Subcutaneous phaeohyphomycosis caused by<i>Phaeoacremonium parasiticum</i>in a renal transplant patient

Marques, Sílvio Alencar; Camargo, Rubens de Figueiredo; Summerbell, Richard C.; Hoog, G. Sybren de; Ishioka, Priscila; Chambo-Cordaro, L. M.; Marques, Mariângela Esther Alencar

doi:10.1080/13693780600895181

Cited by 25 publications

(16 citation statements)

References 23 publications

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“…Organ transplantation is also a common risk factor (28,38,112,142,235,236,262,271,286,296,465,484,514,556,587,645,679,704,725). Apparently nosocomial cases have also been reported, with skin irritations from dressings or i.v.…”

Section: Phaeohyphomycosismentioning

confidence: 99%

Melanized Fungi in Human Disease

2010

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SUMMARY Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes. Many are soil organisms and are generally distributed worldwide, though certain species appear to have restricted geographic ranges. Though they are uncommon causes of disease, melanized fungi have been increasingly recognized as important pathogens, with most reports occurring in the past 20 years. The spectrum of diseases with which they are associated has also broadened and includes allergic disease, superficial and deep local infections, pneumonia, brain abscess, and disseminated infection. For some infections in immunocompetent individuals, such as allergic fungal sinusitis and brain abscess, they are among the most common etiologic fungi. Melanin is a likely virulence factor for these fungi. Diagnosis relies on careful microscopic and pathological examination, as well as clinical assessment of the patient, as these fungi are often considered contaminants. Therapy varies depending upon the clinical syndrome. Local infection may be cured with excision alone, while systemic disease is often refractory to therapy. Triazoles such as voriconazole, posaconazole, and itraconazole have the most consistent in vitro activity. Further studies are needed to better understand the pathogenesis and optimal treatment of these uncommon infections.

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Section: Phaeohyphomycosismentioning

confidence: 99%

Melanized Fungi in Human Disease

2010

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“…As the fungus is usually acquired by traumatic inoculation from soil or by contamination with material through unnoticed skin fissures (13), infections due to Phaeoacremonium were mostly localized to the skin and the soft tissues (24/42 cases [57%]) and were usually only subcutaneous (21/42 cases [50%]), including 2 mycetomas and 1 onychomycosis. In three patients, skin infection secondarily extended to joints or became disseminated.…”

Section: Types Of Articlesmentioning

confidence: 99%

Dual Invasive Infection with Phaeoacremonium parasiticum and Paraconiothyrium cyclothyrioides in a Renal Transplant Recipient: Case Report and Comprehensive Review of the Literature of Phaeoacremonium Phaeohyphomycosis

et al. 2015

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e Despite increasing reports of human infection, data about the optimal care of Phaeoacremonium infections are missing. We report a case of an infection due to Phaeoacremonium parasiticum and Paraconiothyrium cyclothyrioides, initially localized to skin and soft tissue, in a kidney transplant patient. Despite surgical drainage and excision of the lesion and combination antifungal therapy with voriconazole and liposomal amphotericin B, a disseminated infection involving the lungs and brain developed and led to death. We performed a systematic literature review to assess the general features and outcome of human infections due to Phaeoacremonium species. Thirty-six articles were selected, and 42 patients, including ours, were reviewed. Thirty-one patients (74%) were immunocompromised because of organ or bone marrow transplantation (n ‫؍‬ 17), diabetes or glucose intolerance (n ‫؍‬ 10), rheumatoid arthritis or Still's disease (n ‫؍‬ 4), chronic hematological diseases (n ‫؍‬ 3), or chronic granulomatous disease (n ‫؍‬ 3). Ten patients (24%) reported initial cutaneous trauma. Skin and soft tissue infections represented 57% of infections (n ‫؍‬ 24), and disseminated infections, all occurring in immunocompromised patients, represented 14% of infections (n ‫؍‬ 6). The main antifungal drugs used were azoles (n ‫؍‬ 41) and amphotericin B (n ‫؍‬ 16). Surgical excision or drainage was performed in 64% of cases (n ‫؍‬ 27). The cure rate was 67% (n ‫؍‬ 28). There were 10% cases of treatment failure or partial response (n ‫؍‬ 4), 19% relapses (n ‫؍‬ 8), and 7% losses to follow-up (n ‫؍‬ 3). The death rate was 19% (n ‫؍‬ 8). Management of Phaeoacremonium infections is complex because of slow laboratory identification and limited clinical data, and treatment relies on a combination of surgery and systemic antifungal therapy. R eports of human diseases related to dark molds are increasing with the expanded spectrum of immunocompromised patients. Phaeohyphomycoses are a heterogenous group of cutaneous, subcutaneous, and systemic infections caused by fungi that are distributed worldwide, with melanized cell walls that develop in the host's tissue as dark-walled septate mycelial elements (1). Phaeoacremonium species, which are found in the environment in soil or in woody plants, as endophytes or as agents of plant disease, particularly in grapevines (2), are included in the phaeohyphomycosis group. Initially described in 1974 as Phialophora parasitica by Ajello et al. (3) and then transferred in 1996 to the new hyphomycete genus Phaeoacremonium by Crous et al., as Phaeoacremonium parasiticum (4), this fungus is a rare cause of human disease, occurring in both immunocompetent and immunosuppressed subjects. Reports of Phaeoacremonium infections are increasing over time, probably because laboratory confirmation of fungal pathogens has improved and because of the increase in immunocompromised conditions in the population. However, clinical and treatment data on Phaeoacremonium infection are scarce.We describe a case of a disseminated in...

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“…However, in the remaining 43% of cases, a wide spectrum of infections ranging from osteoarticular involvement, pulmonary nodules, endophthalmitis, invasive disseminated infection associated with fungemia, brain abscesses, endocarditis, and liver and spleen abscesses were observed (5)(6)(7)(8)(9)(10)(11)(12). Disseminated and severe infections were commonly associated with solid organ transplantation and other immunosuppressive conditions (3,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Considering that the morphological identification of black fungi, and of Phaeoacremonium in particular, is problematic (28) and relies on sequencing of the internal transcribed space (ITS) ribosomal DNA (rDNA) region or ␤-tubulin or calmodulin genes (29)(30)(31), many cases in routine microbiology laboratories may have passed unnoticed (28).…”

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confidence: 99%

In Vitro Susceptibility Profiles of Eight Antifungal Drugs against Clinical and Environmental Strains of Phaeoacremonium

Badali

Khodavaisy

Fakhim

et al. 2015

Antimicrob Agents Chemother

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hIn vitro susceptibilities of a worldwide collection of molecularly identified Phaeoacremonium strains (n ‫؍‬ 43) belonging to seven species and originating from human and environmental sources were determined for eight antifungal drugs. Voriconazole had the lowest geometric mean MIC (0.35 g/ml), followed by posaconazole (0.37 g/ml), amphotericin B (0.4 g/ml), and isavuconazole (1.16 g/ml). Caspofungin, anidulafungin, fluconazole, and itraconazole had no activity.

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Subcutaneous phaeohyphomycosis caused byPhaeoacremonium parasiticumin a renal transplant patient

Cited by 25 publications

References 23 publications

Melanized Fungi in Human Disease

Melanized Fungi in Human Disease

Dual Invasive Infection with Phaeoacremonium parasiticum and Paraconiothyrium cyclothyrioides in a Renal Transplant Recipient: Case Report and Comprehensive Review of the Literature of Phaeoacremonium Phaeohyphomycosis

In Vitro Susceptibility Profiles of Eight Antifungal Drugs against Clinical and Environmental Strains of Phaeoacremonium

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