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Pathogenic References 1001-1543

Fungal Glossary Pathogenic References as provided by Texas Tech University Health Sciences Center, Department of Microbiology and Immunology.

1001

Primary cutaneous zygomycosis due to Mucor circinelloides. Chandra S, Woodgyer A. Australas J Dermatol. 2002 Feb;43(1):39-42.

A 62-year-old woman with myelodysplastic syndrome presented with a 4-week history of a large indurated ulcer with a black eschar on the forearm following trauma. On biopsy a diagnosis of zygomycosis was made as broad, sparsely septate, thin-walled hyphae were seen in the deep dermis and subcutaneous fat. The zygomycete fungus Mucor circinelloides was cultured from tissue. Further investigation confirmed that the infection was localized to the skin. The 6 x 4 cm lesion was excised and the defect closed with a neurovascular island flap. No other treatment was undertaken. The patient died 6 months later from her haematological disease without recurrence of the fungal infection.

1002

A case of cutaneous mucormycosis in Shanghai, China. Wang JJ, Satoh H, Takahashi H, Hasegawa A. Mycoses. 1990 Jun;33(6):311-5.

A 34-year-old female farmer suffered from localized cutaneous mucormycosis for 17 years. At the first admission, the lesion was a dull red plaque, about 7 x 9 cm in size with ulcerations, surrounded by some nodules on the dorsum of her right hand. General examination did not reveal abnormal findings except the skin lesion. Direct examination of skin scrapings in 10% KOH revealed broad, sparsely septate, branching hyphae. Histopathology showed many intradermal granulomata and microabscesses as well as mycelial elements comprising broad, distorted, ribbon-like strands. Some of them were phagocytized by multi-nucleated giant cells. Cultures revealed rapidly growing yellow colonies on Sabouraud dextrose agar medium at 25 degrees C. Sporangiophores branched in sympodia and the sporangia were globose, 35-60 microns in diameter. Their walls were deliquescent, but some of them were rather persistent. Columellae were mostly globose, 12-17 microns in diameter, up to 35 microns with collars. Sporangiospores were mainly ellipsoidal, 1.5-2.5 x 3-5 microns in size, but sometimes highly variable in size and shape. The maximum growth temperature of the isolate was 37 degrees C. The pathogenic organism isolated was tentatively identified as Mucor lusitanicus, which, as far as we know, has not been reported as a causative agent of cutaneous mucormycosis.

1003

Subcutaneous mucormycosis caused by Mucor hiemalis Wehmer f. luteus (Linnemann) Schipper 1973. Costa AR, Porto E, Tayah M, Valente NY, Lacaz Cda S, Maranhao WM, Rodrigues MC. Mycoses. 1990 May;33(5):241-6.

The authors report a case of subcutaneous mucormycosis in a diabetic patient with verrucous lesions in the fourth finger of the right hand. Initially diagnosed as a fixed cutaneous sporotrichosis case, success was obtained with the use of potassium iodide with healing of the lesion in a period of nearly 5 months. At present the patient remains under clinical observation with no treatment or relapse.

1004

A fatal case of gastric mucormycosis and diabetic ketoacidosis.Paulo De Oliveira JE, Milech A.Endocr Pract. 2002 Jan-Feb;8(1):44-6.

OBJECTIVE: To describe a case of gastric mucormycosis in conjunction with severe bleeding in a young woman, which occurred after an episode of ketoacidosis and had a fatal outcome. METHODS: We present a case report, including detailed clinical and pathologic findings in a woman with gastric mucormycosis associated with severe bleeding. RESULTS: A 17-year-old woman sought medical assistance for diabetic ketoacidosis and severe epigastric pain. Chest radiography showed normal findings, and blood and urine cultures were negative for bacterial growth. Endoscopy disclosed an extensive ulcerated lesion involving the greater curvature and posterior wall of the stomach. Biopsy specimens demonstrated the presence of invasive mucormycosis. Treatment with amphotericin B was initiated, but severe persistent gastrointestinal bleeding resulted in the patient's demise. CONCLUSION: In conjunction with diabetic ketoacidosis, severe infection by Mucor has been reported mainly in the rhino-orbital area. Although uncommon, the gastrointestinal tract can also be involved. In the case described, severe hemorrhage ensued and caused the patient's death.

1005

[Myelodysplastic syndrome developing acute myelocytic leukemia with gastric mucormycosis] Sasaki A, Tsukaguchi M, Takayasu K, Hanai J. Rinsho Byori. 1993 Sep;41(9):1054-8.

80-year-old female was admitted to our hospital because of pancytopenia. Her peripheral and bone marrow examinations were performed. According to the criteria of FAB classification, the diagnosis was myelodysplastic syndrome (refractory anemia with excess of blasts in transformation). Etoposide was administered to decrease leukemic blasts. However, she still had high fever and increasing of CRP. Hematological data also showed the increasing of WBC count, blast cells, and LDH enzyme. Antibiotics and anti fungal drugs were also not effective. She died of respiratory failure, although the cautions and extensive treatment was tried. Autopsy findings revealed proliferation of mucor in the mucosa of stomach. So, we reported here a very rare case of gastric mucormycosis, localizing exclusively in the stomach which was difficult to diagnose while she was alive.

1006

Successful treatment of mucor infection after liver or pancreas-kidney transplantation. Jiménez C, Lumbreras C, Aguado JM, Loinaz C, Paseiro G, Andrés A, Morales JM, Sánchez G, García I, del Palacio A, Moreno E. Transplantation. 2002 Feb 15;73(3):476-80.

OBJECTIVE: To describe a case of gastric mucormycosis in conjunction with severe bleeding in a young woman, which occurred after an episode of ketoacidosis and had a fatal outcome. METHODS: We present a case report, including detailed clinical and pathologic findings in a woman with gastric mucormycosis associated with severe bleeding. RESULTS: A 17-year-old woman sought medical assistance for diabetic ketoacidosis and severe epigastric pain. Chest radiography showed normal findings, and blood and urine cultures were negative for bacterial growth. Endoscopy disclosed an extensive ulcerated lesion involving the greater curvature and posterior wall of the stomach. Biopsy specimens demonstrated the presence of invasive mucormycosis. Treatment with amphotericin B was initiated, but severe persistent gastrointestinal bleeding resulted in the patient's demise. CONCLUSION: In conjunction with diabetic ketoacidosis, severe infection by Mucor has been reported mainly in the rhino-orbital area. Although uncommon, the gastrointestinal tract can also be involved. In the case described, severe hemorrhage ensued and caused the patient's death.

1007

Hepatic and small bowel mucormycosis after chemotherapy in a patient with acute lymphocytic leukemia. Suh IW, Park CS, Lee MS, Lee JH, Chang MS, Woo JH, Lee IC, Ryu JS. J Korean Med Sci. 2000 Jun;15(3):351-4.

Mucormycosis is a rare but invasive opportunistic fungal infection with increased frequency during chemotherapy-induced neutropenia. The clinical infections due to Mucor include rhinocerebral, pulmonary, cutaneous, gastrointestinal and disseminated diseases. The first two are the most common diseases and all entities are associated with a high mortality rate. Still hepatic involvement of Mucor is rarely reported. We experienced a case of hepatic and small bowel mucormycosis in a 56-year-old woman after induction chemotherapy for B-cell acute lymphocytic leukemia. Initial symptoms were a high fever unresponsive to broad spectrum antibiotics and pain in the left lower abdominal quadrant. It was followed by septic shock, deterioration of icterus and progressively elevated transaminase. An abdominal CT demonstrated multiple hypodense lesions with distinct margins in both lobes of liver and pericolic infiltration at small bowel and ascending colon. Diagnosis was confirmed by biopsy of the liver. The histopathology of the liver showed hyphae with the right-angle branching, typical of mucormycosis. The patient was managed with amphotericin B and operative correction of the perforated part of the small bowel was performed. However, the patient expired due to progressive hepatic failure despite corrective surgery and long-term amphotericin B therapy.

1008

Subacute disseminated mucormycosis in a diabetic male. Nolan RL, Carter RR 3rd, Griffith JE, Chapman SW. Am J Med Sci. 1989 Oct;298(4):252-5.

Mucormycosis is an opportunistic invasive infection caused by fungi of the order Mucorales. Rhizopus, Absidia, and Mucor are the most commonly encountered genera. Disease is characterized by vascular invasion, thrombosis, and tissue necrosis. Rhinocerebral disease is the most common manifestation but pulmonary, cutaneous, gastrointestinal, and widely disseminated forms have been reported. Pulmonary and disseminated disease are usually seen in neutropenic patients with leukemia or lymphoma. Both present as fever and unexplained pulmonary infiltrates unresponsive to antibacterials and corticosteroids. Disease is usually fulminant and has a high mortality rate. Diagnosis is most commonly made at autopsy. A single case of disseminated disease is reported that is unusual in its subacute course and its occurrence in an otherwise healthy non-neutropenic diabetic male.

1009

Cerebral mucormycosis after liver transplantation: a case report. Webb M, Dowdy L, Bundschu C, Nery J, Schiff E, Tzakis AG. Clin Transplant. 1998 Dec;12(6):596-9.

A fatal case of cerebral mucormycosis occurring shortly after liver transplantation is described. The patient was a 32-yr-old male with advanced end-stage liver disease manifested by tense ascites, spontaneous bacterial peritonitis, deepening jaundice and anuria requiring hemodialysis. The 3rd day after successful liver transplantation the patient developed acute respiratory failure, then focal motor signs. Computed tomography showed fluid in the left maxillary sinus, partial opacification of the ethmoid and sphenoid sinuses, and diffuse low density lesions in both cerebral hemispheres. Despite treatment for cerebritis and cerebral edema, the patient's pupils became fixed and dilated, and brain death was declared. Autopsy revealed mucor sinusitis and cerebritis. Mucormycosis is an opportunistic fungal infection occurring in patients with diabetic ketoacidosis, malignancy, or immunodeficiency, and in those receiving wide-spectrum antibiotics, corticosteroids, or cytotoxic therapy. Mucor most frequently involves the face, rhinocerebral disease predominating. These infections are difficult to treat, but are curable with aggressive and frequent surgical debridement, discontinuation or reduction of immunosuppressive therapy and amphotericin. The diagnosis of mucormycosis is very difficult to make in cases such as the present one, in which the typical presentation and classical signs are not present. A high index of suspicion based on identified risk factors may assist in more rapid diagnosis of this life-threatening mycosis.

1010

Infection of the postoperative cavity of the ear with the Mucor mucedo fungus] Lev NA. Vestn Otorinolaringol. 1966 Mar-Apr;28(2):87-8.

 

1013

Fatal aortic Myceliophthora thermophila infection in a patient affected by cystic medial necrosis. Farina C, Gamba A, Tambini R, Beguin H, Trouillet JL. Med Mycol. 1998 Apr;36(2):113-8.

A 22-year-old Italian woman developed fungal aortitis after cardiac surgery for aortic insufficiency. She experienced two episodes of septic embolization and subsequently underwent replacement of the aortic root and initial ascending aorta by a homograft. The lumina of the ascending aorta, aortic arch and the origin of the innominate artery were completely filled with vegetation. From the involved tissue the phaeoid thermophilic hyphomycete Myceliophthora thermophila (Apinis) van Oorschot was isolated in pure culture. This is the second report of isolation of this fungus from humans and the first isolation of a human pathogenic strain of M. thermophila causing fatal vasculitis in a patient affected by cystic medial necrosis. A detailed morphological description of the isolate is also provided.

1014

Fatal disseminated infection caused by Myceliophthora thermophila, a new agent of mycosis: case history and laboratory characteristics. Bourbeau P, McGough DA, Fraser H, Shah N, Rinaldi MG. J Clin Microbiol. 1992 Nov;30(11):3019-23.

We report a case of human infection caused by the hyphomycete Myceliophthora thermophila. A 7-year-old male with neurofibromatosis (type 1) was diagnosed in 1987 with acute myeloblastic leukemia associated with the chromosomal abnormality monosomy 7. The patient experienced multiple serious infections over a three-year period before expiring in 1990 while in the end stage of leukemia. Autopsy findings included fungal vegetations of the left atrium, ascending aorta, and pulmonary arteries and fungal invasion of both lungs. Cultures yielded M. thermophila. We believe that this is the first reported fatality caused by M. thermophila.

1015

Frontal sinusitis caused by Myriodontium keratinophilum. Maran AG, Kwong K, Milne LJ, Lamb D. Br Med J (Clin Res Ed). 1985 Jan 19;290(6463):207.

 

1024

Mycoleptodiscus indicus: a new etiologic agent of phaeohyphomycosis. Padhye AA, Davis MS, Reddick A, Bell MF, Gearhart ED, Von Moll L. J Clin Microbiol. 1995 Oct;33(10):2796-7.

Mycoleptodiscus indicus, a dematiaceous hyphomycete, was identified as the causal agent of subcutaneous infection in the knee of a 72-year-old male gardener residing in coastal South Carolina. The patient had Wegener's granulomatosis and immunodeficiency. Synovial fluid and biopsy tissue sections from the prepatellar bursa stained with hematoxylin and eosin, periodic acid-Schiff, and Gomori methenamine silver stains revealed branched, septate hyphae and many moniliform hyphal elements. When tissue sections were stained by the Fontana-Masson procedure, melanin pigment in the hyphal cell walls and at the septa was evident. A velvety, dematiaceous mold was isolated from both synovial fluid and the biopsy tissue. Sporulation was induced by exposure of slide cultures on potato dextrose agar to UV light for 12 h at 25 degrees C followed by incubation of the slide cultures at 25 degrees C in the dark for 4 weeks. Clypeate sporodochia consisting of ampulliform, compressed, phialidic conidiogenous cells produced curved, hyaline, one-celled conidia with setulae at one or both ends. Initial treatment with fluconazole for 7 days was not effective, and cultures were positive after treatment. Treatment with amphotericin B with concomitant irrigation and debridement of the affected area followed by treatment with itraconazole resulted in resolution of the infection.

1027

Invasive Nattrassia mangiferae infections: case report, literature review, and therapeutic and taxonomic appraisal. Sigler L, Summerbell RC, Poole L, Wieden M, Sutton DA, Rinaldi MG, Aguirre M, Estes GW, Galgiani JN. J Clin Microbiol. 1997 Feb;35(2):433-40.

We report on a case of subcutaneous infection of the arm caused by the coelomycetous fungus Nattrassia mangiferae (formerly Hendersonula toruloidea) in a steroid-dependent diabetic man with chronic obstructive lung disease. The man was a resident of Arizona, where the fungus is known to be endemic on Eucalyptus camaldulensis and on citrus trees. Diagnosis of fungal infection was made by observation of narrow hyphal filaments by histopathology of biopsy specimens and isolation of a fast-growing black mold which demonstrated hyphae and arthroconidia of varying widths typical of the Scytalidium synanamorph (S. dimidiatum). The formation of pycnidia, which at maturity expressed conidia with a central median dark band, allowed for the confirmation of the isolate as N. mangiferae. Remission of the lesions occurred following intravenous therapy with amphotericin B, followed by topical clotrimazole treatment. We use this patient's case report as an opportunity to review the literature on cases of deep infection caused by Scytalidium species, to evaluate the antifungal susceptibilities of a spectrum of Scytalidium isolates, and to review the taxonomy of Scytalidium species isolated from human infections.

1028

Hendersonula toruloidea infection in Thailand. Kotrajaras R, Chongsathien S, Rojanavanich V, Buddhavudhikrai P, Viriyayudhakorn S. Int J Dermatol. 1988 Jul-Aug;27(6):391-5.

Hendersonula toruloidea infection is present in Thailand, where the clinical picture of tinea pedis is scales 61%, erythema 22%, maceration 10.8%, and hyperkeratosis 9%. The diagnosis was confirmed by repeated isolation of H. toruloidea. The slow-growing type was found more often than the fast-growing in the ratio of 2.8:1. In patients with H. toruloidea infection, skin test with Hs antigen of 1:10 was positive. Griseofulvin sensitivity test revealed that the MIC of 20 cultures was more than 100 micrograms/ml. Only 2 out of 93 cases (0.02%) were cured with half-strength Whitfield ointment for 4 months. Pathomechanism of the infection is being studied.

1029

Hendersonula toruloidea, causative agent of a fungal verrucous dermatitis observed in Algeria] Mariat F, Liautaud B, Liautaud M, Marill FG. Sabouraudia. 1978 Jun;16(2):133-40.

A verrucose dermatitis of the face, accompanied by onychomycosis was observed in a 30 years old male living in Algeria. He was born there and 15 years previously he had been treated successfully for "Dermatophytic disease" due to Trichophyton verrucosum. A deficiency in his cellular immune mechanism was noted at that time. On this occasion Hendersonula toruloidea was isolated from facial lesions and affected nails. The infection of the face, but not the nails, responded to treatment with amphotericin B. In the facial lesions, the fungus was present as single cell units sometimes with a false bud or a short hyphal extension. Cross walls were occasionally present but the cell walls were not pigmented. Intratesticular inoculation of the isolates to guinea pigs resulted in an infection in which the morphology of the fungus conformed to that found in the facial lesions. In cultures, the isolates of H. toruloidea conformed to the descriptions in literature, although pycnidia were not formed.

1030

Hendersonula toruloidea infection of the skin and nails. Eady R, Moore M.

Trans St Johns Hosp Dermatol Soc. 1974;60(1):104-8.

 

1031

Infection of thefeet and nails with Hendersonula toruloidea. Gentles JC, Evans EG. Sabouraudia. 1970 May;8(1):72-5.

 

1032

Onychomycosis caused by Scytalidium dimidiatum. Report of two cases. Review of the taxonomy of the synanamorph and anamorph forms of this coelomycete. Lacaz CS, Pereira AD, Heins-Vaccari EM, Cucé LC, Benatti C, Nunes RS, de Melo NT, de Freitas-Leite RS, Hernández-Arriagada GL. Rev Inst Med Trop Sao Paulo. 1999 Sep-Oct;41(5):319-23.

The authors report two cases of onychomycosis in the dystrophic form, one of them involving an HIV-positive patient, provoked by Scytalidium dimidiatum, previously called Scytalidium lignicola. The subject is reviewed from the taxonomic viewpoint, considering the anamorph Hendersonula toruloidea as a synonym of Nattrassia mangiferae, and having Scytalidium dimidiatum as the major synanamorph. According to many mycologists, Scytalidium hyalinum may be a separate species or a hyaline mutant of Scytalidium dimidiatum. Scytalidium lignicola Pesante 1957 was considered to be the type-species of the genus by ELLIS (1971)13 and later to be a "conidial state" of Hendersonula toruloidea by the same author, today known as Nattrassia mangiferae. The microorganism lives only on the roots of certain plants (mainly Platanus and Pinus). It produces pycnidia and is not considered to be a pathogen, although it is considered as a possible emerging agent capable of provoking opportunistic fungal lesions. The importance of this topic as one of the most outstanding in fungal taxonomy, so likely to be modified over time, as well as its interest in the field of dermatologic mycology, are emphasized.

1033

Case report. Nattrassia mangiferae endophthalmitis. Gumbo T, Mkanganwi N, Robertson VJ, Masvaire P. Mycoses. 2002 Apr;45(3-4):118-9.

Nattrassia mangiferae is a plant pathogen that is also known as a cause of skin infection in humans. Reports of invasive human infection are extremely rare. A 60-year-old-immunocompetent patient presented with endophthalmitis one week after the left eye was injured by a piece of grass. Cultures of an aqueous tap grew N. mangiferae. The patient responded to oral ketoconazole. This suggests that N. mangiferae may be an invasive pathogen in plant penetration injuries and that ketoconazole may be an alternative treatment, especially in countries with poor resources.

1041

Disseminated Neocosmospora vasinfecta infection in a patient with acute nonlymphocytic leukemia. Cornely OA, Chemnitz J, Brochhagen HG, Lemmer K, Schütt H, Söhngen D, Staib P, Wickenhauser C, Diehl V, Tintelnot K. Emerg Infect Dis. 2001 Jan-Feb;7(1):149-52.

We report Neocosmospora vasinfecta infection following chemotherapy for acute nonlymphocytic leukemia. N. vasinfecta, a plant pathogen, was identified by culture and genetic sequencing. Susceptibility testing revealed in vitro resistance for common antifungals.

1042

Osteoarthritis caused by Neocosmospora vasinfecta. Kac G, Piriou P, Guého E, Roux P, Trémoulet J, Denis M, Judet T. Med Mycol. 1999 Jun;37(3):213-7.

We report the case of a patient who developed an ankle osteoarthritis due to the Ascomycete Neocosmospora vasinfecta, following accidental multiple trauma to his legs in whilst in Africa. Antifungal susceptibility testing was performed. Despite a low amphotericin B minimal inhibitory concentration, parenteral antifungal therapy failed and amputation was required to resolve the osteoarthritis. Possible reasons for the failure of this antifungal treatment are examined.

1043

Leg granuloma due to Neocosmospora vasinfecta in a renal graft recipient. Ben Hamida F, Achard JM, Westeel PF, Chandenier J, Bouzernidj M, Petit J, Carme B, Fournier A. Transplant Proc. 1993 Jun;25(3):2292.

 

1050

Cerebral Aspergillosis Caused by Neosartorya hiratsukae, Brazil. Guarro J, Kallas EG, Godoy P, Karenina A, Gené J, Stchigel A, Colombo AL. Emerg Infect Dis. 2002 Sep;8(9):989-91.

We report the first case of infection by Neosartorya hiratsukae, an ascomycete in which the conidial state resembles Aspergillus fumigatus. The fungus caused a brain infection in a Brazilian woman, who died despite itraconazole treatment. Diagnosis was established by direct microscopic examination, computed tomographic scan, and magnetic resonance imaging of the brain, and repeated cultures from the lesions. The in vitro antifungal susceptibility of the isolate is provided.

1051

Neosartorya fischeri: an invasive fungal pathogen in an allogeneic bone marrow transplant patient. Lonial S, Williams L, Carrum G, Ostrowski M, McCarthy P Jr. Bone Marrow Transplant. 1997 Apr;19(7):753-5.

Invasive fungal infections are a complication of allogeneic BMT. We report the first case of a Neosartorya fischeri fungal infection in a patient following allogeneic BMT. Neosartorya fischeri is related to Aspergillus fumigatus, but it is a distinct fungal species. Despite granulocytic engraftment and aggressive anti-fungal therapy with amphotericin B, the patient died of overwhelming fungal infection on day 60 post-BMT. Neosartorya fischeri is a pathogen that grows slowly in culture which can delay or confuse identification. This case further supports the need for more effective prophylaxis and treatment of non-Candida fungal infections in the allogeneic BMT population.

1052

Osteomyelitis caused by Neosartorya pseudofischeri. Padhye AA, Godfrey JH, Chandler FW, Peterson SW. J Clin Microbiol. 1994 Nov;32(11):2832-6.

The first case of osteomyelitis caused by Neosartorya pseudofischeri is reported. The patient, a 77-year-old male with a history of silicosis and tuberculosis, on X-ray examination revealed lytic lesions of L2 and L3 vertebrae suspicious for metastatic lesions. Histologic examination of biopsy specimens from vertebral bodies showed short, distorted, extra- and intracellular, hyaline hyphal fragments. The culture from the biopsy tissue produced numerous, evanescent asci containing eight ellipsoidal ascospores with two distinctive equatorial bands ca. 1 micron wide. When examined by a scanning electron microscope, ascospores exhibited a convex surface ornamented with raised flaps of tissue, in shape resembling triangular projections or long ridge lines. The conidial state (anamorph) was identified as Aspergillus thermomutatus on the basis of conidial columns which were smaller and less tightly packed as well as of a lighter shade of green than those observed in Aspergillus fumigatus. On the basis of the morphologic features of the ascospores, the teleomorph was identified as N. pseudofischeri.

1053

Graft-related endocarditis caused by Neosartorya fischeri var. spinosa. Summerbell RC, de Repentigny L, Chartrand C, St Germain G. J Clin Microbiol. 1992 Jun;30(6):1580-2.

The first case of endocarditis caused by Neosartorya fischeri var. spinosa is reported. The patient was a child who received a calf pericardium graft after removal of a previously inserted Dacron graft associated with deterioration of adjacent tissue. Copious vegetations removed from the heart were found to be composed of septate hyaline fungal filaments. The fungus was recognized in culture by its bivalved, winged, spiny ascospores, its Aspergillus fischerianus anamorph, and its thermotolerance.

1054

Neosartorya fischeri var fischeri (Wehmer) Malloch and Cain 1972 (anamorph: Aspergillus fischerianus Samson and Gams 1985) as a cause of mycotic keratitis. Coriglione G, Stella G, Gafa L, Spata G, Oliveri S, Padhye AA, Ajello L. Eur J Epidemiol. 1990 Dec;6(4):382-5.

The first case of mycotic keratitis caused by Neosartorya fischeri var. fischeri the teleomorph of Aspergillus fischerianus, is described. The patient, a 62-year-old man, had no history of trauma to his infected left eye. The infection progressed despite treatment with ketoconazole and the eye had to be eviscerated. Histological studies revealed the presence of hyaline, septate mycelium in the eye tissue. Cultures gave rise to a thermotolerant mould that developed both its asexual and sexual forms. The isolate was identified on the basis of the morphologic features of its anamorphic and teleomorphic states. In the literature only seven other species of Aspergillus have been unequivocally reported as causing mycotic keratitis.

1055

[Recent contribution to the study of mycetoma in Senegal. Neotestudina rosatii. Pyrenochaeta romeroi. Aspergillus nidulans] Baylet R, Camain R, Chabal J, Izarn R. Bull Soc Med Afr Noire Lang Fr. 1968;13(2):311-3.

 

1056

[Agents of mycetomas: a bacteriological and parasitological study (author's transl)] Peloux Y, Quilici M. Med Trop (Mars). 1979 Jan-Feb;39(1):9-15.

Microscopic agents responsible of Mycetomas are reviewed. They may be bacteria belonging to the Actinomycetalae order (Nocardia, Actinomadura, Streptomyces) or very various fungi belonging to the classes of Adelomycetes or Ascomycetes (Madurella, Leptosphaeria, Neotestudina, etc.). Though the procedures for collecting and transporting samples are the same, direct microscopic examination gives possibility to choose among the selective culture media the most appropriate ones to isolate either fungi or Actinomycetalae. Technics of identification for the most important bacterial agents are given, but fungi can be identified in only very specialized laboratories. Immunological methods may bring valuable indications for helping diagnosis or treatment supervision.

1057

The histopathological features of pale grain eumycetoma. Hay RJ, Mackenzie DW. Trans R Soc Trop Med Hyg. 1982;76(6):839-44.

Histological findings in 24 cases of pale grain eumycetoma have been compared. The inflammatory response and morphology of grains caused by different organisms are very similar. However the histological appearances of Neotestudina rosatii infections, although reminiscent of dermatophyte mycetomas, are distinctive. The characteristic features include the presence of cement and the short swollen hyphal segments. Petriellidium boydii grains are more likely to contain numerous vesicles or swollen hyphae and be surrounded by a prominent eosinophilic fringe. In contrast, Fusarium and Acremonium grains usually have a minimal fringe and contain a dense mass of intermeshing hyphae. However the features separating P. boydii and Fusarium/Acremonium grains are not invariable and can only be used as an approximate guide to the correct identity of the organism.

1058

Description of a new agent for maduromycosis, Neotestudina rosatii, n. gen., n. sp., isolated in Africa] SEGRETAIN G, DESTOMBES P. C R Acad Sci (Paris) 1961 Nov 27;253:2577-9.

 

1060

Nigrospora causing corneal ulcer--a case report. Muralidhar S, Sulthana M. Indian J Pathol Microbiol. 1997 Oct;40(4):549-51.

A patient from a rural background developed corneal ulceration following an insect hitting the eye. Corneal scrapings when processed for bacterial and fungal growth yielded Nigrospora, a contaminant fungus. This fungus has been quoted in literature as a common contaminant of no pathogenic significance. Herein, we describe its role as the causative agent of corneal ulcer, which has not been reported thus far.

1064

Isolation of a Nodulisporium species from a case of cerebral phaeohyphomycosis. Umabala P, Lakshmi V, Murthy AR, Prasad VS, Sundaram C, Beguin H. J Clin Microbiol. 2001 Nov;39(11):4213-8.

A fungal infection of the brain of a 55-year-old male patient is reported. The lesion and involved fungus were located exclusively in the right medial temporo-parietal region. The patient was successfully treated with surgical resection of the lesion and antifungal chemotherapy. Few pathogenic dematiaceous fungi exhibit neurotropism and can cause primary infection in the central nervous system (CNS). The etiological agent is described as a Nodulisporium species. To date Nodulisporium has never been reported as an agent of CNS infection in humans.

1068

. Infections due to dematiaceous fungi in organ transplant recipients: case report and review. Singh N, Chang FY, Gayowski T, Marino IR. Clin Infect Dis. 1997 Mar;24(3):369-74.

Dematiaceous fungi are being increasingly recognized as pathogens in organ transplant recipients. We describe a case of invasive esophagitis due to Cladophialophora bantiana in a small bowel transplant recipient and review a total of 34 cases of infections due to dematiaceous fungi in organ transplant recipients. The median time to the onset of fungal infection after transplantation was 22 months. Clinically, two distinct patterns of infections were observed: 79% of the patients had skin and/or soft-tissue infections or joint infections (predominantly due to Exophiala species), and 21% had systemic invasive infections (predominantly brain abscesses due to Ochroconis gallopavum [Dactylaria gallopava, Dactylaria constricta var. gallopava]). The overall mortality rate among the patients with skin and/or soft-tissue infections or joint infections and the patients with systemic invasive disease was 7% and 57%, respectively; two of five patients with brain abscesses were cured with antifungal therapy. Recognition of infections due to dematiaceous fungi is important since these infections, unlike invasive aspergillosis, may be more amenable to therapy.

1069

Successful therapy for cerebral phaeohyphomycosis due to Dactylaria gallopava. Nieto-Rodriguez JA, Kusne S. Clin Infect Dis. 1996 Jul;23(1):211.

 

1070

Successful therapy for cerebral phaeohyphomycosis due to Dactylaria gallopava in a liver transplant recipient. Vukmir RB, Kusne S, Linden P, Pasculle W, Fothergill AW, Sheaffer J, Nieto J, Segal R, Merhav H, Martinez AJ. Clin Infect Dis. 1994 Oct;19(4):714-9.

A 68-year-old liver transplant recipient who was being treated with FK 506 and immunosuppressive steroid therapy was admitted to our medical center because of a tonic-clonic seizure. Computed tomography of the head revealed multiple discrete cerebral abscesses, and culture of fluid drained intraoperatively yielded a dematiaceous fungus. The isolate was susceptible to amphotericin B and itraconazole but was resistant to flucytosine and fluconazole. The patient was successfully treated with a prolonged course of amphotericin B colloidal dispersion and itraconazole, as evidenced by both clinical and radiographic resolution of disease over a 2-year follow-up.

1071

Phaeohyphomycosis caused by Dactylaria (human dactylariosis): report of a case with review of the literature. Kralovic SM, Rhodes JC. J Infect. 1995 Sep;31(2):107-13.

Phaeohyphomycosis due to Dactylaria (Ochroconis) spp. is a rare infection of man. It was first reported in 1986. All patients have had significant immunosuppression. To our knowledge, this is the second case of phaeohyphomycosis caused by Dactylaria constricta var. gallopava in a liver transplant patient and it developed even though he had been receiving fungal prophylaxis with fluconazole. Moreover, this case may represent nosocomial acquisition. In addition, we have reviewed the English language literature of previously reported patients with phaeohyphomycosis caused by Dactylaria spp.

1072

Subcutaneous abscesses caused by Ochroconis gallopavum. Fukushiro R, Udagawa S, Kawashima Y, Kawamura Y. J Med Vet Mycol. 1986 Jun;24(3):175-82.

A subcutaneous fungus infection that occurred in a patient with an acute myeloblastic leukemia was found to be caused by Ochroconis gallopavum (Dactylaria gallopava). In histological sections dematiaceous, septate hyphae were present. A darkly pigmented fungus was isolated on Sabouraud glucose medium. The mycological features of the causative agent were typical of O. gallopavum. The patient died after 6 months of treatment with antileukemic drugs and 5-fluorocytosine. At autopsy, tissue sections revealed leukemic infiltrates in most of the internal organs but fungal invasion was not detected.

1073

A case report of a dactylaria fungal infection in a lung transplant patient. Mazur JE, Judson MA. Chest. 2001 Feb;119(2):651-3.

Dematiaceous fungi such as Dactylaria gallopava are becoming more prevalent in transplant patients, with 50% of outcomes being fatal. In this report, we describe a 32-year-old woman who presented with swelling in the right shoulder area and right lateral neck. On further investigation with a CT scan, a fluid collection in the shoulder was identified, drained, and subsequently grew D gallopava. We report the successful treatment of an invasive Dactylaria infection in a lung transplant patient predominantly by medical chemotherapy, although surgical incision and drainage was performed on one of the fungal lesions.

1074

Multiple lung abscesses due to Ochroconis gallopavum, a dematiaceous fungus, in a nonimmunocompromised wood pulp worker. Odell JA, Alvarez S, Cvitkovich DG, Cortese DA, McComb BL. Chest. 2000 Nov;118(5):1503-5.

An occurrence of multiple chronic lung abscesses managed by lobectomy is described. These abscesses were present for 13 years in the patient, a nonimmunocompromised wood pulp worker. The patient had hemoptysis at presentation. The organism isolated was Ochroconis gallopavum, a dematiaceous fungus known to cause disease in immunocompromised patients and epidemic encephalitis in poultry. The fungus is typically found in warm environments and in decaying compost; for this reason, we postulate that his illness was occupationally acquired.

