Denisse Vázquez-González

Endemic systemic mycoses: coccidioidomycosis, histoplasmosis, paracoccidioidomycosis and blastomycosis

Endemic deep or systemic mycoses are common in specific geographical areas of the world. Coccidioidomycosis is present in semi‐desert areas, histoplasmosis and paracoccidioidomycosis in tropical regions and blastomycosis belongs to temperate climates. The two former are widely distributed in the American continent and some tropical regions of the world; the third is limited to Central and South America, and the last to North America and Central and East Africa. These mycoses all have a similar pathogenesis, as the inoculum enters the host through the respiratory tract. Cutaneous manifestations are secondary to lymphatic and hematogenous dissemination. These deep mycoses are exceptional in Europe. Most cases are observed in returning travelers from endemic areas, aid workers, archaeologists, speleologist and immigrants. However, there have been some autochthonous cases of histoplasmosis due to Histoplasma capsulatum var. capsulatum reported in European countries such as Italy and Germany. In this article, we provide up‐to‐date epidemiological, clinical, diagnostic and therapeutic data on the four most important imported systemic mycoses in Europe.

Rhinocladiella aquaspersa, proven agent of verrucous skin infection and a novel type of chromoblastomycosis

We report a case of chromoblastomycosis which resembled sporotrichosis due to the presence of warty nodules and lymphatic distribution on the forearm in a 56-year-old male. Mycological and histopathological investigation of exudates and biopsy tissue samples revealed a granulomatous lesion with muriform cells, the hallmark of chromoblastomycosis. The infection showed only localized expansion with verrucous plaques suggesting a new clinical type of the disease. The causative agent was identified as Rhinocladiella aquaspersa. This case prompted a study of the clinical spectrum of R. aquaspersa, through which we identified a second case caused by this fungus in a 62-year-old Brazilian female. The case was unusual in that R. aquaspersa exhibited hyphae rather than muriform cells in tissue. Given the difficulties treating chromoblastomycosis and other infections caused by melanized fungi, we evaluated the in vitro activities of extended-spectrum triazoles, amphotericin B, and echinocandins against these clinical isolates of R. aquaspersa. Itraconazole (MIC; 0.063 mg/l) and posaconazole (MIC; 0.125 mg/l) had the highest in vitro activities, while voriconazole and isavuconazole had somewhat lower activities (MICs; 2 mg/l) against the isolates. Amphotericin B and anidulafungin each had an MIC of 1 mg/l, whereas the MIC of caspofungin was 8 mg/l.

Opportunistic filamentous mycoses: aspergillosis, mucormycosis, phaeohyphomycosis and hyalohyphomycosis

Opportunistic filamentous mycoses are widely distributed all over the world. They are rarely observed in Europe but are common in developing countries. The most common are the aspergilloses (due to Aspergillus spp.) mostly in neutropenia and immunosuppression; the mucormycoses characterized by rapid progression in patients with diabetic ketoacidosis; the phaeohyphomycoses due to pigmented fungi causing either a mild superficial or a very serious deep disease and the hyalohyphomycoses due to hyaline filamentous fungi (Fusarium spp., Pseudallescheria spp., Scopulariopsis spp.). Cutaneous manifestations are usually secondary to dissemination from pulmonary or visceral disease; primary cases are less frequent and due to direct inoculation into the skin.

Subcutaneous mycoses: chromoblastomycosis, sporotrichosis and mycetoma

Subcutaneous mycoses are common in subtropical and tropical regions of the world. They are rarely observed in Europe. These mycoses are heterogeneous, but all are caused by penetrating trauma of the skin. Most cases in Europe are observed in returning travelers, aid workers, archaeologists and immigrants. Therefore, a careful, thorough history is essential in order to reach a proper diagnosis. We provide up‐to‐date epidemiological, clinical, diagnostic, and therapeutic data on the three most important imported subcutaneous mycoses in Europe: chromoblastomycosis, sporotrichosis and mycetoma.

Opportunistic yeast infections: candidiasis, cryptococcosis, trichosporonosis and geotrichosis

Opportunistic yeast infections are diseases caused by fungi which normally are saprophytic and do not cause disease in humans or animals. The prevalence of these diseases has been increasing due to immunosuppressive, corticosteroid, and long‐term antibiotic treatment following organ transplantation or after serious metabolic, hematological, or immunological diseases. We review epidemiological, clinical, diagnostic, and therapeutic aspects of the four “big” opportunistic yeast infections: candidiasis, cryptococcosis, trichosporonosis, and geotrichosis.

Tinea imbricata in the Americas.

Purpose of review The aim is to provide an overview on tinea imbricata, or Tokelau, a superficial mycosis caused by Trichophyton concentricum, a strictly anthropophilic dermatophyte with a well-defined geographic distribution and predisposing factors that include genetic, racial and immunologic susceptibility patterns and a specific environment. Recent findings This review covers the most interesting aspects of the infrequent disease tinea imbricata, including the historical background, the epidemiologic aspects, highlighting the genetic and racial patterns of susceptibility to the acquisition of the disease, and the immunologic aspects that help to explain its clinical behavior. We also present a clinical description of the disease, the differential diagnosis and how currently some other emerging diseases such as syphilis in immunocompromised patients can mimic tinea imbricata. The therapeutic options are still griseofulvin and nowadays terbinafine, but the access to the treatments in the endemic zones and the changes in habits of the affected population make control and prevention of the disease difficult. Summary Tinea imbricata, or Tokelau, remains an infrequent superficial mycosis restricted to endemic zones in the South Pacific islands (Polynesia and Melanesia), South Asia and some specific areas of South America. Migration phenomena and global changes in the climate may modify the incidence and characteristics of the disease.

