Sporotrichosis in a U.S. Army Basic Trainee

ABSTRACT Lymphocutaneous sporotrichosis is a mycotic disease caused by traumatic inoculation of the dimorphic fungus Sporothrix schenckii, found ubiquitously in decaying vegetation. The potential for outbreaks, difficulty with timely diagnosis, as well as the prolonged treatment course and recovery from surgical intervention can have a substantial impact on the medical readiness of service members. Treatment with the antifungal therapy of choice, itraconazole, requires close patient monitoring for the duration of treatment for clinical response, drug tolerance, as well as therapeutic drug levels. We present a case of a U.S. Army enlistee with sporotrichosis contracted during basic training, highlighting the impact of delayed diagnosis and prolonged treatment course and recovery on medical readiness.

Rhodotoruliosis: An Emerginag Opportunistic Mycosis of Humans and Animals

Rhodotoruliosis is an opportunistic emerging mycotic disease that affects both humans and animals. The source of infection is exogenous; and disease can occur in sporadic as well as epidemic form. The disease is caused by Rhodotorula, basidiomycetous yeast that lives as a saprophyte in the environment. Rhodotorula glutinis, R. mucilaginosa (R.rubra), and R. minuta are the most frequently encountered species of Rhodotorula. The species can be isolated from a wide range of sources in nature, including the soil, air, ocean, plants, dairy products, and the household environment. Fungemia, meningitis, ventriculitis, peritonitis, endocarditis, keratitis, endophtalmitis, hydrosalpinx, oral ulcer and lymphadenitis have all been linked to the fungus in humans. It causes skin infections in chicken, sea lion, and cat, lung infection in sheep, epididymitis in dog, and mastitis in cow and buffalo. The organism is an opportunist, taking advantage of immunosuppressive circumstances, indwelling devices, and antibiotic exposure. In order to confirm the diagnosis of rhodotoruliosis, laboratory assistance is required. The direct demonstration of Rhodotorula in the clinical specimens and its isolation in pure and luxuriant growth still considered the gold standard of diagnosis. Amphotericin B or one of its lipid formulations appears to be the medication of choice for treating the patient. The infection due to Rhodotorula especially in immunosuppressed individuals can be life threatening if the treatment is delayed. Prognosis of systemic disease in compromised subject may be grave. Early diagnosis is essential to start specific antifungal therapy of rhodotorulosiosis to prevent serious complications.

Molecular Tools for Detection and Identification of Paracoccidioides Species: Current Status and Future Perspectives

Paracoccidioidomycosis (PCM) is a mycotic disease caused by the Paracoccidioides species, a group of thermally dimorphic fungi that grow in mycelial form at 25 °C and as budding yeasts when cultured at 37 °C or when parasitizing the host tissues. PCM occurs in a large area of Latin America, and the most critical regions of endemicity are in Brazil, Colombia, and Venezuela. The clinical diagnosis of PCM needs to be confirmed through laboratory tests. Although classical laboratory techniques provide valuable information due to the presence of pathognomonic forms of Paracoccidioides spp., nucleic acid-based diagnostics gradually are replacing or complementing culture-based, biochemical, and immunological assays in routine microbiology laboratory practice. Recently, taxonomic changes driven by whole-genomic sequencing of Paracoccidioides have highlighted the need to recognize species boundaries, which could better ascertain Paracoccidioides taxonomy. In this scenario, classical laboratory techniques do not have significant discriminatory power over cryptic agents. On the other hand, several PCR-based methods can detect polymorphisms in Paracoccidioides DNA and thus support species identification. This review is focused on the recent achievements in molecular diagnostics of paracoccidioidomycosis, including the main advantages and pitfalls related to each technique. We discuss these breakthroughs in light of taxonomic changes in the Paracoccidioides genus.

Aspergillus mediastinal lymphadenopathy with bronchial invasion mimicking cancer in an immunocompetent host

The clinical presentation of pulmonary mycotic disease is determined by the interaction between the fungus and host. Inhalation of spores resulting in sino-pulmonary disease is the most frequent manifestation. It can have a myriad radiological manifestations ranging from ground glassing, fleeting consolidations, and cavitation to interstitial thickening. Mediastinal lymphadenopathy locally eroding into multiple bronchi is highly unusual. The main clinical presentations are cough, hemoptysis, and dull chest pain. Diagnosis is based on either indirect serological tests or direct visualization of hyphae under the microscope. We present a case of a 25-year-old laborer with hemoptysis and weight loss; found to have mediastinal lymphadenopathy invading endobronchially. Tuberculosis, lymphoma, and bronchogenic carcinoma were our initial differential diagnosis, but invasive aspergillosis was later confirmed following biopsy. The role of a fungal etiology in pulmonary lesions among immunocompetent individuals is often overlooked. This case highlights the need to keep a broad differential in mind while dealing with mediastinal lymphadenopathy.

