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Gil-Pallares P, Gracia-Cazaña T, Álvarez-Salafranca M, Gorgojo MA, García-García M, Beltrán-Rosel A, Almenara-Blasco M, Navarro-Bielsa A, Gilaberte Y. Cutaneous Alternariosis in Immunosuppressed Patients Treated with Photodynamic Therapy and Oral Antifungals, a Synergistic Strategy. Pharmaceuticals (Basel) 2024; 17:245. [PMID: 38399460 PMCID: PMC10893038 DOI: 10.3390/ph17020245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Cutaneous alternariosis is a rare condition, more frequently presented in immunocompromised patients, which usually requires long courses of systemic antifungals that may interact with other medications. The presented series shows three cases of cutaneous alternariosis in immunocompromised patients and organ transplant recipients that were successfully treated with photodynamic therapy and oral antifungals, allowing a reduction in the systemic treatment duration and therefore decreasing the risk of side effects and drug interactions.
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Affiliation(s)
- Pedro Gil-Pallares
- Department of Dermatology, Miguel Servet University Hospital, 50009 Zaragoza, Spain (M.Á.-S.); (M.A.-B.); (Y.G.)
- Department of Surgery and Medical-Surgical Specialities, Universidad de Santiago de Compostela, 15705 Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
| | - Tamara Gracia-Cazaña
- Department of Dermatology, Miguel Servet University Hospital, 50009 Zaragoza, Spain (M.Á.-S.); (M.A.-B.); (Y.G.)
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
| | - Marcial Álvarez-Salafranca
- Department of Dermatology, Miguel Servet University Hospital, 50009 Zaragoza, Spain (M.Á.-S.); (M.A.-B.); (Y.G.)
| | | | - Mar García-García
- Department of Pathology, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain;
| | - Antonio Beltrán-Rosel
- Department of Microbiology, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Manuel Almenara-Blasco
- Department of Dermatology, Miguel Servet University Hospital, 50009 Zaragoza, Spain (M.Á.-S.); (M.A.-B.); (Y.G.)
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
| | - Alba Navarro-Bielsa
- Department of Dermatology, Miguel Servet University Hospital, 50009 Zaragoza, Spain (M.Á.-S.); (M.A.-B.); (Y.G.)
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
| | - Yolanda Gilaberte
- Department of Dermatology, Miguel Servet University Hospital, 50009 Zaragoza, Spain (M.Á.-S.); (M.A.-B.); (Y.G.)
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Department of Dermatology, University of Zaragoza, 50009 Zaragoza, Spain
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2
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Zheng M, Zhou X, Pang J, Yang Z, Zou Y, Zhang L, Xu Y, Yin R. New methylene blue-mediated photodynamic inactivation of multidrug-resistant Fonsecaea nubica infected chromoblastomycosis in vitro. Braz J Microbiol 2023; 54:873-883. [PMID: 37145297 PMCID: PMC10234991 DOI: 10.1007/s42770-023-00974-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/10/2023] [Indexed: 05/06/2023] Open
Abstract
Chromoblastomycosis is a fungal disease presented with local warty papule, plaque, and verrucous nodules. In addition, the incidence and drug resistance of chromoblastomycosis are increasing each year worldwide. Photodynamic therapy is a promising method to treat mycoses. The purpose of this study was to evaluate the effect of new methylene blue (NMB)-induced PDT on multidrug-resistant chromoblastomycosis in vitro. We isolated one wild-type strain pathogen from one clinical patient diagnosed with chromoblastomycosis for over 27 years. The pathogen was identified by histopathology, the morphology of fungal culture, and genetic testing. Drug susceptibility testing was performed on the isolate. It was cultured with logarithmic growth phase spore in vitro and incubated with different concentrations of NMB for 30 min, and received illumination by red light-emitted diode with different light doses. After photodynamic treatment, the scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were conducted. The pathogen was Fonsecaea nubica, and it was resistant to itraconazole, terbinafine, amphotericin B, voriconazole andcaspofungin. At the same NMB concentration, the sterilization efficiency of NMB-photodynamic therapy (PDT) on F. nubica increased with increasing light intensity; F. nubica was completely killed at 25 µmol/L NMB with a light dose of 40 J/cm2 or 50 µmol/L NMB and light doses of ≥ 30 J/cm2. SEM and TEM observed ultrastructural changes after PDT. NMB-PDT inactivates the survival of multidrug-resistant F. nubica in vitro; it therefore has the potential to become an alternative or adjuvant treatment for refractory chromoblastomycosis.
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Affiliation(s)
- Mengxue Zheng
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Xiaoqing Zhou
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Jiayin Pang
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Zengjun Yang
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yongzhen Zou
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Lian Zhang
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yan Xu
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Rui Yin
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
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Piksa M, Lian C, Samuel IC, Pawlik KJ, Samuel IDW, Matczyszyn K. The role of the light source in antimicrobial photodynamic therapy. Chem Soc Rev 2023; 52:1697-1722. [PMID: 36779328 DOI: 10.1039/d0cs01051k] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Antimicrobial photodynamic therapy (APDT) is a promising approach to fight the growing problem of antimicrobial resistance that threatens health care, food security and agriculture. APDT uses light to excite a light-activated chemical (photosensitiser), leading to the generation of reactive oxygen species (ROS). Many APDT studies confirm its efficacy in vitro and in vivo against bacteria, fungi, viruses and parasites. However, the development of the field is focused on exploring potential targets and developing new photosensitisers. The role of light, a crucial element for ROS production, has been neglected. What are the main parameters essential for effective photosensitiser activation? Does an optimal light radiant exposure exist? And finally, which light source is best? Many reports have described the promising antibacterial effects of APDT in vitro, however, its application in vivo, especially in clinical settings remains very limited. The restricted availability may partially be due to a lack of standard conditions or protocols, arising from the diversity of selected photosensitising agents (PS), variable testing conditions including light sources used for PS activation and methods of measuring anti-bacterial activity and their effectiveness in treating bacterial infections. We thus sought to systematically review and examine the evidence from existing studies on APDT associated with the light source used. We show how the reduction of pathogens depends on the light source applied, radiant exposure and irradiance of light used, and type of pathogen, and so critically appraise the current state of development of APDT and areas to be addressed in future studies. We anticipate that further standardisation of the experimental conditions will help the field advance, and suggest key optical and biological parameters that should be reported in all APDT studies. More in vivo and clinical studies are needed and are expected to be facilitated by advances in light sources, leading to APDT becoming a sustainable, alternative therapeutic option for bacterial and other microbial infections in the future.
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Affiliation(s)
- Marta Piksa
- Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Science, Weigla 12, 53-114, Wroclaw, Poland
| | - Cheng Lian
- Organic Semiconductor Centre, SUPA, School of Physics and Astronomy, University of St Andrews, Fife, KY16 9SS, UK.
| | - Imogen C Samuel
- School of Medicine, University of Manchester, Manchester, M13 9PL, UK
| | - Krzysztof J Pawlik
- Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Science, Weigla 12, 53-114, Wroclaw, Poland
| | - Ifor D W Samuel
- Organic Semiconductor Centre, SUPA, School of Physics and Astronomy, University of St Andrews, Fife, KY16 9SS, UK.
| | - Katarzyna Matczyszyn
- Institute of Advanced Materials, Faculty of Chemistry, Wroclaw University of Science and Technology, Wyb. Wyspianskiego 27, 50-370 Wroclaw, Poland.
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Yang Z, Liu C, Xiong H, Shi D. Photodynamic therapy, a promising treatment approach for cutaneous infectious granulomas. Photodiagnosis Photodyn Ther 2022; 39:102952. [PMID: 35691563 DOI: 10.1016/j.pdpdt.2022.102952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/26/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022]
Abstract
Cutaneous infectious granulomas are mainly caused by fungi and bacteria. Antibiotics are the primary therapeutic choices for the diseases, but the drug-resistant pathogens become increasingly prevalent. Thus, there is an urgent need to explore novel approaches to treating cutaneous infectious granulomas. Photodynamic therapy (PDT) is widely used as an alternative treatment for various kinds of skin diseases, and evidence has been accumulating that PDT is also effective for the treatment of cutaneous infectious granulomas. In this narrative review, we sought to summarize the recent literature concerning the applications and mechanisms of PDT in the treatment of cutaneous infectious granulomas. Clinical and basic research has demonstrated that PDT is an effective approach in treating fungal infections such as sporotrichosis and chromoblastomycosis. In addition, PDT is also used to treat atypical mycobacterial infections such as Mycobacterium marinum. PDT can significantly shorten the duration of antibiotics treatment, resulting in diminishment of adverse effects. The potential mechanisms of PDT are to kill the pathogens directly or elicit modulatory effects on the immune microenvironments. We conclude that PDT is a promising therapeutic choice for the treatment of cutaneous infectious granulomas.
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Affiliation(s)
- Zhiya Yang
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining 272000, Shandong, China
| | - Chen Liu
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining 272000, Shandong, China
| | - Huabao Xiong
- Institute of Immunology and Molecular Medicine, Basic Medical School, Jining Medical University, Jining 272067, Shandong, China.
| | - Dongmei Shi
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining 272000, Shandong, China; Department of Dermatology, Jining No.1 People's Hospital, Jining 272001, Shandong, China.