Dermatophyte isolation in the socks of patients with tinea pedis and onychomycosis

with diaminodiphenylsulfone. Cutis 1974; 13: 869–871. 3 Predivelle J, Logan R, Russell-Jones R. A comparison of dapsone with 13-cis-retinoic acid in the treatment of nodular cystic acne. Clin Exper Dermatol 1988; 13: 67–71. 4 Prussick R, Shear NH. Dapsone hypersensitivity syndrome. J Am Acad Dermatol 1996; 35: 346–349. 5 Kenneth EG. Dapsone and sulfapyridine. Systemic drugs for skin diseases. Saunders, Philadelphia, 1991: 247–264.

Cutaneous blastomycosis. An imported case with good response to itraconazole.

BACKGROUND Blastomycosis is a subacute or chronic deep mycosis caused by a dimorphic fungus called Blastomyces dermatitidis, which generally produces a pulmonary form of the disease and, to a lesser extent, extra-pulmonary forms such as cutaneous, osteoarticular and genitourinary, among others. Cutaneous blastomycosis is the second clinical presentation in frequency. It is considered as primary when it begins by inoculation of the fungus due to traumas, and secondary when the lung fails to contain the infection. CASE-REPORT We present the case of a 57 year-old male who had a 5 year-history of an irregularly shaped verrucous infiltrative plaque related to and insect bite and posterior trauma due to the manipulation of the lesion. B. dermatitidis was identified using direct examination, stains, isolation in culture media, histopathology, and molecular studies. An antifungal susceptibility test was performed using method M38-A2 (CLSI). Clinical and mycological cure was achieved with itraconazole. CONCLUSIONS This cutaneous blastomycosis case acquired in the United States (Indianapolis) is rather interesting and looks quite similar to other mycoses such as coccidioidomycosis or sporotrichosis. The presented case shows one of the multiple issues concerning migration between neighboring countries.

Subkutane Mykosen: Chromoblastomykose, Sporotrichose und Myzetom

Zusammenfassung Subkutane Mykosen sind in tropischen und subtropischen Gebieten verbreitet, in Europa selten. Sie bilden eine heterogene Gruppe. Allen gemeinsam ist das Eindringen der Erreger durch transkutane Verletzungen. In Europa findet man sie vor allem bei aus den Tropen zurückkehrenden Reisenden, Mitarbeitern von Hilfsorganisationen, Archäologen und Immigranten. Deshalb ist die sorgfältige und vollständige Anamnese die wichtigste Voraussetzung dafür, gleich an die richtige Diagnose zu denken. Zweck dieses Beitrages ist, aktuelle epidemiologische, klinische, diagnostische und therapeutische Informationen über die drei am häufigsten nach Europa eingeschleppten subkutanen Mykosen zu vermitteln: Chromoblastomykose, Sporotrichose und Myzetom.

Abdominal actinomycetoma with double aetiology due to Nocardia brasiliensis and Actinomadura madurae

EJD, vol. 28, n◦ 1, January-February 2018 2. Kono M, Nomura T, Ohguchi Y, et al. Comprehensive screening for a complete set of Japanese-population-specific filaggrin gene mutations. Allergy 2014; 69: 537-40. 3. Kono M, Nishida K, Takeichi T, Sugiura K, Akiyama M. Ripplepattern lichen amyloidosis in a case of ichthyosis vulgaris with a novel FLG mutation. J Eur Acad Dermatol Venereol 2017; 31: e130-2. 4. Hotz A, Oji V, Bourrat E, et al. Expanding the clinical and genetic spectrum of KRT1, KRT2 and KRT10 mutations in keratinopathic ichthyosis. Acta Derm Venereol 2016; 96: 473-8. 5. Garg K, Singh D, Mishra D. Peeling skin syndrome: current status. Dermatol Online J 2010; 16: 10. 6. Sandilands A, O’Regan GM, Liao H, et al. Prevalent and rare mutations in the gene encoding filaggrin cause ichthyosis vulgaris and predispose individuals to atopic dermatitis. J Invest Dermatol 2006; 126: 1770-5. 7. Nomura T, Akiyama M, Sandilands A, et al. Prevalent and rare mutations in the gene encoding filaggrin in Japanese patients with ichthyosis vulgaris and atopic dermatitis. J Invest Dermatol 2009; 129: 1302-5. 8. Steijlen PM, Perret CM, Schuurmans Stekhoven JH, Ruiter DJ, Happle R. Ichthyosis bullosa of Siemens: further delineation of the phenotype. Arch Dermatol Res 1990; 282: l-5. 9. Basarab T, Smith FJ, Jolliffe VM, et al. Ichthyosis bullosa of Siemens: report of a family with evidence of a keratin 2e mutation, and a review of the literature. Br J Dermatol 1999; 140: 689-95. 10. Kim S, Wong P, Coulombe PA. A keratin cytoskeletal protein regulates protein synthesis and epithelial cell growth. Nature 2006; 441: 362-5.