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Favilla LD, Herman TS, Goersch CDS, de Andrade RV, Felipe MSS, Bocca AL, Fernandes L. Expanding the Toolbox for Functional Genomics in Fonsecaea pedrosoi: The Use of Split-Marker and Biolistic Transformation for Inactivation of Tryptophan Synthase ( trpB) Gene. J Fungi (Basel) 2023; 9:jof9020224. [PMID: 36836338 PMCID: PMC9963410 DOI: 10.3390/jof9020224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
Chromoblastomycosis (CBM) is a disease caused by several dematiaceous fungi from different genera, and Fonsecaea is the most common which has been clinically isolated. Genetic transformation methods have recently been described; however, molecular tools for the functional study of genes have been scarcely reported for those fungi. In this work, we demonstrated that gene deletion and generation of the null mutant by homologous recombination are achievable for Fonsecaea pedrosoi by the use of two approaches: use of double-joint PCR for cassette construction, followed by delivery of the split-marker by biolistic transformation. Through in silico analyses, we identified that F. pedrosoi presents the complete enzymatic apparatus required for tryptophan (trp) biosynthesis. The gene encoding a tryptophan synthase trpB -which converts chorismate to trp-was disrupted. The ΔtrpB auxotrophic mutant can grow with external trp supply, but germination, viability of conidia, and radial growth are defective compared to the wild-type and reconstituted strains. The use of 5-FAA for selection of trp- phenotypes and for counter-selection of strains carrying the trp gene was also demonstrated. The molecular tools for the functional study of genes, allied to the genetic information from genomic databases, significantly boost our understanding of the biology and pathogenicity of CBM causative agents.
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Affiliation(s)
- Luísa Dan Favilla
- Laboratory of Applied Immunology, Institute of Biology, Campus Darcy Ribeiro, University of Brasília, Asa Norte, Federal District, Brasilia 70910-900, Brazil
- Graduate Program in Molecular Biology, Institute of Biology, Campus Darcy Ribeiro, University of Brasília, Asa Norte, Federal District, Brasilia 70910-900, Brazil
| | - Tatiana Sobianski Herman
- Laboratory of Applied Immunology, Institute of Biology, Campus Darcy Ribeiro, University of Brasília, Asa Norte, Federal District, Brasilia 70910-900, Brazil
- Graduate Program in Molecular Patology, Faculty of Medicine, Campus Darcy Ribeiro, University of Brasília, Asa Norte, Federal District, Brasilia 70910-900, Brazil
| | - Camila da Silva Goersch
- Laboratory of Applied Immunology, Institute of Biology, Campus Darcy Ribeiro, University of Brasília, Asa Norte, Federal District, Brasilia 70910-900, Brazil
- Graduate Program in Microbial Biology, Institute of Biology, Campus Darcy Ribeiro, University of Brasília, Asa Norte, Federal District, Brasilia 70910-900, Brazil
| | - Rosangela Vieira de Andrade
- Graduate Program of Genomic Sciences and Biotechnology, Catholic University of Brasilia, Campus Asa Norte, Asa Norte, Federal District, Taguatinga 70790-160, Brazil
| | - Maria Sueli Soares Felipe
- Graduate Program of Genomic Sciences and Biotechnology, Catholic University of Brasilia, Campus Asa Norte, Asa Norte, Federal District, Taguatinga 70790-160, Brazil
| | - Anamélia Lorenzetti Bocca
- Laboratory of Applied Immunology, Institute of Biology, Campus Darcy Ribeiro, University of Brasília, Asa Norte, Federal District, Brasilia 70910-900, Brazil
- Graduate Program in Molecular Biology, Institute of Biology, Campus Darcy Ribeiro, University of Brasília, Asa Norte, Federal District, Brasilia 70910-900, Brazil
- Graduate Program in Molecular Patology, Faculty of Medicine, Campus Darcy Ribeiro, University of Brasília, Asa Norte, Federal District, Brasilia 70910-900, Brazil
| | - Larissa Fernandes
- Laboratory of Applied Immunology, Institute of Biology, Campus Darcy Ribeiro, University of Brasília, Asa Norte, Federal District, Brasilia 70910-900, Brazil
- Graduate Program in Microbial Biology, Institute of Biology, Campus Darcy Ribeiro, University of Brasília, Asa Norte, Federal District, Brasilia 70910-900, Brazil
- Centro Metropolitano, Faculty of Ceilândia, Campus UnB Ceilândia, University of Brasília, Ceilândia Sul, Federal District, Brasilia 72220-275, Brazil
- Correspondence:
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Guevara A, Nery AF, de Souza Carvalho Melhem M, Bonfietti L, Rodrigues AM, Hagen F, de Carvalho J, de Camargo ZP, de Souza Lima B, Vicente VA, Hahn RC. Molecular epidemiology and clinical-laboratory aspects of chromoblastomycosis in Mato Grosso, Brazil. Mycoses 2022; 65:1146-1158. [PMID: 35869803 PMCID: PMC9828117 DOI: 10.1111/myc.13505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Chromoblastomycosis is a disease caused by melanized fungi, primarily belonging to the genera Fonsecaea and Cladophialophora, mainly affecting individuals who are occupationally exposed to soil and plant products. This research aimed to determine the clinical, epidemiological and laboratory characteristics of chromoblastomycosis in the state of Mato Grosso, Brazil. MATERIALS AND METHODS Patients diagnosed with chromoblastomycosis treated at the Júlio Müller University Hospital, Cuiabá, Brazil, from January 2015 to December 2020, whose isolates were preserved in the Research Laboratory of the Faculty of Medicine of the Federal University of Mato Grosso. Isolates were identified by partly sequencing the Internal Transcribed Spacer (ITS) and β-tubulin (BT2) loci. AFLP fingerprinting was used to explore the genetic diversity. Susceptibility to itraconazole, voriconazole, 5-fluorocytosine, terbinafine and amphotericin B was determined by the broth microdilution technique. RESULTS Ten patients were included, nine were male (mean age = 64.1 years). Mean disease duration was 8.6 years. Lesions were mainly observed in the lower limbs. Predominant clinical forms were verrucous and scarring. Systemic arterial hypertension and type II diabetes mellitus were the predominant comorbidities. Leprosy was the main concomitant infectious disease. Fonsecaea pedrosoi was the unique aetiological agent identified with moderate genetic diversity (H = 0.3934-0.4527; PIC = 0.3160-0.3502). Antifungal agents with the highest activity were terbinafine, voriconazole and itraconazole. CONCLUSION Chromoblastomycosis is affecting the poor population in rural and urban areas, mainly related to agricultural activities, with F. pedrosoi being the dominant aetiologic agent. All isolates had low MICs for itraconazole, voriconazole and terbinafine, confirming their importance as therapeutic alternatives for chromoblastomycosis.
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Affiliation(s)
- Armando Guevara
- Laboratory of Mycology/Research, Faculty of MedicineFederal University of Mato GrossoCuiabáMato GrossoBrazil
| | - Andréia Ferreira Nery
- Júlio Muller University HospitalFederal University of Mato GrossoCuiabáMato GrossoBrazil
| | - Márcia de Souza Carvalho Melhem
- Health DepartmentMycology Nucleus of Instituto Adolfo LutzSão PauloSPBrazil,School of MedicineFederal University of Mato Grosso do SulCampo Grande, MSBrazil
| | - Lucas Bonfietti
- Health DepartmentMycology Nucleus of Instituto Adolfo LutzSão PauloSPBrazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular BiologyFederal University of São Paulo (UNIFESP)São PauloBrazil,Department of Medicine, Discipline of Infectious DiseasesFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Ferry Hagen
- Westerdijk Fungal Biodiversity InstituteUtrechtThe Netherlands,Institute for Biodiversity and Ecosystem Dynamics (IBED)University of AmsterdamThe Netherlands,Department of Medical MicrobiologyUtrecht University Medical CenterUtrechtThe Netherlands
| | - Jamile Ambrósio de Carvalho
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular BiologyFederal University of São Paulo (UNIFESP)São PauloBrazil,Department of Medicine, Discipline of Infectious DiseasesFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular BiologyFederal University of São Paulo (UNIFESP)São PauloBrazil,Department of Medicine, Discipline of Infectious DiseasesFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Bruna Jacomel F. de Souza Lima
- Microbiology, Parasitology and Pathology Post‐Graduation Program, Department of PathologyFederal University of ParanáCuritibaParanáBrazil
| | | | - Rosane Christine Hahn
- Laboratory of Mycology/Research, Faculty of MedicineFederal University of Mato GrossoCuiabáMato GrossoBrazil,Júlio Muller University HospitalFederal University of Mato GrossoCuiabáMato GrossoBrazil
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Does DHN-Melanin Always Protect Fungi against Antifungal Drugs? The Fonsecaea/Micafungin Paradigm. MICROBIOLOGY RESEARCH 2022. [DOI: 10.3390/microbiolres13020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Several human pathogenic fungi produce melanin. One of its properties during parasitism is the protection against antifungal drugs. This occurs with the agents of chromoblastomycosis, in which DHN-melanin reduces antifungal susceptibility to terbinafine and itraconazole. Since these agents are resistant to some antifungal drugs, we investigated the role of DHN-melanin on the Fonsecaea susceptibility to amphotericin B, micafungin, fluconazole, and flucytosine, drugs that usually present high minimal inhibitory concentrations (MIC) to this genus. Seven strains from three Fonsecaea human pathogenic species were treated with tricyclazole, a DHN-melanin inhibitor, and the MIC of the treated and untreated cells were compared. A survival assay was performed to confirm the alterations in the susceptibility of strains with reduced melanization, and the chitin levels of the strains were estimated by fluorescence. Tricyclazole did not affect fluconazole and flucytosine MIC, while melanin inhibition increased susceptibility to amphotericin B. Surprisingly, DHN-melanin inhibition decreased the susceptibility to micafungin. Survival assays confirmed this result on five strains. Cell wall chitin levels of the strains were not associated with the decrease in micafungin susceptibility. The results show that DHN-melanin does not have a role in the intrinsic resistance of Fonseacaea spp. to amphotericin B, fluconazole, and flucytosine, and its inhibition may promote micafungin resistance.
