Novel cases of cutaneous phaeohyphomycosis by Alternaria alstromeriae, Epicoccum tritici and Phialemonium obovatum from North India

Abstract

Background A growing number of non‐dermatophytic moulds and yeasts with the ability to act as human pathogens are reported every year. Dematiaceous fungi cause phaeohyphomycosis which encompasses a broad spectrum of diseases ranging from superficial (cutaneous and subcutaneous) to disseminated infections. Such fungal infections are responsible for causing significant morbidity and mortality, frequently in immunocompromised patients and rarely in immunocompetent patients. Objectives To investigate the prevalence of cutaneous mycosis in Jammu district (India) and to isolate and identify the recovered causal agents from the affected skin of the patients. Methods For direct microscopy, 10% KOH was used. Skin samples were collected carefully from the affected areas of suspected patients, followed by the isolation and identification of the causal agents by cultural examination, morphological examination and ITS sequencing. Results Herein, we report and describe three new cases of cutaneous phaeohyphomycosis from District Jammu of Union Territory Jammu and Kashmir, India. The age of the patients under study ranged from 17 to 42 years and the duration of infection from 1 to 2 years. The etiological agents that were recovered from the patients under study were Alternaria alstromeriae, Epicoccum tritici and Phialemonium obovatum. These dematiaceous fungal species were isolated from the skin specimen of immunocompetent hosts. Conclusion Among the three isolated etiological agents, two (Alternaria alstromeriae, Epicoccum tritici) represent new global records and one (Phialemonium obovatum) new record to India as causal agents of cutaneous phaeohyphomycosis. Careful microscopic and mycological examination form the basis of correct diagnosis of such fungal infections in the absence of simple and reliable laboratory tests (serologic or antigen tests).

Phaeohyphomycosis: A Review

“…In India, cases of Alternaria alstromeriae, Epicoccum tritici, and Phialemonium obovatum have been reported [13].…”

“…C. cassiicola has only been reported in less than 10 cases [10]. Sharma et al identified two new agents isolated for the first time in the world (A. alstromeriae, E. tritici) and another one isolated for the first time in India (P. obovatum) [13]. P. verrucosa can be isolated from soil, wood, and vegetation and has been reported in cases of subcutaneous phaeohyphomycosis [27].…”

“…The only case related to P. crystallina, which occurred in a 35-year-old woman, reported the presence of a dark red plaque on the left cheek, with 16 years of evolution [13].…”

“…Sporotrichoid patterns have been reported in some cases. A. alstromeriae has been reported in the fourth and fifth interdigital space of the right foot, with erythema, skin maceration, and fissures [13].…”

“…verrucosa presents as red plaques and facial nodules [29]. E. tritici was reported as erythematous-squamous plaques in the lower extremities, while P obovatum has been reported in the left foot, with scaly lesions, hyperkeratosis, and erythema [13].…”