First Case of Subcutaneous Mycoses Caused by Dirkmeia churashimaensis and a Literature Review of Human Ustilaginales Infections

ObjectiveDirkmeia churashimaensis, belonging to Ustilaginales fungi, has never been reported as clinical pathogenic until very recently. In this study, we report an unusual subcutaneous infection with Dirkmeia churashimaensis and reviewed all human Ustilaginales infections. The aim is to better understand their epidemiology, infection type, risk factors, and the sensitivity to antifungal agents.MethodsAn 80-year-old female farmer developed extensive plaques and nodules on her left arm within 2 years. Pathological and microbiological examinations identified a new pathological agent, Dirkmeia churashimaensis, as the cause of this infection. The patient was successfully cured by oral itraconazole. We reviewed a total of 31 cases of Ustilaginales cases, among of which only three were skin infections.ResultsLocal barrier damage (i.e., surgery, trauma, and basic dermatosis) and systemic immunodeficiency (i.e., preterm and low birthweight, Crohn’s disease, malignant cancer, and chemotherapy) are risk factors for Ustilaginales infection. The D1/D2 and ITS regions are the frequently used loci for identifying the pathogens together with phenotype. Most patients could survive due to antifungal treatment, whereas seven patients died. Amphotericin B, posaconazole, itraconazole, and voriconazole showed good activity against these reported strains, whereas fluconazole, 5-flucytosine, and echinocandins usually showed low susceptibility. Itraconazole had good efficiency for subcutaneous infections.ConclusionsThe present case study and literature review reveal that Ustilaginales can be opportunistic pathogenic normally in immunocompromised and barrier damage people. A proper identification of fungi can be crucial for clinical treatment, and more data of antifungal are needed for choice of medication against this kind of infections.

Fungal dermatitis by Scopulariopsis brevicaulisin Guinea pig (Cavia porcellus)

Fungal dermatitis is classified into superficial, cutaneous and subcutaneous mycoses. However, the incidence of fungal dermatitis in small mammals is relatively low. Among rodents guinea pig the most affected specie, however it usually has an asymptomatic pattern. The present text reports an unusual case of fungal dermatitis in Caviaporcelluscaused by Scopulariopsis brevicaulis. The animal was received with complaint of alteration of coat around the neck, as well as report of incorrect feeding management. During the physical examination the presence of a dry and crusty dermatitis, negative on fluorescence test of wood. Samples of blood, skin, scabs and hair were collected for parasitic and mycological analysis. The hematological evaluation showed only a discrete eosinophilia; no ectoparasites were observed, but it was noticed the presence of Scopulariopsis brevicaulis. The animal underwent terbinafine and griseofulvin protocol, with total regression of the lesions after 30 days. S. brevicaulis is an unusual geophilic fungus causing animal mycosis, presenting more pathological reports in human mycoses, thus, representing a zoonotic potential. According to the clinical findings and results obtained from mycology assay, it was diagnosed dermatitis by Scopulariopsis brevicaulis, secondary to nutritional deficiency. The combined use of topical terbinafine with systemic griseofulvin was efficient in the treatment. Finally, it was recommended a dietary correction.

Histopathological evaluation of chromoblastomycosis: A literature review

Chromoblastomycosis (CBM) is a cutaneous or subcutaneous mycoses. The trauma occurs when the fungus is installed and is more prevalent in individuals living in tropical and subtropical regions, with earliest descriptions dating back to 1920. The diagnosis of CBM is based on the incidence of cases in the endemic areas and is commonly reached through microbiological analyses to identify the etiologic agent in clinical samples. The process for the analysis of the collected samples allows one to visualise the muriform cells, which are brown, rounded structures having crossed chambers and that can be commonly called sclerotic bodies, characterising the positive diagnosis. The objective of this review was to verify the connection of the histopathological techniques to the diagnosis of CBM.