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Maubon D, Garnaud C, Ramarozatovo LS, Fahafahantsoa RR, Cornet M, Rasamoelina T. Molecular Diagnosis of Two Major Implantation Mycoses: Chromoblastomycosis and Sporotrichosis. J Fungi (Basel) 2022; 8:jof8040382. [PMID: 35448613 PMCID: PMC9027143 DOI: 10.3390/jof8040382] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023] Open
Abstract
Chromoblastomycosis and sporotrichosis are the two main implantation mycoses that are now recognized as fungal neglected tropical diseases (NTDs). Their laboratory diagnosis mainly relies on direct microscopy, histopathology, and identification of the fungus by culture. However, to be appropriately used, these techniques require mycological expertise that is not widely available and may be absent in peripheral health care facilities in endemic areas. In addition, they lack sensitivity and specificity, and the culture for isolation and identification can have a long time-to-results period. Molecular methods, including matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), have been developed in well-equipped reference laboratories. They greatly improve the rapidity and accuracy of diagnosis; in particular, for species identification. Recently, PCR and sequencing have paved the way for more user-friendly point-of-care tests, such as those based on LAMP or RCA technologies, which can be used in basic healthcare settings and even in field consultations.
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Affiliation(s)
- Danièle Maubon
- Translational Innovation in Medicine and Complexity, Centre National de la Recherche Scientifique, Université Grenoble Alpes, Domaine de la Merci, Centre Hospitalier Universitaire Grenoble Alpes, Service de Parasitologie-Mycologie, Bd de la Chantourne, CEDEX, 38706 La Tronche, France; (D.M.); (C.G.)
| | - Cécile Garnaud
- Translational Innovation in Medicine and Complexity, Centre National de la Recherche Scientifique, Université Grenoble Alpes, Domaine de la Merci, Centre Hospitalier Universitaire Grenoble Alpes, Service de Parasitologie-Mycologie, Bd de la Chantourne, CEDEX, 38706 La Tronche, France; (D.M.); (C.G.)
| | | | | | - Muriel Cornet
- Translational Innovation in Medicine and Complexity, Centre National de la Recherche Scientifique, Université Grenoble Alpes, Domaine de la Merci, Centre Hospitalier Universitaire Grenoble Alpes, Service de Parasitologie-Mycologie, Bd de la Chantourne, CEDEX, 38706 La Tronche, France; (D.M.); (C.G.)
- Correspondence:
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Liu H, Sun J, Li M, Cai W, Chen Y, Liu Y, Huang H, Xie Z, Zeng W, Xi L. Molecular Characteristics of Regional Chromoblastomycosis in Guangdong, China: Epidemiological, Clinical, Antifungal Susceptibility, and Serum Cytokine Profiles of 45 Cases. Front Cell Infect Microbiol 2022; 12:810604. [PMID: 35252030 PMCID: PMC8894709 DOI: 10.3389/fcimb.2022.810604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/24/2022] [Indexed: 11/20/2022] Open
Abstract
Chromoblastomycosis (CBM) is a chronic disease caused by several species of dematiaceous fungi. In this study, a regional collection of 45 CBM cases was conducted in Guangdong, China, a hyper-endemic area of CBM. Epidemiology findings indicated that the mean age of cases was 61.38 ± 11.20 years, long duration ranged from 3 months to 30 years, and the gender ratio of male to female was 4.6:1. Thirteen cases (29%) declared underlying diseases. Verrucous form was the most common clinical manifestation (n = 19, 42%). Forty-five corresponding clinical strains were isolated, and 28 of them (62%) were identified as F. monophora; the remaining 17 (38%) were identified as F. nubica through ITS rDNA sequence analysis. Antifungal susceptibility tests in vitro showed low MICs in azoles (PCZ 0.015–0.25 μg/ml, VCZ 0.015–0.5 μg/ml, and ITZ 0.03–0.5 μg/ml) and TRB (0.015–1 μg/ml). Itraconazole combined with terbinafine was the main therapeutic strategy used for 31 of 45 cases, and 68% (n = 21) of them improved or were cured. Cytokine profile assays indicated upregulation of IL-4, IL-7, IL-15, IL-11, and IL-17, while downregulation of IL-1RA, MIP-1β, IL-8, and IL-16 compared to healthy donors (p < 0.05). The abnormal cytokine profiles indicated impaired immune response to eliminate fungus in CBM cases, which probably contributed to the chronic duration of this disease. In conclusion, we investigated the molecular epidemiological, clinical, and laboratory characteristics of CBM in Guangdong, China, which may assist further clinical therapy, as well as fundamental pathogenesis studies of CBM.
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Affiliation(s)
- Hongfang Liu
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Guangdong Dermatology Hospital of Anhui Medical University, Guangzhou, China
| | - Jiufeng Sun
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Minying Li
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Wenying Cai
- Sun Yat-sen Memorial Hospital of Zhongshan University, Guangzhou, China
| | - Yangxia Chen
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Yinghui Liu
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Huan Huang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Zhenmou Xie
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Weiying Zeng
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Liyan Xi
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Sun Yat-sen Memorial Hospital of Zhongshan University, Guangzhou, China
- Department of Dermatology and Venerology, Guangzhou First People’s Hospital, Guangzhou, China
- *Correspondence: Liyan Xi,
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6
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Climate Change Impact on Chromoblastomycosis. Fungal Biol 2022. [DOI: 10.1007/978-3-030-89664-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7
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Guevara A, Siqueira NP, Nery AF, Cavalcante LRDS, Hagen F, Hahn RC. Chromoblastomycosis in Latin America and the Caribbean: epidemiology over the past 50 years. Med Mycol 2021; 60:6391503. [PMID: 34637525 DOI: 10.1093/mmy/myab062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/30/2021] [Accepted: 10/09/2021] [Indexed: 01/19/2023] Open
Abstract
Chromoblastomycosis is a chronic disease caused by melanized fungi that mainly affect individuals performing soil-related labour. The objective of this study was to analyse the epidemiological and clinical characteristics of chromoblastomycosis in Latin America and the Caribbean by an extensive literature review. An integrative review was performed of English, French, Portuguese, and Spanish publications in LILACS, SciELO, PubMed, SCOPUS and Web of Science databases covering the period 1969-2019. A total of 1,211 articles were identified, of which 132 were included in the review, covering 2,081 patients, 80.3% were male, the mean age was 56.1 years. The mean duration of the disease was 10.8 years. The lesions were mainly described in the lower limbs (60%). The most frequent clinical forms were verrucous (46.4%) and tumorous (21.7%). Major disease symptoms and signs consisted of itching and pain. Bacterial infection and functional limitation were important complications. Immunosuppression post-kidney transplantation was the most frequent comorbidity while leprosy was the main concomitant infectious disease. Fonsecaea pedrosoi and Cladophialophora carrionii were the predominant etiological agents. Majority of the cured cases were treated with itraconazole as monotherapy or in combination with other antifungals, surgery or cryosurgery. Chromoblastomycosis affects hundreds of rural workers in Latin America and the Caribbean, causing disability and personal, family and economic losses. It is important to prioritize epidemiological surveillance and early diagnosis of this disease in order to reveal its real prevalence and direct resources to preventive actions, diagnosis and early treatment. LAY SUMMARY Chromoblastomycosis is a slowly progressing chronic disease caused by melanized fungi. We collected data from South America and the Caribbean covering 1969-2019, the 132 articles included 2 081 patients, mean disease duration was 10.8 years. Fonsecaea pedrosoi and Cladophialophora carrionii predominated.
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Affiliation(s)
- Armando Guevara
- Mycology/Research Laboratory, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Nathan Pereira Siqueira
- Mycology/Research Laboratory, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Andreia Ferreira Nery
- Department of Internal Medicine, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.,Júlio Muller University Hospital, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | | | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, Utrecht, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Utrecht The Netherlands
| | - Rosane Christine Hahn
- Mycology/Research Laboratory, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.,Júlio Muller University Hospital, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
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Santos DWCL, de Azevedo CDMPES, Vicente VA, Queiroz-Telles F, Rodrigues AM, de Hoog GS, Denning DW, Colombo AL. The global burden of chromoblastomycosis. PLoS Negl Trop Dis 2021; 15:e0009611. [PMID: 34383752 PMCID: PMC8360387 DOI: 10.1371/journal.pntd.0009611] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Chromoblastomycosis (CBM), represents one of the primary implantation mycoses caused by melanized fungi widely found in nature. It is characterized as a Neglected Tropical Disease (NTD) and mainly affects populations living in poverty with significant morbidity, including stigma and discrimination. METHODS AND FINDINGS In order to estimate the global burden of CBM, we retrospectively reviewed the published literature from 1914 to 2020. Over the 106-year period, a total of 7,740 patients with CBM were identified on all continents except Antarctica. Most of the cases were reported from South America (2,619 cases), followed by Africa (1,875 cases), Central America and Mexico (1,628 cases), Asia (1,390 cases), Oceania (168 cases), Europe (35 cases), and USA and Canada (25 cases). We described 4,022 (81.7%) male and 896 (18.3%) female patients, with the median age of 52.5 years. The average time between the onset of the first lesion and CBM diagnosis was 9.2 years (range between 1 month to 50 years). The main sites involved were the lower limbs (56.7%), followed by the upper limbs (19.9%), head and neck (2.9%), and trunk (2.4%). Itching and pain were reported by 21.5% and 11%, respectively. Malignant transformation was described in 22 cases. A total of 3,817 fungal isolates were cultured, being 3,089 (80.9%) Fonsecaea spp., 552 (14.5%) Cladophialophora spp., and 56 Phialophora spp. (1.5%). CONCLUSIONS AND SIGNIFICANCE This review represents our current knowledge on the burden of CBM world-wide. The global incidence remains unclear and local epidemiological studies are required to improve these data, especially in Africa, Asia, and Latin America. The recognition of CBM as NTD emphasizes the need for public health efforts to promote support for all local governments interested in developing specific policies and actions for preventing, diagnosing and assisting patients.
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Affiliation(s)
- Daniel Wagner C. L. Santos
- Special Mycology Laboratory—LEMI, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil
- Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | - Vania Aparecida Vicente
- Microbiology, Parasitology, and Pathology Post Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Flávio Queiroz-Telles
- Department of Public Health, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - G. Sybren de Hoog
- Microbiology, Parasitology, and Pathology Post Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, Brazil
- Center of Expertise in Mycology, Radboud University Medical Center/CWZ, Nijmegen, The Netherlands
| | - David W. Denning
- Global Action Fund for Fungal Infections, Geneva, Switzerland
- Manchester Fungal Infection Group, Core Technology Facility, The University of Manchester, Manchester, United Kingdom
| | - Arnaldo Lopes Colombo
- Special Mycology Laboratory—LEMI, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil
- Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil
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Vitale RG, Giudicessi SL, Romero SM, Al-Hatmi AMS, Li Q, de Hoog GS. Recent developments in less known and multi-resistant fungal opportunists. Crit Rev Microbiol 2021; 47:762-780. [PMID: 34096817 DOI: 10.1080/1040841x.2021.1927978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Fungal infections have increased in recent years due to host factors, such as oncohaematological and transplant-related disorders, immunosuppressive therapy, and AIDS. Additionally, molecular and proteomic facilities have become available to identify previously unrecognizable opportunists. For these reasons, reports on less-known and recalcitrant mycoses, such as those caused by black fungi, hyaline filamentous fungi, coelomycetes, Mucorales, and non-Candida yeasts have emerged. In this review, novel taxonomy in these groups, which often are multi-resistant to one or several classes of antifungals, is discussed. Clinical presentations, diagnosis and current treatment of some major groups are summarised.
