Qingtao Kong

A case of subcutaneous phaeohyphomycosis caused by Cladosporium cladosporioides and its treatment

Phaeohyphomycosis refers to a group of cutaneous, subcutaneous and systemic infections caused by certain dematiaceous fungi characterised by production of melanin in the mycelium. In the past decades, increasing numbers of pathogenic genera causing phaeohyphomycosis have been recognised worldwide, including mainly Exophiala, Phialophora, Cladosporium, Xylohypha, Curvularia, Dactylaria, Exserohilum, Bipolaris, Lecythophora and Alternaria. This communication reports the first case of subcutaneous phaeohyphomycosis due to Cladosporium cladosporioides in China and its pathogenic characteristics.

The newly nonsporulated characterization of an Aspergillus fumigatus isolate from an immunocompetent patient and its clinic indication

Aspergillus fumigatus (A. fumigatus) commonly produces abundant and heavily melanized infectious conidia, which are the primary agents that cause invasive aspergillosis (IA) in immunocompromised patients. We isolated a white nonsporulating A. fumigatus strain (A1j) from an immunocompetent patient. It was identified by histopathological examination and morphological observation, and subsequently confirmed by DNA sequencing of internal transcribed spacer (ITS) regions and partial β-tubulin genes. Neither a long waiting time nor passage on various medium types could stimulate the formation of spores and pigment. No significant relative difference was found in sensitivity to antifungal agents or cell wall destabilizing reagents, as compared to wild-type A. fumigatus Af293. Nevertheless, A1j was hypovirulent in the immunosuppressed mice model, consistent with the good result in our patient. RNA deep-sequencing analysis (RNA-seq) revealed that hundreds of transcripts were significantly dysregulated, including those related to pigmentation and sporulation. qRT-PCR confirmed the anergic state of key regulator brlA for sporulation under the induction of conidiation conditions, but without mutation. To the best of our knowledge, this is the first report of a white, nonsporulating A. fumigatus strain infection in an immunocompetent patient. In our opinion, A1j may represent a mutant of typical A. fumigatus, providing a new clue for identification of clinical A. fumigatus isolates. Furthermore, the good prognosis of our patient and the reduced virulence in the mice model infected with A1j highlight the potential of sporulation inhibitors as a new generation of antifungal agents.

Chronically recurrent and widespread tinea corporis due to Trichophyton rubrum in an immunocompetent patient.

A 31-year-old immunocompetent male who presented with a 4-year history of extensive erythematous and scaly plaques involving the abdomen, gluteal and inguen regions with concomitant tinea pedis and onychomycosis is described. Diagnosis was based on positive mycological examination and positive histopathologic examination. Species identification was performed by growth on Sabouraud dextrose agar and by sequencing of the internal transcribed spacer regions of the rDNA region. The pathogen identified was Trichophyton rubrum. The same fungal species was cultured from his abdominal, gluteal, foot and toenail. A combination therapy with systemic terbinafine and topically applied terbinafine cream was successful. A 1-year follow-up did not show any recurrence of infection.

A case of a cerebral syphilitic gumma developed in a few months mimicking a brain tumor in a human immunodeficiency virus-negative patient

Abstract Cerebral syphilitic gumma is extremely rare and easily misdiagnosed. We illustrate a case of a cerebral syphilitic gumma developed in just a few months mimicking a brain tumor in a HIV-negative patient and Treponema pallidum was detected in the cerebral syphilitic gumma.

Drug eruptions induced by allopurinol associated with HLA-B*5801.

Allopurinol, a drug commonly used for treating gout and hyperuricemia, is a frequent cause of drug eruptions. Recent investigations suggest that HLA-BFNx015801 allele is a very strong marker for allopurinol-induced cutaneous adverse drug reactions (cADRs). In this article we report two cases of allopurinol-induced drug eruptions in patients carrying the HLA-BFNx015801 allele and review the literature on the association between HLA-BFNx015801 and allopurinol-induced cADRs based on a MEDLINE and PubMed search.

Transcriptomic and virulence factors analyses of Cryptococcus neoformans hypoxia response

Cryptococcus neoformans is an environmental pathogen requiring atmospheric levels of oxygen for optimal growth. Upon inhalation, C. neoformans disseminates to the brain and causes meningoencephalitis. However, the mechanisms by which the pathogen adapts to the low‐oxygen environment in the brain have not been investigated. We isolated a C. neoformans strain with a small capsule from a host tissue, although this strain produces large capsules in normoxic conditions. We hypothesize that this difference in capsule size is attributed to hypoxia caused by chronic inflammatory response. This study investigated the effect of hypoxia on virulence factors (including capsule, melanin, urease, and phospholipase) of C. neoformans and conducted transcriptomic analyses of the virulence‐associated genes. We found that C. neoformans grew under hypoxic condition, albeit slowly, and that hypoxia may have inhibited the capsule size, melanin production, and phospholipase and urease activities in C. neoformans.