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Legabão BC, Fernandes JA, de Oliveira Barbosa GF, Bonfim-Mendonça PS, Svidzinski TI. The zoonosis sporotrichosis can be successfully treated by photodynamic therapy: A scoping review. Acta Trop 2022; 228:106341. [PMID: 35131203 DOI: 10.1016/j.actatropica.2022.106341] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 12/20/2022]
Abstract
Sporotrichosis is a worldwide zoonosis, prevalent in tropical and subtropical regions. In recent years, there has been a substantial increase in human and feline cases reported in Brazil. Despite this, the antifungal treatment for sporotrichosis is still limited, and thus, research into new therapeutic modalities must be encouraged. Recently, photodynamic therapy has been introduced as a treatment for sporotrichosis. This work presents an overview of both in vitro and in vivo studies that have used photodynamic therapy in the context of photoinactivation of Sporothrix species. Until now, as far as the authors are aware, this is the first scope review specifically on photodynamic therapy for the treatment of sporotrichosis. A systematic electronic search was conducted in two databases: Web of Science and PubMed. Seven original articles published from 2010 to July 2021 were selected, six of which met the proposed inclusion and exclusion criteria and were considered in this scoping review. Concerning the photoinactivation of Sporothrix spp. the results have been promising as studies, in both animals and humans, have reported significant clinical and mycological effects. The most used photosensitizers were methylene blue and its derivatives, and aminolevulinic acid and its methyl derivative, methyl aminolevulinic acid. In conclusion, photodynamic therapy has great potential in treatment of sporotrichosis, as its fungicidal effect both in vitro and in vivo has clearly been demonstrated. Photodynamic therapy could be used in conjunction with classic antifungal agents to optimize treatment outcomes.
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Li Z, Nguyen L, Bass DA, Baran TM. Effects of patient-specific treatment planning on eligibility for photodynamic therapy of deep tissue abscess cavities: retrospective Monte Carlo simulation study. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:083007. [PMID: 35146973 PMCID: PMC8831513 DOI: 10.1117/1.jbo.27.8.083007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
SIGNIFICANCE Antimicrobial photodynamic therapy (PDT) effectively kills bacterial strains found in deep tissue abscess cavities. PDT response hinges on multiple factors, including light dose, which depends on patient optical properties. AIM Computed tomography images for 60 abscess drainage subjects were segmented and used for Monte Carlo (MC) simulation. We evaluated effects of optical properties and abscess morphology on PDT eligibility and generated treatment plans. APPROACH A range of abscess wall absorptions (μa , wall) and intra-cavity Intralipid concentrations were simulated. At each combination, the threshold optical power and optimal Intralipid concentration were found for a fluence rate target, with subjects being eligible for PDT if the target was attainable with <2000 mW of source light. Further simulations were performed with absorption within the cavity (μa , cavity). RESULTS Patient-specific treatment planning substantially increased the number of subjects expected to achieve an efficacious light dose for antimicrobial PDT, especially with Intralipid modification. The threshold optical power and optimal Intralipid concentration increased with increasing μa , wall (p < 0.001). PDT eligibility improved with patient-specific treatment planning (p < 0.0001). With μa , wall = 0.2 cm - 1, eligibility increased from 42% to 92%. Increasing μa , cavity reduced PDT eligibility (p < 0.0001); modifying the delivered optical power had the greatest impact in this case. CONCLUSIONS MC-based treatment planning greatly increases eligibility for PDT of abscess cavities.
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Affiliation(s)
- Zihao Li
- University of Rochester, The Institute of Optics, Rochester, New York, United States
| | - Lam Nguyen
- University of Rochester, Department of Biomedical Engineering, Rochester, New York, United States
| | - David A. Bass
- University of Rochester Medical Center, Department of Imaging Sciences, Rochester, New York, United States
| | - Timothy M. Baran
- University of Rochester, Department of Biomedical Engineering, Rochester, New York, United States
- University of Rochester Medical Center, Department of Imaging Sciences, Rochester, New York, United States
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Wang D, Kuzma ML, Tan X, He TC, Dong C, Liu Z, Yang J. Phototherapy and optical waveguides for the treatment of infection. Adv Drug Deliv Rev 2021; 179:114036. [PMID: 34740763 PMCID: PMC8665112 DOI: 10.1016/j.addr.2021.114036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 02/07/2023]
Abstract
With rapid emergence of multi-drug resistant microbes, it is imperative to seek alternative means for infection control. Optical waveguides are an auspicious delivery method for precise administration of phototherapy. Studies have shown that phototherapy is promising in fighting against a myriad of infectious pathogens (i.e. viruses, bacteria, fungi, and protozoa) including biofilm-forming species and drug-resistant strains while evading treatment resistance. When administered via optical waveguides, phototherapy can treat both superficial and deep-tissue infections while minimizing off-site effects that afflict conventional phototherapy and pharmacotherapy. Despite great therapeutic potential, exact mechanisms, materials, and fabrication designs to optimize this promising treatment option are underexplored. This review outlines principles and applications of phototherapy and optical waveguides for infection control. Research advances, challenges, and outlook regarding this delivery system are rigorously discussed in a hope to inspire future developments of optical waveguide-mediated phototherapy for the management of infection and beyond.
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Affiliation(s)
- Dingbowen Wang
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Michelle Laurel Kuzma
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Xinyu Tan
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA; Academy of Orthopedics, Provincial Key Laboratory of Bone and Joint Degenerative Diseases, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong Province 510280, China
| | - Tong-Chuan He
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA; Department of Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Cheng Dong
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Zhiwen Liu
- Department of Electrical Engineering, Materials Research Institute, The Pennsylvania State University, University Park, PA 16802, USA
| | - Jian Yang
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA.
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Reviewing the Etiologic Agents, Microbe-Host Relationship, Immune Response, Diagnosis, and Treatment in Chromoblastomycosis. J Immunol Res 2021; 2021:9742832. [PMID: 34761009 PMCID: PMC8575639 DOI: 10.1155/2021/9742832] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/30/2021] [Indexed: 01/19/2023] Open
Abstract
Chromoblastomycosis (CBM) is a neglected human disease, caused by different species of pigmented dematiaceous fungi that cause subcutaneous infections. This disease has been considered an occupational disease, occurring among people working in the field of agriculture, particularly in low-income countries. In 1914, the first case of CBM was described in Brazil, and although efforts have been made, few scientific and technological advances have been made in this area. In the field of fungi and host cell relationship, a very reduced number of antigens were characterized, but available data suggest that ectoantigens bind to the cell membrane of host cells and modulate the phagocytic, immunological, and microbicidal responses of immune cells. Furthermore, antigens cleave extracellular proteins in tissues, allowing fungi to spread. On the contrary, if phagocytic cells are able to present antigens in MHC molecules to T lymphocytes in the presence of costimulation and IL-12, a Th1 immune response will develop and a relative control of the disease will be observed. Despite knowledge of the resistance and susceptibility in CBM, up to now, no effective vaccines have been developed. In the field of chemotherapy, most patients are treated with conventional antifungal drugs, such as itraconazole and terbinafine, but these drugs exhibit limitations, considering that not all patients heal cutaneous lesions. Few advances in treatment have been made so far, but one of the most promising ones is based on the use of immunomodulators, such as imiquimod. Data about a standard treatment are missing in the medical literature; part of it is caused by the existence of a diversity of etiologic agents and clinical forms. The present review summarizes the advances made in the field of CBM related to the diversity of pathogenic species, fungi and host cell relationship, antigens, innate and acquired immunity, clinical forms of CBM, chemotherapy, and diagnosis.
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Aroso RT, Schaberle FA, Arnaut LG, Pereira MM. Photodynamic disinfection and its role in controlling infectious diseases. Photochem Photobiol Sci 2021; 20:1497-1545. [PMID: 34705261 PMCID: PMC8548867 DOI: 10.1007/s43630-021-00102-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/03/2021] [Indexed: 12/23/2022]
Abstract
Photodynamic therapy is witnessing a revival of its origins as a response to the rise of multi-drug resistant infections and the shortage of new classes of antibiotics. Photodynamic disinfection (PDDI) of microorganisms is making progresses in preclinical models and in clinical cases, and the perception of its role in the clinical armamentarium for the management of infectious diseases is changing. We review the positioning of PDDI from the perspective of its ability to respond to clinical needs. Emphasis is placed on the pipeline of photosensitizers that proved effective to inactivate biofilms, showed efficacy in animal models of infectious diseases or reached clinical trials. Novel opportunities resulting from the COVID-19 pandemic are briefly discussed. The molecular features of promising photosensitizers are emphasized and contrasted with those of photosensitizers used in the treatment of solid tumors. The development of photosensitizers has been accompanied by the fabrication of a variety of affordable and customizable light sources. We critically discuss the combination between photosensitizer and light source properties that may leverage PDDI and expand its applications to wider markets. The success of PDDI in the management of infectious diseases will ultimately depend on the efficacy of photosensitizers, affordability of the light sources, simplicity of the procedures, and availability of fast and efficient treatments.
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Affiliation(s)
- Rafael T Aroso
- Chemistry Department, University of Coimbra, 3004-535, Coimbra, Portugal
| | - Fábio A Schaberle
- Chemistry Department, University of Coimbra, 3004-535, Coimbra, Portugal
| | - Luís G Arnaut
- Chemistry Department, University of Coimbra, 3004-535, Coimbra, Portugal.
| | - Mariette M Pereira
- Chemistry Department, University of Coimbra, 3004-535, Coimbra, Portugal.
