Cutaneous and ungual phaeohyphomycosis caused by species ofChaetomiumKunze (1817) ex Fresenius, 1829

Infective endocarditis caused by Chaetomium globosum

Chaetomium globosum is a dematiaceous, filamentous fungus belonging to the large genus saprobic ascomycetes and is rarely involved in human infection. We present the case of a 25-year-old man undergoing tricuspid valve replacement due to recurrent prosthetic ring endocarditis. Initially, it was considered culture-negative endocarditis; however, the diagnosis of Chaetomium globosum could only be provided by DNA isolation of the mold isolate grown in culture and the valve tissue samples taken from the patient. This report describes the first documented tricuspid endocarditis caused by Chaetomium species and discusses the importance of molecular tools to enhance the diagnostic process in culture-negative endocarditis, especially for fastidious and nonculturable microorganisms.

Chaetomium globosum Cutaneous Fungal Infection Confirmed by Molecular Identification: A Case Report from Malaysia

An 11-year-old girl presented with multiple blisters on her the right foot complicated with cellulitis. The conventional and molecular identification were performed on the culture. The internal transcribed spacer (ITS) region in rRNA gene of the isolate was amplified by PCR. The sequence of the amplified ITS region matched 99 % with that of Chaetomium globosum in the GenBank. This is the first report describing C. globosum causing cutaneous infection in Malaysia.

Phaeohyphomycosis and onychomycosis due to Chaetomium spp., including the first report of Chaetomium brasiliense infection

Chaetomium species have been rarely described as aetiological agents of invasive and dermatomycotic infections in humans. The majority of cases have been reported within the last two decades. Treatment failed in most of these cases. In this paper we present two cases in which Chaetomium spp. can be clearly identified as an aetiological agent in pathological conditions. In the first report, we describe a new aetiological agent, Chaetomium brasiliense, which was implicated in a case of otitis externa in a patient with spinocellular carcinoma basis cranii. The patient had been repeatedly treated for relapsing otitis externa and had previously undergone surgery several times for otitis media. The fungal aetiology was confirmed by repeated positive culture and histologic studies. The second case involved onychomycosis with strikingly brown nail discoloration due to Chaetomium globosum in an otherwise healthy patient. The nail lesion was successfully cured by oral terbinafine. The determination of both species was supported by sequencing of rDNA regions. The morphological aspect of Chaetomium spp. identification is also discussed. In vitro antifungal susceptibility tests demonstrated that both isolates were susceptible to terbinafine and azole derivates except fluconazole. Amphotericin B was effective only against the C. brasiliense strain. We review the literature to summarize clinical presentations, histologic findings, and treatment strategies.

Melanized fungi in human disease

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.

Three isolations of Chaetomium globosum from erythematous epilation of canine skin

Chaetomium globosum is commonly found in natural environments worldwide and is known to be a causative agent for emerging fungal infections. The present study describes a case of erythematous epilation of a dog caused by C. globosum. A mixed-breed young dog, a 4-months-old male, weighing 7.25 kg, showed depilation, scales, and dermatitis with slightly itchiness on his skin. The main symptom was an erythematous epilation on the left subocular skin 7.5 cm in diameter, accompanied by elephantiasis-like hyperplasia and scales. Similar lesions were observed on the skin on both sides of the ear lobes, the heels, tail, and left angulus oris. The scales from the crusted lesion were cultured on chrolamphenicole-added potato dextrose agar plates at the first visit, as well as followed by ambulatory practices. The isolates at the first visit, 1 and 3 weeks after treatment, were identified as C. globosum by mycological study and the D1/D2 domain of the large subunit rRNA gene sequence. The patient dog was treated by ketoconzole both orally and externally. The lesions were cured, showing new hair growth 9 weeks later. In addition, the susceptibilities to antifungal agents for the present C. globosum isolate were as follows: amphotericin B, 4.0 microg/ml; 5-FC 64.0 microg/ml; itraconazole, 0.5 microg/ml; miconazole, 1.0 microg/ml; fulconazole, 16.0 microg/ml; ketoconazole, 0.25 microg/ml; and micafungin, 16.0 microg/ml.

