1
|
Malallah OS, Coleman L, Nasereddin SM, Lockhat M, Chen T, Jones SA. Systematic review and QSPR analysis of chemical penetration through the nail to inform onychomycosis candidate selection. Drug Discov Today 2024; 29:103844. [PMID: 38000719 DOI: 10.1016/j.drudis.2023.103844] [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: 10/06/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 11/26/2023]
Abstract
Recalcitrant nail plate infections can be life-long problems because localizing antifungal agents into infected tissues is problematic. In this systematic review, guided by the SPIDER method, we extracted chemical nail permeation data for 38 compounds from 16 articles, and analyzed the data using quantitative structure-property relationships (QSPRs). Our analysis demonstrated that low-molecular weight was essential for effective nail penetration, with <120 g/mol being preferred. Interestingly, chemical polarity had little effect on nail penetration; therefore, small polar molecules, which effectively penetrate the nail, but not the skin, should be set as the most desirable target chemical property in new post-screen onychomycosis candidate selections.
Collapse
Affiliation(s)
- Osamah S Malallah
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK
| | - Lucy Coleman
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford GU2 7XH, UK
| | - Sara M Nasereddin
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK; College of Pharmacy, Amman Arab University, Mubis, Amman 11953, Jordan
| | - Mohammad Lockhat
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK
| | - Tao Chen
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford GU2 7XH, UK
| | - Stuart A Jones
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK; Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King's College, SE1 9NH, UK.
| |
Collapse
|
2
|
Cortez JL, Tan SY, Abelman R, Chin-Hong P, McCalmont TH, Fox L, Haemel A. Deep cutaneous candidiasis of the lip in a patient with acute myelogenous leukemia. JAAD Case Rep 2022; 27:32-34. [PMID: 35996445 PMCID: PMC9391514 DOI: 10.1016/j.jdcr.2022.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jose L Cortez
- Department of Dermatology, University of California, San Francisco, San Francisco, California.,Department of Dermatology, University of New Mexico, Albuquerque, New Mexico
| | - Sally Y Tan
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Rebecca Abelman
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Peter Chin-Hong
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Timothy H McCalmont
- Department of Dermatology, University of California, San Francisco, San Francisco, California.,Department of Pathology, University of California, San Francisco, San Francisco, California.,Golden State Dermatology Associates, Walnut Creek, California
| | - Lindy Fox
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Anna Haemel
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| |
Collapse
|
3
|
Paul J, Czech MM, Balijepally R, Brown JW. Diagnostic and therapeutic challenges of treating opportunistic fungal cellulitis: a case series. BMC Infect Dis 2022; 22:435. [PMID: 35513796 PMCID: PMC9074255 DOI: 10.1186/s12879-022-07365-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/08/2022] [Indexed: 05/08/2024] Open
Abstract
Background Cellulitis is an infection most commonly caused by bacteria and successfully treated with antibiotics. However, certain patient populations, especially the immunocompromised, are at risk for fungal cellulitis, which can be misidentified as bacterial cellulitis and contribute to significant morbidity and mortality. Case presentations We describe three cases of opportunistic fungal cellulitis in immunosuppressed patients that were initially mistaken for bacterial infections refractory to antibiotic therapy. However, atypical features of cellulitis ultimately prompted further diagnostics to identify fungal cellulitis and allow initiation of appropriate antifungals. We discuss: (1) a 52-year-old male immunosuppressed hematopoietic cell transplant recipient with Fusarium solani cellulitis on his right lower extremity that was treated with amphotericin B and voriconazole with full resolution of the cellulitis; (2) a 70-year-old male lung transplant recipient with Fusarium solani cellulitis on his left lower extremity that ultimately progressed despite antifungals; and (3) a 68-year-old male with a history of kidney transplantation with suspected Purpureocillium lilacinum cellulitis on his left lower extremity ultimately treated with posaconazole with resolution of the skin lesions. Conclusions Fusarium solani and Purpureocillium lilacinum are important pathogens causing opportunistic fungal cellulitis. These cases remind providers to be vigilant for fungal cellulitis when skin and soft tissue infection does not adequately respond to antibiotics and atypical features of cellulitis are present.
Collapse
Affiliation(s)
- Jed Paul
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Lane Building, L134 MC:5107, Stanford, CA, 94305-5107, USA
| | - Mary M Czech
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Lane Building, L134 MC:5107, Stanford, CA, 94305-5107, USA. .,Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA, USA.
| | - Ramya Balijepally
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Lane Building, L134 MC:5107, Stanford, CA, 94305-5107, USA
| | - Janice Wes Brown
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Lane Building, L134 MC:5107, Stanford, CA, 94305-5107, USA.,Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA, USA.,Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
4
|
Masood M, Jamal T, Nye A, Shah S, Shea S. Surgical management of a local angioinvasive fungal soft tissue infection in the knee: a case report. J Surg Case Rep 2022; 2022:rjab546. [PMID: 35035876 PMCID: PMC8755634 DOI: 10.1093/jscr/rjab546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022] Open
Abstract
A 58-year-old male with an insignificant past medical history presented with chronic myelogenous leukemia in blast crisis. He began induction chemotherapy complicated by neutropenic fever. The patient then developed a nontender 1.5 cm violaceous firm indurated papule above the left patella with satellite lesions on his wrist and chest. A biopsy of the left patella showed obliterated blood vessels in the deep reticular dermis and numerous hyphae with septation and acute angle branching in the vessel wall consistent with angioinvasive aspergillosis. He was started on liposomal amphotericin and empiric voriconazole. Urgent local surgical excision of the primary lesion was recommended for source control. There is no clear recommendation on surgical intervention for angioinvasive aspergillosis, and further direction is needed. We present a case that illustrates surgical debridement for angioinvasive aspergillosis to be an effective method of source control along with systemic antifungal therapy.
Collapse
Affiliation(s)
- Mavra Masood
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia 23298, USA
| | - Tameem Jamal
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia 23298, USA
| | - Anthony Nye
- Department of Plastic Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia 23298, USA
| | - Syed Shah
- Department of General Surgery, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia 23249, USA
| | - Sofia Shea
- Department of Dermatology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia 23249, USA
| |
Collapse
|
5
|
Awal G, Singh G. Dermatological adverse events of cancer chemotherapy: An observational clinicoepidemiological study from a tertiary care center. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2022. [DOI: 10.4103/ijdd.ijdd_36_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
6
|
Merad Y, Derrar H, Tabouri S, Berexi-Reguig F. Candida guilliermondii Onychomycosis Involving Fingernails in a Breast Cancer Patient under Docetaxel Chemotherapy. Case Rep Oncol 2021; 14:1530-1535. [PMID: 34899247 PMCID: PMC8613606 DOI: 10.1159/000519695] [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: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/19/2022] Open
Abstract
Onychomycosis has been shown to have a higher incidence in cancer patients. Nail toxicity is a quite common side effect of anticancer agents. Taxotere© is a chemotherapeutic known to cause great incidence of nail change and has a role in subungual suppuration. We report on a 52-year-old woman with breast cancer admitted in our institution for onycholysis. Because of the stage and histology of breast cancer, neoadjuvant chemotherapy was initiated. The patient received 8 cycles of Taxotere and Adriamycin (AT), and she underwent a modified radical mastectomy. Three months later, the patient developed evidence of onycholysis, involving all the fingernails. We observed the following changes in nails of all the digits in both hands: onycholysis, dystrophy, oedema, and exudate. Nail scraping and purulent discharge were collected and cultured on Sabouraud medium. Physical features of the colonies and biochemical tests (Auxacolor©) revealed Candida guilliermondii as the sole etiologic agent of onychomycosis. This case details an onycholysis in a breast cancer case successfully managed solely with amorolfine lacquer. This clinical and mycological presentation should alert the clinician to the possibility of onychomycosis induced by docetaxel chemotherapy.
