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Postepy Dermatologii I Alergologii Oct 2014Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue. The infection usually results from a traumatic injury and inoculation of... (Review)
Review
Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue. The infection usually results from a traumatic injury and inoculation of microorganism from a specific group of dematiaceous fungi (usually Fonsecaea pedrosoi, Phialophora verrucosa, Cladophialophora carrionii). In the tissues fungi produce characteristic sclerotic cells or muriform cells. Dermal lesions can range from small nodules to large papillary-like eruptions. The disease has been described worldwide but the prevalence is higher in rural populations in countries with a tropical or subtropical climate, such as Madagascar in Africa and Brazil in South America. Diagnostic techniques are based on direct examination, culture and histopathology. Despite a variety of treatment modalities, which include long courses of antifungals, surgical excision and destructive physical therapies, the disease remains one of the most difficult deep mycotic infections to eradicate.
PubMed: 25395928
DOI: 10.5114/pdia.2014.40949 -
PLoS Neglected Tropical Diseases Aug 2021Chromoblastomycosis (CBM), represents one of the primary implantation mycoses caused by melanized fungi widely found in nature. It is characterized as a Neglected...
BACKGROUND
Chromoblastomycosis (CBM), represents one of the primary implantation mycoses caused by melanized fungi widely found in nature. It is characterized as a Neglected Tropical Disease (NTD) and mainly affects populations living in poverty with significant morbidity, including stigma and discrimination.
METHODS AND FINDINGS
In order to estimate the global burden of CBM, we retrospectively reviewed the published literature from 1914 to 2020. Over the 106-year period, a total of 7,740 patients with CBM were identified on all continents except Antarctica. Most of the cases were reported from South America (2,619 cases), followed by Africa (1,875 cases), Central America and Mexico (1,628 cases), Asia (1,390 cases), Oceania (168 cases), Europe (35 cases), and USA and Canada (25 cases). We described 4,022 (81.7%) male and 896 (18.3%) female patients, with the median age of 52.5 years. The average time between the onset of the first lesion and CBM diagnosis was 9.2 years (range between 1 month to 50 years). The main sites involved were the lower limbs (56.7%), followed by the upper limbs (19.9%), head and neck (2.9%), and trunk (2.4%). Itching and pain were reported by 21.5% and 11%, respectively. Malignant transformation was described in 22 cases. A total of 3,817 fungal isolates were cultured, being 3,089 (80.9%) Fonsecaea spp., 552 (14.5%) Cladophialophora spp., and 56 Phialophora spp. (1.5%).
CONCLUSIONS AND SIGNIFICANCE
This review represents our current knowledge on the burden of CBM world-wide. The global incidence remains unclear and local epidemiological studies are required to improve these data, especially in Africa, Asia, and Latin America. The recognition of CBM as NTD emphasizes the need for public health efforts to promote support for all local governments interested in developing specific policies and actions for preventing, diagnosing and assisting patients.
Topics: Ascomycota; Chromoblastomycosis; Fonsecaea; Global Burden of Disease; Humans; Phialophora
PubMed: 34383752
DOI: 10.1371/journal.pntd.0009611 -
Journal of Fungi (Basel, Switzerland) Jan 2021Chromoblastomycosis is a chronic severely mutilating disease caused by fungi of the order . Classically, has been listed among these etiologic agents. This species is...
Chromoblastomycosis is a chronic severely mutilating disease caused by fungi of the order . Classically, has been listed among these etiologic agents. This species is known to occur in the environment and has been found to cause other infections like phaeohyphomycosis, while reported cases of chromoblastomycosis are scant. is phylogenetically diverse, and thus retrospective confirmation of etiology is necessary. We studied ten proven cases of chromoblastomycosis from Mexico and further analyzed the population genetics and genomics of the species to understand their pathogenicity and predilection. The clinical strains were molecularly identified as ( = 4), ( = 4), and ( = 2). No genetic distinction between clinical and environmental strains was possible. Further analysis of strains from diverse origins are needed to address eventual differences in virulence and niche predilection between the species.
PubMed: 33572699
DOI: 10.3390/jof7020095 -
Journal of Clinical Microbiology Jan 2020
PubMed: 31992652
DOI: 10.1128/JCM.01657-18 -
Persoonia Jun 2017as defined by its type species is a genus of , and a member of the group known as 'black yeasts and relatives'. has been reported from mutilating human infections...
as defined by its type species is a genus of , and a member of the group known as 'black yeasts and relatives'. has been reported from mutilating human infections such as chromoblastomycosis, disseminated phaeohyphomycosis and mycetoma, while morphologically similar fungi are rather commonly isolated from the environment. Phenotypes are insufficient for correct species identification, and molecular data have revealed significant genetic variation within the complex of species currently identified as or . Multilocus analysis of 118 strains revealed the existence of five reproductively isolated species apparently having different infectious potentials. Strains of the sexual morph cluster within . The newly defined taxa differ markedly in their predilection for the human host.