Mucocutaneous manifestations of inflammatory bowel disease in central China –a single‐centre study

hereditary osteodystrophy (AHO), plate-like osteoma cutis (POC) and progressive osseous heteroplasia (POH). The three GNAS-associated entities FOP, POC and POH are all characterized by intramembranous ossification beginning in the dermis. Although distinctive features are seen in each of these entities, there is also considerable clinical overlap, which make correct and early diagnosis of cutaneous ossification more difficult. As in our case, the patient developed the characteristic ossifications consistent with POH, but he also exhibited some phenotypes suggestive of AHO. In this study, we identified a novel de novo mutation c.74delA in GNAS gene in a Chinese infant with POH. The distribution of the skin lesions was rather unusual in our case, as heterotopic ossification was noted not only on common areas, such as the limbs, the trunk or the face, but also on the left fingers and the helix of the left ear. Moreover, the severe phenotype within the right wrist in such an early age and the transient elevated phosphate, which are suggestive of AHO, make the newly identified mutation in this locus (Lys 25) more important for POH. In conclusion, the present case clearly indicates that POH can occur on the ear or fingers as an atypical phenotype and suggests that investigation of the GNAS gene is a powerful diagnostic tool for POH, especially for POH lesions found on uncharacteristic body sites. This research was supported by the Foundation of the Shanghai Natural Science Foundation of China (16ZR1432400) and the Medical Innovation Foundation of Fujian Province in China (2014-CXB-27).

The author's reply to comment on ‘psoriasis/inflammatory bowel diseases: a time to solve the liaison’

I would like to sincerely thank Abdelmaksoud1 for sharing several valuable suggestions about my study2 . At the following, the points mentioned by the author will be discussed. This article is protected by copyright. All rights reserved.

Atrophic nodular cutaneous amyloidosis

Primary cutaneous amyloidosis is limited to the skin without involving any other tissue. Nodular amyloidosis is rare, and atrophic nodular cutaneous amyloidosis is even rarer. We describe the fourth case of atrophic nodular cutaneous amyloidosis by searching PubMed databases. A 52-year-old female presented to our hospital with a 2-year history of orange papules and nodules without subjective symptom on her right abdomen. Review of systems was negative. Atrophic nodular amyloidosis may progress to primary systemic disease in up to 7% of cases. Because our patient had no systemic involvement, she was diagnosed with atrophic nodular cutaneous amyloidosis based on characteristic symptoms and histopathologic examination. Routine follow-up for this patient is necessary to detect any potential disease progression.Primary cutaneous amyloidosis is limited to the skin without involving any other tissue. Nodular amyloidosis is rare, and atrophic nodular cutaneous amyloidosis is even rarer. We describe the fourth case of atrophic nodular cutaneous amyloidosis by searching PubMed databases. A 52-year-old female presented to our hospital with a 2-year history of orange papules and nodules without subjective symptom on her right abdomen. Review of systems was negative. Atrophic nodular amyloidosis may progress to primary systemic disease in up to 7% of cases. Because our patient had no systemic involvement, she was diagnosed with atrophic nodular cutaneous amyloidosis based on characteristic symptoms and histopathologic examination. Routine follow-up for this patient is necessary to detect any potential disease progression.

Innate and adaptive immune response to chronic pulmonary infection of hyphae of Aspergillus fumigatus in a new murine model

Purpose. The pathogenesis of chronic pulmonary aspergillosis (CPA) has seldom been studied due partly to a lack of animal models. Since hypha is the main morphology colonizing the airway in CPA, its critical to study the immune reaction to chronic pulmonary infection of hyphae of Aspergillus fumigatus, which also has seldom been studied in vivo before. Methodology. We established a novel murine model of chronic pulmonary infection of hyphae by challenging immunocompetent mice with tightly‐structured hyphae balls intratracheally, and described the ensuing immunoreaction to hyphae and conidia, and the pathogenesis of CPA. Results. Our experiment proved that the hyphae balls could induce a chronic pulmonary infection for 28 days with a considerable recrudescence at day 28 post‐infection. Lungs infected with hyphae balls were remarkable for the many neutrophils and macrophages that flooded into airway lumens, with peribronchiolar infiltration of leukocytes. There was a transient increase of Th2 cells and Th17 cells at day 7 post‐infection in the lung tissue. In contrast, lungs infected with conidia showed no peribronchiolar infiltration of leukocytes, but an influx of a great number of macrophages, and a much less number of neutrophils in the lumen. Besides, conidia activated the co‐response of Th1, Th2 and Th17 cells with an increase of Treg cells in the lung tissue (quite different from most previous studies). Conclusion. We established a new murine model of chronic infection of hyphae to mimic the formation of CPA, and provide a new marker for different immune responses to hyphae and conidia.