DOCSLIB.ORG

Coexisting Chromoblastomycosis and Mycobacterium Fortuitum Skin And

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Coexisting Chromoblastomycosis and Mycobacterium Fortuitum Skin And 2008 19 365-370 Coexisting Chromoblastomycosis and Mycobacterium fortuitum Skin and Subcutaneous Infection Shie-Shian Huang1, Sai-Cheong Lee1,5, Chao-Wei Lee2, Hsin-Chun Ho3, and Liang-Che Chang4 1Division of Infectious Disease, 2Department of Surgery, 3Department of Dermatology, 4Department of Pathology, Chang Gung Memorial Hospital, Keelung; 5Chang Gung Institute of Technology, Kwei-Shan Tao-Yuan, Taiwan, Republic of China Abstract We report a diabetic patient with coexisting skin and subcutaneous infection of chromoblastomy- cosis and Mycobacterium fortuitum. Cultures of these skin lesions or discharges frequently fail to demon- strate these organisms. Aggressive skin biopsy revealed finding and diagnosis of chromoblastomyco- sis and Mycobacterium fortuitum. We performed repeat skin biopsies and tissue cultures for this pa- tient. The culture of right arm yielded Fonsecaea pedrosoi and the culture of left arm yielded Mycobacterium fortuitum. Preferred treatment is usually surgical excision or cryosurgery with liquid nitrogen for small lesions of chromoblastomycosis but we administered itraconazole 200 mg per day for 6 months and the lesions completely recovered with only the sequelae of pigmentation. The Mycobacterium fortuitum infection of left arm was cured with 8-month combination therapy of levofloxacin, clarithromycin, and 7-month treatment of amikacin. Duration of treatment depends on the clinical response and achievement of mycologic and histopathological cure. ( J Intern Med Taiwan 2008; 19: 365-370 ) Key Words Ĉ Chromoblastomycosis, Fonsecaea pedrosoi, Mycobacterium fortuitum Correspondence and requests for reprints : Dr. Sai-Cheong Lee Address : Division of Infectious Disease, Chang Gung Memorial Hospital, 222, Mai-Chin Road, 204 Keelung, Taiwan, Republic of China. 366 S. S. Huang, S. C. Lee, C. W. Lee, H. C. Ho, and L. C. Chang Background Chromoblastomycosis(chromomycosis) is a chronic localized fungal infection of the skin and the subcutaneous tissue caused by traumatic skin and in- oculated with dematiaceous fungi (usually Fonsecaea pedrosoi, Fonsecaea compacta, Phialophora verru- cosa or Cladosporium carrionii )1-4. The lesions are frequently localized in the feet or legs of outdoor per- sons associated with farming and woodcutting and warty or cauliflower-like in appearance. This disease is found worldwide and frequently reported from Fig.1.Broad, nonseptate hyphae, vertical branching and 5 hollow appearance, consistent with mucormyco- Madagascar and Brazil , rarely reported from North sis, from right lower leg lesion. (haematoxylin and 6 Africa and Asia. We report a diabetic patient with si- eosin stain, 10 Ű 40) multaneously coexisting cutaneous infection of chro- moblastomycosis, Mycobacterium fortuitum and mu- cormycosis. Case A 74-year-old woman had been a patient of hy- pertension known for 20 years, diabetes known for 4 years and received regularly medication control from the physicians. Besides, she often complained of low back pain and received some injection drugs to re- lieve her discomforts. She also frequently helped her son to feed some salt-water fishes which they culti- Fig.2.Suppurative granulomatous inflammation and vated near her home. presence of round, yellow-brown, thick-walled She had poorly healing wound (4 Ű 8 square sclerotic bodies extracellularly pathognomonic cm) over right lower leg. This wound showed necrot- with chromoblastomycosis. (haematoxylin and eosin stain, 10 Ű 40) ic change and poorly responsive to vancomycin and cefriaxone infusion in December, 2005. She received staining of sections showed suppurative granulo- above knee amputation on December 21th, 2005. The matous inflammation and presence of round, yel- histopathological examination of the wound showed low-brown, thick-walled sclerotic bodies extracel- compatible with mucormycosis (Figure 1). No anti- lularly pathognomonic with chromoblastomycosis fungal regimen was administered for the mucormy- (Figure 2). The culture of right arm yielded cosis because of the clean amputation wound. Fonsecaea pedrosoi (Figure 3). Itraconazole 200 mg She was also noted that she had papules and per day was administered to control the chro- plaque lesions over her right forearm at the same moblastomycosis. time. But she could not remember how long she had After 2 months of treatment, the right forearm these lesions or any trauma history. The skin biop- lesions showed progression with ulcerating and sy was performed and the haematoxylin and eosin necrotic change. Multiple nodular lesions (from 0.1 Chromoblastomycosis Induced Skin and Subcutaneous Infection 367 Fig.3.Sabouraud's dextrose agar at 37 ƨ yielded ele- Fig.5.The left forearm lesions of Mycobacterium fortui- vated and granular brownish black colonies and tum infection Fonsecaea pedrosoi identification was confirmed We kept itraconazole 200 mg per day for the pa- tient