Sporotrichosis in Mexico

Sporotrichosis is an endemic mycosis caused by the species of the Sporothrix genus, and it is considered one of the most frequent subcutaneous mycoses in Mexico. This mycosis has become a relevant fungal infection in the last two decades. Today, much is known of its epidemiology and distribution, and its taxonomy has undergone revisions. New clinical species have been identified and classified through molecular tools, and they now include Sporothrix schenckii sensu stricto, Sporothrix brasiliensis, Sporothrix globosa, and Sporothrix luriei. In this article, we present a systematic review of sporotrichosis in Mexico that analyzes its epidemiology, geographic distribution, and diagnosis. The results show that the most common clinical presentation of sporotrichosis in Mexico is the lymphocutaneous form, with a higher incidence in the 0–15 age range, mainly in males, and for which trauma with plants is the most frequent source of infection. In Mexico, the laboratory diagnosis of sporotrichosis is mainly carried out using conventional methods, but in recent years, several researchers have used molecular methods to identify the Sporothrix species. The treatment of choice depends mainly on the clinical form of the disease, the host’s immunological status, and the species of Sporothrix involved. Despite the significance of this mycosis in Mexico, public information about sporotrichosis is scarce, and it is not considered reportable according to Mexico’s epidemiological national system, the “Sistema Nacional de Vigilancia Epidemiológica.” Due to the lack of data in Mexico regarding the epidemiology of this disease, we present a systematic review of sporotrichosis in Mexico, between 1914 and 2019, that analyzes its epidemiology, geographic distribution, and diagnosis.

Superficial and subcutaneous mycoses

Tegument mycoses are classified into three groups: 1) Superficial skin mycoses or superficial mycoses: infections sustained by fungi limited to the skin horny layer or the hair extrafollicular portion, without a significant inflammatory response in the host. 2) Skin mycoses (dermatophytosis) sensu stricto: fungal infections in which skin and its annexes, at the level of the keratinized layers, are involved with an evident immune response by the host 3) Mycosis of the subcutaneous tissue: fungal infections that mainly affect the subcutaneous tissue and secondarily, by contiguity, skin, bones and other tissues, with a strong immune response by the host [...].

A prospective clinico mycological study of deep mycoses in a tertiary centre in Tamil Nadu

<p class="abstract"><strong>Background:</strong> Deep mycoses which<strong> </strong>includes subcutaneous mycoses and systemic mycoses, accounts for about 1% of the all the fungal infections seen in human beings. Though rare, these infections assume significance due to the increased morbidity and mortality associated with them. The objective of the study was to study the incidence, clinical presentation, aetiological agents and histopathological findings of deep mycoses in patients attending the mycology section, department of dermatology of a tertiary centre in Chennai.</p><p class="abstract"><strong>Methods:</strong> All Patients with clinical suspicion of deep mycoses who presented to mycology section during the period from November 2015 to September 2016 were screened. The samples from these patients were subjected to direct microscopy by potassium hydroxide wet mount, culture and histopathology.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among the 8250 patients who attended mycology OPD, 41 patients (0.5%) had deep mycoses. The commonly affected age group was 41-50 yrs (29.7%). Males (73.2%) were predominantly affected. Of the 41 patients, 26.8% were immunocompromised. 37 patients (90.2%) had subcutaneous infection and 4 (9.8%) had opportunistic mycoses. Mycetoma (43.2%) was the most common subcutaneous mycoses. Mucormycosis (75%) and aspergillosis (25%) were the opportunistic mycoses observed. KOH positivity was 100%, while culture positivity was 65.7%. <em>Madurella mycetomatis,</em> <em>Phialophora verrucosa</em>, <em>Rhizopus arrhizus</em> and <em>Aspergillus fumigatus</em> were the common organisms isolated in this study.</p><p class="abstract"><strong>Conclusions:</strong> Mycetoma is the most common subcutaneous mycoses in this part of India. Eumycetoma is more common than actinomycetoma. Phaeohyphomycosis is on the rise. Simple KOH examination would pave way for an early diagnosis and prompt treatment of deep mycoses.</p>