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Affiliation(s)
- Roxana G Vitale
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina.,Unidad de Parasitología, Sector Micología, Hospital J. M. Ramos Mejía, Buenos Aires, Argentina
| | - Silvana L Giudicessi
- Facultad de Farmacia y Bioquímica, Cátedra de Biotecnología, Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto de Nanobiotecnología (NANOBIOTEC), UBA-CONICET, Buenos Aires, Argentina
| | - Stella M Romero
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina.,Instituto Multidisciplinario de Biología Vegetal (IMBIV), CONICET, FCEFyN, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Abdullah M S Al-Hatmi
- Center of Expertise in Mycology of Radboud, University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Natural & Medical Science Research Center, University of Nizwa, Nizwa, Omán
| | - Qirui Li
- Department of Pharmacy, Guiyang Medical University, Guiyang, PR China
| | - G Sybren de Hoog
- Center of Expertise in Mycology of Radboud, University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Key Laboratory of Environmental Pollution Monitoring and Disease Control, School of Basic Medical Sciences, Guizhou Medical University, Guiyang, PR China.,Department of Medical Microbiology, People's Hospital of Suzhou, National New & Hi-Tech Industrial Development Zone, Suzhou, PR China
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10
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Campos-Macias P, Arenas R, Aquino CJ, Romero-Navarrete M, Martínez-Hernández F, Martínez-Chavarría LC, Xicohtencatl-Cortes J, Hernández-Castro R. Chromoblastomycosis caused by Fonsecaea monophora in Mexico. J Mycol Med 2021; 31:101114. [PMID: 33684836 DOI: 10.1016/j.mycmed.2021.101114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/01/2020] [Accepted: 01/15/2021] [Indexed: 12/19/2022]
Abstract
Chromoblastomycosis is a chronic subcutaneous fungal infection caused by melanized fungi. It is usually an occupational mycosis affecting people in rural areas in tropical and subtropical regions. We present two cases of chromoblastomycosis in Mexican farmers, characterized by skin verrucous plaques. Direct examination with KOH 10% showed the presence of muriform cells. The fungal isolation was carried out in Sabouraud dextrose agar and molecular identification was achieved by 18S-ITS1-5.8S-ITS2-28S rRNA gene amplification and sequencing. Fonsecaeamonophora was identified in both cases. A therapy with itraconazole and terbinafine was used with a partial favorable response. However, patients did not return for medical examination after 4 months. The current status of the patients is unknown. We reported the first two cases of chromoblastomycosis caused by F. monophora in Mexico.
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Affiliation(s)
- Pablo Campos-Macias
- Facultad de Medicina, Hospital Aranda de la Parra, Universidad de Guanajuato, 37000 León, Guanajuato. Mexico
| | - Roberto Arenas
- Servicio de Micología, Hospital General "Dr. Manuel Gea González", 14080 Tlalpan, Ciudad de México, Mexico
| | - Caren J Aquino
- Centro Dermatológico del Sureste "Dr. Fernando Latapí", 29000 Tuxtla Gutiérrez, Chiapas. Mexico
| | | | - Fernando Martínez-Hernández
- Departamento de Ecología de Agentes Patógenos. Hospital General "Dr. Manuel Gea González", 14080 Tlalpan, Ciudad de México, Mexico
| | - Luary C Martínez-Chavarría
- Departamento de Patología, Facultad de Medicina Veterinaria y Zootecnia. Universidad Nacional Autónoma de México, 04510 Coyoacán, Ciudad de México, Mexico
| | - Juan Xicohtencatl-Cortes
- Laboratorio de Bacteriología Intestinal, Hospital Infantil de México "Dr. Federico Gómez", 06720 Cuauhtémoc, Ciudad de México, Mexico
| | - Rigoberto Hernández-Castro
- Departamento de Ecología de Agentes Patógenos. Hospital General "Dr. Manuel Gea González", 14080 Tlalpan, Ciudad de México, Mexico.
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11
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Breda LCD, Menezes IG, Paulo LNM, de Almeida SR. Immune Sensing and Potential Immunotherapeutic Approaches to Control Chromoblastomycosis. J Fungi (Basel) 2020; 7:jof7010003. [PMID: 33375204 PMCID: PMC7822212 DOI: 10.3390/jof7010003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022] Open
Abstract
Chromoblastomycosis (CBM) is a neglected, chronic, and progressive subcutaneous mycosis caused by different species of fungi from the Herpotrichiellaceae family. CBM disease is usually associated with agricultural activities, and its infection is characterized by verrucous, erythematous papules, and atrophic lesions on the upper and lower limbs, leading to social stigma and impacts on patients' welfare. The economic aspect of disease treatment is another relevant issue. There is no specific treatment for CBM, and different anti-fungal drug associations are used to treat the patients. However, the long period of the disease and the high cost of the treatment lead to treatment interruption and, consequently, relapse of the disease. In previous years, great progress had been made in the comprehension of the CBM pathophysiology. In this review, we discuss the differences in the cell wall composition of conidia, hyphae, and muriform cells, with a particular focus on the activation of the host immune response. We also highlight the importance of studies about the host skin immunology in CBM. Finally, we explore different immunotherapeutic studies, highlighting the importance of these approaches for future treatment strategies for CBM.
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12
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Skin Fungal Infections in Children: Diagnostic Challenges. CURRENT FUNGAL INFECTION REPORTS 2020. [DOI: 10.1007/s12281-020-00407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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13
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Environmental Screening of Fonsecaea Agents of Chromoblastomycosis Using Rolling Circle Amplification. J Fungi (Basel) 2020; 6:jof6040290. [PMID: 33212756 PMCID: PMC7712894 DOI: 10.3390/jof6040290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 12/15/2022] Open
Abstract
Chromoblastomycosis is a chronic, cutaneous or subcutaneous mycosis characterized by the presence of muriform cells in host tissue. Implantation disease is caused by melanized fungi related to black yeasts, which, in humid tropical climates, are mainly members of the genus Fonsecaea. In endemic areas of Brazil, F. pedrosoi and F. monophora are the prevalent species. The current hypothesis of infection is traumatic introduction via plant materials, especially by plant thorns. However, isolation studies have demonstrated a low frequency of the agents in environmental substrates. The present study aimed to detect F. pedrosoi and F. monophora in shells of babassu coconuts, soil, plant debris, and thorns from endemic areas of chromoblastomycosis in Maranhão state, northern Brazil, using Rolling Circle Amplification (RCA) with padlock probes as a new environmental screening tool for agents of chromoblastomycosis. In addition to molecular screening, the environmental samples were analyzed by fungal isolation using mineral oil flotation. The limit of detection of the RCA method was 2.88 × 107 copies of DNA per sample for the used padlock probes, indicating that this represents an efficient and sensitive molecular tool for the environmental screening of Fonsecaea agents. In contrast, with isolation from the same samples using several selective methods, no agents of chromoblastomycosis were recovered.
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14
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Breda LCD, Breda CNDS, de Almeida JRF, Paulo LNM, Jannuzzi GP, Menezes IDG, Albuquerque RC, Câmara NOS, Ferreira KS, de Almeida SR. Fonsecaeapedrosoi Conidia and Hyphae Activate Neutrophils Distinctly: Requirement of TLR-2 and TLR-4 in Neutrophil Effector Functions. Front Immunol 2020; 11:540064. [PMID: 33193308 PMCID: PMC7609859 DOI: 10.3389/fimmu.2020.540064] [Citation(s) in RCA: 5] [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: 03/03/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022] Open
Abstract
Chromoblastomycosis is a chronic and progressive subcutaneous mycosis caused mainly by the fungus Fonsecaea pedrosoi. The infection is characterized by erythematous papules and histological sections demonstrating an external layer of fibrous tissue and an internal layer of thick granulomatous inflammatory tissue containing mainly macrophages and neutrophils. Several groups are studying the roles of the innate and adaptive immune systems in F. pedrosoi infection; however, few studies have focused on the role of neutrophils in this infection. In the current study, we verify the importance of murine neutrophils in the killing of F. pedrosoi conidia and hyphae. We demonstrate that phagocytosis and reactive oxygen species during infection with conidia are TLR-2- and TLR-4-dependent and are essential for conidial killing. Meanwhile, hyphal killing occurs by NET formation in a TLR-2-, TLR-4-, and ROS-independent manner. In vivo experiments show that TLR-2 and TLR-4 are also important in chromoblastomycosis infection. TLR-2KO and TLR-4KO animals had lower levels of CCL3 and CXCL1 chemokines and impaired neutrophil migration to the infected site. These animals also had higher fungal loads during infection with F. pedrosoi conidia, confirming that TLR-2 and TLR-4 are essential receptors for F. pedrosoi recognition and immune system activation. Therefore, this study demonstrates for the first time that neutrophil activation during F. pedrosoi is conidial or hyphal-specific with TLR-2 and TLR-4 being essential during conidial infection but unnecessary for hyphal killing by neutrophils.
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Affiliation(s)
- Leandro Carvalho Dantas Breda
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | | | - José Roberto Fogaça de Almeida
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Larissa Neves Monteiro Paulo
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Grasielle Pereira Jannuzzi
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Isabela de Godoy Menezes
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Renata Chaves Albuquerque
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Niels Olsen Saraiva Câmara
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Karen Spadari Ferreira
- Departamento de Ciências Farmacêuticas, Instituto de Ciências Naturais, Universidade Federal de São Paulo, Diadema, Brazil
| | - Sandro Rogério de Almeida
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
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15
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Sendrasoa FA, Razanakoto NH, Rakotoarisaona MF, Andrianarison M, Raharolahy O, Rasamoelina T, Ranaivo IM, Sata M, Ratovonjanahary V, Maubon D, Rakoto Andrianarivelo M, Cornet M, Ramarozatovo LS, Rapelanoro Rabenja F. Clinical aspects of previously treated chromoblastomycosis: A case series from Madagascar. Int J Infect Dis 2020; 101:228-232. [PMID: 33011283 DOI: 10.1016/j.ijid.2020.09.1479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To describe the clinical aspects of chromoblastomycosis (CBM) presented by patients who had received incomplete antifungal treatment before consultation. METHODS A prospective study of patients with clinically suspected CBM was performed between 2013 and 2018 in the Department of Dermatology at the University Hospital Antananarivo, and during consultation campaigns. RESULTS Patients develop CBM over a period of more than 10 years, and many will have already received antifungals prescribed by general practitioners before consulting with a dermatologist. Such treatment obviously modifies the clinical presentation. From the 63 CBM patients in this large study, we describe 12 patients who received oral antifungals (terbinafine, griseofulvine, itraconazole, fluconazole) before consultation. The most frequent clinical aspect presented by these patients was cicatricial lesions, which are characteristically smooth and non-elevated, and enlarge by peripheral extension, with atrophic scarring at the center. CONCLUSION Our study is the first to show that cicatricial lesions are a clinical aspect presented by CBM patients who received antifungals before presentation.
