101
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Shankar S, Biswas J, Gopal L, Bagyalakshmi R, Therese L, Borse NJ. Anterior chamber exudative mass due to Scedosporium apiospermum in an immunocompetent individual. Indian J Ophthalmol 2007; 55:226-7. [PMID: 17456946 DOI: 10.4103/0301-4738.31949] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Endogenous intraocular infection of fungal etiology is extremely rare in an immunocompetent individual. Usually, an antecedent history of trauma, surgery, intravenous drug abuse or an immunocompromized state can be elicited. Scedosporium apiospermum is a known cause of keratomycosis after traumatic implantation and can cause fatal disseminated infection in immunocompromized patients. However, cases of S. apiospermum intraocular infection in immunocompetent individuals have been very rarely reported in literature. We report here a case of an anterior chamber exudative mass due to S. apiospermum in an immunocompetent individual which was managed successfully with anterior chamber wash and intravitreal injection of voriconazole.
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Affiliation(s)
- Sandeep Shankar
- Medical and Vision Research Foundations, Sankara Nethralaya, College Road, Chennai, India
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102
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Lopez MJ, Robinson SO, Cooley AJ, Prichard MA, McGinnis MR. Molecular identification ofPhialophora oxysporaas the cause of mycetoma in a horse. J Am Vet Med Assoc 2007; 230:84-8. [PMID: 17199497 DOI: 10.2460/javma.230.1.84] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION An 18-year-old mare was evaluated for an oral mass that developed after extraction of a broken incisor. CLINICAL FINDINGS An ulcerated, firm, darkly pigmented, approximately 5-cm-diameter spherical mass involved the gingiva lateral and dorsal to the right first to third maxillary incisors. Osteolysis of the roots of the first and second right maxillary incisors and periosteal proliferation of the adjacent premaxilla margins were apparent on radiographs. Histologic examination of the mass revealed multiple coalescing and ramifying foci of abscess formation, each containing a well-defined, discrete, black mass (2 to 7 mm in diameter). Myriad fungal hyphae enmeshed in a black, granular, cementlike material were within each of the black structures. Mycetoma was the histologic diagnosis. The causative agent could not be identified via culture because of lack of distinguishing characteristics. Fungal DNA was isolated from frozen fungal cultures and paraffin sections. The D1/D2 domains of the large subunit P gene rDNA were amplified and sequenced. The sequences of the D1/D2 domains of both isolates were 96% homologous with those of Phialophora oxyspora. TREATMENT AND OUTCOME The mass was surgically excised, the local area curetted, and the wound allowed to heal by second intention. Postoperative treatment consisted of administration of phenylbutazone and IV administration of sodium iodide followed by oral administration of potassium iodide. There was no evidence of recurrence 1 year later. CLINICAL RELEVANCE Mycetomata should be a differential diagnosis for equine gingival masses. Identification of the fungal agent can be critical for selection of optimal treatments. Molecular methods may permit definitive identification when standard phenotypic-based identification criteria are inconclusive.
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Affiliation(s)
- Mandi J Lopez
- Laboratory for Equine and Comparative Orthopedic Research, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA
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103
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Abstract
BACKGROUND Mycetoma is a chronic infection caused by aerobic actinomycetes and filamentous fungi. It is an occupational disease frequent in tropical countries and is uncommon in children. METHODS A retrospective (25 years) report of mycetomas was conducted in children less than 15 years of age. Each of the cases was studied clinically and proven with microbiologic tests: direct examinations (to identify and classify the grains), cultures and identification based on morphology and biochemical tests. The therapeutic experience of the cases was also reviewed. RESULTS In a 25-year period, a total of 334 mycetomas were seen at our institution, 15 of which (4.5%) were in patients 15 years of age and younger (mean age: 11.2 years, age range: 6-15 years). Twelve cases were males and 3 females. The main clinical location was the foot in 10 of 15 (66.6%). Etiologies included 13 actinomycetomas and 2 eumycetomas. Etiologic agents were Nocardia brasiliensis in 12 cases, Nocardia asteroides in one and Madurella mycetomatis in 2. Eleven of the13 cases of actinomycetomas treated with trimethoprim-sulfamethoxazole plus diaminodiphenylsulfone were cured. The 2 failures were successfully treated with amoxicillin/clavulanate. One of the eumycetomas was cured with itraconazole therapy, whereas the other failed various treatments eventuating in surgical amputation. CONCLUSIONS Mycetomas are exceptional in children; in our setting, actinomycetomas are more frequent than eumycetomas. The clinical and microbiologic diagnosis is simple. Overall, treatment response is better for actinomycetomas than for eumycetomas.
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Affiliation(s)
- Alexandro Bonifaz
- Mycology Department, Hospital General de Mexico, Mexico City, Mexico.
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104
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Loulergue P, Hot A, Dannaoui E, Dallot A, Poirée S, Dupont B, Lortholary O. Successful treatment of black-grain mycetoma with voriconazole. Am J Trop Med Hyg 2006; 75:1106-7. [PMID: 17172376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Fungal mycetoma (or eumycetoma) are endemic diseases in tropical areas that have economic effects because of their chronic and disabling evolution. Classic treatments include surgery and antifungal drugs, but these have multiple side effects. We report a case of black-grain fungal mycetoma successfully treated with voriconazole without side effects. The duration of the treatment remains unclear, but must be prolonged because of the frequency of relapses.
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Affiliation(s)
- Pierre Loulergue
- Centre d'Infectiologie Necker-Pasteur, et Service de Radiologie, Hôpital Necker-Enfants Malades, Université Paris V, Paris, France.
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105
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Abstract
Mycetomas are chronic, progressive infections caused either by fungi (eumycetoma) or filamentous bacteria (actinomycetoma) and are characterized by the triad of draining sinuses, tumefaction, and the presence of macroscopic grains. We describe a case of eumycetoma in a cardiac transplant recipient caused by the soil saprophyte Acremonium species. This represents only the fifth case of eumycetoma reported in a solid organ transplant recipient. With the population of immunosuppressed patients and the incidence of invasive fungal infections increasing, consideration should be given to unusual saprophytic fungal infections as emerging opportunistic pathogens.
