Subcutaneous phaeohyphomycosis caused by Exophiala spinifera

The second human subcutaneous infection due to Exophiala spinifera from the United States is described. Identification was based on the morphology of the fungus in tissue and the morphological features of the culture obtained from the biopsy material. Correct diagnosis and treatment with ketoconazole and 5-fluorocytosine cured the infection.     

Subcutaneous phaeohyphomycosis caused by Cladosporium devriesii, sp. nov

A 26-year-old woman from Grand Cayman Island with a 3-month history of a lump in the left breast was presumptively diagnosed as having a carcinoma. A segmental resection was attempted. Histologic examination of the biopsied tissue showed extensive granulomatous inflammation, necrosis, and septate, branched, dematiaceous hyphae in the intralobular ducts as well as in the surrounding tissues. When cultured on Sabouraud dextrose and brain heart infusion agars, the tissue yielded a slow-growing, downy, dematiaceous mould. Microscopically, it produced short, branched and unbranched chains of holoblastic conidia in acropetal manner from erect conidiophores that were characteristic of the genus Cladosporium. The isolate grew well at 36-37 degrees C, but failed to grow above 37 degrees C. It did not liquefy gelatin nor decompose casein, xanthine, hypoxanthine, or tyrosine, but did hydrolyze urea. Comparative studies with other pathogenic and saprophytic species of Cladosporium revealed that it represented an undescribed species. It is named Cladosporium devriesii, sp. nov.     

Phaeohyphomycosis caused by Exophiala moniliae

We studied two cases of phaeohyphomycosis that occurred in Japan. Histopathologic examination of biopsy material showed the presence of dematiaceous catenulate fungal cells and mycelium characteristic of phaeohyphomycosis. In detailed mycologic study of the two cultures isolated from the patients we found that both formed conidiogenous cells with proximal swellings with long, neck-like extensions bearing distinct annellations and clusters of conidia at their apices. The isolates were identified as Exophiala moniliae de Hoog. These two Japanese cases are the second and third known cases of phaeohyphomycosis caused by E. moniliae and the first recorded in that country.     

An outbreak of phaeohyphomycosis in rainbow trout caused by Scolecobasidium humicola

A previously undescribed host for the opportunistic dematiaceous hyphomycete, Scolecobasidium humicola, is reported. Several epizootics among rainbow trout, Salmo gairdneri, occurred in a Tennessee fish hatchery from 1969 to 1973. Symptoms included surface lesions, blisters and abscesses. The kidneys and other internal organs were invaded by the mycelium of S. humicola. Tissue morphology of the fungus was typical of that associated with phaeohyphomycosis. Experimental infections were reproduced in fingerling rainbow trout after intraperitoneal inoculation of S. humicola. Following a change in the hatchery's water supply, no new epizootics have occurred.     

Subcutaneous phaeohyphomycosis due to Curvularia lunata in a renal transplant patient

BackgroundPhaeohyphomycosis is defined as an infection caused by melanized fungi. It predominates in tropical climate and is currently classified as superficial, allergic, central nervous system or lung infections, and disseminated. Curvularia is one of the many genres which can cause this disease. Phialophora, Alternaria and Exophiala are more commonly isolated from subcutaneous lesions.Case reportA 25-year-old male, renal transplant recipient presents with an ulcer on his left leg. Subcutaneous phaeohyphomycosis due to Curvularia lunata was diagnosed based on mycological examination and histopathological findings. He was successfully treated with systemic itraconazole and surgical resection.ConclusionThe incidence of phaeohyphomycosis has increased in the last decades, especially in immunosuppressed individuals; nevertheless the number of cases does not allow for therapeutic controlled trials to be performed. Hence, we consider that it is important to communicate individual cases and reviews of the literature, to increase awareness of the disease, its clinical presentation and response to treatment.     

Mitochondrial DNA analysis ofExophiala moniliae

Mitochondrial DNA(mtDNA) analysis with restriction enzymes, Hae III, Hind III and Msp I was performed in 17Exophiala moniliae strains. The results were as follows: (1)E. moniliae could be classified into 10 types based on restriction patterns, (2)E. moniliae is suggested to be a complex organism because of extensive mtDNA polymorphism among strains likeE. jeanselmei and (3) two types ofE. moniliae are identical with two types ofE. jeanselmei. These results suggest thatE. moniliae is not genetically defined fromE. jeanselmei and the taxonomical status ofE. moniliae requires reevaluation     

Subcutaneous cystic granuloma caused byPhialophora verrucosa

A case of subcutaneous cystic granuloma caused byPhialophora verrucosa was reported. The patient was 21-year-old Japanese female with systemic lupus erythematosus (SLE) who had received prolonged steroid therapy. P. verrucosa has occasionally been isolated from patients as one of etiological agents of chromomycosis. There have been, however, no paper published to report an isolation of this fungus from subcutaneous cyst or abscess of a patient. This case is the first report of subcutaneous cystic granuloma induced clinically byP. verrucosa.     