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Affiliation(s)
| | | | | | | | - Onivola Raharolahy
- Department of Dermatology, Faculty of Medicine Antananarivo, Antananarivo, Madagascar
| | | | - Irina Mamisoa Ranaivo
- Department of Dermatology, Faculty of Medicine Antananarivo, Antananarivo, Madagascar
| | - Moril Sata
- Department of Dermatology, Faculty of Medicine Antananarivo, Antananarivo, Madagascar
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16
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Rasamoelina T, Maubon D, Andrianarison M, Ranaivo I, Sendrasoa F, Rakotozandrindrainy N, Rakotomalala FA, Bailly S, Rakotonirina B, Andriantsimahavandy A, Rabenja FR, Andrianarivelo MR, Cornet M, Ramarozatovo LS. Endemic Chromoblastomycosis Caused Predominantly by Fonsecaea nubica, Madagascar 1. Emerg Infect Dis 2020; 26:1201-1211. [PMID: 32441639 PMCID: PMC7258462 DOI: 10.3201/eid2606.191498] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Chromoblastomycosis is an implantation fungal infection. Twenty years ago, Madagascar was recognized as the leading focus of this disease. We recruited patients in Madagascar who had chronic subcutaneous lesions suggestive of dermatomycosis during March 2013-June 2017. Chromoblastomycosis was diagnosed in 50 (33.8%) of 148 patients. The highest prevalence was in northeastern (1.47 cases/100,000 persons) and southern (0.8 cases/100,000 persons) Madagascar. Patients with chromoblastomycosis were older (47.9 years) than those without (37.5 years) (p = 0.0005). Chromoblastomycosis was 3 times more likely to consist of leg lesions (p = 0.003). Molecular analysis identified Fonsecaea nubica in 23 cases and Cladophialophora carrionii in 7 cases. Of 27 patients who underwent follow-up testing, none were completely cured. We highlight the persistence of a high level of chromoblastomycosis endemicity, which was even greater at some locations than 20 years ago. We used molecular tools to identify the Fonsecaea sp. strains isolated from patients as F. nubica.
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17
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Sendrasoa FA, Rakotoarisaona MF, Ranaivo IM, Razanakoto NH, Sata M, Raharolahy O, Andrianarison M, Ratovonjanahary V, Rasamoelina T, Rapelanoro Rabenja F, Ramarozatovo LS. [Management of chromoblastomycosis, a challenge for limited-resource countries such as Madagascar]. Ann Dermatol Venereol 2020; 147:377-382. [PMID: 32220474 DOI: 10.1016/j.annder.2020.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/18/2019] [Accepted: 01/16/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Chromoblastomycosis (CBM) is a chronic fungal infection of the skin and subcutaneous tissue caused by dematiaceous fungi. CBM lesions are recalcitrant and extremely difficult to eradicate. We report three cases of CBM with difficulties in therapeutic management. OBSERVATION Three men aged 36, 50 and 67 years, all farmers, presented for between three and ten years with hyperkeratotic, scaly plaques with black dots on the right thigh and left leg, respectively. For all patients, mycological examination showed fumagoid cells, all of which were pathognomonic for CBM. PCR identified Fonsecaeanubica in one patient and Cladophialophoracarrionii in two patients. All patients received itraconazole 200mg/day for over 18 months. Two patients required combined therapy with terbinafine for seven months, which improved lesions; however, relapse occurred in one patient during the 5th month of this combined therapy and five months after the end of this treatment in the other. The patient on monotherapy (itraconazole) also presented recurrence of lesions five months after the end of treatment. DISCUSSION Itraconazole is the standard therapy for CBM, with cure rates ranging from 15 to 80%. Success with itraconazole after eight to twelve months was reported by several authors. Fonsecaea and Cladophialophora are the most common species found in Madagascar, and while these organisms are susceptible to triazoles in vitro, clinical response is not so clear-cut. CONCLUSION Although unavailable in Madagascar, posaconazole and isavoconazole appear to be effective in treating chromoblastomycosis.
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Affiliation(s)
- F-A Sendrasoa
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar.
| | - M-F Rakotoarisaona
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - I-M Ranaivo
- USFR dermatologie, hôpital universitaire Morafeno Toamasina, Toamasina, Madagascar
| | - N-H Razanakoto
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - M Sata
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - O Raharolahy
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - M Andrianarison
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - V Ratovonjanahary
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - T Rasamoelina
- Centre d'infectiologie Charles Mérieux, Antananarivo, Madagascar
| | - F Rapelanoro Rabenja
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - L-S Ramarozatovo
- USFR dermatologie, hôpital universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
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Panigrahi A, Padhi S, Mohanty I. Chromoblastomycosis: A rare fungal infection from a nonendemic region—Southern Odisha. JOURNAL OF DR. NTR UNIVERSITY OF HEALTH SCIENCES 2020. [DOI: 10.4103/jdrntruhs.jdrntruhs_79_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Yang CS, Chen CB, Lee YY, Yang CH, Chang YC, Chung WH, Lee HE, Hui RCY, Chuang YH, Hong HS, Sun PL. Chromoblastomycosis in Taiwan: A report of 30 cases and a review of the literature. Med Mycol 2019; 56:395-405. [PMID: 29087525 DOI: 10.1093/mmy/myx075] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/21/2017] [Indexed: 01/19/2023] Open
Abstract
Chromoblastomycosis (CBM) is an implantation mycosis characterized by the presence of pigmented muriform cells in tissue. CBM is endemic in Taiwan, but only three formal cases have been reported to date because of underreporting. To describe and update its epidemiologic features, we report a series of 30 cases between 2003 and 2016 at a single medical center. Patients were predominately male (2.75:1). The mean age of onset was 65.9 years, and disease duration ranged from 2 months to 20 years. Diabetes was the most common comorbidity, and extremities were the most frequent sites of involvement. The lesions presented as papuloplaque, verrucous, cicatricial, targetoid, or mixed types. The dermoscopic features were variable, including red dots, white vague areas, black globules, and sand-like patterns. Among 10 Fonsecaea isolates further identified by sequencing the ITS regions of ribosomal DNA, nine were F. monophora and one was F. nubica. All but one patient received either systemic antifungal agents, surgical excision, or both. Surgical excision achieved a higher complete remission rate than the other forms of treatment did.
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Affiliation(s)
- Ching-Sheng Yang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Collegeof Medicine,Chang Gung University, Taoyuan, Taiwan.,Departmentof Dermatology, Chang Gung Memorial Hospital, Keelung Branch, Taiwan
| | - Yung-Yi Lee
- Departmentof Dermatology, Chang Gung Memorial Hospital, Taipei Branch, Taiwan
| | - Chih-Hsun Yang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Ya-Ching Chang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Wen-Hung Chung
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Hua-En Lee
- Departmentof Dermatology, Chang Gung Memorial Hospital, Taipei Branch, Taiwan
| | | | - Ya-Hui Chuang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Hong-Shang Hong
- Departmentof Dermatology, Chang Gung Memorial Hospital, Keelung Branch, Taiwan
| | - Pei-Lun Sun
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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You Z, Yang X, Yu J, Zhang J, Ran Y. Chromoblastomycosis Caused by Fonsecaea nubica: First Report in Northern China and Literature Review. Mycopathologia 2018; 184:97-105. [PMID: 30547378 DOI: 10.1007/s11046-018-0307-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 11/19/2018] [Indexed: 02/05/2023]
Abstract
Chromoblastomycosis is found worldwide with higher incidence in tropical and subtropical regions. Fonsecaea spp. is one of the major causative agents of this disease. First case of chromoblastomycosis due to Fonsecaea nubica in Northern China is reported in a 75-year-old Chinese male. We firstly summarized molecular identification methods of Fonsecaea spp. and all the strains of F. nubica reported in the literature. Sequencing of internal transcribed spacer alone and/or combined with actin (ACT1), partial cell division cycle (CDC42) and partial beta-tubulin (BT2) were most commonly used to identify species, while lactase (Lac), homogentisate (HmgA) and polyketide synthase (PKS1) were also used in some cases. Most strains were isolated from South America and Eastern China. Five clinical cases of chromoblastomycosis due to F. nubica from Asia and Europe were also reviewed. All the five patients were male, over 30 years old, and their lesions occurred after trauma.
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Affiliation(s)
- Zimeng You
- Department of Dermatovenereology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Xiaoxiao Yang
- Department of Dermatology, First Affiliated Hospital, Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Jianbin Yu
- Department of Dermatology, First Affiliated Hospital, Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Jiangan Zhang
- Department of Dermatology, First Affiliated Hospital, Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, 450052, Henan Province, China.
| | - Yuping Ran
- Department of Dermatovenereology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Wuhou District, Chengdu, 610041, Sichuan Province, China.
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Fransisca C, He Y, Chen Z, Liu H, Xi L. Molecular identification of chromoblastomycosis clinical isolates in Guangdong. Med Mycol 2018; 55:851-858. [PMID: 28053146 DOI: 10.1093/mmy/myw140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/02/2016] [Indexed: 11/13/2022] Open
Abstract
Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue. The most common etiologic agent encountered in Southern China is from the genus Fonsecaea. Fonsecaea species are often misidentified due to indistinct morphology features; furthermore, recent taxonomy revision was done on the fungi genus. Herein, a comprehensive evaluation with molecular sequencing data based on internal transcribed spacer (ITS) ribosomal DNA regions as molecular targets were implemented to 37 clinical isolates from chromoblastomycosis patients. Twenty strains that were formerly identified as Fonsecaea pedrosoi through morphological characteristic were verified to be either Fonsecaea nubica or Fonsecaea monophora, while 17 strains were appropriately identified as F. monophora. A phylogenetic method was further performed to establish the species delimitation. Our investigations validate that the clinical isolates from Guangdong consist of F. monophora and the recently found new species, F. nubica. In this study, F. pedrosoi has not been isolated from chromoblastomycosis patients in Guangdong, Southern China. Reevaluation of previous reports regarding F. pedrosoi as chromoblastomycosis etiologic agent in China is necessary for a comprehensive assessment of geographic distribution pattern of Fonsecaea species. This study is the first reported study presenting large samples of F. nubica domestic or abroad.