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Affiliation(s)
- Adam S Geyer
- Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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106
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Vázquez-Tsuji O, Campos Rivera T, Rondán Zárate A, Mirabal García M. Endobronquitis por Scedosporium apiospermum en una niña con fibrosis quística. Rev Iberoam Micol 2006; 23:245-8. [PMID: 17388652 DOI: 10.1016/s1130-1406(06)70054-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A case of endobronchitis by Scedosporium apiospermum in a child with cystic fibrosis is presented. The bronchial aspirate's cytology showed the presence of a large amount of septated-dichotomized hyphae. The bronchial aspirate's culture showed the presence of Scedosporium apiospermum in a pure culture of three consecutive samples. The scanning electron microscopy study of the mucosal surface revealed scarce mycelia with the presence of abundant conidiae. The transmission electron microscopy of the mucosa revealed inflammatory infiltrates constituted by macrophages, polymorphonuclear leukocytes, a lot of dichotomized mycelia and macrophages with hyphae and conidiae within the phagosomes. The patient was treated with amphotericin B and itraconazole.
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Affiliation(s)
- Oscar Vázquez-Tsuji
- Laboratorio de Biología Molecular y Microscopía Electrónica, Facultad Mexicana de Medicina, Universidad La Salle, Mexico.
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107
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Abstract
A 29-year-old woman with swelling, multiple nodules and discharging sinuses of her right foot is presented. A single nodule on the sole was excised 15 years ago and since then she has had recurrent attacks of swelling and discharging sinuses that improved partially with antibiotics. Magnetic resonance images (MRI) revealed an ill-defined mass predominantly with low signal intensity on T2W images. Within the granulomata, multiple unenhancing foci, with low T1W and T2W signal most likely representing the fungal balls or grains were detected. Histopathological examination revealed large clusters of microorganisms resembling fungal hyphae and bacteria, which were surrounded by mixed inflammatory infiltrate cells and stained positively by PAS and Gomori's methenamine silver stain. As minimal regression was seen on MRI with 4 months' itraconazole (200 mg day(-1)) treatment, co-trimoxazole (160 TMP/800 SMX b.i.d.) was added to treatment. Complete remission was established by MRI examination after 10 months with this combination therapy.
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Affiliation(s)
- Kamer Gündüz
- Department of Dermatology, Celal Bayar University, No. 25/5 Manisa, Turkey.
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108
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Bates DD, Mims JW. Invasive fungal sinusitis caused by Pseudallescheria boydii: case report and literature review. Ear Nose Throat J 2006; 85:729-37. [PMID: 17168149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Fungal sinusitis secondary to Pseudallescheria boydii is rare, as only 25 cases have been previously reported in the literature. Although Pboydii resembles Aspergillus on pathologic examination, it is typically resistant to amphotericin B. Therefore, culture is necessary to differentiate the two. Patients with P boydii sinusitis should generally be treated with a combination of surgery and antifungal therapy. Combination treatment is particularly important for immunocompromised patients with fungal invasion because mortality among these patients is high. The prognosis is better for immunocompetent patients, even those with fungal invasion. We describe a new case of invasive fungal sinusitis secondary to P. boydii infection, and we review the literature on this emerging pathogen.
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Affiliation(s)
- Dwight D Bates
- Department of Otolaryngology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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109
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Musk M, Chambers D, Chin W, Murray R, Gabbay E. Successful Treatment of Disseminated Scedosporium Infection in 2 Lung Transplant Recipients: Review of the Literature and Recommendations for Management. J Heart Lung Transplant 2006; 25:1268-72. [PMID: 17045941 DOI: 10.1016/j.healun.2006.06.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 02/21/2006] [Accepted: 06/02/2006] [Indexed: 11/18/2022] Open
Abstract
Scedosporium species (sp) can cause disseminated disease in lung transplant recipients with almost universal mortality. We present 2 cases of disseminated disease, which responded to voriconazole therapy. In the first case, polymerase chain reaction was used to make a rapid diagnosis and allow differentiation from Aspergillus sp. In this patient, Scedosporium sp could be isolated in the urine despite therapy, and direct irrigation of the renal tract with voriconazole was used with apparent efficacy. In the other case, withdrawal of therapy resulted in clinical relapse, suggesting that lifelong therapy is probably required.
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Affiliation(s)
- Michael Musk
- Lung Transplant Unit, Royal Perth Hospital, Perth, Western Australia, Australia
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110
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Abstract
Since its discovery as an agent of mycetoma nearly a century ago, Pseudallescheria boydii with its asexual (synanamorphic) form, Scedosporium apiospermum, is now recognized as an important emerging opportunistic pathogen causing invasive mycosis in immunocompromised patients. The clinical spectrum of pseudallescheriasis is wide. Invasive disease of the lung, CNS and dissemination are serious manifestations in immunocompromised patients. This organism responds poorly to amphotericin B, and its histopathologic resemblance to aspergillosis often results in a delay in diagnosis. In vitro data, animal models and accumulating clinical experience support the use of voriconazole as a primary treatment for pseudallescheriasis. This paper reviews the microbiology, ecology, epidemiologic trends, clinical manifestations and current treatment options of pseudallescheriasis.
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Affiliation(s)
- Thomas A O'Bryan
- The Pennsylvania State University, College of Medicine, Hershey, PA 17033, USA.
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111
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Kapoor S, Khunger N, Jain RK, Dayal S, Mishra S, Capoor MR. Iatrogenic actinomycetoma of neck and back successfully treated with sulphonamides. Clin Exp Dermatol 2006; 32:95-6. [PMID: 16824049 DOI: 10.1111/j.1365-2230.2006.02225.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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112
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Abstract
Septic arthritis due to fungal infection is uncommon, but when it does occur it can have a devastating effect. Scedosporium prolificans is an emerging fungal pathogen that appears to have a predilection for bone and cartilaginous surfaces. This fungus is resistant to most commonly prescribed antifungal agents. We report the successful treatment of Scedosporium prolificans septic arthritis with a combination of surgery and new antifungal agents.
