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Tóth EJ, Nagy GR, Homa M, Ábrók M, Kiss IÉ, Nagy G, Bata-Csörgő Z, Kemény L, Urbán E, Vágvölgyi C, Papp T. Recurrent Scedosporium apiospermum mycetoma successfully treated by surgical excision and terbinafine treatment: a case report and review of the literature. Ann Clin Microbiol Antimicrob 2017; 16:31. [PMID: 28410611 PMCID: PMC5391591 DOI: 10.1186/s12941-017-0195-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/21/2017] [Indexed: 12/12/2022] Open
Abstract
Background Scedosporium apiospermum is an emerging opportunistic filamentous fungus, which is notorious for its high levels of antifungal-resistance. It is able to cause localized cutaneous or subcutaneous infections in both immunocompromised and immunocompetent persons, pulmonary infections in patients with predisposing pulmonary diseases and invasive mycoses in immunocompromised patients. Subcutaneous infections caused by this fungus frequently show chronic mycetomatous manifestation. Case report We report the case of a 70-year-old immunocompromised man, who developed a fungal mycetomatous infection on his right leg. There was no history of trauma; the aetiological agent was identified by microscopic examination and ITS sequencing. This is the second reported case of S. apiospermum subcutaneous infections in Hungary, which was successfully treated by surgical excision and terbinafine treatment. After 7 months, the patient remained asymptomatic. Considering the antifungal susceptibility and increasing incidence of the fungus, Scedosporium related subcutaneous infections reported in the past quarter of century in European countries were also reviewed. Conclusions Corticosteroid treatment represents a serious risk factor of S. apiospermum infections, especially if the patient get in touch with manure-enriched or polluted soil or water. Such infections have emerged several times in European countries in the past decades. The presented data suggest that besides the commonly applied voriconazole, terbinafine may be an alternative for the therapy of mycetomatous Scedosporium infections.
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Affiliation(s)
- Eszter J Tóth
- MTA-SZTE "Lendület" Fungal Pathogenicity Mechanisms Research Group, Hungarian Academy of Sciences, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary.,Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary
| | - Géza R Nagy
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Mónika Homa
- MTA-SZTE "Lendület" Fungal Pathogenicity Mechanisms Research Group, Hungarian Academy of Sciences, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary.,Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary
| | - Marianna Ábrók
- Institute of Clinical Microbiology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Ildikó É Kiss
- Institute of Clinical Microbiology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Gábor Nagy
- MTA-SZTE "Lendület" Fungal Pathogenicity Mechanisms Research Group, Hungarian Academy of Sciences, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary.,Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary
| | - Zsuzsanna Bata-Csörgő
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Lajos Kemény
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Edit Urbán
- Institute of Clinical Microbiology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Csaba Vágvölgyi
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary
| | - Tamás Papp
- MTA-SZTE "Lendület" Fungal Pathogenicity Mechanisms Research Group, Hungarian Academy of Sciences, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary. .,Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, Szeged, 6726, Hungary.
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Buonfrate D, Gobbi F, Angheben A, Marocco S, Farina C, Van Den Ende J, Bisoffi Z. Autochthonous cases of mycetoma in Europe: report of two cases and review of literature. PLoS One 2014; 9:e100590. [PMID: 24963778 PMCID: PMC4070928 DOI: 10.1371/journal.pone.0100590] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/17/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mycetoma is a chronic granulomatous infection involving cutaneous and subcutaneous tissues. It is endemic in tropical and subtropical areas, but sporadic cases have been reported also in countries of temperate climate. The purpose of this paper is to review the cases of mycetoma in European subjects (and presumably acquired in Europe), to give an insight in the main factors associated with this condition, and to describe two previously unpublished cases observed at our Centre. METHODS AND FINDINGS PubMed was systematically searched for case reports and case series of mycetoma in Europeans reported between 1980 and 2014, using specific search strategies. Two further cases diagnosed by the authors are described. Forty-two cases were collected. Eleven cases were caused by Scedosporium apiospermium, mainly in immunosuppressed patients from Bulgaria, Germany, the Netherlands, Portugal, Slovenia, Spain and the United Kingdom. Excluding all patients with immunosuppression, 29 cases remain. Most of them were reported from Bulgaria and in Albanian patients (all diagnosed outside Albania). In the Bulgarian case series many different micro-organisms, both bacteria and fungi, were isolated, while all the 5 cases from Albania were caused by Actinomadura spp. Other countries reporting cases were Greece, Italy and Turkey. In general, Actinomadura spp is the most frequent causative agent isolated, followed by Nocardia spp and Madurella mycetomatis. The foot was the most reported site involved. Most patients were medically treated, but unfortunately a long-term follow up (at least one year) was available only in a few cases. CONCLUSIONS Our review and our own cases suggest that Europeans without travel history can be affected by Madura foot. The lack of a surveillance system is likely to cause an underreporting of cases. Moreover, the unfamiliarity of Western doctors with this peculiar infection may cause a mismanagement, including unnecessary amputations.
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Affiliation(s)
- Dora Buonfrate
- Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
- * E-mail:
| | - Federico Gobbi
- Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Andrea Angheben
- Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Stefania Marocco
- Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Claudio Farina
- Microbiology Institute, AO Papa Giovanni XXIII, Bergamo, Italy
| | - Jef Van Den Ende
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Zeno Bisoffi
- Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
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Farina C, Gotti E, Suter F, Goglio A. Scedosporium apiospermum Soft-Tissue Infection: A Case Report and Review of Kidney Transplant Literature. Transplant Proc 2006; 38:1333-5. [PMID: 16797295 DOI: 10.1016/j.transproceed.2006.03.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2005] [Indexed: 11/30/2022]
Abstract
Scedosporium apiospermum is an environmental mould. Human infections caused by this organism have been observed; however, only a few case reports show its role as a telluric contaminant to kidney recipients. We have reported here a case of a dramatic soft tissue infection by S. apiospermum in a kidney-transplanted man. Surgical drainage together with voriconazole systemic therapy was successful.
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Affiliation(s)
- C Farina
- Microbiology Institute, A. O. Ospedale San Carlos Borromeo, Milano, Italy.
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