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Affiliation(s)
- Cindy Fransisca
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ya He
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiwen Chen
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongfang Liu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liyan Xi
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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22
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Le TA, Nguyen KL, Pham MH, Vi TT, Do NA. Case Report: A Case of Chromoblastomycosis Caused by Fonsecaea pedrosoi in Vietnam. Mycopathologia 2018; 184:115-119. [PMID: 29974323 DOI: 10.1007/s11046-018-0284-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 06/27/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissues caused by different melanized fungi. The disease occurs worldwide, particularly in tropical and subtropical regions but not reported in Vietnam. A 47-year-old women was admitted to hospital 103, Hanoi, Vietnam, with a 10-year lasting lesion on backside of her right shank. Diagnosis of chromoblastomycosis was made after discovery of a muriform cell in histopathological examination. A black, slow-growth fungus was isolated and identified as Fonsecaea pedrosoi after molecular analysis. After 1-month treatment with itraconazole, the lesion has significant improvement. CONCLUSION This is the first case of chromoblastomycosis caused by Fonsecaea pedrosoi reported in Vietnam.
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Affiliation(s)
- Tran-Anh Le
- Department of Parasitology, Vietnam Military Medical University (VMMU), Phung Hung Street, Ha Dong Town, Hanoi, Vietnam.
| | - Khac-Luc Nguyen
- Department of Parasitology, Vietnam Military Medical University (VMMU), Phung Hung Street, Ha Dong Town, Hanoi, Vietnam
| | - My-Hang Pham
- Department of Dermatological Disease, Hospital 103, Vietnam Military Medical University (VMMU), Hanoi, Vietnam
| | - Thuat-Thang Vi
- Department of Pathology, Hospital 103, Vietnam Military Medical University (VMMU), Hanoi, Vietnam
| | - Ngoc-Anh Do
- Department of Parasitology, Vietnam Military Medical University (VMMU), Phung Hung Street, Ha Dong Town, Hanoi, Vietnam
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23
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Thomas E, Bertolotti A, Barreau A, Klisnick J, Tournebize P, Borgherini G, Zemali N, Jaubert J, Jouvion G, Bretagne S, Picot S. From phaeohyphomycosis to disseminated chromoblastomycosis: A retrospective study of infections caused by dematiaceous fungi. Med Mal Infect 2018; 48:278-285. [PMID: 29656841 DOI: 10.1016/j.medmal.2017.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/30/2016] [Accepted: 09/12/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Infections caused by dematiaceous fungi are more common in tropical and subtropical areas. We aimed to describe the clinical, microbiological and therapeutic aspects of case patients diagnosed at a University Hospital located on an Indian Ocean island. PATIENTS AND METHODS We performed an observational retrospective study of infections caused by dematiaceous fungi diagnosed at the University Hospital of Saint-Pierre, Reunion, from 2000 to 2015. Mycological identifications were performed at the National Reference Center for Invasive Mycosis and Antifungal Agents (Paris). RESULTS The review of clinical and microbiological data of 11 patients identified revealed that five were infected by dematiaceous fungi. Two had cutaneous phaeohyphomycosis, two had cerebral phaeohyphomycosis and one had cutaneous chromoblastomycosis with brain and potentially medullary dissemination. Skin lesions and cerebral abscesses were quite varied. CONCLUSION Infections caused by dematiaceous fungi are rare. Medullary and brain localizations are extremely rare, especially for chromoblastomycosis. Cutaneous manifestations of phaeohyphomycosis are varied; diagnosis is thus more difficult. It is therefore important, when confronted with a chronic tumor-like lesion in endemic areas, to perform a biopsy for pathology and fungal culture. While surgical excision is not always sufficient, medical treatment of these infections is not standardized, but relies on an azole, which can be associated with another antifungal agent.
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Affiliation(s)
- E Thomas
- Service de bactériologie, virologie, parasitologie, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - A Bertolotti
- Service de maladies infectieuses, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - A Barreau
- Service de bactériologie, virologie, parasitologie, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - J Klisnick
- Service de maladies infectieuses, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - P Tournebize
- Service de neurologie, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - G Borgherini
- Service de maladies infectieuses, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - N Zemali
- Service de bactériologie, virologie, parasitologie, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - J Jaubert
- Service de bactériologie, virologie, parasitologie, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion
| | - G Jouvion
- Institut Pasteur, histopathologie humaine et modèles animaux, 28, rue du Docteur-Roux, 75015 Paris, France
| | - S Bretagne
- Institut Pasteur, centre national de référence des mycoses invasives et des antifongiques, 28, rue du Docteur-Roux, 75015 Paris, France
| | - S Picot
- Service de bactériologie, virologie, parasitologie, centre hospitalier universitaire de La Réunion, site Sud, BP 350, 97448 Saint-Pierre cedex, Reunion.
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Label M, Karayan LC, De Hoog S, Afeltra J, Bustamante T, Vitale RG. Differential distribution patterns of Fonsecaea agents of chromoblastomycosis, exemplified by the first case due to F. monophora from Argentina. Med Mycol Case Rep 2017; 20:35-38. [PMID: 29552459 PMCID: PMC5852295 DOI: 10.1016/j.mmcr.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/04/2017] [Accepted: 11/24/2017] [Indexed: 11/17/2022] Open
Abstract
Chromoblastomycosis is a mutilating infection of the skin and subcutaneous tissues caused by melanized fungi belonging to the order Chaetothyriales. Proven cases of the main agent, Fonsecaea pedrosoi are mainly limited to (sub)tropical, humid climates of Latin and Central America and the Caribbean. Fonsecaea monophora has a global distribution along the equator. Cases outside the (sub)tropics have thus far mostly been considered to have been imported, but here we report the first endemic case by F. monophora from Argentina. Patient was a 82-year-old rural female worker from Corrientes, a province with a dry continental climate.
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Affiliation(s)
- Marcelo Label
- Dermatology Division, Ramos Mejia Hospital, Buenos Aires C1221ADC, Argentina
| | - Luciana C Karayan
- Ramos Mejia Hospital, Parasitology Unit, Mycology Branch, Buenos Aires C1221ADC, Argentina
| | - Sybren De Hoog
- Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Javier Afeltra
- Ramos Mejia Hospital, Parasitology Unit, Mycology Branch, Buenos Aires C1221ADC, Argentina
| | - Togo Bustamante
- Dermatology Division, Ramos Mejia Hospital, Buenos Aires C1221ADC, Argentina
| | - Roxana G Vitale
- Ramos Mejia Hospital, Parasitology Unit, Mycology Branch, Buenos Aires C1221ADC, Argentina.,Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands.,The National Council of Scientific and Technological Research (CONICET), Buenos Aires, Argentina
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25
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Kang RB, Simonson DC, Stoner SE, Hughes SR, Agger WA. The Clinical Presentation of Subcutaneous Phaeohyphomycosis: A Case Series from Yetebon, Ethiopia. Clin Med Res 2017; 15:88-92. [PMID: 29018005 PMCID: PMC5849443 DOI: 10.3121/cmr.2017.1377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/06/2017] [Accepted: 10/03/2017] [Indexed: 11/18/2022]
Abstract
Subcutaneous phaeohyphomycosis is a chronic fungal infection usually found on the lower extremity and feet of agricultural workers in the tropics. It can present with various skin manifestations, verrucous to nodular plaques, and is caused by multiple species of fungi. Laboratory confirmation requires skin samples for pathology and fungal cultures. Cure, often difficult in resource-poor countries, requires months of antifungal therapy. We describe the cases of three men from Ethiopia who were seen and are being treated by American doctors who traveled there on a medical mission.
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Affiliation(s)
- Rachel B Kang
- Department of Medical Education, Gundersen Medical Foundation, La Crosse, Wisconsin, USA
| | - Devin C Simonson
- Department of Podiatry, Gundersen Health System; La Crosse, Wisconsin, USA
| | - Sarah E Stoner
- Department of Microbiology, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Sarah R Hughes
- Department of Pathology, Gundersen Health System, La Crosse, Wisconsin, USA
| | - William A Agger
- Department of Medical Education, Gundersen Medical Foundation, La Crosse, Wisconsin, USA
- Infectious Disease Section, Gundersen Health System, La Crosse, Wisconsin, USA
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Abstract
Chromoblastomycosis (CBM), also known as chromomycosis, is one of the most prevalent implantation fungal infections, being the most common of the gamut of mycoses caused by melanized or brown-pigmented fungi. CBM is mainly a tropical or subtropical disease that may affect individuals with certain risk factors around the world. The following characteristics are associated with this disease: (i) traumatic inoculation by implantation from an environmental source, leading to an initial cutaneous lesion at the inoculation site; (ii) chronic and progressive cutaneous and subcutaneous tissular involvement associated with fibrotic and granulomatous reactions associated with microabscesses and often with tissue proliferation; (iii) a nonprotective T helper type 2 (Th2) immune response with ineffective humoral involvement; and (iv) the presence of muriform (sclerotic) cells embedded in the affected tissue. CBM lesions are clinically polymorphic and are commonly misdiagnosed as various other infectious and noninfectious diseases. In its more severe clinical forms, CBM may cause an incapacity for labor due to fibrotic sequelae and also due to a series of clinical complications, and if not recognized at an early stage, this disease can be refractory to antifungal therapy.
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27
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Rasamoelina T, Raharolahy O, Rakotozandrindrainy N, Ranaivo I, Andrianarison M, Rakotonirina B, Maubon D, Rakotomalala F, Rakoto Andrianarivelo M, Andriantsimahavandy A, Rapelanoro Rabenja F, Ramarozatovo L, Cornet M. Chromoblastomycosis and sporotrichosis, two endemic but neglected fungal infections in Madagascar. J Mycol Med 2017; 27:312-324. [DOI: 10.1016/j.mycmed.2017.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 01/19/2023]
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28
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Queiroz-Telles F, Fahal AH, Falci DR, Caceres DH, Chiller T, Pasqualotto AC. Neglected endemic mycoses. THE LANCET. INFECTIOUS DISEASES 2017; 17:e367-e377. [PMID: 28774696 DOI: 10.1016/s1473-3099(17)30306-7] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/19/2016] [Accepted: 03/23/2017] [Indexed: 01/18/2023]
Abstract
Fungi often infect mammalian hosts via the respiratory route, but traumatic transcutaneous implantation is also an important source of infections. Environmental exposure to spores of pathogenic fungi can result in subclinical and unrecognised syndromes, allergic manifestations, and even overt disease. After traumatic cutaneous inoculation, several fungi can cause neglected mycoses such as sporotrichosis, chromoblastomycosis, mycetoma, entomophthoramycosis, and lacaziosis. Most of these diseases have a subacute to chronic course and they can become recalcitrant to therapy and lead to physical disabilities, including inability to work, physical deformities, and amputations. For many years, paracoccidioidomycosis was considered the most prevalent endemic systemic mycosis in the Americas, but this situation might be changing with recognition of the worldwide presence of Histoplasma capsulatum. Both paracoccidioidomycosis and histoplasmosis can mimic several infectious and non-infectious medical conditions and lead to death if not recognised early and treated. Cutaneous implantation and systemic mycoses are neglected diseases that affect millions of individuals worldwide, especially in low-income countries where their management is suboptimum because challenges in diagnosis and therapeutic options are substantial issues.