Collapse
Affiliation(s)
- Yassine Merad
- Department of Parasitology-Mycology, Central Laboratory, Hassani “Abdelkader University Hospital,”, Sidi Bel Abbès, Algeria
- Laboratoire de Synthèse de l'Information Environnementale, Université de Lille, Lille, France
| | - Hichem Derrar
- Department of Pulmonary and Lung Diseases, Sidi Bel Abbès, Algeria
| | - Sarah Tabouri
- Departement of Oncology, Centre Anti Cancer, Sidi Bel Abbès, Algeria
| | | |
Collapse
|
7
|
Song Y, Liu X, de Hoog GS, Li R. Disseminated Cryptococcosis Presenting as Cellulitis Diagnosed by Laser Capture Microdissection: A Case Report and Literature Review. Mycopathologia 2021; 186:423-433. [PMID: 33813690 DOI: 10.1007/s11046-021-00543-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/15/2021] [Indexed: 12/17/2022]
Abstract
Disseminated cryptococcosis primarily affects immunosuppressed patients and has a poor outcome if diagnosis and treatment are delayed. Skin lesions are rarely manifest causing misdiagnosis. We present a case of cryptococcal cellulitis with severe pain in a kidney transplant recipient on long-term immunosuppressive therapy. Multiple organs were involved, and there was cutaneous dissemination of the lesions. Histopathology revealed abundant yeast-like cells with wide capsular halos in subcutaneous tissue, suggesting Cryptococcus spp. infection. Laser capture microdissection (LCM)-PCR on skin biopsies confirmed Cryptococcus neoformans var. grubii. A literature review of 17 cases of disseminated cryptococcosis with cutaneous cellulitis or panniculitis in HIV-negative individuals found that over half the patients (52.9%, 9/17) had a history of glucocorticoid therapy, and that the most common site was the legs (76.5%, 13/17). C. neoformans was the main pathogenic species, accounting for 88.2% (15/17) of cases. Fungal cellulitis should be included in the differential diagnosis of cellulitis that fails to respond to antimicrobial therapy in HIV-negative immunosuppressed individuals. Non-culture-based molecular techniques aid in rapid pathogen identification in histologically positive, unculturable specimens.
Collapse
Affiliation(s)
- Yinggai Song
- Department of Dermatology and Venerology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China
| | - Xiao Liu
- Department of Dermatology and Venerology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China
| | - G Sybren de Hoog
- Research Center for Medical Mycology, Peking University, Beijing, China
- Center of Expertise in Mycology of Radboud University Medical Center / Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | - Ruoyu Li
- Department of Dermatology and Venerology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
- Research Center for Medical Mycology, Peking University, Beijing, China.
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China.
- Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China.
| |
Collapse
|
8
|
Burstein VL, Beccacece I, Guasconi L, Mena CJ, Cervi L, Chiapello LS. Skin Immunity to Dermatophytes: From Experimental Infection Models to Human Disease. Front Immunol 2020; 11:605644. [PMID: 33343578 PMCID: PMC7738607 DOI: 10.3389/fimmu.2020.605644] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022] Open
Abstract
Dermatophytoses (ringworms) are among the most frequent skin infections and are a highly prevalent cause of human disease worldwide. Despite the incidence of these superficial mycoses in healthy people and the compelling evidence on chronic and deep infections in immunocompromised individuals, the mechanisms controlling dermatophyte invasion in the skin are scarcely known. In the last years, the association between certain primary immunodeficiencies and the susceptibility to severe dermatophytosis as well as the evidence provided by novel experimental models mimicking human disease have significantly contributed to deciphering the basic immunological mechanisms against dermatophytes. In this review, we outline the current knowledge on fungal virulence factors involved in the pathogenesis of dermatophytoses and recent evidence from human infections and experimental models that shed light on the cells and molecules involved in the antifungal cutaneous immune response. The latest highlights emphasize the contribution of C-type lectin receptors signaling and the cellular immune response mediated by IL-17 and IFN-γ in the anti-dermatophytic defense and skin inflammation control.
Collapse
Affiliation(s)
- Verónica L. Burstein
- Laboratorio de Parasitología y Micología Experimental. Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| | - Ignacio Beccacece
- Laboratorio de Parasitología y Micología Experimental. Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| | - Lorena Guasconi
- Laboratorio de Parasitología y Micología Experimental. Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| | - Cristian J. Mena
- Laboratorio de Parasitología y Micología Experimental. Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| | - Laura Cervi
- Laboratorio de Parasitología y Micología Experimental. Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| | - Laura S. Chiapello
- Laboratorio de Parasitología y Micología Experimental. Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina
| |
Collapse
|
9
|
Surgical Management and Outcomes of Cutaneous Mold Infections in Immunocompromised Children. Ann Plast Surg 2020; 84:441-445. [DOI: 10.1097/sap.0000000000002215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Common traps/pitfalls and emergency diagnosis in dermatopathology. Mod Pathol 2020; 33:128-139. [PMID: 31673083 DOI: 10.1038/s41379-019-0386-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/27/2019] [Indexed: 11/09/2022]
Abstract
Although all diagnoses in dermatopathology are important, three main groups may be highlighted. One group includes diagnoses that need to be communicated to the treating physician as soon as possible (this review includes infectious process while erythema multiforme and related diseases are discussed elsewhere in this series). A second group has diagnoses significant for their association with syndromes or internal malignancies. And a third group includes malignant lesions that can be confused histologically with benign ones or lesions that have an aggressive behavior unexpected for their apparently low-grade histology. This manuscript describes some of these important diseases and the method we use to reach the diagnosis, and as such it may be considered to be a "survival" guide for the dermatopathologist.
Collapse
|
11
|
Pena Amaya P, Flores A, Christmann A, Detoni D, Drelichman G, Soberón B, Fernández Escobar N, Córdoba S, Vazquez M. [Phaeohyphomycosis by Exserohilum rostratum in a pediatric patient with acute lymphoblastic leukemia after bone marrow transplantation]. Rev Argent Microbiol 2019; 52:195-197. [PMID: 31870615 DOI: 10.1016/j.ram.2019.11.002] [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: 07/15/2019] [Revised: 10/07/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022] Open
Abstract
The genus Exserohilum consists of dematiaceous or darkly pigmented fungi. Most of the species included in this genus are phytopathogens, saprobes and only three of these species would be pathogenic to humans: Exserohilumrostratum, Exserohilumlongirostratum and Exserohilummcginnisii. Localized and systemic infections have been reported both in immunocompetent and immunosuppressed patients. A clinical case of cutaneous infection by E. rostratum in an immunocompromised pediatric patient is presented in this study.'