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Ziental D, Mlynarczyk DT, Czarczynska-Goslinska B, Lewandowski K, Sobotta L. Photosensitizers Mediated Photodynamic Inactivation against Fungi. NANOMATERIALS 2021; 11:nano11112883. [PMID: 34835655 PMCID: PMC8621466 DOI: 10.3390/nano11112883] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 01/12/2023]
Abstract
Superficial and systemic fungal infections are essential problems for the modern health care system. One of the challenges is the growing resistance of fungi to classic antifungals and the constantly increasing cost of therapy. These factors force the scientific world to intensify the search for alternative and more effective methods of treatment. This paper presents an overview of new fungal inactivation methods using Photodynamic Antimicrobial Chemotherapy (PACT). The results of research on compounds from the groups of phenothiazines, xanthanes, porphyrins, chlorins, porphyrazines, and phthalocyanines are presented. An intensive search for a photosensitizer with excellent properties is currently underway. The formulation based on the existing ones is also developed by combining them with nanoparticles and common antifungal therapy. Numerous studies indicate that fungi do not form any specific defense mechanism against PACT, which deems it a promising therapeutic alternative.
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Affiliation(s)
- Daniel Ziental
- Chair and Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, Grunwaldzka 6, 60-780 Poznan, Poland; (D.Z.); (K.L.)
| | - Dariusz T. Mlynarczyk
- Chair and Department of Chemical Technology of Drugs, Poznan University of Medical Sciences, Grunwaldzka 6, 60-780 Poznan, Poland;
| | - Beata Czarczynska-Goslinska
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, Grunwaldzka 6, 60-780 Poznan, Poland;
| | - Konrad Lewandowski
- Chair and Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, Grunwaldzka 6, 60-780 Poznan, Poland; (D.Z.); (K.L.)
| | - Lukasz Sobotta
- Chair and Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, Grunwaldzka 6, 60-780 Poznan, Poland; (D.Z.); (K.L.)
- Correspondence:
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Shi L, Wu Q, Yang J, Tan J, Yang H, Hu C, Zhang Y, Zhang H, Zhang L, Liu Y, Yang L, Wang X. ALA-PDT successfully treated Majocchi's granuloma by directly killing Trichophyton tonsurans and recruiting T lymphocytes. Photodiagnosis Photodyn Ther 2021; 35:102328. [PMID: 34004363 DOI: 10.1016/j.pdpdt.2021.102328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/11/2021] [Accepted: 04/30/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Majocchi's granuloma (MG) is a deep persistent suppurative granulomatous perifolliculitis which might be caused by Trichophyton tonsurans (T. tonsurans). Conventional treatment for MG is oral administration of systematic antifungal drugs, associated with a low cure rate and a high relapse rate. ALA-PDT is a new approach for fungal infection. METHODS A case of refractory MG was treated by 3 times of ALA-PDT. At the same time, T. tonsurans strains isolated from the lesions of the patient were used for an in vitro inhibition experiment and an in vivo experiment in guinea pig model to furtherly verify the effectiveness and investigate the mechanism of ALA-PDT for T. tonsurans. RESULTS After 3 times of ALA-PDT, the lesions of MG were eliminated. And the mycological and pathological examination showed a disappearance of fungi in follicles. In vitro and in vivo experiment both demonstrated that ALA-PDT could obviously inhibit the growth of T. tonsurans partly by directly destroying the structure of fungal cells and recruiting CD4 + T cells. CONCLUSION ALA-PDT is a potentially effective noninvasive method for the treatment of MG with mechanisms of direct killing and with CD4+ T cell-mediated immune response.
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Affiliation(s)
- Lei Shi
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Baode Road 1278, Shanghai, 200443, China
| | - Qianqian Wu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Baode Road 1278, Shanghai, 200443, China
| | - Jin Yang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Baode Road 1278, Shanghai, 200443, China
| | - Jingwen Tan
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, Baode Road 1278, Shanghai 200443, China
| | - Hong Yang
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, Baode Road 1278, Shanghai 200443, China
| | - Chan Hu
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Baode Road 1278, Shanghai, 200443, China
| | - Yunfeng Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Baode Road 1278, Shanghai, 200443, China
| | - Haiyan Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Baode Road 1278, Shanghai, 200443, China
| | - Linglin Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Baode Road 1278, Shanghai, 200443, China
| | - Yeqiang Liu
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, Baode Road 1278, Shanghai 200443, China
| | - Lianjuan Yang
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, Baode Road 1278, Shanghai 200443, China.
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Baode Road 1278, Shanghai, 200443, China.
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Skin Fungal Infections in Children: Diagnostic Challenges. CURRENT FUNGAL INFECTION REPORTS 2020. [DOI: 10.1007/s12281-020-00407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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13
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Cwalinski T, Polom W, Marano L, Roviello G, D’Angelo A, Cwalina N, Matuszewski M, Roviello F, Jaskiewicz J, Polom K. Methylene Blue-Current Knowledge, Fluorescent Properties, and Its Future Use. J Clin Med 2020; 9:jcm9113538. [PMID: 33147796 PMCID: PMC7693951 DOI: 10.3390/jcm9113538] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/24/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022] Open
Abstract
Methylene blue is a fluorescent dye discovered in 1876 and has since been used in different scientific fields. Only recently has methylene blue been used for intraoperative fluorescent imaging. Here, the authors review the emerging role of methylene blue, not only as a dye used in clinical practice, but also as a fluorophore in a surgical setting. We discuss the promising potential of methylene blue together with the challenges and limitations among specific surgical techniques. A literature review of PubMed and Medline was conducted based on the historical, current and future usage of methylene blue within the field of medicine. We reviewed not only the current usage of methylene blue, but we also tried to grasp its’ function as a fluorophore in five main domains. These domains include the near-infrared imaging visualization of ureters, parathyroid gland identification, pancreatic tumors imaging, detection of breast cancer tumor margins, as well as breast cancer sentinel node biopsy. Methylene blue is used in countless clinical procedures with a relatively low risk for patients. Usage of its fluorescent properties is still at an early stage and more pre-clinical, as well as clinical research, must be performed to fully understand its potentials and limitations.
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Affiliation(s)
- Tomasz Cwalinski
- Department of Surgical Oncology, Medical University of Gdansk, 80-214 Gdansk, Poland; (T.C.); (J.J.)
| | - Wojciech Polom
- Department of Urology, Medical University of Gdansk, 80-214 Gdansk, Poland; (W.P.); (M.M.)
| | - Luigi Marano
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, 53-100 Siena, Italy; (L.M.); (F.R.)
| | - Giandomenico Roviello
- Department of Health Sciences, University of Florence, viale Pieraccini 6, 50139 Florence, Italy;
| | - Alberto D’Angelo
- Department of Biology and Biochemistry, University of Bath, Bath BA2 7AY, UK;
| | - Natalia Cwalina
- Department of Pediatrics Ascension St. John Children’s Hospital, Detroit, MI 48236, USA;
| | - Marcin Matuszewski
- Department of Urology, Medical University of Gdansk, 80-214 Gdansk, Poland; (W.P.); (M.M.)
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, 53-100 Siena, Italy; (L.M.); (F.R.)
| | - Janusz Jaskiewicz
- Department of Surgical Oncology, Medical University of Gdansk, 80-214 Gdansk, Poland; (T.C.); (J.J.)
| | - Karol Polom
- Department of Surgical Oncology, Medical University of Gdansk, 80-214 Gdansk, Poland; (T.C.); (J.J.)
- Correspondence: ; Tel.: +48-583-493-190
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14
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Lan Y, Lu S, Zhang J. Retinoid combined with photodynamic therapy against hyperkeratotic chromoblastomycosis: A case report and literature review. Mycoses 2020; 64:18-23. [PMID: 32989774 DOI: 10.1111/myc.13190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 01/28/2023]
Abstract
Chromoblastomycosis (CBM) is a chronic granulomatous fungal infection caused by melanised or brown-pigmented fungi. It can lead to chronic persistent infections and may cause incapacity for labour in some severe clinical forms. The optimal therapy for CBM is still uncertain. Here, we reported the case of a 66-year-old male who has had red plaque and recurrent keratinised protrusions on his right forearm for 20 years. He was treated orally with terbinafine, itraconazole and isotretinoin. He also received carbon dioxide(CO2 ) laser to eradicate the keratinised protrusions and promote the penetration of photosensitiser. After the CO2 laser, 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) was adopted immediately to inhibiting the growth of fungi in subcutaneous tissue. The patient received an important improvement with a plaque and crust reduction after 4 months. For such recalcitrant case of chromoblastomycosis, the use of retinoid, CO2 laser combined with ALA-PDT may be a new adjuvant therapy. We further reviewed the cases of chromoblastomycosis treated with laser, photodynamic therapy or retinoic acid.
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Affiliation(s)
- Yu Lan
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Dermatology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Sha Lu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junmin Zhang
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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15
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Santos DWCL, Vicente VA, Weiss VA, de Hoog GS, Gomes RR, Batista EMM, Marques SG, de Queiroz-Telles F, Colombo AL, de Azevedo CDMPES. Chromoblastomycosis in an Endemic Area of Brazil: A Clinical-Epidemiological Analysis and a Worldwide Haplotype Network. J Fungi (Basel) 2020; 6:jof6040204. [PMID: 33022951 PMCID: PMC7711792 DOI: 10.3390/jof6040204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/27/2020] [Accepted: 10/01/2020] [Indexed: 12/14/2022] Open
Abstract
Chromoblastomycosis (CBM) is a neglected implantation mycosis prevalent in tropical climate zones, considered an occupational disease that affects impoverished rural populations. This retrospective study described clinical aspects of CBM in a hyperendemic area in Brazil and constructed a worldwide haplotype network of Fonsecaea spp. strains. The variables were collected from medical records using a standard report form, reporting 191 patients with CBM from Maranhão, Brazil. The mean age was 56.1 years, 168 (88%) patients were male and predominantly farmers (85.8%). The mean time of evolution of the disease until diagnosis was 9.4 years. Lower limbs (81.2%) and upper limbs (14.2%) were the main sites affected. Most patients exhibited verrucous (55%) and infiltrative plaque (48.2%). Fonsecaea spp. were identified in 136 cases and a haplotype network constructed with ITS sequences of 185 global strains revealed a total of 59 haplotypes exhibiting high haplotypic and low nucleotide diversities. No correlation was observed between the different haplotypes of Fonsecaea species and dermatological patterns, severity of disease or geographic distribution inside Maranhão. Data from this area contributed to better understanding the epidemiology of CBM. For the first time, a robust haplotype network with Fonsecaea strains reveals an evolutionary history with a recent population expansion.