because she was very thin and old age. The right forearm lesions of chromoblastomycosis improved progressively and completely recovered after 6- month itraconazole treatment with only the sequelae of pigmentation. The left forearm nodular lesions due to M. fortuitum infection improved slowly to the com- bined regimens of levofloxacin 500 mg and clar- ithromycin 1000 mg per day, even for one-month treatment. Then we added amikacin 300 mg intra- muscular injection twice a week. The left forearm le- sions had improved and nodular lesions disappeared Fig.4.The right forearm lesions of chromoblastomyco- after 8-month combination therapy of levofloxacin, sis infection clarithromycin, and 7-month treatment of amikacin. Ű 0.2 Ű 0.2 cubic cm-2.3 Ű 3.6 Ű 2 cubic cm) over We stopped these drugs for one month and there is no left forearm started to present in recent 2 months. We any more skin lesion noted again. performed skin biopsy on both arms again and the Because this is a very rare case that several un- histopathological examination of the left arm showed usual skin and subcutaneous infections including mu- atypical mycobacterial infection with suppurative cormycosis, chromoblastomycosis, and Mycobac- granulomatous inflammation. Lowenstein Jensen terium fortuitum coexisted in this patient. We per- media yielded Mycobacterium fortuitum and the iso- formed several examinations for her to survey the un- late was only sensitive to amikacin and kanamycin. derlying disease except diabetes including white The histopathological examination of the right fore- blood cell and differential count, cortisol level, antin- arm showed chromoblastomycosis and the culture on uclear antibody, C3, C4, HIV antibody, im- Sabouraud's dextrose agar at 37 ƨ yielded elevated munoglobulin A, G, M, protein electrophoresis, and and granular brownish black colonies. Fonsecaea pe- Nitroblue tetrazolium test. These examinations all drosoi identification was confirmed by microscopic showed negative finding or the results were within colony morphology. normal level. 368 S. S. Huang, S. C. Lee, C. W. Lee, H. C. Ho, and L. C. Chang and have favorably clinical outcome7. The duration Conclusion of treatment is often more than 12 months until the Chromoblastomycosis is a chronic fungal infec- clinical and mycologic cure are achieved without any tion of the subcutaneous tissues, extend slowly, and pathologic evidence of chromoblastomycosis. may spread along the lymphatic drainage or au- Terbinafine 500 mg daily8 or oral pulse itraconazole toinoculation to neighboring areas of the skin. The 400 mg daily, for 7 days each month9 are another infection often results from a traumatic injury and the choices of regimens for treatment. In our patient, we patient often doesn't remember how long she or he had administered itraconazole 200 mg per day for 6 has had it. Chromoblastomycosis (chromomycosis) months and her right forearm lesions had improved is inoculated with dematiaceous fungi (usually progressively. No relapsed lesion was observed after Fonsecaea pedrosoi, Fonsecaea compacta, Phialo- 6-month followed up. phora verrucosa or Cladosporium carrionii ). Mycobacterium fortuitum is a rapidly growing Fonsecaea pedrosoi is the most common dematia- mycobacteria and appears ubiquitously in water and ceous fungi causing the chromoblastomycosis. The soil10, 11. It causes cutaneous infections through trau- conidiophores of Fonsecaea pedrosoi are septate, ma or clinical procedures 12. This patient frequently erect and compactly sympodial. Fonsecaea pe- helped her son to feed some salt-water fishes which drosoi's elongate conidia differ from Rhinocladiella they cultivated near her home and had the potential type and are not like the Phialophora's phialides with risks of trauma, mucormycosis, chromoblastomyco- vase shaped and terminal cuplike collarettes. The sis and M. fortuitum infections. M. fortuitum often conidiophores of Cladosporium are septate and have showed resistance to clarithromycin and this could large primary shield-shaped conidia that produce explain that our patient initially had the poor response short branching chains of oval conidia having small to clarithromycin and levofloxacin. We changed to dark hila. Fonsecaea pedrosoi identification was con- amikacin 300 mg intramuscular injection every 3-day firmed by microscopic colony morphology with these interval and then the left forearm lesions improved differences. The organisms often gain entry into the dramatically. human body by direct contact with wood splinters, This patient had the initial presentation of poor- soil or thorns. The most common appearance is warty, ly healing wound over right
Load more

Recommended publications
  • Next-Generation Sequencing for Hypothesis-Free Genomic Detection