Collapse
Affiliation(s)
- Paula Pena Amaya
- Servicio de Microbiología, Hospital de Niños «Ricardo Gutiérrez», Ciudad Autónoma de Buenos Aires, Argentina.
| | - Antonio Flores
- Servicio de Microbiología, Hospital de Niños «Ricardo Gutiérrez», Ciudad Autónoma de Buenos Aires, Argentina
| | - Analía Christmann
- Unidad de Transplante de Médula Ósea, Hospital de Niños «Ricardo Gutiérrez», Ciudad Autónoma de Buenos Aires, Argentina
| | - Débora Detoni
- Unidad de Transplante de Médula Ósea, Hospital de Niños «Ricardo Gutiérrez», Ciudad Autónoma de Buenos Aires, Argentina
| | - Guillermo Drelichman
- Unidad de Transplante de Médula Ósea, Hospital de Niños «Ricardo Gutiérrez», Ciudad Autónoma de Buenos Aires, Argentina
| | - Bárbara Soberón
- Unidad de Transplante de Médula Ósea, Hospital de Niños «Ricardo Gutiérrez», Ciudad Autónoma de Buenos Aires, Argentina
| | - Nicolás Fernández Escobar
- Unidad de Transplante de Médula Ósea, Hospital de Niños «Ricardo Gutiérrez», Ciudad Autónoma de Buenos Aires, Argentina
| | - Susana Córdoba
- INEIA-ANLIS «Carlos G. Malbrán», Ciudad Autónoma de Buenos Aires, Argentina
| | - Miryam Vazquez
- Servicio de Microbiología, Hospital de Niños «Ricardo Gutiérrez», Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
12
|
Fever, Cough, and Skin Lesion in an Immunocompetent Patient. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Maddy AJ, Sanchez N, Shukla BS, Maderal AD. Dermatological manifestations of fungal infection in patients with febrile neutropaenia: A review of the literature. Mycoses 2019; 62:826-834. [DOI: 10.1111/myc.12928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Austin J. Maddy
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami Florida
| | - Nelson Sanchez
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami Florida
| | - Bhavarth S. Shukla
- Department of Internal Medicine University of Miami Miller School of Medicine Miami Florida
| | - Andrea D. Maderal
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami Florida
| |
Collapse
|
14
|
Bhatia R, Parambath N, Yadav S, Mridha AR. Rapidly growing targetoid necrotic plaques in an immunocompetent man. Postgrad Med J 2019; 95:284. [PMID: 30979788 DOI: 10.1136/postgradmedj-2018-136039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 02/15/2019] [Accepted: 02/27/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Riti Bhatia
- Dermatology department, All India Institute of Medical Sciences, New Delhi, India
| | - Nimitha Parambath
- Dermatology department, All India Institute of Medical Sciences, New Delhi, India
| | - Savita Yadav
- Dermatology department, All India Institute of Medical Sciences, New Delhi, India
| | - Asit R Mridha
- Pathology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
15
|
Dermatologic Conditions of the Early Post-Transplant Period in Hematopoietic Stem Cell Transplant Recipients. Am J Clin Dermatol 2019; 20:55-73. [PMID: 30298481 DOI: 10.1007/s40257-018-0391-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hematopoietic stem cell transplants (HSCTs) are used to treat a variety of conditions, including hematologic malignancies, bone marrow failure syndromes, and immunodeficiencies. Over 60,000 HSCTs are performed annually worldwide, and the numbers continue to increase. Indeed, as new conditioning regimens develop, more and more individuals, including those of older age, will be eligible for transplants. Nevertheless, although HSCTs are clearly a life-saving and necessary treatment for thousands of patients per year, there is still substantial morbidity and mortality associated with the procedure. Of note, skin eruptions in the post-HSCT period are frequent and often significantly reduce quality of life in recipients. Moreover, these cutaneous findings sometimes herald an underlying systemic condition, presenting possible opportunities for timelier intervention. Dermatologists therefore play a vital role in distinguishing life-threatening conditions from benign issues and prompting recognition of critical complications earlier in their course. This article aims to review the major dermatologic conditions occurring in the early post-HSCT period.
Collapse
|
16
|
Abstract
Cutaneous infections are common in immunocompromised patients. Neutropenia predisposes patients to fungal, bacterial and viral infections. Antibacterial antifungal and antiviral prophylaxis have caused a significant reduction in some of these infections. There are two main types of cutaneous infections : primary cutaneous infections and cutaneous manifestations of a disseminated infection. In the latter, skin lesions may be the window to disseminated bloodstream infection and the first and only evidence of a disseminated life threatening infection. The diagnosis may be at your fingertips; therefore a thorough skin exam is the clue. However, it’s also important to know the characteristic lesions associated with different infections. It will help expedite diagnosis so appropriate treatment is initiated promptly in neutropenic patients, which can be lifesaving. In a retrospective study of 43 neutropenic febrile patients with cutaneous lesions, fungal infections were the most frequent, and nodular lesions on the lower extremities were the most prevalent (Naorungroj and Aiempanakit, J Am Acad Dermatol 74:AB166, 2016). Skin biopsy for pathological study and culture remains the gold standard and should be obtained early to confirm the suspected diagnosis. In these immunocompromised patients the inflammatory response is altered by either the primary disease or its treatment. Therefore, routine pathogens may present in an atypical fashion, with diminished or absent induration, erythema, or pustulation in response to bacterial resulting cutaneous infection without typical cellulitis (Urabe, Clin Infect Dis 39:S53–S55, 2004). Skin lesions are evaluated not only by morphology, but also in the context of the clinical setting and biopsy result. The skin biopsy is inexpensive, relatively noninvasive and without contraindication, and may avoid the need for more invasive procedures such an open lung biopsy (Grossman, et al., Cutaneous manifestations of infection in the immunocompromised host. Springer Science+Business Media, LLC, New York, 2012). In addition to antimicrobial therapy, surgery should not be postponed in the face of progressive skin and soft tissue infection in this population (Brzozowski and Ross, J Hand Surg Br 22:679–680, 1997).
Collapse
Affiliation(s)
| | - Jorge Lamarche
- James Haley VA Hospital, USF Morsani College of Medicine, Tampa, FL USA
| | - John N. Greene
- Moffitt Cancer Center and Research Institute, USF Morsani College of Medicine, Tampa, FL USA
| |
Collapse
|
17
|
Hayashida MZ, Seque CA, Enokihara MMSES, Porro AM. Disseminated fusariosis with cutaneous involvement in hematologic malignancies: report of six cases with high mortality rate. An Bras Dermatol 2018; 93:726-729. [PMID: 30156626 PMCID: PMC6106674 DOI: 10.1590/abd1806-4841.20187476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/01/2017] [Indexed: 11/22/2022] Open
Abstract
Fusariosis is due to inhalation or direct contact with conidia. Clinical presentation depends on host's immunity and can be localized, focally invasive or disseminated. Given the severity of this infection and the possibility for the dermatologist to make an early diagnosis, we report six cases of patients with hematologic malignancies, who developed febrile neutropenia an skin lesions suggestive of cutaneous fusariosis. All patients had skin cultures showing growth of Fusarium solani complex, and they received amphotericin B and voriconazole. As this infection can quickly lead to death, dermatologists play a crucial role in diagnosing this disease.
