Marilia Marufuji Ogawa

Treatment of subcutaneous phaeohyphomycosis and prospective follow-up of 17 kidney transplant recipients

BACKGROUND Subcutaneous phaeohyphomycosis in solid organ recipients may have an adverse outcome. OBJECTIVE We sought to describe the disease course, treatment, and outcome of allograft function in kidney transplant recipients with phaeohyphomycosis. METHODS Seventeen patients were followed for a mean period of 25.4 months to analyze the clinical response to treatment. RESULTS There was no treatment failure or relapsing disease among 12 patients who completed treatment. Two patients were still in treatment with disease remission. One patient discontinued the study during treatment with partial remission, one died after finishing treatment with disease remission, and one was dropped from the study because contact was lost. Immunosuppressive regimens were not changed. Two of 17 patients had a significant reduction in allograft function. LIMITATIONS The follow-up time was short and the number of patients was small. CONCLUSIONS The outcome of phaeohyphomycosis in kidney transplant recipients was favorable with minimal impact on renal allograft function.

Molecular Identification of Melanised Non-Sporulating Moulds: A Useful Tool for Studying the Epidemiology of Phaeohyphomycosis

Subcutaneous infections caused by melanised fungi have been increasingly reported among transplant patients, and these infections have the potential for blood and visceral dissemination. Some moulds, such as Mycelia sterilia, cannot grow and sporulate on different media, making their identification impossible by conventional methods. The fast and accurate identification of melanised fungi at the species level is important because species may have tropism to different organs and different susceptibilities to antifungal agents. Molecular tools have been reported to be helpful for the species identification of non-sporulating moulds. Our goal was to identify the species of M. sterilia isolates obtained from clinical samples of transplant patients using sequences of ITS and the D1/D2 regions of rDNA. Clinical samples were obtained from eight kidney transplant recipients who developed subcutaneous fungal infections. The diagnosis was confirmed by histopathology and conventional culture. Histopathology showed septated, melanised hyphae, and the cultures identified non-sporulating fungi. Therefore, the DNA from the M. sterilia isolates was subjected to PCR amplification and sequencing of the ITS and D1/D2 regions. Genus/species identification was obtained by comparison with gene banks. We obtained the following identifications: Alternaria sp. (2), Cochliobolus lunatus/Curvularia lunata (2), Cochliobolus hawaiiensis/Bipolaris hawaiiensis (1), Ochroconis sp. (1), Medicocopsis romeroi/Pyrenochaeta romeroi (1) and Nigrograna mackinnonii/Pyrenochaeta mackinnonii (1).

Mycetoma caused by Fusarium solani with osteolytic lesions on the hand: case report

Eumycetoma is a mycotic disease caused by saprophytic soil fungi that are usually inoculated through minor injuries. A case of mycetoma in a Brazilian farmer aged71 years is reported. This patient presented erythema and edema on the dorsal surface of the left hand with multiple crusted and cicatricial lesions. No macroscopic grains were observed. The histopathological findings showed grains consisted of numerous hyphae which stained well with Gomori-Grocott method. This material obtained by cutaneous biopsy was submitted to culture on Sabouraud’s medium and the colonies were identified as Fusarium solani. The radiological studies revealed bone osteolytic lesions and the ultrasound showed pseudocysts and fistulae at the site of this infection. The patient was treated with oral ketoconazole with a good clinical response.

Lymphoscintigraphic analysis in chromoblastomycosis.

Background One of the main complications of chromoblastomycosis is lymphedema. The purpose of this study was to evaluate the lymphatic system of the limbs of patients with chromoblastomycosis using lymphoscintigraphy. It is a reliable, objective and noninvasive means of supporting the diagnosis of lymphedema.

Limitations of DNA Sequencing for Diagnosis of a Mixed Infection by Two Fungi, Phaeoacremonium venezuelense and a Plectophomella sp., in a Transplant Recipient

ABSTRACT We describe a rare case of a subcutaneous infection by both Phaeoacremonium venezuelense and Plectophomella sp. in a Brazilian male. Sequencing of a β-tubulin gene fragment allowed us to confirm the identification of the former. However, a similar procedure of sequencing rRNA gene fragments was not useful for the identification of the latter fungus.