The Effects of Oregano Oil on Fungal Infections Associated with Metabolic Syndrome

This study aims to compare the evolution of mycosis associated with metabolic syndrome under allopathic treatment compared to phytotherapy using oregano essential oil. The study was conducted over a period of 6 months, on a total of 72 patients diagnosed with fungal infections associated with metabolic syndrome. The patients were divided into 3 groups, depending on the administered treatment: group 1: 24 patients who received allopathic treatment; group 2: 24 patients who received oregano oil treatment; group 3: control, which did not undergo any antifungal treatment. All three groups were subjected to specific diet therapy for mycosis. The patients were initially evaluated at 10 days after the begining of the treatment (to track mycotic disease evolution in the acute phase), at 60 days (to evaluate the recurrence of mycoses) and at 180 days to track recurrent disease. Most infections were acute (77.78%), the chronic ones representing only 5.56% of cases. There were also 12 cases with recurrent infections (16.67%), out of which 6 cases (8.33%) had previously shown resistance to Nystatin. In the 72 cases there was a sensitivity of 100.00% for oregano oil and Ketaconazolum, insignificantly higher than for Myconazolum (97.22%, p=0.157), but significantly higher than for Clotrimazolum and Nystatinum (94.44%, p=0.0437), Variconazole and Fluconazole (88.89%, p=0.0038) and Itraconazole (86.11%, p=0.0011). The results of this study showed an increased efficiency of oregano oil on the symptomatic and paraclinical improvement of mycotic infections in the study, both on short term and on long term, which was completed with high tolerability.

Talaromikosis Marneffei

Talaromycosis marneffei is a mycotic disease caused by Talaromyces marneffei which primarily infectimmunocompromised patient. This disease is endemic in Southeast Asia, and Indonesia consider as endemic area dueto a case of tourist who got the infection after visiting Indonesia. Diagnosis was made based on clinical suspicion withlaboratory confirmation. Clinical manifestations are not specific, such as fever, anemia, weight loss, lymphadenopathy,hepatomegaly, splenomegaly, respiratory disorder, and cutaneous manifestation. Histopathology and culture are themost common examination performed for diagnosis. In histopathology examination, fungi appear as fission arthroconidiacells which shape round to oval, with cross wall formation inside or outside macrophage and histiocyte. Thermaldimorphism characteristic can be observed in fungal culture. Fungi grows as mold at 25oC-30oC and as yeast at 37oC.Definitive identification of T. marneffei was done by molecular examination using primers derived from ITS region asprimary marker and beta tubulin region as secondary marker. Talaromyces marneffei is sapronosis, that transmitted viainhalation of conidia from environment.

Bilateral adrenal histoplasmosis diagnosed on CT guided biopsy

Adrenal histoplasmosis is an uncommon mycotic disease occurring in only 0.65% of non-AIDS patients. We report a case of bilateral adrenal histoplasmosis diagnosed on CT guided biopsy in a diabetic patient. JMS 2018: 21 (2):126

An Assessment of Alternative Therapeutic Options for the Treatment of Prolonged Zoonotic Fungal Infections in Companion Animals

Zoonotic disease is an ongoing issue, becoming more prominent as more microbial species display antimicrobial resistance. The role of companion animals in society is also increasing as therapy dogs become the mainstay for many special needs persons. In order to ensure public health safety, it is essent ial to determine the extent of resistance amongst zoonotic pathogens and where possible to suggest novel treatment options to counteract such resistance. Fungal species are increasingly recognised as the causative agent in numerous incidents of canine morb idity. Therefore, the development of new, safe and effective chemotherapeutic agents is essential to prevent and control mycotic disease. Chronic incidents of cutaneous candidiasis as diagnosed in the cases used for this study are particularly high risk fo r zoonotic transmission. Studies described herein evaluate the resistance of these canine isolates of Candida species to common antifungal agents and identify levels of resistance using recognised in vitro methods. Results show high levels of resistance to amphotericin B, fluconazole and caspofungin for Candida albicans and Candida krusei isolates. This clinical resistance was more prominent in isolated species compared to control species. Novel compounds namely phendione and Roussin Black salts show promis ing antifungal activity with minimum inhibitory concentrations determined.

Subcutaneous Phaeohyphomycosis of Foot in an Immunocompetent Host

ABSTRACTWe report a case of subcutaneous phaeohyphomycosis of foot, which is a mycotic disease that produces brown pigmented hyphae, pseudohyphae and yeast form in combination. The patient was immunocompetent and had injury 23 years before, and developed a non healing foot ulcer which was clinically suspected as tuberculous or carcinomatous etiology. Local wide excision was done and sent in formalin for histopathological examination. Microscopically pigmented septate, hyphae and yeast forms were identified on hematoxylin and eosin stained sections which were confirmed by special stains such as periodic acid-Schiff and Gomori’s methenamine silver stains.

Pathology of mycotic gastritis in a wild Indian freshwater/marsh crocodile (Mugger; Crocodylus palustris): a case report

There is no report on systemic mycotic disease in wild crocodilians so far. This report describes possibly the first ever case of deep gastric mycosis in a wild Indian crocodile. A carcass of an adult female, broad snouted Indian marsh crocodile was brought for necropsy. Externally, all visible mucous membranes, eyes, cloacal opening and joints were normal. On opening the carcass, all visceral organs were found in normal position and appeared grossly normal. The stomach was empty except for the presence of a few small wooden and bony pieces, and several dark blackish patches of raised plaques on the gastric mucosa. Other areas of gastric mucosa showed diffuse congestion with petechial haemorrhages and oedema. Microscopically, gastric mucosa in plaque areas appeared extensively thickened and fibrosed with moderate infiltration of mononuclear cells. Gastric glands were atrophied due to massive fibrosis which appeared to have completely replaced the mucosal architecture in the affected area. In the superficial gastric mucosa and also deep in the fibrosed tissue, spherical to oval, variable sized, thick walled bodies, several of them budding and often forming small chains, sprouting and even germinating, giving rise to branched hyphae, were conspicuously observed. These fungal bodies were found to be PAS-positive. Species identification of the mould could not be done. The present case appears to be the first report of invasive mycotic gastritis in a wild Indian crocodile (Crocodylus palustris), most probably caused by Candida albicans.