Collapse
Affiliation(s)
- Marina Zoéga Hayashida
- Department of Dermatology, Escola Paulista de Medicina, Universidade
Federal de São Paulo, São Paulo (SP), Brazil
| | - Camila Arai Seque
- Department of Dermatology, Escola Paulista de Medicina, Universidade
Federal de São Paulo, São Paulo (SP), Brazil
| | | | - Adriana Maria Porro
- Department of Dermatology, Escola Paulista de Medicina, Universidade
Federal de São Paulo, São Paulo (SP), Brazil
| |
Collapse
|
18
|
Banerjee S, Tian T, Wei Z, Shih N, Feldman MD, Peck KN, DeMichele AM, Alwine JC, Robertson ES. Distinct Microbial Signatures Associated With Different Breast Cancer Types. Front Microbiol 2018; 9:951. [PMID: 29867857 PMCID: PMC5962706 DOI: 10.3389/fmicb.2018.00951] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/24/2018] [Indexed: 12/11/2022] Open
Abstract
A dysbiotic microbiome can potentially contribute to the pathogenesis of many different diseases including cancer. Breast cancer is the second leading cause of cancer death in women. Thus, we investigated the diversity of the microbiome in the four major types of breast cancer: endocrine receptor (ER) positive, triple positive, Her2 positive and triple negative breast cancers. Using a whole genome and transcriptome amplification and a pan-pathogen microarray (PathoChip) strategy, we detected unique and common viral, bacterial, fungal and parasitic signatures for each of the breast cancer types. These were validated by PCR and Sanger sequencing. Hierarchical cluster analysis of the breast cancer samples, based on their detected microbial signatures, showed distinct patterns for the triple negative and triple positive samples, while the ER positive and Her2 positive samples shared similar microbial signatures. These signatures, unique or common to the different breast cancer types, provide a new line of investigation to gain further insights into prognosis, treatment strategies and clinical outcome, as well as better understanding of the role of the micro-organisms in the development and progression of breast cancer.
Collapse
Affiliation(s)
- Sagarika Banerjee
- Tumor Virology Program, Department of Otorhinolaryngology-Head and Neck Surgery and Microbiology, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Tian Tian
- Department of Computer Science, New Jersey Institute of Technology, Newark, NJ, United States
| | - Zhi Wei
- Department of Computer Science, New Jersey Institute of Technology, Newark, NJ, United States
| | - Natalie Shih
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael D. Feldman
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kristen N. Peck
- Tumor Virology Program, Department of Otorhinolaryngology-Head and Neck Surgery and Microbiology, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Angela M. DeMichele
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - James C. Alwine
- Department of Cancer Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Erle S. Robertson
- Tumor Virology Program, Department of Otorhinolaryngology-Head and Neck Surgery and Microbiology, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
19
|
Brettholz AM, Mccauley SO. Mucormycosis: Early Identification of a Deadly Fungus [Formula: see text]. J Pediatr Oncol Nurs 2018; 35:257-266. [PMID: 29560764 DOI: 10.1177/1043454218763092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mucormycosis is a rare invasive fungal infection that affects immunocompromised patients and is fatal when not identified and treated early. Diagnosis is often delayed as the symptoms are nonspecific and frequently mimic other common diseases. Pediatric patients with cancer are at risk for the infection; however, there is limited research that applies directly to the pediatric population. An understanding of the risk factors and clinical presentation of mucormycosis is crucial for the pediatric oncology provider to initiate the workup and provide prompt treatment. The gold standard for diagnosing mucormycosis is biopsy; however, the use of polymerase chain reaction is a novel tool that is being investigated. The mainstays of treatment are antifungal medications, surgery, and reversal of predisposing risk factors, although, new therapies are also emerging. This article will review the pathophysiology, clinical manifestations, and diagnostics of mucormycosis and will discuss current treatment and management strategies for the pediatric oncology clinician to allow for timely diagnosis and intervention to optimize patient outcomes.
Collapse
|
20
|
Aiempanakit K, Naorungroj S, Chiratikarnwong K, Auepemkiate S, Apinantriyo B. Risk Factors for Invasive Fungal Infection among Thai Oncologic Patients with Febrile Neutropenia and Cutaneous Presentation: A 5-Year Retrospective Study in Southern Thailand. Asian Pac J Cancer Prev 2017; 18:3239-3243. [PMID: 29286213 PMCID: PMC5980877 DOI: 10.22034/apjcp.2017.18.12.3239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Febrile neutropenia (FNP) is a condition defined by fever and neutropenia. There are current only limited data on related cutaneous manifestations. This study aimed to assess cutaneous lesions and their etiologies in a Thai group of FNP patients. Methods: A retrospective analysis was conducted on 43 non-transplant febrile neutropenic patients with concurrent cutaneous lesions, as determined by dermatopathologic studies at Songklanagarind Hospital in Thailand over a five-year period. Results: The mean age was 39 years (SD: 18.8). Approximately 60% were male. The most common underlying disease was a hematologic neoplasm. Twenty-one of the participants had developed FNP within 7.5±8.7 days after presenting with skin lesions. Twenty-two participants had skin lesions 9.0±11.1 days after FNP diagnosis. Cutaneous manifestations were mostly in the form of multiple lesions (67.4%), of which the most common were nodular skin lesions (37.2%) presenting on the lower extremities of the body (58.1%). The dermatopathologic diagnoses included infections which were almost all fungal and leukemia cutis. The development of skin lesions after FNP proved to be a statistically significant risk factor for fungal infection (OR 8.13, P = 0.009), whereas age (over 40 years) proved to be a statistically significant protective factor (OR 0.20, P = 0.04). Conclusions: There are a variety of cutaneous manifestations in FNP, of which the most common were cutaneous nodular skin lesions in the lower extremities. The most frequent infection was fungal in patients under 40 who had developed skin lesions after FNP.
Collapse
Affiliation(s)
- Kumpol Aiempanakit
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand.
| | | | | | | | | |
Collapse
|
21
|
Abstract
There exists little guidance on chemotherapy toxicity management in patients with a history of or active hepatitis C viral infection. We report four cases of patients with solid organ tumors and hepatitis C viral infection, who have experienced severe or unexpected toxicities with chemotherapy. Based on the four case reports, we recommend increased laboratory monitoring for toxicities, initial dose reductions for chemotherapy given with palliative intent, or pre-emptive use of growth factor support, even if the patient presents with normal liver function tests. In this patient population, we also recommend treating active hepatitis C viral infection prior to chemotherapy treatment when possible.