    Frickmann et al. BMC Microbiology (2019) 19:75 https://doi.org/10.1186/s12866-019-1448-0 RESEARCH ARTICLE Open Access Next-generation sequencing for hypothesis- free genomic detection of invasive tropical infections in poly-microbially contaminated, formalin-fixed, paraffin-embedded tissue samples – a proof-of-principle assessment Hagen Frickmann1,2* , Carsten Künne3, Ralf Matthias Hagen4, Andreas Podbielski2, Jana Normann2, Sven Poppert5,6, Mario Looso3 and Bernd Kreikemeyer2 Abstract Background: The potential of next-generation sequencing (NGS) for hypothesis-free pathogen diagnosis from (poly-)microbially contaminated, formalin-fixed, paraffin embedded tissue samples from patients with invasive fungal infections and amebiasis was investigated. Samples from patients with chromoblastomycosis (n = 3), coccidioidomycosis (n = 2), histoplasmosis (n = 4), histoplasmosis or cryptococcosis with poor histological discriminability (n = 1), mucormycosis (n = 2), mycetoma (n = 3), rhinosporidiosis (n = 2), and invasive Entamoeba histolytica infections (n = 6) were analyzed by NGS (each one Illumina v3 run per sample). To discriminate contamination from putative infections in NGS analysis, mean and standard deviation of the number of specific sequence fragments (paired reads) were determined and compared in all samples examined for the pathogens in question. Results: For matches between NGS results and histological diagnoses, a percentage of species-specific reads greater than the 4th standard deviation above the mean value of all 23 assessed sample materials was required. Potentially etiologically relevant pathogens could be identified by NGS in 5 out of 17 samples of patients with invasive mycoses and in 1 out of 6 samples of patients with amebiasis. Conclusions: The use of NGS for hypothesis-free pathogen diagnosis from contamination-prone formalin- fixed, paraffin-embedded tissue requires further standardization.
    [Show full text]
  • Developments in Fungal Taxonomy
    CLINICAL MICROBIOLOGY REVIEWS, July 1999, p. 454–500 Vol. 12, No. 3 0893-8512/99/$04.00ϩ0 Copyright © 1999, American Society for Microbiology. All Rights Reserved. Developments in Fungal Taxonomy JOSEP GUARRO,* JOSEPA GENE´, AND ALBERTO M. STCHIGEL Unitat de Microbiologia, Departament de Cie`ncies Me`diques Ba`siques, Facultat de Medicina i Cie`ncies de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain INTRODUCTION .......................................................................................................................................................454 THE CONCEPT OF SPECIES IN FUNGI .............................................................................................................455 PHYLOGENY AND EVOLUTION...........................................................................................................................455 NOMENCLATURE.....................................................................................................................................................456 CURRENT MYCOLOGICAL TYPING METHODS..............................................................................................457 Morphology..............................................................................................................................................................457 Downloaded from Molecular Techniques ............................................................................................................................................459 Other Techniques....................................................................................................................................................460
    [Show full text]
  • Severe Chromoblastomycosis-Like Cutaneous Infection Caused by Chrysosporium Keratinophilum
    fmicb-08-00083 January 25, 2017 Time: 11:0 # 1 CASE REPORT published: 25 January 2017 doi: 10.3389/fmicb.2017.00083 Severe Chromoblastomycosis-Like Cutaneous Infection Caused by Chrysosporium keratinophilum Juhaer Mijiti1†, Bo Pan2,3†, Sybren de Hoog4, Yoshikazu Horie5, Tetsuhiro Matsuzawa6, Yilixiati Yilifan1, Yong Liu1, Parida Abliz7, Weihua Pan2,3, Danqi Deng8, Yun Guo8, Peiliang Zhang8, Wanqing Liao2,3* and Shuwen Deng2,3,7* 1 Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China, 2 Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China, 3 Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China, 4 CBS-KNAW Fungal Biodiversity Centre, Royal Netherlands Academy of Arts and Sciences, Utrecht, Netherlands, 5 Medical Mycology Research Center, Chiba University, Chiba, Japan, 6 Department of Nutrition Science, University of Nagasaki, Nagasaki, Japan, 7 Department of Dermatology, First Hospital of Xinjiang Medical University, Urumqi, China, 8 Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China Chrysosporium species are saprophytic filamentous fungi commonly found in the Edited by: soil, dung, and animal fur. Subcutaneous infection caused by this organism is Leonard Peruski, rare in humans. We report a case of subcutaneous fungal infection caused by US Centers for Disease Control and Prevention, USA Chrysosporium keratinophilum in a 38-year-old woman. The patient presented with Reviewed by: severe chromoblastomycosis-like lesions on the left side of the jaw and neck for 6 years. Nasib Singh, She also got tinea corporis on her trunk since she was 10 years old.