Paracoccidioidomycosis : an uncommon localization in the scrotum

Summary. Paracoccidioidomycosis is a systemic fungal infection caused by the thermally dimorphic fungus Paracoccidioides brasiliensis. The authors present a case of a 49‐year‐old man who developed verrucous lesions on nasal mucosa and on genital localization (inguinal and scrotal), without signs of systemic disease. Direct mycological examination, culture on Sabouraud glucose medium, and biopsy were positive for P. brasitiensis. The interest of this case is the genital localization which is uncommon in this infection. Moreover, there are few cases described in the literature.

Prevalence of acquired melanocytic naevi in Brazilian schoolchildren

Background.  The prevalence of acquired melanocytic naevi (AMN) is one of the most important known risk factors for malignant melanoma (MM) in homogeneous white populations. However, there are few studies on AMN in heterogeneous populations. Insight into the causes of AMN in heterogeneous populations in a country with intense ultraviolet radiation should lead to successful strategies in the prevention of MM.

Unusual location of cutaneous leishmaniasis on the hallux in a Brazilian patient

A 70‐year‐old white Brazilian woman from a rural area had a 2‐year history of a painful lesion on her left toe. The lesion increased progressively in size followed by toenail destruction. She was treated with systemic antibiotics for secondary bacterial infection several times without any clinical response.

Epidemiological profile of nonmelanoma skin cancer in renal transplant recipients: experience of a referral center

BACKGROUND Nonmelanoma skin cancer is the most common form of cancer in humans and also the malignant disease that is increasingly common among kidney transplant recipients. OBJECTIVE To determine the epidemiological characteristics of renal transplant recipients with nonmelanoma skin cancer seen at a referral transplantation center. METHODS Cross-sectional descriptive study with renal transplant recipients presenting nonmelanoma skin cancer, treated at a transplantation referral center between 08/01/2004 and 08/31/2009. Analyzed variables were: gender, age, skin phototype, occupational and recreational sun exposure, use of photoprotection, personal and family history of non-melanoma skin cancer, clinical type and location, time between transplantation and the appearance of the first nonmelanoma skin cancer, occurrence of viral warts, timing of transplantation, type of donor, cause of kidney failure, previous transplants, comorbidities, pre-transplant dialysis, type and duration of dialysis. RESULTS 64 subjects were included. Males - 71.9%; low skin phototypes (up to Fitzpatrick III) - 89%; mean age - 57.0 years - and mean age at transplant - 47.3 years; sun exposure - 67.2% occupational - and 64.1% recreational; photoprotection - 78.2% (although only 34.4% in a regular manner); squamous cell carcinoma - 67.2%; squamous cell carcinoma/basal cell carcinoma ratio - 2:1; personal history of nonmelanoma skin cancer - 25% - and family history - 10.9%; location at photoexposed area - 98.4%; average latency time between transplantation and first nonmelanoma skin cancer appearance - 78.3 months; viral warts (HPV) after transplant - 53.1%; average timing of transplantation - 115.5 months; living donor - 64.1%; triple regimen (antirejection) - 73.2%; comorbidities - 92.2%; pre-transplant dialysis - 98.4%; hemodialysis - 71.7%; average duration of dialysis - 39.1 months; previous transplants - 3.1%; hypertension as cause of renal failure - 46.9%. CONCLUSION This study allowed the epidemiological characterization of a population of kidney transplant recipients with nonmelanoma skin cancer.

Generalized Lichen nitidus associated with Down's syndrome: case report

Lichen nitidus is a disease of unknown etiology, characterized by flesh-colored, shiny papules of 1-2 mm and generally asymptomatic or with mild pruritus. The most common sites of occurrence are genitalia, upper limbs, trunk and abdomen. The generalized form is rare. This is the fourth reported case of lichen nitidus associated with Down Syndrome.