Collapse
Affiliation(s)
- Amy Ly
- 1 Department of Pharmacy, University of Washington Medicine/Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Heather H Cheng
- 2 Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,3 Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Laura Alwan
- 1 Department of Pharmacy, University of Washington Medicine/Seattle Cancer Care Alliance, Seattle, WA, USA
| |
Collapse
|
22
|
Abstract
In the ever-aging population of the world, the field of geriatrics continues to grow in importance. As human beings age, the skin undergoes a unique array of changes that predispose it to a specific set of dermatoses, infections, and neoplasms. Some of these physiologic alterations are comparable to the changes that happen in immunosuppressed individuals. Given the importance of immunosuppressive medications in treatment of many common skin conditions, we have reviewed the current literature to assist the practicing clinician in using immunosuppressive medications in the geriatric population.
Collapse
Affiliation(s)
- Artem M Sergeyenko
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - David J Rosenfeld
- Department of Dermatology, Loyola University Medical Center, Maywood, IL
| | - Maria M Tsoukas
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois.
| |
Collapse
|
23
|
Abstract
The skin is colonized by a diverse collection of microorganisms which, for the most part, peacefully coexist with their hosts. Skin and soft tissue infections (SSTIs) encompass a variety of conditions; in immunocompromised hosts, SSTIs can be caused by diverse microorganisms-most commonly bacteria, but also fungi, viruses, mycobacteria, and protozoa. The diagnosis of SSTIs is difficult because they may commonly masquerade as other clinical syndromes or can be a manifestation of systemic disease. In immunocompromised hosts, SSTI poses a major diagnostic challenge, and clinical dermatological assessment should be initially performed; to better identify the pathogen and to lead to appropriate treatment, etiology should include cultures of lesions and blood, biopsy with histology, specific microbiological analysis with special stains, molecular techniques, and antigen-detection methodologies. Here, we reviewed the epidemiology, pathophysiology, clinical presentation, and diagnostic techniques, including molecular biological techniques, used for SSTIs, with a focus on the immunocompromised host, such as patients with cellular immunodeficiency, HIV, and diabetic foot infection.
Collapse
|
24
|
The Tetrazole VT-1161 Is a Potent Inhibitor of Trichophyton rubrum through Its Inhibition of T. rubrum CYP51. Antimicrob Agents Chemother 2017; 61:AAC.00333-17. [PMID: 28483956 DOI: 10.1128/aac.00333-17] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/28/2017] [Indexed: 11/20/2022] Open
Abstract
Prior to characterization of antifungal inhibitors that target CYP51, Trichophyton rubrum CYP51 was expressed in Escherichia coli, purified, and characterized. T. rubrum CYP51 bound lanosterol, obtusifoliol, and eburicol with similar affinities (dissociation constant [Kd ] values, 22.7, 20.3, and 20.9 μM, respectively) but displayed substrate specificity, insofar as only eburicol was demethylated in CYP51 reconstitution assays (turnover number, 1.55 min-1; Km value, 2 μM). The investigational agent VT-1161 bound tightly to T. rubrum CYP51 (Kd = 242 nM) with an affinity similar to that of clotrimazole, fluconazole, ketoconazole, and voriconazole (Kd values, 179, 173, 312, and 304 nM, respectively) and with an affinity lower than that of itraconazole (Kd = 53 nM). Determinations of 50% inhibitory concentrations (IC50s) using 0.5 μM CYP51 showed that VT-1161 was a tight-binding inhibitor of T. rubrum CYP51 activity, yielding an IC50 of 0.14 μM, whereas itraconazole, fluconazole, and ketoconazole had IC50s of 0.26, 0.4, and 0.6 μM, respectively. When the activity of VT-1161 was tested against 34 clinical isolates, VT-1161 was a potent inhibitor of T. rubrum growth, with MIC50, MIC90, and geometric mean MIC values of ≤0.03, 0.06, and 0.033 μg ml-1, respectively. With its selectivity versus human CYP51 and drug-metabolizing cytochrome P450s having already been established, VT-1161 should prove to be safe and effective in combating T. rubrum infections in patients.
Collapse
|
25
|
|
26
|
Yacoub A, Soni KK, Mojica L, Mai J, Morano J, Cruse CW, Sandin RL, Nanjappa S, Bohra C, Gajanan G, Greene JN. Primary Gangrenous Cutaneous Mold Infections in a Patient With Cancer and Neutropenia. Cancer Control 2017; 23:265-71. [PMID: 27556666 DOI: 10.1177/107327481602300309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Opportunistic fungal infections caused by Aspergillus and Candida followed by infections with Fusarium, Rhizopus, Mucor, and Alternaria species are an important cause of morbidity and mortality in patients with hematological malignancies. Cutaneous mucormycosis infections are rare, and the incidence, outcomes, and factors associated with survival in the setting of hematological malignancies are not clear. METHODS A literature search was conducted for all cases of primary cutaneous mold infections in patients with hematological malignancy, of which 50 cases were found. Our case of a patient with a hematological malignancy who sustained a cat bite that in turn caused a primary cutaneous mold infection is also included. RESULTS In the 51 cases identified, 66.7% were neutropenic upon presentation, and 54.9% were male with an average age of 32 years. Aspergillus species (33.3%) was the most cited followed by Rhizopus species (19.6%). Overall mortality rate was 29.4% and was observed more frequently in patients with neutropenia (60.0%) and without surgical intervention (73.3%). Survival rate was higher (35.3%) for cases utilizing both antifungal and surgical intervention. The antifungal agent with the highest survival rate was amphotericin B and its formulations (58.8%). CONCLUSIONS Neutropenia within hematological malignancies demonstrate a risk for developing severe cutaneous fungal infections, of which primary cutaneous mucormycosis can carry significant mortality. Combination antifungal therapy and surgical debridement appears to be associated with higher survival outcomes and warrants further investigation.
Collapse
Affiliation(s)
- Abraham Yacoub
- Department of Infectious Diseases and Tropical Medicine, Moffitt Cancer Center, Tampa, FL 33612, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Wan J, Piette EW, Rosenbach M. Purpuric and cream-colored plaques in an immunocompromised person: A case of disseminated trichosporonosis. JAAD Case Rep 2016; 2:275-7. [PMID: 27486593 PMCID: PMC4949493 DOI: 10.1016/j.jdcr.2016.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Joy Wan
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Evan W Piette
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
28
|
Invasive Cutaneous Rhizopus Infections in an Immunocompromised Patient Population Associated with Hospital Laundry Carts. Infect Control Hosp Epidemiol 2016; 37:1251-3. [PMID: 27457379 DOI: 10.1017/ice.2016.157] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
29
|
Abstract
Cutaneous complications are common in patients with leukemia. However, the cause is not always immediately clear, as there are often numerous potential etiologies. Thrombocytopenia or coagulopathy can result in ecchymoses or petechiae, whereas extramedullary (EM) involvement by leukemia can present as a rash. Leukemia can also result in skin manifestations via indirect means, including several types of paraneoplastic phenomena. Moreover, various agents routinely used to treat leukemia-most notably cytarabine (cytosine arabinoside)-can precipitate quite profound skin eruptions. Finally, infections, including fungal invasion of the skin, can be responsible for rashes, as can the vast array of antimicrobials that are administered to leukemia patients.