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Affiliation(s)
| | | | - Diego R Falci
- Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Centro Universitário La Salle, Canoas, Brazil
| | - Diego H Caceres
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alessandro C Pasqualotto
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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29
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Cole DC, Govender NP, Chakrabarti A, Sacarlal J, Denning DW. Improvement of fungal disease identification and management: combined health systems and public health approaches. THE LANCET. INFECTIOUS DISEASES 2017; 17:e412-e419. [PMID: 28774694 DOI: 10.1016/s1473-3099(17)30308-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 11/29/2016] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
More than 1·6 million people are estimated to die of fungal diseases each year, and about a billion people have cutaneous fungal infections. Fungal disease diagnosis requires a high level of clinical suspicion and specialised laboratory testing, in addition to culture, histopathology, and imaging expertise. Physicians with varied specialist training might see patients with fungal disease, yet it might remain unrecognised. Antifungal treatment is more complex than treatment for bacterial or most viral infections, and drug interactions are particularly problematic. Health systems linking diagnostic facilities with therapeutic expertise are typically fragmented, with major elements missing in thousands of secondary care and hospital settings globally. In this paper, the last in a Series of eight papers, we describe these limitations and share responses involving a combined health systems and public health framework illustrated through country examples from Mozambique, Kenya, India, and South Africa. We suggest a mainstreaming approach including greater integration of fungal diseases into existing HIV infection, tuberculosis infection, diabetes, chronic respiratory disease, and blindness health programmes; provision of enhanced laboratory capacity to detect fungal diseases with associated surveillance systems; procurement and distribution of low-cost, high-quality antifungal medicines; and concomitant integration of fungal disease into training of the health workforce.
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Affiliation(s)
- Donald C Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Nelesh P Govender
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), Johannesburg, South Africa; Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jahit Sacarlal
- Department of Microbiology, Eduardo Mondlane University, Maputo, Mozambique
| | - David W Denning
- Global Action Fund for Fungal Infections, Geneva, Switzerland; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; The National Aspergillosis Centre, University Hospital of South Manchester, Manchester, UK
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30
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Ramírez Soto MC, Malaga G. Subcutaneous mycoses in Peru: a systematic review and meta-analysis for the burden of disease. Int J Dermatol 2017; 56:1037-1045. [PMID: 28670680 DOI: 10.1111/ijd.13665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 03/10/2017] [Accepted: 05/03/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a worrying lack of epidemiological data on the geographical distribution and burden of subcutaneous mycoses in Peru, hindering the implementation of surveillance and control programs. OBJECTIVES This study aimed to estimate the disease burden of subcutaneous mycoses in Peru and identify which fungal species were commonly associated with these mycoses. METHODS We performed a meta-analysis after a systematic review of the published literature in PubMed, LILACS, and SciELO to estimate the burden of subcutaneous mycoses in 25 regions in Peru. The disease burden was determined in terms of prevalence (number of cases per 100,000 inhabitants) and the number of reported cases per year per region. RESULTS A total of 26 studies were eligible for inclusion. Results showed that sporotrichosis was the most common subcutaneous mycosis (99.7%), whereas lobomycosis, chromoblastomycosis, and subcutaneous phaeohyphomycosis were rare. Cases of eumycetoma and subcutaneous zygomycosis were not found. Of the 25 regions, the burden of sporotrichosis was estimated for four regions classified as endemic; in nine regions, only isolated cases were reported. The highest burden of sporotrichosis was in Apurimac (15 cases/100,000 inhabitants; 57 cases/year), followed by Cajamarca (3/100,000 inhabitants; 30/year), Cusco (0.5/100,000 inhabitants; 4/year), and La Libertad (0.2/100,000 inhabitants; 2/year). In two regions, the mycoses predominantly affected children. CONCLUSIONS Sporotrichosis is the most common subcutaneous mycosis in Peru, with a high disease burden in Apurimac. Chromoblastomycosis, lobomycosis, and subcutaneous phaeohyphomycosis are rare mycoses in Peru.
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Affiliation(s)
| | - German Malaga
- Medicine School, Universidad Peruana Cayetano Heredia, Lima, Peru
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31
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First case of chromoblastomycosis due to Phoma insulana. Enferm Infecc Microbiol Clin 2016; 36:95-99. [PMID: 27726899 DOI: 10.1016/j.eimc.2016.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/25/2016] [Accepted: 08/30/2016] [Indexed: 11/22/2022]
Abstract
Chromoblastomycosis is a chronic infection, caused by pigmented fungi affecting skin and subcutaneous tissues characterized by verrucous nodules or plaques. Fonsecaea pedrosoi and Cladophialophora carrionii are the prevalent agents in the endemic areas. Phoma is an uncommon agent of human infection and involved mainly with phaeohyphomycosis cases. The case of a patient with a history of laceration in foot followed by verrucous aspect and scaly lesions, which had evolved for 27 years is presented. On physical examination disease was clinically compatible with chromoblastomycosis and the microscopic examination of scales showed fumagoid cells. On culture a dematiaceous fungus was grown. The agent was confirmed to be Phoma insulana based on its morphology and PCR-sequencing. This fungal agent has not been previously reported in association with this pathology.
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32
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Abstract
Chromoblastomycosis (CMB) is a chronic fungal infection of the skin and the
subcutaneous tissue caused by a transcutaneous traumatic inoculation of a specific
group of dematiaceous fungi occurring mainly in tropical and subtropical zones
worldwide. If not diagnosed at early stages, patients with CBM require long term
therapy with systemic antifungals, sometimes associated with physical methods. Unlike
other neglected endemic mycoses, comparative clinical trials have not been performed
for this disease. Nowadays, therapy is based on a few open trials and on expert
opinion. Itraconazole either as monotherapy or associated with other drugs, or with
physical methods, is widely used. Recently, photodynamic therapy has been
successfully employed in combination with antifungals in patients presenting with
CBM. In the present revision the most used therapeutic options against CBM are
reviewed as well as the several factors that may have impact on the patient's
outcome.
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Affiliation(s)
- Flavio Queiroz-Telles
- Departamento de Saúde Pública, Universidade Federal do Paraná, Curitiba, PR, Brasil,
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33
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Li XQ, Guo BL, Cai WY, Zhang JM, Huang HQ, Zhan P, Xi LY, Vicente VA, Stielow B, Sun JF, de Hoog GS. The role of melanin pathways in extremotolerance and virulence of Fonsecaea revealed by de novo assembly transcriptomics using illumina paired-end sequencing. Stud Mycol 2016; 83:1-18. [PMID: 27504027 PMCID: PMC4969264 DOI: 10.1016/j.simyco.2016.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Melanisation has been considered to be an important virulence factor of Fonsecaea monophora. However, the biosynthetic mechanisms of melanisation remain unknown. We therefore used next generation sequencing technology to investigate the transcriptome and digital gene expression data, which are valuable resources to better understand the molecular and biological mechanisms regulating melanisation in F. monophora. We performed de novo transcriptome assembly and digital gene expression (DGE) profiling analyses of parent (CBS 122845) and albino (CBS 125194) strains using the Illumina RNA-seq system. A total of 17 352 annotated unigenes were found by BLAST search of NR, Swiss-Prot, Gene Ontology, Clusters of Orthologous Groups and Kyoto Encyclopedia of Genes and Genomes (KEGG) (E-value <1e‒5). A total of 2 283 unigenes were judged to be the differentially expressed between the two genotypes. We identified most of the genes coding for key enzymes involved in melanin biosynthesis pathways, including polyketide synthase (pks), multicopper oxidase (mco), laccase, tyrosinase and homogentisate 1,2-dioxygenase (hmgA). DEG analysis showed extensive down-regulation of key genes in the DHN pathway, while up-regulation was noted in the DOPA pathway of the albino mutant. The transcript levels of partial genes were confirmed by real time RT-PCR, while the crucial role of key enzymes was confirmed by either inhibitor or substrate tests in vitro. Meanwhile, numbers of genes involved in light sensing, cell wall synthesis, morphology and environmental stress were identified in the transcriptome of F. monophora. In addition, 3 353 SSRs (Simple Sequence Repeats) markers were identified from 21 600 consensus sequences. Blocking of the DNH pathway is the most likely reason of melanin deficiency in the albino strain, while the production of pheomelanin and pyomelanin were probably regulated by unknown transcription factors on upstream of both pathways. Most of genes involved in environmental tolerance to oxidants, irradiation and extreme temperatures were also assembled and annotated in transcriptomes of F. monophora. In addition, thousands of identified cSSR (combined SSR) markers will favour further genetic linkage studies. In conclusion, these data will contribute to understanding the regulation of melanin biosynthesis and help to improve the studies of pathogenicity of F. monophora.
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Affiliation(s)
- X Q Li
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - B L Guo
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - W Y Cai
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - J M Zhang
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - H Q Huang
- Department of Dermatology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - P Zhan
- Dermatology Hospital of Jiangxi Province, Nanchang, China; CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands; Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
| | - L Y Xi
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - V A Vicente
- Basic Pathology Department, Federal University of Paraná State, Curitiba, Paraná, Brazil
| | - B Stielow
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - J F Sun
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - G S de Hoog
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands; Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands; Basic Pathology Department, Federal University of Paraná State, Curitiba, Paraná, Brazil; Biological Sciences Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Dermatology, First Hospital of Peking University, Beijing, China
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Deng S, Tsui CKM, Gerrits van den Ende AHG, Yang L, Najafzadeh MJ, Badali H, Li R, Hagen F, Meis JF, Sun J, Dolatabadi S, Papierok B, Pan W, de Hoog GS, Liao W. Global Spread of Human Chromoblastomycosis Is Driven by Recombinant Cladophialophora carrionii and Predominantly Clonal Fonsecaea Species. PLoS Negl Trop Dis 2015; 9:e0004004. [PMID: 26496430 PMCID: PMC4619687 DOI: 10.1371/journal.pntd.0004004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/22/2015] [Indexed: 12/20/2022] Open
Abstract
Global distribution patterns of Cladophialophora carrionii, agent of human chromoblastomycosis in arid climates of Africa, Asia, Australia, Central-and South-America, were compared with similar data of the vicarious Fonsecaea spp., agents of the disease in tropical rain forests. Population diversities among 73 C. carrionii strains and 60 strains of three Fonsecaea species were analyzed for rDNA ITS, partial β-tubulin, and amplified fragment-length polymorphism (AFLP) fingerprints. Populations differed significantly between continents. Lowest haplotype diversity was found in South American populations, while African strains were the most diverse. Gene flow was noted between the African population and all other continents. The general pattern of Fonsecaea agents of chromoblastomycosis differed significantly from that of C. carrionii and revealed deeper divergence among three differentiated species with smaller numbers of haplotypes, indicating a longer evolutionary history.