PubMed: 29151624
DOI: 10.3767/003158517X692779 -
Retinal Cases & Brief Reports May 2023To report a rare case of a subretinal Phialophora richardsiae abscess in a patient with chronic granulomatous disease (CGD).
PURPOSE
To report a rare case of a subretinal Phialophora richardsiae abscess in a patient with chronic granulomatous disease (CGD).
METHODS
A 21-year-old male with CGD and a history of invasive pulmonary aspergillosis presented with progressive loss of vision and pain in his left eye. He was found to have a subretinal abscess with a macula involving serous retinal detachment. A diagnostic and therapeutic pars plana vitrectomy, subretinal biopsy with debridment, inferior retinectomy and silicone oil tamponade was performed. Intraoperative cultures grew Pleurostoma (Phialophora) richardsiae. He was treated with systemic liposomal amphotericin B and high-dose Posaconazole. However, eye eventually required enucleation.
RESULTS
Preoperative visual acuity (VA) was light perception on the left eye and improved to count fingers at 4 weeks post-operative. However, VA rapidly declined to light perception, he developed an opaque white cataract, iris neovascularization, posterior synechiae, and corectopia. The retina remained attached under silicone oil. Histopathology revealed granuloma formation and active fungal elements.
DISCUSSION/CONCLUSION
The case supports the importance of vitreoretinal surgery to determine a definitive systemic diagnosis. Treatment of Phialophora infection is surgically challenging to manage and has a poor visual prognosis in patients with CGD.
PubMed: 37267629
DOI: 10.1097/ICB.0000000000001442 -
Mycoses May 2021Black opportunists Phialophora verrucosa complex species can cause different disease types in competent and in immunocompromised individuals, but are remarkably...
BACKGROUND
Black opportunists Phialophora verrucosa complex species can cause different disease types in competent and in immunocompromised individuals, but are remarkably overrepresented in CARD9-related infections.
OBJECTIVES
To better understand the ecology and potential pathogenicity of opportunistic Phialophora species and reveal eventual genetic parameters associated with the behaviour in vivo and genetic profiles in patients with CARD9 immunodeficiency.
METHODS
Genomes of 26 strains belonging to six species of the Phialophora verrucosa complex were sequenced. Using multilocus analysis, all environmental and clinical strains were identified correctly. We compared the genomes of agents from different disease types among each other including CARD9 immunodeficiency.
RESULTS
We obtained genome sizes of the 26 Phialophora strains ranged between 32 and 37 MB. Some species showed considerable intraspecific genomic variation. P americana showed the highest degree of variability. P verrucosa was variable in CAZy enzymes, whereas P americana varied in PKS-related genes. Phialophora species, particularly P verrucosa, are relatively frequent in patients with CARD9-related immunodeficiency. Different mutations in the CARD9 gene seem to increase susceptibility for infection by different groups of species, that is either Candida, dermatophytes or black fungi. A number of patients with chromoblastomycosis revealed an as yet unknown CARD9 mutation. TNFα impairment was prevalent in patients with CARD9 infections, while CBM patients were invariably IFNγ.
CONCLUSIONS
From genomic investigations, the known virulence factors between clinical and environmental strains did not reveal any significant difference. Phialophora complex has an equal chance to cause infection in humans, either healthy or CARD9-impaired.
Topics: CARD Signaling Adaptor Proteins; Candidiasis; Chromoblastomycosis; Fungal Proteins; Genome, Fungal; Genomics; Humans; Immunocompromised Host; Opportunistic Infections; Phaeohyphomycosis; Phialophora; Phylogeny
PubMed: 33455056
DOI: 10.1111/myc.13244 -
Acta Cytologica 2020Phaeohyphomycosis caused by phaeoid fungi is a type of mycosis emerging worldwide which causes a wide variety of clinical manifestations.
OBJECTIVE
Phaeohyphomycosis caused by phaeoid fungi is a type of mycosis emerging worldwide which causes a wide variety of clinical manifestations.
STUDY DESIGN
A retrospective analysis of 11 cases diagnosed with fungal inflammation on cytology over a period of 6 years (2013-2018) was done along with culture/histopathologic confirmation.
