In this article, we describe a chronic case of rhinofacial mucormycosis caused by Mucor irregularis, formerly known as Rhizomucor variabilis var. variabilis, a rare mycotic agent in humans. The infection caused progressive destruction of the nasal septum and soft and hard palate, leading to collapse of the nose bridge and an ulcerative gaping hole. The mucoralean mold cultured from a nasal biopsy specimen was determined by multilocus DNA sequence data to be conspecific with M. irregularis. CASE REPORTAn 18-year-old male patient from south India presented to
We describe a case of blastomycosis in a diabetic patient from South India who had visited Milwaukee, Wisconsin, an endemic area for blastomycosis in the USA. After his return to Bangalore, India, the patient developed intermittent fever of moderate to high grade, cough, loss of weight and appetite, and abscesses in the left cubital fossa and thigh regions. Systemic examination at our hospital revealed that he had dullness to percussion over the chest region and decreased breath sounds. Direct examination of Gram-stained smears of the pus from an abscess showed many broad-based budding yeast cells and culture yielded a dimorphic fungus later identified as Blastomyces dermatitidis. Histologic examination of the curettage tissue slides stained with hematoxylin and eosin, periodic acid Schiff's reagent, and Gomori's methenamine silver stain procedures showed many broad-based budding cells characteristic of B. dermatitidis. The patient was successfully treated, initially with amphotericin B, followed by oral itraconazole for a period of 6 months. Blastomycosis cases in India are reviewed and the likely source of infection in this patient is discussed.
We describe the first case of white grain pedal eumycetoma caused by Phaeoacremonium krajdenii in a 41-year-old man from Goa, India. Based on histological examination of biopsy tissue showing serpentine granules, a culture of the granules yielding phaeoid fungal colonies, and morphological characteristics and sequence comparison of the partial -tubulin gene with the ex-type isolate of P. krajdenii, the causal agent was identified as P. krajdenii. CASE REPORTA 41-year-old patient from Goa, India, visited a dermatologist in December 2000 with complaints of a single nodular, painful swelling over the dorsum of his foot that had persisted for 1 year. About 18 years earlier, he had developed a swelling and multiple discharging sinuses over the dorsum of his right foot. At that time, he was treated surgically by a local surgeon, and based on a histological examination, he was diagnosed as having a mycetoma of the foot. He was treated with cotrimoxazole and sulfamethoxazole for a period of 6 months without improvement. However, following surgery, the swelling of the foot had subsided. After about 10 years, new nodules and swellings had developed over the operated scar. At this time, he consulted a dermatologist and was referred to one of us (B.M.H.) for mycological examination.Over the scars of the previous surgery, a single small, nodular lesion measuring 6 by 6 mm was observed. The nodule was aseptically punctured, and a pale white granule, 0.5 to 2.0 mm in diameter, was aspirated. Direct examination of one-half of the granule in potassium hydroxide showed numerous hyalines, septate hyphae, and a few thick-walled cells. The other half of the granule was cultured on Sabouraud glucose agar containing chloramphenicol (SabϩC) and incubated at 25 to 30°C. White to off-white fungal colonies became evident after 8 to 10 days. Colonies slowly became darker and velvety and were olivaceous grayish brown. A provisional diagnosis of white grain mycetoma was made. A biopsy could not be done at this time because of the patient's refusal of the procedure. He was advised to take ketoconazole (400 mg/day). However, the patient did not start the treatment because he was going to a foreign country on a job assignment. During his stay there for the next 2 years, new lesions appeared on the plantar aspect of the foot (Fig. 1A).After his return in October 2000, a biopsy was performed. A portion of the biopsy tissue was sent for histopathological examination, and another portion was cultured. The specimen yielded the same fungus as had been obtained previously. Both a biopsy tissue block and a subculture were sent to one of us (A.A.P.) at the Centers for Disease Control and Prevention (CDC) for additional studies. The X-ray examination of the foot had shown no bone involvement but revealed soft-tissue swelling. Results for routine clinical chemistry, hematological investigations, and serology for human immunodeficiency virus were within normal limits. The patient was treated with itraconazole tablets (400 mg/day) for 4 months. A surgical ...
We describe a case of white grain eumycetoma of the foot of an Indian male caused by a slow-growing, poorly sporulating fungus that does not match any known agent of this infection. Histologic examination of a biopsy tissue specimen showed oval, lobular, white granules composed of hyaline, septate hyphae, and thick-walled chlamydospores. Culture of granules from a draining sinus yielded compact, very-slow-growing, poorly sporulating colonies producing a strong reddish brown pigment that diffused into the medium. The fungus was identified as a Cylindrocarpon sp. based on the development of rare cylindrical conidia borne from solitary phialides lacking collarettes, in addition to chlamydospores formed singly or in short chains.
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