First Spanish case of onychomycosis caused byChaetomium globosum

Members of the fungal genus Chaetomium usually colonize cellulose-containing plant remains but on rare occasions may cause opportunistic mycoses and cutaneous infection in otherwise healthy individuals. To our knowledge, there have been only five credible descriptions of onychomycosis caused by members of this genus and only two of these contained information on therapy. We describe the first case of Chaetomium globosum onychomycosis recorded in Spain. The etiologic significance of the fungus was confirmed by its repeated isolation at different times, to the exclusion of dermatophytes. Clinically, the affected nails showed an excellent response to terbinafine and complete cure appeared to have been attained.

A case of subcutaneous phaeohyphomycosis caused byChaetomium globosumand the sequences analysis ofC. globosum

A 14-year-old boy developed painful erythema and necrosis on his face with petechia on his upper extremities. Microscopically, necrotic tissue treated with potassium hydroxide showed branched, dematiaceous, septate hyphae. Chaetomium globosum was isolated repeatedly from the necrotic tissues. Morphology and thermotolerance test of the pathogen were also studied. The internal transcribed spacer region in rRNA gene was amplified and sequenced. The sequence of this patient matched well with that of C. globosum in GenBank and from other patients and environment.

Magnetic resonance imaging findings in fatal primary cerebral infection due to Chaetomium strumarium

This report describes MRI findings of a rare case of biopsy-proven fatal cerebral infection with Chaetomium strumarium in a 28-year-old man with a history of i.v. drug abuse. Magnetic resonance imaging revealed rapidly progressing lesions with irregular peripheral enhancement, possible central haemorrhage and significant mass effect. Only six cases of cerebral infection with Chaetomium have been reported in the English literature. This is the first report in the radiology literature describing the imaging findings. The previously reported cases of cerebral infection by the Chaetomium species are also reviewed.

Case report. Onychomycosis due to Chaetomium globosum successfully treated with itraconazole

We have experienced a case of toenail infection caused by Chaetomium globosum which we treated with itraconazole 100 mg day-1 for 6 months, after which time the nail lesions were almost cured. Our case is the first reported case of onychomycosis caused by Ch. globosum in Japan, and the seventh in the world.

[Aspergillus fumigatus and Chaetomium homopilatum in a leukemic patient. Pathogenic significance of Chaetomium species]

From the tracheal secretion of a leukaemic patient Aspergillus fumigatus and Chaetomium homopilatum was isolated. Radiographically (HR-CT) an invasive pulmonary mycosis was diagnosed from which the patient died. As an autopsy was not performed, the role of the isolated fungi could not be clarified safely. Aspergillus fumigatus is supposed to have been responsible for the invasive mycosis. The etiopathological significance of Ch. homopilatum remained unclear. The isolation of Ch. homopilatum was a reason for reviewing the genus Chaetomium. In the literature 18 reported cases of infections by Chaetomium sp. were found. Ch. globosum was the most prevalent species and caused mostly onychomycosis. Ch. strumarium and Ch. atrobrunneum caused brain infections. The predisposing factor in case of onychomycosis and cutaneous lesions was a trauma, and the systemic mycoses were a consequence of leukaemia, renal transplantation, intravenous drug use or renal failure. The reported cases show, that Chaetomium sp. may cause infections, if predisposing factors are present. Therefore the isolation of Chaetomium sp. in clinical specimen should not regarded as a contamination, and the possible etiopathological significance should be clarified.

Examination of soils from residential garbage in Betul, India, for fungi by the keratin baiting technique

A report on an examination of soils from residential garbage of Betul, India, for fungi by the keratin (materials) baiting technique is presented. A total of 69 fungi representing 39 species among 17 genera were isolated. In all the soil samples, only two genera, namely Aspergillus (190.9%), followed by Fusarium (118.18%), were most frequently isolated. Maximum colonisation of fungi was found on hair, followed by horn, feathers and nails. For the first time, the genus Fusoma is reported here as a keratinophilic fungus. The keratin baiting technique was found very effective in detecting a broad spectrum of fungi in biological wastes and compost.