1075

Pulmonary infection due to Ochroconis gallopavum treated successfully after orthotopic heart transplantation. Jenney A, Maslen M, Bergin P, Tang SK, Esmore D, Fuller A. Clin Infect Dis. 1998 Jan;26(1):236-7.

 

1076

Dactylaria gallopava infection presenting as a pulmonary nodule in a single-lung transplant recipient. Burns KE, Ohori NP, Iacono AT. J Heart Lung Transplant. 2000 Sep;19(9):900-2.

We describe the first case of a pulmonary nodule caused by Dactylaria gallopava in a lung-transplant recipient. An asymptomatic lung-allograft recipient was found to have a 2-cm nodule in the native lung 450 days after transplantation. Culture of a transthoracic needle biopsy of the solitary pulmonary nodule revealed Dactylaria gallopava. Treatment was initiated with amphotericin B for a period of 21 days followed by oral itraconazole for an 8-month period.

1077

Dactylaria infection of a human being: pulmonary disease in a heart transplant recipient. Mancini MC, McGinnis MR. J Heart Lung Transplant. 1992 Jul-Aug;11(4 Pt 1):827-30.

We describe a case of pulmonary abscess caused by Dactylaria constricta in a heart transplant recipient. A 30-year-old man with a 1-month history of fever and cough was found by computed tomographic scan to have a cavitary lesion in the lingular segment in the upper lobe of his left lung. Culture of a needle biopsy specimen yielded a pure culture of D. constricta. The patient was successfully treated with systemic amphotericin B therapy, which resulted in resolution of the clinical symptoms and of the cavitary lesion.

1078

Disseminated Dactylaria gallopava infection in a diabetic patient with chronic lymphocytic leukemia of the T-cell type. Terreni AA, DiSalvo AF, Baker AS Jr, Crymes WB, Morris PR, Dowda H Jr. Am J Clin Pathol. 1990 Jul;94(1):104-7.

A 62-year-old male with a 20-year history of diabetes and three-year history of adult T-cell lymphocytic leukemia developed a systemic infection with Dactylaria gallopava. At autopsy the fungus was found in the brain, lungs, liver, spleen, and kidney. The organism has caused disease in chickens and turkey poults and has been found in chicken litter, hot springs, and the effluent of a thermonuclear reactor. This report documents the second human infection and the first case of disseminated human dactylariosis.

1079

Disseminated Dactylaria constricta infection in a renal transplant recipient. Malani PN, Bleicher JJ, Kauffman CA, Davenport DS. Transpl Infect Dis. 2001 Mar;3(1):40-3.

We report the case of a 32-year-old renal transplant recipient who developed disseminated Dactylaria constricta infection. The patient died despite treatment with amphotericin B, itraconazole, and fluconazole.

1084

Oidiodendron cerealis isolated from neurodermitis nuchae. Blomqvist K, Salonen A. Dermatologica. 1969;139(2):158-60.

 

1085

Ovadendron sulphureo-ochraceum endophthalmitis after cataract surgery. Lee BL, Grossniklaus HE, Capone A Jr, Padhye AA, Sekhon AS. Am J 1995 Mar;119(3):307-12.

PURPOSE: We examined an 82-year-old woman with delayed-onset endophthalmitis caused by an opportunistic pathogen, Ovadendron sulphureo-ochraceum. METHODS: Tissue obtained during vitrectomy was cultured and examined by light and electron microscopy. An enucleation specimen was examined by light microscopy. RESULTS: The patient had fungal endophthalmitis, with O. sulphureo-ochraceum present in the lens capsule. The eye developed a necrotizing scleritis secondary to O. sulphureo-ochraceum. The patient failed to respond to intravitreous, subconjunctival, and systemic amphotericin B, and the eye was enucleated. CONCLUSION: In this case of O. sulphureo-ochraceum as a human pathogen, the organism caused endophthalmitis after cataract extraction.

1094

Growing incidence of cutaneous and ungual infections by non-dermatophyte fungi at Jabalpur (M.P.). Naidu J. Indian J Pathol Microbiol. 1993 Apr;36(2):113-8.

A random survey of skin and nail infections was done at Jabalpur (M.P.). Out of the 80 suspected cases 60 were culture positive. Out of these 25 were of dermatophyte infection followed by 21 cases of phaeohyphomycosis, 7 of aspergillosis, 4 of hyalohyphomycosis, 2 of mixed infection in which a non-dermatophyte was associated with a dermatophyte and 1 had yeast infection. Trichophyton rubrum was the only dermatophyte isolated. Among the non-dermatophyte infections cases of Alternaria chlamydospora, Cladosporium sphaero-spermum, Curvularia senegalensis, Chaetomium globosum, Scopulariopsis brumptii, Paecilomyces variotii and Aspergillus chevalieri are for the first time documented as etiologic agent of cutaneous and ungual mycosis from India.

1095

Paecilomyces variotii. An unusual cause of isolated sphenoid sinusitis. Thompson RF, Bode RB, Rhodes JC, Gluckman JL. Arch Otolaryngol Head Neck Surg. 1988 May;114(5):567-9.

Isolated fungal sphenoid sinusitis is an unusual head and neck infection. We describe the first reported case (to our knowledge) of Paecilomyces variotii sphenoid sinusitis. In addition, it represents one of the few reported cases of isolated fungal sphenoid sinusitis. Diagnosis and management of this condition are described. Aggressive surgical management is advocated when fungal sphenoid sinusitis is suspected.

1096

Paecilomyces fungus infection of the paranasal sinuses. Nayak DR, Balakrishnan R, Nainani S, Siddique S. Int J Pediatr Otorhinolaryngol. 2000 Apr 15;52(2):183-7.

Fungal infections caused by Paecilomyces species are very rare and occur in adult patients with impaired host defences or following foreign body implants. They are found worldwide in soil and decaying vegetation. We describe a case of an 8 year old child who came with complaints of left sided nasal obstruction and discharge, telecanthus, diplopia and epiphora. On examination and investigation he had pansinusitis caused by P. lilacinus. An endoscopic sinus surgery was done and the patient was on oral Itraconazole for 6 months. To our knowledge, this is the first case reported in the paediatric age group.

1097

Complicated soft tissue infection with prepatellar bursitis caused by Paecilomyces lilacinus in an immunocompetent host: case report and review. Westenfeld F, Alston WK, Winn WC. J Clin Microbiol. 1996 Jun;34(6):1559-62.

Documented Paecilomyces lilacinus infections are quite rare. Most reports involve immunocompromised patients or implanted objects. We report the first case of complicated soft tissue infection caused by P. lilacinus in an immunocompetent host. The spectrum of infections involving this fungus is reviewed.

1098

Paecilomyces pyelonephritis complicating nephrolithiasis and review of Paecilomyces infections. Sherwood JA, Dansky AS. J Urol. 1983 Sep;130(3):526-8.

We report a case of Paecilomyces variotii isolated from the renal pelvis at ureterolithotomy. The patient presented with nephrolithiasis, acute flank pain, fever and pyuria, which resolved postoperatively. Paecilomyces has infected the cornea, prosthetic lens implants, lacrimal sac, maxillary sinuses, prosthetic mitral and aortic valves, skin and a ventriculoperitoneal shunt.

1099

Paecilomyces marquandii cellulitis in a kidney transplant patient. Naldi L, Lovati S, Farina C, Gotti E, Cainelli T. Br J Dermatol. 2000 Sep;143(3):647-9.

 

1100

Paecilomyces lilacinus cellulitis in an immunocompromised patient. Jade KB, Lyons MF, Gnann JW Jr. Arch Dermatol. 1986 Oct;122(10):1169-70.

Paecilomyces lilacinus, a saprophytic soil fungus, is an uncommon human pathogen. An immunocompromised patient developed a deep cellulitis due to P lilacinus. The infection responded poorly to intravenous amphotericin B but eventually resolved after combination therapy with amphotericin B and flucytosine (5-fluorocytosine). Previous in vitro studies have suggested that miconazole is the most active antifungal agent against P lilacinus.

1101

Chronic suppurative otitis media caused by Paecilomyces variotii. Dhindsa MK, Naidu J, Singh SM, Jain SK. J Med Vet Mycol. 1995 Jan-Feb;33(1):59-61.

A case of chronic suppurative otitis media is described in a patient with a chronic cold and cough. The presenting symptoms were otorrhoea, perforation of the tympanic membrane and granulation in the air cells of the left mastoid cavity. X-ray showed sclerotic mastoid and partial cellular obliteration. Histologic sections revealed aggregated fungal masses, filamentous hyphae and single-celled structures of Paecilomyces variotii. The infection responded to topical ketoconazole therapy. This is the first reported case of chronic suppurative otitis media caused by P. variotii.

1102

Paecilomyces javanicus endocarditis of native and prosthetic aortic valve. Allevato PA, Ohorodnik JM, Mezger E, Eisses JF. Am J Clin Pathol. 1984 Aug;82(2):247-52.

A 41-year-old diabetic woman developed endocarditis of the aortic valve caused by Paecilomyces javanicus six years after insertion of a porcine mitral valve heterograft. The patient died shortly after aortic valve replacement. Autopsy revealed vegetations of the aortic heterograft, valve ring abscess and ascending aortitis due to Paecilomyces. There was no involvement of the mitral valve heterograft. Lesions due to mycotic emboli were found in the kidneys, spleen, and brain. Cultures of the surgically removed aortic valve and of the kidney at autopsy produced rapid growth of P. javanicus. The gross and microscopic pathologic and cultural characteristics of this organism are described with a review of the literature. Previously reported cases of Paecilomyces endocarditis occurred only in prosthetic heart valves. This is the first known report of P. javanicus endocarditis of a native valve and its prosthetic heart valve heterograft.

1103

Infective endocarditis caused by Paecilomyces varioti. Kalish SB, Goldschmidt R, Li C, Knop R, Cook FV, Wilner G, Victor TA. Am J Clin Pathol. 1982 Aug;78(2):249-52.

The first reported case of Paecilomyces varioti endocarditis occurring on a porcine heterograft prosthesis is presented and the clinical and pathological features described in the four previously reported cases of prosthetic valvular endocarditis caused by this organism are reviewed. In each case, infection became apparent more than two months after cardiac surgery. Three of the four patients with infected aortic prosthesis developed outflow obstruction secondary to valvular vegetations. All patients died regardless of medical or surgical intervention. Appropriate therapy remains unknown.

1104

Multifocal osteomyelitis caused by Paecilomyces varioti in a patient with chronic granulomatous disease. Cohen-Abbo A, Edwards KM. Infection. 1995 Jan-Feb;23(1):55-7.

This report describes an 18-year-old male patient with chronic granulomatous disease who developed cutaneous nodules and multifocal osteomyelitis with the saprophytic fungus Paecilomyces varioti. After several biopsies the organism was identified. Anti-fungal susceptibility testing was performed. Combination therapy with amphotericin B and gamma-interferon followed by long-term therapy with itraconazole and gamma-interferon resulted in a clinical response.

1105

Cerebral Paecilomyces javanicus infection. An ultrastructural study. Ho KL, Allevato PA, King P, Chason JL. Acta Neuropathol (Berl). 1986;72(2):134-41.

A 41-year-old diabetic woman developed Paecilomyces javanicus endocarditis and subsequent cerebral fungal embolism and vasculitis with massive infarction and hemorrhage 6 years after a mitral valve replacement with porcine heterograft. The organism was identified by the culture from the infected brain tissue and aortic valve. Cerebral infection due to fungus Paecilomyces is rare. This report documents the cerebral manifestations of fungus Paecilomyces javanicus and describes for the first time the ultrastructure of such an organism obtained from the infected tissue. Their ultrastructural findings, similar to those described in Paecilomyces farinosus derived from culture, include a double-layered cell wall, a triple unit plasma membrane, abundant cytoplasmic lipid droplets, vacuoles, membranous profiles and septal formation. This report further demonstrates hyphae with packed 50A filaments and granulofibrillary material and features suggestive of intrahyphal hyphae, not previously described in fungus Paecilomyces.

1106

Lung abscess caused by Paecilomyces lilacinus. Ono N, Sato K, Yokomise H, Tamura K. Respiration. 1999;66(1):85-7.

We report the case of a 57-year-old man who was referred to our department for further investigation of an abnormal chest shadow. Radiography on admission demonstrated a coin lesion in the right hilum. To make a final diagnosis, right middle lobectomy was performed and the mass was revealed to be a fungal abscess. Further examination confirmed that the fungus was Paecilomyces lilacinus. This is the first reported case of lung abscess caused by P. lilacinus in an otherwise healthy person.

1107

Paecilomyces varioti pneumonia in a patient with diabetes mellitus. Byrd RP Jr, Roy TM, Fields CL, Lynch JA. J Diabetes Complications. 1992 Apr-Jun;6(2):150-3.

Paecilomyces is a saprophytic soil fungus that is an uncommon human pathogen. We report a diabetic patient who developed an upper lobe pulmonary infection due to Paecilomyces varioti. This pneumonia responded poorly to oral imidazole therapy with ketoconazole. Eventual treatment of the chronic infiltrating process required administration of intravenous amphotericin B. This experience emphasizes the potential pathologic nature of this fungus when immunity is compromised by poorly controlled diabetes.

1108

Progressive cutaneous hyalohyphomycosis due to Paecilomyces lilacinus: rapid response to treatment with caspofungin and itraconazole. Safdar A. Clin Infect Dis. 2002 May 15;34(10):1415-7.

A case of rapidly progressive cutaneous infection due to Paecilomyces lilacinus developed in a woman with advanced pancreatic cancer who did not have granulocytopenia. The infection responded favorably to caspofungin and itraconazole combination therapy.

1109

Case report. Successful treatment of cutaneous Paecilomyces lilacinus infection with oral itraconazole in an immune competent host. Gottlieb T, Atkins BL. Mycoses. 2001 Dec;44(11-12):513-5.

A 59-year-old woman presented to us with an eight-month history of Paecilomyces lilacinus soft tissue infection. She was treated with a six-month course of oral itraconazole. The lesion resolved fully without the need for adjunctive surgery. Susceptibility testing confirmed susceptibility to itraconazole. This is the second case of confirmed P. lilacinus soft tissue infection in an immunocompetent host treated with oral itraconazole alone.

1110

Cutaneous hyalohyphomycosis caused by Paecilomyces lilacinus in a renal transplant patient. Blackwell V, Ahmed K, O'Docherty C, Hay RJ. Br J Dermatol. 2000 Oct;143(4):873-5.

We describe a renal transplant recipient with cutaneous hyalohyphomycosis due to Paecilomyces lilacinus and highlight the increasing importance of such opportunistic fungal infections in immunosuppressed patients.

1111

Cutaneous hyalohyphomycosis caused by Paecilomyces lilacinus in an immunocompetent host successfully treated with itraconazole: case report and review. Gutiérrez-Rodero F, Moragón M, Ortiz de la Tabla V, Mayol MJ, Martín C. Eur J Clin Microbiol Infect Dis. 1999 Nov;18(11):814-8.

Paecilomyces lilacinus is an emerging fungal pathogen that is highly resistant to many antifungal drugs. Skin and subcutaneous soft tissue infections caused by this organism are very unusual. Most cases occur in patients with impaired host defenses or following surgical procedures. There has been only one previous report of a histologically confirmed cutaneous infection due to Paecilomyces lilacinus in a patient without predisposing factors. Described here is the second histopathologically proven case of Paecilomyces lilacinus cutaneous infection in a healthy patient without any apparent portal of entry. Prolonged antifungal chemotherapy with itraconazole led to resolution of the skin lesion. This case of sporadic cutaneous infection due to Paecilomyces lilacinus is believed to be the first reported in Europe and the first histopathologically proven case successfully treated with itraconazole.

1112

Outbreak of invasive mycoses caused by Paecilomyces lilacinus from a contaminated skin lotion. Orth B, Frei R, Itin PH, Rinaldi MG, Speck B, Gratwohl A, Widmer AF. Ann Intern Med. 1996 Nov 15;125(10):799-806.

BACKGROUND: Invasive mycoses are an important cause of illness and death in immunocompromised patients. Infections with molds other than aspergilli have been increasingly seen in patients with hematologic cancers, but epidemics of these infections have not yet been reported. OBJECTIVE: To describe an outbreak of invasive mycoses with Paecilomyces lilacinus in severely neutropenic patients. DESIGN: An outbreak investigation. SETTING: The hematology-oncology isolation and bone marrow transplantation unit of the University Hospital, Basel, Switzerland. PATIENTS: 25 consecutive patients admitted between 17 August 1993 (the date of the first manifestation of P. lilacinus infection) and 31 October 1993 (when the unit was closed). MEASUREMENTS: Clinical and microbiological data, including histologic findings; cultures from several patient sites; and environmental examinations of potential airborne, parenteral, enteric, and horizontal routes of transmission. Infections were defined by the isolation of P. lilacinus from clinically evident skin eruptions. RESULTS: 12 of the 25 patients (48%) were infected or colonized. Nine patients (36%), including all bone marrow transplant recipients, had documented invasive P. lilacinus infections. All 9 infected patients had papular, pustular, or necrotic skin eruptions. Two patients with severe graft-versus-host disease died with refractory fungal disease; 1 also had microbiologically documented endophthalmitis and kidney infiltrates. Seven affected patients no longer had P. lilacinus after recovery of bone marrow function. The organism was resistant in vitro to amphotericin B, itraconazole, and fluconazole. Patients did not respond clinically to these agents. The outbreak was ultimately traced to a contaminated, commercially available, pharmaceutically prepared skin lotion. The outbreak ended after the skin lotion was recalled and has not recurred after a follow-up period of 2 years. CONCLUSION: Contaminated skin lotion is a potential cause of opportunistic fungal infections in immunocompromised hosts. Paecilomyces lilacinus is a common saprophytic mold that can cause, by direct cutaneous inoculation, invasive infections associated with illness and death.

1113

Paecilomyces lilacinus fungemia in an adult bone marrow transplant recipient. Chan-Tack KM, Thio CL, Miller NS, Karp CL, Ho C, Merz WG. Med Mycol. 1999 Feb;37(1):57-60.

Paecilomyces lilacinus is a rare fungal pathogen in humans. We report a case of fungemia caused by P. lilacinus in a non-neutropenic adult, 120 days after bone marrow transplant. The patient's primary risk factor was the presence of an indwelling vascular catheter. Her initial clinical course was characterized by fever, chills, and rigors. Blood cultures from the central line and peripheral veins were positive, as was a peripheral specimen drawn after removal of the catheter. Two initial peripheral specimens were positive for P. lilacinus only by blind subculture and/or sustained incubation. She developed peripheral pulmonary nodules following the fungemia, thus raising the possibility of disseminated disease, but definitive diagnosis was confounded by Pseudomonas bacteremia. The nodules cleared and she recovered following removal of the central line and treatment with amphotericin B and 5-fluorocytosine, despite in vitro resistance to these antifungal drugs. This case underscores the increasing importance of P. lilacinus as a human pathogen capable of producing disease in immunocompetent, as well as in immunocompromised hosts. Also of note is that blood culture systems may require extended incubation or subcultures in order to detect fungi.

1114

Paecilomyces varioti fungemia in a bone marrow transplant patient. Shing MM, Ip M, Li CK, Chik KW, Yuen PM. Bone Marrow Transplant. 1996 Feb;17(2):281-3.

Paecilomyces varioti, a fungus resembling penicillium spp, has been described in conjunction with impaired host defence or foreign body implants. We report a case of Paecilomyces varioti catheter-related fungemia that occurred during neutropenia in an allogeneic BMT patient receiving antifungal prophylaxis with fluconazole. Successful treatment was achieved by removal of central venous catheter, intravenous amphotericin B and oral itraconazole.

1115

Paecilomyces lilacinus catheter-related fungemia in an immunocompromised pediatric patient. Tan TQ, Ogden AK, Tillman J, Demmler GJ, Rinaldi MG. J Clin Microbiol. 1992 Sep;30(9):2479-83.

Paecilomyces lilacinus catheter-related fungemia in an immunocompromised child is reported. The presence of a central venous catheter and the patient's immunocompromised status were felt to be predisposing factors for this unusual infection. To our knowledge, this is the first description of P. lilacinus catheter-related fungemia, and our patient may be the youngest reported patient with this mycosis who was cured.

1119

Ocular and central nervous system paracoccidioidomycosis in a pregnant woman with acquired immunodeficiency syndrome. Luiz V; Belfort, Rubens Jr. Finamor LP, Muccioli C, Martins MC, Rizzo LV, Belfort R Jr. Am J Ophthalmol. 2002 Sep;134(3):456-9.

PURPOSE: To describe an atypical case of central nervous system and ocular paracoccidioidomycoses simulating ocular toxoplasmosis in a pregnant woman with acquired immunodeficiency syndrome (AIDS). DESIGN: Interventional case report. METHODS: Case report. RESULTS: A 25-year-old pregnant woman with AIDS, presented with a severe ocular inflammation in the right eye involving the choroid, retina, and the optic disk, which rapidly progressed to retinal detachment, iris neovascularization, and neovascular glaucoma. The left eye was normal. Magnetic resonance imaging (MRI) showed a focal hypodense contrast-enhanced ring lesion in the brain. Serum antibody titers were negative for Toxoplasma gondii, but the polymerase chain reaction was positive for the parasite in the vitreous sample. The patient responded partially to specific treatment for toxoplasmosis, and there was a small reduction in size of the brain lesion. She progressed to a blind painful eye, which was enucleated. Paracoccidioides brasiliensis was found in the histopathological studies of the eye and oropharynx. With the diagnosis of disseminated ocular paracoccidioidomycoses, the patient was treated with trimethoprim-sulfamethoxazole with a satisfactory outcome and reduction in size of the brain lesion. CONCLUSION: Although ocular infection with ocular paracoccidioidomycoses is rare, this diagnosis should be considered when investigating ocular inflammation in a patient with AIDS.

1120

The pathobiology of Paracoccidioides brasiliensis. Borges-Walmsley MI, Chen D, Shu X, Walmsley AR. Trends Microbiol. 2002 Feb;10(2):80-7.

Paracoccidioides brasiliensis causes one of the most prevalent systemic mycoses in Latin America--paracoccidioidomycosis. It is a dimorphic fungus that undergoes a complex transformation in vivo, with mycelia in the environment producing conidia, which probably act as infectious propagules upon inhalation into the lungs, where they transform to the pathogenic yeast form. This transition is readily induced in vitro by temperature changes, resulting in modulation of the composition of the cell wall. Notably, the polymer linkages change from beta-glucan to alpha-glucan, possibly to avoid beta-glucan triggering the inflammatory response. Mammalian oestrogens inhibit this transition, giving rise to a higher incidence of disease in males. Furthermore, the susceptibility of individuals to paracoccidioidomycosis has a genetic basis, which results in a depressed cellular immune response in susceptible patients; resistance is conferred by cytokine-stimulated granuloma formation and nitric oxide production. The latency period and persistence of the disease and the apparent lack of efficacy of humoral immunity are consistent with P. brasiliensis existing as a facultative intracellular pathogen.

1121

metropolitan area of Rio de Janeiro. Nogueira SA, Guedes AL, Wanke B, Capella S, Rodrigues K, Abreu TF, Morais JC, Lambert JS. J Trop Pediatr. 2001 Oct;47(5):311-5.

The authors describe a case of paracoccidioidomycosis in a 7-year-old girl from the city of Rio de Janeiro who initially presented to her physician with a lesion in her calcaneous which was misdiagnosed and treated as bacterial osteomyelitis. Later, cutaneous manifestations, lymph node enlargement, and hepatosplenomegaly developed and biopsy of the skin and cervical lymph nodes showed the fungus which was also present in the sputum. It is emphasized that Paracoccidioides brasiliensis can be the cause of bone lesions in endemic areas of Latin America and that response to treatment with amphotercin B is good.

1122

Paracoccidioidomycosis of the central nervous system: case report] da Silva CE, Cordeiro AF, Gollner AM, Cupolilo SM, Quesado-Filgueiras M, Curzio MF. Arq Neuropsiquiatr. 2000 Sep;58(3A):741-7.

The involvement of the central nervous system in paracoccidioidomycosis is more frequent than previously thought. The first reference to the possibility that Paracoccidioides brasiliensis could affect the central nervous system was by Pereira & Jacobs in 1919. Since then, a great number of other studies has showed this form of clinical behavior and, in some of them, the frequency has ranged 27.27%. We report a clinical case of a 34-year-old white Brazilian woman admitted because of bacterial pneumonia. In the sixth day of admission, the patient developed cerebellar symptomatology with nausea, vomiting, dysmetria and gait disturbance. Central nervous system computer tomographic scanning disclosed a hypodense lesion in the right cerebellar hemisphere. The patient was submitted to surgery with total excision of the lesion. Histopathological examination confirmed the diagnosis of neuroparacoccidioidomycosis. Coadjuvant treatment with sulfamethoxazole-trimetoprim was introduced. The patient had a good outcome and was discharge 30 days after surgery.

1123

Endemic regions of paracoccidioidomycosis in Brazil: a clinical and epidemiologic study of 584 cases in the southeast region. Blotta MH, Mamoni RL, Oliveira SJ, Nouér SA, Papaiordanou PM, Goveia A, Camargo ZP. Am J Trop Med Hyg. 1999 Sep;61(3):390-4.

This paper describes the clinical-seroepidemiologic characteristics of patients with paracoccidioidomycosis (PCM) who visited the University Hospital at the State University of Campinas (Campinas, Sao Paulo, Brazil). The study group consisted of 584 individuals (492 males and 92 females) with ages ranging from 5 to 87 years. The highest incidence of the disease occurred between the ages of 41 and 50 years for men and between 11 and 40 years for women. Rural activities were the principal occupation of 46% of the patients. The diagnosis was confirmed by histopathologic examination and demonstration of fungus in scrapings, secretions, or in the sputum. Serologic test results for PCM were positive in 80% of the 584 patients studied. The significant number of patients, including 33 children less than 14 years old, indicates the presence of the fungus in the area and that this region is an important endemic area for PCM.

1124

Paracoccidioidomycosis. Bethlem EP, Capone D, Maranhao B, Carvalho CR, Wanke B. Curr Opin Pulm Med. 1999 Sep;5(5):319-25.

Paracoccidioidomycosis is a systemic infection caused by the dimorphic fungus Paracoccidioides brasiliensis. It is commonly an endemic disease in Latin America, but several cases have been reported outside this area, particularly now in this time of world globalization. Primary pulmonary infection occurs commonly in the first and second decades of life and usually has a benign, self-limited respiratory infection course. The adult chronic manifestation of the disease is usually the result of reactivation of quiescent lesions with diffuse lung infiltrates, predominately of the interstitial pattern, with or without involvement of various other organs. The finding of this disease in a patient is an important step for the large differential diagnosis of the interstitial lung diseases group.

1125

Palpebral paracoccidioidomycosis. Burnier SV, Sant'Anna AE. Mycopathologia. 1997;140(1):29-33.

This paper describes two cases of eyelid paracoccidioidomycosis (South American blastomycosis) in which it was the first signal of the disease. In both cases the first clinical diagnosis made was not a fungal infection, but a neoplastic disease that was not confirmed by the pathology study. In the first patient we suspected a primary infection on the eyelid, because there was no other systemic signs of the disease, and in the second patient we noted a very advanced pulmonary lesions caused by the Paracoccidioides brasiliensis. We believe that, in endemic areas, the histopathological study should be made before every excisional procedures to avoid unnecessary palpebral mutilation.

1126

Paracoccidioidoma: case record and review. dos Santos JW, Michel GT, Londero AT. Mycopathologia. 1997;137(2):83-5.

A case of solitary pulmonary paracoccidioidal lesion-paracoccidioidoma-is related. It is the first reported case in Brazil. The literature on spontaneously regressive lesion of paracoccidioidomycosis is commented upon.

1153

Penicillium marneffei infection and solitary pulmonary nodule. Chang C, Chan CK, Chow KC, Lam CW. Hong Kong Med J. 1998 Mar;4(1):59-62.

We report on a patient infected with human immunodeficiency virus who presented with fever, a solitary pulmonary nodule, and cervical lymphadenopathy. The diagnosis of Penicillium marneffei infection was made from an excisional lymph node biopsy and a sputum culture. The microbiology, pathology, diagnosis, and treatment of the case are discussed. A high level of clinical suspicion is necessary for making an early diagnosis and improving the outcome of infection.

1154

Fatal Penicillium citrinum pneumonia with pericarditis in a patient with acute leukemia. Mok T, Koehler AP, Yu MY, Ellis DH, Johnson PJ, Wickham NW. J Clin Microbiol. 1997 Oct;35(10):2654-6.

We report here a case of fatal Penicillium citrinum infection. The patient, who suffered from acute myeloid leukemia, developed signs and symptoms typical of fungal pneumonia and pericardial tamponade after undergoing standard induction chemotherapy. Despite attaining complete remission of her leukemia, the patient succumbed 8 weeks after presentation. At autopsy, multiple nodular cavitary pulmonary lesions with invasion by fungal hyphae were found. Pericardial and lung tissue obtained at autopsy grew P. citrinum, a fungus ubiquitous in the environment but seldom reported as a pathogen. The microbiological findings were consistent with the histopathological features and confirmed this as a case of true P. citrinum infection causing fatal pulmonary and pericardial complications in an immunocompromised host.

1155

Unusual lung mycosis: Penicillium++ marneffei infection] Breton P, Bani Sadr F, Germaud P, Leautez S, Morin O, Raffi F. Rev Pneumol Clin. 1998 May;54(2):85-7.

We report an uncommon radiographic finding which led to the diagnosis of Penicillium marneffei pulmonary mycosis in an HIV positive woman. The patient who lived in France had travelled several times to her native country. Thailand, prior to the development of fever, weight loss, skin lesions with a macular aspect around the umbilicus. The chest x-ray demonstrated non-excavated round opacities. Penicillium marneffei was isolated from alveolar lavage fluid and blood samples. This rare fungus is usually found in immunodepressed subjects, especially HIV+ patients (CD4 < 50) should be suspected in subjects who have travelled to endemic zones (Southeast Asia). Penicillium marneffei is considered as a criteria for AIDS. P. marneffei is the only dimorphic member of the Penicillium genus and has a particular affinity for the reticuloendothelial system. Clinical manifestations vary, usually with skin lesions. Mycology diagnosis is usually made on blood samples as well as alveolar lavage or pleural fluids. Antifungals (amphotericin B. itraconazole, ketoconazole) are generally effective but the risk of relapse underlines the importance of secondary prophylaxis in immunodepressed subjects.

1156

Imported penicilliosis marneffei in the United States: report of a second human infection. Pautler KB, Padhye AA, Ajello L. Sabouraudia. 1984;22(5):433-8.

The first natural infection due to Penicillium marneffei in a human was reported in the United States in 1973. We describe a second case of penicilliosis marneffei that was diagnosed in Florida. In both instances, the patients had a history of travel in Southeast Asia where P. marneffei is endemic. The Florida patient had recurrent episodes of hemoptysis attributed to bronchitis and bronchiectasis. In spite of therapy with various antibacterial antibiotics for tuberculosis, the granulomatous lesions in the left upper lobe of the lungs persisted. The diagnosis of penicilliosis marneffei was established by isolating and identifying the dimorphic species of Penicillium, P. marneffei. The histopathologic features of the lung tissue included granulomata with central areas of necrosis and neutrophilic infiltration with many yeast-like, tissue-form cells of P. marneffei, which multiplied by a fission rather than a budding process.

1157

[Onychopathy due to Penicillium (green nails): topical treatment with econazole nitrate] Rotoli M, Capizzi R, Tulli A. G Ital Dermatol Venereol. 1982 May-Jun;117(3):XV-XVII

 

1158

A case of invasive penicilliosis in Hong Kong with immunologic evaluation. So SY, Chau PY, Jones BM, Wu PC, Pun KK, Lam WK, Lawton JW. Am Rev Respir Dis. 1985 Apr;131(4):662-5.

A 53-yr-old Chinese sailor developed prolonged pyrexia with unresolved lobar pneumonia, cervical lymphadenopathy, generalized subcutaneous abscesses, and pericardial effusion. Penicillium marneffei was isolated from pericardial fluid and subcutaneous pus and was demonstrated on histologic sections of lymph nodes and lung tissue. The penicilliosis was treated successfully with amphotericin B, ketoconazole, and 5-fluorocytosine. Subsequently, he also developed other T-lymphocyte-related opportunistic infections such as disseminated cutaneous herpes zoster and chronic osteomyelitis of sternum caused by Salmonella typhimurium. He was also a chronic carrier of cytomegalovirus. Further investigations showed that he had persistent depression of T-lymphocyte function and enhancement of B-lymphocyte activity, the cause of which was undetermined.

1159

Cutaneous manifestations of disseminated Penicillium marneffei mycosis in five HIV-infected patients. Chiewchanvit S, Mahanupab P, Hirunsri P, Vanittanakom N. Mycoses. 1991 May-Jun;34(5-6):245-9.

Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand.

Five cases of disseminated Penicillium marneffei mycosis of Thai HIV patients, presented between November 1990 and April 1991, have been investigated. All patients were male and had bone marrow involvement. They showed mucocutaneous lesions with papules predominantly on the faces and upper extremities (5 cases), palatal papules (3 cases), and chronic genital ulcer (2 cases). P. marneffei was cultured, and the specific tissue form of the fungus was demonstrated histopathologically from skin and bone marrow specimens. In future, with increasing awareness of mucocutaneous lesions, disseminated penicilliosis in HIV-infected patients might be diagnosed sooner, thus leading to earlier therapy and better prognosis of the disease.

