Microbiological and molecular diagnosis of deep localized cutaneous infection with Trichophyton mentagrophytes

Sommer, Sabine; Barton, Richard; Wilkinson, S. M.; Merchant, W.; Evans, E. G. V.; Moore, Martin

doi:10.1046/j.1365-2133.1999.02985.x

Cited by 18 publications

(10 citation statements)

References 10 publications

(10 reference statements)

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“…Keratin is encountered by the pathogen immediately upon adherence and in the early stages of growth, while elastin occurs in the dermis. Dermatophyte infections penetrate deeply in immunocompromised hosts (17,22) and occasionally cause systemic infections (27). Profuse growth, as well as strong expression of Tri m 4, was observed on blood plasma, which is consistent with the view that dermatophytes have the potential to cause deep mycoses and are stopped from doing so only by the immune system.…”

Section: Discussionsupporting

confidence: 66%

Markers for Host-Induced Gene Expression inTrichophytonDermatophytosis

et al. 2005

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Dermatophytes are adapted to infect keratinized tissues by their ability to utilize keratin as a nutrient source. Although there have been numerous reports that dermatophytes like Trichophyton sp. secrete proteolytic enzymes, virtually nothing is known about the patterns of gene expression in the host or even when the organisms are cultured on protein substrates in the absence of a host. We characterized the expression of an aminopeptidase gene, the Trichophyton mentagrophytes homolog of the Trichophyton rubrum Tri r 4 gene. The T. rubrum gene was originally isolated based on the ability of the protein encoded by it to induce immediate and delayed-type hypersensitivity in skin tests. T. mentagrophytes Tri m 4 is closely related to Tri r 4 (almost 94% identity at the protein level). Tri m 4 resembles other protease-encoding genes thought to be virulence factors (for example, DPP V of Aspergillus fumigatus). The Tri m 4 protein was detected immunochemically both in fungal extracts and in the culture medium. Expression of the Tri m 4 gene was induced severalfold when T. mentagrophytes was grown on keratin and elastin. Ex vivo, strong induction was observed after culture on blood plasma, but the use of homogenized skin did not result in a significant increase in Tri m 4 transcript levels. In order to identify additional genes encoding putative virulence factors, differential cDNA screening was performed. By this method, a fungal thioredoxin and a cellulase homolog were identified, and both genes were found to be strongly induced by skin extracellular matrix proteins. Induction by superficial (keratin) and deep (elastin) skin elements suggests that the products of these genes may be important in both superficial and deep dermatophytosis, and models for their function are proposed. Upregulation of several newly identified T. mentagrophytes genes on protein substrates suggests that these genes encode proteins which are relevant to the dermatophyte-skin interaction.

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Section: Discussionsupporting

confidence: 66%

Markers for Host-Induced Gene Expression inTrichophytonDermatophytosis

et al. 2005

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“…3,4,15 Clinical, pathologic, and microbiologic diagnosis of deep dermatophytosis in individuals who are immunocompromised can be difficult. 3,4,9,15,17,18 Our patient initially presented with a red-purple tumoral lesion, so we initially suspected a neoplastic condition (cutaneous lymphoma or Kaposi's sarcoma) or a deep fungal infection like cutaneous aspergillosis. When histopathologic examination revealed multiple septate hyphae in the dermis, our focus was a deep fungal infection, such as dermatophytosis.…”

Section: Discussionmentioning

confidence: 98%

Deep dermatophytosis caused by Trichophyton rubrum with concomitant disseminated nocardiosis in a renal transplant recipient

Seckın¹,

Arıkan²,

Haberal³

2004

Journal of the American Academy of Dermatology

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“…One of the most prevalent species of this group is T. rubrum (7,20). Rarely, these pathogens cause a more aggressive and invasive form of infection (1,4,6,9,14,18,19) that may present in one of three major patterns, as follows. (i) Majocchi's granuloma (nodular granulomatous perifolliculitis), described more than a century ago (13), is an infection of dermal and subcutaneous tissue, related to disruption of hair follicles and spillage of fungi into the dermis, which produces a granulomatous inflammation.…”

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confidence: 99%

Deep Infection by Trichophyton rubrum in an Immunocompromised Patient

Nir-Paz¹,

Elinav²,

Pierard

et al. 2003

J Clin Microbiol

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Dermatophytes are common pathogens of skin but rarely cause invasive disease. We present a case of deep infection by Trichophyton rubrum in an immunocompromised patient. T. rubrum was identified by morphological characteristics and confirmed by PCR. Invasiveness was apparent by histopathology and immunohistochemistry. The patient was treated successfully with itraconazole. CASE REPORTA 56-year-old male was admitted for evaluation of elevated erythrocyte sedimentation rate (ESR), anemia, and multiple subcutaneous nodules on both legs. The patient was under close medical supervision due to an autoimmune disease with liver, cardiac, and lung involvement.His medical history included pericarditis (27 years before admission), and a profound jaundice after a respiratory infection treated with cefuroxime (3 years before admission). Serology was negative for hepatitis viruses and positive for antiparietal, antinuclear, and antineutrophil cytoplasmic antibodies. Liver biopsy revealed a profound destruction of liver architecture, fibrosis, active inflammation, and cholestasis. Treatment with steroids was followed by a good clinical response and normalization of liver enzymes. Attempts to wean the patient from steroids including administration of azathioprine and cyclosporine failed, and during the 2 years prior to admission he received both prednisone and cyclosporine. Several weeks before admission, he was evaluated for a chronic cough. He had undergone a transbronchial biopsy that disclosed chronic inflammation and thickening of the basement membrane, without any specific diagnosis, but responded to an increase of the dose of steroids. A few weeks later, while trying to taper the steroids, he developed multiple, hard cutaneous nodules, distributed mainly on the lower limbs. Some later softened and discharged caseous material spontaneously.Other underlying conditions included glucose-6-phosphate dehydrogenase deficiency, nephrolithiasis, benign prostate hypertrophy, bilateral inguinal hernia repair, and osteoporosis.On admission, medications included prednisone (10 mg once a day [QD]), cyclosporine (100 mg QD), ursodeoxycholic acid (300 mg twice a day), alendronate (10 mg QD), omeprazole (20 mg QD), and calcium (600 mg) and vitamin D (0.25 g) once daily. On physical examination, rhonchi were heard over both lungs. A few hard, mobile subcutaneous nodules were present on both lower limbs, mainly around the knees and thighs (Fig. 1a), and the sacral area. Some of these nodules were purplish and soft. Onychomycosis was present on the feet and both hands (Fig. 1b and c).Laboratory test results were as follows: ESR, 80; hemoglobin level, 10.8 g/dl; leukocyte count, 7,900/l (42% granulocytes); albumin level, 34 g/liter; total protein level, 83 g/liter; liver enzyme levels, normal.Two of the patient's nodules were excised. A granulomatous inflammatory reaction was present in the dermis and hypodermis. It was composed of monocytes, macrophages, multinucleated giant cells, and rare neutrophils (Fig. 2). Septate hyphae were revealed...

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Microbiological and molecular diagnosis of deep localized cutaneous infection with Trichophyton mentagrophytes

Cited by 18 publications

References 10 publications

Markers for Host-Induced Gene Expression inTrichophytonDermatophytosis

Markers for Host-Induced Gene Expression inTrichophytonDermatophytosis

Deep dermatophytosis caused by Trichophyton rubrum with concomitant disseminated nocardiosis in a renal transplant recipient

Deep Infection by Trichophyton rubrum in an Immunocompromised Patient

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