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Affiliation(s)
- Shuwen Deng
- Shanghai Institute of Medical Mycology, Changzheng Hospital, Shanghai, China
- First Hospital of Xinjiang Medical University, Xinjiang, China
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Clement K. M. Tsui
- British Columbia Public Health Microbiology & Reference Laboratory at BCCDC site, Provincial Health Services Authority, Vancouver, Canada
| | | | - Liyue Yang
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Mohammad Javad Najafzadeh
- Department of Parasitology and Mycology & Cancer Molecular Pathology Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Badali
- Department of Medical Mycology and Parasitology / Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ruoyu Li
- Research Center for Medical Mycology, Beijing Medical University, Beijing, China
| | - Ferry Hagen
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jacques F. Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jiufeng Sun
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Somayeh Dolatabadi
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Weihua Pan
- Shanghai Institute of Medical Mycology, Changzheng Hospital, Shanghai, China
| | - G. S. de Hoog
- Shanghai Institute of Medical Mycology, Changzheng Hospital, Shanghai, China
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Research Center for Medical Mycology, Beijing Medical University, Beijing, China
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
- King Abdulaziz University, Jeddah, Saudi Arabia
- * E-mail: (GSdH); (WL)
| | - Wanqing Liao
- Shanghai Institute of Medical Mycology, Changzheng Hospital, Shanghai, China
- * E-mail: (GSdH); (WL)
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35
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Carolina Rojas O, León-Cachón RBR, Pérez-Maya AA, Aguirre-Garza M, Moreno-Treviño MG, González GM. Phenotypic and molecular identification ofFonsecaea pedrosoistrains isolated from chromoblastomycosis patients in Mexico and Venezuela. Mycoses 2015; 58:267-72. [DOI: 10.1111/myc.12308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 01/20/2015] [Accepted: 02/05/2015] [Indexed: 11/29/2022]
Affiliation(s)
- O. Carolina Rojas
- División Ciencias de la Salud; Departamento de Ciencias Básicas; Universidad de Monterrey; San Pedro Garza García Nuevo León México
- Departamento de Microbiología; Facultad de Medicina; Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Rafael B. R. León-Cachón
- División Ciencias de la Salud; Departamento de Ciencias Básicas; Universidad de Monterrey; San Pedro Garza García Nuevo León México
| | - Antonio Alí Pérez-Maya
- Departamento de Bioquímica y Medicina Molecular; Facultad de Medicina; Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Marcelino Aguirre-Garza
- División Ciencias de la Salud; Departamento de Ciencias Básicas; Universidad de Monterrey; San Pedro Garza García Nuevo León México
| | - María G. Moreno-Treviño
- División Ciencias de la Salud; Departamento de Ciencias Básicas; Universidad de Monterrey; San Pedro Garza García Nuevo León México
| | - Gloria M. González
- Departamento de Microbiología; Facultad de Medicina; Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
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36
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Abstract
Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue. The infection usually results from a traumatic injury and inoculation of microorganism from a specific group of dematiaceous fungi (usually Fonsecaea pedrosoi, Phialophora verrucosa, Cladophialophora carrionii). In the tissues fungi produce characteristic sclerotic cells or muriform cells. Dermal lesions can range from small nodules to large papillary-like eruptions. The disease has been described worldwide but the prevalence is higher in rural populations in countries with a tropical or subtropical climate, such as Madagascar in Africa and Brazil in South America. Diagnostic techniques are based on direct examination, culture and histopathology. Despite a variety of treatment modalities, which include long courses of antifungals, surgical excision and destructive physical therapies, the disease remains one of the most difficult deep mycotic infections to eradicate.
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Brandt ME, Warnock DW. Epidemiology, Clinical Manifestations, and Therapy of Infections Caused by Dematiaceous Fungi. J Chemother 2013; 15 Suppl 2:36-47. [PMID: 14708965 DOI: 10.1179/joc.2003.15.supplement-2.36] [Citation(s) in RCA: 189] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The dematiaceous (brown-pigmented) fungi are a large and heterogenous group of moulds that cause a wide range of diseases including phaeohyphomycosis, chromoblastomycosis, and eumycotic mycetoma. Among the more important human pathogens are Alternaria species, Bipolaris species, Cladophialophora bantiana, Curvularia species, Exophiala species, Fonsecaea pedrosoi, Madurella species, Phialophora species, Scedosporium prolificans, Scytalidium dimidiatum, and Wangiella dermatitidis. These organisms are widespread in the environment, being found in soil, wood, and decomposing plant debris. Cutaneous, subcutaneous, and corneal infections with dematiaceous fungi occur worldwide, but are more common in tropical and subtropical climates. Infection results from traumatic implantation. Most cases occur in immunocompetent individuals. Dematiaceous moulds are also important causes of invasive sinusitis and allergic fungal sinusitis. Infection is thought to follow inhalation. Although cerebral infection is the commonest form of systemic phaeohyphomycosis, other localized deep forms of the disease, such as arthritis, and endocarditis, have been reported. Disseminated infection is uncommon, but its incidence is increasing, particularly among immunocompromised individuals. Scedosporium prolificans is the most frequent cause. A number of dematiaceous fungi are neurotropic, including Cladophialophora bantiana, Ramichloridium mackenziei, and Wangiella dermatitidis. Although cases have occurred in immunocompromised persons, cerebral phaeohyphomycosis is most common in immunocompetent individuals with no obvious risk factors. Most forms of disease caused by dematiaceous fungi require both surgical and medical treatment. Itraconazole is currently the most effective antifungal agent for chromoblastomycosis and subcutaneous phaeohyphomycosis, while ketoconazole remains useful for mycetoma. Extensive surgical debridement combined with amphotericin B treatment is recommended for chronic invasive sinusitis. Long-term treatment with itraconazole has led to improvement or remission in some patients that had failed to respond to amphotericin B. Allergic fungal sinusitis requires surgical removal of impacted mucin combined with postoperative oral corticosteroids. Antifungal treatment is not usually of benefit, but post-operative itraconazole may reduce the need for reoperation. The clinical outcome of cerebral and other deep-seated forms of phaeohyphomycosis is dismal, with long-term survival being reported only when complete surgical resection of discrete lesions is possible. The development of new antifungal agents and combination treatment may help to improve the management of these infections.
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Affiliation(s)
- M E Brandt
- Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Sangwan J, Lathwal S, Juyal D, Sharma N. Fonsecaea pedrosoi: a rare etiology in fungal keratitis. J Clin Diagn Res 2013; 7:2272-3. [PMID: 24298496 DOI: 10.7860/jcdr/2013/6627.3491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 08/23/2013] [Indexed: 11/24/2022]
Abstract
Fungal corneal ulcer is common in India due to tropical climate and a large agrarian population that is at risk. Fonsecaea pedrosoi is the most common agent of chromoblastomycosis, a chronic localized fungal infection of the skin and subcutaneous tissues mainly involving lower extremities. We report a rare case of corneal chromoblastomycosis caused by F.pedrosoi, which was successfully treated with topical Amphotericin B followed by a long course of oral antifungal therapy. To the best of our knowledge, this is the first case of mycotic keratitis caused by F.pedrosoi, from the foothills of Himalayas.
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Affiliation(s)
- Jyoti Sangwan
- Assistant Professor, Department of Microbiology & Immunology, Veer Chandra Singh Garhwali Govt. Medical Sciences & Research Institute , Srinagar Garhwal-246174, Uttarakhand, India
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González GM, Rojas OC, González JG, Kang Y, de Hoog G. Chromoblastomycosis caused by Rhinocladiella aquaspersa. Med Mycol Case Rep 2013; 2:148-51. [PMID: 24432242 PMCID: PMC3885939 DOI: 10.1016/j.mmcr.2013.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/15/2013] [Accepted: 08/21/2013] [Indexed: 11/28/2022] Open
Abstract
A case of chromoblastomycosis of the hand caused by Rhinocladiella aquaspersa is described. The case was acquired locally in tropical Venezuela and was successfully treated with oral itraconazole.
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Affiliation(s)
- Gloria M. González
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - O. Carolina Rojas
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - José G. González
- Hospital Universitario Dr. José Eleuterio González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Yingqian Kang
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Department of Microbiology, Guiyang Medical College, Guiyang, China
| | - G.S. de Hoog
- Department of Microbiology, Guiyang Medical College, Guiyang, China
- Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, The Netherlands
- Peking University Health Science Center, Research Center for Medical Mycology, Beijing, China
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Shanghai Institute of Medical Mycology, Changzheng Hospital, Second Military Medical University, Shanghai, China
- Basic Pathology Department, Federal University of Paraná State, Curitiba, Paraná, Brazil
- King Abdulassiz University, Jeddah, Saudi Arabia
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Queiroz-Telles F, Santos DWCL. Chromoblastomycosis in the Clinical Practice. CURRENT FUNGAL INFECTION REPORTS 2012. [DOI: 10.1007/s12281-012-0116-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Subcutaneous mycoses are common in tropical and subtropical regions of the world. These infections have multiple features in common, including similar epidemiology, mode of transmission, indolent chronic presentation with low potential for dissemination in immunocompetent hosts, and pyogranulomatous lesions on histopathology. Herein, we provide up-to-date epidemiologic, clinical, diagnostic, and therapeutic data for three important subcutaneous mycoses: chromoblastomycosis, mycetoma, and sporotrichosis.