    [Show full text]
  • Pathogenicity Classification of Fungi Status December 2014 (CGM/141218-03)
    Classification of Organisms: Pathogenicity classification of fungi Status December 2014 (CGM/141218-03) COGEM advice CGM/141218-03 Pathogenicity classification of fungi COGEM advice CGM/141218-03 Dutch Regulations Genetically Modified Organisms In the Decree on Genetically Modified Organisms (GMO Decree) and its accompanying more detailed Regulations (GMO Regulations) genetically modified micro-organisms are grouped in four pathogenicity classes, ranging from the lowest pathogenicity Class 1 to the highest Class 4.1 The pathogenicity classifications are used to determine the containment level for working in laboratories with GMOs. A micro-organism of Class 1 should at least comply with one of the following conditions: a) the micro-organism does not belong to a species of which representatives are known to be pathogenic for humans, animals or plants, b) the micro-organism has a long history of safe use under conditions without specific containment measures, c) the micro-organism belongs to a species that includes representatives of class 2, 3 or 4, but the particular strain does not contain genetic material that is responsible for the virulence, d) the micro-organism has been shown to be non-virulent through adequate tests. A micro-organism is grouped in Class 2 when it can cause a disease in humans or animals whereby it is unlikely to spread within the population while an effective prophylaxis, treatment or control strategy exists, as well as an organism that can cause a disease in plants. A micro-organism is grouped in Class 3 when it can cause a serious disease in humans or animals whereby it is likely to spread within the population while an effective prophylaxis, treatment or control strategy exists.
    [Show full text]
  • Fungal Infections in HIV-Positive Peruvian Patients: Could the Venezuelan Migration Cause a Health Warning Related-Infectious Diseases?
    Moya-Salazar J, Salazar-Hernández R, Rojas-Zumaran V, Quispe WC. Fungal Infections in HIV-positive Peruvian Patients: Could the Venezuelan Migration Cause a Health Warning Related-infectious Diseases?. J Infectiology. 2019; 2(2): 3-10 Journal of Infectiology Journal of Infectiology Research Article Open Access Fungal Infections in HIV-positive Peruvian Patients: Could the Venezuelan Migration Cause a Health Warning Related-infectious Diseases? Jeel Moya-Salazar1,2*, Richard Salazar-Hernández3, Victor Rojas-Zumaran2, Wanda C. Quispe3 1School of Medicine, Faculties of Health Science, Universidad Privada Norbert Wiener, Lima, Peru 2Pathology Department, Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Peru 3Cytopathology and Genetics Service, Department of Pathology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru Article Info Abstract Article Notes In patients with human immunodeficiency virus (HIV), opportunistic Received: December 22, 2018 infections occur that could compromise the health of patients. In order to Accepted: March 7, 2019 determine the frequency of fungal opportunistic and superficial infections *Correspondence: in HIV-positive men-who-have-sex-with-men (MSM) patients at the Hospital Jeel Moya-Salazar, M.T, M.Sc., 957 Pacific Street, Urb. Sn Nacional Guillermo Almenara, we conducted a cross-sectional retrospective Felipe, 07 Lima, Lima 51001, Peru; Telephone No: +51 986- study. We include Peruvian patients >18 years-old, derived from infectious or 014-954; Email: [email protected]. gynecological offices, with or without antiretroviral treatment. © 2019 Moya-Salazar J. This article is distributed under the One hundred thirteen patients were enrolled (36.7±10, range: 21 to terms of the Creative Commons Attribution 4.0 International 68 years), which 46 (40.7%) has an opportunistic fungal infection, mainly License.