Collapse
Affiliation(s)
| | | | - Raghava Induru
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Jonathan M Gerber
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC.
| |
Collapse
|
30
|
Abstract
Dermatology consultation can improve diagnostic accuracy in the hospitalized patient with cutaneous disease. Dermatology consultation can streamline and improve treatment plans, and potentially lead to cost savings. Dermatology consultants can be a valuable resource for education for trainees, patients, and families. Inpatient consultative dermatology spans a breadth of conditions, including inflammatory dermatoses,infectious processes, adverse medication reactions, and neoplastic disorders, many of which can be diagnosed based on dermatologic examination alone, but when necessary, bedside skin biopsies can contribute important diagnostic information.
Collapse
Affiliation(s)
- Lauren K Biesbroeck
- Division of Dermatology, University of Washington School of Medicine, 1959 Northeast Pacific Street BB-1353, Box 356524, Seattle, WA 98195-6524, USA
| | - Michi M Shinohara
- Division of Dermatology, University of Washington School of Medicine, 1959 Northeast Pacific Street BB-1353, Box 356524, Seattle, WA 98195-6524, USA.
| |
Collapse
|
31
|
Chantaphakul H, Sanon T, Klaewsongkram J. Clinical characteristics and treatment outcome of Stevens-Johnson syndrome and toxic epidermal necrolysis. Exp Ther Med 2015; 10:519-524. [PMID: 26622347 DOI: 10.3892/etm.2015.2549] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 04/17/2015] [Indexed: 01/11/2023] Open
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are erythematous skin lesions with blister formation accompanied by mucosal involvement. These conditions are considered to be life-threatening illnesses. Understanding the clinical presentation, risk factors, treatment options and results will be advantageous for physicians in the management of patients in the future. The aim of the present study was to review and analyze the clinical manifestations, drug implications, treatment and outcome of patients with SJS and/or TEN who had been hospitalized in a tertiary care center. All hospitalized patients with SJS and/or TEN during a 5-year period were retrospectively reviewed. The clinical severity was graded according to the score of toxic epidermal necrolysis (SCORTEN) scale. Clinical symptoms, diagnosis, possible precipitating factors, management and outcome data were collected for analysis. A total of 43 patients (mean age, 49.5 years) were hospitalized and classified into the SJS group (55.8%), SJS/TEN overlap group (20.9%) and TEN group (23.3%). The majority of the patients (90.7%) had mucocutaneous eruptions associated with oral drug administration. Allopurinol, anticonvulsants and antibiotics were the most common causative agents for the mucocutaneous eruption. Twenty-eight patients (65.1%) were treated with corticosteroids. The mortality rate was 6.9%. Comparison between the survival group and the non-survival group revealed that patient age >70 years (P=0.014) and body surface area involvement >20% (P<0.01) were the significant factors associated with mortality. The use of systemic steroids was higher in the survival group in comparison with the non-survival group (65.1 vs. 0%, respectively; P=0.014). The mucocutaneous eruptions in SJS and TEN are mostly caused by medication. With early recognition and treatment, the mortality rate in this study was lower than that in previous reports. Patient age and the area of mucocutaneous involvement were significant factors associated with mortality.
Collapse
Affiliation(s)
- Hiroshi Chantaphakul
- Department of Medicine, Division of Allergy and Immunology, Faculty of Medicine, Chulalongkorn University, Patumwan, Bangkok 10330, Thailand
| | - Thanomsak Sanon
- Department of Medicine, Division of Allergy and Immunology, Faculty of Medicine, Chulalongkorn University, Patumwan, Bangkok 10330, Thailand
| | - Jettanong Klaewsongkram
- Department of Medicine, Division of Allergy and Immunology, Faculty of Medicine, Chulalongkorn University, Patumwan, Bangkok 10330, Thailand
| |
Collapse
|
32
|
Lourdes LS, Mitchell CL, Glavin FL, Schain DC, Kaye FJ. Recurrent dermatophytosis (Majocchi granuloma) associated with chemotherapy-induced neutropenia. J Clin Oncol 2015; 32:e92-4. [PMID: 24470005 DOI: 10.1200/jco.2012.47.3330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
33
|
Reischies F, Hoenigl M. The role of surgical debridement in different clinical manifestations of invasive aspergillosis. Mycoses 2014; 57 Suppl 2:1-14. [PMID: 25186615 DOI: 10.1111/myc.12224] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/30/2014] [Accepted: 07/09/2014] [Indexed: 11/30/2022]
Abstract
Invasive aspergillosis (IA) has a wide spectrum of clinical presentations and is associated with high mortality rates. Early initiation of systemic antimould therapy remains the most important measure to reduce mortality. Surgical debridement is an important additional therapeutic option mainly in cases of extrapulmonary IA. The main intention for surgical intervention in IA is to obtain material for diagnosis and antifungal susceptibility testing. There are, however, also therapeutic implications for surgical interventions in rare manifestation of IA such as endocarditis or mycotic aneurysm. Here, we will review the role of surgical interventions in the treatment of different clinical manifestations of IA.
Collapse
Affiliation(s)
- Frederike Reischies
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | | |
Collapse
|
34
|
Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJC, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue
Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:147-59. [DOI: 10.1093/cid/ciu296] [Citation(s) in RCA: 1187] [Impact Index Per Article: 118.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion.
Collapse
Affiliation(s)
- Dennis L. Stevens
- Division of Infectious Diseases, Department of Veterans Affairs, Boise, Idaho
| | - Alan L. Bisno
- Medical Service, Miami Veterans Affairs Health Care System, Florida
| | | | | | - Ellie J. C. Goldstein
- University of California, Los Angeles, School of Medicine, and R. M. Alden Research Laboratory, Santa Monica, California
| | | | - Jan V. Hirschmann
- Medical Service, Puget Sound Veterans Affairs Medical Center, Seattle, Washington
| | - Sheldon L. Kaplan
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - James C. Wade
- Geisinger Health System, Geisinger Cancer Institute, Danville, Pennsylvania
| |
Collapse
|
35
|
|
36
|
Al-Abdely HM, Alothman AF, Salman JA, Al-Musawi T, Almaslamani M, Butt AA, Al Thaqafi AO, Raghubir N, Morsi WE, Yared NA. Clinical practice guidelines for the treatment of invasive Aspergillus infections in adults in the Middle East region: Expert panel recommendations. J Infect Public Health 2014; 7:20-31. [DOI: 10.1016/j.jiph.2013.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/05/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022] Open
|
37
|
Abstract
Dermatologic infections are among the most commonly experienced complications of cancer and anti-cancer therapy. Alterations in host immune function secondary to the underlying malignant process and/or its treatment have been linked to an increase in the risk of infections. The skin and its appendages (i.e., hair and nails) represent the first line of defense against infectious microorganism; its dysfunction as a physical barrier and an immunologic organ in cancer patients leads to an increased susceptibility to infectious organisms. Moreover, a cancer patient's vulnerable state facilitates dissemination of infections to other sites, secondarily involving the skin. This chapter delineates dermatologic infections that are unique to cancer patients as a result of their underlying malignancies and associated comorbidities as well as those resulting from antineoplastic therapies.