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Affiliation(s)
- Philip A Dalton
- Department of Orthopaedic Surgery, The Ipswich General Hospital, Ipswich, Australia.
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113
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Porte L, Khatibi S, Hajj LE, Cassaing S, Berry A, Massip P, Linas MD, Magnaval JF, Sans N, Marchou B. Scedosporium apiospermum mycetoma with bone involvement successfully treated with voriconazole. Trans R Soc Trop Med Hyg 2006; 100:891-4. [PMID: 16714039 DOI: 10.1016/j.trstmh.2005.12.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 12/22/2005] [Accepted: 12/22/2005] [Indexed: 11/23/2022] Open
Abstract
Treatment of Scedosporium apiospermum mycetoma usually requires limb amputation. A 49-year-old woman, from Ivory Coast, was diagnosed with Madura foot in 1995. She failed to respond to several treatments including itraconazole, fluconazole and co-trimoxazole, and refused limb amputation. In December 2002 she was admitted to hospital in France with a painful, swollen right leg and foot. She had no fever and C-reactive protein was 120 mg/l. Magnetic resonance imaging (MRI) confirmed the destruction of tarsus bones with a tibia extension. Voriconazole (400 mg/day) treatment was initiated in March 2003; a significant clinical improvement was observed within 4 months as confirmed by C-reactive protein (16 mg/l) and MRI. Voriconazole was maintained for 18 months with good tolerance. Cholestasis appeared after the first month and remained stable. In October 2004 voriconazole was discontinued due to side effects on the liver (alanine aminotransferase 17 times the normal level); MRI showed impressive regression of bone lesions. As of July 2005, the patient remains clinically well. Voriconazole appears to be a promising drug for the treatment of S. apiospermum mycetomas.
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Affiliation(s)
- L Porte
- Department of Infectious and Tropical Diseases, Purpan University Hospital, 31059 Toulouse Cedex, France.
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114
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Fuentes A, Arenas R, Reyes M, Fernández RF, Zacarías R. [Actinomycetoma and Nocardia sp. Report of five cases treated with imipenem or imipenem plus amikacin]. GAC MED MEX 2006; 142:247-52. [PMID: 16875355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
INTRODUCTION Dapsone with trimethoprim-sulfamethoxazol is currently the standard treatment for actinomycetoma. In select cases, amikacin, streptomycin, kanamycin, amoxicillin/clavulanic acid or phosphomycin may be also added. Imipenem has shown to be effective both in vitro and in vivo against some actinomycetes. Amikacin with Imipenem has a synergistic effect. OBJECTIVES To report our preliminary findings using imipenem alone or with amikacin for severe or multi-resistant mycetomas due to Nocardia sp. MATERIAL AND METHODS We present 5 cases of chronic mycetoma infection previously treated with anti-bacterial multidrug regimens. All patients were hospitalized and treated with imipenem 500 mg IV, three times a day for three weeks. Three patients received in addition amikacin. RESULTS We included 3 male and 2 female patients. The average length of disease duration was 7.4 years. In 3 cases mycetoma was located on the back; one of them involved the rib and the lung. One case was localized in the abdominal wall, and another one involved the posterior side of the cervical region. Two patients achieved clinical and bacteriological cure one year after treatment with Imipenem, and the remaining three displayed clinical improvement, even though grains were observed, cultures where negative. None of the 5 patients studied showed clinical evidence of adverse reactions to Imipenem. CONCLUSIONS Imipenem is a strong antibiotic and constitutes an important treatment alternative for severe or multi-resistant mycetoma especially for cases with bone and visceral involvement.
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Affiliation(s)
- Adán Fuentes
- Departamento de Dermatología, Hospital General Dr Manuel Gea González SSA, México DF
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115
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Oh IK, Baek S, Huh K, Oh J. Periocular abscess caused by Pseudallescheria boydii after a posterior subtenon injection of triamcinolone acetonide. Graefes Arch Clin Exp Ophthalmol 2006; 245:164-6. [PMID: 16612634 DOI: 10.1007/s00417-006-0325-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Revised: 02/28/2006] [Accepted: 03/02/2006] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A posterior subtenon injection of triamcinolone acetonide is an alternative to intravitreal injection in diabetic macular edema and is known to have fewer vision-threatening complications. Here, we report a case of periocular abscess following posterior subtenon injection of triamcinolone. METHODS A 62-year-old woman who had diabetic macular edema and disc neovascularization underwent a posterior subtenon injection of triamcinolone acetonide and panretinal laser photocoagulation. One month later a periocular abscess was noted in the inferotemporal area adjacent to the scleral wall. Pus was removed by fine-needle aspiration, and microbiologic cultures identified Pseudallescheria boydii. The patient was given systemic and subconjunctival treatment with itraconazole. However, conjunctival infection and anterior chamber inflammation worsened, and another posterior subtenon abscess was found. RESULTS Despite long-term systemic and topical itraconazole therapy, retinal detachment and vitreous opacity were shown on B-scan, and atrophic bulbi resulted. CONCLUSIONS Pseudallescheria boydii infection of the eye and orbit can result in a poor visual outcome. Prompt surgical debridement and drainage of the abscess, along with appropriate antifungal therapy based on susceptibility testing, must be mandatory.
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Affiliation(s)
- In Kyung Oh
- Department of Ophthalmology, Anam Hospital, Korea University College of Medicine, 26-1 Anam-dong 5-ga, Sungbuk-gu, Seoul, 136-705, South Korea
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116
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Bocanegra R, Najvar LK, Hernandez S, McCarthy DI, Graybill JR. Caspofungin and liposomal amphotericin B therapy of experimental murine scedosporiosis. Antimicrob Agents Chemother 2006; 49:5139-41. [PMID: 16304187 PMCID: PMC1315953 DOI: 10.1128/aac.49.12.5139-5141.2005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Immunosuppressed mice were infected intravenously with conidia of Scedosporium prolificans. Treatment was begun 1 day later with liposomal amphotericin B, caspofungin, or both drugs initiated concurrently. Amphotericin B and caspofungin were each effective, but combined therapy did not appear to offer advantages over liposomal amphotericin B alone.
