Parathyridaria percutanea and Subcutaneous Phaeohyphomycosis

An unusual subcutaneous mycosis due to Parathyridaria percutanea in an immunocompromised individual

Solid Organ transplant recipients are at risk of opportunistic infections due to immunosuppressed state, prolonged hospital stay and exposure to multiple antibiotics. Subcutaneous mycoses are heterogenous group of fungal infections affecting dermis and subcutaneous tissue due to penetrating injury. Subcutaneous mycosis in immunocompromised individual causes significant morbidity in the form of chronic discharging sinuses and systemic spread. Parathyridaria percutanea is an emerging cause of subcutaneous mycosis in transplant patients and is difficult to identify phenotypically. It is relatively novel pathogen and only few cases are reported in Indian population. Here we present a case of subcutaneous mycosis who presented with multiple discharging sinuses over left foot. Timely identification of implicating pathogen and initiation of targeted anti-fungal therapy plays important role in decreasing hospital stay and overall financial burden to patient. Present case also highlights importance of genotypic methods in diagnosing emerging fungal infection in immunocompromised individuals, when phenotypic identification fails.

Contribution of shotgun metagenomics in the diagnosis of a subcutaneous phaeohyphomycosis caused by Parathyridaria percutanea

Diagnosis of subcutaneous infection caused by Parathyridaria percutanea, a rare and emerging tropical fungal pathogen identified in an immunocompromised woman using clinical shotgun metagenomics.

Dematiaceous fungal infections in solid organ transplantation: systematic review and bayesian meta-analysis

BACKGROUND

Dematiaceous fungi cause a number of infectious syndromes referred to as phaeohyphomycosis among both immunocompetent and immunocompromised hosts. We performed a systematic review to characterize these infections in solid organ transplant recipients (SOTR).

METHODS

We searched PubMed database (last searched 1/6/2022) for English-language reports on dematiaceous fungal infections in SOTR. Included reports needed individualized demographic, treatment, and outcome data; pediatric reports were excluded. A universally applicable bias assessment was performed on reports. Models for infection type and outcome were created using the Bayesian paradigm.

RESULTS

We included 149 reports on 201 cases of dematiaceous fungal infections in SOTR. The mean age was 54 years, 72% were men, and kidney recipients accounted for 61% of cases. Skin and soft tissue infection (SSTI) was the most common infectious syndrome (73%). Death from infection occurred in 7% of cases (14/201), with disseminated (32%) cases having the highest mortality. Our model for infection type predicted the relative probability of central nervous system infection to be highest in liver recipients. Across all transplant types, higher relative probabilities of disseminated and pulmonary infections occur in the early post-transplant period, and the predicted probabilities for these infection types decreased after 100 months post-transplantation.

DISCUSSION

We identified SSTI as the most common dematiaceous fungal infections in SOTR. Disseminated infections carried the worst prognosis. The evidence in this review is limited by the heterogeneity of included cases. No funding source was used, and this review's protocol was not registered. This article is protected by copyright. All rights reserved.