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Kim G, Yoo SJ, Yoo JR, Seo KB. The first case report of thorn-induced Alternaria alternata infection of the hand in an immunocompetent host. BMC Infect Dis 2022; 22:304. [PMID: 35351014 PMCID: PMC8962066 DOI: 10.1186/s12879-022-07280-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fungal infection secondary to a penetrating plant thorn injury in upper extremities is infrequently reported especially in immunocompetent hosts. Alternaria is a dematicaceous hyphomycete, commonly found in decay and plant pathogens, and Alternaria alternata has been regarded as the most frequent species among more than 400 s of its species. This case is the first report of thorn-induced Alternaria alternata infection of the hand in an immunocompetent host. CASE PRESENTATION A 47-year-old male patient was admitted to our institution with persistent pain and swelling of the right hand even after a prior surgical removal of a previous thorn injury. Upon impression of abscess, chronic extensor tenosynovitis, and septic arthritis at the 3rd metacarpophalangeal joint based on advanced imaging, the patient underwent surgical incision and drainage. Intraoperative culture, biopsy, and gene molecular sequencing results revealed fungal infection with Alternaria alternata. Postoperatively, the patient was treated with oral itraconazole (200 mg q 12 h) for nine consecutive months. CONCLUSIONS We report the first case of chronic extensor tenosynovitis and septic arthritis of the hand with Alternaria alternata after a thorn injury in an immunocompetent host. Despite rare incidences of fungal extensor tenosynovitis and septic arthritis, the current case strongly suggests a careful examination of social history and surgical debridement along with a prolonged use of appropriate anti-fungal agents in thorn injuries.
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Affiliation(s)
- Gyeongmin Kim
- Division of Hand Surgery, Department of Orthopedic Surgery, Jeju National University Hospital, Jeju, South Korea
| | - Seung Jin Yoo
- Division of Hand Surgery, Department of Orthopedic Surgery, Jeju National University Hospital, Jeju, South Korea
| | - Jeong Rae Yoo
- Division of Infectious Disease, Department of Internal Medicine, Jeju National University Hospital, Jeju, South Korea
| | - Kyu Bum Seo
- Division of Hand Surgery, Department of Orthopedic Surgery, Jeju National University Hospital, Jeju, South Korea.
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Radcliffe C, Radcliffe AJ, Azar MM, Grant M. Dematiaceous fungal infections in solid organ transplantation: systematic review and bayesian meta-analysis. Transpl Infect Dis 2022; 24:e13819. [PMID: 35253959 DOI: 10.1111/tid.13819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/03/2022] [Accepted: 02/19/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Dematiaceous fungi cause a number of infectious syndromes referred to as phaeohyphomycosis among both immunocompetent and immunocompromised hosts. We performed a systematic review to characterize these infections in solid organ transplant recipients (SOTR). METHODS We searched PubMed database (last searched 1/6/2022) for English-language reports on dematiaceous fungal infections in SOTR. Included reports needed individualized demographic, treatment, and outcome data; pediatric reports were excluded. A universally applicable bias assessment was performed on reports. Models for infection type and outcome were created using the Bayesian paradigm. RESULTS We included 149 reports on 201 cases of dematiaceous fungal infections in SOTR. The mean age was 54 years, 72% were men, and kidney recipients accounted for 61% of cases. Skin and soft tissue infection (SSTI) was the most common infectious syndrome (73%). Death from infection occurred in 7% of cases (14/201), with disseminated (32%) cases having the highest mortality. Our model for infection type predicted the relative probability of central nervous system infection to be highest in liver recipients. Across all transplant types, higher relative probabilities of disseminated and pulmonary infections occur in the early post-transplant period, and the predicted probabilities for these infection types decreased after 100 months post-transplantation. DISCUSSION We identified SSTI as the most common dematiaceous fungal infections in SOTR. Disseminated infections carried the worst prognosis. The evidence in this review is limited by the heterogeneity of included cases. No funding source was used, and this review's protocol was not registered. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Marwan M Azar
- Yale University School of Medicine, New Haven, CT, USA.,Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew Grant
- Yale University School of Medicine, New Haven, CT, USA.,Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
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Harada T, Fukumoto T, Nakamura K, Ohnuma K, Nishigori C. Successful thermotherapy combined with terbinafine hydrochloride 1% cream for cutaneous alternariosis in a post-transplantation patient. Australas J Dermatol 2020; 62:e323-e325. [PMID: 33070334 DOI: 10.1111/ajd.13489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Tomoka Harada
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Fukumoto
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Korefumi Nakamura
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichiro Ohnuma
- Department of Clinical Laboratory, Kobe University Hospital, Kobe, Japan
| | - Chikako Nishigori
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
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Bajwa R, Wojciechowski AL, Hsiao CB. Cutaneous alternariosis in a renal transplant patient successfully treated with posaconazole: Case report and literature review. Med Mycol Case Rep 2017; 15:16-20. [PMID: 28180057 PMCID: PMC5279863 DOI: 10.1016/j.mmcr.2017.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/12/2017] [Accepted: 01/17/2017] [Indexed: 11/20/2022] Open
Abstract
Cutaneous alternariosis is an uncommon fungal infection that most commonly presents in organ transplant patients on immunosuppressive therapy. There are no clinical trials or guidelines to guide treatment of this condition, however itraconazole is the most commonly used antifungal in published cases. Here we report on a case of cutaneous alternariosis in a renal transplant recipient treated with a newer antifungal, posaconazole. A review of published reports of cutaneous alternariosis since 2008 is also discussed.
