclusion: Curvularia sp. and Alternaria sp. were the predominant pathogenic genera causing dematiaceous fungal keratitis. Among the causative fungi, infections due to Scedosporium sp. were associated with the worst outcomes. Ulocladium sp. and Epicoccum sp. were also identified. Both the species are not reported previously as a causal organism of dematiaceous fungal keratitis from North India.

Chromoblastomycssis: a neglected tropical disease / Cromoblastomicose: doença tropical negligenciada

SUMMARYChromoblastomycosis (CMB) is a chronic fungal infection of the skin and the subcutaneous tissue caused by a transcutaneous traumatic inoculation of a specific group of dematiaceous fungi occurring mainly in tropical and subtropical zones worldwide. If not diagnosed at early stages, patients with CBM require long term therapy with systemic antifungals, sometimes associated with physical methods. Unlike other neglected endemic mycoses, comparative clinical trials have not been performed for this disease. Nowadays, therapy is based on a few open trials and on expert opinion. Itraconazole either as monotherapy or associated with other drugs, or with physical methods, is widely used. Recently, photodynamic therapy has been successfully employed in combination with antifungals in patients presenting with CBM. In the present revision the most used therapeutic options against CBM are reviewed as well as the several factors that may have impact on the patient's outcome.

RESUMOCromoblastomicose (CMB) é uma infecção fúngica crônica da pele e tecido subcutâneo causada pela inoculação transcutânea traumática de um grupo específico de fungos dermatiáceos que ocorrem principalmente em zonas tropicais e subtropicais do mundo. Quando não são diagnosticados nas fases iniciais, pacientes com CBM necessitam de tratamentos prolongados com antifúngicos sistêmicos, por vezes associados a métodos físicos. Diferentemente de outras micoses endêmicas negligenciadas, não foram realizados ensaios clínicos comparativos para esta doença. Atualmente a terapia é baseada em alguns poucos ensaios abertos e em opiniões de especialistas. Itraconazol é amplamente utilizado como monoterapia ou em associação com outras drogas, ou com métodos físicos. Recentemente, a terapia fotodinâmica foi empregada com sucesso combinada a antifúngicos em pacientes com CBM. Neste manuscrito as opções terapêuticas mais utilizadas contra CBM foram revistas, assim como os diversos fatores que podem influenciar a evolução dos pacientes.

ADR: An atypical presentation of rare dematiaceous fungus.

The association of fungus in allergic fungal rhino sinusitis has been around 200 times in the world literature. As per the available literature, the most common agent identified so far appears to be ASPERGILLUS, though the condition is increasingly associated with Dematiaceous fungi. Here we report for the first time the presence of unusual fungus in allergic rhino sinusitis, which has not been reported so far.

Bipolaris: a rare etiology of ureteric mycosis with Double J stent in situ.

Fungi classified under the genera Bipolaris are dematiaceous hyphomycetes which are rare sources of human diseases. The dematiaceous fungi in other words “black fungi” are so named due to the presence of dark melanin like pigment in their cell wall. Majority of the species of Bipolaris, are either soil saprobes or plant pathogens, however few species of these saprobes like Bipolaris australiensis, Bipolaris hawaiiensis & Bipolaris spicifera are potential pathogens which are capable of causing infections in both immunocompetent & immunocompromised humans. The spectrum of human infections caused by Bipolaris include cutaneous and subcutaneous infections, allergic sinusitis, keratitis, allergic broncho pulmonary diseases, orbitopathy, CNS infections, Peritonitis associated with Ambulatory peritoneal dialysis, infections of implant devices & allografts. Here we report a case of ureteric infection due to Bipolaris species in a patient with Double J (DJ) stent in situ. Amphotericin B, itraconazole, voriconazole and imidazole are common antifungals found to be effective in treating Bipolaris infections.

Use ITS gene sequence analysis to identify dematiaceous fungi / 实用医学杂志

Objectives Use ITS gene sequence analysis to identify 15 strains of dematiaceous fungi , to learn the types of pathogenic strains and clinical treatment. Methods By observing the colony morphology and microscope morphological of the dematiaceous fungi isolated from superficial mycoses , and identified by ITS gene sequence analysis. Results 15 strains were identified by morphological observation as dematiaceous fungi.The amplified bands were identified by Tanon-3500 gel imaging system between 500 ~ 700 bp. Blast sequencing results show that 2 strains Alternaria alternate , 2 strains Cladosporium sphaerospermum. 2 strains Exophiala dermatitis, 1 strains Cladosporium cladosporioides, Curvularia lunata, Talaromyces rugulosus, Phaeobotryon cupressi, Cladosporium tenuissimum, Fonseceea pedrosoi, Exophiala werneckii, Exophiala oligosperma and Fonsecaea monophora. Conclusion ITS gene sequence analysis can identify dematiaceous fungi effectively , avoided undetected and misdiagnose cause by the lack of clinical experience.

