Facial cutaneous phaeohyphomycosis associated with Alternaria infectoriae infection
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Summary Cutaneous nodular disease in the horse is relatively rare and usually associated with arthropod bites, dermal hyperplasia and inflammatory or neoplastic infiltrates. Equine phaeohyphomycosis, particularly alternariosis, has been previously described in the literature and is usually associated with Alternaria alternata . In this article we report a case of phaeohyphomycosis caused by a member of Alternaria section Infectoriae in a horse. To our knowledge this is the first time that this organism has been identified in equids. Despite A. Infectoriae being commonly isolated in individuals receiving immunosuppressive therapy and/or suffering from Cushing's syndrome, we could not determine a link between pituitary pars intermedia dysfunction and fungal infection in this case. The mare responded well to surgical excision of the cutaneous lesions and made a full recovery.Keywords:
Phaeohyphomycosis
Zygomycosis
Rare molds are increasingly emerging as a cause of deep and invasive fungal infections. We report here a rare case of cutaneous phaeohyphomycosis of the lower limbs due to Alternaria alternata associated with extra-ungual localization of Scopulariopsis brevicaulis. Diagnosis was made based on repeated, direct, microscopic mycological and histological examinations. The study revealed hyphae and fungal cells in a granulomatous dermal infiltrate. Identification of the molds was based on macroscopic appearance on culture of samples from the lesions on Sabouraud's dextrose agar and microscopic appearance on Lactophenol cotton blue following slide culture.
Phaeohyphomycosis
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To identify recent trends in the frequency of zygomycosis in autopsy cases, we conducted epidemiological analysis every four years from 1989 to 2009 using national data reported in the "Annual of Pathological Autopsy Cases in Japan."153,615 cases were autopsied, of which 6622 (4.3%) were found to have had mycosis. Among these, there were 243 cases (3.7%) of zygomycosis, which was the fourth most predominant causative agent of mycoses among the monopathogen mycoses. Of the complicated mycoses, zygomycosis accounted for 56 cases. A total of 299 cases with zygomycoses were observed. The frequency of zygomycosis appeared to be generally stable over the twenty-year period from 1989 to 2009, at around 4% of autopsy cases having mycosis. Younger patients tended to have severe and complicated infections that were characteristic of zygomycosis, compared with non-zygomycosis. The pulmonary and gastrointestinal (GI) systems were the most common foci in our analysis, reflecting the severity of zygomycosis in these sites. Hematological disease was the most frequent underlying disease, but there was a peak of neonatal infections in 2009, which was the first time that this was observed in our studies.These results of the epidemiological analysis of autopsy cases with mycosis demonstrate that clinicians should promptly recognize and treat zygomycosis.
Zygomycosis
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Phaeohyphomycosis
Chromoblastomycosis
Immunosuppression
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Zygomycosis is characterized by a very high lethality, often favoured by rapid fungal growth in blood vessels causing the formation of thrombi and infarcts in several organs, a disease poor in symptoms. A disseminated mycosis normally is a complication of a granulocytopenia which is in our days more frequently observed as localized manifestation, whereas the typical rhinocerebral manifestation complicating diabetic ketoacidosis has become more rare. The diagnosis of zygomycosis can apparently be obtained easier by histology than by culture. The prognosis of zygomycosis can be improved by: 1. an early examination by biopsy, 2. if possible a rapid correction of predisposing factors (e.g. correction of acidosis), 3. an early antimycotic therapy by amphotericin B in risk patients, even if no causative agent can be cultured.
Zygomycosis
Diabetic ketoacidosis
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Although the dematiaceous fungus Veronaea botryosa is rarely encountered clinically, it can be pathogenic.A patient with a history of diabetes mellitus, coronary artery disease, and Cushing's syndrome had recurrent multifocal, crusted, brownish-red noduloplaques on the right forearm, left upper limb, and right knee. A skin biopsy was obtained for histopathology and fungal cultures.The histopathology showed brownish hyphae and yeast-like cells scattered in granulomatous infiltrates. Slide cultures revealed erect and straight conidiophores with two-celled cylindrical conidia, which have round tops and truncated bases. The fungus was identified as Veronaea botryosa. The disease slowly progressed despite a 6-month itraconazole regimen (200 mg daily). Subsequent use of Amphoterecin B produced only mild clinical improvements. Susceptibility tests showed resistance to both agents.Cutaneous phaeohyphomycosis caused by V. botryosa is extremely rare. Antifungal susceptibility tests are important for choosing the appropriate drug and predicting the clinical outcome.
Phaeohyphomycosis
Histopathology
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Two cases of ungual and cutaneous phaeohyphomycosis caused by Alternaria alternata and Alternaria chlamydospora are described. Oxiconazole and amorolfine were most effective in vitro against A. alternata and A. chlamydospora respectively. This is the first report of A. chlamydospora as an opportunistic pathogen of skin.
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Fungal pathogen
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Zygomycosis and aspergillosis are two serious opportunistic fungal infections that are commonly seen in immunocompromised patients. Since both these fungi invade vessels of the arterial system, an early and rapid diagnosis by direct examination of KOH mounts of the relevant clinical sample can confirm the diagnosis. Here, we present an unusual case of a diabetic patient who presented with nasal blockade and bleeding for 2 months, along with occasional haemoptysis for 15 days. On investigation, the patient was diagnosed with a case of rhinocerebral zygomycosis and was treated with amphotericin B (1 mg kg(-1) day(-1)), which was subsequently replaced with liposomal amphotericin B (2 mg kg(-1) day(-1)). However, the patient did not completely respond to therapy as haemoptysis continued. Further investigations revealed the presence of Aspergillus flavus in respiratory specimens. Thus, a final diagnosis of rhinocerebral zygomycosis with pulmonary aspergillosis in a non-HIV-infected patient was made, but due to infection of two vital sites by these fungi, the patient could not be saved.
Zygomycosis
Pulmonary aspergillosis
Opportunistic infection
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A phaeohyphomycotic infection caused by Alternaria alternata is reported in a 5-month-old Spanish mare. The diagnosis was made by direct microscopic examination and by repeated isolation of the fungus in culture. This is the first documented case to be reported in Spain.
Phaeohyphomycosis
Isolation
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Background. Pulmonary zygomycosis (PZ), an emerging mycosis among patients with cancer, has a clinical manifestation similar to that of invasive pulmonary aspergillosis (IPA). Most cases of PZ in such patients develop as breakthrough infections if treatment with antifungal agents effective against Aspergillus species is administered. However, clinical criteria to differentiate PZ from IPA are lacking.
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