RESULTS
Of the total of 11 cases, 9 cases presented with subcutaneous swellings and 1 case each with brain and lung lesions. The age range was 30-83 years (mean: 53.6); 8 patients were male and 3 were female. Cytologic smears showed fungal profiles with septate tortuous hyphae, as well as swollen and narrow, yeast-like swellings with an irregular breadth of the hyphae in all cases. The fungal profiles were visualized on a Masson-Fontana stain. The background showed inflammatory cells, giant cells, and necrosis in variable proportions. Five cases were diagnosed as phaeohyphomycosis on cytology, whereas 3 cases were misdiagnosed as aspergillus and 2 as candida. In 1 case, typing of the fungus was not done. Histopathology was available in 5 cases, and in all these a diagnosis of phaeohyphomycosis was reached. Ten of the 11 cases had confirmation on fungal culture.
CONCLUSIONS
Phaeoid fungi are rarely seen in routine cytologic practice. Careful evaluation of cytologic smears and an awareness of the characteristic morphologic features of phaeohyphomycosis are helpful in arriving at a correct diagnosis. Fine needle aspiration cytology provides a rapid diagnosis, enabling prompt therapy.
Topics: Adult; Aged; Aged, 80 and over; Cytodiagnosis; Female; Follow-Up Studies; Humans; Male; Middle Aged; Phaeohyphomycosis; Phialophora; Retrospective Studies
PubMed: 32203955
DOI: 10.1159/000506432 -
Allergologie Select 2018Allergic skin and respiratory diseases range among the most frequent afflictions in industrialized countries. Due to this fact the importance of indoor mold pollution... (Review)
Review
Allergic skin and respiratory diseases range among the most frequent afflictions in industrialized countries. Due to this fact the importance of indoor mold pollution based on dampness is discussed. In a sentinel health study of the State Health Agency (LGA) children attending of 4th grade of a primary school were tested by an in-vitro allergy screening (UniCap 100/Phadia) for the mold allergens mx1 (Penicillium chrysogenum m1, Cladosporium herbarum m2, Aspergillus fumigatus m3 and Alternaria alternata m6). Primarily about 5% of the children were sensitized against molds which are associated with the ambient air. The investigations showed that most of the children were sensitized against Alternaria alternata and concerning the IgE-concentration (kU/l) Alternaria alternata had the highest concentration among the tested allergens. Commonly children with sensitization against molds were polysensitized. It is unclear if the allergy screening against mold mx1 includes molds with indication for indoor mold pollution such as Acremonium spp., Aspergillus penicillioides, Aspergillus restrictus, Aspergillus versicolor, Chaetomium spp., Phialophora spp., Stachybotrys chartarum, Tritirachium (Engyodontium) album und Trichoderma spp. by means of crossreaction. Therefore, such investigations do not admit any conclusion about health problems as a result of indoor mold pollution. At the present state of knowledge exposure measurements of indoor mold pollutions are not possible, at most a semiquantitative assessment. Although it is generally accepted that dwellings with moisture and mold represent a health risk, knowledge about indoor mold pollution and the related health problems is lacking.
PubMed: 31826039
DOI: 10.5414/ALX01296E -
American Journal of Ophthalmology Case... Mar 2023To report the initial case of microbial keratitis caused by , a rare cause of fungal keratitis.
PURPOSE
To report the initial case of microbial keratitis caused by , a rare cause of fungal keratitis.
OBSERVATIONS
A 66-year-old gentleman with a complex right eye (OD) ocular history including herpes simplex virus infectious epithelial keratitis with subsequent neurotrophic keratopathy, and prior combined and fungal keratitis presented with pain OD in the absence of an antecedent trauma. The patient was found to have a filamentous fungal keratitis, which was subsequently cultured and identified as by the laboratory. Despite topical and oral antifungal treatment based on sensitivities determined by the lab, the patient ultimately required intrastromal and subconjunctival antifungal injections, corneal crosslinking, and superficial keratectomy with amniotic membrane to clinically improve. The fungal keratitis recurred twice, with each occurrence rapidly progressing to corneal perforation. Months after the second penetrating keratoplasty, the patient's mental status declined due to multiorgan failure. An occult pulmonary malignancy was discovered during this hospital stay, and the patient was lost to follow-up after entering hospice.
CONCLUSIONS AND IMPORTANCE
We report a unique case of fungal keratitis caused by and the subsequent management, including both medical and surgical interventions Despite a multimodal treatment regimen, this case demonstrates the recalcitrant and potentially recurrent nature of fungal keratitis caused by .
PubMed: 36714019
DOI: 10.1016/j.ajoc.2023.101800