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Affiliation(s)
- Rosie Bocanegra
- The University of Texas Health Science Center at San Antonio, Department of Medicine/Division of Infectious Diseases (MC 7881), 7703 Floyd Curl Drive, San Antonio, Texas 78229-3900, USA.
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117
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De Palma L, Marinelli M, Pavan M, Manso E, Ranaldi R. A rare European case of Madura Foot due to actinomycetes. Joint Bone Spine 2006; 73:321-4. [PMID: 16563843 DOI: 10.1016/j.jbspin.2005.10.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Accepted: 10/04/2005] [Indexed: 11/18/2022]
Abstract
We present a case of mycetoma by Actinomadura spp. on the foot of an Albanian young man arrived to our observation approximately 5 years after the first clinical manifestations (hard tumefaction, slightly painful upon weight-bearing and palpation and cutaneous fistulas that discharged an abundant granulomatous secretion). Direct microscopic analysis and culture of the white-yellowish grains included Gram staining, which showed extensively branched Gram-positive hyphae less than 1 mm in diameter, allowing to make a diagnosis of Actinomycetoma. Since Actinomycetoma is sensitive to drug treatment, the patient was given trimethoprim-sulfamethoxazole and amikacin twice daily for 45 days. After six months of chemotherapy, the patient's general condition improved, the swelling is slightly diminished and grain extrusion has ceased. The patient has been able to resume ambulation with normal footwear. Given the absence of liver and kidney functional alterations, the patient is scheduled to continue pharmacological treatment with trimethoprim-sulfamethoxazole.
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Affiliation(s)
- Luigi De Palma
- Cattedra di Ortopedia e Traumatologia, Università Politecnica delle Marche, Ancona, Ospedali Riuniti Umberto, Italy.
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118
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Abstract
We describe a patient with Pseudallescheria boydii keratitis. The treatment of mycotic keratitis remains difficult. This case demonstrates that identification and susceptibility testing should be rapidly performed. In cases of indolent keratitis, the possibility of fungal infection should be kept in mind.
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Affiliation(s)
- Yelda Ozkurt
- 1st Eye Clinic, Kartal Training and Research Hospital, Istanbul, Turkey
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119
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Enshaieh SH, Darougheh A, Asilian A, Iraji F, Shahmoradi Z, Yoosephi A, Davami M, Siadat AH, Vaez A. Disseminated subcutaneous nodules caused by Pseudallescheria boydii in an atopic patient. Int J Dermatol 2006; 45:289-91. [PMID: 16533231 DOI: 10.1111/j.1365-4632.2004.02546.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present a 40-year-old woman with atopic dermatitis and multiple purulent subcutaneous nodules of 20 years' evolution. The biopsy material was cultured and revealed Pseudallescheria boydii. The patient was treated with oral itraconazole for 4 months and incision and drainage of the lesions. Afterwards the patient remained asymptomatic and no new lesions were detected.
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Affiliation(s)
- S H Enshaieh
- Department of Dermatology, St-Zahra Hospital, Isfahan University School Of Medicine, Isfahan, Iran
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120
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Abstract
OBJECTIVES An open-label study was performed to assess the efficacy and safety of terbinafine in the treatment of eumycetoma. METHODS Single-center, open-label study, including 27 patients with signs and symptoms of eumycetoma which had developed within 5 years and was confirmed by mycological examination. The intention-to-treat population (n=23) received 500 mg of terbinafine bid for 24-48 weeks. Efficacy evaluations included clinical signs and symptoms (e.g. sinuses open or closed, degree of tumefaction, and emission of grains either present or absent); mycological examinations from Week 24 onwards; and investigators' overall assessment of efficacy (cure, improved since baseline, unchanged since baseline, or deterioration since baseline). Safety evaluations included monitoring of adverse events, laboratory assessments, vital signs and physical examinations. RESULTS Good clinical improvement was seen in patients who completed the study (n=20). Tumefaction was absent or improved in 80% of patients; sinuses were closed in 50% of patients, and grain emissions were absent in 65% of patients. Of the 16 patients who had repeat mycological assessment, four (25%) were mycologically cured. In the investigators' overall opinion at the end of the study, five (25%) were cured and 11 (55%) were clinically improved. The majority of adverse events reported were mild to moderate, and consistent with the known tolerability profile of terbinafine. CONCLUSION High-dose terbinafine (1,000 mg/day) is well tolerated and clinically effective in patients with eumycetoma, a difficult-to-treat subcutaneous mycoses.
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Affiliation(s)
- Bassirou N'diaye
- Service de Dermatologie B P 3001, Hôpital A. Le Dantec, Dakar, Senegal
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121
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Guarro J, Kantarcioglu AS, Horré R, Rodriguez-Tudela JL, Cuenca Estrella M, Berenguer J, de Hoog GS. Scedosporium apiospermum: changing clinical spectrum of a therapy-refractory opportunist*. Med Mycol 2006; 44:295-327. [PMID: 16772225 DOI: 10.1080/13693780600752507] [Citation(s) in RCA: 225] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Current knowledge on the opportunist Scedosporium apiospermum (teleomorph: Pseudallescheria boydii), generated over a period of more than 120 years, is reviewed. The natural environmental habitat of the fungus is unknown; nutrient-rich, brackish waters like river estuaria have been suggested. The fungus is strongly promoted by agricultural and particularly by industrial pollution.
