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Santosh T, Chakrabarti I, Palit A, Srivastava S. Incidental detection of Cladosporium in cytology. Diagn Pathol 2024; 19:45. [PMID: 38424618 PMCID: PMC10903045 DOI: 10.1186/s13000-024-01469-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Fungal infection incidental detection is a common encounter in cytopathology practices. Detection of the fungal organisms and awareness of the morphological features are challenges for the cytopathologist. CASE PRESENTATION We report a case of incidental detection of a fungal organism in a 67-year-old male patient with complaints of bilateral elbow joint swellings. Cytology was done and showed a fungal organism (Cladosporium sps.). CONCLUSION Fine needle aspiration cytology (FNAC) along with Rapid on-site evaluation (ROSE) is a rapid, minimally invasive technique used for the diagnosis and detection of various fungi / parasites leading to early and definitive treatment.
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Affiliation(s)
- Tummidi Santosh
- Department of Pathology & Lab Medicine, AIIMS, Kalyani, West Bengal, India.
| | | | - Aparna Palit
- Department of Dermatology & Venereology, AIIMS, Kalyani, West Bengal, India
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Kantarcioglu AS, Guarro J, De Hoog S, Apaydin H, Kiraz N. An updated comprehensive systematic review of Cladophialophora bantiana and analysis of epidemiology, clinical characteristics, and outcome of cerebral cases. Med Mycol 2018; 55:579-604. [PMID: 28007938 DOI: 10.1093/mmy/myw124] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 11/01/2016] [Indexed: 12/28/2022] Open
Abstract
Cladophialophora bantiana is a phaeoid fungus that only rarely has been isolated from sources other than the human brain. It has a particular tropism for the central nervous system (CNS). We have integrated and updated large-scale data related to several aspects of C. Bantiana and reviewed all the available reports on its cerebral infections, focusing on their geographical distribution, infection routes, immune status of infected individuals, type and location of infections, clinical manifestations and treatment and outcome, briefly looking over the spectrum of other disease entities associated with C. bantiana, that is, extra-cerebral and animal infections and on the environmental sources of this fungus. Among the agents of phaeohyphomycosis, a term used to describe an infection caused by a dark pigmented fungus, C. bantiana has some significant specific features. A total of 120 case reports were identified with a significantly higher percentage of healthy subjects than immune-debilitated patients (58.3% vs. 41.7%). Infections due to C. bantiana occur worldwide. The main clinical manifestations are brain abscess (97.5%), coinfection of brain tissue and meninges (14.2%) and meningitis alone (2.5%). Among immunocompetent patients, cerebral infection occurred in the absence of pulmonary lesions. The mortality rate is 65.0% regardless of the patient's immune status. The therapeutic options used include surgery or antifungals alone, and the combination of both, in most cases the fatal outcome being rapid after admission. Since the fungus is a true pathogen, laboratory workers should be made aware that BioSafety Level-3 precautions might be necessary.
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Affiliation(s)
- A Serda Kantarcioglu
- Mycology Unit, Department of Medical Microbiology, Cerrahpasa Medical Faculty, 343098 Cerrahpasa, Istanbul, Turkey
| | - Josep Guarro
- Unitat de Microbiologia, Facultat de Medicina i Ciencies de la Salut, IISPV, Universitat Rovira i Virgili, E-43201 Reus, Spain
| | - Sybren De Hoog
- Centraalbureau voor Schimmelcultures, Utrecht, and Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
| | - Hulya Apaydin
- Department of Neurology, Cerrahpasa Medical Faculty, 34098 Cerrahpasa, Istanbul, Turkey
| | - Nuri Kiraz
- Mycology Unit, Department of Medical Microbiology, Cerrahpasa Medical Faculty, 343098 Cerrahpasa, Istanbul, Turkey
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Kazmers NH, Fryhofer GW, Gittings D, Bozentka DJ, Steinberg DR, Gray BL. Acute Deep Infections of the Upper Extremity: The Utility of Obtaining Atypical Cultures in the Presence of Purulence. J Hand Surg Am 2017; 42:663.e1-663.e8. [PMID: 28550986 DOI: 10.1016/j.jhsa.2017.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 04/16/2017] [Accepted: 05/04/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE In the setting of acute deep upper extremity infections, evidence is lacking to guide the decision whether to send atypical cultures (fungal and acid-fast-bacillus [AFB]) during surgical debridement, especially in the presence of purulent fluid that is commonly observed with typical bacterial infections. Our purpose was to determine the frequency of positive atypical cultures and the frequency with which they alter treatment, and identify factors associated with positive atypical cultures. METHODS We retrospectively identified 100 adult patients undergoing surgical debridement of acute deep infections of the upper extremity in which fungal and/or AFB cultures were sent. Necrotizing and superficial infections were excluded. Descriptive statistics were used to describe patient characteristics, infection diagnoses, number of cultures sent with corresponding rates of positivity, and treatments. Cohorts with positive and negative atypical cultures were compared with bivariate analysis for all collected variables. RESULTS One or more immunocompromising comorbidities were present in 46% of patients. Diagnoses included soft tissue abscess (46%), suppurative flexor tenosynovitis (22%), septic arthritis (21%), osteomyelitis (9%), and septic bursitis (2%). Aerobic bacterial, anaerobic bacterial, fungal, and AFB cultures were sent in 100%, 99%, 94%, and 82% of patients, respectively. Corresponding rates of positivity were 74%, 34.3%, 5.3%, and 2.4%, respectively. Atypical cultures were positive for 7% of patients and 2.9% of all atypical tests sent. Antibiotic treatment was influenced by atypical culture data for 4% of patients. For patients with positive atypical cultures, purulence was observed during surgery in 86% of cases. Bivariate analysis demonstrated symptom duration greater than 7 days as potentially associated with atypical culture positivity. CONCLUSIONS Intraoperative purulence at the time of surgical intervention should not deter the surgeon from obtaining atypical cultures. As expected, atypical cultures are infrequently positive given the rarity of associated diseases. Symptoms greater than 7 days may predict a higher incidence of atypical culture positivity for patients being treated surgically within 30 days of initial symptom onset. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic IV.
