Photodynamic therapy combined with antifungal drugs against chromoblastomycosis and the effect of ALA-PDT on Fonsecaea in vitro

Hu, Yongxuan; Qi, Xinyu; Sun, Hengbiao; Lu, Yan; Hu, Yanqing; Chen, Xuyang; Liu, Kangxing; Yang, Yonggang; Mao, Zuhao; Wu, Zhiyang; Zhou, Xianyi

doi:10.1371/journal.pntd.0007849

Cited by 25 publications

(25 citation statements)

References 31 publications

(54 reference statements)

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“…Our limited experience in our service obtained cure and/or clinical improvement in 7 out 10 cases treated. Several authors have shown that cryotherapy and photodynamic therapy appear promising as adjunctive therapy in patients with extensive lesions [ 39 , 40 ]. Recently, some Brazilian groups, including our center, have been using topical immunomodulatory drugs (imiquimod) or intramuscular administration of glucan as adjuvant therapy, obtaining significant improvement of the lesions, but without cure [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Chromoblastomycosis in an Endemic Area of Brazil: A Clinical-Epidemiological Analysis and a Worldwide Haplotype Network

Santos

Vicente

Weiss

et al. 2020

JoF

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Chromoblastomycosis (CBM) is a neglected implantation mycosis prevalent in tropical climate zones, considered an occupational disease that affects impoverished rural populations. This retrospective study described clinical aspects of CBM in a hyperendemic area in Brazil and constructed a worldwide haplotype network of Fonsecaea spp. strains. The variables were collected from medical records using a standard report form, reporting 191 patients with CBM from Maranhão, Brazil. The mean age was 56.1 years, 168 (88%) patients were male and predominantly farmers (85.8%). The mean time of evolution of the disease until diagnosis was 9.4 years. Lower limbs (81.2%) and upper limbs (14.2%) were the main sites affected. Most patients exhibited verrucous (55%) and infiltrative plaque (48.2%). Fonsecaea spp. were identified in 136 cases and a haplotype network constructed with ITS sequences of 185 global strains revealed a total of 59 haplotypes exhibiting high haplotypic and low nucleotide diversities. No correlation was observed between the different haplotypes of Fonsecaea species and dermatological patterns, severity of disease or geographic distribution inside Maranhão. Data from this area contributed to better understanding the epidemiology of CBM. For the first time, a robust haplotype network with Fonsecaea strains reveals an evolutionary history with a recent population expansion.

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Section: Discussionmentioning

confidence: 99%

Chromoblastomycosis in an Endemic Area of Brazil: A Clinical-Epidemiological Analysis and a Worldwide Haplotype Network

Santos

Vicente

Weiss

et al. 2020

JoF

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“…Moreover, the combination of antifungal drugs and PDT may enhance the penetrability of photosensitiser due to the increase of the permeability of fungal cell membrane, so as to make them have synergistic killing effect. 19 In conclusion, we reported a case of chromoblastomycosis due to F monophora, presenting unusual clinical manifestations. We described in detail the necessary diagnostic procedures and summarised the characteristics of laser, photodynamic therapy and retinoic acid treatment for CBM in the literature.…”

Section: Re Vie W and Discussionmentioning

confidence: 75%

“…Hence, CO 2 laser can not only play a therapeutic role, but also improve the efficacy of photodynamic therapy. Moreover, the combination of antifungal drugs and PDT may enhance the penetrability of photosensitiser due to the increase of the permeability of fungal cell membrane, so as to make them have synergistic killing effect 19 …”

Section: Review and Discussionmentioning

confidence: 99%

Retinoid combined with photodynamic therapy against hyperkeratotic chromoblastomycosis: A case report and literature review