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Affiliation(s)
- Daniel Wagner C. L. Santos
- Special Mycology Laboratory—LEMI, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, 04039-032 SP, Brazil; (D.W.C.L.S.); (A.L.C.)
- Division of Infectious Diseases, Federal University of São Paulo, São Paulo, 04024-002 SP, Brazil
| | - Vania Aparecida Vicente
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, 81531-980 PR, Brazil; (V.A.V.); (V.A.W.); (G.S.d.H.); (R.R.G.); (F.d.Q.-T.)
- Bioprocess Engineering and Biotechnology Graduate Program, Federal University of Paraná, Curitiba, 81531-980 PR, Brazil
| | - Vinicius Almir Weiss
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, 81531-980 PR, Brazil; (V.A.V.); (V.A.W.); (G.S.d.H.); (R.R.G.); (F.d.Q.-T.)
| | - G. Sybren de Hoog
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, 81531-980 PR, Brazil; (V.A.V.); (V.A.W.); (G.S.d.H.); (R.R.G.); (F.d.Q.-T.)
- Center of Expertise in Mycology, Radboud University Medical Center/CWZ, 6525 GA Nijmegen, The Netherlands
| | - Renata R. Gomes
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, 81531-980 PR, Brazil; (V.A.V.); (V.A.W.); (G.S.d.H.); (R.R.G.); (F.d.Q.-T.)
| | - Edith M. M. Batista
- Department of Medicine, Federal University of Maranhão, São Luís, 65080-040 MA, Brazil; (E.M.M.B.); (S.G.M.)
| | - Sirlei Garcia Marques
- Department of Medicine, Federal University of Maranhão, São Luís, 65080-040 MA, Brazil; (E.M.M.B.); (S.G.M.)
| | - Flávio de Queiroz-Telles
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, 81531-980 PR, Brazil; (V.A.V.); (V.A.W.); (G.S.d.H.); (R.R.G.); (F.d.Q.-T.)
| | - Arnaldo Lopes Colombo
- Special Mycology Laboratory—LEMI, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, 04039-032 SP, Brazil; (D.W.C.L.S.); (A.L.C.)
- Division of Infectious Diseases, Federal University of São Paulo, São Paulo, 04024-002 SP, Brazil
| | - Conceição de Maria Pedrozo e Silva de Azevedo
- Department of Medicine, Federal University of Maranhão, São Luís, 65080-040 MA, Brazil; (E.M.M.B.); (S.G.M.)
- Post-Graduation Program of Health Science, Federal University of Maranhão, São Luís, 65080-040 MA, Brazil
- Correspondence:
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16
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Methylene blue mediated antimicrobial photodynamic therapy in clinical human studies: The state of the art. Photodiagnosis Photodyn Ther 2020; 31:101828. [DOI: 10.1016/j.pdpdt.2020.101828] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 04/17/2020] [Accepted: 05/15/2020] [Indexed: 11/23/2022]
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17
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Photodynamic therapy treatment of superficial fungal infections: A systematic review. Photodiagnosis Photodyn Ther 2020; 31:101774. [DOI: 10.1016/j.pdpdt.2020.101774] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/01/2020] [Accepted: 04/10/2020] [Indexed: 01/31/2023]
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18
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Monfrecola G, Megna M, Rovati C, Arisi M, Rossi M, Calzavara-Pinton I, Fabbrocini G, Calzavara-Pinton P. A Critical Reappraisal of Off-Label Use of Photodynamic Therapy for the Treatment of Non-Neoplastic Skin Conditions. Dermatology 2020; 237:262-276. [PMID: 32554971 DOI: 10.1159/000507926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the past 30 years, topical photodynamic therapy (PDT) has been investigated for the treatment of a broad spectrum of cosmetic, inflammatory, and infectious skin conditions with variable, and often contrasting, results. However, the non-expert clinician may be in difficulty evaluating these results because different sensitizers, concentrations, formulations, light sources, and irradiation protocols have been used. In addition, many of these studies have poor quality design being case reports and uncontrolled studies of few cases. SUMMARY With the aim to clarify the potential usefulness of PDT for the treatment of infectious and inflammatory skin diseases as well as selected cosmetic indications, we searched for randomized controlled clinical trials, non-randomized comparative studies, retrospective studies, and case series studies with a number of at least 10 patients, published since 1990. Later, we reappraised the results in order to give a simple critical overview. Key Messages: Evidence from the literature seems to strongly support the use of ALA- and MAL-PDT for the treatment of common skin diseases such as acne, warts, condylomata, and Leishmania skin infection and for photorejuvenation, i.e., the correction of selected cosmetic changes of aging and photoaging. For other disorders, the level of evidence and strength of recommendation are lower, and controlled randomized studies with prolonged follow-ups are necessary in order to assess the clinical usefulness and other potential advantages over current treatment options.
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Affiliation(s)
- Giuseppe Monfrecola
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Chiara Rovati
- Dermatology Department, University of Brescia, Brescia, Italy
| | | | | | | | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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19
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Yang W, Zhang W, Luo J, Chen J, Tan Y, Lei X. 5-aminolevulinic acid-based photodynamic therapy associated with Itraconazole successfully treated a case of chromoblastomycosis. Photodiagnosis Photodyn Ther 2020; 29:101589. [PMID: 31689509 DOI: 10.1016/j.pdpdt.2019.101589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 11/17/2022]
Abstract
Chromoblastomycosis (CBM) is a prevalent implantation fungal infection. Patients with CBM show chronic granulomatous hyperplasia with ulcers and exudation. It may cause incapacity for labor in some severe clinical forms and it is often refractory to antifungal therapies. There is no optimal treatment. Here we report a case of a 71-year-old male farmer with refractory CBM who was successfully treated with 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) and Itraconazole in 2 months. Clinical cure was achieved with no obvious side effects.
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Affiliation(s)
- Weijiang Yang
- Department of Dermatology, Daping Hospital, The Army Medical University, Chongqing 400042, China
| | - Wentao Zhang
- Department of Dermatology, Daping Hospital, The Army Medical University, Chongqing 400042, China
| | - Jiefu Luo
- Department of Dermatology, Daping Hospital, The Army Medical University, Chongqing 400042, China
| | - Jinyi Chen
- Department of Dermatology, Daping Hospital, The Army Medical University, Chongqing 400042, China
| | - Yang Tan
- Department of Dermatology, Daping Hospital, The Army Medical University, Chongqing 400042, China
| | - Xia Lei
- Department of Dermatology, Daping Hospital, The Army Medical University, Chongqing 400042, China.
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20
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Morton CA, Szeimies RM, Basset-Séguin N, Calzavara-Pinton PG, Gilaberte Y, Haedersdal M, Hofbauer GFL, Hunger RE, Karrer S, Piaserico S, Ulrich C, Wennberg AM, Braathen LR. European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 2: emerging indications - field cancerization, photorejuvenation and inflammatory/infective dermatoses. J Eur Acad Dermatol Venereol 2019; 34:17-29. [PMID: 31805604 DOI: 10.1111/jdv.16044] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/24/2019] [Indexed: 12/12/2022]
Abstract
In addition to approved indications in non-melanoma skin cancer in immunocompetent patients, topical photodynamic therapy (PDT) has also been studied for its place in the treatment of, as well as its potential to prevent, superficial skin cancers in immune-suppressed patients, although sustained clearance rates are lower than for immune-competent individuals. PDT using a nanoemulsion of ALA in a daylight or conventional PDT protocol has been approved for use in field cancerization, although evidence of the potential of the treatment to prevent new SCC remained limited. High-quality evidence supports a strong recommendation for the use of topical PDT in photorejuvenation as well as for acne, refractory warts, cutaneous leishmaniasis and in onychomycosis, although these indications currently lack approvals for use and protocols remain to be optimized, with more comparative evidence with established therapies required to establish its place in practice. Adverse events across all indications for PDT can be minimized through the use of modified and low-irradiance regimens, with a low risk of contact allergy to photosensitizer prodrugs, and no other significant documented longer-term risks with no current evidence of cumulative toxicity or photocarcinogenic risk. The literature on the pharmacoeconomics for using PDT is also reviewed, although accurate comparisons are difficult to establish in different healthcare settings, comparing hospital/office-based therapies of PDT and surgery with topical ointments, requiring inclusion of number of visits, real-world efficacy as well as considering the value to be placed on cosmetic outcome and patient preference. This guideline, published over two parts, considers all current approved and emerging indications for the use of topical photodynamic therapy in Dermatology prepared by the PDT subgroup of the European Dermatology Forum guidelines committee. It presents consensual expert recommendations reflecting current published evidence.