1160

Case report: cutaneous penicilliosis due to Penicillium chrysogenum. López-Martínez R, Neumann L, González-Mendoza A. Mycoses. 1999;42(4):347-9.

A case of cutaneous penicilliosis in a young man, without immunological compromise is reported. The lesions in the neck were characterized by two exudative reddish-purple pruriginous and painless spots. Penicilliosis was diagnosed after serial laboratory studies based on the observation of hyphae by direct microscopic examination and histopathology. Cultures of the tissue obtained from the lesions, developed mould colonies with typical conidia of Penicillium chrysogenum, which was thermotolerant at 37 degrees C. The treatment with itraconazole was successful, and 15 days after cessation of therapy, no recurrence of infection was observed. The epidemiology of this type of mycosis is commented upon, as well as the rarity of infections produced by Penicillium, even as opportunistic pathogens. The isolation of P. chrysogenum from skin lesions is exceptional.

1161

Case report. Fungaemia due to Penicillium piceum, a member of the Penicillium marneffei complex. Horré R, Gilges S, Breig P, Kupfer B, de Hoog GS, Hoekstra E, Poonwan N, Schaal KP. Mycoses. 2001 Dec;44(11-12):502-4.

Due to the inability of most Penicillium species to grow at 37 degrees C, systemic non-marneffei infections are very rare in the human host. We describe a case of fungemia due to Penicillium piceum in a female patient, who died a few days after repeated isolation of this fungus from blood cultures. The species is a member of the section Biverticillata of Penicillium, as was confirmed by rDNA Internal Transcribed Spacer (ITS) sequence data, and hence may share virulence factors with P. marneffei.

1162

Systemic Penicillium marneffei infection in a child with common variable immunodeficiency. Lin WC, Dai YS, Tsai MJ, Huang LM, Chiang BL. J Formos Med Assoc. 1998 Nov;97(11):780-3.

Penicillium marneffei is rarely pathogenic in humans. Most previously reported cases of P. marneffei infection were from Southeast Asia where patients were usually in an immunocompromised state due to human immunodeficiency virus (HIV) infection. The majority of the patients reported in Western countries were immunocompromised by malignancy, especially Hodgkin's lymphoma. In Taiwan, the first case of P. marneffei infection was reported in 1994 and involved an adult with HIV infection. We report a case of systemic P. marneffei infection in a child with common variable immunodeficiency (CVID). The patient, a 4-year, 5-month-old boy, had a 1-year history of oligoarthritis resembling juvenile rheumatoid arthritis (JRA). He developed a low grade fever (38 degrees C) and hepatosplenomegaly 1 month before admission to the hospital. Although cultures of synovial fluid obtained at the time of onset of oligoarthritis did not grow any organisms, cultures of blood, bone marrow, synovial fluid, and lymph node biopsy samples taken during this admission were positive for P. marneffei. Further immunologic studies revealed a profile characteristic of CVID. The fungal infection was finally eradicated by combined therapy with amphotericin B, fluconazole, itraconazole, and regular immunoglobulin replacement. This case reminds us that JRA or JRA-like arthritis should be differentiated from septic arthritis caused by rare pathogens in immunocompromised patients.

1163

Penicillium marneffei fungemia in an AIDS patient: the first case report in Taiwan. Chiang CT, Leu HS, Wu TL, Chan HL. Changgeng Yi Xue Za Zhi. 1998 Jun;21(2):206-10.

We report a 36-year-old man with acquired immunodeficiency syndrome (AIDS), presenting systemic Penicillium marneffei (PM) infection. Fungal culture from the blood isolated PM. PM-induced enteritis was also suspected in this patient although there was no direct evidence. He also had other manifestations of immunocompromised status, including military tuberculosis and oral candidiasis. He died of respiratory failure in spite of prompt treatment for infection. This is the first confirmed case of PM infection in Taiwan.

1164

Systemic infection caused by Penicillium decumbens in a patient with acquired immunodeficiency syndrome. Alvarez S. J Infect Dis. 1990 Jul;162(1):283.

 

1165

Penicillium marneffei osteomyelitis. Chan YF, Woo KC. J Bone Joint Surg Br. 1990 May;72(3):500-3.

We report a case of systemic Penicillium marneffei infection in a Chinese woman who presented with multiple osteolytic lesions and radiographic changes similar to those seen in other fungal osteomyelitides. This infection is often misdiagnosed as tuberculosis and has a high mortality rate. The correct diagnosis is important since early antifungal therapy is life-saving.

1166

A case of Penicillium marneffei osteomyelitis involving the axial skeleton. Pun TS, Fang D. Hong Kong Med J. 2000 Jun;6(2):231-3.

Fungal infection of bone by Penicillium marneffei is rare. We report on a case of Penicillium marneffei infection in a Filipino woman, which involved multiple soft-tissue abscesses and infection of the axial skeleton. Early diagnosis and treatment of this potentially reversible disease is emphasised. Such an approach is essential to prevent bony destruction from becoming too advanced and, more importantly, to prevent any damage to the spinal cord from occurring.

1167

Fungal infections of ear with special reference to chronic suppurative otitis media. Talwar P, Chakrabarti A, Kaur P, Pahwa RK, Mittal A, Mehra YN. Mycopathologia. 1988 Oct;104(1):47-50.

Fungus were found to take important role in ear infections of the 344 patients (CSOM 286, Otomycosis 44, Otitis externa 14), significant fungal infections (with positive smear and culture) were detected on 49%, 79.5%, 66.6% patients respectively. 84.8% patients were detected both by smear and culture, 14.1% patients by culture and 0.1% patients in smear preparation only. In CSOM patients, age predominated in 20-27 yrs group, sex in male below 30 yrs, and Aspergillus flavus, A. niger, Penicillium, A. fumigatus in mycelial fungus, Candida albicans, C. parapsillosis in yeast. But in 18 post antibiotic fungus infected patients Penicillium and A. niger were the important isolates. In otomycosis and otitis externa patients A. niger took the main role.

1168

Fatal necrotizing esophagitis due to Penicillium chrysogenum in a patient with acquired immunodeficiency syndrome. Hoffman M, Bash E, Berger SA, Burke M, Yust I. Eur J Clin Microbiol Infect Dis. 1992 Dec;11(12):1158-60.

Although blue-green molds of the genus Penicillium are ubiquitous in the human environment, invasive penicilliosis is uncommon and primarily encountered among immunosuppressed patients. A patient with HIV infection who died of severe necrotizing esophagitis caused by Penicillium chrysogenum is reported and the relevant English language literature on human penicilliosis is reviewed. Although infectious esophagitis is commonly associated with AIDS, Penicillium esophagitis has not been described in such patients.

1169

Successful management of Penicillium endocarditis. DelRossi AJ, Morse D, Spagna PM, Lemole GM. J Thorac Cardiovasc Surg. 1980 Dec;80(6):945-7.

Penicillium endocarditis involving an aortic valvular tissue prosthesis (Ionescu-Shiley) was successfully managed. This is the fourth reported case of Penicillium endocarditis, and the first survivor. A review of the literature shows that this fungus is ubiguitous though rarely pathogenic. The management of this rare type of infection is outlined.

1174

Phaeomycotic cyst caused by Phaeoacremonium parasiticum] Kitamura K, Mochizuki T, Ishizaki H, Fukushiro R. Nippon Ishinkin Gakkai Zasshi. 2000;41(2):89-95.

Division of Dermatology, Kanazawa National Hospital, Kanazawa, Ishikawa, Japan.
Phaeoacremonium parasiticum was identified as the causative agent of a phaeomycotic cyst seen just below the right knee of a 59-year-old healthy woman. She had no history of trauma. Direct KOH examination of the pus aspirated from the subcutaneous nodule revealed abundant mycelia, which were not too deeply brown in color. The nodule was surgically excised, and there was no recurrence during a half year of observation. Tissue section of the excised material revealed rather a large cavity extending from the cutis to the subcutis. The cavity had a thick wall composed of granulomatous tissues. Mycelial and yeast-like fungal elements were seen within the cavity and the granulomatous tissues. A dematiaceous fungus was cultured from both pus and the excised material. The isolates were characterized by a dark green to black colony, unbranched or infrequently branched, brownish conidiophores bearing an aculeate monophialide with a narrow funnel-shaped collarette, and slimy, hyaline, one-celled, ellipsoid to allantoid conidia.

1175

Subcutaneous phaeohyphomycosis caused by Phaeoacremonium rubrigenum in an immunosuppressed patient. Matsui T, Nishimoto K, Udagawa S, Ishihara H, Ono T. Nippon Ishinkin Gakkai Zasshi. 1999;40(2):99-102.

BACKGROUND: Phaeohyphomycosis refers to infection by dematiaceous fungi with pigmented hyphae or yeast-like cells in the tissue. In humans, this disease is usually considered to be an opportunistic infection. The causal agents of phaeohyphomycosis include numerous species belonging to different genera and they are increasing as a result of the development of intensive medical therapy. OBSERVATION: We report the case of a 61-year-old Japanese female under corticosteroid treatment for malignant rheumatoid arthritis. An asymptomatic subcutaneous tumor developed on the back of her left foot. Histological examination of the excised material revealed mixed cell granuloma (H&E) and the presence of branched hyphal elements (periodic acid-Schiff). A fungus grown in pure culture was identified as Phaeoacremonium rubrigenum. CONCLUSION: The hyphomycete genus, Phaeoacremonium, was proposed in 1996 by Crous et al. Three species belonging to this genus have been isolated from clinical specimens: P. inflatipes, from a human toenail, human synovial fluid and human mycetoma of the foot, P. parasiticum, from a subcutaneous lesion on a kidney transplant patient and several other sources, and P. rubrigenum, from a human patient with pneumonia. To our knowledge, however, this is the first report of phaeohyphomycosis caused by Phaeoacremonium rubrigenum.

1176

Phaeohyphomycosis caused by Phaeoacremonium inflatipes. Padhye AA, Davis MS, Baer D, Reddick A, Sinha KK, Ott J. J Clin Microbiol. 1998 Sep;36(9):2763-5.

Phaeoacremonium inflatipes, one of three species previously classified as strains of Phialophora parasitica, was identified as the causal agent of a subcutaneous infection of the left foot of an 83-year-old woman from South Carolina. The patient had a granulomatous growth over the anteromedial aspect of her left foot. It was surgically excised, which led to complete healing without complications. Tissue sections of the excised mass stained with hematoxylin and eosin and Gomori's methenamine silver strains showed many septate hyphal elements of various lengths, some exhibiting brownish pigment in the cell walls of the hyphae. Portions of the tissue, when cultured, yielded many colonies which were initially glabrous, off white becoming velvety, greyish brown on aging. Microscopically, their hyphae were septate, branched, and phaeoid and bore lateral and terminal, erect, septate conidiophores. The conidiogenous cells (phialides) were terminal or lateral, mostly monophialidic, subcylindrical to spinelike in shape, and constricted at their bases and bore funnel-shaped, inconspicuous collarettes at their tips. The conidia were subhyaline, oblong, and ellipsoid to allantoid.

1177

Phaeoacremonium parasiticum infective endocarditis following liver transplantation. Heath CH, Lendrum JL, Wetherall BL, Wesselingh SL, Gordon DL. Clin Infect Dis. 1997 Nov;25(5):1251-2.

 

1178

Dermoscopy in the diagnosis of tinea nigra plantaris. Smith SB, Beals SL, Elston DM, Meffert JJ. Cutis. 2001 Dec;68(6):377-80.

Tinea nigra is a relatively uncommon dermatiaceous fungal infection, usually caused by Phaeoannellomyces werneckii, that may mimic a melanocytic lesion. We describe the value of epiluminescent dermoscopy of tinea nigra plantaris compared with other common diagnostic tools and procedures available (clinical appearance, potassium hydroxide [KOH], culture, culture mount preparation, and biopsy). A case of tinea nigra plantaris was evaluated clinically, microscopically with KOH, and dermatoscopically. Dermatoscopic findings were evaluated according to the Stolz system. Dermoscopy, clinical presentation, and microscopy with KOH all confirmed the diagnosis, with dermoscopy being the fastest and simplest procedure. Dermoscopy is a useful clinical adjuntive tool in differentiating tinea nigra from a melanocytic lesion.

1179

Bilateral tinea nigra plantaris and tinea nigra plantaris mimicking melanoma. Tseng SS, Whittier S, Miller SR, Zalar GL. Cutis. 1999 Oct;64(4):265-8.

Tinea nigra, a superficial fungal infection caused by Phaeoannellomyces werneckii, presents as a hyperpigmented, nonscaling macule of variable size and shape. Typically lacking induration, erythema, or pruritus, these "ink spot" lesions may resemble junctional nevi or malignant melanoma. Rapid, noninvasive diagnosis can be provided by potassium hydroxide examination, demonstrating numerous large, dematiaceous hyphae.

1180

Tinea nigra palmaris. Hughes JR, Moore MK, Pembroke AC. Clin Exp Dermatol. 1993 Sep;18(5):481-2.

Tinea nigra is a clinically distinctive superficial mycosis of the palms, and occasionally the soles, caused by Phaeoannellomyces werneckii. A patient, resident in the United Kingdom, is described who acquired the infection in Thailand. The condition cleared after treatment with topical miconazole cream 2%.

1181

Phaeohyphomycotic cyst caused by a recently described species, Phaeoannellomyces elegans. Engleberg NC, Johnson J 4th, Bluestein J, Madden K, Rinaldi MG. J Clin Microbiol. 1987 Apr;25(4):605-8.

An 81-year-old man presented with a chronic, painful nodule on the palmar surface of the left fourth finger. As a former farm worker, the patient acknowledged frequent soil-contaminated wounds of the left hand 4 to 12 years previously, but he denied any recent trauma. The patient's other medical problems included a history of chronic immunoglobulin A gammopathy and a new pleural mass eroding into adjacent ribs on chest X-ray. The finger nodule was excised and consisted of an intact phaeohyphomycotic cyst which yielded growth of a darkly pigmented fungus. At 25 degrees C, the isolate formed annellidic yeast cells having dark-brown walls consistent with the recently described species Phaeoannellomyces elegans. In vitro antifungal susceptibility tests indicated resistance to amphotericin B and variable susceptibility to imidazoles. The lesion was excised, and the patient received no antifungal therapy. After 9 months of follow-up, the fungal infection shows no signs of recurrence.

1182

Phaeoisaria clematidis as a cause of keratomycosis. O, Zorat-Yu C, Figueras MJ. J Clin Microbiol. 2000 Jun;38(6):2434-7.

We report the first case of human infection by Phaeoisaria clematidis. This fungus caused a corneal ulcer in a Brazilian man who had previously suffered an eye injury. Diagnosis was established by positive direct examination and repeated cultures. The isolate was clearly resistant in vitro to the six antifungal agents tested.

1183

Phaeohyphomycosis due to Alternaria spp. and Phaeosclera dematioides: a histopathological study. Pec J, Palencarova E, Plank L, Straka S, Pec M, Jesenska Z, Filo V. Mycoses. 1996 May-Jun;39(5-6):217-21.

A case of phaeohyphomycosis caused by strains of both Alternaria spp. and Phaeosclera dematioides is presented. The biopsy material was studied using histological, immunohistochemical and transmission electron microscopy techniques. The agent's dematiaceous mycelia are composed of thick-walled hyphae, branched and unbranched, with terminal vesicular formations. All the described structures occur alone or in chains within multinuclear giant foreign body-type cells or invading an abscess. Also present are budding forms. Immunostaining of histiocytic inflammatory cells in either. diffuse or granulomatous infiltrates revealed cytoplasmic positivity for lysozyme and Ki-MIP antibody. The lymphocytic infiltrates of the upper corium show predominantly small T lymphocytes (CD3 and CD45RO positive) and absence of CD20-positive B cells. Plasma cells occurring within the infiltrates of the deeper parts show polyclonal expression of both Ig light chains.

1184

Phaeohyphomycosis caused by Alternaria species and Phaeosclera dematioides Sigler, Tsuneda and Carmichael. Palencarova E, Jesenska Z, Plank L, Straka S, Baska T, Hajtman A, Pec J. Clin Exp Dermatol. 1995 Sep;20(5):419-22.

A case of phaeohyphomycosis caused by strains of both Alternaria spp. and Phaeosclera dematioides is presented. First clinical signs of mycosis appeared on the patient's face, after an injury with a straw stalk during the wheat harvest in Germany in 1942. Further signs developed in 1955 at one forearm, and again in 1968 in the mouth, leading to perforation of the palate. After treatment with amphotericin B (1973-75) she went into a 13-year-long, clinically asymptomatic remission. She relapsed in 1988, when eight foci of the disease developed, mostly on both forearms. Diabetes mellitus and asthma developed at this time. After pulse therapy with itraconazole the patient remains in a good clinical condition.

1185

Chromomycosis caused by Fonsecaea compacta (Carrion 1940) with secondary phaeohyphomycotic infection caused by Phaeosclera dermatioides (Sigler 1981)] Krempl-Lamprecht L, Luderschmidt C, Wehrmann W. Mykosen. 1987 Oct;30(10):454-60, 463-7.

 

1186

Mycotic keratitis caused by Phaeotrichoconis crotalariae. New report. Shukla PK, Jain M, Lal B, Agrawal PK, Srivastava OP. Mycoses. 1989 May;32(5):230-2.

A case of mycotic keratitis caused by Phaeotrichoconis crotalariae (IMI 275955) is described for the first time. Experimental corneal lesions in albino rabbits and the histopathology are also presented.

1187

Phialemonium curvatum infection after bone marrow transplantation. Heins-Vaccari EM, Machado CM, Saboya RS, Silva RL, Dulley FL, Lacaz CS, Freitas Leite RS, Hernandez Arriagada GL. Rev Inst Med Trop Sao Paulo. 2001 May-Jun;43(3):163-6.

We report a case of cutaneous infection caused by Phialemonium curvatum GAMS et COOKE, 1983, after bone marrow transplantation. The genus Phialemonium was created by GAMS & MCGINNIS in 1983 including three new species: Ph. obovatum, Ph. curvatum and Ph. dimorphosporum, and represents an intermediate genus between Acremonium and Phialophora. Nowadays, the genus Phialemonium is considered to be a pheoid fungus which may cause the eventual lesions observed in pheo- and hyalohyphomycosis. Species of this genus have been described as opportunistic agents in humans and animals, mainly as a result of immunosuppression. In the present case, the patient had multiple myeloma and received an allogenic bone marrow transplant from his HLA-compatible brother. Two months after transplantation, he developed purplish and painful nodular lesions on the right ankle. Some of these lesions drained spontaneously and apparently hyaline mycelial filaments were observed, whose culture was initially identified as Acremonium sp. Subsequent studies showed that the fungus was Phialemonium curvatum. The infection was treated with amphotericin B, followed by ketoconazole. The patient was submitted to surgical debridement followed by two skin grafts to repair the bloody area. The duration of the treatment was 4 months and secondary prophylaxis with ketoconazole alone was maintained for one additional month. No recurrence was observed after discontinuation of treatment. The authors comment on the pathogenicity of the genus Phialemonium.

1188

A phaeohyphomycotic cyst and peritonitis caused by Phialemonium species and a reevaluation of its taxonomy. King D, Pasarell L, Dixon DM, McGinnis MR, Merz WG. J Clin Microbiol. 1993 Jul;31(7):1804-10.

Two cases of human fungal infections caused by members of the genus Phialemonium, a genus proposed by Gams and McGinnis (1983) for fungi intermediate between the genera Acremonium and Phialophora, are presented. The first case was a phaeohyphomycotic cyst on the foot of a renal transplant recipient. The fungus was detected by direct examination and histopathology and was recovered by several procedures over 4 months. It was flat, glabrous, and white becoming yellow with the production of a diffusible yellow pigment; it had conidiophores that were mostly solitary and lateral and terminal phialides and adelophialides with distinct collarettes producing cylindrical to curved conidia. The isolate resembled both Phialemonium dimorphosporum and Phialemonium curvatum, although its characteristics were more consistent with those of the latter. The second case was peritonitis in a renal transplant recipient. The fungus was white-to-cream colored and yeast like, but later became black with a green diffusible pigment, and produced obovoid conidia; it was easily identified as Phialemonium obovatum. Difficulties encountered in the identification and taxonomy of members of this genus highlight the need for standardized conditions, e.g., potato dextrose agar culture incubated at 24 to 25 degrees C for morphologic comparisons, to control significant variations due to culture conditions.

1189

Phialemonium obovatum infection in a burned child. McGinnis MR, Gams W, Goodwin MN Jr. J Med Vet Mycol. 1986 Feb;24(1):51-5.

Phialemonium obovatum is reported for the first time as an opportunistic fungal pathogen of man. The fungus was recovered from biopsy specimens consisting of cutaneous and subcutaneous tissue obtained from thermal burn wounds antemortem and from spleen tissue and three burn sites postmortem. The hyaline hypae of P. obovatum were seen invading viable tissue and blood vessels. The taxonomy of the genus Phialemonium and the criteria for determining fungal burn wound invasion are discussed.

1190

Fatal endocarditis in a neonate caused by the dematiaceous fungus Phialemonium obovatum: case report and review of the literature. Gavin PJ, Sutton DA, Katz BZ. J Clin Microbiol. 2002 Jun;40(6):2207-12.

Phialemonium species are grouped by most authorities among the dematiaceous fungi. Like several other darkly pigmented fungi, they appear to be an emerging cause of human disease, especially in the immunocompromised host. As numbers of immunocompromised patients increase, the trend of unusual fungi emerging as new pathogens is set to continue. Previous experience suggests that reports of rare fungal infections among selected patients often heralds the emergence of infection in a wider population of patients. We report a case of fatal endocarditis caused by Phialemonium obovatum in a premature neonate. To our knowledge this is the first documented case of native valve endocarditis due to this species, and we review the literature on invasive disease caused by the species. Unfamiliar fungal isolates are frequently misidentified or mistaken for environmental contaminants, and because of their relative rarity, data upon which to base antifungal treatment are limited. Thus, the diagnosis and treatment of unusual fungal pathogens present a significant challenge to clinicians and microbiologists alike. Early referral of such isolates to a specialist reference laboratory is advisable.

1191

Late bioprosthetic valve endocarditis caused by Phialemonium aff. curvatum and Streptococcus sanguis: a case report. Schønheyder HC, Jensen HE, Gams W, Nyvad O, Van Nga P, Aalbaek B, Stenderup J. J Med Vet Mycol. 1996 Jun-Jul;34(3):209-14.

Dual fungal and Streptococcus sanguis endocarditis is reported in a 63-year-old woman 7 months after placement of a porcine aortic valve prosthesis. Both micro-organisms were isolated by blood cultures, and the patient succumbed after a full course of antibacterial chemotherapy without having received antifungal chemotherapy. The best possible designation of the fungus was Phialemonium aff. curvatum W. Gams & W. B. Cooke, as represented by CBS 331.93. At autopsy hyphae were revealed in the porcine valve tissue by conventional staining. A hyperimmune rabbit antiserum raised towards strain CBS 331.93 and extensively absorbed with heterologous fungal antigens reacted strongly with hyphae in the valve tissue by indirect immunofluorescence technique. We consider it most likely that the Phialemonium infection evolved insidiously from the time of open heart surgery and led to a haematogenous streptococcal infection of a more fulminant course.

1192

Osteolytic phaeohyphomycosis caused by Phialemonium obovatum. Magnon KC, Jalbert M, Padhye AA. Arch Pathol Lab Med. 1993 Aug;117(8):841-3.

Phialemonium obovatum was found to be the cause of nosocomial osteomyelitis in a 41-year-old man after sustaining a nonpenetrating injury to his lumbar and cervical region. Histologic examination of fragments of disk and bone from L3-4 hemilaminectomy showed multiple fragments of fibrocartilage with focal necrosis, chronic inflammation, and granulation tissue formation. Sections stained with Gomori's methenamine silver procedure showed multiple fungal elements in necrotic areas consisting of irregularly branched, hyaline septate hyphae having swollen cells, and occasional yeastlike cells. The use of Fontana-Masson silver stain showed the presence of melanin in cells walls and septa of the hyphae. Phialemonium obovatum was isolated when the ground tissue from disk and bone from L3-4 was cultured on biphasic brain-heart infusion medium. Colonies were moist, off-white to ochraceous with a characteristic green, diffusible pigment on the reverse side. The isolate grew well up to 40 degrees C. It formed characteristic adelophialides without conspicuous collarettes and basal septa and produced smooth, one-celled, hyaline, and obovate conidia.

1193

Phialemonium fungemia: two documented nosocomial cases. Guarro J, Nucci M, Akiti T, Gené J, Cano J, Barreiro MD, Aguilar C. J Clin Microbiol. 1999 Aug;37(8):2493-7.

Two fungal isolates recovered from the blood of two immunosuppressed patients are described as Phialemonium curvatum. One patient died, while the other, who was infected with Exophiala jeanselmei at the same time, survived after successful treatment with itraconazole. Analysis of internal transcribed spacer sequences demonstrated that the isolates belonged to the same strain and that the source of infection was probably a catheter. The taxonomic position of P. curvatum is discussed, and Phialemonium dimorphosporum is considered a synonym. The in vitro inhibitory activities of six antifungal agents (amphotericin B, itraconazole, ketaconazole, miconazole, flucytosine, and fluconazole) were determined against seven isolates of Phialemonium. Except for flucytosine, all of them were remarkably effective. Phialemonium should be added to the list of potential causes of nosocomial fungemia in cancer patients.

1195

Phaeohyphomycosis due to Phialophora richardsiae. Tam M, Freeman S. Australas J Dermatol. 1989;30(1):37-40.

Phaeohyphomycosis, an infection characterised by dematiaceous yeast-like cells, hyphae and pseudohyphae in tissue, is an uncommon condition, often affecting immunosuppressed patients. A sixty four year old boat-builder, receiving treatment with prednisone and azathioprine developed multiple cutaneous nodules on the extremities. Histology showed a mixed dermal inflammatory infiltrate with scattered spores and hyphae. Culture revealed two organisms, Phialophora richardsiae and Exophiala jeanselmei. Fluorocytosine was initially given but the organism was found to be resistant. Since side effects have been associated with long term ketoconazole therapy, a less toxic and more potent triazole compound, itraconazole, was used. After three months, the lesions had completely resolved without adverse clinical or biochemical changes.

1196

Phialophora repens, an emerging agent of subcutaneous phaeohyphomycosis in humans. Hironaga M, Nakano K, Yokoyama I, Kitajima J. J Clin Microbiol. 1989 Mar;27(3):394-9.

A 63-year-old Japanese man had phaeohyphomycosis that occurred as a solitary subcutaneous nodule on the dorsal aspect of his left hand. In the nodule there were foci of mixed granulomatous and suppurative infiltrations circumscribed by thick fibrous tissue reaction. The foci contained short septate hyphae and occasionally small rounded aggregates of irregularly branched septate hyphae, both of which were nonpigmented or rarely weakly pale brown. Fungal culture from the nodule was positive for a dematiaceous mold. The mycologic features of the mold were typical of Phialophora repens. The infection was successfully treated by excision of the nodule. This is the second reported case of infection due to P. repens.

1197

Case report. Phaeohyphomycosis caused by Phialophora verrucosa developed in a patient with non-HIV acquired immunodeficiency syndrome. Ohira S, Isoda K, Hamanaka H, Takahashi K, Nishimoto K, Mizutani H. Mycoses. 2002 Feb;45(1-2):50-4.

A 53-year-old woman had asymptomatic multiple nodules on her gluteal region for 6 months. She had a history of systemic corticosteroid treatment for Evans' syndrome. Recently she had developed an immunodeficiency condition with CD4+ cell depletion without an HIV infection and a normal serum gamma globulin level. A smear from the purulent exudate of the nodules revealed many brown-coloured hyphae, spores and few large dark-brown cells. A short, hairy, dark-brown coloured colony was cultivated on Sabouraud glucose agar. Slide culturing revealed only a Phialophora-type conidia formation, and the fungus was diagnosed as Phialophora verrucosa. Severe immunosuppressive condition (non-HIV acquired immunodeficiency syndrome) of this patients after systemic corticosteroid treatment for Evans' syndrome predisposed an opportunistic cutaneous fungal infection due to P. verrucosa. Cases with cutaneous infection due to P. verrucosa reported in Japan are summarized and discussed.

1198

A case of chromoblastomycosis due to Phialophora verrucosa responding to treatment with fluconazole. Guerriero C, De Simone C, Tulli A. Eur J Dermatol. 1998 Apr-May;8(3):167-8.

We report the case of a 40-year-old Filippino woman, with a 5-year history of a slowly spreading, painful skin lesion on her left foot. Histological examination showed a dermal, granulomatous infiltrate consisting of neutrophils, histiocytes and lymphocytes, with "sclerotic bodies" in the cytoplasm of phagocytic cells. Mycological culture revealed the presence of Phialophora verrucosa and confirmed the histopathological diagnosis of chromo-blastomycosis. Association of surgical curettage of the exuberant, infected tissue with systemic fluconazole administration gave good therapeutic results with no relevant side effects.

1199

Phialophora mutabilis endocarditis. Slifkin M, Bowers HM Jr. Am J Clin Pathol. 1975 Jan;63(1):120-30.

This is the first reported case of fungal endocarditis due to vegetative growth of Phialophora mutabilis on a prosthetic mitral valve. The patient had rheumatic heart disease with mitral and aortic stenosis. Four months after the mitral and aortic valves had been replaced by prostheses the patient developed congestive failure. Because of increased left atrial pressure, the mitral prosthesis was replaced. A large matted obstructive fungal vegetation was found on the prosthesis. Culture of this vegetation grew Phialophora mutabilis. The patient died postoperatively, and at autopsy the fungus was not found in other tissues. Culturally and morphologically, P. mutabilis shows wide variation in pigmentation, colonial and microscopic appearance. Conidia formation from intercalary cells along the hyphae is somewhat similar to that of Aureobasidium spp. P. mutabilis was injected into mice. Mice pretreated with cortisone died 3 to 5 weeks after intraperitoneal inoculation, while the majority of untreated mice died within 20 weeks of inoculation.

1200

Phialophora verrucosa: a new cause of mycetoma. Turiansky GW, Benson PM, Sperling LC, Sau P, Salkin IF, McGinnis MR, James WD. J Am Acad Dermatol. 1995 Feb;32(2 Pt 2):311-5.

A 29-year-old Thai woman had draining sinus tracts, tumefaction, and granules on the plantar aspect of the foot. Phialophora verrucosa was isolated from the lesion. P. verrucosa is a major agent of chromoblastomycosis, which is known to rarely cause subcutaneous phaeohyphomycosis. This dematiaceous fungus has not been previously reported to cause mycetoma. This case illustrates the clinical spectrum of disease of this fungus. The salient features of mycetoma and management options are presented.

1201

Subcutaneous chromomycotic abscesses caused by Phialophora gougerotii. Kotrajaras R, Chongsathien S. Int J Dermatol. 1979 Mar;18(2):150-4.

Subcutaneous chromomycotic absesses due to phialophora gougerotii in a 50-year-old woman were characterized by subcutaneous abscesses adhering together through fistulous tracts, rupturing and leaving black crusts over multiple sinuses mimicking mycetoma. Reinfection occurred in contaminated excised lesions. Intradermal inoculation in different anemic patients caused abscesses in 14 days and healed without therapy in eight weeks. No spreading to other organs was found after intraperitoneal inoculation of mice for eight weeks.

1202

Study of mold allergy in asthmatic children in Hungary. Szánthó A, Osváth P, Horváth Z, Novák EK, Kujalek E. J Investig Allergol Clin Immunol. 1992 Mar-Apr;2(2):84-90.

We studied the change in sensitivity to propagating aerogenic fungi (spores, conidia) in extrinsic asthmatic children living in an urban environment from 1977 to 1988. According to the skin test, 10.6% of those examined in 1977 were sensitive to the fungi, the proportion being 30.4% in 1985 and 38.5% in 1987/88. The increase may be explained by the increasing frequency of sensitivity to Alternaria alternata and Phoma betae. In skin tests with Bencard allergens, reaction to both types was frequently observed. Of those sensitive to P. betae, 83% were also sensitive to A. alternata, and 87.5% of those sensitive to A. alternata were also sensitive to P. betae. The frequency of cross-reactions observed both with skin tests and specific IgE determinations suggests the presence of a common allergen, or epitope. The effect of environmental factors was analyzed with computer techniques. P. betae allergy was not related to detectable mold, humidity or number of pot plants in the home. The living conditions changed during the study period as follows: 1) housing conditions improved; 2) energy-saving building technologies were generally accepted; and 3) air pollution increased, also affecting the vegetation. The sensitizing masses of spores and conidia originated most likely from molds living on plants weakened and diseased by environmental pollution.

1204

Subcutaneous phaeohyphomycosis caused by Phoma cava. Report of a case and review of the literature. Zaitz C, Heins-Vaccari EM, de Freitas RS, Arriagada GL, Ruiz L, Totoli SA, Marques AC, Rezze GG, Müller H, Valente NS, Lacaz Cda S. Rev Inst Med Trop Sao Paulo. 1997 Jan-Feb;39(1):43-8.

We report a case of subcutaneous phaeohyphomycosis observed in a male patient presenting pulmonary sarcoidosis and submitted to corticosteroid treatment. He presented nodular erythematous-violaceous skin lesions in the dorsum of the right hand. Histopathological examination of the biopsied lesion revealed dematiaceous hyphae and yeast-like cells, with a granulomatous tissual reaction. The isolated fungus was identified as Phoma cava. A review of the literature on fungal infection caused by different Phoma species, is presented. The patient healed after therapy with amphotericin B. followed by itraconazole.