Feo-hifomicose sistêmica em cão / Systemic phaeohyphomycosis in a dog

Descrevem-se os achados clínicos, laboratoriais e histopatológicos de feo-hifomicose sistêmica em um cão. Clinicamente observou-se cansaço, ascite, apatia, hiporexia, perda de peso e polidipsia. O animal estava sendo tratado para erliquiose e babesiose. Após 11 dias, o cão retornou com hepatopatia grave e veio a óbito em 48 horas. Na necropsia, observaram-se nódulos enegrecidos em vários órgãos da cavidade abdominal. Histologicamente, havia reação granulomatosa necrosante com hemorragia, associada a miríades de hifas fúngicas pigmentadas intralesionais em múltiplos órgãos, caracterizando feo-hifomicose sistêmica. Ressalta-se a importância de incluir esta doença no diagnóstico diferencial de hepatopatias graves em cães com ascite.

The objective of this study was to describe clinical, laboratorial and histopathological findings of systemic phaeohyphomycosis in a dog. The animal was presented with a history of fatigue, ascites, lethargy, weight and appetite loss and polydipsia. The therapy for erliquiose and babesiosis was started. After 11 days, the dog returned with severe liver disease and died after forty-eight hours. At necropsy, there were black nodules in various abdominal organs. Histologically, necrotizing granulomatous reaction with hemorrhage associated with myriads of intralesional pigmented fungal hyphae was observed in multiple organs, characterizing systemic phaeohyphomycosis. Thus, it is important to include this illness in the differential diagnosis of severe liver diseases in dogs with ascites.

Chromoblastomycosis in Santa Catarina state, Brazil / Cromoblastomicosis en el estado de Santa Catarina, Brasil

A case of chromoblastomycosis caused by Cladophialophora carrionii is reported. The diabetic and hypertensive patient presented serpiginous and verrucous lesions, with centrifugal evolution. The patient, with a history of disease for 59 years, had not been diagnosed or treated before. Dematiaceous septate hyphal and elliptical conidia were seen on microscopic observations. The isolated fungus was identified on the basis of micro-macromorphologic characteristics.

Se reportó un caso de cromoblastomicosis causado por Cladophialophora carrionii. El paciente, diabético e hipertenso, presentaba lesiones de apariencia verrugosa y serpiginosa, con evolución centrífuga. Tenía un historial de enfermedad hace 59 años sin haber sido diagnosticado hasta entonces. En el examen microscópico de observaron elementos hifales septados, pigmentados y con conidios elípticos. La identificación del hongo se basó en las características macromorfológicas y micromorfológicas.

Subcutaneous phaeohyphomycosis caused by cladophialophora boppii.

Subcutaneous phaeohyphomycosis is an infection of the skin and subcutaneous tissue, caused by dematiaceous fungi. An adult male presented with a history of multiple reddish nodules over the face and hands. Histopathological examination of the skin biopsies showed a dense granulomatous infiltrate of macrophages, containing intracytoplasmic basophilic bodies throughout the dermis. Gomori methenamine-silver stained sections revealed yeast cells within macrophages. Multiple cultures on Sabouraud's dextrose agar grew Cladophialophora boppii. The patient was treated with oral itraconazole for a year and the response monitored with dermal ultrasound. This is the first case report of subcutaneous phaeohyphomycosis caused by Cl. boppii in India.

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.

Infections Caused by Dematiaceous Fungi / 대한의진균학회지

The dematiaceous fungi, characterized by having melanin in their cell walls, have become significant due to an increasing cause of human skin disease in Korea. The disease caused by dematiaceous fungi contain pityriasis (tinea) nigra, onychomycosis (in part), black piedra, keratomycosis (in part), chromoblastomycosis, phaeohyphomycosis, and eumycotic mycetoma (in part). Chromoblastomycosis is subcutaneous mycotic disease that contain sclerotic cells and histologically show pseudoepitheliomatous hyperplasia with microabscess, and phaeohyphomycosis is a group of mycotic infections that contain dematiaceous yeast-like cells, pseudohypae-like elements, hyphae or combination of these form in tissue.