Collapse
Affiliation(s)
- Mona Gandhi
- Division of Dermatology, John H. Stroger, Jr. Hospital of Cook County, 1900 W. Polk Street, Administration Building, Room 519, Chicago, IL, 60612, USA,
| | | | | |
Collapse
|
38
|
Juhas E, Reyes-Mugica M, Michaels MG, Grunwaldt LJ, Gehris RP. Exserohilum infection in an immunocompromised neonate. Pediatr Dermatol 2013; 30:e232-3. [PMID: 22937836 DOI: 10.1111/j.1525-1470.2012.01829.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Invasive fungal infections in children have increased in recent years, coinciding with greater survival of preterm neonates and children with immunodeficiencies, more intense chemotherapy regimens, and greater use of stem cell and solid organ transplantation. We describe a case of an immunosuppressed neonate who developed cutaneous Exserohilum rostratum infection.
Collapse
Affiliation(s)
- Elizabeth Juhas
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PennsylvaniaDivision of Pediatric PathologyDivision of Pediatric Infectious DiseasesDivision of Pediatric Plastic SurgeryDivision of Pediatric Dermatology, Children's Hospital of Pittsburgh University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | |
Collapse
|
39
|
Farmakiotis D, Ciurea AM, Cahuayme-Zuniga L, Kontoyiannis DP. The diagnostic yield of skin biopsy in patients with leukemia and suspected infection. J Infect 2013; 67:265-72. [DOI: 10.1016/j.jinf.2013.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 05/24/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
|
40
|
Agrawal P, Peter JV, George R. Dermatological manifestations and relationship to outcomes of patients admitted to a medical intensive care unit: a study from a tertiary care hospital in India. Postgrad Med J 2013; 89:501-7. [PMID: 23538394 DOI: 10.1136/postgradmedj-2012-131610] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM To determine the prevalence of dermatological manifestations in intensive care unit (ICU) patients and assess its impact on outcomes. METHODS This was a prospective cohort study of 1013 ICU patients admitted between December 2009 and April 2011. Patients were categorised following an initial screening (within 48 h) and subsequent daily review as those with dermatological manifestations in association with multisystem disorder (category 1), occurring due to treatment or critical illness (category 2), coincidental lesions (category 3) or primary dermatological conditions needing intensive care (category 4). Outcomes included mortality, duration of ventilation and hospitalisation. Factors associated with mortality were explored using univariate and multivariate analyses. RESULTS Dermatological manifestations were observed in 427 (42.2%) patients, predominantly of categories 1 (n=159) and 2 (n=160). Common aetiologies were infections (39.3%) and mechanical, thermal or physical injuries (32.8%). Primary dermatological conditions (n=33) included 21 patients with cutaneous infections, 3 with angioedema, 2 each with pemphigus, toxic epidermal necrolysis and psoriasis, and 1 each with Stevens-Johnson syndrome, drug hypersensitivity syndrome and crusted scabies. The presence of cutaneous lesions increased mortality risk (OR 1.56, 95% CI 1.20 to 2.03) and significantly (p<0.001) prolonged ventilation and hospitalisation. Mortality was higher (p<0.001) in patients in categories 4 (65.6%) and 2 (57.5%) compared to those without manifestations (35.5%). After adjusting for age, Acute Physiology And Chronic Health Evaluation II (APACHE-II) score, ventilation and dialysis, the association between dermatological manifestations and mortality was insignificant (OR 1.37, 95% CI 0.97 to 1.95). CONCLUSIONS Dermatological manifestations are common in ICU patients. Their presence may impact mortality and duration of ventilation and hospitalisation.
Collapse
Affiliation(s)
- Poonam Agrawal
- Department of Dermatology, Venereology and Leprosy, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | | | | |
Collapse
|
41
|
Abecasis M, Ferreira I, Teixeira G, Miranda N. Widespread Skin Nodules as a Manifestation of Breakthrough Invasive Aspergillosis in a Bone Marrow Transplant Patient. Clin Drug Investig 2013; 33 Suppl 1:S15-7. [DOI: 10.1007/s40261-012-0015-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
42
|
Barton RC. Laboratory diagnosis of invasive aspergillosis: from diagnosis to prediction of outcome. SCIENTIFICA 2013; 2013:459405. [PMID: 24278780 PMCID: PMC3820361 DOI: 10.1155/2013/459405] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 11/14/2012] [Indexed: 06/02/2023]
Abstract
Invasive aspergillosis (IA), an infection caused by fungi in the genus Aspergillus, is seen in patients with immunological deficits, particularly acute leukaemia and stem cell transplantation, and has been associated with high rates of mortality in previous years. Diagnosing IA has long been problematic owing to the inability to culture the main causal agent A. fumigatus from blood. Microscopic examination and culture of respiratory tract specimens have lacked sensitivity, and biopsy tissue for histopathological examination is rarely obtainable. Thus, for many years there has been a great interest in nonculture-based techniques such as the detection of galactomannan, β -D-glucan, and DNA by PCR-based methods. Recent meta-analyses suggest that these approaches have broadly similar performance parameters in terms of sensitivity and specificity to diagnose IA. Improvements have been made in our understanding of the limitations of antigen assays and the standardisation of PCR-based DNA detection. Thus, in more recent years, the debate has focussed on how these assays can be incorporated into diagnostic strategies to maximise improvements in outcome whilst limiting unnecessary use of antifungal therapy. Furthermore, there is a current interest in applying these tests to monitor the effectiveness of therapy after diagnosis and predict clinical outcomes. The search for improved markers for the early and sensitive diagnosis of IA continues to be a challenge.
Collapse
Affiliation(s)
- Richard C. Barton
- Mycology Reference Centre, Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds LS1 3EX, UK
| |
Collapse
|
43
|
Impact and Etiology of Periungual Toe Infections in Neutropenic Patients. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2012. [DOI: 10.1097/ipc.0b013e3182506da4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
44
|
Venugopal TV, Venugopal PV. Primary cutaneous aspergillosis from Tamilnadu diagnosed by fine needle aspiration cytology. Med Mycol Case Rep 2012; 1:103-6. [PMID: 24371752 DOI: 10.1016/j.mmcr.2012.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 09/20/2012] [Accepted: 09/21/2012] [Indexed: 11/26/2022] Open
Abstract
Aspergillus are ubiquitous and more than 30 species have been reported to be involved in human infection. Most of the cases occur in immunocompromised patients and are disseminated in the blood. Primary cutaneous aspergillosis in immunocompetent hosts is rare. We report a unique case of primary cutaneous aspergillosis in an immunocompetent patient diagnosed by fine needle aspiration cytology. The characteristic ascocarp and ascospores of Aspergillus species were found in the aspirate and Aspergillus glaucus was isolated in pure culture. The case is presented to increase the awareness of the usefulness of fine needle aspiration cytology for diagnosing fungal infections.