1205

Subcutaneous phaeohyphomycosis caused by an unusual pathogen: Phoma species. Hirsh AH, Schiff TA. J Am Acad Dermatol. 1996 Apr;34(4):679-80.

 

1206

First report of subcutaneous phaeohyphomycosis of the foot caused by Phoma minutella. Baker JG, Salkin IF, Forgacs P, Haines JH, Kemna ME. J Clin Microbiol. 1987 Dec;25(12):2395-7.

Phoma minutella, a dematiaceous hyphomycete, was isolated to the exclusion of all other fungi from a subcutaneous inflammatory process on the foot of a farmer undergoing corticosteroid therapy for myasthenia gravis. Isolation was achieved on several nutrient media. Examination of stained smears and sections revealed dematiaceous fungal elements consistent with the mold. This is the first reported association of P. minutella with a human infection and only the second reported case involving a Phoma sp. as the etiologic agent of a subcutaneous infection.

1207

The isolation of Phoma eupyrena from a human lesion. Bakerspigel A, Lowe D, Rostas A. Arch Dermatol. 1981 Jun;117(6):362-3.

A strain of the soil-borne fungus Phoma eupyrena was isolated from the skin of an 18-month-old boy who had a crusting, erythematous, perioral eruption of one month's duration. Treatment with clotrimazole, 15% zinc oxide paste, and dimethicone resulted in eradication of the fungus and in complete healing of the lesions in eight weeks.

1210

Ultrastructural aspects of hair digestion in black piedra infection. Figueras MJ, Guarro J, Zaror L. J Med Vet Mycol. 1997 Jan-Feb;35(1):1-6.

The ultrastructural pattern of human hair infection by Piedraia hortae in vivo has been studied. The fungus destroyed the cuticular layers of the hair and was able to penetrate deeply into the cortex. The course of destruction of human hair is described and compared with that produced by other fungi. Two well-defined types of cortex digestion were characterized. The slow rate of keratin degradation at the cortex together with the compacted stromatic organization of the nodules are argued as the main reasons that guarantee the long survival of the fungus, and therefore the chronic course of the disease. The data provided in this paper may help to understand the mechanisms that regulate the pathogenicity of this fungus.

1211

Black piedra: the first case treated with terbinafine (Lamisil). Gip L. Br J Dermatol. 1994 Apr;130 Suppl 43:26-8.

A 23-year-old Swedish Caucasian man presented with typical clinical signs of black piedra of his scalp after his return from 4-months' stay in India. There were black nodules around the hair shafts, and the crushed nodules revealed numerous asci and ascospores on microscopy. Piedraia hortae was isolated from the concretions. He was treated with oral terbinafine 250 mg daily for 6 weeks. At the end of treatment no nodules were visible, but 16 days later a few 'new' black concretions appeared. Microscopy of these nodules revealed markedly degenerated fungal elements, and cultures were negative. No further signs of the disease were seen 2 months after cessation of therapy. In vitro susceptibility tests showed that Piedraia hortae was sensitive to terbinafine. This case demonstrates that terbinafine is effective in the treatment of black piedra.

1212

Facultative and obligate pathogenic moulds in skin affections] Rieth H. Hautarzt. 1978 Jan;29(1):22-6.

Molds are vegetable microorganisms, which differ from dermatophytes sensitive to griseofulvin, and from yeasts, which do not form aerial mycelium. Most of the molds, phytopathogenic or which live from dead organic substances, are apathogenic to humans. Only a couple of dozen species can parasitize on the skin, usually together with dermatophytes or yeasts. Onychomycoses with molds appear mostly in elderly people, and fungus affections of external auditory passage in seborrheic eczema of the ear. The hair can be infected by Piedraia hortae, resulting in hard black nodules. After the identification of molds on the skin, criticism is necessary, since in more than 95% of the cases they are accidental germs. Several cultures and microscopic tests are necessary to assure the diagnosis. Broad-spectrum antimycotics is the predominant choice for treatment, but also amphotericin B, nystatin and pimaricin.

1218

Cutaneous lesions due to Pleurophoma (Phoma) complex. Rosen T, Rinaldi MJ, Tschen JA, Stern JK, Cernoch P. South Med J. 1996 Apr;89(4):431-3.

We report a case of striking and disfiguring facial mycosis due to an organism belonging to the Pleurophoma complex of Coelomycetes. This condition was likely acquired through repeated contact with infected soil and exacerbated by prolonged applications of topical corticosteroid preparations. Antifungal drug susceptibility testing was used to direct a therapeutic choice in this unusual infection.

1219

Phaeohyphomycotic cutaneous disease caused by Pleurophoma in a cardiac transplant patient. Dooley DP, Beckius ML, Jeffery BS, McAllister CK, Radentz WH, Feldman AR, Rinaldi MG, Bailey SR, Keeling JH. J Infect Dis. 1989 Mar;159(3):503-7.

A 56-y-old female cardiac transplant patient treated with cyclosporine and prednisone noted the onset of three nontender red nodules on the legs and arms after gardening. Biopsy of all lesions revealed inflammatory cells and hyphal elements in the dermis. The dematiaceous fungus cultured from biopsy tissue was a pycnidial-forming organism of the genus Pleurophoma. The lesions responded to the topical application of miconazole.

1220

Phaeohyphomycotic soft tissue disease caused by Pleurophomopsis lignicola in a kidney transplant patient. Farina C, Punithaligham E, Ruggenenti P, Goglio A. J Med Microbiol. 1997 Aug;46(8):699-703.

A 44-year-old immunocompromised man presented with multiple tissue abscesses, covering the entire left limb. A dematiaceous fungus compatible with Pleurophomopsis lignicola Petrak was isolated from the diseased tissue in pure culture. This is the second reported isolation of this fungus from man and the first report of fatal soft tissue infection. A detailed morphological description of the isolate is provided.

1221

Maxillary sinusitis caused by Pleurophomopsis lignicola. Padhye AA, Gutekunst RW, Smith DJ, Punithalingam E. J Clin Microbiol. 1997 Aug;35(8):2136-41.

In immunocompetent 59-year-old man developed sinusitis over a 6- to 8-month period after cutting down a rotted maple tree (Acer sp.). A polypoid obstruction with a bloody drainage was evident in his right nasal cavity. A computed tomographic scan showed an opacification of the maxillary sinus. Surgery was performed to remove a fungus ball that had extended into the patient's medial sinus cavity. Sections of the sinonasal mucosa revealed marked acute and chronic sinusitis with inflammation, congestion, and hemorrhage. Sections from the pasty brown to black debrided material revealed a fungus ball consisting of an extensive network of brown-pigmented, septate, profusely branched hyphae. When grown on oat agar, the phaeoid fungus produced pycnidia and was identified as Pleurophomopsis lignicola. The genus Pleurophomopsis includes seven species, which are all known from plant material. This report documents for the first time a coelomycetous fungus, P. lignicola, causing sinusitis in an immunocompetent patient.

1222

Subcutaneous abscess caused by Pleurophomopsis lignicola Petr: first case. Chabasse D, de Bievre C, Legrand E, Saint-Andre JP, de Gentile L, Cimon B, Bouchara JP. J Med Vet Mycol. 1995 Nov-Dec;33(6):415-7.

The dematiaceous coelomycete Pleurophomopsis lignicola Petr. was isolated repeatedly in pure culture from a subcutaneous abscess of the left leg in a farmer undergoing corticosteroid therapy for asthma gravis. To our knowledge, we report the first case involving this fungus as an aetiological agent of subcutaneous phaeohyphomycosis.

1223

Polycytella hominis gen. et sp. nov., a cause of human pale grain mycetoma. Campbell CK. J Med Vet Mycol. 1987 Oct;25(5):301-5.

A hyphomycete isolated from a pale-grain eumycetoma in an indian male patient is described as a species of a new form-genus, Polycytella hominis. The fungus is characterized by elongate multiseptate conidia in which only the apical compartment becomes thick-walled and retains viable cytoplasm. The appearance of P. hominis in the host tissues is described and compared with other pale-grain eumycetomas.

1224

Polypaecilum insolitum (=Scopulariopsis divaricata) isolated from cases of otomycosis. Yamashita K, Yamashita T. Sabouraudia. 1972 Jul;10(2):128-31

 

1226

Pseudallescheria boydii knee arthritis in a young immunocompetent adult two years after a compound patellar fracture. Lavy D, Morin O, Venet G, Maugars Y, Prost A, Berthelot JM. Joint Bone Spine. 2001 Dec;68(6):517-20.

Pseudallescheria boydii arthritis of the knee developed in a 32-year-old immunocompetent man 2 years after a compound patellar fracture contaminated with soil. No other potential portal of entry was identified, suggesting that the fungus remained latent for 2 years. Pseudallescheria arthritis often occurs after a prolonged latency period, causing minimal symptoms that contrast with the frequently severe radiological changes. Although this organism often shows limited sensitivity to most antifungal agents, our patient achieved a full recovery after surgical synovectomy and 6 months of itraconazole therapy (400 mg/ d). This case illustrates the importance of testing for fungi in patients with torpid arthritis, particularly when mild clinical symptoms contrast with severe bone and joint destruction.

1227

Pseudallescheria boydii osteoarthritis in a patient with acute lymphoblastic leukemia: a case report] Le Gouill SL, Morineau N, Miégeville M, Milpied N, Harousseau JL, Moreau P. Rev Med Interne. 1999 May;20(5):434-8.

INTRODUCTION: The outcome of neutropenic patients with Pseudallescheria boydii infection is poor. EXEGESIS: We report the first case of Pseudallescheria boydii hip arthritis in a patient treated for acute lymphoblastic leukemia. In vitro susceptibility testing showed that the strain was resistant to amphotericin B, fluorocytosine and nystatin, but susceptible to itraconazole. The patient received oral itraconazole (600 mg/day) and clinical symptoms initially resolved. Two months later, after a course of chemotherapy and high-dose steroids while receiving oral itraconazole treatment, the patient developed fever, skin lesions and disseminated lung infiltrates due to Pseudallescheria boydii and finally died. CONCLUSION: This case illustrates the severity of fungal infections due to Pseudallescheria boydii despite a presumably well-conducted antifungal therapy.

1228

Arthritis without grains caused by Pseudallescheria boydii. Ginter G, de Hoog GS, Pschaid A, Fellinger M, Bogiatzis A, Berghold C, Reich EM, Odds FC. Mycoses. 1995 Sep-Oct;38(9-10):369-71.

Severe infection of the knee joint by Pseudallescheria boydii in a 23-year-old female resulted in complete destruction of the cartilaginous surface. The possibility of entry of the fungus through mild abrasions of unperforated skin is discussed. The clinical appearance is compared with that of Scedosporium prolificans. Antimycotic miconazole-itraconazole treatment, applied during a period of 4 months, was successful; no side-effects were noted.

1229

Vertebral osteomyelitis secondary to Pseudallescheria boydii. Lonser RR, Brodke DS, Dailey AT. J Spinal Disord. 2001 Aug;14(4):361-4.

Because Pseudallescheria boydii vertebral osteomyelitis is rare and frequently resistant to available antifungal agents, the proper treatment of this lesion has not been defined. To better determine the best treatment of this lesion, the authors evaluated a case P. boydii vertebral osteomyelitis and reviewed the literature. A 48-year-old man had isolated thoracic vertebral osteomyelitis resulting from P. boydii and associated severe thoracic back pain and proximal lower extremity pain and weakness. Magnetic resonance imaging studies revealed continued collapse of the T6--T7 vertebrae despite previous posterior debridement and appropriate antifungal chemotherapy. On admission to the authors' institution, the patient underwent a right thoracotomy, anterior debridement with transthoracic T6--T7 corpectomies and strut grafting, followed by posterior fusion and stabilization with pedicle screws. After operation, the patient's pain, hyperalgesia, and lower extremity symptoms resolved. He was treated with a 12-month course of itraconazole. Imaging and laboratory studies show no evidence of recurrence. P. boydii vertebral osteomyelitis can have devastating neurologic sequelae if not treated properly. The frequent lack of response of this unusual fungal infection to systemic therapy requires frequent serial follow-up examinations. Patients with evidence of progression on imaging studies or neurologic findings should undergo early and aggressive surgical debridement.

1230

Osteomyelitis due to Pseudallescheria boydii. Hung LH, Norwood LA. South Med J. 1993 Feb;86(2):231-4.

This report describes an unusual opportunistic fungal infection in an immunocompetent young man who had no cutaneous involvement and whose infection was diagnosed 6 years after an accident. The unusual clinical presentation and difficulties in making a correct diagnosis are discussed and prophylactic antifungal chemotherapy is suggested.

1231

Pseudallescheria boydii mycetoma in northern New England. Stierstorfer MB, Schwartz BK, McGuire JB, Miller AC. Int J Dermatol. 1988 Jul-Aug;27(6):383-7.

Mycetoma is a chronic subcutaneous fungal infection characterized by tumefaction, draining sinuses, and grains. It is most common in the tropics but occasionally occurs in the United States. We report a case of a mycetoma affecting the foot of a 38-year-old mentally retarded man from northern New England. The causal organism was identified as Pseudallescheria boydii, the most common cause of mycetoma in the United States. The patient showed a partial response to 8 months of ketoconazole therapy.

1232

Case report. Atypical cutaneous pseudallescheriosis refractory to antifungal agents. Ginter G, Petutschnig B, Pierer G, Soyer HP, Reischle S, Kern T, de Hoog S. Mycoses. 1999;42(7-8):507-11.

We report on a 65-year-old male heart transplant recipient who was otherwise in good condition. The patient was immunocompromised secondarily due to cyclosporin, prednisolone and azathioprine when widespread pustular skin lesions with erythematous margins subsequently developed on his left forearm. There was no history of trauma or septic temperature. Bacterial cultures were sterile and the results of native and cultural investigation studies were negative. A biopsy specimen of the lesion demonstrated hyalohyphomycosis with numerous septate hyphae within granulomas throughout the dermis. Subcutaneous tissues were not involved. Culture plates inoculated with pus and skin from the punch biopsy showed growth of a mould yielding Pseudallescheria boydii. Sensitivity testing was performed with miconazole, ketoconazole and itraconazole showing the best in vitro activity against P. boydii. In spite of treatment with itraconazole, the erythema and pustules continued to spread and therapy was changed to intravenous miconazole. Due to ongoing progression after 3 months of antifungal therapy surgical debridement was required. After 2 years of follow up, he had no recurrence.

1233

Pseudallescheriasis in northern Britain. Milne LJ, McKerrow WS, Paterson WD, Petrie GR, Postlethwaite R. J Med Vet Mycol. 1986 Oct;24(5):377-82.

Five cases of Pseudallescheria boydii infection are reported from the northern part of the United Kingdom. None of the patients had travelled abroad. Three cases of otitis in which P. boydii was associated with bacterial infections were diagnosed within a 6-month period. A lady who had diabetes mellitus presented with a pulmonary fungus ball in a pre-existent cavity caused by a previous bacterial infection. After minor trauma at the site of an old skin graft, a farmer's wife developed an ulcer on the dorsum of the right ankle. Precipitating antibodies were demonstrated except in two of the cases of ear infection. The management of the individual cases is discussed.

1234

Pseudallescheria boydii infection of the brain: imaging with pathologic confirmation. Albernaz V, Huston B, Castillo M, Mukherji S, Bouldin TW. AJNR Am J Neuroradiol. 1996 Mar;17(3):589-92.

Pseudallescheria boydii is a rare opportunistic microorganism that usually infects immunosuppressed hosts. In this patient with cerebral infection by P boydii, imaging findings included enhancement of the ependyma of a lateral ventricle and of the caudate nucleus.

1235

Pseudallescheria boydii infection of the central nervous system. Kershaw P, Freeman R, Templeton D, DeGirolami PC, DeGirolami U, Tarsy D, Hoffmann S, Eliopoulos G, Karchmer AW. Arch Neurol. 1990 Apr;47(4):468-72

Pseudallescheria boydii is a rare cause of central nervous system infection characteristically presenting as a neutrophilic meningitis or multiple brain abscesses. Factors predisposing to central nervous system infection with this fungus include immunosuppression and near drowning. The organism is infrequently cultured from fluid obtained by lumbar puncture, delaying clinical recognition and appropriate antifungal therapy. All untreated patients with P boydii infection of the central nervous system died. We describe a patient who developed a persistent neutrophilic meningitis with focal neurologic deficits due to P boydii 6 months after a freshwater aspiration pneumonia. We also review the characteristic clinical and pathologic features of previously reported cases and emphasize the importance of early detection and treatment in the management of this frequently intractable disease.

1236

The first case of Pseudallescheria boydii meningitis in China--electron microscopic study and antigenicity analysis of the agent. Huang HJ, Zhu JY, Zhang YH. J Tongji Med Univ. 1990;10(4):218-21.

Reported in this paper is the first case of isolation of Pseudallescheria boydii from cerebral spinal fluid of a boy with meningitis in China. Morphology and culture were observed by light microscopy, electron scanning microscopy and transmission electron microscopy. In addition, mycelium antigen prepared by SDS-PAGE was compared with that of the other strain of Scedosporium apiospermum. Both of the strains showed more than 40 peptide lines. Their molecular weight was very similar. On the CS-930 Dual-Wavelength TLC Scanner the peaks of both antigens showed to lie in nearly the same position. It could be concluded that Pseudallescheria boydii and Scedosporium apiospermum belong to the same genus, but they are of different strains and reproductive phases.

1237

Meningitis caused by Pseudallescheria boydii treated with voriconazole. Poza G, Montoya J, Redondo C, Ruiz J, Vila N, Rodriguez-Tudela JL, Ceron A, Simarro E. Clin Infect Dis. 2000 Jun;30(6):981-2.

Meningitis caused by Pseudallescheria boydii is an uncommon infection of the CNS that usually has a poor prognosis and a difficult treatment. We describe a case of chronic meningitis caused by P. boydii in an immunocompetent host that was successfully treated with voriconazole, a new antifungal agent.

1238

Isolated sphenoid sinusitis due to Pseudallescheria boydii. Watters GW, Milford CA. J Laryngol Otol. 1993 Apr;107(4):344-6.

A case of sphenoid sinusitis due to Pseudallescheria boydii is described in a 52-year-old non-immunocompromised woman. Treatment should always involve surgical drainage, and antifungal chemotherapy may be of benefit if there is histological evidence of invasion of surrounding tissue. For P. boydii infection miconazole should be the agent of choice, rather than amphotericin B. For this reason it is important to obtain culture and histological examination of sinus contents if fungal infection is suspected.

1239

Superior sagittal sinus infection with Petriellidium boydii: case report. Fessler RG, Brown FD. Neurosurgery. 1989 Apr;24(4):604-7.

A case of infection of the superior sagittal sinus with Petriellidium boydii is reported. This relatively common fungal pathogen rarely invades the central nervous system. Immunological compromise and poor personal hygiene seem to be common attributes shared by this patient and the 4 previous patients reported to have suffered invasion of the central nervous system by this organism. This report is unique in that it is the first demonstrating apparent hematogenous dissemination of this organism to the central nervous system.

1240

Maxillary sinusitis from Pseudallescheria boydii. Efficacy of surgical therapy. Winn RE, Ramsey PD, McDonald JC, Dunlop KJ. Arch Otolaryngol. 1983 Feb;109(2):123-5.

Pseudallescheria boydii is a ubiquitous mold of soil and is a frequent cause of mycetoma in the United States. Involvement of the sinuses is extremely rare. The necessity of medical and/or surgical management is largely unknown but appears to be dependent on variables of host defense mechanisms, as the fungus is relatively avirulent. Chronic maxillary sinusitis secondary to P boydii developed in a noncompromised woman. Evidence of erosion of the bony wall of the orbit was encountered at operation. Successful eradication of this infection was accomplished with surgical drainage alone.

1241

Pulmonary pseudallescheriasis in a patient with diabetes mellitus and alcoholic liver cirrhosis] Saito Y, Mikami M, Nakamura S, Hashimoto N, Abe Y, Baba M, Takizawa J, Kawakami M, Kamei K. Nihon Kokyuki Gakkai Zasshi. 1998 May;36(5):498-502.

A 62-year-old man with diabetes mellitus and alcoholic liver cirrhosis was admitted to the hospital because of hemoptysis. Chest X-ray films and computed tomograms showed a dense infiltrative lesion and a healed tuberculous cavity with a possible fungus ball in the upper lobe of the right lung. Bronchoscopy revealed that the hemoptysis originated from the right upper-lobe bronchus. The bleeding stopped after thrombin was applied into the bronchus. Filamentous fungi were seen in lavage fluid from the right upper-lobe bronchus. The fungi were identified as Pseudallescheria boydii, and pulmonary pseudallescheriasis was diagnosed. the patient was treated successfully with miconazole (400 mg/day) for 2 months. Pseudallescheriasis should be taken into account in the differential diagnosis of aspergilloma-like lesions.

1242

Invasive pulmonary pseudallescheriasis with direct invasion of the thoracic spine in an immunocompetent patient. Hung CC, Chang SC, Yang PC, Hsieh WC. Eur J Clin Microbiol Infect Dis. 1994 Sep;13(9):749-51.

Most invasive pseudallescheriasis infections have occurred in immunocompromised patients. The case of an immunocompetent patient with invasive pulmonary pseudallescheriasis and subsequent contiguous extension to the ribs and spine is reported. Aspergillosis was mistakenly diagnosed on histopathologic examination of the debrided tissue. Culture of the debrided tissue yielded Pseudallescheria boydii.

1243

Pseudallescheria boydii endocarditis of the pulmonic valve in a liver transplant recipient. Welty FK, McLeod GX, Ezratty C, Healy RW, Karchmer AW. Clin Infect Dis. 1992 Nov;15(5):858-60.

We describe a case of Pseudallescheria boydii endocarditis involving the pulmonic valve in an orthotopic liver transplant recipient. The patient required transplantation because of hepatic failure secondary to chronic active hepatitis B. His postoperative course was complicated by surgery for gastric and duodenal ulcers, persistent fever, and, ultimately, sepsis leading to oliguric renal failure. Two days before death, the patient experienced complete heart block, and an echocardiogram revealed pulmonic valve thickening and an endocardial mass along the left side of the septum. At autopsy the patient was found to have a vegetation on the pulmonic valve and a septal abscess. There were multiple fungal emboli found throughout other organs, and P. boydii was obtained on culture. This unique association between pulmonic valve endocarditis and myocardial septal abscess is discussed. In addition, review of the five previous cases of P. boydii endocarditis reveals that this rare infection is associated with immunosuppression and prosthetic devices.

1244

Native valve endocarditis due to Pseudallescheria boydii in a patient with AIDS: case report and review. Raffanti SP, Fyfe B, Carreiro S, Sharp SE, Hyma BA, Ratzan KR. Rev Infect Dis. 1990 Nov-Dec;12(6):993-6.

A 53-year-old man with AIDS developed mitral valve endocarditis due to infection with the fungus Pseudallescheria boydii. A limited number of cases of prosthetic valve endocarditis caused by this organism have been described. We report a unique case of pseudallescheria infection of a native valve and describe this disease in a patient with AIDS.

1245

Disseminated Petriellidium boydii and pacemaker endocarditis. Davis WA, Isner JM, Bracey AW, Roberts WC, Garagusi VF. Am J Med. 1980 Dec;69(6):929-32.

Clinical and morphologic findings are described in a 62 year old woman with "mixed connective tissue disease" who received corticosteroid therapy, and in whom disseminated and fatal Petriellidium boydii infection with right-sided endocarditis developed. The patient was a gardener. The organism is ubiquitous in soil in many part of the United States; therefore, it is likely that the infection was introduced by this means. Endocarditis due to P. boydii has not been reported previously. In the patient described, massive vegetations nearly obliterated the tricuspid valve orifice, encasing a pacemaker catheter which had been inserted eight years earlier. Although never previously isolated from blood cultures, P. boydii was isolated from 11 consecutive blood cultures. P. boydii is a true fungus and has only recently been appreciated as an opportunistic pathogen in a compromised host.

1246

Disseminated Pseudallescheria boydii infection in a nonimmunocompromised host. Khurshid A, Barnett VT, Sekosan M, Ginzburg AS, Onal E. Chest. 1999 Aug;116(2):572-4.

We present a highly unusual case of pulmonary Pseudallescheria boydii infection in a nonimmunocompromised host with a cavitating mass lesion. The diagnosis was confirmed by open lung biopsy. The patient was treated at another institution with course of amphotericin B, considered an ineffective therapy for this infection, and presented to us with direct extension and invasion of the left atrial appendage and the pulmonary artery, followed by massive pulmonary embolization and hematogenous dissemination to the liver, spleen, kidney, pancreas, and brain.

1247

Disseminated cutaneous Pseudallescheria boydii. Bernstein EF, Schuster MG, Stieritz DD, Heuman PC, Uitto J. Br J Dermatol. 1995 Mar;132(3):456-60.

As increasingly aggressive chemotherapeutic regimens are used to treat malignancy, more patients will become susceptible to various opportunistic pathogens. Specifically, several fungal organisms previously viewed as relatively non-pathogenic are more frequently causing serious disease in these patients. Identification of these organisms is of paramount importance, as some are relatively resistant to standard antifungal therapies. We report a patient with disseminated cutaneous Pseudallescheria boydii, diagnosed from histopathological examination and culture of a skin biopsy specimen. Identification of the organism was achieved shortly before the patient died. Clinicians must be aware of the numerous emerging opportunistic pathogens, which may require special culture techniques for diagnosis and varied or combined modes of therapy.

1248

Allergic bronchopulmonary mycosis caused by Pseudallescheria boydii. Miller MA, Greenberger PA, Amerian R, Toogood JH, Noskin GA, Roberts M, Patterson R. Am Rev Respir Dis. 1993 Sep;148(3):810-2.

Two cases of allergic bronchopulmonary pseudallescheriosis (ABPP) are described. These are the first cases of this allergic bronchopulmonary mycosis (ABPM) reported in which the clinical and serologic criteria are described. The first case was in a patient with mild asthma, and it resolved spontaneously after expectoration of a mucous plug. The second was in a patient with recurrent allergic bronchopulmonary aspergillosis with an exacerbation of ABPM caused by Pseudallescheria boydii. The total serum IgE, IgG, and IgE antibodies against P. boydii and the clinical picture well define ABPP. This diagnosis may be important to recognize in order to prevent a progression of the patient's lung disease.

1249

Mixed allergic bronchopulmonary fungal disease due to Pseudallescheria boydii and Aspergillus. Lake FR, Tribe AE, McAleer R, Froudist J, Thompson PJ. Thorax. 1990 Jun;45(6):489-91.

A 24 year old asthmatic woman with mixed allergic bronchopulmonary fungal disease due to Pseudallescheria boydii and Aspergillus is reported. No previous cases due to P boydii have been described. This patient provides evidence that fungi other than Aspergillus species may cause the condition.

1252

Pseudeurotium ovalis in toenails. Some problems of mycological diagnosis of nail infections. English MP, Harman RR, Turvey JW. Br J Dermatol. 1967 Oct;79(10):553-6.

 

1253

A clinical trial of itraconazole in the treatment of deep mycoses and leishmaniasis. Borelli D. Rev Infect Dis. 1987 Jan-Feb;9 Suppl 1:S57-63.

Itraconazole was administered orally to two patients with sporotrichosis, 10 patients with paracoccidioidomycosis, three with mycetomas (due to Madurella grisea, Streptomyces madurae, and Pseudochaetosphaeronema larense, respectively), nine with chromomycosis due to Cladosporium carrionii, five with chromomycosis due to Fonsecaea pedrosoi and five with leishmaniasis (including one with the nodular disseminated form). The clinical and laboratory tests showed excellent tolerance to the drug with a total absence of adverse reactions. Satisfactory results were achieved against paracoccidioidomycosis, sporotrichosis, and chromomycosis due to C. carrionii (apparent cure was achieved in a short time). Encouraging improvement was noted in the treatment of mycetoma due to M. grisea. Among the five cases of leishmaniasis, a complete clearing was achieved in one and an encouraging improvement in two, including the one with the nodular disseminated form. Two patients with F. pedrosoi infection were apparently cured after the addition of thermotherapy and flucytosine, respectively, to the treatment regimen.

1256

Pyrenochaeta romeroi causing mycetoma pedis in India. Thammayya A, Sanyal M, Basu N. J Indian Med Assoc. 1979 Aug;73(3-4):66-7.

 

1257

. Infection of the finger-nail by Pyrenochaeta unguis-hominis. English MP. Br J Dermatol. 1980 Jul;103(1):91-3.

Infection of the finger-nail of an elderly woman by Pyrenochaeta unguis-hominis is reported. The small lesion was extending slowly into the healthy nail plate. The fungus has been isolated from diseased toe-nails on two previous occasions but its extra-human habitat is unknown.

1259

Pythium insidiosum keratitis confirmed by DNA sequence analysis. Badenoch PR, Coster DJ, Wetherall BL, Brettig HT, Rozenbilds MA, Drenth A, Wagels G. Br J Ophthalmol. 2001 Apr;85(4):502-3.

 

1260

Human pythiosis. Thianprasit M, Chaiprasert A, Imwidthaya P. Curr Top Med Mycol. 1996 Dec;7(1):43-54.

Pythiosis is a cosmopolitan granulomatous disease caused by an aquatic fungus Pythium insidiosum which usually occurs in horses, cattle, dogs, cats or fishes. There have been 28 cases of human pythiosis published in the literature. Twenty three patients have been reported from all over Thailand. Human pythiosis presents in one of three clinical forms: cutaneous or subcutaneous, systemic or vascular and ophthalmic (e.g., corneal ulcer or keratitis). Systemic antibiotics or antimycotics are not effective in the treatment of this infection. A saturated solution of KI gives a beneficial result only in the subcutaneous form. Surgical removal of the source of infection is the method of therapy of vascular and ophthalmic forms.

1261

Pythium insidiosum keratitis. Murdoch D, Parr D. Aust N Z J Ophthalmol. 1997 May;25(2):177-9.

A case of Pythium insidiosum keratitis is described. It is an unusual organism that is difficult to isolate. Cases in animals and humans have been reported from tropical and subtropical parts of the world but this is the first case from a temperate region and was acquired from a hot pool. Although resembling a fungus, it is insensitive to all antifungals and requires wide surgical excision for cure.

1262

Successful medical therapy for deeply invasive facial infection due to Pythium insidiosum in a child. Shenep JL, English BK, Kaufman L, Pearson TA, Thompson JW, Kaufman RA, Frisch G, Rinaldi MG. Clin Infect Dis. 1998 Dec;27(6):1388-93.

Pythiosis occurs in animals and humans who encounter aquatic habitats that harbor Pythium insidiosum. Drug therapy for deeply invasive infections with this organism has been ineffective in humans and animals; patients have been cured only by radical surgical debridement. A 2-year-old boy developed periorbital cellulitis unresponsive to antibiotic and antifungal therapy. The cellulitis extended to the nasopharynx, compromising the airway and necessitating a gastrostomy for feeding. P. insidiosum was isolated from surgical biopsy specimens of the affected tissue. On the basis of in vitro susceptibility studies of the isolate, the patient was treated with a combination of terbinafine and itraconazole. The infection resolved over a period of a few months. The patient remained well 1.5 years after completing a 1-year course of therapy. Cure of deep P. insidiosum infection is feasible with drug therapy.

1263

Human subcutaneous pythiosis. Triscott JA, Weedon D, Cabana E. J Cutan Pathol. 1993 Jun;20(3):267-71.

 

Two cases of subcutaneous infection caused by the primitive aquatic hyphal organism Pythium are described. Pythium is an important pathogen of horses in the U.S.A. and Australia. Cases of human subcutaneous pythiosis have been cited in the literature, but clinical and histopathological features have not been described previously. Both cases occurred in young immunocompetent males in the periorbital region and showed rapid growth, clinically mimicking a tumor and requiring operative biopsy. In both cases there was a history of exposure to either swampy water or horses. The tissue reaction was distinctive, closely resembling that seen in equine pythiosis, comprising well-defined granular eosinophilic islands bordered by macrophages, multinucleate giant cells, fibrosis and numerous eosinophils. Hyphae were well demonstrated with the Grocott stain but only poorly with the PAS method. Identity of the organisms was confirmed with an immunoperoxidase technique employing a polyclonal antiserum to Pythium. Both patients responded well to amphotericin B.

1264

Human pythiosis in Thailand. Imwidthaya P. Postgrad Med J. 1994 Aug;70(826):558-60.

Pythium insidiosum is a protoctista and causes diseases in plants and animals. In Thailand it can cause a unique human infection of three types. The first type is a subcutaneous lesion in thalassaemic patients, with the pathological findings of a granulomatous reaction, diffuse infiltration, and oedema of the vessel walls. The patients responded to a saturated solution of potassium iodide. The second type is chronic inflammation and occlusion of blood vessels mainly in the lower extremities which results in gangrene or aneurysm formation. This type of infection is only found in thalassaemic patients and leads to amputation of the affected extremities or resection of the involved arteries. The third type is keratitis. This type of infection may or may not be associated with thalassaemia. The clinical signs and symptoms do not differentiate it from other types of myocotic keratitis. The patients end up with keratoplasty, evisceration or enucleation. Thailand is an agricultural country, and there are plenty of swampy areas and several plants to support the life cycle of Pythium. Moreover, many people suffer from thalassaemia, and there is no drug available for Pythium. Pythiosis plays an important role in medicine in Thailand.