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Affiliation(s)
- Josep Guarro
- Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
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122
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Buzina W, Feierl G, Haas D, Reinthaler FF, Holl A, Kleinert R, Reichenpfader B, Roll P, Marth E. Lethal brain abscess due to the fungusScedosporium apiospermum(teleomorphPseudallescheria boydii) after a near-drowning incident: case report and review of the literature. Med Mycol 2006; 44:473-7. [PMID: 16882615 DOI: 10.1080/13693780600654588] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A 39-year-old healthy man developed a brain abscess weeks after a near-drowning incident. Scedosporium apiospermum, the anamorph of Pseudallescheria boydii, was isolated from the abscess. The patient died 153 days after the accident despite antifungal therapy. We discuss the role of antifungals and review the literature for comparable cases.
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Affiliation(s)
- W Buzina
- Medical Mycology, Institute of Hygiene, Medical University Graz, Universitaetsplatz, Graz, Austria.
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123
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Negroni R, López Daneri G, Arechavala A, Bianchi MH, Robles AM. [Clinical and microbiological study of mycetomas at the Muñiz hospital of Buenos Aires between 1989 and 2004]. Rev Argent Microbiol 2006; 38:13-8. [PMID: 16784127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
This work presents clinical, microbiological and outcome data collected from 76 patients with mycetomas at the Muñiz Hospital from 1989 to 2004. Forty-nine patients were male and 27 female; the mean age was 43.4 years. The majority of the patients acquired the infection in Argentina: the most affected provinces were Santiago del Estero with 31 cases, and Chaco with 11; 8 cases came from other countries (Bolivia 6 and Paraguay 2). The mean evolution of the disease was 9.2 years. The most frequently observed sites were: feet 63 cases, ankles 3, and knees 2. Forty-eight patients had bone lesions and 5, adenomegalies. The following etiological agents were identified: Madurella grisea 29 cases, Actinomadura madurae 26, Scedosporium apiospermum 5, Nocardia brasiliensis 5, Acremonium spp. 4 (Acremonium falciforme 2, Acremonium kiliense 1, Acremonium recifei 1), Madurella mycetomatis 3, Fusarium solani 2, Nocardia asteroides 1 and Streptomyces somaliensis 1. The main drugs used in the treatments were ketoconazole and itraconazole for maduromycotic mycetomas, and cotrimoxazole associated with ciprofloxacin or amikacin for actinomycetic mycetoma. Six patients had to undergo amputation, 25 cases achieved complete clinical remission and 34 showed remarkable improvement.
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Affiliation(s)
- R Negroni
- Unidad Micología, Hospital Francisco Javier Muñiz. Uspallata 2272, (1282) Buenos Aires, Argentina.
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124
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Abstract
Scedosporium apiospermum is an uncommon cause of fungal infection in the orbit and sinus. Morbidity and mortality rates in immunocompromised patients are high. We review the first case of Scedosporium apiospermum orbito-sinus infection that was successfully treated with the new antifungal agent voriconazole. We highlight the efficacy of this drug, particularly in the treatment of osteomyelitis of the orbit and sinus, which may lead to an improvement in survival rates after Scedosporium infection.
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Affiliation(s)
- M O'Doherty
- Department of Ophthalmology, Mater Misecordiae Hospital, Dublin, Ireland
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125
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126
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Negroni R, Tobón A, Bustamante B, Shikanai-Yasuda MA, Patino H, Restrepo A. Posaconazole treatment of refractory eumycetoma and chromoblastomycosis. Rev Inst Med Trop Sao Paulo 2005; 47:339-46. [PMID: 16553324 DOI: 10.1590/s0036-46652005000600006] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Eumycetoma and chromoblastomycosis are chronic, disfiguring fungal infections of the subcutaneous tissue that rarely resolve spontaneously. Most patients do not achieve sustained long-term benefits from available treatments; therefore, new therapeutic options are needed. We evaluated the efficacy of posaconazole, a new extended-spectrum triazole antifungal agent, in 12 patients with eumycetoma or chromoblastomycosis refractory to existing antifungal therapies. Posaconazole 800 mg/d was given in divided doses for a maximum of 34 months. Complete or partial clinical response was considered a success; stable disease or failure was considered a nonsuccess. All 12 patients had proven infections refractory to standard therapy. Clinical success was reported for five of six patients with eumycetoma and five of six patients with chromoblastomycosis. Two patients were reported to have stable disease. As part of a treatment-use extension protocol, two patients with eumycetoma who initially had successful outcome were successfully retreated with posaconazole after a treatment hiatus of > 10 months. Posaconazole was well tolerated during long-term administration (up to 1015 d). Posaconazole therapy resulted in successful outcome in most patients with eumycetoma or chromoblastomycosis refractory to standard therapies, suggesting that posaconazole may be an important treatment option for these diseases.
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127
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Negroni R, López Daneri G, Maiolo E, Arechavala A. [Clinical cases in medical mycology. Case No. 19]. Rev Iberoam Micol 2005; 22:179-80. [PMID: 16309359 DOI: 10.1016/s1130-1406(05)70038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ricardo Negroni
- Unidad de Micología, Hospital de Infecciosas Francisco Javier Muñiz, Buenos Aires, Argentina.
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128
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129
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Mancini N, Ossi CM, Perotti M, Clementi M, DiGiulio DB, Schaenman JM, Montoya JG, McClenny NB, Berry GJ, Mirels LF, Rinaldi MG, Fothergill AW. Molecular mycological diagnosis and correct antimycotic treatments. J Clin Microbiol 2005; 43:3584; author reply 3584-5. [PMID: 16000516 PMCID: PMC1169111 DOI: 10.1128/jcm.43.7.3584-3585.2005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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130
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Abstract
We report a successfully treated case of mycetoma from which an unusual Nocardia species was isolated. The isolate was identified as N. veterana by biochemical characterization and 16S ribosomal RNA gene sequencing, and it has not been previously reported as a causative agent of human mycetomas. Treatment with various antibiotics over 6 years and surgical resection failed to cure the disease. However, the combination of intravenous imipenem/cilastatin and amikacin along with oral clarithromycin and minocycline proved very effective in this case. This is the first case report of mycetoma due to N. veterana in a clinical setting.