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Affiliation(s)
- Ricardo M La Hoz
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Boulevard, Tinsley Harrison Tower 229, Birmingham, AL, 35294-0006, USA
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Sun J, Najafzadeh MJ, Gerrits van den Ende AHG, Vicente VA, Feng P, Xi L, De Hoog GS. Molecular characterization of pathogenic members of the genus Fonsecaea using multilocus analysis. PLoS One 2012; 7:e41512. [PMID: 22876287 PMCID: PMC3410912 DOI: 10.1371/journal.pone.0041512] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 06/22/2012] [Indexed: 11/18/2022] Open
Abstract
Members of the fungal genus Fonsecaea causing human chromoblastomycosis show substantial geographic structuring. Genetic identity of clinical and environmental strains suggests transmission from plant debris, while the evolutionary processes that have led to spatially separated populations have remained unexplained. Sequences of ITS, BT2, ACT1, Cdc42, Lac and HmgA were analyzed, either by direct sequencing or by cloning. Thirty-seven clinical and environmental Fonsecaea strains from Central and South America, Asia, Africa and Europe were sequenced and possible recombination events were calculated. Phylogenetic trees of Cdc42, Lac and HmgA were statistically supported, but ITS, BT2 and ACT1 trees were not. The Standardized Index of Association (IAS) did not detect recombination (IAS = 0.4778), neither did the Phi-test for separate genes. In Fonsecaea nubica non-synonymous mutations causing functional changes were observed in Lac gene, even though no selection pressures were detected with the neutrality test (Tajima D test, p>0.05). Genetic differentiation of populations for each gene showed separation of American, African and Asian populations. Strains of clinical vs. environmental origin showed genetic distances that were comparable or lower than found in geographic differentiation. In conclusion, here we demonstrated clonality of sibling species using multilocus data, geographic structuring of populations, and a low functional and structural selective constraint during evolution of the genus Fonsecaea.
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Affiliation(s)
- Jiufeng Sun
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Department of Parasitology, Zhongshan School of Medicine, Key Laboratory for Tropical Disease Control, Ministry of Education, Sun Yat-sen University, Guangzhou, Guangdong, China
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Mohammed J. Najafzadeh
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, The Netherlands
- Department of Parasitology and Mycology, and Cancer Molecular Pathology Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Vania A. Vicente
- Department of Basic Pathology, Federal University of Paraná, Curitiba, PR, Brazil
| | - Peiying Feng
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Department of Dermatology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Liyan Xi
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- * E-mail: (LX); (GSDH)
| | - Gerrit S. De Hoog
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, The Netherlands
- Peking University Health Science Center, Research Center for Medical Mycology, Beijing, China
- * E-mail: (LX); (GSDH)
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González GM, Rojas OC, Bocanegra-García V, González JG, Garza-González E. Molecular diversity of Cladophialophora carrionii in patients with chromoblastomycosis in Venezuela. Med Mycol 2012; 51:170-7. [PMID: 22734968 DOI: 10.3109/13693786.2012.695457] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We identified 29 Cladophialophora carrionii isolates recovered from Venezuelan patients with chromoblastomycosis using phenotypic and molecular characteristics. The genetic diversity of isolates was assessed by enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) fingerprinting. We detected four electrophoretic patterns divided into two main clusters (I and II) comprising 10 and 17 isolates, respectively, and two minor clusters (III and IV) with one isolate each. An interesting cluster-age-lesion type association was detected. The median age of patients in cluster I was 37.5 years and in cluster II, 55 years of age (P = 0.04). The C. carrionii isolates found in cluster I were generally obtained from crusty lesions (60%) and isolates in cluster II were usually recovered from plaque type lesions (53%) even though the P values were only slightly less than significant (P = 0.08). No associations were found among the genetic features strains in the two clusters and gender, occupation, geographic origin, lesion size, severity, and duration of the disease. There was also no correlation between antifungal susceptibilities and strain clustering. In conclusion, molecular typing using ERIC-PCR revealed a genomic heterogeneity in the C. carrionii clinical isolates studied.
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Affiliation(s)
- Gloria M González
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
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Mouchalouat MDF, Gutierrez Galhardo MC, Zancopé-Oliveira RM, Monteiro Fialho PC, de Oliveira Coelho JMC, Silva Tavares PM, Francesconi do Valle AC. Chromoblastomycosis: a clinical and molecular study of 18 cases in Rio de Janeiro, Brazil. Int J Dermatol 2011; 50:981-6. [PMID: 21781072 DOI: 10.1111/j.1365-4632.2010.04729.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Chromoblastomycosis (CBM) is a chronic subcutaneous mycosis caused by dematiaceous fungi. METHODS We described epidemiological data, clinical presentation, and treatment of 18 cases of CBM diagnosed in Rio de Janeiro, Brazil. Diagnosis was obtained by mycological, histopathological findings demonstrating typical muriform cells with confirmation of isolated by DNA sequencing of the ribosomal internal transcribed spacer. RESULTS The majority of patients were male (72.2%) ranging from 39 to 83 years old, farm laborers and construction workers. The duration of disease varied from four months to 32 years. The most common presentations were verrucous form in ten (55.6%) patients, followed by tumoral in three (16.7%) patients, primarily of moderate (55.6%) and severe (38.9%) intensity. Lower (44.4%) and upper limbs (33.3%) were the most affected sites. Fonsecaea pedrosoi isolated from 14 (77.8%), and Cladophialophora carrionii isolated from one case (5.6%). Fifteen patients (83.3%) were treated. Six patients (40%) received oral itraconazole 200-400 mg/day, five patients (33.3%) received oral itraconazole 200-400 mg/day combined with fluconazole 200 mg/day, and four (26.7%) patients were submitted to surgery. The duration of therapy varied from 12 to 48 months. Cure rate was 80% (12/15). No relapse was observed after two years of follow-up. CONCLUSIONS Success was due to attending a center with specialized clinical care, laboratory support, and pharmaceutical care.
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Affiliation(s)
- Marcelle de F Mouchalouat
- Laboratório de Dermatologia Laboratório de Micologia Laboratório de Anatomia Patológica, Instituto de Pesquisa Clínica Evandro Chagas (IPEC), Fundação Oswaldo Cruz, Brazil.
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Najafzadeh MJ, Sun J, Vicente VA, Klaassen CHW, Bonifaz A, Gerrits van den Ende AHG, Menken SBJ, de Hoog GS. Molecular epidemiology of Fonsecaea species. Emerg Infect Dis 2011; 17:464-9. [PMID: 21392438 DOI: 10.3201/eid1703.100555] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To assess population diversities among 81 strains of fungi in the genus Fonsecaea that had been identified down to species level, we applied amplified fragment-length polymorphism (AFLP) technology and sequenced the internal transcribed spacer regions and the partial cell division cycle, beta-tubulin, and actin genes. Many species of the genus Fonsecaea cause human chromoblastomycosis. Strains originated from a global sampling of clinical and environmental sources in the Western Hemisphere, Asia, Africa, and Europe. According to AFLP fingerprinting, Fonsecaea isolates clustered in 5 groups corresponding with F. pedrosoi, F. monophora, and F. nubica: the latter 2 species each comprised 2 groups, and F. pedrosoi appeared to be of monophyletic origin. F. pedrosoi was found nearly exclusively in Central and South America. F. monophora and F. nubica were distributed worldwide, but both showed substantial geographic structuring. Clinical cases outside areas where Fonsecaea is endemic were probably distributed by human migration.
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Abstract
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.
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Yap FBB. Chromoblastomycosis in Sarawak, East malaysian Borneo. Trans R Soc Trop Med Hyg 2009; 104:168-9. [PMID: 19766279 DOI: 10.1016/j.trstmh.2009.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 05/26/2009] [Accepted: 05/26/2009] [Indexed: 11/29/2022] Open
Abstract
A retrospective study was conducted to determine the clinical characteristics and treatment outcomes of 11 new patients with a histological diagnosis of chromoblastomycosis at Sarawak General Hospital, Malaysia, between 1996 and 2008. The majority (81.8%) were males, and the median age at presentation was 40 years. Over half the patients were farmers. All the patients had irregular verrucous lesions, mostly on the lower limbs (90.9%), and had initially been misdiagnosed. The mean duration of the lesions was 13.8 years. Oral terbinafine and itraconazole were administered to all the patients; clinical cure was seen in 54.5%, and partial response in 18.2%. Concomitant electrocautery and cryotherapy were only effective for small lesions.
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Affiliation(s)
- Felix Boon Bin Yap
- Department of Dermatology, Sarawak General Hospital, 93586 Kuching, Sarawak, Malaysia.
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Esterre P, Inzan C, Ratsioharana M, Andriantsimahavandy A, Raharisolo C, Randrianiaina E, Roig P. A multicentre trial of terbinafine in patients with chromoblastomycosis: Effect on clinical and biological criteria. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639809160714] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mouchalouat MDF, Galhardo MCG, Fialho PCM, Coelho JMCDO, Zancopé-Oliveira RM, Valle ACFD. Cladophialophora carrionii: a rare agent of chromoblastomycosis in Rio de Janeiro State, Brazil. Rev Inst Med Trop Sao Paulo 2009; 50:351-3. [PMID: 19082378 DOI: 10.1590/s0036-46652008000600008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 09/29/2008] [Indexed: 11/21/2022] Open
Abstract
A 73 year-old male farm laborer from a rural area presented a 15 year history of extensive tumoral lesions over his left leg. Histological studies of skin biopsy showed pseudoepitheliomatous hyperplasia and granulomatous chronic inflammatory process with muriform cells, confirming chromoblastomycosis (CBM). Cladophialophora carrionii was isolated in culture. Treatment with itraconazole 400 mg/day for 12 months resulted in complete remission of lesions. As far we aware, this is the first case report of CBM caused by Cladophialophora carrionii in Rio de Janeiro State, Brazil.
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Sousa MG, Ghosn EEB, Nascimento RC, Bomfim GF, Noal V, Santiago K, de Maria Pedrozo E Silva Azevedo C, Marques SG, Gonçalves AG, de Castro Lima Santos DW, Criado PR, Costa Martins JE, Almeida SR. Monocyte-derived dendritic cells from patients with severe forms of chromoblastomycosis induce CD4+ T cell activation in vitro. Clin Exp Immunol 2009; 156:117-25. [PMID: 19210522 DOI: 10.1111/j.1365-2249.2008.03870.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Dendritic cells (DCs) have been described as initiators and modulators of the immune response. Recently we have shown a predominant production of interleukin-10 cytokine, low levels of interferon-gamma and inefficient T cell proliferation in patients with severe forms of chromoblastomycosis. Chromoblastomycosis starts with subcutaneous inoculation of Fonsecaea pedrosoi into tissue where DCs are the first line of defence against this microorganism. In the present study, the interaction of F. pedrosoi and DCs obtained from patients with chromoblastomycosis was investigated. Our results showed that DCs from patients exhibited an increased expression of human leucocyte antigen D-related (HLA-DR) and co-stimulatory molecules. In the presence of conidia, the expression of HLA-DR and CD86 was up-regulated by DCs from patients and controls. Finally, we demonstrate the reversal of antigen-specific anergy and a T helper type 1 response mediated by DCs incubated with F. pedrosoi conidea.
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Affiliation(s)
- M Glória Sousa
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de Sao Paulo, SP, Brazil
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