Cutaneous manifestations of subcutaneous and systemic fungal infections in tropical regions: a retrospective study from a referral center in southern Taiwan

Abstract

Background Deep cutaneous fungal infections, including subcutaneous mycoses and systemic fungal infection with cutaneous involvement, cause significant morbidity and mortality in light of increasing immunocompromised patients and global warming. Although a few studies reviewed deep fungal infections in temperate regions, a relevant study in tropical regions is lacking. We evaluated features of deep cutaneous fungal infections in southern Taiwan among the tropical regions. Methods We retrospectively reviewed all histopathological specimens with deep cutaneous fungal infections in a single referral center from 2001 to 2014 and successfully identified 23 cases. Medical chart review revealed patient demographic data, clinical presentation, underlying disease, microbiological culture reports, and treatment outcomes. Results The average patient age was 52 years. Fourteen cases had primary subcutaneous mycoses, and nine had systemic mycoses. Fifteen patients were immunocompromised, including hematological malignancies. Acquired immune deficiency syndrome (AIDS) and long‐term steroid use were most commonly associated with deep fungal infections. The positive culture growth rate was 63%. Fonsecaea sp. was most frequently identified by tissue culture. Aspergillosis, mucormycosis, and disseminated cryptococcosis were particularly fatal. Conclusions Diabetes and long‐term steroid use appear as major risk factors for advanced mycoses in this region. Rapid diagnosis with skin biopsy and tissue culture along with appropriate treatment of deep cutaneous fungal infection are necessary.

Deep cutaneous fungal infection by Pleosporales: An exceptional pathogen in tropical Taiwan

“…Blastomyces dermatitidis , Candida and Fonsecaea spp. were the most common organisms reported in previous studies in the USA, Korea and Taiwan 1,2,3 . In addition to common fungi, some emerging species require special attention.…”

Mycetoma due to Aspergillus flavus in a diabetic patient: Case report and literature review

“…Aspergillus species are opportunistic microorganisms, globally distributed in air, soil, and plants, and the majority of cases reported occurred in patients with predisposing conditions such as hematologic malignancies, steroid use, human immunodeficiency virus, diabetes mellitus, etc. [ [19] , [20] , [21] , [60] ]. In patients with immunodeficiency, a more severe disease that may eventually destroy tissues including bones may occur [ [22] , [23] , [24] , [61] ].…”

Community-acquired Disseminated <i>Exophiala dermatitidis</i> Mycosis with Necrotizing Fasciitis in Chronic Graft-versus-host Disease

“…A number of fungal species can manifest skin lesions as the presentation of their systemic fungal infections in immunocompromised patients with onco-hematological diseases and/or a history of HSCT. These fungi include yeasts, such as Trichosporon (18) or Cryptococcus (19); molds, such as Fusarium (20), Mucor (21) or Pseudallescheria ( Pseudallescheria / Scedosporium complex) (22); and other black fungi, such as Fonsecaea (23). Importantly, all of these fungi, including Exophiala , are non-susceptible to echinocandins, which are one of the most empirically used antifungal drugs for deep-seated mycoses.…”