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Affiliation(s)
- M Kashima
- Department of Dermatology, St Marianna University, Kawasaki, Kanagawa 216-8511, Japan.
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131
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Abstract
Scedosporium prolificans is an unusual infection, especially following pterygium surgery. A 63-year-old man who developed an uncomfortable, red right eye 10 years after pterygium surgery with adjunctive mitomycin C is described. To the best of the authors' knowledge, this is the first reported case of S. prolificans sclerokeratitis following pterygium surgery with adjunctive mitomycin C.
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Affiliation(s)
- Ravinder P Singh
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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132
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Lacroix C, de Kerviler E, Morel P, Derouin F, Feuilhade de Chavin M. Madurella mycetomatis mycetoma treated successfully with oral voriconazole. Br J Dermatol 2005; 152:1067-8. [PMID: 15888176 DOI: 10.1111/j.1365-2133.2005.06534.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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133
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Dan M, Mereuţă AI, Burcoveanu C. [Disseminated infections due to Scedosporium apiospermum in a patient with anaplastic large cell lymphoma. A case study]. Rev Med Chir Soc Med Nat Iasi 2005; 109:638-41. [PMID: 16607764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
A 42-year-old man was diagnosed with hepatosplenic T-cell lymphoma in November 2003. Remission was incompletely achieved despite 10 courses of chemotherapy. He developed fever (38.5-39 degrees C), chills, cough and morning expectoration after the 61 courses of chemotherapy. During this period, an ultrasound of the abdomen showed multiple hypodense lesions of the liver. Culture of the sputum yielded Scedosporium apiospermum. Fungal cultures from blood remained negative. The patient was treated with voriconazol. After one month from therapy, an ultrasound examination showed decreasing of hypodense lesions of the liver, and no further lesions appeared. Based on significant improvement of liver lesions with voriconazole therapy, we proposed the diagnostic "probable" disseminated infections due to S.apiospermum.
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Affiliation(s)
- Maria Dan
- Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi, Facultatea de Medicină, Disciplina de Microbiologie Medicala, Spitalul Clinic de Urgenţe Sf. Spiridon, Iaşi
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134
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Schaenman JM, DiGiulio DB, Mirels LF, McClenny NM, Berry GJ, Fothergill AW, Rinaldi MG, Montoya JG. Scedosporium apiospermum soft tissue infection successfully treated with voriconazole: potential pitfalls in the transition from intravenous to oral therapy. J Clin Microbiol 2005; 43:973-7. [PMID: 15695722 PMCID: PMC548045 DOI: 10.1128/jcm.43.2.973-977.2005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
An immunocompromised patient with an invasive soft tissue infection due to Scedosporium apiospermum was successfully treated with voriconazole and surgical debridement. After transition from intravenous to oral therapy, successive adjustments of the oral dose were required to achieve complete resolution. For soft tissue infections due to molds characterized by thin, septate hyphae branching at acute angles, voriconazole should be considered a first-line antifungal agent. The potential usefulness of plasma voriconazole levels for guiding optimal therapy should be investigated.
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Affiliation(s)
- Joanna M Schaenman
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Dr., Rm. S-100, Stanford, CA 94305, USA.
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135
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136
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Abstract
We present the case of a 31-year-old patient who developed widespread mycetoma across her back and shoulders caused by Cladophialophora bantiana 16 years after injury to those sites from tornado debris. The patient also had a history of systemic lupus erythematosus treated with systemic steroids. Systemic antifungal treatment with fluconazole and itraconazole proved ineffective, and surgical debridement was required. Nine other culture-confirmed cases of cutaneous infection with this organism have been reported worldwide. This type of infection can occur in immunocompromised or immunocompetent patients, and may respond to systemic antifungals or surgery.
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Affiliation(s)
- Kelly D Werlinger
- Department of Dermatology at UT Southwestern Medical Center, Dallas, Texas, USA
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137
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Vilela R, Duarte OMV, Rosa CA, Castro JGF, Lyon S, Motta RL, Moura ACL. A case of eumycetoma due to Madurella grisea in northern Brazil. Mycopathologia 2005; 158:415-8. [PMID: 15630550 DOI: 10.1007/s11046-004-2844-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2004] [Accepted: 09/02/2004] [Indexed: 10/26/2022]
Abstract
A case of mycetoma caused by the black fungus Madurella grisea in northern Brazil is reported. The lesion was located on the patient's right foot without bone involvement. Clinical samples were collected by opening the fistules with a scalp and the grains removed for microbiological and histopathological analyses. Although mycetoma caused by M. grisea has been previously reported in Brazil, this is the first time that of this fungus has been identify in this particular region of the country.
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138
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Dieng MT, Niang SO, Diop B, Ndiaye B. [Actinomycetomas in Senegal: study of 90 cases]. Bull Soc Pathol Exot 2005; 98:18-20. [PMID: 15915967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Mycetoma is a pathological process during which eumycetomic (fungal) or actinomycotic causative agents from exogenous source produce grains. Medical treatment is available for actinomycetomas and surgery is still the main treatment for eumycetoma. We report 90 cases of actinomycetoma occuring in male adult patients coming mainly from central Senegal. Patients living far from health structures consult after a long evolution period for tumors and pains which prevent them from carrying out their activities. The three etiological agents in our patients were Actinomadura pelletieri (60 cases), Actinomadura madurae (25 cases) and Streptomyces somaliensis (5 cases). The three clinical features are inflammatory forms (75 cases) mainly due to Actinomadura pelletieri, tumoral forms (13 cases) and cystic forms (2 cases). Lesions are localized on the foot in 50% of cases and in other part of the body for the other half. Bone damage was observed in 55% of cases. 83% of the patients were cured after a one-year treatment of sulfametoxazole adminstered orally. Two patients died of visceral involvement.
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Affiliation(s)
- M T Dieng
- Service de dermatologie, CHU Le Dantec, BP 3001, Dakar, Sénégal.