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Affiliation(s)
| | - George W Fryhofer
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Caviedes MP, Torre AC, Eliceche ML, Valdivia Monteros DC, Volonteri VI, Galimberti RL. Cutaneous phaeohyphomycosis. Int J Dermatol 2017; 56:415-420. [PMID: 28295266 DOI: 10.1111/ijd.13590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Phaeohyphomycosis is an infrequent infection in human beings. However, in recent years, its prevalence has augmented in immunosuppressed patients (mostly in solid organ transplanted patients). Infection can be mucocutaneous or disseminated. In the former, the fungus inoculation occurs mainly through traumatism. Lesions may be polymorphic and asymptomatic, isolated or multiple, and are usually localized in exposed areas of the limbs and head. Treatment is not standardized. When possible, surgical resection of the lesion is combined with systemic antifungals. METHODS We communicate three phaeohyphomycosis cases with cutaneous compromise. RESULTS The cases we present show diverse clinical characteristics and varied severity and evolution. CONCLUSION It is important for dermatologists to recognize this cutaneous fungus infection because the diagnosis using microscopic examination and mycological culture depends on the clinical suspicion.
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Affiliation(s)
- Mariana P Caviedes
- Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ana C Torre
- Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maite Lisa Eliceche
- Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Victoria I Volonteri
- Department of Pathology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo L Galimberti
- Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Universidad de Buenos Aires, Buenos Aires, Argentina
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Saegeman V, Bammens B, De Munter P, Neyt J, Cossey V, Schuermans A. How to isolate a patient with Cladophialophora bantiana infection? An opinion. J Hosp Infect 2015; 91:89-90. [PMID: 26122625 DOI: 10.1016/j.jhin.2015.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
Affiliation(s)
- V Saegeman
- Department of Laboratory Medicine UZ Leuven, Leuven, Belgium; Department of Microbiology and Immunology KU Leuven, Leuven, Belgium; Department of Epidemiology and Infection Control, UZ Leuven, Leuven, Belgium.
| | - B Bammens
- Department of Nephrology, UZ Leuven, Leuven, Belgium
| | - P De Munter
- Department of Internal Medicine, UZ Leuven, Leuven, Belgium
| | - J Neyt
- Department of Orthopaedics, UZ Leuven, Leuven, Belgium
| | - V Cossey
- Department of Microbiology and Immunology KU Leuven, Leuven, Belgium
| | - A Schuermans
- Department of Microbiology and Immunology KU Leuven, Leuven, Belgium
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Schoeffler A, Redon E, Contet-Audonneau N, Cuny JF, Lo-Jeanpierre B, Beurey P, Barbaud A, Schmutz JL. [Cutaneous phaeohyphomycosis due to Cladophialophora bantiana]. Ann Dermatol Venereol 2011; 138:504-7. [PMID: 21700072 DOI: 10.1016/j.annder.2011.01.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 12/29/2010] [Accepted: 01/27/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND Among dematiaceous fungi responsible for phaeohyphomycosis, Cladophialophora bantiana is an opportunistic pathogen that causes central nervous system infections, chiefly in immunocompromised patients. Only a few reports on skin involvements have been reported in the recent dermatological literature. Herein we report the case of an immunocompetent patient with cutaneous phaeohyphomycosis. CASE REPORT A 48-year-old male presented a nodular, painless and non-suppurative lesion with a diameter of 1cm on the right buttock that had developed since his return from a trip to Vietnam. A diagnosis of phaeohyphomycosis due to C. bantiana was made based on the histopathology and mycology examinations, which allowed the identification of C. bantiana, a dematiaceous (black) fungus from hyphomycete species. DISCUSSION C. bantiana is a neurotropic fungus that causes central nervous system infections in particular. Extracerebral involvement is rare and only a few cases of cutaneous phaeohyphomycosis have been reported. Furthermore, since immunocompromised hosts are more vulnerable, this mycosis is more commonly seen in immunocompromised patients. However in this particular case, an intramuscular injection of corticosteroids could have caused local immunosuppression. The prognosis depends on both localization and site. There are no guidelines for optimal treatment.