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Affiliation(s)
- Rajinder Bajwa
- Niagara Falls Memorial Medical Center, 621 10th Street, Niagara Falls, NY 14302, USA
| | - Amy L. Wojciechowski
- Niagara Falls Memorial Medical Center, 621 10th Street, Niagara Falls, NY 14302, USA
- D’Youville College School of Pharmacy, 320 Porter Avenue, Buffalo, NY 14201, USA
- Corresponding author at: Niagara Falls Memorial Medical Center, 621 10th Street, Niagara Falls, NY 14302, USA.
| | - Chiu-Bin Hsiao
- Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA
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5
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Alternaria arborescens Infection in a Healthy Individual and Literature Review of Cutaneous Alternariosis. Mycopathologia 2014; 179:147-52. [DOI: 10.1007/s11046-014-9822-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
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Chowdhary A, Meis J, Guarro J, de Hoog G, Kathuria S, Arendrup M, Arikan-Akdagli S, Akova M, Boekhout T, Caira M, Guinea J, Chakrabarti A, Dannaoui E, van Diepeningen A, Freiberger T, Groll A, Hope W, Johnson E, Lackner M, Lagrou K, Lanternier F, Lass-Flörl C, Lortholary O, Meletiadis J, Muñoz P, Pagano L, Petrikkos G, Richardson M, Roilides E, Skiada A, Tortorano A, Ullmann A, Verweij P, Cornely O, Cuenca-Estrella M. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi. Clin Microbiol Infect 2014; 20 Suppl 3:47-75. [DOI: 10.1111/1469-0691.12515] [Citation(s) in RCA: 216] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 12/13/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022]
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Sečníková Z, Jůzlová K, Vojáčková N, Kazakov DV, Hošková L, Fialová J, Džambová M, Hercogová J. The rare case ofAlternaria alternatacutaneous and pulmonary infection in a heart transplant recipient treated by azole antifungals. Dermatol Ther 2013; 27:140-3. [DOI: 10.1111/dth.12096] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Zuzana Sečníková
- Dermatovenereology Department; 2nd Medical Faculty; Charles University, Bulovka Hospital; Prague Czech Republic
| | - Kateřina Jůzlová
- Dermatovenereology Department; 2nd Medical Faculty; Charles University, Bulovka Hospital; Prague Czech Republic
| | - Naděžda Vojáčková
- Dermatovenereology Department; 2nd Medical Faculty; Charles University, Bulovka Hospital; Prague Czech Republic
| | - Dmitry V. Kazakov
- Sikl's Department of Pathology; Charles University Medical Faculty Hospital; Pilsen Czech Republic
| | - Lenka Hošková
- Cardiology Department; Institute of Clinical and Experimental Medicine; Prague Czech Republic
| | - Jorga Fialová
- Dermatovenereology Department; 2nd Medical Faculty; Charles University, Bulovka Hospital; Prague Czech Republic
| | - Martina Džambová
- Dermatovenereology Department; 2nd Medical Faculty; Charles University, Bulovka Hospital; Prague Czech Republic
| | - Jana Hercogová
- Dermatovenereology Department; 2nd Medical Faculty; Charles University, Bulovka Hospital; Prague Czech Republic
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Abstract
Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes, including chromoblastomycosis, mycetoma, and phaeohyphomycosis. [corrected]. Many are soil organisms and are generally distributed worldwide, though certain species appear to have restricted geographic ranges. Though they are uncommon causes of disease, melanized fungi have been increasingly recognized as important pathogens, with most reports occurring in the past 20 years. The spectrum of diseases with which they are associated has also broadened and includes allergic disease, superficial and deep local infections, pneumonia, brain abscess, and disseminated infection. For some infections in immunocompetent individuals, such as allergic fungal sinusitis and brain abscess, they are among the most common etiologic fungi. Melanin is a likely virulence factor for these fungi. Diagnosis relies on careful microscopic and pathological examination, as well as clinical assessment of the patient, as these fungi are often considered contaminants. Therapy varies depending upon the clinical syndrome. Local infection may be cured with excision alone, while systemic disease is often refractory to therapy. Triazoles such as voriconazole, posaconazole, and itraconazole have the most consistent in vitro activity. Further studies are needed to better understand the pathogenesis and optimal treatment of these uncommon infections.