Genetic Diversity of Dematiaceous Fungi Using Random Amplified Polymorphic DNA / 대한의진균학회지

BACKGROUND: There are three kinds of diseases caused by dematiaceous fungi: chromoblastomycosis, phaeohyphomycosis, and eumycotic mycetoma. The dematiaceous fungi have been identified and classified by morphological, biochemical and physiological tests. Recently molecular analysis has been introduced to the field of medical mycology. OBJECTIVE: We investigated the genetic diversity of dematiaceous fungi using random amplified polymorphic DNA (RAPD). METHODS: The dematiaceous fungal strains studied were eight clinical isolates of chromoblastomycosis and phaeohyphomycosis agents (3 strains of Fonsecaea pedrosoi, 2 strains of Exophiala dermatitidis, 1 strain of Exophiala jeanselmei, 1 strain of Phialophora verrucosa, 1 strain of Rhinocladiella aquaspersa) and 4 standard strains (F. pedrosoi IFM 4889, E. dermatitidis IFM 4828, P. verrucosa IFM 4928, R. aquaspersa IFM 4930). Total twelve strains of dematiaceous fungi were cultured on Sabouraud's dextrose broth and their DNA were extracted by bead-beating method. RESULTS: The optimal condition for PCR was template DNA 0.025 mg and annealing temperature 39 degrees C. The RAPD analysis using OPA 10 primer (5'-GTGATCGCAG-3') of Operon kit showed different patterns among dematiaceous fungi. But one clinical isolate of F. pedrosoi showed intra-specific variability. CONCLUSION: The RAPD analysis is considered a rapid and reliable method for identification and classification of dematiaceous fungi if the procedure is carefully standardized with adequate primer.

Ribosomal DNA Gene Analysis of Dematiaceous Fungi Using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism / 대한피부과학회지

BACKGROUND: There are three kinds of diseases caused by dematiaceous fungi: chromoblastomycosis, phaeohyphomycosis, and eumycotic mycetoma. The dematiaceous fungi have been identified and classified by morphological, biochemical and physiological tests. Recently molecular analysis has been introduced to the field of medical mycology. OBJECTIVE: Ribosomal DNA gene analysis of dematiaceous fungi using polymerase chain reaction(PCR)-restriction fragment length polymorphism(RFLP) is investigated. METHODS: The dematiaceous fungal strains studied were eight clinical isolates of chromoblastomycosis and phaeohyphomycosis agents(3 strains of Fonsecaea pedrosoi, 2 strains of Exophiala dermatitidis, 1 strain of Exophiala jeanselmei, 1 strain of Phialophora verrucosa, 1 strain of Rhinocladiella aquaspersa) and 4 standard strains(F. pedrosoi IFM 4889, E. dermatitidis IFM 4828, P. verrucosa IFM 4928, R. aquaspersa IFM 4930). Total twelve strains of dematiaceous fungi were cultured on Sabouraud dextrose broth and their DNA was extracted by bead-beating method. PCR-RFLP of ribosomal gene small subunit(SSU rDNA) and internal transcribed spacer(ITS)1-ITS2 ribosomal regions using the primer pairs NS1-NS2 and ITS1-ITS4, respectively were done. RESULTS: The PCR product obtained from the SSU rDNA amplification was of approximately 603 bp and restriction profile was clustered into two genetically heterogenous groups, the first one formed by F. pedrosoi and the second one formed by other dematiaceous fungi. In contrast, the amplified PCR products of ITS regions ranged in sized from 580 to 620 bp and restriction profile was clustered into five genetically heterogenous groups and it can be possible to differentiate dematiaceous fungi. But one clinical isolate of F. pedrosoi showed intra-specific variability. CONCLUSION: The PCR-RFLP analysis of SSU rDNA and ITS regions provided useful information for identification and classification of dematiaceous fungi.

Fungi Colonizing Sapwood of Japanese Red Pine Logs in Storage

The Korean sawmills have recently recognized the importance of prevention of fungal discoloration due to increased losses in revenue. Before establishing integrated control strategies of fungal discoloration, more complete knowledge about causal organisms is needed. As a first step, we initiated a through survey of fungi colonizing commercially important softwood (Pinus densiflora, Pinus koraiensis, and Pinus radiata) logs and lumber in Korea. In this paper we report results obtained from Japanese red pine (Pinus densiflora) log study. In summer 2000, fungi were isolated from Japanese red pine logs in storage, and identified based on their cultural and morphological characteristics. A total of 595 fungi were isolated, representing 21 genera and 30 species. Mold fungi, mostly Trichoderma species, were the most frequently isolating fungi, representing more than half of all isolates. Dematiaceous fungi represented approximately one fifth of the isolates, and Rhinocladiella atorvirens was the most abundant in all samples. Opiostoma species represented 7% of all isolates from cores planted on malt extract agar (MEA) and the incidence of these species doubled with the addition of streptomycin and cycloheximide to MEA. The results indicate that Japanese red pine sapwood is susceptible to colonization by a variety of fungal species. As a result, control strategies that concentrate on one fungus may have limited success because of interference from competing flora.