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Affiliation(s)
- A Schoeffler
- Service de dermatologie, CHU de Nancy, hôpitaux de Brabois, bâtiment des spécialités médicales Philippe-Canton, 54500 Vandœuvre-Les-Nancy, France.
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Pincus LB, Schwartz BS, Cunningham G, Saeed S, Berger TG. Cutaneous phaeohyphomycosis caused by Cladophialophora bantiana in a scar after treatment with intralesional corticosteroid injections. J Am Acad Dermatol 2009; 61:537-8. [PMID: 19700025 DOI: 10.1016/j.jaad.2008.11.908] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 11/05/2008] [Accepted: 11/07/2008] [Indexed: 11/30/2022]
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Bonifaz A, Hoog SD, Mcginnis MR, Saúl A, Rodríguez-Cortés O, Araiza J, Cruz M, Mercadillo P. Eumycetoma caused byCladophialophora bantianasuccessfully treated with itraconazole. Med Mycol 2009; 47:111-4. [DOI: 10.1080/13693780802430639] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Petrini B, Farnebo F, Hedblad MA, Appelgren P. Concomitat late soft tissue infections byCladophialophora bantianaandMycobacterium abscessusfollowing tsunami injuries. Med Mycol 2006; 44:189-92. [PMID: 16519023 DOI: 10.1080/13693780500294949] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A Swedish man and woman sustained severe soft tissue injuries during the tsunami catastrophe in Thailand in December 2004, and subsequently received partial thickness skin grafts after multiple surgical revisions. Four to six weeks post trauma they displayed signs of purulent infections in the non-traumatized, virtually intact skin outside the resection margins. Skin biopsies revealed granulomatous reactions and pigmented fungal hyphae were observed in specimens from the male patient. Cladophialophora bantiana and Mycobacterium abscessus were recovered concomitantly from samples obtained from both patients. Antifungal treatment was given with voriconazole for one month, after which no fungal growth was detected on biopsies. Antimycobacterial treatment was given with clarithromycin and amikacin. The symptoms gradually subsided in the male patient, but recurrent abscesses were noted with the female patient, from which M. abscessus was recovered despite prolonged antibiotic therapy.
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Affiliation(s)
- Björn Petrini
- Departments of Clinical Microbiology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
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Hussey SM, Gander R, Southern P, Hoang MP. Subcutaneous phaeohyphomycosis caused by Cladophialophora bantiana. Arch Pathol Lab Med 2005; 129:794-7. [PMID: 15913432 DOI: 10.5858/2005-129-794-spcbcb] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary subcutaneous phaeohyphomycosis can rarely be caused by Cladophialophora bantiana, and we present the histologic and culture findings of such a case. A 32-year-old African American woman with systemic lupus erythematosus presented with a 2-year history of multiple, recurrent, tender, and ulcerated skin nodules with purulent drainage on her upper back. Histologic sections of the excision demonstrated features of phaeohyphomycosis. Culture findings were characteristic of C bantiana. Of interest, at age 10 she had sustained traumatic implantation of wood splinters into this area during a tornado, yet clinical symptoms of a subcutaneous infection did not manifest until she developed lupus erythematosus at age 27. Our case highlights the role of trauma and immunosuppression in the pathogenesis of subcutaneous phaeohyphomycosis.
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Affiliation(s)
- Sean M Hussey
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9073, USA
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Al-Abdely HM, Najvar LK, Bocanegra R, Graybill JR. Antifungal therapy of experimental cerebral phaeohyphomycosis due to Cladophialophora bantiana. Antimicrob Agents Chemother 2005; 49:1701-7. [PMID: 15855484 PMCID: PMC1087650 DOI: 10.1128/aac.49.5.1701-1707.2005] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cladophialophora bantiana is associated with central nervous system infection and a poor outcome. C. bantiana tends to be resistant to amphotericin B. Accordingly, we evaluated amphotericin B and three triazoles--posaconazole, itraconazole, and fluconazole--for treatment of C. bantiana infection in mice. In immunosuppressed ICR mice infected intravenously, posaconazole, itraconazole, and amphotericin B prolonged survival. This improvement in survival corresponded with a reduction in brain fungal concentrations for mice which were given itraconazole and posaconazole, but not amphotericin B. In nonimmunosuppressed BALB/c mice infected intracerebrally, posaconazole showed dose-dependent responses in survival and reduction of brain tissue counts. These responses were observed for short, delayed, and prolonged therapy. Although posaconazole prolonged the survival of mice with reductions in brain fungal counts, it did not sterilize brain tissue with continuous therapy for 8 weeks. We concluded that posaconazole shows promise for the treatment of C. bantiana brain infections.