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Affiliation(s)
- C A Morton
- Department of Dermatology, Stirling Community Hospital, Stirling, UK
| | - R-M Szeimies
- Department of Dermatology, Regensburg University Hospital, Regensburg, Germany.,Department of Dermatology & Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - N Basset-Séguin
- Department of Dermatology, Hôpital Saint Louis, Paris, France
| | | | - Y Gilaberte
- Department of Dermatology, Hospital Universitario miguel servet IIS Aragón, Zaragoza, Spain
| | - M Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - G F L Hofbauer
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland
| | - R E Hunger
- Department of Dermatology Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Karrer
- Department of Dermatology, Regensburg University Hospital, Regensburg, Germany
| | - S Piaserico
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | - C Ulrich
- Skin Cancer Centre, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A-M Wennberg
- Department of Dermatology, Sahlgrenska University Hospital, Gothenburg, Sweden
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21
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Morais JAV, Rodrigues MC, Ferreira FF, Ranjan K, Azevedo RB, Poças-Fonseca MJ, Muehlmann LA. Photodynamic therapy inhibits cell growth and enhances the histone deacetylase-mediated viability impairment in Cryptococcus spp. in vitro. Photodiagnosis Photodyn Ther 2019; 29:101583. [PMID: 31731064 DOI: 10.1016/j.pdpdt.2019.101583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/09/2019] [Accepted: 10/18/2019] [Indexed: 01/08/2023]
Abstract
Cryptococcosis is a disseminated infection caused mainly by C. neoformans and C. gattii. Limitations for the treatment involve the selection of isolates resistant to conventional antifungal drugs, prolonged treatment time and drugs side effects. This study evaluated the combined effect of histone deacetylase inhibitors (HDACi) and photodynamic therapy (PDT) on the growth of C. neoformans and C. gattii in vitro. Results showed that PDT inhibited yeasts proliferation and enhanced the HDACi-mediated cell viability impairment in Cryptococcus spp.
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Affiliation(s)
- José Athayde Vasconcelos Morais
- Laboratory of Nanoscience and Immunology, Faculty of Ceilandia, University of Brasilia, Brasilia, DF, Brazil; Laboratory of Nanobiotechnology, Department of Genetics and Morphology, Institute of Biological Sciences, University of Brasilia, Brasilia, DF, Brazil
| | - Mosar C Rodrigues
- Laboratory of Nanoscience and Immunology, Faculty of Ceilandia, University of Brasilia, Brasilia, DF, Brazil; Laboratory of Nanobiotechnology, Department of Genetics and Morphology, Institute of Biological Sciences, University of Brasilia, Brasilia, DF, Brazil
| | - Fernanda F Ferreira
- Laboratory of Gene Regulation and Mutagenesis, Department of Genetics and Morphology, Institute of Biological Sciences, University of Brasilia, Brasilia, DF, Brazil
| | - Kunal Ranjan
- Laboratory of Gene Regulation and Mutagenesis, Department of Genetics and Morphology, Institute of Biological Sciences, University of Brasilia, Brasilia, DF, Brazil
| | - Ricardo Bentes Azevedo
- Laboratory of Nanobiotechnology, Department of Genetics and Morphology, Institute of Biological Sciences, University of Brasilia, Brasilia, DF, Brazil
| | - Marcio J Poças-Fonseca
- Laboratory of Gene Regulation and Mutagenesis, Department of Genetics and Morphology, Institute of Biological Sciences, University of Brasilia, Brasilia, DF, Brazil
| | - Luis A Muehlmann
- Laboratory of Nanoscience and Immunology, Faculty of Ceilandia, University of Brasilia, Brasilia, DF, Brazil; Laboratory of Nanobiotechnology, Department of Genetics and Morphology, Institute of Biological Sciences, University of Brasilia, Brasilia, DF, Brazil.
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22
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Chen B, Sun Y, Zhang J, Chen R, Zhong X, Wu X, Zheng L, Zhao J. In vitro Evaluation of Photodynamic Effects Against Biofilms of Dermatophytes Involved in Onychomycosis. Front Microbiol 2019; 10:1228. [PMID: 31231330 PMCID: PMC6568038 DOI: 10.3389/fmicb.2019.01228] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/16/2019] [Indexed: 02/01/2023] Open
Abstract
Dermatophytes are the most common cause of onychomycosis, counting for 90% fungal nail infection. Although dermatophyte pathogens are normally susceptible to antifungal agents, onychomycosis often results in refractory chronic disease, and the formation of biofilms frequently underlines the inadequate responses and resistance to standard antifungal treatment. Numerous in vitro and in vivo antimicrobial photodynamic therapy (aPDT) studies have shown biofilm eradication or substantial reduction, however, such investigation has not yet been expanded to the biofilms of dermatophytes involved in onychomycosis. To shed a light on the potential application of aPDT in the clinic management of onychomycosis, in particular with the manifestation of dermatophytoma, we investigated photodynamic effects on the viabilities and the drug susceptibilities of the biofilm of dermatophytes in vitro. Here, methylene blue at the concentration of 8, 16, and 32 μg/ml applied as photosensitizing agent and LED (635 ± 10 nm, 60 J/cm2) as light source were employed against six strains of Trichophyton rubrum, ten strains of Trichophyton mentagrophytes and three strains of Microsporum gypseum isolated from clinical specimens. Our results indicated highly efficient photodynamic inhibition, exhibiting CFU (colony forming unit) reduction up to 4.6 log10, 4.3 log10, and 4.7 log10 against the biofilms formed by T. rubrum, T. mentagrophytes, and M. gypseum, respectively. Subjected biofilms displayed considerable decreases in SMICs (sessile minimum inhibitory concentrations) to multiple antifungal agents when compared with untreated groups, indicating the biofilms of dermatophytes became more susceptible to conventional antifungal drugs after aPDT. Additionally, the obliteration of biofilm after aPDT could be observed as shattered and ruptured structures being evident in SEM (Scanning Electron Microscopy) images. These findings suggest that aPDT is an attractive alternative treatment holding great promise for combating recalcitrant onychomycosis associated with the biofilm formation.
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Affiliation(s)
- Borui Chen
- Department of Dermatology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Dermatology Hospital of Fuzhou, Fuzhou, China
| | - Yi Sun
- Department of Dermatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, China
| | | | - Ruijun Chen
- Dermatology Hospital of Fuzhou, Fuzhou, China
| | - Xiurong Zhong
- Electron Microscopy Laboratory, Fujian Medical University, Fuzhou, China
| | - Xiaomo Wu
- Dermatology Hospital of Fuzhou, Fuzhou, China
| | - Libao Zheng
- Dermatology Hospital of Fuzhou, Fuzhou, China
| | - Jingjun Zhao
- Department of Dermatology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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23
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Photodynamic therapy of deep tissue abscess cavities: Retrospective image‐based feasibility study using Monte Carlo simulation. Med Phys 2019; 46:3259-3267. [DOI: 10.1002/mp.13557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/11/2019] [Accepted: 04/17/2019] [Indexed: 01/11/2023] Open
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24
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Effects of Photodynamic Inactivation on the Growth and Antifungal Susceptibility of Rhizopus oryzae. Mycopathologia 2019; 184:315-319. [PMID: 30689142 DOI: 10.1007/s11046-019-00321-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
Mucormycosis is an aggressive and high-mortality opportunistic fungal infection, especially in immunocompromised patients. Conventional antifungals or surgery showed a limited effect on this disease. The antimicrobial photodynamic therapy (aPDT) has been proven to be a promising therapeutic choice against multiple pathogenic fungi. We evaluated the effect of aPDT by using methylene blue (MB) combined with a light emitting diode (LED) on the viability of Rhizopus oryzae, as well as the antifungal susceptibility after aPDT treatment in vitro. A total of six strains were included in this study; MB (8, 16, and 32 μg/ml) was chosen for the photosensitizer, and a light source of LED (635 ± 10 nm, 12 J/cm2) device was used to active it. aPDT with MB (32 μg/ml) and LED was highly effective in cell growth inhibition and exhibited colony-forming unit reductions of up to 4.3log10. The minimal inhibitory concentration ranges of itraconazole, posaconazole, and amphotericin B decreased from > 32 μg/ml to 4-8 μg/ml, 8-16 μg/ml to 0.5-2 μg/ml, and 2-4 μg/ml to 0.25-0.5 μg/ml, respectively, after pre-treatment with MB (8 μg/ml) and LED. In conclusion, aPDT with MB and LED was a promising therapeutic option against R. oryzae infections alone or combined with antifungal agents. However, further investigation is needed to determine the potential for clinic therapy and to elucidate the underlying mechanism.
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Chaturvedi V, Bouchara JP, Hagen F, Alastruey-Izquierdo A, Badali H, Bocca AL, Cano-Lira JF, Cao C, Chaturvedi S, Chotirmall SH, van Diepeningen AD, Gangneux JP, Guinea J, de Hoog S, Ilkit M, Kano R, Liu W, Martinez-Rossi NM, de Souza Carvalho Melhem M, Ono MA, Ran Y, Ranque S, de Almeida Soares CM, Sugita T, Thomas PA, Vecchiarelli A, Wengenack NL, Woo PCY, Xu J, Zancope-Oliveira RM. Eighty Years of Mycopathologia: A Retrospective Analysis of Progress Made in Understanding Human and Animal Fungal Pathogens. Mycopathologia 2018; 183:859-877. [PMID: 30506286 DOI: 10.1007/s11046-018-0306-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/09/2018] [Indexed: 11/30/2022]
Abstract
Mycopathologia was founded in 1938 to 'diffuse the understanding of fungal diseases in man and animals among mycologists.' This was an important mission considering that pathogenic fungi for humans and animals represent a tiny minority of the estimated 1.5-5 million fungal inhabitants on Earth. These pathogens have diverged from the usual saprotrophic lifestyles of most fungi to colonize and infect humans and animals. Medical and veterinary mycology is the subdiscipline of microbiology that dwells into the mysteries of parasitic, fungal lifestyles. Among the oldest continuing scientific publications on the subject, Mycopathologia had its share of 'classic papers' since the first issue was published in 1938. An analysis of the eight decades of notable contributions reveals many facets of host-pathogen interactions among 183 volumes comprising about 6885 articles. We have analyzed the impact and relevance of this body of work using a combination of citation tools (Google Scholar and Scopus) since no single citation metric gives an inclusive perspective. Among the highly cited Mycopathologia publications, those on experimental mycology accounted for the major part of the articles (36%), followed by diagnostic mycology (16%), ecology and epidemiology (15%), clinical mycology (14%), taxonomy and classification (10%), and veterinary mycology (9%). The first classic publication, collecting nearly 200 citations, appeared in 1957, while two articles published in 2010 received nearly 150 citations each, which is notable for a journal covering a highly specialized field of study. An empirical analysis of the publication trends suggests continuing interests in novel diagnostics, fungal pathogenesis, review of clinical diseases especially with relevance to the laboratory scientists, taxonomy and classification of fungal pathogens, fungal infections and carriage in pets and wildlife, and changing ecology and epidemiology of fungal diseases around the globe. We anticipate that emerging and re-emerging fungal pathogens will continue to cause significant health burden in the coming decades. It remains vital that scientists and physicians continue to collaborate by learning each other's language for the study of fungal diseases, and Mycopathologia will strive to be their partner in this increasingly important endeavor to its 100th anniversary in 2038 and beyond.