1265

Additional case of Ramichloridium mackenziei cerebral phaeohyphomycosis from the Middle East. Khan ZU, Lamdhade SJ, Johny M, Al-Khalidi J, Thussu A, Yossef HN, Al-Obaid I, Nasser AA. Med Mycol. 2002 Aug;40(4):429-33.

In this report we describe a case of cerebral phaeohyphomycosis involving a 56-year-old Egyptian male who worked as a mason in Kuwait for 6 years. Computerized tomography scan of the brain revealed presence of a large abscess in the left occipital lobe. Aspirated pus from the abscess showed branched, septate, hyphae with light brown pigmentation. Cultured pus grew the fungus Ramichloridium mackenziei. Despite amphotericin B (1 mg kg(-1) per day) therapy for 2 weeks, the patient expired. The isolate was later found to be resistant to amphotericin B ( > 32 microg ml(-1)). Antifungal susceptibility testing to other agents was also performed.

1266

Ramichloridium mackenziei brain abscess: report of two cases and review of the literature. Kanj SS, Amr SS, Roberts GD. Med Mycol. 2001 Feb;39(1):97-102.

We report two cases of brain abscesses caused by Ramichloridium mackenziei, a neurotropic dematiaceous fungus that seems to be geographically restricted to the Middle East. One of the patients had chronic myelomonocytic leukemia but did not receive any chemotherapeutic agents. The other patient was a normal host. Both cases had a fatal outcome despite aggressive antifungal therapy and surgical intervention. Herein, we review all previously described cases in the literature, and discuss the epidemiology, mycology and histopathology of this life-threatening organism.

1267

Cerebral phaeohyphomycosis caused by Ramichloridium obovoideum (Ramichloridium mackenziei): case report. Podnos YD, Anastasio P, De La Maza L, Kim RB. Neurosurgery. 1999 Aug;45(2):372-5.

OBJECTIVE AND IMPORTANCE: Only a few cerebral infections with the dark-walled mold Ramichloridium obovoideum (Ramichloridium mackenziei) have been reported in the literature. Central nervous system infections caused by this fungus have poor prognoses; the optimal medical and surgical treatments have not yet been established. We report a case of cerebral R. obovoideum infection for which a combination of medical and surgical treatments failed. CLINICAL PRESENTATION: A 58-year-old Kuwaiti woman, with a history of chronic renal failure requiring hemodialysis, presented with a 3-day history of left frontal headache, blurry vision, dizziness, and right-sided clumsiness. Computed tomography demonstrated multiple, ring-enhancing, cerebral lesions (the largest of which measured 2-3 cm) in the deep left parieto-occipital region. INTERVENTION: A computed tomography-guided needle biopsy of the parieto-occipital lesion yielded 10 ml of dark caseous fluid. Stains demonstrated long, branching, septate hyphae. Fungal cultures grew R. obovoideum. The patient was treated with a combination of amphotericin B and itraconazole. The condition of the patient continued to deteriorate, and stereotactic aspiration of the largest lesion was performed. Despite this approach, the lesion progressed and the patient died. CONCLUSION: R. obovoideum is being increasingly recognized as a cause of cerebral abscesses in patients residing in the Middle East. Prognoses are poor, and responses to antifungal therapy are generally short-lived. Until more effective therapies are found, the greatest chance for adequate treatment involves early recognition, prompt treatment with antifungal agents, and attempts at complete resection.

1268

S. case report of cerebral phaeohyphomycosis caused by Ramichloridium obovoideum (R. mackenziei): criteria for identification, therapy, and review of other known dematiaceous neurotropic taxa. Sutton DA, Slifkin M, Yakulis R, Rinaldi MG. J Clin Microbiol. 1998 Mar;36(3):708-15

We report a case of cerebral phaeohyphomycosis in a 36-year-old male caused by the neurotropic fungus Ramichloridium obovoideum (Matushima) de Hoog 1977 (Ramichloridium mackenziei Campbell et Al-Hedaithy 1993). This man resided in the Middle East, where the fungus appears to be endemic and, possibly, geographically restricted, since all previous reports of brain abscesses due to this organism have been for patients indigenous to this area. As a servant of the Saudi Arabian royal family, he appeared in the United States seeking treatment for chronic weight loss, fatigue, decreased memory, and a more recent 2-week history of right-hand weakness which worsened to involve the entire right upper extremity. On the day prior to his admission, he had a focal motor seizure with rotation of the head and eyes to the right, followed by secondary generalization. A computerized tomogram showed a ring-enhancing hypodense lesion in the left parietal subcortical region with associated edema and mass effect. Diagnosis of a fungal etiology was made following a parietal craniotomy and excisional biopsy by observation of septate, dematiaceous hyphal elements 2 to 3 microm in width on hematoxylin-and-eosin-stained sections from within areas of inflammation and necrosis. Culture of the excised material grew out a dematiaceous mould which was subsequently identified as R. obovoideum. At two months postsurgery and with a regimen of 200 mg of itraconazole twice a day, the patient was doing well and returned to Saudi Arabia. His condition subsequently deteriorated, however, and following a 7-month course of itraconzole, he expired. We use this case to alert clinicians and personnel in clinical mycology laboratories of the pathogenicity of this organism and its potential occurrence in patients with central nervous system signs and symptoms who have resided in the Middle East and to review and/or compare R. obovoideum with other neurotropic, dematiaceous taxa and similar nonneurotropic, dematiaceous species.

1269

Fatal brain abscesses caused by Ramichloridium obovoideum: report of three cases. Naim-ur-Rahman, Mahgoub ES, Chagla AH. Acta Neurochir (Wien). 1988;93(3-4):92-5.

Three cases of brain abscesses caused by Ramichloridium obovoideum are reported. Inspite of adequate antifungal chemotherapy and multiple surgical procedures, all the three patients died of the rupture of a recurrant abscess into the ventricles. Ramichloridium obovoideum was identified as the causative fungus of these brain abscesses. Clinical, histological and mycological features of these cases are described. To our knowledge this is the first time that this fungus is isolated from a brain abscess in Saudi Arabia. The possibility that this life threatening cerebral mycosis may be endemic in this part of the world is considered.

1270

Golden tongue' syndrome caused by Ramichloridium schulzeri. Rippon JW, Arnow PM, Larson RA, Zang KL. Arch Dermatol. 1985 Jul;121(7):892-4.

A 54-year-old woman entered the hospital for induction chemotherapy for acute lymphocytic leukemia. On hospital day 23, while the patient was neutropenic, an erosive lesion appeared on the left side of the tongue. During the next several days the lesion extended over the dorsum of the tongue and was golden orange. Surface scrapings were obtained; the involved site underwent a biopsy and was cultured. Branching septate mycelia of varying diameters were seen on microscopic examination of direct mounts and a biopsy specimen of the tongue. Eight to ten colonies of a fungus grew out in culture. The fungus was golden orange on Sabouraud's glucose agar and brown-gray on corn-meal agar, and was identified as Ramichloridium schulzeri. The lesion regressed during the next two weeks while the patient received amphotericin B therapy and showed an increased granulocyte count. This case seems to be the first authenticated infection caused by this uncommonly encountered soil saprophyte.

1272

Auricular chromoblastomycosis caused by Rhinocladiella aquaspersa. Arango M, Jaramillo C, Cortés A, Restrepo A. Med Mycol. 1998 Feb;36(1):43-5.

An unusual case of chromoblastomycosis localized in the ear and caused by R. aquaspersa is presented. The patient was a 60-year-old male urban resident, who had had the disease for 5 years. The lesion was darkly pigmented, infiltrative and crusty. Sclerotic cells were seen on direct examinations and the fungus was recovered in culture and identified on the basis of the characteristic sporulation. Itraconazole therapy at a dose of 200 mg day-1 for 7 months produced complete healing.

1274

Rhinosporidiosis and peripheral keratitis. Bhomaj S, Das JC, Chaudhuri Z, Bansal RL, Sharma P. Ophthalmic Surg Lasers. 2001 Jul-Aug;32(4):338-40.

Report of a case of peripheral keratitis caused by Rhinosporidium seeberi. The patient was seen in a referral practice. Corneal scraping was performed on a middle-aged female patient presenting with peripheral keratitis and progressive nasal obstruction that revealed spores suggestive of rhinosporidiosis. The patient was started on topical amphotericin B 0.15% eye drops. Ear, nose, and throat (ENT) examination showed presence of a polypoid lesion in the left nostril for which a polypectomy was performed. Histopathological examination confirmed rhinosporidiosis. Complete resolution of the keratitis was observed. Topical amphotericin B is an effective drug in the management of this condition. Keratitis secondary to rhinosporidial infection has not been described although occasional patients with limbal and scleral involvement have been reported. Corneal scraping was effective in helping us make a tentative diagnosis.

1275

Rhinosporidiosis presenting with two soft tissue tumors followed by dissemination. Angunawela P, De Tissera A, Dissanaike AS. Pathology. 1999 Feb;31(1):57-8.

Rhinosporidiosis is caused by Rhinosporidium seeberi. Most mycologists believe that R. seeberi is either a Chytridium related to the Olpidiaceae (order Chytridialis, class Chytridiomycetes) or a Synchytrium. This is the first documented case of tumoral rhinosporidiosis in a Sri Lankan and the third documented case in the world literature. A 44 year old male presented with a large mass above the thigh and a similar mass over the anterior chest wall, both masses contained R. seeberi. Later examination of the patient revealed nasal polyps, confirming that the tumors were due to systemic spread of this infection.

1276

[Nasal rhinosporidiosis] Soler Lluch E, Ruiz González M, González García J, Ruiz Martín F, García Linares C. Acta Otorrinolaringol Esp. 1998 Aug-Sep;49(6):498-500.

Rhinosporidiosis is a granulomatous disease of uncertain mycotic origin that is characterized by polypoid lesions, predominantly of the nasal mucous membrane and conjunctiva. It is endemic to India and Sri Lanki, but occasionally occurs in other regions of the world. We report a case in Spain. The modes of infection and transmission, as well as treatment, are discussed.

1277

Rhinosporidiosis. Report of a case with an unusual presentation with bony involvement. Adiga BK, Singh N, Arora VK, Bhatia A, Jain AK. Acta Cytol. 1997 May-Jun;41(3):889-91.

BACKGROUND: Rhinosporidiosis, a fungal infection due to Rhinosporidium seeberi, frequently produces polypoidal lesions in the nose. Sites like the conjunctiva, larynx, trachea, nasopharynx, skin and genitourinary tract are less frequently involved. Generalized rhinosporidiosis with skin and visceral involvement is extremely rare. This report describes the fine needle aspiration cytology (FNAC) of rhinosporidiosis occurring as a solitary lesion with erosion of cortical bone. CASE REPORT: FNAC of a soft tissue swelling overlying a lytic lesion on the anterior aspect of the tibia was performed in a 40-year-old male. Smears revealed numerous sporangia and spores of R seeberi. There were no mucocutaneous lesions. Histologic examination confirmed the bony involvement. CONCLUSION: The FNAC diagnosis of rhinosporidiosis is specific. Preoperative diagnosis is possible even in cases with unusual clinical presentations.

1278

Infection of the conjunctiva by Rhinosporidium seeberi. Reidy JJ, Sudesh S, Klafter AB, Olivia C. Surv Ophthalmol. 1997 Mar-Apr;41(5):409-13.

Rhinosporidiosis is an unusual fungal disease that rarely affects the eye. It was first described as a pathogen in humans at the turn of the century. The etiologic agent, Rhinosporidium seeberi, commonly produces granulomatous inflammation of the upper respiratory mucosa. Most reported ocular infections have occurred in hot, dry climatic regions. We present a case of conjunctival rhinosporidiosis in an 11-year-old boy from western New York state, the first such report from the temperate zones of North America. The clinical characteristics, histopathologic features, and recommended therapeutic measures are discussed.

1279

Rhinosporidiosis: presentation of 4 cases] González Núñez MA, Rodríguez Fernández AM, Méndez Vega AR, Martí Peña J, Pérez Toril Galán J, Carapeto Márquez de Prado R. Med Clin (Barc). 1990 May 12;94(18):689-92.

We report 4 cases of rhinosporidiosis in the province of Cáceres. Two had nasal localization and in two ocular conjunctiva was involved. Three patients, two of which came from the same village, had the antecedent of bathing in the same stagnant water. The diagnosis was made by the microscopic observation of characteristic sporangia of Rhinosporidium seeberi in the histopathological study. The lesions did not respond to antibiotic and antiinflammatory treatment. After excision there were no recurrences, and the patients are asymptomatic after 1 1/2 year follow up.

1282

Mycotic keratitis due to Rhizoctonia sp. Srivastava OP, Lal B, Agrawal PK, Agarwal SC, Chandra B, Mathur IS. Sabouraudia. 1977 Jul;15(2):125-31.

A case of mycotic keratitis due to Rhizoctonia sp. is reported for the first time. Fungal hyphae were detected in corneal scrapings and cultures were found positive for Rhizoctonia sp. on two occasions. Species could not be identified and it has been disposed in Herb. IMI as Rhizoctonia sp. (IMI 200029). The isolate grew faster at 37 degrees C than at 28 degrees C and its pathogenicity was established in rabbit's eye.

1284

Zygomycosis: review of 16 cases] González A, del Palacio A, Cuétara MS, Gómez C, Carabias E, Malo Q. Enferm Infecc Microbiol Clin. 1996 Apr;14(4):233-9.

BACKGROUND. Zygomycosis (mucormycosis or phycomycosis) is the infection caused by zygomycetes (non partitioned mycelial fungi, usually saprophytes). All cases of zygomycosis diagnosed in the Hospital 12 de Octubre in Madrid, Spain, from 1976 to 1994 were reviewed. METHODS. The underlying diseases of the patients, the factors favoring infection (alteration of the cutaneous barrier and administration of antimicrobians and corticosteroids) and the possible nosocomial origin of infection were analyzed. RESULTS. Over this period of time, 16 cases of zygomycosis were diagnosed with different clinical forms depending on the route of entry (rhino-orbital-cerebral, cutaneous or disseminated). The species isolated were Rhizopus oryzae, Rhizomucor pusillus, Absidia corymbifera and Rhizopus stolonifer. The species could not be determined in two cases. CONCLUSIONS. The diagnosis of zygomycosis should be based on a combined histological and microbiological study which allows both, differentiation between colonization and infection and isolation of the implicated species. Treatment is that of the underlying diseases, extensive surgical resection and amphotericin B.

1285

Cellulitis caused by Rhizomucor pusillus in a diabetic patient receiving continuous insulin infusion pump therapy. Wickline CL, Cornitius TG, Butler T. South Med J. 1989 Nov;82(11):1432-4.

We have reported a case of primary cutaneous zygomycosis in a diabetic patient receiving continuous insulin infusion pump therapy. We believe this to be the first reported case of a fungal infection associated with the use of an insulin pump. The infection itself was an unusually mild and chronic zygomycosis, possibly due to a low production rate of proteolytic enzymes by a rare opportunistic human pathogen, Rhizomucor pusillus.

1286

Diabetic ketoacidosis and rhino-orbital mucormycosis. Dokmetas HS, Canbay E, Yilmaz S, Elaldi N, Topalkara A, Oztoprak L, Yildiz E. Diabetes Res Clin Pract. 2002 Aug;57(2):139-42.

Mucormycosis often develops in immunocompromised patients, particularly in patients with diabetic ketoacidosis. Unless early diagnosis and treatment is established mucormycosis leads rapidly to death. A 38-year-old woman was admitted to the hospital with a severe diabetic ketoacidosis. Her clinical status improved in 4 days as a result of aggressive medical treatment. She has complained left cheek pain on the 10th day and had a swelling of her left cheek, facial edema, a black eschar on the palate and nasal cavity in association with visual disturbance and total ophthalmology in a short time. CT scan revealed left orbital cellulitis and pansinusitis. Excessive surgical treatment was performed and liposomal amphotericin-B, 4 mg/(kg day) was applied. Extensive fungal invasion of the orbit and the sinuses was demonstrated in the pathological species and Rhizomucor species were yielded with culture. Repeated superficial debridement was also performed. After 10 weeks, she was discharged with suggestion of insulin treatment and liposomal amphotericin-B with progressively decreasing doses. At the 13th month following the presentation, the patient was free of disease as confirmed by serial imaging and under good glycaemic control with insulin treatment. Although mucormycosis is a fatal infection, early diagnosis and aggressive treatment may decrease mortality.

1287

Nosocomial infection by Rhizomucor pusillus in a clinical haematology unit. del Palacio Hernanz A, Fereres J, Larregla Garraus S, Rodriguez-Noriega A, Sanz Sanz F. J Hosp Infect. 1983 Mar;4(1):45-9.

Three patients suffering from acute leukaemia were treated with cytotoxic agents and broad-spectrum antibiotics and received blood transfusion and nasal packing for severe epistaxis. All developed necrosis of nasal and facial tissues, with facial swelling an oedema; two biopsies showed typical phycomycete mycelium, and Rhizomucor pusillus was grown from one biopsy. Air and surfaces in the unit and the air intake and ducting were all heavily colonized by Rh. pusillus and other phycomycetes. It is suggested that Rh. pusillus spores from the air invaded the tissues in the conditions promoted by the nasal packing in these patients with impaired defences.

1288

Cure of pulmonary Rhizomucor pusillus infection in a patient with hairy-cell leukemia: role of liposomal amphotericin B and GM-CSF. Ma B, Seymour JF, Januszewicz H, Slavin MA. Leuk Lymphoma. 2001 Nov-Dec;42(6):1393-9.

We describe a case of successfully treated multifocal pulmonary Rhizomucor pusillus, a condition which has previously been universally fatal. A 77 year-old man had a background of chronic neutropenia due to hairy-cell leukemia, splenectomy, corticosteroid therapy and an obstructing left ureteric transitional-cell carcinoma. He was successfully treated with 3 months of high-dose liposomal amphotericin B and 7 months of granulocyte-macrophage colony-stimulating factor. Treatment was complicated by mild reversible deterioration of renal function. There was a near complete radiological response to the therapy at 6 months and the patient remains well 20 months following diagnosis of R. pusillus and 13 months following cessation of treatment.

1289

Infection due to Rhizomucor pusillus: report of four cases in patients with leukemia and review. St-Germain G, Robert A, Ishak M, Tremblay C, Claveau S. Clin Infect Dis. 1993 May;16(5):640-5.

Rhizomucor pusillus, a thermophilic fungus of the order Mucorales, is a rare cause of human infection. A search of the literature has produced only seven reports describing nine cases of infection caused by this organism. Recently, over a period of 17 months, four cases of R. pusillus infection in patients with leukemia were diagnosed: a cluster of three cases in a Montreal hospital and one isolated case from Quebec City. All four cases were proven both by histopathologic examination and by culture of tissues. In three cases, pulmonary involvement was confirmed following lung surgery, and in one case, disseminated infection was observed at autopsy. All patients received amphotericin B, and two underwent surgical debridement; however, none of the patients survived.

1290

[Disseminated aspergillosis and mucormycosis. A case report] Molle M, Blaschke-Hellmessen R, Schuler U, Nowak R, Ehninger G. Mycoses. 1996;39 Suppl 1:59-64.

This paper reports a simultaneous pulmonary infection due to Aspergillus fumigatus and Rhizomucor pusillus which evolved to disseminated aspergillosis and mucormycosis in a leukaemic and neutropenic 40-year-old woman. Both fungi were cultured ante mortem from bronchial secretion. Although high doses of intravenous amphotericin B were administered, the course of the infection was fatal. At autopsy, aspergilli were demonstrated by histology in lungs and brain, and zygomycetes were found to have invaded liver and kidneys.

1293

Rhinocerebral zygomycosis in a patient with acute lymphoblastic leukemia. Lerchenmüller C, Göner M, Büchner T, Berdel WE. Ann Oncol. 2001 Mar;12(3):415-9.

We report a case of a 28-year-old man with acute lymphoblastic leukemia who developed rhinocerebral zygomycosis during induction chemotherapy. This life-threatening fungal infection is an infrequent cause of neutropenic fever, and is occasionally found in patients with leukemia and lymphoma, or patients with severely compromised defence mechanisms due to other diseases. It is caused by moulds belonging to the Mucoraceae family, and is characterized by local destruction of the affected organ. In our patient, the infection spread from the paranasal sinuses to the right orbit, destroyed intraorbital structures and resulted in blindness within days. Biopsy from the right maxillary sinus was performed and mucormycosis was suspected through microscopic examination. Culture of the resected specimen identified Rhizopus arrhizus as the causing agent. Treatment of zygomycosis should consist of radical surgical debridement of the infected tissue, together with intensive broad-spectrum antimycotic therapy with amphotericin B. What could be learned from this case is, that aggressive approaches to identify the cause of infection is necessary, and that aggressive treatment strategies are inevitable to overcome the infection. Furthermore, treatment of the underlying disease should be continued as soon as possible.

1294

Fatal rhino-orbital-cerebral zygomycosis. Kameh DS, Gonzalez OR, Pearl GS, Walsh AF, Gambon T, Kropp TM. South Med J. 1997 Nov;90(11):1133-5.

Rhinocerebral zygomycosis is usually an aggressive, fulminant and, at times, fatal disease most often affecting poorly controlled diabetics of all ages. We report the case of a 13-month-old white boy, a previously undiagnosed diabetic. He came to our hospital with recurrent epistaxis, decreasing consciousness, and a small visible infection at the inner canthus of the left eye. Initial evaluation revealed that the patient was in diabetic ketoacidosis. Despite aggressive medical and surgical treatment, his condition deteriorated rapidly, including the development of diabetes insipidus, and he died 4 days after admission. At autopsy, he was found to have fungal cerebritis (Rhizopus) with multiple areas of infarction and massive cerebral edema.

1295

Chiasmal infarction and sudden blindness caused by mucormycosis in AIDS and diabetes mellitus. Lee BL, Holland GN, Glasgow BJ. Am J Ophthalmol. 1996 Dec;122(6):895-6.

PURPOSE: To report rapidly progressive rhino-orbitocerebral mucormycosis in a 47-year-old woman with both diabetes mellitus and the acquired immunodeficiency syndrome (AIDS). METHOD: Case report including postmortem examination of the eyes, orbit, and brain of a patient with rhino-orbitocerebral mucormycosis, diabetes mellitus, and AIDS. RESULTS: Invasion by hyphae of the Rhizopus species produced an occlusive vasculitis and massive infarction of the optic chiasm. Fungal organisms were discovered in multiple granulomata of the optic nerve. CONCLUSION: Infarction at the optic chiasm probably caused sudden blindness in this patient.

1296

Orbitofacial mucormycosis with unusual pathological features. Albert DM, Lesser RL, Cykiert RC, Zakov ZN. Br J Ophthalmol. 1979 Oct;63(10):699-703.

A 52-year-old man with mild diabetes and acute stem cell leukaemia developed an orbitofacial mucormycosis. Cultures showed the fungus to be Rhizopus oryzae. Vigorous treatment with amphotericin B and other bactericidal and bacteriostatic antibiotics for a concurrent sepsis failed to suppress the infections, and the patient died. On post-mortem examination characteristic haematoxylin-staining, broad, aseptate fungal hyphae were found in the right eye, orbit, and lung. A striking and unusual feature of this case is the presence of brightly birefringent crystals within the severely degenerated eye. These were found by histochemical staining and x-ray diffraction studies to be calcium salts of fatty acids, apparently liberated from necrotic adipose tissue of the orbit.

1297

[A case of abrupt pulmonary infection by Rhizopus microsporus var. rhizopodiformis during treatment for bronchial asthma] Maniwa K, Tanaka E, Taguchi Y, Oida K, Inoue T, Kato T, Sakuramoto M, Maeda Y, Terada K, Aihara M. Kansenshogaku Zasshi. 2002 May;76(5):396-9.

We presented a case of pulmonary Rhizops microsporus var. rhizopodiformis infection which developed abruptly during treatment of bronchial asthma by systemic corticosteroids. The patient, an 85 year-old-woman, was given systemic steroid therapy for 15 days. She suddenly became febrile two days after the therapy and was coughing up yellow sputum. Chest X-ray film showed multiple nodules with cavities which became worsened rapidly. A specimen of sputum culture gave a growth of Mucoraceae, which was identified to be Rhizopus microsporus var. rhizopodiformis. She was given amphotericin B and miconazole was added on the basis of MIC value of the strain. Although she improved initially, her clinical course showed neutropenia, pseudomembranous enterocolitis, malnutrition, and then died after about six months. Because the diagnosis of pulmonary mucormycosis is difficult and prognosis is poor, further studies for investigating clinical features would be necessary.

1298

Pulmonary mucormycosis in a diabetic patient. Vincent L, Biron F, Jardin P, Piens M, Dannaoui E, Isaac S, Guibert B, Pacheco Y. Ann Med Interne (Paris). 2000 Dec;151(8):669-72.

We present the case of a 54 year-old male from Moldavia with diabetes mellitus (type II diabetic), admitted to hospital in January 1999, with ketoacidosis and consolidation of the lower left lobe. The diagnosis of mucormycosis was confirmed by identification of large, nonseptate hyphae of the order Mucorales. A strain of Rhizopus oryzae (Rhizopus arrhizus) was isolated from culture on sabouraud medium. The patient was treated by systemic amphotericin B, associated with surgical debridement (lobectomy).The treatment with amphotericin B was stopped after ten days and the patient was completely asymptomatic and returned to Moldavia. Mucormycoses are rare, and tend to be encountered in individuals with predisposing factors such as malignant blood disorders (immunocompromised patients) or diabetes mellitus. Prognosis is poor, resembling infection with Aspergillus, despite aggressive treatment as in the present case. The gravity of the condition can be accounted for by the thrombotic and necrosing nature of the fungal invasion of lung vessels.

1299

Pulmonary Rhizopus infection in a diabetic renal transplant recipient. Demirag A, Elkhammas EA, Henry ML, Davies EA, Pelletier RP, Bumgardner GL, Dorner B, Ferguson RM. Clin Transplant. 2000 Feb;14(1):8-10.

Infectious complications after renal transplantation remain a major cause of morbidity and mortality. Mucormycosis is a rare infection in renal transplant recipients; however, mortality is exceedingly high. Risk factors predisposing to this disease include prolonged neutropenia, diabetes, and patients who are immunosuppressed (Singh N, Gayowski T, Singh J, Yu LV. Invasive gastrointestinal zygomycosis in a liver transplant recipient: case report and review of zygomycosis in solid-organ transplant recipients, Clin Infect Dis 1995: 20: 617). Life-threatening infections can occur, as this fungus has the propensity to invade blood vessel endothelium, resulting in hematological dissemination. We report a case of cavitary Rhizopus lung infection, 2 months after renal transplantation, where the patient was treated successfully with Amphotericin B and surgical resection of the lesions with preservation of his allograft function. In this era of intensified immunosuppression, we may see an increased incidence of mucormycosis in transplant population. Invasive diagnostic work-up is mandatory in case of suspicion; Amphotericin B and, in selected cases, surgical resection are the mainstays of therapy.

1300

Pulmonary Rhizopus rhizopodiformis cavitary abscess in a cardiac allograft recipient. Tan HP, Razzouk A, Gundry SR, Bailey L. J Cardiovasc Surg (Torino). 1999 Apr;40(2):223-6.

Pulmonary mucormycosis is rare in solid organ transplant recipients. Only one case has been reported previously in a cardiac allograft recipient. However, the Rhizopus species in that study was not identified. We report a case of successful surgical treatment of pulmonary cavitary mucormycosis due to Rhizopus rhizopodiformis in a cardiac allograft transplant recipient. A review of the literature on pulmonary mucormycosis occurring in solid organ transplant recipients is also presented.

1301

Rhizopus lung abscess in renal transplant patient successfully treated by lobectomy. Gribetz AR, Chuang MT, Burrows L, Teirstein AS. Chest. 1980 Jan;77(1):102-4.

A 46-year-old man with diabetes mellitus and cadaveric kidney transplant, maintained on a regimen of prednisone and azathioprine, developed a necrotizing pneumonia. The abscess cavity became secondarily infected with Rhizopus and was cured by surgical resection. Secondary invasion of an abscess cavity by Rhizopus and the successful surgical treatment of pulmonary phycomycosis in an immunosuppressed patient have not previously been reported.

1302

Fatal genitourinary mucormycosis in a patient with undiagnosed diabetes. Williams JC, Schned AR, Richardson JR, Heaney JA, Curtis MR, Rupp IP, von Reyn CF. Clin Infect Dis. 1995 Sep;21(3):682-4.

We present what we believe is the first report in the world literature of penile necrosis due to mucormycosis, a rare and often fatal fungal infection. This case of rhizopus mucormycosis began with a penile lesion in a 27-year-old patient with undiagnosed diabetes; it led to necrosis of the phallus, lower urinary tract, rectum, and pelvic musculature and finally to death. Despite repeated aggressive surgical debridement in conjunction with medical therapy, we were unable to halt the progression of the fungal and synergistic bacterial infections.

1303

Cutaneous zygomycosis: a case report and review of Japanese reports. Kobayashi M, Hiruma M, Matsushita A, Kawai M, Ogawa H, Udagawa S. Mycoses. 2001;44(7-8):311-5.

A 69-year-old man, a carpenter with idiopathic thrombopenic purpura and interstitial pneumonia, was treated with steroid pulse therapy and antibiotics. On the seventh day of steroid therapy, a conglomeration of papules, vesicles and pustules appeared in an area of the left buttock in contact with his napkin. In a Parker KOH specimen of the crust of the lesion, many non-septate hyphae were seen, and culture of material obtained by biopsy yielded Rhizopus microsporus var. microsporus. Ketoconazole cream was applied topically for 1 week, and the exanthema healed. After the third month of inpatient treatment, the patient's overall condition had returned to normal, and he was discharged. Cutaneous zygomycosis is a rare disease, and only 19 cases have been reported in Japan. Its characteristics, as reported in these cases, have been collected and collated.

1304

Primary cutaneous mucormycosis in a trauma patient. Song WK, Park HJ, Cinn YW, Rheem I, Pai H, Shin JH. J Dermatol. 1999 Dec;26(12):825-8.

We report a rare case of primary cutaneous mucormycosis caused by Rhizopus oryzae that occurred in an immunocompetent trauma patient. The patient had encrusted erythematous plaques with pustules on the left shin, which had been abraded in a traffic accident. Histologic examination revealed widespread granulomatous inflammation and characteristic broad, non-septate hyphae with right-angle branching in the dermis. The infection was cured with intravenous amphotericin B therapy.

1305

Primary cutaneous mucormycosis in a premature infant: case report and review of the literature. Linder N, Keller N, Huri C, Kuint J, Goldshmidt-Reuven A, Barzilai A. Am J Perinatol. 1998 Jan;15(1):35-8.

Mucormycosis is an uncommon infection caused by fungi of the order Mucorales, family Mucoraceae, and almost always occurs in individuals with predisposing factors such as diabetes mellitus, metabolic acidosis, or immunodeficiency states. Although mucormycosis is a rare infection in childhood, sporadic cases of skin infections have been described in young infants and older children; primary skin infection has been associated with multiple nosocomial outbreaks caused by contaminated elastic bandages. In all reported cases involving premature infants, the elimination of the infection involved surgical debridement. We report for the first time successful conservative treatment with intravenous amphotericin B in a premature infant with primary cutaneous infection caused by Rhizopus oryzae.

1306

Subcutaneous mucormycosis caused by Rhizopus oryzae probable nosocomial acquired infection.Telles Filho Fde Q, Coelho A, Porto E, Lameira RF, Freitas MM, Barboza J, Ramos JL. Rev Inst Med Trop Sao Paulo. 1985 Jul-Aug;27(4):201-6.

 

1307

Inguinal abscess caused by Rhizopus rhizopodiformis: successful treatment with surgery and amphotericin B. West BC, Kwon-Chung KJ, King JW, Grafton WD, Rohr MS. J Clin Microbiol. 1983 Dec;18(6):1384-7.

Rhizopus rhizopodiformis has seldom been isolated from human mucormycosis. We report the first subcutaneous abscess to be caused by this fungus. It occurred in a diabetic man and presented as an inguinal mass, suggestive of a hernia, superficial to his cadaveric renal transplant. The fungus was readily isolated from pus inoculated onto blood and chocolate agars after a short incubation. The patient was cured by surgical drainage and treatment with 2.0 g of intravenous amphotericin B. Complete identification of such isolates is recommended.

1308

Radiographic and radionuclide findings in Rhizopus osteomyelitis. Moore PH Jr, McKinney RG, Mettler FA Jr. Radiology. 1978 Jun;127(3):665-6.

A case of Rhizopus osteomyelitis is described. The radionuclide and radiographic findings differ from those of osteomyelitis secondary to common pathogens: low-level radionuclide activity is observed, while soft-tissue swelling, periosteal reaction, and loss of fascial margins are absent.

1309

Disseminated Rhizopus infection in a premature infant. Craig NM, Lueder FL, Pensler JM, Bean BS, Petrick ML, Thompson RB, Eramo LR. Pediatr Dermatol. 1994 Dec;11(4):346-50.

A 16-day-old premature male infant developed rapidly expanding necrotic facial plaques. Histology and cultures of tissue biopsy specimens revealed infection with Rhizopus arrhizius. The patient was treated aggressively with surgical debridement, amphotericin B, and rifampin, but had a progressive spread of the cutaneous infection and a fatal clinical course. He had gastrointestinal and pulmonary involvement on autopsy. Zygomycoses are rapidly progressive infections which generally affect immunocompromised hosts. Premature infants should be included as individuals at risk for disseminated zygomycotic disease.