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Affiliation(s)
- Hail M Al-Abdely
- Division of Infectious Diseases, Department of Medicine, The University of Texas Health Science Center at San Antonio, Texas, USA.
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Werlinger KD, Yen Moore A. Eumycotic mycetoma caused by Cladophialophora bantiana in a patient with systemic lupus erythematosus. J Am Acad Dermatol 2005; 52:S114-7. [PMID: 15858506 DOI: 10.1016/j.jaad.2004.12.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present the case of a 31-year-old patient who developed widespread mycetoma across her back and shoulders caused by Cladophialophora bantiana 16 years after injury to those sites from tornado debris. The patient also had a history of systemic lupus erythematosus treated with systemic steroids. Systemic antifungal treatment with fluconazole and itraconazole proved ineffective, and surgical debridement was required. Nine other culture-confirmed cases of cutaneous infection with this organism have been reported worldwide. This type of infection can occur in immunocompromised or immunocompetent patients, and may respond to systemic antifungals or surgery.
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Affiliation(s)
- Kelly D Werlinger
- Department of Dermatology at UT Southwestern Medical Center, Dallas, Texas, USA
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Abramo F, Bastelli F, Nardoni S, Mancianti F. Feline cutaneous phaeohyphomycosis due to Cladophyalophora bantiana. J Feline Med Surg 2002; 4:157-63. [PMID: 12360955 DOI: 10.1053/jfms.2002.0183] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A case of feline cutaneous phaeohyphomycosis due to Cladophyalophora bantiana is described. The cat was presented with breathing difficulty and a swollen, ulcerated nodule on the dorsal nose and left nostril. Histological examination of the nodule revealed a cystic granulomatous dermatitis characterised by neutrophils, macrophages and giant cells. Pigmented, yeast-like fungus cells and hyphal elements were easily identified in haematoxylin-eosin stained tissue sections. Cladophyalophora bantiana was isolated from a tissue specimen. This organism, primarily known to cause cerebral infection in humans and cats, only rarely causes cutaneous infection. Despite anti-fungal chemotherapy two relapses occurred. The cat was feline immunodeficiency virus- and feline leukemia virus-negative and even if the owner was unaware of trauma, the hypothesis of wound contamination is the most likely.
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Affiliation(s)
- F Abramo
- Department of Animal Pathology, University of Pisa, Italy.
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Abstract
Transplantation is now currently and increasingly performed for the treatment of various acute and chronic diseases. Today the kidney, heart, lung, heart-lung, liver, pancreas, kidney-pancreas, small bowel and bone marrow are being transplanted. The immunological status of patients receiving such transplants exposes them to the risk of developing bacterial, viral and fungal infections. The etiological agents of mycotic diseases involving the skin of transplant recipients range from the common dermatophytes through yeasts such as Candida spp., Malassezia spp. and dimorphic fungi to the emerging molds Fusarium spp. and Pseudallescheria boydii. The very wide spectrum of fungi causing cutaneous disease produces equally varied clinical aspects. Lesions may be typical, but are very often aspecific or ambiguous. Cutaneous lesions may be the sign of a trivial mycotic disease or the marker of a disseminated, potentially lethal fungal illness, so great attention should be given to their early recognition. Cutaneous manifestations due to Candida spp., Aspergillus spp., dematiaceous fungi and Pityrosporum folliculitis are usually observed early after transplant, cryptococcosis more than 6 months later, while the frequency of dermatophytoses increases as time goes by. Coccidioides immitis, Histoplasma capsulatum and Blastomyces dermatitidis may appear any time after transplantation. The management of the more severe forms of cutaneous mycosis in transplant recipients is difficult. Besides the fact that early recognition is not easy, there are also problems regarding the effectiveness and the toxicity of the therapy and drug-drug interactions. Prophylactic measures to avoid fungal contamination must be performed during hospitalization; patients should be taught how to avoid contamination, not only during the first period after transplantation, when high dosage immunosuppressive drugs are given, but also later when a normal lifestyle is resumed.
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Affiliation(s)
- Annarosa Virgili
- Dipartimento di Medicina Clinica e Sperimentale - Sezione di Dermatologia, Università degli Studi di Ferrara, Ferrara, Italy.
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