Fatal cerebral mycoses caused by the ascomycete Chaetomium strumarium

Three cases of fatal cerebral mycosis in males with prior histories of intravenous drug use from the United States and Australia are reported. Infection in each case was limited to brain abscess; no other sites of infection were observed. The fungus seen by histopathology and isolated from the brain tissue in each case was identified as Chaetomium strumarium. This is the first report of human infection by this species, and C. strumarium is the second species of Chaetomium known to cause primary brain infection. Chaetomium strumarium is unusual among members of the genus Chaetomium in forming ascocarps covered with pale, thin-walled, flexuous hairs, a feature leading to its original placement in the genus Achaetomium. Presence of pinkish exudate droplets and/or crystals associated with hyphae or ascocarps, sometimes accompanied by a pinkish diffusible pigment; good growth at 42 degrees C; and production of small conidia further distinguish this species. The brain abscess isolates were compared with isolates from prior cases of cerebral infection which had been identified as either Chaetomium atrobrunneum or Chaetomium globosum. With reidentification of one isolate originally identified as C. globosum to C. atrobrunneum, only C. strumarium and C. atrobrunneum have been confirmed to cause infection involving the brain.

Pathogenicity and antifungal susceptibility of Chaetomium species

Several reports have been published implicating Chaetomium spp. as opportunistic pathogens. A critical review of these cases was made, and the majority of the responsible strains were studied. Chaetomium globosum was the most common species, being isolated in at least nine clinical cases of infection. Some of these clinical isolates and others from environmental sources were tested against six antifungal agents (5-fluorocytosine, fluconazole, amphotericin B, itraconazole, ketoconazole and miconazole). The 23 strains tested were totally resistant to the first two drugs, and none of the other antifungal agents demonstrated fungicidal activity. There were no significant differences between the susceptibility of the clinical strains and the other strains.

Longitudinal melanonychia caused by trichophyton rubrum. Histochemical and ultrastructural study of two cases

Two patients had black pigmentation affecting a great toenail that clinically simulated longitudinal melanonychia; Trichophyton rubrum with a diffusible black pigment was consistently isolated from the nail lesions. Light microscopic examination of nail samples stained with hematoxylin-eosin-safranine showed hyphae containing a brown cytoplasmic pigment. The positive Masson-Fontana stain suggested that the pigment was related to melanin. Both histologic and ultrastructural studies demonstrated intracytoplasmic polymerization, a method of final enzymatic polymerization that is unusual for melanin-producing fungal strains.

Feo-hifomicose subcutânea por Exophiala jeanselmei: registro de três casos em transplantados renais

São registrados três casos de feo-hifornicose subcutânea em transplantados renais provocados pela Exophiala jeanselmei (Langeron) McGinnis et Padhye 1977, fungo demácio capaz, também, de produzir raramente eumicetoma de grãos pretos. Este fungo, segundo KWON-CHUNG & BENNETT, 1992(27) é antigenicamente muito heterogêneo, sendo identificados até o presente momento três sorotipos com subgrupos dentro de cada um deles. A feo-hifomicose subcutânea vem se tornando cada vez mais freqüente em transplantados renais, submetidos a terapêutica imunodepressora. Como a Exophiala jeanselmei já foi isolada do meio ambiente, torna-se dificil explicar a patogenia desses casos por um despertar ou reativação de processos quiescentes. Os Autores fizeram ampla revisão da literatura, registrando principalmente os casos de feo-hifomicose publicados no Brasil. Sugerem também, eventual ação fungistática da ciclosporina A sobre a Exophiala jeanselmei.

Fungal melanonychia: ungual phaeohyphomycosis caused by Wangiella dermatitidis

A 51-year-old female Japanese patient developed black pigmentation affecting both big toe-nails. Direct potassium hydroxide examination of the nail tissue demonstrated clusters of spherical dematiaceous cells, toruloid hyphae, and septate hyphae. Wangiella dermatitidis was repeatedly isolated from the affected toe-nail lesions. This case represents the first documented case of ungual phaeohyphomycosis, 'fungal melanonychia,' caused by the dematiaceous fungus W. dermatitidis. The patient was successfully treated with a topical solution of bifonazole.

Onychomycosis caused by Chaetomium globosum Kunze

In this paper we report a case of onychomycosis caused by Chaetomium globosum. The patient had lesions of the fingernails of the left hand. The direct microscopical examination of the nails showed light-brown hyphae with thick-walled cells. The histopathological examination revealed thick aggregated hyphal element in the nail plate. Amongst the antimycotics tested oxiconazole with MIC values of 0.3 microgram/ml-1 was found to be most effective in vitro against Chaetomium globosum.