1310

Disseminated mucormycosis in AIDS] Lagorce Pages C, Fabre A, Bruneel F, Zimmermann U, Henin D. Ann Pathol. 2000 Sep;20(4):343-5.

Mucormycosis is a rare often fatal opportunistic condition. It mainly occurs in immunocompromised subjects but rarely in AIDS patients. An eighteen-year-old HIV+ man from Zaire died rapidly from disseminated mucormycosis with pulmonary, cardiac, renal, hepatic, splenic and gastric involvement. Fungi were observed in all these organs with a particular vascular trophism. Rhizopus orizae was identified on cultures. Rapid microscopic diagnosis, in the localized stage, could improve the poor prognosis of this infection.

1311

Disseminated zygomycosis due to Rhizopus schipperae after heatstroke. Anstead GM, Sutton DA, Thompson EH, Weitzman I, Otto RA, Ahuja SK. J Clin Microbiol. 1999 Aug;37(8):2656-62.

A 21-year-old woman suffered heatstroke and developed diarrhea while trekking across south Texas. The heatstroke was complicated by seizures, rhabdomyolysis, pneumonia, renal failure, and disseminated intravascular coagulation. The patient's stool and blood cultures grew Campylobacter jejuni. The patient subsequently developed paranasal and gastrointestinal zygomycosis and required surgical debridement and a prolonged course of amphotericin B. The zygomycete cultured was Rhizopus schipperae. This is only the second isolate of R. schipperae that has been described. R. schipperae is characterized by the production of clusters of up to 10 sporangiophores arising from simple but well-developed rhizoids. These asexual reproductive propagules are produced on Czapek Dox agar but are absent on routine mycology media, where only chlamydospores are observed. Despite multiorgan failure, bacteremia, and disseminated zygomycosis, the patient survived and had a good neurological outcome. Heatstroke has not been previously described as a risk factor for the development of disseminated zygomycosis.

1312

Fatal fungal peritonitis in an adolescent on continuous ambulatory peritoneal dialysis: association with deferoxamine. Nakamura M, Weil WB Jr, Kaufman DB. Pediatr Nephrol. 1989 Jan;3(1):80-2.

An unusual case of Rhizopus microsporus (mucormycosis) fungal infection in a teenage boy on continuous ambulatory peritoneal dialysis is presented. Premortem cultures were negative and the patient developed a rapidly disseminated fatal infection. The patient was being treated with deferoxamine (DFO) for iron and aluminum overload. An argument is made for a probable association between DFO and this fatal fungal infection in patients with end-stage renal disease.

1314

Meningitis caused by Rhodotorula rubra in an HIV-infected patient. Gyaurgieva OH, Bogomolova TS, Gorshkova GI. J Med Vet Mycol. 1996 Sep-Oct;34(5):357-9.

Meningitis caused by Rhodotorula spp. in HIV-infected patients has not been reported previously. We present a brief review of the literature regarding medically important species of Rhodotorula and a case of meningitis caused by Rhodotorula rubra in an HIV-infected patient. The diagnosis was confirmed by the isolation of the fungus from the CSF. The course of Rhodotorula-induced meningitis was characterized by gradual development over several months, severe headache and high body temperature. No signs of damage to the meninx or inflammatory changes were observed. Therapy with 5-fluorocytosine for 15 days was successful in eliminating the yeast from the CSF. Eight months later the meningitis relapsed with R. rubra being recovered from the CSF. Suppressive therapy with itraconazole (400 mg daily during 3 months) followed by maintenance therapy (200 mg daily) eradicated the infection.

1315

Rhodotorula glutinis-related meningitis. Lanzafame M, De Checchi G, Parinello A, Trevenzoli M, Cattelan AM. J Clin Microbiol. 2001 Jan;39(1):410.

 

1316

Opportunistic infection with Rhodotorula in cancer patients treated by chemotherapy: two case reports. Alliot C, Desablens B, Garidi R, Tabuteau S. Clin Oncol (R Coll Radiol). 2000;12(2):115-7.

Rhodotorula species are commensal yeasts of variable pathogenicity. The authors report the case histories of two patients presenting with febrile neutropenia. The first was a 3-year-old girl who had been treated with combination chemotherapy for a tumour of the posterior fossa. The second was a 46-year-old man who had received chemotherapy for lymphoplasmocytic lymphoma, followed by consolidation treatment with autologous bone marrow transplantation. Investigation revealed infection caused by Rhodotorula. The outcome was favourable after removal of the catheter in both patients. Rhodotorula species have been isolated during a variety of infectious complications. Almost all published cases of fungaemia concern patients with central venous catheters that have been in place over long periods, who have also been treated with broad spectrum antibiotics. Neoplasia represents the most frequent underlying disease. The pathogenicity of Rhodotorula species appears to be moderate in most cases; fungal therapy or the removal of infected catheters is generally effective. Nevertheless, Rhodotorula has been reported to provoke fatal endocarditis or meningitis and can probably cause septic shock.

1317

Endocarditis caused by Rhodotorula successfully treated with 5-fluorocytosine. Naveh Y, Friedman A, Merzbach D, Hashman N. Br Heart J. 1975 Jan;37(1):101-4.

A 7-year-old boy suffering from aortic regurgitation and mitral stenosis and regurgitation was admitted with endocarditis caused by Rhodotorula pilimanae and was treated successfully with orally administered antifungal agent, namely 5-fluorocytosine (5-FC). A dose of 100 mg per kg body weight, divided into four equal parts, was prescribed. After a prolonged febrile period his temperature dropped to normal on the fourth day of 5-FC therapy. Review of the published reports disclosed few cases of endocarditis due to Rhodotorula spp. and this case seems to be the first treated with 5-FC. Follow-up in one year, after discharge from the hospital, revealed no evidence of relapse.

1318

Rhodotorula sp. infection in corneal interface following lamellar keratoplasty--a case report. Panda A, Pushker N, Nainiwal S, Satpathy G, Nayak N. Acta Ophthalmol Scand. 1999 Apr;77(2):227-8.

 

PURPOSE: To report an unusual organism causing infection following lamellar keratoplasty. METHOD: Case report. RESULT: Both gram stain smear and culture from the interlamellar bed revealed Rhodotorula sp., a red yeast as a causative agent. CONCLUSION: Rhodotorula sp. can cause corneal lamellar graft infection.

1319

Successful treatment of CAPD peritonitis caused by rhodotorula mucilaginosa. de Zoysa JR, Searle M, Lynn KL, Robson RA. Perit Dial Int. 2001 Nov-Dec;21(6):627-8.

 

1320

Rhodotorula rubra peritonitis in a child undergoing intermittent cycling peritoneal dialysis. Wong V, Ross L, Opas L, Lieberman E. J Infect Dis. 1988 Feb;157(2):393-4.

 

1321

Rhodotorula rubra peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. Eisenberg ES, Alpert BE, Weiss RA, Mittman N, Soeiro R. Am J Med. 1983 Aug;75(2):349-52.

Although still uncommon, fungal peritonitis is being reported with increasing frequency in patients with renal failure who are undergoing long-term peritoneal dialysis. Although most cases have involved Candida albicans, other opportunistic pathogens have been reported as well. Recently, three patients were seen with serious peritoneal infections due to Rhodotorula rubra, a "nonpathogenic" fungus. In two patients, peritoneal fibrosis made further peritoneal dialysis impossible. The third patient died from complications of peritonitis. Environmental cultures revealed a possible common-source outbreak. Literature review reveals that infection due to this organism is most unusual and occurs only in the hospital setting in patients with serious compromise of host defenses.

1322

Rhodotorula rubra ventriculitis. Donald FE, Sharp JF, Firth JL, Crowley JL, Ispahani P. J Infect. 1988 Mar;16(2):187-91.

We describe a case of post-operative ventriculitis in an immunocompetent patient caused by an unusual organism, namely Rhodotorula rubra. The patient was treated successfully with antifungal agents.

1323

Central venous catheter-related Rhodotorula rubra fungemia. Chung JW, Kim BN, Kim YS. J Infect Chemother. 2002 Mar;8(1):109-10.

With the increased use of indwelling central venous catheters, increasing numbers of cases of Rhodotorula fungemia have been observed in patients with neoplasia and neutropenia. In most patients with catheter-related Rhodotorula fungemia, the condition has been treated with broadspectrum antibiotics. We report two cases of central venous catheter-related Rhodotorula rubra fungemia that occurred in patients with acute myeloblastic leukemia. Both patients were in a state of neutropenia. One patient was treated with amphotericin B and his central venous catheter was removed, but he died of Klebsiella pneumoniae bacteremia. The other patient was treated with amphotericin B and discharged, with a central venous catheter, after recovery from neutropenia. Although the management of catheter-related Rhodotorula fungemia infections remains controversial, resolution of the underlying disease is more important than catheter removal for recovery from Rhodotorula rubra fungemia.

1324

Transient fungemia due to Rhodotorula rubra in a cancer patient: case report and review of the literature. Samonis G, Anatoliotaki M, Apostolakou H, Maraki S, Mavroudis D, Georgoulias V. Infection. 2001 May-Jun;29(3):173-6.

A unique case of Rhodotorula rubra transient fungemia in a post-chemotherapy, febrile neutropenic patient with colon cancer, suffering from gastrointestinal mucositis, is described. The fungus was isolated repeatedly from his blood. However, all signs and symptoms of the infection disappeared, without antifungal treatment, as soon as neutropenia and mucositis, both of short duration, resolved. Restoration of the patient's defense mechanisms was adequate for disappearance of the fungus from the patient's blood and full recovery.

1325

Case report. Rhodotorula rubra fungaemia due to use of indwelling venous catheters. Kiraz N, Gülbas Z, Akgün Y. Mycoses. 2000;43(5):209-10.

Rhodotorula has been an infrequent cause of infection in humans but there have been some case reports about this systemic yeast infection. In this article, a Rhodotorula rubra fungaemia due to an indwelling catheter in a 23-year-old woman who had been diagnosed with non-Hodgkin's lymphoma grade IV B is described.

1326

Rhodotorula rubra fungaemia in an immunosuppressed patient. Papadogeorgakis H, Frangoulis E, Papaefstathiou C, Katsambas A. J Eur Acad Dermatol Venereol. 1999 Mar;12(2):169-70.

We report the case of a patient who, following surgical removal of an extensive tumour of the bowel, developed fungaemia. The yeast was isolated from repeated blood and urine cultures and identified as Rhodotorula rubra on the basis of macroscopic and microscopic features. Following treatment with amphotericin B, the patient's condition improved and the cultures became sterile.

1327

Rhodotorula septicemia: report of a case. Sheu MJ, Wang CC, Wang CC, Shi WJ, Chu ML. J Formos Med Assoc. 1994 Jul;93(7):645-7.

With the increased use of central venous catheters in cancer patients, there has been an increase in the recovery of environmental and skin organisms from blood cultures. A red yeast, Rhodotorula, an infrequent cause of infection in humans, was isolated from a patient with acute myeloblastic leukemia undergoing bone marrow transplant while he received parenteral nutritional fluids by an indwelling catheter. The patient was clinically ill, as manifested by fever and chills. The patient was treated with amphotericin B and the catheter was removed. He survived the fungemic episode with no recurrence of fungal infection.

1333

Seven cases of fungemia with Saccharomyces boulardii in critically ill patients. Lherm T, Monet C, Nougière B, Soulier M, Larbi D, Le Gall C, Caen D, Malbrunot C. Intensive Care Med. 2002 Jun;28(6):797-801.

Saccharomyces boulardii (Sb) is a particular strain of Saccharomyces cerevisiae (Sc). This viable yeast is used in intensive care adult patients, delivered in packets of 500 mg, for preventing diarrhea associated with antibiotics or enteral feeding at a regimen of 1-2 g/day. Between June 1996 and October 1998, seven cases of fungemia with Sb occurred in a 12-bed intensive care unit (ICU). All the patients concerned were severely ill patients, mechanically ventilated, treated by broad spectrum antibiotics with central venous catheter and were pretreated with Sb, except for one patient. In this study, Sb was identified by specific mycologic methods and confirmed the genomic identity between isolates of blood culture and yeasts from the treatment packets, contrary to a few other reports concerning Saccharomyces species published in international literature. The hypothesis discussed for explaining these cases of Sb fungemia are: (1) an intestinal translocation of Sb administered at a high dosage in severely ill patients, (2) a contamination of the central venous catheter, especially in the patient not pretreated with Sb and (3) a massive colonization of critically ill patients by the yeast as has been reported for Candida species. We note that cases of fungemia with Sc and Sb have become more and more frequent in the international literature during the last 10 years and we do not recommend administering Sb treatment in critically ill patients.

1334

Saccharomyces cerevisiae fungemia in a neutropenic patient treated with Saccharomyces boulardii. Cesaro S, Chinello P, Rossi L, Zanesco L. Support Care Cancer. 2000 Nov;8(6):504-5.

A case of Saccharomyces fungemia in an 8-month-old baby affected by acute myeloid leukemia while receiving intensive chemotherapy is reported. The patient was receiving prophylaxis treatment with Saccharomyces boulardii capsules (Codex) to prevent diarrhea, which is commonly associated with this type of chemotherapy. Fever spiked just the day after ending the chemotherapy course, and a strain of Saccharomyces cerevisiae was isolated from blood culture although the patient was also receiving antifungal prophylaxis with fluconazole. The patient recovered, though still neutropenic, with amphotericin-B and removal of the central venous catheter. The common biochemical characteristics make it difficult to differentiate between the strain of Saccharomyces cerevisiae and that of Saccharomyces boulardii with routine methods. In other cases, authors demonstrated an identity between the two strains with a more detailed analysis. These reports raise concern about the potential side effects of such biotherapeutic agents.

1335

Fungemia with Saccharomyces cerevisiae in two newborns, only one of whom had been treated with ultra-levura. Perapoch J, Planes AM, Querol A, López V, Martínez-Bendayán I, Tormo R, Fernández F, Peguero G, Salcedo S. Eur J Clin Microbiol Infect Dis. 2000 Jun;19(6):468-70.

Ultra-Levura (Upsamedica, Spain) is a yeast (Saccharomyces boulardii) widely used as a biotherapeutic agent. To date, few adverse effects have been reported, although fungemia with Saccharomyces cerevisiae can occur in weak and immunosuppressed patients. Reported here are two cases of fungemia with Saccharomyces cerevisiae. One patient had been treated with Ultra-Levura and the other contracted the infection from the first. This is the first report of infection with Saccharomyces boulardii (Saccharomyces cerevisiae) in a patient who was not being treated with the agent.

1336

Saccharomyces fungemia complicating Saccharomyces boulardii treatment in a non-immunocompromised host. Rijnders BJ, Van Wijngaerden E, Verwaest C, Peetermans WE. Intensive Care Med. 2000 Jun;26(6):825.

 

1337

Saccharomyces keratitis and endophthalmitis. Kirsch LS, Brownstein S, Deschênes J, Sorgini C, Jackson WB. Can J Ophthalmol. 1999 Jun;34(4):229-32.

 

1338

Primary cutaneous zygomycosis due to Saksenaea vasiformis and Apophysomyces elegans. Chakrabarti A, Kumar P, Padhye AA, Chatha L, Singh SK, Das A, Wig JD, Kataria RN. Clin Infect Dis. 1997 Apr;24(4):580-3.

We report three cases of primary cutaneous zygomycosis due to either Saksenaea vasiformis (two patients) or Apophysomyces elegans (one patient). Extensive surgical debridement helped two patients recover from their infections. The underlying disease in the one patient who died was diabetes mellitus. We reviewed the literature on primary cutaneous zygomycosis and found that S. vasiformis and A. elegans were the etiologic agents in 16 and 13 earlier cases, respectively.

1339

Cutaneous zygomycosis caused by Saksenaea vasiformis in a diabetic patient. Bearer EA, Nelson PR, Chowers MY, Davis CE. J Clin Microbiol. 1994 Jul;32(7):1823-4.

A 49-year-old woman with diabetes mellitus rapidly developed necrotizing cellulitis with fat necrosis and vasculitis after minor trauma to the right arm. Zygomycosis was diagnosed histologically. The lesion responded to aggressive debridement, amphotericin B, and normalization of blood glucose. Cultures yielded structures characteristic of Saksenaea vasiformis only after transfer to saline agar.

1340

Subcutaneous mucormycosis caused by Saksenaea vasiformis in a thalassaemic child: first case report in Thailand. Tanphaichitr VS, Chaiprasert A, Suvatte V, Thasnakorn P. Mycoses. 1990 Jun;33(6):303-9.

A first case of subcutaneous infection caused by Saksenaea vasiformis in an 11-year-old Thai thalassaemic boy was described. The specific diagnosis of infection was attained from microscopic demonstration of the causal agent as well as the isolation of the fungus. The patient was successfully treated by debridement of the lesion and parenteral amphotericin B. The predisposing factors, source of infection and regimen for treatment are discussed.

1341

First case of subcutaneous zygomycosis caused by Saksenaea vasiformis in India. Padhye AA, Koshi G, Anandi V, Ponniah J, Sitaram V, Jacob M, Mathai R, Ajello L, Chandler FW. Diagn Microbiol Infect Dis. 1988 Feb;9(2):69-77.

The first case of subcutaneous zygomycotic infection caused by Saksenaea vasiformis in a rice mill worker from India is described. The infection, confined to the man's left foot, showed multiple draining sinuses, inflammation, and intermittent low-grade fever following a crushing injury when a log fell on his foot. Histopathologic examination of two biopsy specimens, taken at 3-wk intervals, revealed the presence of broad, sparsely septate, branched, hyaline hyphae characteristic of a zygomycete. When they were grown on a nutritionally deficient medium, two cultures isolated from the biopsied tissues formed numerous, vase-shaped sporangia typical of S. vasiformis. Necrosis of the affected area led to amputation of the fore part of the foot. A split thickness graft was well accepted, and treatment with potassium iodide, following the graft, cured the infection.

1342

Rhinocerebral zygomycosis caused by Saksenaea vasiformis. Kaufman L, Padhye AA, Parker S. J Med Vet Mycol. 1988;26(4):237-41.

A fatal rhinocerebral zygomycotic infection caused by Saksenaea vasiformis in a 71-year-old man was diagnosed based on the presence of broad, infrequently septate, branched, hyaline hyphae in tissue obtained from the right and left base of the skull, soft tissue, both maxillary sinuses and the sphenoid sinus; isolation of S. vasiformis from the tissue; and demonstration of mucoraceous antibodies by enzyme-linked immunosorbent assay. Fluorescent antibody studies carried out with a Rhizopus arrhizus conjugate, stained hyphal fragments in tissue with a 2+ intensity.

1343

Saksenaea vasiformis breast abscess related to gardening injury. Wilson M, Robson J, Pyke CM, McCormack JG. Aust N Z J Med. 1998 Dec;28(6):845-6.

 

1344

Saksenaea vasiformis osteomyelitis. Pierce PF, Wood MB, Roberts GD, Fitzgerald RH Jr, Robertson C, Edson RS. J Clin Microbiol. 1987 May;25(5):933-5.

A 24-year-old man sustained a crush injury to the tibia, which subsequently became infected with Saksenaea vasiformis. He was treated with debridement and a free myocutaneous flap, but amputation was necessary because of mycotic osteomyelitis. S. vasiformis was recovered and identified on the basis of its characteristic morphology on cornmeal agar.

1345

Disseminated mucormycosis due to Saksenaea vasiformis in an immunocompetent adult. Solano T, Atkins B, Tambosis E, Mann S, Gottlieb T. Clin Infect Dis. 2000 Jun;30(6):942-3.

A case of disseminated infection due to Saksenaea vasiformis in a previously well adult male is presented. The clinical presentation was that of septic shock with a distinctive rash. At postmortem, endocarditis and widespread dissemination were evident.

1346

Disseminated zygomycosis (mucormycosis) caused by Saksenaea vasiformis. Hay RJ, Campbell CK, Marshall WM, Rees BI, Pincott J. J Infect. 1983 Sep;7(2):162-5.

A 14-year-old child from Iraq presented with an acute febrile illness accompanied by large necrotic skin lesions and bronchopneumonia from which he subsequently died. The infection was caused by an unusual zygomycete fungus Saksenaea vasiformis. Previous reports of infection with this organism are rare and tissue invasion has usually followed traumatic injury. In the child reported here no predisposing abnormalities were apparent.

1347

Disseminated Saksenaea vasiformis infection. Torell J, Cooper BH, Helgeson NG. Am J Clin Pathol. 1981 Jul;76(1):116-21.

Herein reported is a second case of human Saksenaea vasiformis infection. This unusual zygomycete was isolated postmortem from the tissues of an immunocompromised woman. The patient died of a disseminated infection that caused cutaneous, pulmonary, and renal infarcts. Clinical and pathologic features of the case and manifestations of zygomycete infection are discussed.

1348

Invasive infection with Sarcinosporon inkin in a patient with chronic granulomatous disease. Kenney RT, Kwon-Chung KJ, Witebsky FG, Melnick DA, Malech HL, Gallin JI. Am J Clin Pathol. 1990 Sep;94(3):344-50.

Sarcinosporon inkin, a rare skin fungus, was found to have caused progressive pneumonia in a young male with chronic granulomatous disease. Histologic sections of right upper lobe lung tissue showed clusters of globose to oblong hyalin-walled, septate, sporangia throughout the necrotic areas within the pyogranulomas. Pure cultures of S. inkin were recovered from the surgical specimen of the lung. Current status of the taxonomy of S. inkin is reviewed and clarified. Treatment of the patient with Amphotericin B and white blood cell transfusions led to clinical and radiographic response. This is the first documented case of systemic infection caused by S. inkin.

1350

Infection and colonization by Scedosporium prolificans] López L, Gaztelurrutia L, Cuenca-Estrella M, Monzón A, Barrón J, Hernández JL, Pérez R. Enferm Infecc Microbiol Clin. 2001 Aug-Sep;19(7):308-13.

BACKGROUND: Scedosporium prolificans is a dematiaceous fungus that is known to cause a wide spectrum of infections in humans, bearing a severity and a prognosis that is relationed with the patients immune status. METHODS: A retrospective review was made of the clinical charts of all patients who developed positive S. prolificans cultures in our centre from 1990 to 2000. Isolates were identified by colonial morphology and microscopic features. The in vitro susceptibility was evaluated using the microdilution method according to NCCLS. RESULTS: S. prolificans was isolated in 15 patients. Eight were affected with cystic fibrosis and the isolation of S. prolificans in their airways did not worsen their clinical status. Among the remaining 7 cases there were five leukemic patients with neutropenia and two immunocompetent hosts with cutaneous infection and endocarditis. Four of five neutropenic patients died of sudden sepsis and S. prolificans was isolated from blood cultures made a few days before their death, and the fifth neutropenic case suffered a bilateral pneumonia with improving course probably due to recovery from neutropenia. As to the immunocompetent group the clinical course was good in the cutaneous infection case, but the endocarditis case died four days after the antifungical therapy was started. All the isolates tested were found to be resistant to amphotericin, 5 flucytosine, fluconazole, itraconazole, voriconazole, miconazole and terbinafine. CONCLUSIONS: Scedosporium prolificans is a fungal pathogen that colonizes the airways of patients affected with cystic fibrosis. It can also cause a wide variety of infections, whose severity and prognosis depends on the patients immune status. Due to the resistance of this fungus to antifungal drugs, the therapeutic options are limited. Only with the correction of neutropenia and surgery in local infections in immunocompetent hosts it has been possible to cure these infections.

1351

Cutaneous Scedosporium apiospermum infection in an immunocompromised patient. Bower CP, Oxley JD, Campbell CK, Archer CB. J Clin Pathol. 1999 Nov;52(11):846-8.

Scedosporium apiospermum infection occurred in the left forearm of a patient who was taking oral prednisolone for pulmonary fibrosis. The infection appeared to follow a scratch from a blackcurrant bush. This is the first reported case in the United Kingdom of a cutaneous infection from Scedosporium apiospermum in an immunocompromised patient.

1352

Cutaneous infection by Scedosporium apiospermum and its successful treatment with itraconazole. Liu YF, Zhao XD, Ma CL, Li CX, Zhang TS, Liao WJ. Clin Exp Dermatol. 1997 Jul;22(4):198-200.

We report the case of a 42-year-old man with a 13-year history of bilateral faciocervical infiltrative erythema, which had been misdiagnosed as tuberculoderma and which had failed to respond to treatment with adrenal corticosteroids and antituberculotics. On admission to the department, Scedosporium apiospermum was identified on lesion biopsies and fungus cultures as the causative agent and a diagnosis of cutaneous infection by S. apiospermum was made. This is the first report of chronic skin granuloma caused by S. apiospermum in China. Treatment with oral itraconazole (100-400 mg/day) led to clinical cure within 4 months.

1353

Chronic, recurrent osteomyelitis caused by Scedosporium inflatum. Malekzadeh M, Overturf GD, Auerbach SB, Wong L, Hirsch M. Pediatr Infect Dis J. 1990 May;9(5):357-9.

 

1354

Pathology of hyalohyphomycosis caused by Scedosporium apiospermum (Pseudallescheria boydii): an emerging mycosis. Tadros TS, Workowski KA, Siegel RJ, Hunter S, Schwartz DA. Hum Pathol. 1998 Nov;29(11):1266-72.

The genus Scedosporium contains two medically significant species of emerging mycotic agents, S. apiospermum and S. prolificans, which have received scant attention. Scedosporium apiospermum is the anamorph, or asexual state, of the cosmopolitan fungus Pseudallescheria boydii, with both sharing the same risk factors for infection, clinical spectrum, and histopathologic features. Scedosporium prolificans is a recently recognized agent of bone, soft tissue, and joint infections that occurs with highest frequency in children and young adults. S. prolificans may also cause potentially fatal disseminated infections in immunocompromised persons. The drug sensitivities of both Scedosporium species are significantly different from those of most other fungi, and thus identification of these organisms is important. Unfortunately, the pathological features of Scedosporium infections may be easily confused with other mycotic agents, resulting in delayed or inappropriate medical therapy. Because many pathologists and clinicians are unfamiliar with the significance of Scedosporium spp. infection, this communication describes three persons with differing clinical and pathological presentations of S. apiospermum infection. In one patient with sickle cell disease and chronic mycotic sinusitis, fungal colonies of S. apiospermum removed from the sinuses showed a pattern of alternating zones of mycelial hypercellularity and hypocellularity associated with conidiation, similar to a previous report of P. boydii infection. The clinicopathologic features of an immunocompetent person with S. apiospermum osteomyelitis, and a patient with S. apiospermum infection of the brain after bone marrow transplantation, are also described.

1355

Successful treatment of Scedosporium apiospermum suppurative arthritis with itraconazole. Piper JP, Golden J, Brown D, Broestler J. Pediatr Infect Dis J. 1990 Sep;9(9):674-5.

1356

Endocarditis and hip arthritis associated with Scedosporium inflatum. Toy EC, Rinaldi MG, Savitch CB, Leibovitch ER. South Med J. 1990 Aug;83(8):957-60.

A 30-year-old man had endocarditis and hip arthritis associated with the recently recognized fungus, Scedosporium inflatum. Inhibition, and possibly cure, of endocarditis occurred with medical therapy alone. Data from in vitro susceptibility testing did not predict clinical response. This case also illustrates the need to standardize fungal susceptibility testing and to remain vigilant for emerging pathogens.

1357

Scedosporium apiospermum (Pseudallescheria boydii) endocarditis. O'Bryan TA, Browne FA, Schonder JF. J Infect. 2002 Apr;44(3):189-92.

Scedosporium apiospermum, the asexual state of Pseudallescheria boydii, is increasingly recognized as an opportunistic pathogen. We report a case of native valve endocarditis due to this organism that developed in an elderly patient following a prolonged hospitalization. Literature on endocarditis caused by S. apiospermum and P. boydii is reviewed.

1358

Endocarditis caused by Scedosporium prolificans after autologous peripheral blood stem cell transplantation. Carreter de Granda ME, Richard C, Conde E, Iriondo A, Marco de Lucas F, Salesa R, Zubizarreta A. Eur J Clin Microbiol Infect Dis. 2001 Mar;20(3):215-7.

 

1359

Deep infections caused by Scedosporium prolificans. A report on 16 cases in Spain and a review of the literature. Scedosporium Prolificans Spanish Study Group. Berenguer J, Rodríguez-Tudela JL, Richard C, Alvarez M, Sanz MA, Gaztelurrutia L, Ayats J, Martinez-Suarez JV. Medicine (Baltimore). 1997 Jul;76(4):256-65.

Scedosporium prolificans, a mold morphologically similar to Scedosporium apiospermum, may cause asymptomatic colonization or localized or disseminated infection following trauma, surgery, and immunosuppression. S. prolificans is normally resistant to available antifungal agents, and prognosis depends largely on the host's immune status, extent of infection, and feasibility of surgical debridement. We report on 16 patients with deep S. prolificans infections, focusing on predisposing factors, clinical characteristics, outcome, postmortem findings, and antifungal susceptibility testing to 6 antifungal agents. Between 1989 and 1994, 16 cases of deep infections by S. prolificans were documented in 6 clinical centers in Spain (15 adults and 1 child: male/female = 0.77). Fifteen patients had underlying hematologic malignancy (14 with neutropenia) and 1 had a prosthetic cardiac valve. Syndromes included disseminated infection in 14 patients (1 with prosthetic valve endocarditis) and fungal pneumonia and meningoencephalitis in 1 patient each. S. prolificans was isolated from 2 specimens in 14 patients and from 1 specimen in 2 patients (blood, n = 12; respiratory tract, n = 4; CNS, n = 4; and skin biopsy, n = 3). Antifungal susceptibility testing by a micromethod with RPMI-2% glucose medium was performed in 8 isolates, all of which were resistant to amphotericin B, flucytosine, ketoconazole, fluconazole, itraconazole, and miconazole. All patients received antifungal therapy (amphotericin B, n = 9; amphotericin B+ flucytosine, n = 1; amphotericin B+ itraconazole, n = 2; liposomal amphotericin B+ itraconazole, n = 1; amphotericin B+ fluconazole, n = 1 and 2 underwent surgical procedures. Two patients survived coinciding with hematologic recovery and 14 (87.5%) patients died in a median time of 4 days after the first positive culture (range, 0-60 d). Necropsy was performed in 10 patients, and disseminated infection was found in 9. In conclusion, S. prolificans is an emerging multiresistant fungal pathogen that may cause asymptomatic colonization, localized infection related to trauma or surgery, and rapidly fatal disseminated infection in immunocompromised hosts, particularly those with neutropenia. This mycosis underscores the urgent need for new antifungal agents.

1360

Maxillary sinusitis: isolation of Scedosporium (Monosporium) apiospermum, anamorph of Petriellidium (Allescheria) boydii. Bloom SM, Warner RR, Weitzman I. Mt Sinai J Med. 1982 Nov-Dec;49(6):492-4.

 

1361

Pulmonary infection with Scedosporium prolificans in an immunocompetent individual. Greig JR, Khan MA, Hopkinson NS, Marshall BG, Wilson PO, Rahman SU. J Infect. 2001 Jul;43(1):15-7.

We report a case of histologically confirmed Scedosporium prolificans pulmonary infection secondary to long-standing bronchiectasis that necessitated excision lung surgery. This case emphasizes the difficulties with the medical management of deep-seated fungal infections.

1362

Invasive Scedosporium apiospermum infection in a heart transplant recipient presenting with multiple skin nodules and a pulmonary consolidation. Kusne S, Ariyanayagam-Baksh S, Strollo DC, Abernethy J. Transpl Infect Dis. 2000 Dec;2(4):194-6.

 

1363

Pneumonia due to Scedosporium apiospermum in a patient with HIV infection. Rollot F, Blanche P, Richaud-Thiriez B, Le Pimpec-Barthes F, Riquet M, Dusser D, Salmon D, Sicard D. Scand J Infect Dis. 2000;32(4):439.

A 29-y-old woman from Congo Democratic Republic was admitted to hospital with dyspnoea of 5-months duration. Chest X-ray showed left white lung and infiltrates of the right superior lobe. The patient underwent left pneumonectomy. Histopathological examination showed pulmonary cavitary lesions and bronchectasis full of branching septated fungi. Cultures yielded Scedosperium apiospermum.

1364

Invasive pulmonary infection due to Scedosporium apiospermum in two children with chronic granulomatous disease. Jabado N, Casanova JL, Haddad E, Dulieu F, Fournet JC, Dupont B, Fischer A, Hennequin C, Blanche S. Clin Infect Dis. 1998 Dec;27(6):1437-41.

Scedosporium apiospermum is an opportunistic fungus in humans. The incidence of S. apiospermum infection in patients with acquired neutropenia (e.g., patients receiving chemotherapy and bone marrow transplant recipients) is steadily increasing. S. apiospermum has poor in vitro susceptibility to "conventional" antifungal agents, rendering the management of infections complex. Patients with chronic granulomatous disease (CGD) are highly susceptible to fungal infections, which are mostly due to Aspergillus species. We describe two children with CGD and invasive pulmonary infection due to S. apiospermum. Both patients were treated with antifungal therapy including azole derivatives (itraconazole or voriconazole) and surgical resection of infected tissues. These cases highlight that scedosporium infection can closely mimic aspergillus infection and should be considered in any case in which there is a failure to respond to appropriate "conventional" antifungal therapy. We also suggest that the emergence of this pathogen may have been favored by long-term use of amphotericin B in both patients.