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Affiliation(s)
- Vishnu Chaturvedi
- New York State Department of Health and University at Albany, Albany, NY, USA.
| | | | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | | | - Hamid Badali
- Mazandaran University of Medical Sciences, Sari, Iran
| | | | | | - Cunwei Cao
- Guangxi Medical University, Nanning, China
| | - Sudha Chaturvedi
- New York State Department of Health and University at Albany, Albany, NY, USA
| | | | | | | | | | - Sybren de Hoog
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | | | - Rui Kano
- Nihon University College of Bioresource Sciences, Fujisawa, Japan
| | - Weida Liu
- Peking Union Medical College, Nanjing, China
| | | | | | | | | | | | | | | | - Philip A Thomas
- Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirappalli, India
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de Brito AC, Bittencourt MDJS. Chromoblastomycosis: an etiological, epidemiological, clinical, diagnostic, and treatment update. An Bras Dermatol 2018; 93:495-506. [PMID: 30066754 PMCID: PMC6063100 DOI: 10.1590/abd1806-4841.20187321] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/24/2017] [Indexed: 01/19/2023] Open
Abstract
Chromoblastomycosis is a chronic, granulomatous, suppurative mycosis of the skin and subcutaneous tissue caused by traumatic inoculation of dematiaceous fungi of the family Herpotrichiellaceae. The species Fonsecaea pedrosoi and Cladophialophora carrionii are prevalent in regions where the disease is endemic. Chromoblastomycosis lesions are polymorphous: verrucous, nodular, tumoral, plaque-like, and atrophic. It is an occupational disease that predominates in tropical and subtropical regions, but there have been several reports of cases in temperate regions. The disease mainly affects current or former farm workers, mostly males, and often leaving disabling sequelae. This mycosis is still a therapeutic challenge due to frequent recurrence of lesions. Patients with extensive lesions require a combination of pharmacological and physical therapies. The article provides an update of epidemiological, clinical, diagnostic, and therapeutic features.
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Affiliation(s)
- Arival Cardoso de Brito
- Dermatology Course, Universidade Federal do Pará,
Belém (PA), Brazil
- Medical Residency in Dermatology, Universidade Federal do
Pará, Belém (PA), Brazil
- Dermatopathology Laboratory, Universidade Federal do Pará,
Belém (PA), Brazil
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Cai Q, Yang LJ, Chen J, Yang H, Gao ZQ, Wang XL. Successful Sequential Treatment with Itraconazole and ALA-PDT for Cutaneous Granuloma by Candida albicans: A Case Report and Literature Review. Mycopathologia 2018; 183:829-834. [PMID: 29767317 DOI: 10.1007/s11046-018-0267-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/25/2018] [Indexed: 02/06/2023]
Abstract
Photodynamic therapy (PDT) is a process that combines a photosensitizing drug and light and promotes phototoxic responses in target cells, mainly via oxidative damage. Antifungal photodynamic therapy has been successfully employed against Candida species, dermatophytes, and deep mycoses. We present a case of a cutaneous granuloma caused by C. albicans treated with 5-aminolevulinic acid (ALA)-PDT. A 64-year-old man presented with two plaques on his right hand and wrist for 2 years. The diagnosis was made based on histopathology, mycology, and molecular identification of paraffin-embedded tissues. The patient was treated with itraconazole for 1 month and two sessions of ALA-PDT. After 2 months of follow-up, the patient was cured and has not experienced any recurrence to date. ALA-PDT was well tolerated in this patient with little pain. In general, application of PDT in mycoses is safe and effective in most cases. ALA-PDT is a good choice for inactivation of C. albicans.
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Affiliation(s)
- Qing Cai
- Department of Mycology, Shanghai Dermatology Hospital, Shanghai, China
| | - Lian-Juan Yang
- Department of Mycology, Shanghai Dermatology Hospital, Shanghai, China.
| | - Jia Chen
- Department of Pathology, Shanghai Dermatology Hospital, Shanghai, China
| | - Hong Yang
- Department of Mycology, Shanghai Dermatology Hospital, Shanghai, China
| | - Zhi-Qin Gao
- Department of Mycology, Shanghai Dermatology Hospital, Shanghai, China
| | - Xiu-Li Wang
- Institute of Photomedicine, Shanghai Dermatology Hospital, Shanghai, China.
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Pérez-Laguna V, García-Malinis AJ, Aspiroz C, Rezusta A, Gilaberte Y. Antimicrobial effects of photodynamic therapy. GIORN ITAL DERMAT V 2018; 153:833-846. [PMID: 29683289 DOI: 10.23736/s0392-0488.18.06007-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The microorganisms that cause infections are increasing their resistance to antibiotics. In this context, alternative treatments are necessary. The antimicrobial photodynamic therapy (aPDT) is a therapeutic modality based on photosensitizing molecules that end up generating reactive oxygen species that induce the destruction of the target cells when are irradiated with light of a suitable wavelength and at a proper dose. The cells targeted by aPDT are all types of microorganisms (bacteria, fungi and parasites) including viruses and has been proven effective against representative members of all of them. In the field of dermatology, aPDT has been tested with promising results in different infections such as chronic ulcers, acne, onychomycosis and other cutaneous mycoses, as well as in leishmaniasis. Therefore, it is presented as a possible treatment option against the agents that cause skin and/or mucous infections.
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Affiliation(s)
| | | | - Carmen Aspiroz
- Unit of Microbiology, Hospital Royo Villanova, Zaragoza, Spain
| | - Antonio Rezusta
- IIS Aragón, Zaragoza, Spain.,Department of Microbiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Yolanda Gilaberte
- IIS Aragón, Zaragoza, Spain - .,Department of Dermatology, Hospital Universitario Miguel Servet, Zaragoza, Spain
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29
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Synthesis and biological evaluation of new water-soluble photoactive chlorin conjugate for targeted delivery. Eur J Med Chem 2018; 144:740-750. [DOI: 10.1016/j.ejmech.2017.12.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/15/2017] [Accepted: 12/16/2017] [Indexed: 11/19/2022]
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Photodynamic effects on Fonsecaea monophora conidia and RAW264.7 in vitro. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2017; 176:112-117. [DOI: 10.1016/j.jphotobiol.2017.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 08/28/2017] [Accepted: 09/01/2017] [Indexed: 01/10/2023]
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Abstract
Chromoblastomycosis (CBM), also known as chromomycosis, is one of the most prevalent implantation fungal infections, being the most common of the gamut of mycoses caused by melanized or brown-pigmented fungi. CBM is mainly a tropical or subtropical disease that may affect individuals with certain risk factors around the world. The following characteristics are associated with this disease: (i) traumatic inoculation by implantation from an environmental source, leading to an initial cutaneous lesion at the inoculation site; (ii) chronic and progressive cutaneous and subcutaneous tissular involvement associated with fibrotic and granulomatous reactions associated with microabscesses and often with tissue proliferation; (iii) a nonprotective T helper type 2 (Th2) immune response with ineffective humoral involvement; and (iv) the presence of muriform (sclerotic) cells embedded in the affected tissue. CBM lesions are clinically polymorphic and are commonly misdiagnosed as various other infectious and noninfectious diseases. In its more severe clinical forms, CBM may cause an incapacity for labor due to fibrotic sequelae and also due to a series of clinical complications, and if not recognized at an early stage, this disease can be refractory to antifungal therapy.