Lan

Zhang

2020

Mycoses

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is a chronic cutaneous and subcutaneous disease caused by melanised fungi. It is usually associated with traumatic inoculation and occurs in the lower extremities. The treatment of this infectious disease remains challenging because of the diversity of clinical manifestations and aetiological agents. Without proper treatment, the disease can lead to incapacity in the work due to fibrotic sequelae or other complications. In worst cases, it can lead to skin cancer. 1 The aetiological agents of CBM are Fonsecaea, Phialophora, Cladophialophora, Rhinocladiella and Exophiala, among them the genus Fonsecaea is the most common. The species of the genus Fonsecaea comprises four species: F pedrosoi, F monophora, F nubica and F pugnacius. 2 F monophora and F pugnacious show significant neurotropism, which eventually leads to transmission to the brain and other organs. 3,4 In southern China, chromoblastomycosis is mainly caused by Fonsecaea pedrosoi and Fonsecaea monophora. Here, we presented a case of chromoblastomycosis with 20-year duration caused by F monophora. Clinical manifestations were not only included typical plaques and scales, but also appeared recurrent keratinised protrusions, and the infection lasted for a long time and involved an entire forearm. We observed a positive clinical effect of oral antifungal drugs, retinoid combined with carbon dioxide laser and ALA-PDT.

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“…Combining the potential of PDT with antibiotics in treating bacterial infections [16], the approach could also be applied to other infectious ulcers. Furthermore, it has been reported that miconazole can be used to increase the efficacy of PDT against Candida albicans [17] and antifungal agents combined with ALA-PDT can enhance the treatment of chromoblastomycosis [18]. Given those results, we hypothesized that PDT might also increase the efficacy of itraconazole against trichosporonosis.…”

Section: Discussionmentioning

confidence: 93%

Combinatory Effect of ALA‐PDT and Itraconazole Treatment for Trichosporon asahii

Lan

Zheng

et al. 2020

Lasers Surg Med

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Background and Objectives: Trichosporiosis is an opportunistic infection that includes superficial infections, white piedra, hypersensitivity pneumonitis, and invasive trichosporonosis. The effect of antifungal agents against these infections is largely weakened by drug resistance and biofilms-related virulence. Photodynamic therapy (PDT) is a new therapeutic approach developed not only to combat cancerous lesions but also to treat infectious diseases such as fungal infections. However, there are few studies on the antimicrobial mechanism of 5-aminolevulinic acid PDT (ALA-PDT) in treating Trichosporon. In this work, we explored the possibility of combining ALA-PDT with an antifungal agent to enhance the therapeutic efficacy of Trichosporon asahii (T. asahii) in a clinical setting and in vitro. Study Design/Materials and Methods: The biofilms of T. asahii were constructed by a 96-well plate-based method in vitro. The planktonic and adherent T. asahii were exposed to different concentrations of photosensitizers and different light doses. After PDT treatment, counting colony-forming units and tetrazolium (XTT) reduction assay were used to estimate the antifungal efficacy. The minimal inhibitory concentration of itraconazole before and after PDT treatment was determined by the broth dilution method, and XTT viability assay was used to detect and evaluate the synergistic potential of ALA-PDT and itraconazole combinations in inhibiting biofilms. Scanning electron microscopy (SEM) was performed to assess the disruption of biofilms. Results: Using combination therapy, we have successfully treated a patient who had a T. asahii skin infection. Further in vitro studies showed that the antifungal effect of ALA-PDT on planktonic and adherent T. asahii was dependent on the concentration of ALA and light dosages used. We also found that the sensitivity of both planktonic and biofilm cells to itraconazole were increased after ALA-PDT. Synergistic effect were observed for biofilms in ALA-PDT and itraconazole-combined treatment. The disruption of biofilms was confirmed by SEM, suggesting that ALA-PDT effectively damaged the biofilms and the destruction was further enhanced by ALA-PDT combination of antifungal agents. Conclusions: In conclusion, these data suggest that ALA-PDT could be an alternative strategy for controlling infections caused by Trichosporon. The combination therapy of ALA-PDT with itraconazole could result in increased elimination of planktonic cells and biofilms compared with single therapy. All these findings indicate that it could be a promising treatment against trichosporonosis. Lasers Surg. Med.

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Photodynamic therapy combined with antifungal drugs against chromoblastomycosis and the effect of ALA-PDT on Fonsecaea in vitro

Cited by 25 publications

References 31 publications

Chromoblastomycosis in an Endemic Area of Brazil: A Clinical-Epidemiological Analysis and a Worldwide Haplotype Network

Chromoblastomycosis in an Endemic Area of Brazil: A Clinical-Epidemiological Analysis and a Worldwide Haplotype Network

Retinoid combined with photodynamic therapy against hyperkeratotic chromoblastomycosis: A case report and literature review

Combinatory Effect of ALA‐PDT and Itraconazole Treatment for Trichosporon asahii

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