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Fauconneau A, Lalanne N, Couprie B, Pujol S, Taieb A, Jouary T. [Pigmented nodular lesion of the foot]. Ann Dermatol Venereol 2010; 137:145-7. [PMID: 20171440 DOI: 10.1016/j.annder.2009.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 09/21/2009] [Indexed: 11/29/2022]
Affiliation(s)
- A Fauconneau
- Unité de dermatologie-cancérologie, service de dermatologie, hôpital Saint-André, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France
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Boyce R, Deziel P, Otley C, Wilhelm M, Eid A, Wengenack N, Razonable R. Phaeohyphomycosis due to Alternaria species in transplant recipients. Transpl Infect Dis 2009; 12:242-50. [DOI: 10.1111/j.1399-3062.2009.00482.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pastor F, Guarro J. Alternaria infections: laboratory diagnosis and relevant clinical features. Clin Microbiol Infect 2008; 14:734-46. [DOI: 10.1111/j.1469-0691.2008.02024.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hassan G, Khalaf H, Mourad W. Dermatologic complications after liver transplantation: a single-center experience. Transplant Proc 2007; 39:1190-4. [PMID: 17524929 DOI: 10.1016/j.transproceed.2007.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report our experience with dermatological complications after both deceased donor liver transplantation (DDLT) and living-donor liver transplantation (LDLT). PATIENTS AND METHODS Between April 2001 and November 2006, a total of 116 liver transplantation (LT) procedures were performed (73 DDLTs and 43 LDLTs) in 112 patients (4 re-transplants). Posttransplant dermatological problems were recorded. RESULTS Among 112 OLT recipients, 14 patients (12.5%) experienced dermatologic problems: epidermolysis bullosa acquisita in one patient, which was self-limiting; graft-versus-host-disease in one patient treated with high-dose steroids; Kaposi sarcoma in one patient treated with surgical excision and conversion to sirolimus-based immunosuppression; drug-induced cutaneous vasculitis with deep thigh ulcer formation treated by drug discontinuation and surgical excision of the ulcer; herpes zoster in one patient treated with intravenous antiviral therapy; herpes simplex in two patients treated with local antiviral cream; cyclosporine-induced gingival hyperplasia treated with conversion to FK506; cyclosporine-induced hypertrichosis treated with conversion to FK506; steroid-induced skin hyperpigmentation in one patient treated with steroid withdrawal; hypomagnesemia-induced hair loss treated with daily oral magnesium supplement; pressure-induced alopecia areata in two patients that was self-limiting; and finally, one patient with a pressure-induced heel ulcer that was treated conservatively. In 8 of 14 patients (57%) who suffered from dermatologic problems, the complication was primarily related to immunosuppressive drugs. CONCLUSIONS In our experience, dermatologic complications following LT are not uncommon and usually related to immunosuppressive therapy. Most complications could be prevented by optimizing immunosuppression. The majority of complications were easily managed by simple adjustment of immunosuppression.
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Affiliation(s)
- G Hassan
- Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Abstract
Voriconazole is a broad-spectrum antifungal drug belonging to triazoles class. Recently, it has been recommended for the treatment of invasive candidiasis in non neutropenic patients. In addition, this drug has showed clinical efficacy in the treatment of fungal infections caused by Candida species other than Candida albicans, and also in several other infections caused by less common fungi, such as Aspergillus terreus, Fusarium and Scedosporium.
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Affiliation(s)
- F Javier Pastor
- Unitat de Microbiologia, Facultat de Medicina i Ciencies de la Salut, Universitat Rovira i Virgili, 43201, Reus, Spain
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