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García-Malinis A, Milagro Beamonte A, Torres Sopena L, García-Callen O, Puertolas-Villacampa P, Gilaberte Y. Cutaneous sporotrichosis treated with methylene blue-daylight photodynamic therapy. J Eur Acad Dermatol Venereol 2017; 32:e90-e91. [DOI: 10.1111/jdv.14545] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A.J. García-Malinis
- Unit of Dermatology; San Jorge Hospital; Avenida Martinez de Velasco, 36 Huesca Spain
- Unit of Dermatology; Jaca Hospital; Avenida Rapitan sn, Jaca Huesca Spain
| | - A. Milagro Beamonte
- Department of Microbiology; San Jorge Hospital; Avenida Martínez de Velasco, 36 Huesca Spain
| | - L. Torres Sopena
- Department of Microbiology; San Jorge Hospital; Avenida Martínez de Velasco, 36 Huesca Spain
| | - O. García-Callen
- Unit of Dermatology; Jaca Hospital; Avenida Rapitan sn, Jaca Huesca Spain
| | | | - Y. Gilaberte
- Unit of Dermatology; San Jorge Hospital; Avenida Martinez de Velasco, 36 Huesca Spain
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Lu Q, Sun Y, Tian D, Xiang S, Gao L. Effects of Photodynamic Therapy on the Growth and Antifungal Susceptibility of Scedosporium and Lomentospora spp. Mycopathologia 2017; 182:1037-1043. [PMID: 28836110 DOI: 10.1007/s11046-017-0195-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/18/2017] [Indexed: 01/08/2023]
Abstract
Scedosporium and Lomentospora species are the second most frequent colonizing, allergenic, or invasive fungal pathogens in patients with cystic fibrosis, and are responsible for infections varying from cutaneous and subcutaneous tissue infections caused by traumatic inoculation to severe systemic diseases in immunocompromised patients. The clinical relevance of fungal airway colonization for individual patients harboring Scedosporium and Lomentospora species is still an underestimated issue. The high resistance of Scedosporium and Lomentospora species to antifungal drugs has highlighted the need for alternative treatment modalities, and antimicrobial photodynamic therapy may be one such alternative. In this study, methylene blue was applied as a photosensitizing agent to 6 type strains of Scedosporium and Lomentospora species, and we irradiated the strains using a light-emitting diode (635 ± 10 nm, 12 J/cm2). We evaluated the effects of photodynamic therapy on strain growth and on the in vitro susceptibility of the strains to itraconazole, voriconazole, posaconazole, and amphotericin B. A colony-forming unit reduction of up to 5.2 log10 was achieved. Minimal inhibitory concentration ranges also decreased significantly with photoinactivation. Photodynamic therapy improved both the inactivation rates and the antifungal susceptibility profile of all fungal isolates tested.
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Affiliation(s)
- Qiaoyun Lu
- Department of Dermatology, Central Hospital of Xiangyang, Hubei College of Arts and Science, No. 136 Jingzhou Street, Xiangcheng District, Xiangyang, 441021, People's Republic of China.
| | - Yi Sun
- Department of Dermatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, 434100, People's Republic of China
| | - Dingdan Tian
- Department of Dermatology, Hospital of Wuhan University, Wuhan, 430000, People's Republic of China
| | - Shoubao Xiang
- Department of Dermatology, Central Hospital of Xiangyang, Hubei College of Arts and Science, No. 136 Jingzhou Street, Xiangcheng District, Xiangyang, 441021, People's Republic of China
| | - Lujuan Gao
- Department of Dermatology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People's Republic of China.
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Queiroz-Telles F, Fahal AH, Falci DR, Caceres DH, Chiller T, Pasqualotto AC. Neglected endemic mycoses. THE LANCET. INFECTIOUS DISEASES 2017; 17:e367-e377. [PMID: 28774696 DOI: 10.1016/s1473-3099(17)30306-7] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/19/2016] [Accepted: 03/23/2017] [Indexed: 01/18/2023]
Abstract
Fungi often infect mammalian hosts via the respiratory route, but traumatic transcutaneous implantation is also an important source of infections. Environmental exposure to spores of pathogenic fungi can result in subclinical and unrecognised syndromes, allergic manifestations, and even overt disease. After traumatic cutaneous inoculation, several fungi can cause neglected mycoses such as sporotrichosis, chromoblastomycosis, mycetoma, entomophthoramycosis, and lacaziosis. Most of these diseases have a subacute to chronic course and they can become recalcitrant to therapy and lead to physical disabilities, including inability to work, physical deformities, and amputations. For many years, paracoccidioidomycosis was considered the most prevalent endemic systemic mycosis in the Americas, but this situation might be changing with recognition of the worldwide presence of Histoplasma capsulatum. Both paracoccidioidomycosis and histoplasmosis can mimic several infectious and non-infectious medical conditions and lead to death if not recognised early and treated. Cutaneous implantation and systemic mycoses are neglected diseases that affect millions of individuals worldwide, especially in low-income countries where their management is suboptimum because challenges in diagnosis and therapeutic options are substantial issues.
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Affiliation(s)
| | | | - Diego R Falci
- Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Centro Universitário La Salle, Canoas, Brazil
| | - Diego H Caceres
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alessandro C Pasqualotto
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Ouédraogo MS, Vignon-Pennamen MD, Battistella M, Levy A, Feuilhade de Chauvin M, Petit A. [Chromomycosis acquired in a non-tropical area: A case report]. Ann Dermatol Venereol 2017; 144:438-442. [PMID: 28396061 DOI: 10.1016/j.annder.2017.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 02/07/2017] [Accepted: 02/28/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chromomycosis, or chromoblastomycosis, is caused by cutaneous inoculation of dematiaceous fungi of telluric or plant origin. It is generally seen in tropical or subtropical zones. Treatment of the condition is known to be complex. Herein we report a case of chromomycosis contracted in a temperate region of Eastern Europe/Central Asia that was effectively treated with oral itraconazole and terbinafine in combination with cryotherapy. PATIENTS AND METHODS A 44-year-old immunocompetent male subject consulted for a lesion on the buttocks that he had sustained 16 years earlier, and which, although never previously treated, had only become troublesome within the last few months. The examination revealed a large erythemato-squamous plaque containing a heterogeneous infiltrate. The diagnosis was based upon biopsy, with histological examination revealing sooty mould ; culture of a second sample showed the causative agent to be Fonsecaea pedrosoi. After 30 months of treatment combining oral terbinafine at a very high dose (1000mg/day), topical terbinafine and adjuvant cryotherapy, considerable, though incomplete, improvement was obtained. Finally, combined use of terbinafine (500mg/day) and itraconazole (200mg/day) led to clinical and histological cure. DISCUSSION The possibility of acquiring chromomycosis other than in a tropical zone is slight but has nevertheless been described, particularly in Eastern Europe. In our patient, the exact source of contamination is unknown, although it may have been acquired through frequent horse-riding or use of saunas. This case confirms the efficacy of combined itraconazole and terbinafine against this condition, which is usually difficult to treat.
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Affiliation(s)
- M S Ouédraogo
- Service de dermatologie, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - M-D Vignon-Pennamen
- Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Battistella
- Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - A Levy
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Feuilhade de Chauvin
- Service de mycologie parasitologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - A Petit
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
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Kim JR, Michielsen S. Synthesis of Antifungal Agents from Xanthene and Thiazine Dyes and Analysis of Their Effects. NANOMATERIALS (BASEL, SWITZERLAND) 2016; 6:E243. [PMID: 28335371 PMCID: PMC5302722 DOI: 10.3390/nano6120243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/05/2016] [Accepted: 12/09/2016] [Indexed: 11/29/2022]
Abstract
Indoor fungi growth is an increasing home health problem as our homes are more tightly sealed. One thing that limits durability of the antifungal agents is the scarcity of reactive sites on many surfaces to attach these agents. In order to increase graft yield of photosensitizers to the fabrics, poly(acrylic acid-co-styrene sulfonic acid-co-vinyl benzyl rose bengal or phloxine B) were polymerized and then grafted to electrospun fabrics. In an alternative process, azure A or toluidine blue O were grafted to poly(acrylic acid), which was subsequently grafted to nanofiber-based and microfiber-based fabrics. The fabrics grafted with photosensitizers induced antifungal effects on all seven types of fungi in the order of rose bengal > phloxine B > toluidine blue O > azure A, which follows the quantum yield production of singlet oxygen for these photoactive dyes. Their inhibition rates for inactivating fungal spores decreased in the order of P. cinnamomi, T. viride, A. niger, A. fumigatus, C. globosum, P. funiculosum, and M. grisea, which is associated with lipid composition in membrane and the morphology of fungal spores. The antifungal activity was also correlated with the surface area of fabric types which grafted the photosensitizer covalently on the surface as determined by the bound color strength.
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Affiliation(s)
- Joo Ran Kim
- Fiber Science & Apparel Design, Cornell University, Ithaca, NY 14850, USA.
| | - Stephen Michielsen
- Textile Engineering, Chemistry and Science, North Carolina State University, 2401 Research Dr., Raleigh, NC 27695, USA.
