Cutaneous Infection Caused by Macrophomina phaseolina in a Child with Acute Myeloid Leukemia

Abstract

We report a case of Macrophomina phaseolina skin infection in an immunocompromised child with acute myeloid leukemia, which was treated successfully with posaconazole without recurrence after a hematopoietic stem cell transplant. The fungus was identified by DNA sequencing using both the internal transcribed spacer and D1/D2 region of the 28S ribosomal DNA gene. CASE REPORTA 6-year-old Caucasian girl was diagnosed with acute myeloid leukemia carrying the t(11;19) translocation. She underwent a matched, unrelated hematopoietic stem cell transplant (HSCT) because of increasing minimal residual disease but suffered a relapse in her bone marrow 5 years later. She was then reinduced with a 5-day course of clofarabine, etoposide, and cyclophosphamide. Following this course of chemotherapy, she was discharged from the hospital and placed on prophylactic voriconazole (VRZ), vancomycin, ciprofloxacin, and trimethoprim-sulfamethoxazole. Three weeks later, she presented as an outpatient with tenderness and erythema of a few days' duration above the right medial malleolus.She had no complaints of fever or leg pain and had sustained no trauma to the right leg. On examination. she was afebrile and looked well. Her temperature was 37.1°C, pulse was 101 beats/min, respiratory rate was 20/min, and blood pressure was 95/56 mm Hg. Her lungs were clear to auscultation, and examination of her abdomen revealed no tenderness or hepatosplenomegaly. She had a 2-by-2-cm erythematous, papular, nonulcerative, tender lesion above the right medial malleolus with no induration or inguinal lymphadenopathy. There were no other skin lesions. Her complete blood count revealed a white cell count of 0.1 cells/l (range, 1,800 to 8,000 cells/l), platelet count of 17,000/l (range, 170 to 450,000 cells/l), and hemoglobin of 9.1 g/dl (range, 12 to 16 g/dl). Blood cultures showed no growth. The lesion progressed over the next week on antibiotic and antifungal therapy with meropenem, vancomycin, and VRZ. It became indurated, with a central necrotic eschar and a surrounding rim of erythema, and extended into the subcutaneous tissue. She continued to appear well during this period. Magnetic resonance imaging of the right lower tibia and fibula revealed nonenhancing edema of the skin and subcutaneous fat involving the medial distal right lower leg without muscle or bone involvement or any drainable fluid collection. Computerized tomography of the chest and abdomen revealed no evidence suggestive of any fungal lesions.A punch biopsy was performed through the central ulcerative lesion. The histology showed focal epidermolysis and dermal necrosis accompanied by predominantly histiocytic infiltrate and microhemorrhages. Histopathologic examination with periodic acid-Schiff and Gomori methenamine silver stains revealed abundant infrequently branching septate hyphae in the epidermis and dermis, invading the blood vessels (Fig. 1). There was no pigment seen on the hyphal walls on hematoxylin-eosin or melan A staining.The biopsy specimen was sent for bacterial and f...

Primary Gangrenous Cutaneous Mold Infections in a Patient with Cancer and Neutropenia

“…32 Penetrating trauma remains the major cause of primary cutaneous zygomycosis (Table 2). [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Other causes reported include elasticized bandages and wound dressings, 55 burns, 56 motor vehicle collision, 57 intravenous access, 58 and dog bite. 59 Our case report of primary cutaneous mucormycosis after a cat bite is a rare finding.…”

“…66 The higher overall mortality rate of 29.4% seen in the review of the literature was observed more frequently in patients with neutropenia (60.0%) and without surgical intervention (73.3%), and the survival rate was higher (35.3%) for cases utilizing both antifungal and surgical interventions. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The antifungal agent with the highest survival rate was amphotericin B and its formulations (58.8%). [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] …”

“…[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] In patients with hematological malignancy and primary cutaneous mold infection, outcomes were determined on whether or not the infection was localized vs disseminated. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] In cases in which the infection remained localized, 100% of patients recov- ered; by contrast, in cases of disseminated infection, the mortality rate was 29.4%. [5][6][7][8][9][10][11][12][13][14][15][16][17]…”

ANTIFUNGAL ACTIVITY OF Cirsium arvense EXTRACTS AGAINST PHYTOPATHOGENIC FUNGUS Macrophomina phaseolina

“…phaseolina has shown to be comparatively a hard pathogen to control, and cultural, chemical or biological disease management strategies have failed to provide expected results (Abdel-Kader et al, 2010). So far, no registered fungicide has become available to fight M. phaseolina (Srinivasan et al, 2009), although some fungicides such as quintozene (PCNB) and captan have been used against this pathogen to some extent (Frison et al, 1990;Dubey et al, 2012). However, the plead for sustainable agriculture in an eco-friendly manner cannot be sustained with such health hazard chemicals (Oruc, 2010).…”

“…Moreover, strains that can infect plants and humans have been interestingly reported. Similarly, it is possible that it could spread widely, causing unpredictable losses to every living being (Srinivasan et al, 2009). …”