Outbreaks of phaeohyphomycosis in the chinook salmon (Oncorhynchus tshawytscha) caused by Phoma herbarum

Phoma herbarum has been associated with two outbreaks of systemic mycosis in hatchery-reared chinook salmon (Oncorhynchus tshawytscha) fingerlings. Affected fish exhibited abnormal swimming behavior, exophthalmia, multiple rounded areas of muscle softening, protruded hemorrhagic vents, and abdominal swelling. In all affected fish, swimbladders were filled with whitish creamy viscous fungal mass, surrounded by dark red areas in swimbladder walls, kidneys, and musculature. Clinical and histopathological examinations suggest that the infection may have started primarily in the swimbladder and then spread to the kidneys, gastrointestinal tract, and surrounding musculature. Consistent microscopical findings included broad septate branched fungal hyaline hyphae, 5–12 μm in diameter within the swimbladder, stomach, and often within and adjacent to blood vessels. Profuse growths of woolly brown fungal colonies were obtained from swimbladders and kidneys on Sabouraud medium. On corn meal agar the formation of pycnidia, characteristic of Phoma spp., was detected within 10 days of incubation. Morphological and molecular analyses identified this fungus as Phoma herbarum. This report underscores systemic fungal infections as a threat to raceway-raised salmon.     

Subcutaneous phaeohyphomycosis due to Alternaria infectoria in a renal transplant patient: Surgical treatment with no long-term relapse

BackgroundPhaeohyphomycosis can be caused by a number of different species, being the most common Alternaria alternata and Alternaria infectoria. The biggest risk factor for the development of the infection is immunosuppression.AimsWe present the case of a 64-year-old male renal transplant patient who came to hospital for presenting a tumour in the Achilles region which had been gradually growing in size.MethodsA skin biopsy was taken for histological study and culture of fungi and mycobacteria. Blood tests and imaging studies were performed.ResultsHistopathology study and cultures identified A. infectoria as the causal agent. Imaging studies ruled out internal foci of infection. The lesion was surgically removed with no signs of recurrence after 24 months of follow-up.ConclusionsThere are no treatment guidelines at present for cutaneous and subcutaneous Alternaria spp. infections. Various systemic antifungals have been used, either in combination with surgical removal or alone, with varying results. Surgery alone could be useful in the treatment of solitary, localised lesions in transplant patients in whom there are difficulties in controlling immunosuppression.     

Cutaneous phaeohyphomycosis caused byPhialophora richardsiae and the effect of topical clotrimazole in its treatment

A 15 year-old girl and her 50-year-old mother from Jabalpur, India, were found to have phaeohyphomycotic skin lesions due toPhialophora richardsiae. Among the antimycotics testedin vitro, clotrimazole was found to be most active. Topical application of clotrimazole cream cured the lesions completely.     

Cutaneous phaeohyphomycosis of the sole caused by Exophiala jeanselmei and its susceptibility to amphotericin B, 5-FC and ketaoconazole

Cutaneous phaeohyphomycosis due to E. jeanselmei developed on the sole of a 61 years old Japanese female who was receiving the corticoids therapy for nephrotic syndrome. Although the causative fungus was resistant to 5-fluorocytosine, amphotericin B and ketoconazole, the lesion was successfully treated by surgical excision.     

A case of cutaneous phaeohyphomycosis caused byExserohilum rostratum,its in vitro sensitivity and review of literature

A 40 year old woman presented with the infection of skin of 3 years duration on the upper anterior aspect of fore-arm. Histologic examination of the skin tissue revealed dematiaceous hyphae, aggregated structures or single celled elements. On detailed mycological examination the isolate was identified asExserohilum rostratum. Among the antimycotic tested in vitro amorolfine was found to be most effective with MIC value of 3 mcg/ml. This is the first report ofE. rostratum infection of man from India.     

Curvularia lunata in experimental phaeohyphomycosis

Curvularia lunata strain SP, isolated from a disseminated human infection, infected normal mice, but three other strains of C. lunata and one each of C. pallescens and C. spicifera did not. The SP strain was recovered in cultures from, and hyphal filaments were observed in, abscesses in the liver and spleen of experimentally infected mice. All strains of Curvularia infected mice treated with 400 rads X-irradiation and 10.0 mg cortisone, but at 400 rads and 5.0 mg only two strains of C. lunata (SP and Ghosh) and C. pallescens and C. spicifera infected mice. At 200 rads and 10.0 mg, C. lunata Sp, C. pallescens and C. spicifera; and at 200 rads and 5.0 mg, only C. lunata SP and C. pallescens caused infection. After X-irradiation (200 or 400 rads) or cortisone (5.0 or 10.0 mg) alone only C. lunata SP caused infections in mice.     

Multiseptate bodies in systemic phaeohyphomycosis diagnosed by fine needle aspiration cytology

Fine needle aspiration of a lung nodule in an immunosuppressed adult man revealed numerous dematiaceous (pigmented) fungi with both hyphal and spherical forms. Multiseptate bodies ("muriform" cells) were also present in small numbers. Fonsecaea pedrosoi was cultured from the aspirate. The cytomorphologic features of the fungus in tissue are described, and the significance of finding fungal cells that divide both by budding and fission is discussed.     

Two cases of cutaneous phaeohyphomycosis by Alternaria alternata and Alternaria tenuissima

Two cases of cutaneous phaeohyphomycosis, one with a nodular appearance and the other with an erythematous infiltrating patch, are reported in immunocompromised patients. Diagnosis was based on histological examination, which revealed hyphae and round-shaped fungal cells in a granulomatous dermal infiltrate, and on identification of the moulds when biopsy fragments were cultured on Sabouraud-dextrose agar without cycloheximide. The pathogens were Alternaria tenuissima in the first case and A. alternata in the second. The fungi were examined by scanning electron microscopy. The patients were checked for bone and lung involvement and were then treated with surgical excision and itraconazole, and itraconazole only, respectively, with clinical and mycological resolution. This revised version was published online in August 2006 with corrections to the Cover Date.