    [Show full text]
  • Histopathology of Important Fungal Infections
    Journal of Pathology of Nepal (2019) Vol. 9, 1490 - 1496 al Patholo Journal of linic gist C of of N n e o p ti a a l- u i 2 c 0 d o n s 1 s 0 a PATHOLOGY A m h t N a e K , p d of Nepal a l a M o R e d n i io ca it l A ib ss xh www.acpnepal.com oc g E iation Buildin Review Article Histopathology of important fungal infections – a summary Arnab Ghosh1, Dilasma Gharti Magar1, Sushma Thapa1, Niranjan Nayak2, OP Talwar1 1Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal. 2Department of Microbiology, Manipal College of Medical Sciences , Pokhara, Nepal. ABSTRACT Keywords: Fungus; Fungal infections due to pathogenic or opportunistic fungi may be superficial, cutaneous, subcutaneous Mycosis; and systemic. With the upsurge of at risk population systemic fungal infections are increasingly common. Opportunistic; Diagnosis of fungal infections may include several modalities including histopathology of affected tissue Systemic which reveal the morphology of fungi and tissue reaction. Fungi can be in yeast and / or hyphae forms and tissue reactions may range from minimal to acute or chronic granulomatous inflammation. Different fungi should be differentiated from each other as well as bacteria on the basis of morphology and also clinical correlation. Special stains like GMS and PAS are helpful to identify fungi in tissue sections. INTRODUCTION Correspondence: Dr Arnab Ghosh, MD Fungal infections or mycoses may be caused by Department of Pathology, pathogenic fungi which infect healthy individuals or by Manipal College of Medical Sciences, Pokhara, Nepal.
    [Show full text]
  • Monograph on Dematiaceous Fungi
    Monograph On Dematiaceous fungi A guide for description of dematiaceous fungi fungi of medical importance, diseases caused by them, diagnosis and treatment By Mohamed Refai and Heidy Abo El-Yazid Department of Microbiology, Faculty of Veterinary Medicine, Cairo University 2014 1 Preface The first time I saw cultures of dematiaceous fungi was in the laboratory of Prof. Seeliger in Bonn, 1962, when I attended a practical course on moulds for one week. Then I handled myself several cultures of black fungi, as contaminants in Mycology Laboratory of Prof. Rieth, 1963-1964, in Hamburg. When I visited Prof. DE Varies in Baarn, 1963. I was fascinated by the tremendous number of moulds in the Centraalbureau voor Schimmelcultures, Baarn, Netherlands. On the other hand, I was proud, that El-Sheikh Mahgoub, a Colleague from Sundan, wrote an internationally well-known book on mycetoma. I have never seen cases of dematiaceous fungal infections in Egypt, therefore, I was very happy, when I saw the collection of mycetoma cases reported in Egypt by the eminent Egyptian Mycologist, Prof. Dr Mohamed Taha, Zagazig University. To all these prominent mycologists I dedicate this monograph. Prof. Dr. Mohamed Refai, 1.5.2014 Heinz Seeliger Heinz Rieth Gerard de Vries, El-Sheikh Mahgoub Mohamed Taha 2 Contents 1. Introduction 4 2. 30. The genus Rhinocladiella 83 2. Description of dematiaceous 6 2. 31. The genus Scedosporium 86 fungi 2. 1. The genus Alternaria 6 2. 32. The genus Scytalidium 89 2.2. The genus Aurobasidium 11 2.33. The genus Stachybotrys 91 2.3. The genus Bipolaris 16 2.