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139
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Whyte M, Irving H, O'Regan P, Nissen M, Siebert D, Labrom R. Disseminated Scedosporium prolificans infection and survival of a child with acute lymphoblastic leukemia. Pediatr Infect Dis J 2005; 24:375-7. [PMID: 15818301 DOI: 10.1097/01.inf.0000157213.94392.30] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Scedosporium prolificans is a saprophytic fungus responsible for an increasing number of infections among immunocompromised hosts. Historically, disseminated infection with this organism has resulted in death. We report on a pediatric patient who developed overwhelming S. prolificans sepsis after induction chemotherapy for acute lymphoblastic leukemia. She is well 18 months after the diagnosis of fungal sepsis and continues to receive chemotherapy for leukemia, which remains in remission.
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Affiliation(s)
- Morag Whyte
- Department of Pediatric Oncology, Banksia Unit, Royal Children's Hospital, Herston, Brisbane, Queensland, Australia 4029.
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140
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Affiliation(s)
- A Cordoba
- Service de Dermatologie, Direccion de Especialidades Médicas (D.E.M.), Cordoba, Argentine.
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141
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Vagefi MR, Kim ET, Alvarado RG, Duncan JL, Howes EL, Crawford JB. Bilateral endogenous Scedosporium prolificans endophthalmitis after lung transplantation. Am J Ophthalmol 2005; 139:370-3. [PMID: 15734012 DOI: 10.1016/j.ajo.2004.08.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2004] [Indexed: 12/25/2022]
Abstract
PURPOSE To report a case of bilateral endogenous fungal endophthalmitis resulting from disseminated Scedosporium prolificans. DESIGN Observational case report. METHODS A 56-year-old woman with cystic fibrosis status post dual lung transplantation on chronic immunosuppressive therapy presented with acute graft rejection. Cultures of bronchial brushings revealed S. prolificans. Three weeks after admission, the patient noted increased blurriness and a central scotoma in her right eye. Dilated fundus examination revealed profound vitritis in the right eye with hemorrhagic retinitis involving the macula. A peripheral, yellow choroidal infiltrate with overlying retinitis and localized vitritis was present in the left eye. RESULTS Intravitreal antibiotics were initiated, and vitreous cultures revealed S. prolificans. The patient ultimately succumbed to her disseminated disease. Pathologic examination of the eyes confirmed bilateral endogenous fungal endophthalmitis. CONCLUSION S. prolificans is an opportunistic infection resistant to standard antifungal therapy that can result in endogenous endophthalmitis in immunocompromised individuals.
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Affiliation(s)
- M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, California 94143-0730, USA
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142
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Affiliation(s)
- Luis Angel Montero
- Servicio de Cirugía Ortopédica y Traumatología, Hospital da Costa, Lugo, Spain.
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143
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Abstract
Voriconazole, a second-generation triazole, has recently been approved by the Food and Drug Administration (FDA) to treat invasive aspergillosis and refractory infections with Scedosporium apiospermum or Fusarium spp. The reported side-effects of voriconazole include visual changes, headaches, elevated hepatic enzymes, Steven-Johnson syndrome, toxic epidermal necrolysis, chelitis, photosensitivity, discoid lupus erythematosus and anaphylactoid infusion reactions. Pseudoporphyria was first described in association with nalidixic acid. It has the same clinical and histologic features as porphyria cutanea tarda (PCT) but is distinguished by normal porphyrin levels in the serum, urine and stool. We present the case of a patient who developed pseudoporphyria after receiving treatment with voriconazole.
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Affiliation(s)
- Christopher K Dolan
- United States Naval Reserve, Patuxent River Naval Medical Clinic, Patuxent River, MD, USA
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144
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Prabhakaran S, Gutin PH, Holodny A, Raizer JJ. Isolated primary intracerebral mycetoma: presenting as a mass lesion in a patient with prostate cancer and multiple myeloma. J Neurooncol 2005; 71:49-52. [PMID: 15719275 DOI: 10.1007/s11060-004-6598-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report a patient with a history of prostate cancer and multiple myeloma, with a solitary indolent intracerebral mass lesion without any constitutional symptoms and minimal neurologic symptoms. The radiographic appearance of the lesion was that of a tumor but resection revealed a mycetoma, consistent with Aspergillus. A brief review of the literature discusses the rarity, presentation, diagnosis, and management of primary intracerebral mycetomas.
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Affiliation(s)
- Shyam Prabhakaran
- Department of Neurology and Neuroscience, New York Presbyterian Hospital-Weill Medical Center of Cornell University, USA
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145
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Husain S, Muñoz P, Forrest G, Alexander BD, Somani J, Brennan K, Wagener MM, Singh N. Infections Due to Scedosporium apiospermum and Scedosporium prolificans in Transplant Recipients: Clinical Characteristics and Impact of Antifungal Agent Therapy on Outcome. Clin Infect Dis 2005; 40:89-99. [PMID: 15614697 DOI: 10.1086/426445] [Citation(s) in RCA: 269] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Accepted: 09/01/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Unique characteristics, impact of therapy with antifungal agents, and outcome of infections with Scedosporium species were assessed in transplant recipients. METHODS The patients comprised a total of 80 transplant recipients with Scedosporium infections, including 13 patients from our institutions (University of Pittsburgh Medical Center [Pittsburgh, PA], University of Maryland [Baltimore], Duke University Medical Center [Durham, NC], Emory University [Atlanta, GA], and Hospital Gregorio Maranon [Madrid, Spain]) and 67 reported in the literature. The transplant recipients were compared with 190 non-transplant recipients with scedosporiosis who were described in the literature. RESULTS Overall, 69% of the infections in hematopoietic stem cell transplant (HSCT) recipients and 53% of the infections in organ transplant recipients were disseminated. HSCT recipients, compared with organ transplant recipients, were more likely to have infections caused by Scedosporium prolificans (P=.045), to have an earlier onset of infection (P=.007), to be neutropenic (P<.0001), and to have fungemia (P=.04). Time elapsed from transplantation to Scedosporium infection in transplant recipients has increased in recent years (P=.002). The mortality rate among transplant recipients with scedosporiosis was 58%. In a logistic regression model using amphotericin B as comparison treatment, voriconazole was associated with a trend towards better survival (odds ratio [OR], 10.40; P=.08). Presence of disseminated infection (OR, 0.20; P=.03) predicted lower survival, and receipt of adjunctive surgery as treatment (OR, 5.52; P=.02) independently predicted a better survival in this model. CONCLUSIONS Scedosporium infections in transplant recipients were associated with a high rate of dissemination and a poor outcome overall. The use of newer triazole agents warrants consideration as a therapeutic modality for these infections.