Collapse
Affiliation(s)
- Taralakshmi V Venugopal
- Department of Pathology, Shri Sathya Sai Medical College and Research Institute, Tiruporur, Kanchipuram 603 110, India
| | | |
Collapse
|
45
|
Saghrouni F, Gheith S, Yaacoub A, Ammous O, Ben Abdeljelil J, Fathallah A, Mokni M, Ben Saïd M. Primary cutaneous aspergillosis due to Aspergillus flavus in a neutropenic patient. J Mycol Med 2011. [DOI: 10.1016/j.mycmed.2011.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
46
|
Ceric-Dehdari P, Houcinat Y, Berger TG. [Disseminated papules in a patient with acute myeloid leukemia]. Hautarzt 2010; 61:980-4. [PMID: 20927503 DOI: 10.1007/s00105-010-2048-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cryptococcosis most commonly occurs in immunosuppressed patients. The pathogen is the yeast Cryptococcus neoformans. This article reports on the case of a 20-year-old female patient with acute myeloid leukemia who suddenly developed disseminated livid red papules and papulovesicles. The clinical picture and in particular the histopathology findings led to the diagnosis of cutaneous cryptococcosis, which was successfully treated with amphotericin B. For the differential diagnosis generalized herpes zoster, erythema exudativum multiforme and disseminated molluscum contagiosum must be considered. To confirm the diagnosis attempts can also be made to culture the pathogen from skin biopsy preparations. Furthermore, fungal spores can be rapidly and simply detected with the Tzanck test.
Collapse
Affiliation(s)
- P Ceric-Dehdari
- Department of Dermatology, Tawam Hospital in affiliation with Johns Hopkins Medicine, Al Ain
| | | | | |
Collapse
|
47
|
Kash KM, Sharma S, Goldfarb NI. Is disease management right for oncology? Popul Health Manag 2010; 12:337-43. [PMID: 20038260 DOI: 10.1089/pop.2009.0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The disease management (DM) model for the treatment of chronic conditions has been around for many years and has been found to be effective for diseases of high prevalence and high cost (eg, diabetes, asthma, heart disease). With an increasing number of people living with cancer and the continual escalation of treatment costs, DM vendors have begun to implement DM concepts into cancer care. However, the multitude of cancer types, treatment options, and adverse effects have all presented barriers to oncology DM, and data reflecting the effectiveness of oncology DM have remained scarce. Oncology costs, the lack of congruence between provider and patient expectations of treatment, the lack of prevention and early detection for many cancers, and, most importantly, the inability of people to adhere to healthy lifestyles are additional obstacles that must be overcome. Moreover, when designing an oncology DM program, it is imperative to look at cancers individually as the etiology, treatment, and impact of cancer can be markedly different from one patient to the next. An effective oncology DM program is one that acts to decrease fatigue, reduces nosocomial infections, deals with dehydration and pain, manages anemia, identifies and treats skin infections, recognizes and treats depression and other psychological distress, provides patients access to palliative care services, facilitates informed decision making and end-of-life transitions, and promotes communication between patients and their providers as well as between physicians. Moving forward, DM vendors and health insurance companies capable of incorporating DM with medical management will be in the best position to provide optimal cancer care.
Collapse
Affiliation(s)
- Kathryn M Kash
- Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | | | | |
Collapse
|
48
|
A multifunctional, synthetic Gaussia princeps luciferase reporter for live imaging of Candida albicans infections. Infect Immun 2009; 77:4847-58. [PMID: 19687206 DOI: 10.1128/iai.00223-09] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Real-time monitoring of the spatial and temporal progression of infection/gene expression in animals will contribute greatly to our understanding of host-pathogen interactions while reducing the number of animals required to generate statistically significant data sets. Sensitive in vivo imaging technologies can detect low levels of light emitted from luciferase reporters in vivo, but the existing reporters are not optimal for fungal infections. Therefore, our aim was to develop a novel reporter system for imaging Candida albicans infections that overcomes the limitations of current luciferase reporters for this major fungal pathogen. This luciferase reporter was constructed by fusing a synthetic, codon-optimized version of the Gaussia princeps luciferase gene to C. albicans PGA59, which encodes a glycosylphosphatidylinositol-linked cell wall protein. Luciferase expressed from this PGA59-gLUC fusion (referred to as gLUC59) was localized at the C. albicans cell surface, allowing the detection of luciferase in intact cells. The analysis of fusions to strong (ACT1 and EFT3), oxidative stress-induced (TRX1, TRR1, and IPF9996), and morphogenesis-dependent (HWP1) promoters confirmed that gLUC59 is a convenient and sensitive reporter for studies of gene regulation in yeast or hyphal cells, as well as a flexible screening tool. Moreover, the ACT1-gLUC59 fusion represented a powerful tool for the imaging of disease progression in superficial and subcutaneous C. albicans infections. gLUC59 and related cell surface-exposed luciferase reporters might find wide applications in molecular biology, cell biology, pathobiology, and high-throughput screens.
Collapse
|
49
|
Stergiopoulou T, De Lucca AJ, Meletiadis J, Sein T, Boue SM, Schaufele R, Roilides E, Ghannoum M, Walsh TJ. In vitro activity of CAY-1, a saponin from Capsicum frutescens, against Microsporum and Trichophyton species. Med Mycol 2009; 46:805-10. [PMID: 18608885 DOI: 10.1080/13693780802089831] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Dermatomycoses are among the world's most common diseases and their incidence has increased over recent years, particularly in immunosuppressed patients. In previous studies, the saponin CAY-1 from cayenne pepper (Capsicum frutescens), has shown antifungal activities against Candida albicans and Aspergillus spp. We therefore studied the in vitro antifungal activity of CAY-1 against non-germinating conidia and hyphae of clinical isolates of the dermatophytes Trichophyton mentagrophytes, T. rubrum, T. tonsurans and Microsporum canis. We used a microdilution method to assess the growth inhibitory activities of CAY-1 against conidia (CLSI document M38-A) and a colorimetric procedure (XTT method) to investigate the metabolic inhibitory activity of CAY-1 against hyphae. The minimal inhibitory concentrations (complete visual growth inhibition) of CAY-1 against non-germinating conidia ranged from 10-20 microg/ml for all dermatophyte isolates included in this investigation. In addition, we found >90% inhibition of hyphal metabolic activity of these same isolates with 10-20 microg/ml of CAY-1. Results indicate that CAY-1 merits further investigation as a potential agent for the treatment of dermatomycoses.
Collapse
|
50
|
Swick BL, Reddy SC, Friedrichs A, Stone MS. Disseminated Scopulariopsis-culture is required to distinguish from other disseminated mould infections. J Cutan Pathol 2009; 37:687-91. [PMID: 19615008 DOI: 10.1111/j.1600-0560.2009.01358.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Disseminated fungal infections are a major cause of mortality in severely immunocompromised bone marrow transplant (BMT) patients. Scopulariopsis is a soil saprophytic mould that is typically associated with onychomycosis and only rarely associated with disseminated infection with cutaneous findings. We describe a case of fatal disseminated Scopulariopsis infection in a 56-year-old neutropenic male with chronic myelogenous leukemia status post peripheral blood stem cell transplant that was clinically and histologically indistinguishable from disseminated Aspergillus, Fusarium or zygomycosis infection. Distinguishing the above listed fungi by tissue culture is crucial because disseminated Scopulariopsis is difficult to eradicate and associated with a high mortality rate in the immunocompromised BMT patient population.
Collapse
Affiliation(s)
- Brian L Swick
- University of Iowa, Departments of Dermatology and Pathology, Iowa City, IA 52242, USA.
| | | | | | | |
Collapse
|