    [Show full text]
  • 1 §4-71A-24 LIST of NONRESTRICTED MICROORGANISMS October 25, 2001 SCIENTIFIC NAME FUNGI Absidia Coerulea Absidia Corymbifera Ab
    §4-71A-24 LIST OF NONRESTRICTED MICROORGANISMS October 25, 2001 SCIENTIFIC NAME FUNGI Absidia coerulea Absidia corymbifera Absidia ramosa Absidia spinosa Acremonium falciforme Acremonium kiliense Acremonium recifei Acremonium vitis Agaricus bitorquis Agaricus bisporus Agaricus campestris Agaricus sp. (Portabello mushroom) Alternaria alternata Alternaria geophilia Apiotrichum humicola Arthrobotrys - all species in genus Aspergillus candidus Aspergillus clavatus Aspergillus cremeus Aspergillus flavipipes Aspergillus flavus Aspergillus fumigatus Aspergillus glaucus Aspergillus nidulans Aspergillus niger Aspergillus ochraceus Aspergillus restrictus Aspergillus terreus Aspergillus ustus Aspergillus versicolor Aspergillus wentii Asteromyces cruciatus Aureobasidium pullulans Auricularia polytricha Bipolaris hawaiiensis Blastomyces dermatitidis Blastoschizomyces capitatus Boletus californicus Boletus granulatus Boletus luteus 1 Nonrestricted Microorganisms §4-71A-24 SCIENTIFIC NAME Boletus variegatus Byssochlamys fulva Candida albicans Candida famata Candida geochares Candida glabrata Candida humicola Candida kefyr Candida krusei Candida lipolytica Candida lusitaniae Candida parapsilosis Candida pseudotropicalis Candida quilliermondii Candida rugosa Candida stellatoidea Candida tropicalis Candida zeylanoides Candelabrella - all species in genus Chaetomium globosum Chrysosporium keratinophilum Chrysosporium liquorum Chrysosporium pruinosum Cladosporium bantianum Cladosporium carrionii Cladosporium trichoides Collybia velutipes Cryptococcus albidus
    [Show full text]
  • Chromoblastomycosis Patricia Chang1, Elba Arana2, Roberto Arenas3
    2XU'HUPDWRORJ\2QOLQH Case Report Chromoblastomycosis Patricia Chang1, Elba Arana2, Roberto Arenas3 1Department of Dermatology, Hospital General de Enfermedades IGSS and Hospital Ángeles, Guatemala, 2Elective student, Hospital General de Enfermedades IGSS and Hospital Ángeles, Guatemala, 3Mycology section, “Dr. Manuel Gea González” Hospital, Mexico City, Mexico Corresponding author: Dr. Patricia Chang, E-mail: [email protected] ABSTRACT Chromoblastomycosis is a subcutaneous, chronic, granulomatous mycosis that occurs more frequently in tropical and subtropical countries. We report a case of chromoblastomycosis of the earlobe due to Fonsecaea sp in a male patient of 34 years old, due to its uncommon localization. Key words: Chromoblastomycosis; Fonsecaea pedrosoi; Fonsecaea compacta; Cladosporium carrionii; Fumagoid cells INTRODUCTION plate, hematic crusts and one retroauricular nodule with slightly warty appearance (Figs. 1 and 2). The rest of the The chromoblastomycosis is a sub cutaneous mycosis physical exam was within normal limits. in tropical and subtropical areas considered as an American disease, the main agents are Fonsecaea The patient says that his disease started 3 years ago pedrosoi, in endemic areas of tropical and subtropical with a small asymptomatic “pimple” in his right ear environments; Fonsecaea compacta, Cladosporium that slowly increased its size until he decided to consult. carrionii. The diagnosis of the disease is through the In the last 6 months he had an occasional itch and presence of fumagoids cells. was prescribed different antibiotics and non-specific creams. He does not remember bruising the area. In our environment, chromoblastomycosis is the third most common subcutaneous mycosis. It predominates Three clinical diagnosis were made based on the in the lower limbs in warty form and F pedrosoi is the clinical data: chromoblastomycosis; leishmaniasis; most frequent etiological agent.