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Affiliation(s)
- Shahid Husain
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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146
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Thiagalingam S, Fernando GT, Tan K, O'Donnell BA, Weeks K, Branley M. Orbital apex syndrome secondary to Pseudallescheria boydii fungal sinusitis in an immunocompetent patient. Clin Exp Ophthalmol 2004; 32:545-7. [PMID: 15498073 DOI: 10.1111/j.1442-9071.2004.00877.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Orbital apex syndrome secondary to mucormycosis in immuno-compromised patients is well described; however, few reports exist of a paranasal sinus mycetoma resulting in this presentation in the immuno-competent patient. The case is reported of a 92-year-old man who developed orbital apex syndrome secondary to a sphenoidal sinus mycetoma of Pseudallescheria boydii.
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147
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Abstract
Subcutaneous mycoses are caused by a variety of mostly tropical organisms, usually when they are implanted into the dermis or the subcutaneous tissue. They rarely disseminate or become systemic. Sporotrichosis, mycetoma, and chromoblastomycosis are more common subcutaneous mycoses than are rhinosporidiosis, zygomycosis, pheohyphomycosis, and lobomycosis.
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Affiliation(s)
- Katie R Pang
- Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, USA
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148
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Abstract
Scedosporium apiospermum is a rare cause of fungal vertebral osteomyelitis that may result in chronic infection requiring multiple surgical interventions and long-term medical therapy. This case is the seventh one reported in the literature and is the first to include salvage surgery of a previous major spinal reconstruction. This report is also the first to describe the use of the new antifungal agent voriconazole. In treating this case of chronic vertebral osteomyelitis, several principles are emphasized from both the surgical and medical perspectives. From a surgical perspective, the use of salvage surgery, temporary avoidance of spinal instrumentation, and an appropriate choice of graft materials are emphasized. From a medical perspective, confirmation of the diagnosis, the need for long-term antifungal therapy, the need for long-term patient compliance, and the use of the new antifungal agent voriconazole are emphasized. Application of these principles has led to an adequate 2-year outcome.
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Affiliation(s)
- John W German
- Division of Neurosurgery, and College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA.
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149
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Ortoneda M, Capilla J, Pastor FJ, Serena C, Guarro J. Interaction of granulocyte colony-stimulating factor and high doses of liposomal amphotericin B in the treatment of systemic murine scedosporiosis. Diagn Microbiol Infect Dis 2004; 50:247-51. [PMID: 15582297 DOI: 10.1016/j.diagmicrobio.2004.07.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2004] [Accepted: 07/27/2004] [Indexed: 10/26/2022]
Abstract
Because human infections by Scedosporium prolificans are difficult to treat and show a very poor outcome, new therapeutic strategies are needed. Liposomal amphotericin B (LAMB) (40 mg/kg/day) increased significantly the mean survival time in immunosuppressed mice compared with a control group (22.6 vs. 8.8 days). Amphotericin B deoxycholate (1.5 mg/kg/day) and granulocyte colony-stimulating factor (G-CSF) (300 microg/kg/day) were ineffective. The combination of LAMB (40 mg/kg/day) and G-CSF (150 or 300 microg/kg/day) did not improve the results obtained with LAMB alone.
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Affiliation(s)
- Montserrat Ortoneda
- Unitat de Microbiologia, Facultat de Medicina i Cències de la Salut, Universitat Rovira i Virgili, Reus, Spain
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150
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Capilla J, Mayayo E, Serena C, Pastor FJ, Guarro J. A novel murine model of cerebral scedosporiosis: lack of efficacy of amphotericin B. J Antimicrob Chemother 2004; 54:1092-5. [PMID: 15509616 DOI: 10.1093/jac/dkh468] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Cerebral scedosporiosis is a life-threatening infection that is difficult to treat. The aim of this work was to develop a murine model of cerebral infection by Scedosporium apiospermum using intracranial inoculation and to use this model to evaluate the efficacy of amphotericin B deoxycholate and liposomal amphotericin B. METHODS Mice were rendered neutropenic by intraperitoneal cyclophosphamide and intravenous (iv) 5-fluorouracil administration. Animals were infected with iv or intracranial inoculation of 1 x 10(4), 5 x 10(4) or 5 x 10(5) cfu of a clinical strain of S. apiospermum. Tissue burden reduction was determined in kidneys and brain 4 days after the infection. Efficacy of amphotericin B and liposomal amphotericin B (0.8 mg/kg/day intraperitoneally and 40 mg/kg/day iv, respectively) was evaluated in neutropenic mice infected iv or intracranially with 5 x 10(4) cfu. Survival was analysed with the log-rank test. Fungal burden values of different groups were compared using the Mann-Whitney U-test. RESULTS In our model, intracranial infection produced a higher fungal load in the brain and a lower fungal load in the kidney than iv inoculation. Survival of animals infected intracranially and treated with amphotericin B or liposomal amphotericin B (mean survival time = 8.3 and 9.2 days, respectively) was not different from the control group (P=0.58 and 0.85, respectively). CONCLUSIONS We have developed a murine model of cerebral scedosporiosis, which may be useful for studying various pathological aspects of this infection and evaluating new therapeutic approaches. Amphotericin B and liposomal amphotericin B were unable to resolve the infection.
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Affiliation(s)
- Javier Capilla
- Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain
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