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Mono- and tetra-substituted zinc(II) phthalocyanines containing morpholinyl moieties: Synthesis, antifungal photodynamic activities, and structure-activity relationships. Eur J Med Chem 2016; 114:380-9. [DOI: 10.1016/j.ejmech.2016.02.066] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 01/23/2016] [Accepted: 02/25/2016] [Indexed: 01/18/2023]
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Gao L, Jiang S, Sun Y, Deng M, Wu Q, Li M, Zeng T. Evaluation of the Effects of Photodynamic Therapy Alone and Combined with Standard Antifungal Therapy on Planktonic Cells and Biofilms of Fusarium spp. and Exophiala spp. Front Microbiol 2016; 7:617. [PMID: 27199946 PMCID: PMC4847004 DOI: 10.3389/fmicb.2016.00617] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/14/2016] [Indexed: 12/02/2022] Open
Abstract
Infections of Fusarium spp. and Exophiala spp. are often chronic, recalcitrant, resulting in significant morbidity, causing discomfort, disfigurement, social isolation. Systemic disseminations happen in compromised patients, which are often refractory to available antifungal therapies and thereby lead to death. The antimicrobial photodynamic therapy (aPDT) has been demonstrated to effectively inactivate multiple pathogenic fungi and is considered as a promising alternative treatment for mycoses. In the present study, we applied methylene blue (8, 16, and 32 μg/ml) as a photosensitizing agent and light emitting diode (635 ± 10 nm, 12 and 24 J/cm2), and evaluated the effects of photodynamic inactivation on five strains of Fusarium spp. and five strains of Exophiala spp., as well as photodynamic effects on in vitro susceptibility to itraconazole, voriconazole, posaconazole and amphotericin B, both planktonic and biofilm forms. Photodynamic therapy was efficient in reducing the growth of all strains tested, exhibiting colony forming unit-reductions of up to 6.4 log10 and 5.6 log10 against planktonic cultures and biofilms, respectively. However, biofilms were less sensitive since the irradiation time was twice longer than that of planktonic cultures. Notably, the photodynamic effects against Fusarium strains with high minimal inhibitory concentration (MIC) values of ≥16, 4-8, 4-8, and 2-4 μg/ml for itraconazole, voriconazole, posaconazole and amphotericin B, respectively, were comparable or even superior to Exophiala spp., despite Exophiala spp. showed relatively better antifungal susceptibility profile. MIC ranges against planktonic cells of both species were up to 64 times lower after aPDT treatment. Biofilms of both species showed high sessile MIC50 (SMIC50) and SMIC80 of ≥16 μg/ml for all azoles tested and variable susceptibilities to amphotericin B, with SMIC ranging between 1 and 16 μg/ml. Biofilms subjected to aPDT exhibited a distinct reduction in SMIC50 and SMIC80 compared to untreated groups for both species, except SMIC80 of itraconazole against Fusarium biofilms. In conclusion, in vitro photodynamic therapy was efficient in inactivation of Fusarium spp. and Exophiala spp., both planktonic cultures and biofilms. In addition, the combination of aPDT and antifungal drugs represents an attractive alternative to the current antifungal strategies. However, further investigations are warranted for the reliable and safe application in clinical practice.
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Affiliation(s)
- Lujuan Gao
- Department of Dermatology, Zhongshan Hospital Fudan University Shanghai, China
| | - Shaojie Jiang
- Department of Gastroenterology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University Jingzhou, China
| | - Yi Sun
- Department of Dermatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University Jingzhou, China
| | - Meiqi Deng
- The Second Clinical Medical College, Yangtze University Jingzhou, China
| | - Qingzhi Wu
- Department of Dermatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University Jingzhou, China
| | - Ming Li
- Department of Dermatology, Zhongshan Hospital Fudan University Shanghai, China
| | - Tongxiang Zeng
- Department of Dermatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University Jingzhou, China
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Scorzoni L, Sangalli-Leite F, de Lacorte Singulani J, de Paula e Silva ACA, Costa-Orlandi CB, Fusco-Almeida AM, Mendes-Giannini MJS. Searching new antifungals: The use of in vitro and in vivo methods for evaluation of natural compounds. J Microbiol Methods 2016; 123:68-78. [DOI: 10.1016/j.mimet.2016.02.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/29/2016] [Accepted: 02/03/2016] [Indexed: 12/15/2022]
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40
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Kim JR, Michielsen S. Photodynamic activity of nanostructured fabrics grafted with xanthene and thiazine dyes against opportunistic fungi. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2015; 150:50-9. [DOI: 10.1016/j.jphotobiol.2015.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 04/22/2015] [Accepted: 04/27/2015] [Indexed: 12/24/2022]
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Li XS, Guo J, Zhuang JJ, Zheng BY, Ke MR, Huang JD. Highly positive-charged zinc(II) phthalocyanine as non-aggregated and efficient antifungal photosensitizer. Bioorg Med Chem Lett 2015; 25:2386-9. [DOI: 10.1016/j.bmcl.2015.04.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/18/2015] [Accepted: 04/04/2015] [Indexed: 12/16/2022]
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Kim JR, Michielsen S. Photodynamic antifungal activities of nanostructured fabrics grafted with rose bengal and phloxine B againstAspergillus fumigatus. J Appl Polym Sci 2015. [DOI: 10.1002/app.42114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Joo Ran Kim
- Fiber and Polymer Science; Textile Engineering, Chemistry and Science, North Carolina State University; Raleigh North Carolina
| | - Stephen Michielsen
- Fiber and Polymer Science; Textile Engineering, Chemistry and Science, North Carolina State University; Raleigh North Carolina
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Baltazar LM, Ray A, Santos DA, Cisalpino PS, Friedman AJ, Nosanchuk JD. Antimicrobial photodynamic therapy: an effective alternative approach to control fungal infections. Front Microbiol 2015; 6:202. [PMID: 25821448 PMCID: PMC4358220 DOI: 10.3389/fmicb.2015.00202] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/25/2015] [Indexed: 11/17/2022] Open
Abstract
Skin mycoses are caused mainly by dermatophytes, which are fungal species that primarily infect areas rich in keratin such as hair, nails, and skin. Significantly, there are increasing rates of antimicrobial resistance among dermatophytes, especially for Trichophyton rubrum, the most frequent etiologic agent worldwide. Hence, investigators have been developing new therapeutic approaches, including photodynamic treatment. Photodynamic therapy (PDT) utilizes a photosensitive substance activated by a light source of a specific wavelength. The photoactivation induces cascades of photochemicals and photobiological events that cause irreversible changes in the exposed cells. Although photodynamic approaches are well established experimentally for the treatment of certain cutaneous infections, there is limited information about its mechanism of action for specific pathogens as well as the risks to healthy tissues. In this work, we have conducted a comprehensive review of the current knowledge of PDT as it specifically applies to fungal diseases. The data to date suggests that photodynamic treatment approaches hold great promise for combating certain fungal pathogens, particularly dermatophytes.
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Affiliation(s)
- Ludmila M Baltazar
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx NY, USA ; Department of Medicine, Albert Einstein College of Medicine, Bronx NY, USA
| | - Anjana Ray
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx NY, USA ; Department of Medicine, Albert Einstein College of Medicine, Bronx NY, USA
| | - Daniel A Santos
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Patrícia S Cisalpino
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Adam J Friedman
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx NY, USA ; Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx NY, USA
| | - Joshua D Nosanchuk
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx NY, USA ; Department of Medicine, Albert Einstein College of Medicine, Bronx NY, USA
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In vitro photodynamic inactivation of Sporothrix schenckii complex species. Med Mycol 2014; 52:770-3. [DOI: 10.1093/mmy/myu041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Liu ZH, Xia XJ. Successful sequential treatment with itraconazole and ALA-PDT for chromoblastomycosis because ofAlternaria alternata. Dermatol Ther 2014; 27:357-60. [PMID: 25039437 DOI: 10.1111/dth.12149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ze-Hu Liu
- Department of Dermatology; Affiliated Third Hospital of Hangzhou; Anhui Medical University; Hangzhou China
| | - Xiu-Jiao Xia
- Department of Dermatology; Affiliated Third Hospital of Hangzhou; Anhui Medical University; Hangzhou China
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Gilaberte Y, Aspiroz C, Alejandre MC, Andres-Ciriano E, Fortuño B, Charlez L, Revillo MJ, Hamblin MR, Rezusta A. Cutaneous sporotrichosis treated with photodynamic therapy: an in vitro and in vivo study. Photomed Laser Surg 2013; 32:54-7. [PMID: 24328608 DOI: 10.1089/pho.2013.3590] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sporotrichosis is a fungal infection caused by Sporothrix schenckii complex, usually restricted to the skin, subcutaneous cellular tissue, and adjacent lymphatic vessels. Antimicrobial photodynamic therapy (aPDT) could be a good alternative to manage localized, superficial infections. CASE REPORT A 65-year-old African woman was diagnosed with a fixed cutaneous sporotrichosis on her left arm, treated with itraconazol and oral terbinafine with partial improvement. Topical 16% methyl aminolevulinate (MAL, Metvix(®))-PDT was used without success. METHODS An in vitro photoinactivation test with the isolated microorganism revealed phenothiazinium salts to be more effective than MAL. CONCLUSIONS PDT with intralesional 1% methylene blue (MB) in combination with intermittent low doses of itraconazole obtained complete microbiological and clinical response.
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47
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Challenges in the therapy of chromoblastomycosis. Mycopathologia 2013; 175:477-88. [PMID: 23636730 DOI: 10.1007/s11046-013-9648-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
Abstract
Chromoblastomycosis (CBM) is an implantation mycosis mainly occurring in tropical and subtropical zones worldwide. If not diagnosed at early stages, patients with CBM require long-term therapy with systemic antifungals flanked by various physical treatment regimens. As in other neglected endemic mycoses, comparative clinical trials have not been performed for this disease; nowadays, therapy is mainly based on a few open trials and on expert opinions. Itraconazole, either as monotherapy or associated with other drugs, or with physical methods, is widely used. Recently, photodynamic therapy has been employed successfully in combination with antifungals in patients presenting with CBM. In the present paper, the most used therapeutic options against CBM are reviewed as well as the several factors that may have impact on the patient's outcome.
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Pires L, Bosco SDMG, da Silva Junior NF, Kurachi C. Photodynamic therapy for pythiosis. Vet Dermatol 2013; 24:130-6.e30. [DOI: 10.1111/j.1365-3164.2012.01112.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lyon JP, Rezende RR, Rabelo MP, de Lima CJ, Moreira LM. Synergic Effect of Photodynamic Therapy with Methylene Blue and Surfactants in the Inhibition of Candida albicans. Mycopathologia 2012. [DOI: 10.1007/s11046-012-9601-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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50
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Lu S, Lu C, Zhang J, Hu Y, Li X, Xi L. Chromoblastomycosis in Mainland China: A Systematic Review on Clinical Characteristics. Mycopathologia 2012; 175:489-95. [PMID: 23086329 DOI: 10.1007/s11046-012-9586-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 09/20/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Sha Lu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Rd, Guangzhou, 510120, China
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