    [Show full text]
  • Application to Add Itraconazole and Voriconazole to the Essential List of Medicines for Treatment of Fungal Diseases – Support Document
    Application to add itraconazole and voriconazole to the essential list of medicines for treatment of fungal diseases – Support document 1 | Page Contents Page number Summary 3 Centre details supporting the application 3 Information supporting the public health relevance and review of 4 benefits References 7 2 | Page 1. Summary statement of the proposal for inclusion, change or deletion As a growing trend of invasive fungal infections has been noticed worldwide, available few antifungal drugs requires to be used optimally. Invasive aspergillosis, systemic candidiasis, chronic pulmonary aspergillosis, fungal rhinosinusitis, allergic bronchopulmonary aspergillosis, phaeohyphomycosis, histoplasmosis, sporotrichosis, chromoblastomycosis, and relapsed cases of dermatophytosis are few important concern of southeast Asian regional area. Considering the high burden of fungal diseases in Asian countries and its associated high morbidity and mortality (often exceeding 50%), we support the application of including major antifungal drugs against filamentous fungi, itraconazole and voriconazole in the list of WHO Essential Medicines (both available in oral formulation). The inclusion of these oral effective antifungal drugs in the essential list of medicines (EML) would help in increased availability of these agents in this part of the world and better prompt management of patients thereby reducing mortality. The widespread availability of these drugs would also stimulate more research to facilitate the development of better combination therapies.
    [Show full text]
  • Fungal Infections (Mycoses): Dermatophytoses (Tinea, Ringworm)
    Editorial | Journal of Gandaki Medical College-Nepal Fungal Infections (Mycoses): Dermatophytoses (Tinea, Ringworm) Reddy KR Professor & Head Microbiology Department Gandaki Medical College & Teaching Hospital, Pokhara, Nepal Medical Mycology, a study of fungal epidemiology, ecology, pathogenesis, diagnosis, prevention and treatment in human beings, is a newly recognized discipline of biomedical sciences, advancing rapidly. Earlier, the fungi were believed to be mere contaminants, commensals or nonpathogenic agents but now these are commonly recognized as medically relevant organisms causing potentially fatal diseases. The discipline of medical mycology attained recognition as an independent medical speciality in the world sciences in 1910 when French dermatologist Journal of Raymond Jacques Adrien Sabouraud (1864 - 1936) published his seminal treatise Les Teignes. This monumental work was a comprehensive account of most of then GANDAKI known dermatophytes, which is still being referred by the mycologists. Thus he MEDICAL referred as the “Father of Medical Mycology”. COLLEGE- has laid down the foundation of the field of Medical Mycology. He has been aptly There are significant developments in treatment modalities of fungal infections NEPAL antifungal agent available. Nystatin was discovered in 1951 and subsequently and we have achieved new prospects. However, till 1950s there was no specific (J-GMC-N) amphotericin B was introduced in 1957 and was sanctioned for treatment of human beings. In the 1970s, the field was dominated by the azole derivatives. J-GMC-N | Volume 10 | Issue 01 developed to treat fungal infections. By the end of the 20th century, the fungi have Now this is the most active field of interest, where potential drugs are being January-June 2017 been reported to be developing drug resistance, especially among yeasts.
    [Show full text]
  • Treatment of Chronic Vulvovaginal Candidiasis with Posaconazole and Ciclopiroxolamine
    Vol.2, No.6, 513-518 (2010) Health doi:10.4236/health.2010.26077 Treatment of chronic vulvovaginal candidiasis with posaconazole and ciclopiroxolamine Hans-Jürgen Tietz Fungal Infection and Microbiology Institute, Berlin, Germany; [email protected] Received 21 January 2010; revised 30 January 2010; accepted 2 February 2010. ABSTRACT re-infection from sexual partner(s), and recurrent disease as a result of persistent colonization have been postu- Therapy of chronic recurrent vulvovaginal can- lated. This last postulate is supported by studies showing didiasis (VVC) caused by Candida glabrata is recurrent disease to be caused by identical strains in the still rare in comparison to C. albicans infection, vast majority of cases [2]. but therapy remains more difficult. Combination Though C. albicans is the main pathogen in more than therapy with topical antifungals may improve 95% of cases of acute infection [4], other species are therapy outcome, but still standard agents as implicated in chronic infection, chiefly C. glabrata. The fluconazole or itraconazole often fail. Posa- characteristic features of Candida albicans and Candida conazole is a new systemic triazole with a wide glabrata are listed in Table 1. antifungal spectrum including rare Candida The pathogenic role of C. glabrata is disputed, but pa- species. Up to now, no clinical trials with posa- tients who present to a physician with fungal disease conazole in chronic recurrent VVC have been caused by these atypical pathogens always report symp- undertaken. Here, first results of the application toms. Though vaginal discharge is rare, redness, agoniz- of a new therapy regimen consisting of oral ing itching, and a sour-smelling sticky discharge are posaconazole in combination with topical ci- characteristic.
    [Show full text]