1365

Fatal meningoencephalitis caused by Scedosporium inflatum (Scedosporium prolificans) in a child with lymphoblastic leukemia. Madrigal V, Alonso J, Bureo E, Figols FJ, Salesa R. Eur J Clin Microbiol Infect Dis. 1995 Jul;14(7):601-3.

A fatal case of meningoencephalitis caused by Scedosporium inflatum (Scedosporium prolificans) in a 5-year-old boy with acute myeloblastic leukemia who was given intrathecal treatment is reported. Itraconazole treatment was ineffective. The fungus was identified on brain sections at autopsy and was not observed in any other organ. As no other portal of entry was detected, meningoencephalitis may have originated via direct introduction of the fungus at therapeutic lumbar puncture.

1366

Scedosporium endophthalmitis: two fatal disseminated cases of Scedosporium infection presenting with endophthalmitis. McKelvie PA, Wong EY, Chow LP, Hall AJ. Clin Experiment Ophthalmol. 2001 Oct;29(5):330-4.

The incidence of disseminated infection with Scedosporium species is increasing in patients with haematological malignancy. Two fatal cases are reported of patients with acute myeloid leukaemia and neutropenia who presented with Scedosporium endophthalmitis. Diagnosis of fungal infection was delayed as blood and vitreous cultures were positive only after 3 days in patient 1 and blood culture was positive at 7 days in patient 2. Despite antifungal therapy with amphotericin B and additional fluconazole in patient 2, both patients died of overwhelming fungal septicaemia. Post-mortem examination of the right globe in patient 1 showed haemorrhagic necrotizing chorioretinitis with numerous fungal hyphae in choroidal vessels, choroid, retina and vitreous. Scedosporium species are often resistant to conventional antifungal therapy including amphotericin B. Diagnosis is difficult and mortality in disseminated infection is high.

1367

Scedosporium apiospermum fungemia in a lung transplant recipient. Raj R, Frost AE. Chest. 2002 May;121(5):1714-6.

Scedosporium apiospermum, the asexual anamorph of the cosmopolitan fungus Pseudallescheria boydii, is emerging as an important cause of disseminated infection in immunocompromised patients. We present our experience with the first reported case of S apiospermum fungemia in a lung transplant patient. Disseminated infection resulted in sepsis, multiorgan failure, and death. Review of the literature highlights the diagnostic difficulties related to the similarities between S. apiospermum and Aspergillus sp. This superficial resemblance has a significant impact on clinical outcomes considering the inherent resistance of Scedosporium to amphotericin B, the traditional antifungal of choice for disseminated hyalohyphomycoses.

1368

Disseminated infection and colonization by Scedosporium prolificans: a review of 18 cases, 1990-1999. Idigoras P, Pérez-Trallero E, Piñeiro L, Larruskain J, López-Lopategui MC, Rodríguez N, González JM. Clin Infect Dis. 2001 Jun 1;32(11):E158-65.

Scedosporium prolificans infection was analyzed in 18 patients from whom the fungus was isolated during the period 1990-1999. Of these 18 patients, 12 had some predisposing factor and either unconfirmed infection or colonization, and 6 patients had confirmed disseminated infection: 4 patients with leukemia died, 1 patient with breast cancer who underwent autologous bone marrow transplantation survived, and 1 patient with advanced acquired immunodeficiency syndrome died, although the fungal infection did not seem to affect his clinical symptoms.

1369

Fatal disseminated infection by Scedosporium prolificans during induction therapy for acute leukemia: a case report and literature review. Westerman DA, Speed BR, Prince HM. Pathology. 1999 Nov;31(4):393-4.

We report a case of fatal disseminated fungal infection by Scedosporium prolificans which occurred in a patient with acute leukemia during induction chemotherapy. Rapid clinical deterioration despite high-dose empirical amphotericin B highlights both the pathogenicity of this fungus in immunocompromised hosts and its resistance to standard antifungal therapy.

1370

Fatal Scedosporium prolificans infection in a leukemic patient. Feltkamp MC, Kersten MJ, van der Lelie J, Burggraaf JD, de Hoog GS, Kuijper EJ. Eur J Clin Microbiol Infect Dis. 1997 Jun;16(6):460-4.

The case is described of a 42-year-old patient with acute myeloid leukemia who received two courses of chemotherapy complicated by prolonged bone marrow depression. He was admitted to hospital with fever, hepatosplenomegaly and bilateral nodular pulmonary infiltrates. After admission diffuse cutaneous skin nodules, and hypodense lesions in the hemispheres and cerebellum developed. Cultures of cerebrospinal fluid, bronchoalveolar lavage fluid, skin biopsy specimens and blood revealed Scedosporium prolificans, indicative of disseminated mycosis. Treatment with amphotericin B and fluconazole was unsuccessful and the patient died within five days after admission. Features that may enhance early recognition of Scedosporium prolificans infection by both clinicians and microbiologists, as well as options in the treatment of infection with this fungal agent are discussed.

1371

Disseminated Scedosporium prolificans (S. inflatum) infection after single-lung transplantation. Rabodonirina M, Paulus S, Thevenet F, Loire R, Gueho E, Bastien O, Mornex JF, Celard M, Piens MA. Clin Infect Dis. 1994 Jul;19(1):138-42

This report concerns the first case of disseminated infection with Scedosporium prolificans (S. inflatum) that occurred in a patient who had received an organ transplant and was verified at autopsy. The patient underwent single (right)-lung transplantation and subsequently died on the 33rd postoperative day in a context of septic shock. S. prolificans was isolated from various specimens, including two cultured blood samples. The organism was associated with Candida albicans in some of these specimens. Autopsy revealed the presence of numerous nodular abscesses in the lungs, myocardium, kidneys, spleen, and gall bladder. These abscesses contained mycelial filaments and numerous oval conidia suggestive of Scedosporium species but no yeasts. MIC studies demonstrated the resistance of the S. prolificans isolate to amphotericin B, fluctyosine, miconazole, ketoconazole, and itraconazole, whereas the isolate of C. albicans was susceptible to amphotericin B, flucytosine, miconazole, and ketoconazole. From the data from our case and six published reports of cases of disseminated S. prolificans infection, it can be concluded that this filamentous fungus is a new agent responsible for the most serious mycoses in both neutropenic patients and patients who have undergone organ transplantation.

1375

Brain abscess caused by Schizophyllum commune: an emerging basidiomycete pathogen. Rihs JD, Padhye AA, Good CB. J Clin Microbiol. 1996 Jul;34(7):1628-32.

Despite the worldwide distribution and prevalence of Schizophyllum commune, an emerging basidiomycetous pathogen, human infections occur only rarely. We describe the first well-documented pulmonary infection caused by S. commune which disseminated to the brain of a 58-year-old patient undergoing empiric corticosteroid therapy. Magnetic resonance imaging scans revealed ring-enhancing masses. Histologic examination of biopsy tissue from lungs and brain showed hyaline, septate, branched hyphae with clamp connections. Cultures of the lung tissue grew S. commune, which produced numerous, characteristic flabelliform and medusoid fruiting bodies on Czapek's agar. The isolate was susceptible to amphotericin B (MIC, < 0.03 microgram/ml) and fluconazole (MIC, 8 micrograms/ml). Despite treatment with antifungal and antibacterial agents, the patient developed progressive pulmonary failure and bacterial sepsis and died.

1376

Maxillary sinus infection caused by the homobasidiomycetous fungus Schizophyllum commune. Kern ME, Uecker FA. J Clin Microbiol. 1986 Jun;23(6):1001-5.

We investigated a case of maxillary sinus infection caused by the medusoid mutant of the basidiomycetous fungus Schizophyllum commune. Morphologies of both typical and medusoid forms of S. commune were determined. Prior reports of pathogenic homobasidiomycetes are discussed.

1377

Chronic maxillary sinusitis associated with the mushroom Schizophyllum commune in a patient with AIDS. Rosenthal J, Katz R, DuBois DB, M.orrissey A, Machicao A. Clin Infect Dis. 1992 Jan;14(1):46-8.

Invasive infection with fungi of the Basidiomycota (rusts, smuts, toadstools, mushrooms, and puffballs) is extremely rare. We report such an infection in a patient with human immunodeficiency virus disease who presented with chronic maxillary sinusitis associated with the mushroom Schizophyllum commune. The organism was isolated from the surgical drainage material, and septate hyphae were seen invading the maxillary submucosa. The limited literature on this subject is reviewed.

1378

Chronic sinusitis caused by Schizophyllum commune in AIDS] Marlier S, De Jaureguiberry JP, Aguilon P, Carloz E, Duval JL, Jaubert D. Presse Med. 1993 Jun 26;22(23):1107.

 

1379

Maxillary sinusitis caused by Schizophyllum commune and experience with treatment. Sigler L, Estrada S, Montealegre NA, Jaramillo E, Arango M, De Bedout C, Restrepo A. J Med Vet Mycol. 1997 Sep-Oct;35(5):365-70.

A case of sinusitis caused by the basidiomycete Schizophyllum commune is reported in a 36-year-old female with a history of allergic rhinitis and dermatitis. The patient presented with sudden nasal obstruction, purulent nasal discharge, headache and general discomfort. Computer tomography revealed extensive opacity of the left maxillary sinus as well as erosion of the nasal wall and maxillary bone. Mycological examinations of nasal discharges and material aspirated during anthrostomy showed hyaline, septate hyphae with rare spicules. Primary isolation yielded a white, woolly mould which demonstrated clamp connections and basidiocarp primordia but these characteristics were lost in subculture. Identification was confirmed by vegetative compatibility studies. The patient was treated with itraconazole to avoid possible postsurgical dissemination. Three months after cessation of therapy, no recurrence of infection had occurred.

1380

Diagnostic difficulties caused by a nonclamped Schizophyllum commune isolate in a case of fungus ball of the lung. Sigler L, de la Maza LM, Tan G, Egger KN, Sherburne RK. J Clin Microbiol. 1995 Aug;33(8):1979-83.

The presence of clamp connections on hyphae and the development of fruiting bodies in culture are primary characters which allow identification of the basidiomycete Schizophyllum commune in cases of human infection. The diagnostic problems presented by a nonclamped, nonfruiting isolate from a dense mass in the right upper lobe of the lung in a female with a past history of pulmonary tuberculosis and diabetes are described. Several features of the isolated fungus, including rapid growth rate and white, dense, cottony colonies, tolerance to the fungicide benomyl at a concentration of 10 micrograms/ml, and susceptibility to cycloheximide at 400 micrograms/ml, suggested that it might be a basidiomycete. Transmission electron microscopy showed the presence of a dolipore septum with perforate pore cap characteristic of fungi in the class Holobasidiomycetes. However, species identification remained elusive until compatibility tests with known single-basidiospore isolates confirmed the identification of the sterile lung isolate as S. commune. Sequence analysis of the 5' internal transcribed spacer region of ribosomal DNA further supported conspecificity.

1381

Phototoxic dermatitis caused by celery infected by Sclerotinia sclerotiorum. Austad J, Kavli G. Contact Dermatitis. 1983 Nov;9(6):448-51.

11 men developed a severe phototoxic dermatitis of the hands and forearms after harvesting celery infected with Sclerotinia sclerotiorum. By thin-layer chromatography and fluorescence spectrophotometry, xanthotoxin, bergapten and sphondin were isolated. The Canadida albicans test demonstrated xanthotoxin and bergapten as the phototoxic compounds.

1383

Invasive hyalohyphomycosis caused by Scopulariopsis brevicaulis in a patient undergoing allogeneic bone marrow transplant. Phillips P, Wood WS, Phillips G, Rinaldi MG. Diagn Microbiol Infect Dis. 1989 Sep-Oct;12(5):429-32.

Scopulariopsis brevicaulis is a common soil saprobic mould. Occasionally, S. brevicaulis has been reported as an etiologic agent of human disease. The spectrum of human mycoses includes toenail infection, hypersensitivity pneumonitis, fungus ball formation in a preformed pulmonary cavity, and, most recently, documented deep tissue infections in immunocompromised hosts. A case of invasive hyalohyphomycosis of the great toe caused by S. brevicaulis is reported in an allogeneic bone-marrow transplant recipient.

1384

Scopulariopsis: an invasive nasal infection. Jabor MA, Greer DL, Amedee RG. Am J Rhinol. 1998 Sep-Oct;12(5):367-71.

Scopulariopsis, a soil saprophyte, rarely produces disease and has not been reported to cause invasive nasal destruction in a nonimmunocompromised host. We report the first case of Scopulariopsis in the otolaryngology literature. Prompt surgical debridement is required and usually adequate. Disagreement exists on the use of antifungals as an effective treatment. A case of invasive Scopulariopsis involving the nasal septum of a 72-year-old man is detailed, and successful treatment consisted of local debridement without antifungal drugs. His diagnosis, clinical course, and outcome illustrates the expanding differential diagnosis faced by the otolaryngologist in patients with nasal disease.

1385

Report of the first case of invasive fungal sinusitis caused by Scopulariopsis acremonium: review of scopulariopsis infections. Ellison MD, Hung RT, Harris K, Campbell BH. Arch Otolaryngol Head Neck Surg. 1998 Sep;124(9):1014-6.

Scopulariopsis acremonium is a species of saprophytic fungus not previously reported to cause invasive disease in humans, although invasive infections from other species of Scopulariopsis have been reported and are reviewed. Deep infection with this fungus is associated with a high mortality rate. Invasive fungal sinusitis, in general, is a potentially fatal disease that typically affects immunocompromised patients, such as those receiving intensive chemotherapy or undergoing bone marrow transplantation. We report a case of invasive fungal sinusitis caused by Scopulariopsis acremonium in a patient with leukemia, who was successfully treated with amphotericin B, itraconazole, endoscopic sinus surgery, and granulocyte colony-stimulating factor.

1386

Invasive sinonasal disease due to Scopulariopsis candida: case report and review of scopulariopsosis. Kriesel JD, Adderson EE, Gooch WM 3rd, Pavia AT. Clin Infect Dis. 1994 Aug;19(2):317-9.

Sinonasal infection with fungi of the order Mucorales--termed mucormycosis or zygomycosis--is sometimes seen in immunosuppressed patients, including those with diabetic ketoacidosis and malignancy. We describe a case of invasive sinonasal infection with Scopulariopsis candida (not among the Mucorales organisms) in a 12-year-old girl who was being treated for non-Hodgkin's lymphoma. Only a few cases of invasive infection with Scopulariopsis species have been reported previously; five of six of these cases were associated with persistent or fatal disease. Our patient survived without undergoing radical surgical debridement and was treated with granulocyte colony-stimulating factor, amphotericin B, and itraconazole; chemotherapy was stopped. In vitro susceptibility testing of our patient's Scopulariopsis isolate showed that it was resistant to amphotericin B and that it was relatively susceptible to itraconazole and miconazole. The case described herein demonstrates the expanding spectrum of fungal organisms that may cause invasive sinonasal infection in immunocompromised hosts and the need for reliable antifungal susceptibility testing.

1387

Invasive Scopulariopsis in the immunocompromised host. Neglia JP, Hurd DD, Ferrieri P, Snover DC. Am J Med. 1987 Dec;83(6):1163-6.

Opportunistic infections with fungal organisms have been well described in patients undergoing intensive chemotherapy and bone marrow transplantation. In two patients, invasive infections with the saprophyte Scopulariopsis developed either following intensive chemotherapy or bone marrow transplant. Fungal disease persisted in both patients despite resection of the primary focus and prolonged treatment with the usual antifungal agents, and contributed to the death of one patient.

1388

Subcutaneous mycosis due to Scopulariopsis brevicaulis in an immunocompromised patient] Martel J, Faisant M, Lebeau B, Pinel C, Feray C, Feuilhade M. Ann Dermatol Venereol. 2001 Feb;128(2):130-3.

BACKGROUND: Scopulariopsis brevicaulis is a causal agent of onchomycosis. We report the unusual clinical manifestations caused by this opportunist fungus.CASE REPORT: A 61-year-old man consulted in February 1997 for a budding lesion located on the right medial malleolus. This patient had had a liver transplantation for primary biliary cirrhosis in 1990 and had been taking prednisone and cyclosporine since this time. Cyclosporine had been recently replaced by tacrolimus. The histology examination of a lesion specimen taken from the ankle evidenced a dermal mycosis due to opportunist filamentous fungus. Total excision was performed. The patient then developed nodular lesions of the left elbow during the summer of 1997. Mycology culture of a skin biopsy grew numerous colonies of Scopulariopsis brevicaulis. Excision of the elbow lesion was delayed due to hospitalization for suspected graft rejection and development of insulin-dependent diabetes. The elbow lesion was then resected followed by a skin graft. The mycology examination identified the same causal agent.DISCUSSION: This liver transplant recipient developed two unusual extra-ungual localizations (ankle and elbow) of a Scopulariopsis brevicaulis infection. Chronic immunosuppression favored development of the infection with a pseudo-epithéliomatous presentation. The histology and mycology examinations were necessary for positive diagnosis.

1389

Granulomatous skin infection caused by Scopulariopsis brevicaulis. Bruynzeel I, Starink TM. J Am Acad Dermatol. 1998 Aug;39(2 Pt 2):365-7.

A 14-year-old girl with a granulomatous infection of the cheek caused by Scopulariopsis brevicaulis is described. Treatment successively consisted of itraconazole and/or terbinafine for 19 months, after which clinical and mycologic cure seemed to be obtained. However, a relapse occurred 10 months later.

1390

Ulcerous granulomatous cheilitis with lymphatic invasion caused by Scopulariopsis brevicaulis infection. Creus L, Umbert P, Torres-Rodríguez JM, López-Gil F. J Am Acad Dermatol. 1994 Nov;31(5 Pt 2):881-3.

A 43-year-old man with ulcerous granulomatous cheilitis and submaxillary lymph node invasion caused by Scopulariopsis brevicaulis infection is described. Administration of itraconazole produced a dramatic and definitive cure. Reported cases of deep mycosis caused by S. brevicaulis infection are also reviewed.

1391

. Cutaneous 'ringworm' lesions of Scopulariopsis brevicaulis. Cox NH, Irving B. Br J Dermatol. 1993 Dec;129(6):726-8.

Scopulariopsis brevicaulis is a saprophytic fungus which is occasionally isolated as an apparent cause of toenail fungal infection, and which rarely has been reported as a cause of deep fungal granuloma. We report a case of skin infection with this organism, which was proved by culture of a pure isolate. The skin lesions had an annular ringworm appearance with pustules, they occurred initially at a site of minor injury, and they responded to treatment with terbinafine and itraconazole.

1392

Fungal keratitis due to Scopulariopsis brevicaulis in an eye previously suffering from herpetic keratitis. Del Prete A, Sepe G, Ferrante M, Loffredo C, Masciello M, Sebastiani A. Ophthalmologica. 1994;208(6):333-5.

In the case reported, herpes virus I after having caused relapsing keratitis in an eye promoted the formation of a severe corneal ulcer caused by Scopulariopsis brevicaulis, a saprophytic mycete found in soil, which only once has been described as the cause of keratitis in man. Scopulariopsis was identified microscopically after culturing the conjunctival secretion on Sabouraud dextrose agar medium, while DNA probe tests confirmed the absence of herpes virus I. Topical and oral administration of miconazole and scraping of the corneal infiltrate dispersed the infection. Subsequently local steroids were given to reduce the neovascularization, and a therapeutic contact lens was applied because of intercurrent corneal thinning. Three months after beginning antifungal therapy, the visual acuity had increased from 1/120 to 1/10. The case described confirms that S. brevicaulis can cause opportunist infections in a cornea previously damaged by a different agent.

1393

A case of fungal keratitis caused by Scopulariopsis brevicaulis: treatment with antifungal agents and penetrating keratoplasty. Ragge NK, Hart JC, Easty DL, Tyers AG. Br J Ophthalmol. 1990 Sep;74(9):561-2.

A case of fungal keratitis caused by Scopulariopsis brevicaulis following a penetrating eye injury is described. Treatment with antifungal agents and keratoplasty resulted in a favourable outcome.

1394

Posttraumatic fungal endophthalmitis resulting from Scopulariopsis brevicaulis. Gariano RF, Kalina RE. Retina. 1997;17(3):256-8.

 

1395

A case of mycetoma caused by Scopulariopsis maduromycosis. Wang DL, Xu C, Wang GC. Chin Med J (Engl). 1986 May;99(5):376-8.

 

1396

Cerebral phaeohyphomycosis caused by a dematiaceous scopulariopsis species. Hart AP, Sutton DA, McFeeley PJ, Kornfeld M. Clin Neuropathol. 2001 Sep-Oct;20(5):224-8.

This report describes a rapidly fatal case of cerebral phaeohyphomycosis in a 33-year-old immunocompetent male. The infection presented as a single large lesion in the deep white matter of one temporal lobe, which was then removed surgically. Histologic features observed in the lobectomy specimen were characterized by perivascular sleeves of mononuclear cells accompanied by hemorrhages. These were reminiscent of acute hemorrhagic leukoencephalitis except for the presence of rare fungal organisms and sparse multinucleated giant cells similar to those occurring in AIDS. During the four days following surgery, a large focus of cerebritis with massive invasion of fungi developed in each centrum semiovale around the ventriculostomy sites. Fungal culture of the brain obtained at autopsy grew an organism consistent with a Scopulariopsis species.

1399

Subcutaneous hyphomycosis caused by Scytalidium hyalinum. Zaatari GS, Reed R, Morewessel R. Am J Clin Pathol. 1984 Aug;82(2):252-6.

Scytalidium hyalinum is a hyaline species of the genus Scytalidium. It first was described as a cause of skin and nail infection in humans. In this report, the authors describe the first case of subcutaneous hyphomycosis with multiple cyst formation caused by this fungus. The patient is a 54-year old man who has Reiter's syndrome, liver cirrhosis, and coronary artery disease. He was receiving azathioprine and prednisone for arthritis. The pathology, mycology, and clinical course are discussed.

1400

Subcutaneous phaeohypomycosis caused by Scytalidium dimidiatum in the foot of an immunosuppressed host. Rockett MS, Gentile SC, Zygmunt KH, Gudas CJ. J Foot Ankle Surg. 1996 Jul-Aug;35(4):350-4.

The authors present a case report of a subcutaneous phaeohypomycosis of the foot in an immuno-suppressed patient. The lesion was caused by Scytalidium dimidiatum, a dematiaceous fungus, which has only been reported to cause three previous similar lesions. To our knowledge, this is the first reported case of this fungus causing a deep-seated mycoses in the United States. A review of the literature concerning this organism is also presented.

1401

Two cases of tinea pedis caused by Scytalidium hyalinum. Romano C, Valenti L, Difonzo EM. J Eur Acad Dermatol Venereol. 1999 Jan;12(1):38-42.

Two cases of tinea pedis due to Scytalidium hyalinum, the first to be described in Italy, are reported. The patients were a 41-year-old woman and a 35-year-old man who had spent periods in the Caribbean. The clinical manifestations were indistinguishable from those caused by dermatophytes. In the women they were striking with 'moccasin foot' type lesions, whereas in the man they were less evident, with minor plantar desquamation and interdigital maceration. Diagnosis was based on direct mycological microscopic examination and culture. Clinical and mycological remission were obtained with systemic itraconazole therapy. These cases are reported because infections caused by Scytalidium hyalinum are rare in Europe and their clinical and mycological diagnosis, as well as therapy, may be problematic.

1402

A case of subcutaneous infection in a patient with discoid lupus erythematosus caused by a Scytalidium synanamorph of Nattrassia mangiferae, and its treatment. Dhindsa MK, Naidu J, Singh SM. Med Mycol. 1998 Dec;36(6):425-7.

A case of subcutaneous infection caused by Scytalidium synanamorph of Nattrassia mangiferae is reported in a 24-year-old female suffering from subacute discoid lupus erythematosus. Lesions were seen on the palm of the left hand and dorsal aspect of the right hand. Histopathology of the biopsied specimen revealed light brown hyphae and single celled structures along with many inflammatory cells. The patient showed marked improvement with oral chloroquin and itraconazole orally and ketoconazole cream topically.

1403

Scytalidium dimidiatum pseudodermatophyte, agent of superficial mycoses and phaehyphomycosis] Soler CP, Gerome P, Leguyadec T, Hance P, Nizou JY, Le Vagueresse R. Med Trop (Mars). 1999;59(4):375-7.

Scytalidium dimidiatum is a fungus found mainly in tropical and subtropical zones. Infection can cause a benign disease closely resembling dermatophytosis. In immunocompromised hosts, Scytalidium dimidiatum can also lead to phaehyphomycosis. Although awareness of these hyphae remains limited in developed countries, their incidence is growing due to increasing immigration and tourism. The rising incidence is well illustrated by three patients who presented onyxis and squamous-like manifestations on the arch of the foot upon returning from trips overseas and in whom various treatments were unsuccessful. In all three cases, culture in non-selective Sabouraud medium identified Scytalidium dimidiatum. These findings underline the need for laboratory testing before undertaking local or systemic treatment of onyxis especially since this pathogen can cause systemic disease. Study of ribosome genes showed that Scytalidium hyalinum is an homologous unpigmented mutant form of Scytalidium dimidatum. No antifungal agent has been effective for management of superficial manifestations and prevention depends mainly on the use of appropriate footwear in endemic areas.

1404

Scytalidium dimidiatum melanonychia and scaly plantar skin in four patients from the Maghreb: imported disease or outbreak in a Belgian mosque? Arrese JE, Piérard-Franchimont C, Piérard GE. Dermatology. 2001;202(2):183-5.

Scytalidium dimidiatum is a geophilic dematiaceous, non-dermatophyte mould that can become a pathogen for plants and humans particularly in tropical and subtropical regions. We report 4 cases of S. dimidiatum onychomycosis presenting clinically as thickened and dark toenails. The skin of the soles was scaly. The time and location of the contaminations were uncertain. Indeed, the patients were ancient immigrants from the Maghreb to Belgium. They were also regularly travelling to their countries of origin. They were also often barefoot in the same Belgian mosque. The disease was unresponsive to current oral antifungal treatments.

1408

Sphaeropsis subglobosa keratomycosis--first reported case. Kirkness CM, Seal DV, Clayton YM, Punithalingam E. Cornea. 1991 Jan;10(1):85-9.

Recurrent keratomycosis is reported due to the coelomycete Sphaeropsis subglobosa, which has not been recognised previously as a human pathogen. Infection followed corneal injury by a frayed bamboo cane with implantation of its splinters. Initial successful therapy with 2% clotrimazole topically, to which it was sensitive, was followed by recurrent infection after 39 months, initially a keratitis but progressing to an endophthalmitis. Penetrating keratoplasty was necessary to eradicate the infection. Further isolation of the fungus showed that it had not developed resistance to clotrimazole but had survived dormant, deep in the corneal stroma. S. subglobosa should be considered in bamboo-associated and horticultural injuries.

1413

Dermatitis due to Sporobolomyces infection. Bergman AG, Kauffman CA. Arch Dermatol. 1984 Aug;120(8):1059-60.

A 30-year-old woman had a pruritic skin lesion from which a yeastlike organism, Sporobolomyces holsaticus, was isolated. Members of this group of yeasts are found in the soil throughout the world and have been implicated only twice before in human infection. We report a third case of infection due to a Sporobolomyces organism.

1414

Prosthetic cranioplasty infection due to Sporobolomyces. Morrow JD. J Tenn Med Assoc. 1994 Nov;87(11):466-7.

I have presented an unusual case of an infected prosthetic cranioplasty due to Sporobolomyces species found to be sensitive to amphotericin B in vitro. The infection was successfully treated with a combination of surgery and antifungal therapy.

1415

Sporobolomyces salmonicolor lymphadenitis in an AIDS patient. Pathogen or passenger? Plazas J, Portilla J, Boix V, Pérez-Mateo M. AIDS. 1994 Mar;8(3):387-8.

 

1419

Case report. Successfully treated subcutaneous infection with Sporothrix schenckii in Turkey. Koç AN, Ukşal U, Oymak O. Mycoses. 2001;44(7-8):330-3.

Sporotrichosis is rare in Turkey. We report a 48-year-old man who had subcutaneous sporotrichosis caused by Sporothrix schenckii that was successfully treated with short-term itraconazole and potassium iodide. The isolate was susceptible to itraconazole also in vitro. Short-term itraconazole and potassium iodide should be agents of choice for treatment of subcutaneous sporotrichosis. However, treatment is controversial both in choice of agent used and in duration of therapy.

1420

Prevalence, epidemiology and geographical distribution of Sporothrix schenckii infections in Gauteng, South Africa. Vismer HF, Hull PR. Mycopathologia. 1997;137(3):137-43.

Sporotrichosis is a subcutaneous fungal infection caused by the traumatic implantation of the dimorphic, pathogenic fungus, Sporothrix schenkii. It constitutes the most common subcutaneous fungal infection in the general population in South Africa. Sporotrichosis in South Africa dates back to 1914, when the disease was first diagnosed in the gold mines. Occupational and recreational circumstances of infection are well established, and the environmental requirements for contracting the disease are better understood. Sporotrichosis cases were recorded from 42 suburbs in the greater Pretoria area as well as from 23 towns outside the Pretoria municipal boundary. It occurred in 154 patients with ages ranging from less than 1 year to 90 years old, with males predominating. Females in the area seemed to be at lesser risk, mainly becoming infected through gardening injuries, insect bites or other minor injuries due to outdoor activities. Exposure to possible sources of the fungus, either from recreational or occupational activities in males, was the main determining factor in acquiring the disease. The lymphocutaneous and localized forms of the disease were most often recorded. Our study indicates that, while there is no pronounced seasonal variation, the onset of the disease seemed to be mainly in the cooler and dryer months of the year.

1421

Sporotrichosis. Davis BA. Dermatol Clin. 1996 Jan;14(1):69-76.

Sporothrix schenckii is a fungus that can be found worldwide in decaying vegetative matter. It is the causative agent of sporotrichosis, a chronic infection of humans and animals. The infection is characterized by nodular lesions of the cutaneous and subcutaneous tissues with lymphatic involvement. Systemic spread may occur with bone, muscle, central nervous system, and pulmonary involvement. Diagnosis may be made based on clinical presentation and on laboratory identification of the etiologic agent.

1422

Epidemic cutaneous sporotrichosis. Campos P, Arenas R, Coronado H. Int J Dermatol. 1994 Jan;33(1):38-41.

BACKGROUND. Sporotrichosis is a subcutaneous fungal infection. Lymphocutaneous and fixed sporotrichosis are the most common forms; cases of disseminated sporotrichosis are rare. There have been isolated reports and some epidemic familial outbreaks of the infection. METHODS. We studied four members of two families who contracted sporotrichosis after sleeping in an old and rust-stained camping tent. RESULTS. All cases presented with polymorphic lesions, three of them with multiple sites of inoculation. The camping tent was shown to be the source of infection. CONCLUSIONS. We report an epidemic of sporotrichosis in a family. In three cases disseminated cutaneous sporotrichosis occurred in nonimmunodeficient patients. The isolate of Sporothrix schenckii from a camping tent is extremely rare.

1423

Cutaneous sporotrichosis in Thailand: first reported case. Kwangsukstith C, Vanittanakom N, Khanjanasthiti P, Uthammachai C. Mycoses. 1990 Nov-Dec;33(11-12):513-7.

A case of cutaneous sporotrichosis is reported for the first time in Thailand. The infection occurred in a 33-year-old Thai female who has been in good health and had no history of previous trauma or contact with any animals. Histopathology revealed pseudoepitheliomatous hyperplasia of the epidermis and a combination of granulomatous and pyogenic reactions in the dermis and subcutaneous tissue. Typical asteroid bodies (Splendore-Hoeppli phenomenon) with central yeast cells were seen. Sporothrix schenckii was recovered from skin biopsy specimens. The patient responded well to the treatment with saturated solutions of potassium iodide within three months. No recurrence was seen after more than six months follow-up.

1424

Ocular and concomitant cutaneous sporotrichosis. Vieira-Dias D, Sena CM, Oréfice F, Tanure MA, Hamdan JS. Mycoses. 1997 Oct;40(5-6):197-201.

We report here the case of a 12-year-old girl with concomitant cutaneous and ocular sporotrichosis. Sporothrix schenckii was isolated from skin lesions and aqueous humour. The difficulty in the diagnosis and treatment of this form of mycosis is discussed and the data are compared with those published in the few reports available in the literature.

1425

Endophthalmitis due to Sporothrix schenckii after penetrating ocular injury. Witherspoon CD, Kuhn F, Owens SD, White MF, Kimble JA. Ann Ophthalmol. 1990 Oct;22(10):385-8.

A 13-year-old boy developed endophthalmitis from traumatic inoculation of vegetable material penetrating his right eye. Sporothrix schenckii was morphologically identified from the intraocular fluids. However, repeated attempts to culture the organism proved negative. Seventeen sporotrical endophthalmitis cases have so far been reported, and before this report, only one of them was secondary to trauma. This is the sole eye to our knowledge not only to have escaped enucleation after sporotrical endophthalmitis but to have achieved useful (20/50) vision.

1426

Chronic cavitary pulmonary sporotrichosis: efficacy of oral itraconazole. Ramirez J, Byrd RP Jr, Roy TM. J Ky Med Assoc. 1998 Mar;96(3):103-5.

The small number of patients suffering from pulmonary involvement with Sporothrix schenckii has prevented prospective controlled studies that could determine the optimal therapy for this chronic infection. The clinician's ability to determine the best medical treatment for chronic cavitary pulmonary sporotrichosis is also tempered by the limited use of newer azole antifungal agents in this disorder as well as the relative lack of efficacy reported with older therapies. We present a 50-year-old male with primary pulmonary sporotrichosis whose chronic cavitary disease responded to oral itraconazole.

1427

Pulmonary sporotrichosis with hyphae in a human immunodeficiency virus-infected patient. A case report. Gori S, Lupetti A, Moscato G, Parenti M, Lofaro A. Acta Cytol. 1997 Mar-Apr;41(2):519-21.

BACKGROUND: Pulmonary sporotrichosis is a rare event. Sporothrix schenckii is a dimorphic fungus and develops at 37 degrees C in yeast form. Usually hyphae are not observed in tissues, although their presence has been occasionally demonstrated in biopsies. CASE: A 37-year-old man, human immunodeficiency virus-1 positive, with a CD4 cell count of 345/mm3, developed a productive cough. A sputum smear revealed the presence of a large amount of long, thin, septated micelia. The hyphae bore oval, sessile conidia. Cultures of sputum yielded numerous colonies of S schenckii. CONCLUSION: This is the first report of hyphae of S schenckii in sputum. This case emphasizes the possibilities of cytology for the diagnosis of mycotic infections. Fungi have typical morphologies, and it is possible, on the basis of microscopic evidence, to suspect the nature of the infection early and thus to direct culture procedures.

1428

Fatal pulmonary sporotrichosis caused by Sporothrix schenckii var. luriei in India. Padhye AA, Kaufman L, Durry E, Banerjee CK, Jindal SK, Talwar P, Chakrabarti A. J Clin Microbiol. 1992 Sep;30(9):2492-4.

The first case of fatal pulmonary sporotrichosis caused by Sporothrix schenckii var. luriei in a patient from the northwestern region of India is described. In the absence of cultures, the diagnosis was suspected by notation, in lung tissue, of large, thick-walled, hyaline fungal cells that divided internally by septation or a budding process. The thick-walled, internally septated cells often became muriform. The presence of an "eyeglass" configuration of incompletely separated cells characteristic of S. schenckii var. luriei in large numbers aided the diagnosis. The identity of the etiologic agent was confirmed by application of a fluorescent-antibody reagent specific for S. schenckii.

1429

A case of primary pulmonary sporotrichosis] Nakano H, Suzuki A, Tojima H, Imahashi M, Kashiyama T, Honda A, Watanabe A, Mizuguchi K, Kamei K. Nihon Kyobu Shikkan Gakkai Zasshi. 1989 Feb;27(2):220-4.

We report the first case of primary pulmonary sporotrichosis in Japan. A 53-year-old man was admitted to our hospital for further examination of the abnormal shadows on chest X-ray film. Six months before admission, he was admitted to another hospital because of alcoholic liver disease and diabetes mellitus. Since the initial chest film showed cavities with infiltration in the left upper lung field, he was treated with antituberculous drugs despite negative sputum cultures for mycobacterium. In spite of the medication, his chest X-ray film revealed another cavitary lesion, so he was referred to our hospital. He had been asymptomatic during this period. Chest X-ray on admission disclosed multiple cavities in the left upper lobe and a cavity in the right lower lobe. Repeated sputum specimens, bronchial washings and brushings for cytology and cultures were all negative. In an attempt to clarify the pathogen, percutaneous lung aspiration (PLA) was performed. The PLA sample yielded a positive culture of Sporothrix shenckii. After the diagnosis, S. schenckii was also cultured from sputa. A sporothrix skin test and yeast agglutination test for S. schenckii were positive. In the absence of a history for skin lesion, the patient was diagnosed as a primary pulmonary sporotrichosis. As iodide therapy was ineffective, he was started on a regimen of intravenous amphotericin B. However his renal function progressively deteriorated, so amphotericin B was discontinued. Now he receives miconazole intravenously and is still under careful observation. As far as we know, this is the first report of primary pulmonary sporotrichosis in Japan. The possibility of sporotrichosis should be considered in any cases of undiagnosed cavitary lung diseases.

1430

Sporothrix infection of the lung without cutaneous disease. Primary pulmonary sporotrichosis. England DM, Hochholzer L. Arch Pathol Lab Med. 1987 Mar;111(3):298-300.

The clinical spectrum of sporotrichosis is expanding and now includes pulmonary infection in absence of skin lesions. Lung involvement, albeit unusual, is a granulomatous pneumonitis which may progress to bilateral, apical, fibrotic, and contracted infiltrates or cavities, thereby mimicking tuberculosis or histoplasmosis. The patients are most often middle-aged men with alcoholism and chronic obstructive pulmonary disease. Our case report is yet another variant of primary pulmonary sporotrichosis that presented as diffuse, bilateral granulomatous pneumonitis without cavitation or predilection for upper lobes.

1431

Primary pulmonary sporotrichosis. Report of eight cases with clinicopathologic review. England DM, Hochholzer L. Am J Surg Pathol. 1985 Mar;9(3):193-204.

Pulmonary sporotrichosis in the absence of lymphocutaneous disease is unusual; however, its incidence may be greater than previously recognized. This report describes the AFIP experience in eight cases of primary pulmonary sporotrichosis and reviews an additional 23 cases. The disease is often a bilateral, apical, chronic and cavitary, progressive, destructive, and debilitating infection, most often seen in middle-aged men with a history of alcoholism and chronic obstructive pulmonary disease. In this clinical setting, pulmonary sporotrichosis closely mimics tuberculosis or histoplasmosis. However, this clinical charade can be unmasked by serologic tests, cultures, and identification of the causative agent, Sporothrix schenckii, in sections of paraffin-embedded lung containing necrotizing granulomas and stained with periodic acid-Schiff and Gomori methenamine-silver nitrate. Previously not recognized is the presentation of primary pulmonary sporotrichosis as a solitary, peripheral, necrotizing pulmonary nodule, observed in two patients. Chronic cavitary pulmonary sporotrichosis is usually refractory to drug therapy; however, when combined with surgical resection, cure can be attained.

1432

Sporothrix meningitis. Wescott BL, Nasser A, Jarolim DR. Nurse Pract. 1999 Feb;24(2):90, 93-4, 97-8 passim.

Sporothrix schenckii is a fungus commonly found in soil and on plants, wood splinters, rosebush thorns, and decaying vegetation. It is also carried by some wild and domestic animals and rodents. When this organism penetrates the skin of individuals handling contaminated substances, the cutaneous manifestation may be lymphangitic or fixed. The treatment of choice for the cutaneous form of the disease (sporotrichosis) is potassium iodide. If iodides are contraindicated or not tolerated, itraconazole may be used. Sporotrichosis can persist for years if unrecognized and can progress to systemic forms, including osteoarticular, pulmonary (may occur when the organism is inhaled), and meningeal involvement. Systemic forms can be life-threatening and very difficult to treat. Primary care providers must be familiar with this disorder and its presentation because it is easily mistaken for a bacterial infection and inappropriately treated.

1433

Disseminated cutaneous and meningeal sporotrichosis in an AIDS patient. Donabedian H, O'Donnell E, Olszewski C, MacArthur RD, Budd N. Diagn Microbiol Infect Dis. 1994 Feb;18(2):111-5.

We report the first proven case of Sporothrix meningoencephalitis in an AIDS patient. The patient had dramatic, wide-spread ulcerative and infiltrative disease with progressive meningoencephalitis in spite of amphotericin and itraconazole therapy. Sporothrix was cultured from premortem cerebrospinal fluid and seen in the meninges and in brain vessels at autopsy.

1434

Sporothrix schenckii meningitis in a farmer with Hodgkin's disease. Ewing GE, Bosl GJ, Peterson PK. Am J Med. 1980 Mar;68(3):455-7.

A fatal case of chronic meningeal sporotrichosis occurring as an opportunistic infection in a patient with Hodgkin's disease is presented. A pulmonary source of infection was identified at autopsy. The diagnostic importance of the isolation of Sporothrix schenckii from cerebrospinal fluid, even if only from a single specimen, is stressed.

1435

Musculoskeletal sporotrichosis. Chang AC, Destouet JM, Murphy WA. Skeletal Radiol. 1984;12(1):23-8.

Sporotrichosis is a chronic, indolent, fungal infection that rarely involves the musculoskeletal system. The etiologic agent, Sporothrix schenckii, is ubiquitous in nature and has been isolated from soil, timber, decaying vegetation, and a variety of foliage. The organism gains entrance to the body through trauma to the skin or, in rare instances, by inhalation. The vast majority of infections in humans is characterized by nodular or ulcerated lesions of the cutaneous tissues and adjacent lymphatics. Osteoarticular involvement may occur either by contiguous spread from a cutaneous focus, through direct inoculation of tissue by the organism, or by hematogenous dissemination. The rarity of musculosketetal sporotrichosis often causes a delay in diagnosis which leads to inappropriate therapy and permanent deformity in some patients. Three cases which show a spectrum of bone and joint involvement are presented.

1436

Disseminated sporotrichosis with extensive cutaneous involvement in a patient with AIDS. Ware AJ, Cockerell CJ, Skiest DJ, Kussman HM. J Am Acad Dermatol. 1999 Feb;40(2 Pt 2):350-5.

Sporotrichosis most commonly presents as a localized, lymphocutaneous infection that follows trauma, such as an injury from a rose thorn. In patients infected with HIV, it may be widespread and disseminated. We describe a patient with AIDS who developed disseminated sporotrichosis, a rare opportunistic fungal infection that may affect these patients. The condition remained undiagnosed because of failure to recognize characteristic histopathologic findings and failure of clinicians to interface closely with the microbiology laboratory. The condition was difficult to treat, requiring systemic administration of amphotericin. While localized sporotrichosis is an innocuous disorder that responds well to therapy, in immunocompromised hosts, it is potentially life-threatening and may require prolonged therapy with potentially toxic medications such as amphotericin B. It is important that clinicians be aware of the presentation of this unusual opportunistic infection and that they maintain close communication with pathology and clinical microbiology laboratories to ensure that proper stains and cultures are performed to avoid potential misdiagnosis.

1437

Disseminated sporotrichosis and Sporothrix schenckii fungemia as the initial presentation of human immunodeficiency virus infection. al-Tawfiq JA, Wools KK. Clin Infect Dis. 1998 Jun;26(6):1403-6.

Infection with Sporothrix schenckii causes a localized lymphocutaneous disease in the immunocompetent host, while it frequently results in disseminated disease in the immunocompromised patient. There are a growing number of reports of S. schenckii infection in the human immunodeficiency virus (HIV)-infected population, where the disease usually starts as a localized cutaneous lesion and subsequently disseminates. The optimal treatment of systemic sporotrichosis in HIV-positive patients is as yet unknown. This article presents a case report of disseminated sporotrichosis in an HIV-infected patient, a review of the literature, and discussion of treatment options for HIV-infected patients.

1438

Sporothrix schenckii fungemia without disseminated sporotrichosis. Kosinski RM, Axelrod P, Rex JH, Burday M, Sivaprasad R, Wreiole A. J Clin Microbiol. 1992 Feb;30(2):501-3.

Fungemia is a rare complication of Sporothrix schenckii infection and has always been associated with disseminated sporotrichosis. We describe an immunocompetent patient with localized lymphocutaneous sporotrichosis from whose blood the fungus was isolated. A lysis-centrifugation blood culture system may have improved our ability to detect low-level S. schenckii fungemia.

1439

Disseminated sporotrichosis in patients with AIDS: case report and review of the literature. Heller HM, Fuhrer J. AIDS. 1991 Oct;5(10):1243-6.

Sporotrichosis is the disease caused by the dimorphic fungus Sporothrix schenkii. Disseminated sporotrichosis is an uncommon infection which usually occurs in alcoholics or patients receiving immunosuppressive medication. We report a case of a patient with AIDS who had disseminated sporotrichosis which was progressive and fatal despite antifungal therapy. Four previously reported cases of disseminated sporotrichosis in patients with AIDS are reviewed. Disseminated sporotrichosis occurs in patients with HIV-1 infection and severe CD4 lymphocyte depletion. It usually presents with diffuse cutaneous lesions and is associated with polyarticular arthritis. Response to treatment is variable and chronic suppressive therapy is probably needed to prevent relapse.

1459

Acute pulmonary hemorrhage in a Delaware infant after exposure to Stachybotrys atra. Weiss A, Chidekel AS. Del Med J. 2002 Sep;74(9):363-8.

 

1460

Isolation of Stachybotrys from the lung of a child with pulmonary hemosiderosis. Elidemir O, Colasurdo GN, Rossmann SN, Fan LL. Pediatrics. 1999 Oct;104(4 Pt 1):964-6.

Recently, Stachybotrys atra, a toxigenic fungus, has been implicated as a potential cause of pulmonary hemorrhage/hemosiderosis in infants living in water-damaged homes. Although epidemiologic evidence supports this association, neither the organism nor its toxic products has ever been recovered from humans. We report the first case in which Stachybotrys was isolated from the bronchoalveolar lavage fluid of a child with pulmonary hemorrhage. Stachybotrys was also recovered from his water-damaged home. The patient recovered completely after his immediate removal from the environment and subsequent cleaning of his home. This case provides further evidence that this fungus is capable of causing pulmonary hemorrhage in children.

1461

Clinical experience and results of a Sentinel Health Investigation related to indoor fungal exposure. Johanning E, Landsbergis P, Gareis M, Yang CS, Olmsted E. Environ Health Perspect. 1999 Jun;107 Suppl 3:489-94.

This is a review of exposure conditions, clinical presentation, and morbidity of children and adults with indoor fungal exposure such as toxic Stachybotrys chartarum. Indoor exposure was characterized using different methods including microscopic, culture, cytotoxicity screening tests, and chemical analyses. Clinical case histories and physical and laboratory findings are presented of children (age < 18 years, n = 22; mean age 9 years; 60% females) and adults (age >18 years, n = 125; mean age 39 years, 67% females) who consulted an environmental health specialty clinic. In the pediatric patients' exposure history, widespread fungal contamination of water-damaged building materials with known toxic or allergic fungi was identified. Primarily disorders of the respiratory system, skin, mucous membranes, and central nervous system were reported. Some enumeration and functional laboratory abnormalities, mainly of the lymphatic blood cells, were observed, although no statistically significant differences were found. IgE or IgG fungi-specific antibodies, used as exposure markers, were positive in less than 25% of all tested cases. In an evaluation of a symptomatic girl 11 years of age (sentinel case investigation) living in an apartment with verified toxigenic fungi (i.e., S. chartarum), several health indicators showed improvement after exposure cessation.

1466

Cutaneous infection by Syncephalastrum. Kamalam A, Thambiah AS. Sabouraudia. 1980 Mar;18(1):19-20.

Cutaneous infection of the thumb by a Syncephalastrum sp. is described in an adult male suffering from diabetic ketosis. The fungus was isolated from the skin and was found to produce arteritis in the dermal vessels. The patient died of diabetes mellitus without any associated systemic mycosis. Syncephalastrum in this case had occurred as an opportunistic infection.

1467

An intracavitary fungus ball composed of syncephalastrum. Kirkpatrick MB, Pollock HM, Wimberley NE, Bass JB, Davidson JR, Boyd BW. Am Rev Respir Dis. 1979 Oct;120(4):943-7.

A case of a pulmonary intracavitary fungus ball composed of Syncephalastrum sp., a member of the class Zygomycetes not previously reported in association with human disease, is presented. The fungus was cultured preoperatively from bronchial secretions as well as from the fungal mass from the resected lung. This fungus appeared to behave in a saprophytic manner similar to that of the more common Aspergillus fungus ball.

1468

Taeniolella boppi, a new species, causative agent of chromomycosis] Borelli D. Med Cutan Ibero Lat Am. 1983;11(4):227-32.

The holotype is described of a new species of chromomycetes, that was isolated by Prof. Clovis Bopp (Porto Alegre, Rio Grande do Sul, Brasil) from lesions of chromomycosis in the inferior limb of a woman. The binomium Taeniolella boppii is proposed for the new taxon. The whole mycelium is dark. The culture surface is velvetyyowdery, folded into a few forrows, at first olive green later on olive black in color. The macro-culture's diameter grows 1,5 mm. a day. The minimum growing temperature lies at 10, the optimum one at 23-28 and the maximum one at 36 degrees C. The gelatin and the milk proteins are very slowly digested. The vegetative mycellum is made up of smooth, cylindrical hyphae, whose diameter measure, 2,25-3,75 m. From these toruloid hyphae are formed, simple or ramified whose cells measure 3-4 x 3-5 in size, and are smooth, continuous or 1-septate. Sometimes, bigger intercalary or terminal cells are seen that are ellypsoid and dictyoseptated and can measure until 14 m in diameter. No part of the mycellium secredes. By injecting Taeniolella boppii's cultures into peritoneum of white mice, into the derma of a voluntary, into the testes of a guinea-pig and into the plantar bursa of white mice, no progressive injection could be elicted; only an ephemeral germination of some toruloid cells but not the transformation to the chromomicetic parasitic form could be observed. The holotype is preserved in the mycologic collection of the medical faculty of Caracas at the position FMC 292.

1469

[Chromoblastomycosis caused by a new species: Taeniolella boppii] Bopp C, Vetoratto, Borelli D. Med Cutan Ibero Lat Am. 1983;11(4):221-6.

The authors report a case of a 51-year-old woman, living in the extreme west of the Santa Catarina State (South of Brazil, near the Argentine border), who presented a vegetating plaque in the foot, associated with inflammatory nodules in the leg, according to the sporotrichoid form of chromoblastomycosis, with a histologic pattern distinct from the commonly observed. In culture the fungus produced exclusively and repeatidly colonies of a Cladosporium type. More detailed studies of the fungus made by Dante Borelli of Venezuela, proved it to be the type of a new species of Dematiaceous mould.

1473

Tetraploa keratomycosis. Newmark E, Polack FM. Am J Ophthalmol. 1970 Dec;70(6):1013-5.

 

1474

Phaeohyphomycotic cyst caused by Tetraploa aristata. Markham WD, Key RD, Padhye AA, Ajello L. J Med Vet Mycol. 1990;28(2):147-50.

A case of phaeohyphomycotic cyst on the left knee of a 54-year-old man caused by Tetraploa aristata is described. Identification was based on the coloration and morphology of the fungus in tissue and the macro- and micro-morphologic characteristics of the mould isolated from the cyst fluid. T. aristata is a dematiaceous hyphomycete found on the leaves and stems of a variety of plants. Previously, it has been known as an etiologic agent of two human cases of keratomycosis. Here we describe the first known subcutaneous phaeohyphomycotic infection caused by T. aristata.

1475

Peritonitis due to Thermoascus taitungiacus (Anamorph Paecilomyces taitungiacus). Korzets A, Weinberger M, Chagnac A, Goldschmied-Reouven A, Rinaldi MG, Sutton DA. J Clin Microbiol. 2001 Feb;39(2):720-4.

The first case of human disease due to the thermophilic ascomycete Thermoascus taitungiacus (the teleomorph of Paecilomyces taitungiacus) is presented. T. taitungiacus was recovered from four dialysate fluid specimens of a 57-year-old patient undergoing chronic peritoneal dialysis. Identification was based upon cylindrical conidia, reddish orange nonostiolate ascomata, lack of growth at 20 degrees C, thermotolerance, and ascospores that appeared pale yellow, elliptical, thick walled, and predominately echinulate by light microscopy but irregularly verrucose by scanning electron microscopy.

1476

Prosthetic valve endocarditis due to Thermomyces lanuginosus Tsiklinsky--first case report. Lecso-Bornet M, Gueho E, Barbier-Boehm G, Berthelot G, Gaildrat M, Taravella D, Bergogne-Berezin E. J Med Vet Mycol. 1991;29(3):205-9.

The first case of Thermomyces lanuginosus endocarditis occurring on a porcine heterograft prosthesis, secondary to a Staphylococcus aureus infection of the aortic valve, is reported. The diagnosis was made post-mortem by direct examination of the prosthesis and culture of surgical samples on Sabouraud's agar. Identification was based on the presence of warty, dark brown aleurioconidia. The route of contamination could not be established but the most likely cause was the air of the operating room or the insertion of a contaminated graft.

1480

Tilletiopsis minor: a new etiologic agent of human subcutaneous mycosis in an immunocompromised host. Ramani R, Kahn BT, Chaturvedi V.

J Clin Microbiol. 1997 Nov;35(11):2992-5.

We describe herein the isolation of Tilletiopsis minor from a subcutaneous cyst of a 70-year-old immunocompromised male. The diagnosis was based on repeated isolation of the fungus, observation of hyphal elements in tissue sections, the ability of the mold to grow at or near body temperature, and the achievement of a complete cure following surgery and antifungal therapy.

1501

Invasive infections due to Trichoderma species: report of 2 cases, findings of in vitro susceptibility testing, and review of the literature. Chouaki T, Lavarde V, Lachaud L, Raccurt CP, Hennequin C. Clin Infect Dis. 2002 Dec 1;35(11):1360-7.

Trichoderma species are filamentous fungi that were previously considered to be culture contaminants. We report 2 well-documented cases of invasive Trichoderma infections, and we comprehensively review the literature on this topic. Trichoderma species are mainly responsible for continuous ambulatory peritoneal dialysis-associated peritonitis (7 cases) and invasive infections in immunocompromised patients (9 cases) with a hematologic malignancy or solid-organ transplant. Definitive diagnosis is difficult to achieve because of the lack of specific diagnosis tools. Species identification can benefit from a molecular approach. Trichoderma longibrachiatum is the most common species involved in these infections. Regardless of the type of infection, the prognosis was poor, with 8 deaths among 18 cases. This may be partially because of the resistance of these organisms to the majority of available antifungal agents, including amphotericin B. Trichoderma species now should be added to the growing list of emerging filamentous fungal pathogens.

1502

Acute invasive sinusitis due to Trichoderma longibrachiatum in a liver and small bowel transplant recipient. K, Skedros D, Todo S, Rinaldi MG. Clin Infect Dis. 1998 Feb;26(2):487-9.

We describe a case of acute invasive sinusitis due to an unusual moniliaceous fungus, Trichoderma longibrachiatum Rifai 1969 (a member of the class Hyphomycetes), in a small bowel and liver transplant recipient treated with tacrolimus (FK-506) and prednisone. The patient was successfully treated with surgical debridements and amphotericin B followed by oral itraconazole.

1503

Fatal case of Trichoderma harzianum infection in a renal transplant recipient. Guarro J, Antolin-Ayala MI, Gene J, Gutierrez-Calzada J, Nieves-Diez C, Ortoneda M. J Clin Microbiol. 1999 Nov;37(11):3751-5.

We describe the second known case of human infection by Trichoderma harzianum. A disseminated fungal infection was detected in the postmortem examination of a renal transplant recipient and confirmed in culture. The only other reported infection by this fungus caused peritonitis in a diabetic patient. The in vitro antifungal susceptibilities of the clinical strain and three other strains of Trichoderma species to six antifungal drugs are provided. This case illustrates the widening spectrum of opportunistic Trichoderma spp. in immunocompromised patients and emphasizes the problems in diagnosing invasive fungal diseases.

1504

Fatal disseminated Trichoderma longibrachiatum infection in an adult bone marrow transplant patient: species identification and review of the literature. Richter S, Cormican MG, Pfaller MA, Lee CK, Gingrich R, Rinaldi MG, Sutton DA. J Clin Microbiol. 1999 Apr;37(4):1154-60.

Trichoderma longibrachiatum was recovered from stool surveillance cultures and a perirectal ulcer biopsy specimen from a 29-year-old male who had received an allogeneic bone marrow transplant for acute lymphoblastic leukemia. The amphotericin B (2.0 microgram/ml) and itraconazole (1.0 microgram/ml) MICs for the organism were elevated. Therapy with these agents was unsuccessful, and the patient died on day 58 posttransplantation. At autopsy, histologic sections from the lungs, liver, brain, and intestinal wall showed infiltration by branching septate hyphae. Cultures were positive for Trichoderma longibrachiatum. While Trichoderma species have been recognized to be pathogenic in profoundly immunosuppressed hosts with increasing frequency, this is the first report of probable acquisition through the gastrointestinal tract. Salient features regarding the identification of molds in the Trichoderma longibrachiatum species aggregate are presented.

1505

Trichoderma longibrachiatum infection in a pediatric patient with aplastic anemia. Munoz FM, Demmler GJ, Travis WR, Ogden AK, Rossmann SN, Rinaldi MG. J Clin Microbiol. 1997 Feb;35(2):499-503.

Trichoderma longibrachiatum infection of the skin in an 11-year-old child with severe aplastic anemia and prolonged neutropenia is reported. The patient received systemic antifungal therapy and underwent bone marrow transplantation. To our knowledge, this is the first description of T. longibrachiatum infection in a pediatric patient. It also is the first case successfully treated with medical therapy. A review of the literature suggests that Trichoderma spp. are recognized as human pathogens with increasing frequency, particularly for immunocompromised patients, and should be considered in the differential diagnosis of fungal infections in the pediatric population.

1510

Cutaneous hyalohyphomycosis and onychomycosis caused by Onychocola canadensis: report of the first case from Turkey. Erbagci Z, Balci I, Erkiliç S, Zer Y, Inci R. J Dermatol. 2002 Aug;29(8):522-8.

We present the first Turkish case of skin and nail infection due to Onychocola canadensis in an otherwise healthy farmer who frequently worked barefoot on soil. Cutaneous involvement consisted of scaly and hyperkeratotic lesions resembling tinea pedis, erythematous plaques, and dermal papulonodules of various sizes simulating Majocchi's granuloma. Repeated cultures from nail plates, skin scrapings and needle aspiration materials from papules or nodules all yielded the same mold on Sabouroud dextrose media with and without cycloheximide, trichophyton agar, and potato dextrose agar at 26 degrees C. The causal isolate was identified as Onychocola canadensis Sigler gen. et sp. nov., a slow-growing arthroconidial hyphomycete, on the basis of its colonial and microscopic morphology. While skin lesions were responsive to daily itraconazole in a dose of 200 mg for three months, the onychomycosis was resistant to therapy. To our knowledge, this is the first presentation of O. canadensis as the cause of cutaneous hyalohyphomycosis to date.

1511

Trichophyton rubrum showing deep dermal invasion directly from the epidermis in immunosuppressed patients. Smith KJ, Welsh M, Skelton H. Br J Dermatol. 2001 Aug;145(2):344-8.

Trichophyton rubrum is the most widely encountered dermatophyte infection, and is usually regarded as exclusively keratinophilic often leading to chronic cutaneous and nail infections, even in healthy individuals. We present three patients with acute leukaemias, with ill-defined pre-existent cutaneous eruptions that were treated with a potent topical corticosteroid. All three patients received aggressive marrow toxic chemotherapy. These patients had progression of their cutaneous disease, which showed deep dermal invasion of T. rubrum, invading directly from the epidermis with no evidence of systemic spread. We conclude that systemic pancytopenia, in association with prolonged local immunosuppression, may increase the risk of direct dermal invasion of dermatophyte infections. However, even in these patients, the risk of systemic spread still appears very low. Amphotericin B did not appear effective in treating these dermatophyte infections.

1512

Microbiological and molecular diagnosis of deep localized cutaneous infection with Trichophyton mentagrophytes. Sommer S, Barton RC, Wilkinson SM, Merchant WJ, Evans EG, Moore MK. Br J Dermatol. 1999 Aug;141(2):323-5.

We describe a healthy young woman with a localized deep dermal infection on the right side of the chest wall. It was caused by the dermatophyte Trichophyton mentagrophytes, and resolved after two pulses of oral itraconazole 200 mg twice daily for 1 week. As cultural and microscopic features did not enable a precise identification of the fungus, molecular investigation was undertaken. Patterns of HaeIII restriction digests of genomic DNA from the culture matched those from Arthroderma incurvata and A. benhamiae, which is the teleomorph of T. mentagrophytes var. mentagrophytes.

1522

[Case of Trichocephalus trichurus present in the uvea and treated surgically] Rusinowa E, Rusin A. Klin Oczna. 1973 Feb;43(2):199-201.

 

1523

Exogenous corneal ulcer caused by Tritirachium roseum. Rodrigues MM, Laibson P. Am J Ophthalmol. 1975 Nov;80(5):804-6.

A 29-year-old white man developed a corneal ulcer following trauma to his left cornea by a piece of wire. Tritirachium roseum, a saprophytic fungus, was cultured from corneal scrapings and demonstrated in the corneal button by histopathologic examination.

1525

Cutaneous mold fungus granuloma from Ulocladium chartarum. Altmeyer P, Schon K. Hautarzt. 1981 Jan;32(1):36-8.

Cutaneous granulomas due to the mold fungus Ulocladium chartarum (Preuss) are described in a 58 year old woman. This fungus is usually harmless for mammalian. It is thought that a consisting immunosuppression (Brill-Symmer's disease, therapy with corticosteroids) was a priming condition for the infection. The route of infection in this patient described is unknown.

1527

Central venous catheter infection due to Ustilago species. Patel R, Roberts GD, Kelly DG, Walker RC. Clin Infect Dis. 1995 Oct;21(4):1043-4.

 

1528

Cutaneous phaeohyphomycosis caused by Veronaea bothryosa in a liver transplant recipient successfully treated with itraconazole. Foulet F, Duvoux C, de Bievre C, Hezode C, Bretagne S. Clin Infect Dis. 1999 Sep;29(3):689-90.

 

1529

Occupational asthma in tomato growers following an outbreak of the fungus Verticillium albo-atrum in the crop. Davies PD, Jacobs R, Mullins J, Davies BH. J Soc Occup Med. 1988 Spring-Summer;38(1-2):13-7.

 

1536

Fungal peritonitis in peritoneal dialysis: critical review of six cases. Amici G, Grandesso S, Mottola A, Virga G, Calconi G, Bocci C. Adv Perit Dial. 1994;10:169-73.

Fungal peritonitis (FP) is uncommon in patients on peritoneal dialysis (PD); it is difficult to treat and has a high mortality rate. We report 6 cases of fungal peritonitis observed between 1980 and 1992 in our center. The etiologic agents were: Candida spp., C. guilliermondi, C. parapsilosis, C. albicans, and Verticillium spp. All 6 patients had suffered at least one episode of bacterial peritonitis in the two months before the fungal infection appeared and were all treated by intraperitoneal administration of antibiotics. The catheter was removed early in 3 patients followed by antimycotic therapy, while the remaining 3 patients received antimycotic therapy, with removal of the catheter in a later stage. The result in the first group was that they all switched permanently to hemodialysis, while in the second group there were 2 deaths and 1 transfer to hemodialysis. In the light of these 6 cases, we analyzed 22 published reports to assess risk factors, therapy, and outcome of this pathology. The major predisposing factors were intraperitoneal antibiotics and bacterial peritonitis, and the best results were obtained by continuing PD plus intraperitoneal and systemic antifungal agents.

1537

Verticillium peritonitis in a patient on peritoneal dialysis. Amici G, Grandesso S, Mottola A, Virga G, Teodori T, Maresca MC, Bocci C. Am J Nephrol. 1994;14(3):216-9.

We describe a case of peritonitis due to Verticillium spp. in a 33-year-old farmer on continuous ambulatory peritoneal dialysis (CAPD) for 3 months for end-stage renal failure due to chronic pyelonephritis. The etiologic agent was a hyaline hyphomycete which we report as a new human opportunistic pathogen. The fungus was isolated from the peritoneal fluid culture and from the tip of the catheter; identification was made on the basis of macroscopic and microscopic features. The patient had previously been admitted to our hospital for peritonitis caused by mixed enteric flora and treated for 8 days with intraperitoneal broad-spectrum antibiotic therapy. Five days after discharge he was readmitted for severe abdominal pain and cloudy drainage fluid. Two days of intraperitoneal broad-spectrum antimicrobial therapy produced no clinical improvement. Intravenous fluconazole and oral flucytosine were administered upon identifying the fungus. After another 2 days without improvement, peritoneal dialysis was discontinued and the catheter removed. Antimycotic therapy was continued for 4 days with complete resolution of the peritonitis. The patient chose to start hemodialysis and was discharged in good clinical condition.

1538

Keratitis caused by Verticillium species. Shin JY, Kim HM, Hong JW. Cornea. 2002 Mar;21(2):240-2.

PURPOSE: To report a case of fungal keratitis caused by Verticillium species. METHODS: A 50-year-old man developed pain, redness, and an infiltrate in his left eye and had no history of trauma. The cornea showed superficial, white, stromal infiltrates and epithelial ulceration with a dendritic margin. The clinical features suggested herpetic keratitis, and the patient was treated with topical antiviral medication. Two weeks later, his condition deteriorated. Examination of the left eye showed stromal infiltrates with a feathery margin and epithelial ulceration with its covering white exudates. Corneal scrapings were taken for direct microscopic examination and culture. RESULTS: Corneal scraping showed the presence of fungal filaments. The fungus was identified as Verticillium species. Topical amphotericin B and systemic fluconazole were started after discontinuing the antiviral treatment. Clinically, the inflammation subsided during the 3 weeks after treatment. CONCLUSION: This is a rare case of infectious keratitis caused by Verticillium species. Rare species of fungal infection should be considered in the differential diagnosis of stromal keratitis refractive to conventional medical treatment.

1543

Recurrent self-limited fungemia caused by Yarrowia lipolytica in a patient with acute myelogenous leukemia. Chang CL, Park TH, Lee EY, Lim YT, Son HC. J Clin Microbiol. 2001 Mar;39(3):1200-1.

Yarrowia lipolytica is a weakly pathogenic yeast that is rarely isolated from the blood. We observed transient recurrent catheter-related fungemia attributable to this organism in a leukemic patient. The fungemia and accompanying fever subsided spontaneously. The data suggest that it might be possible to withhold specific treatment for Y. lipolytica fungemia even in an immunocompromised patient.

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