Phaeohyphomycosis and role of internal transcribed spacer
Lokeshwari Gopal, G Balajee, K. S. Mouleeswaran, Anupma Jyoti Kindo, Subramanian Swaminathan, G. Srividhya, Selva Seetharaman, Arun Kumar, Muthukumar Periasamy, Nigel Peter Symss
Citation Information :
Gopal L, Balajee G, Mouleeswaran KS, Kindo AJ, Swaminathan S, Srividhya G, Seetharaman S, Kumar A, Periasamy M, Symss NP. Phaeohyphomycosis and role of internal transcribed spacer. 2021; 23 (2):51-58.
Phaeohyphymocosis is caused by a heterogeneous group of black-pigmented fungi. Clinical manifestations range from small localised subcutaneous lesion to life-threatening invasive and disseminated infection. With increase in immunocompromised patients due to various conditions, phaeoid fungus has gained its role as a pathogen in human diseases. There is no pathognomonic clinical or radiological feature to diagnose phaeohyphomycosis. Thus, the role of diagnostics in histopathology and microbiology is important in identification and diagnosis of this clinical condition. Specimens received for fungal identification were cultured on Sabouraud's Dextrose Agar with 10 mg/L Chloramphenicol (SCA) and identified by conventional methods. Few phaeoid fungi, which did not sporulate even after prolonged incubation under appropriate conditions in routine culture media, were identified by Internal Transcribed Spacer sequencing. Here, we present case series of five patients presented to our hospital with brain abscess, post traumatic wound, two post renal transplant recipients with skin and soft tissue infections, diabetes-associated soft tissue swelling and diagnosed with phaeohyphomycosis from 2017 to 2019.
Chander J. Chromoblastomycosis, phaeohypomycosis. In: Text Book of Medical Mycology. 4th ed. New Delhi: Jaypee Brothers Medical Publishers (p) Ltd; 2018. p. 251-69.
Guarro J, De Hoog GS. Curvularia, Exophiala, Scedosporium, Sporothrix, and other melanized fungi. In: Warnock DW, Brandt ME, Johnson EM, editors. Manual of Clinical Microbiology. 11th ed., Vol. 2. Washington, DC: ASM Press: 2015. p. 2153.
Kumar M, Shukla PK. Use of PCR targeting of internal transcribed spacer regions and single-stranded conformation polymorphism analysis of sequence variation in different regions of rRNA genes in fungi for rapid diagnosis of mycotic keratitis. J Clin Microbiol 2005;43:662-8.
Kantarcioglu AS, Guarro J, De Hoog S, Apaydin H, Kiraz N. An updated comprehensive systematic review of Cladophialophora bantiana and analysis of epidemiology, clinical characteristics, and outcome of cerebral cases. Med Mycol 2017;55:579-604.
Chakrabarti A, Kaur H, Rudramurthy SM, Appannanavar SB, Patel A, Mukherjee KK, et al. Brain abscess due to Cladophialophora bantiana: A review of 124 cases. Med Mycol 2016;54:111-9.
Chowdhary A, Meis JF, Guarro J, de Hoog GS, Kathuria S, Arendrup MC, et al. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: Diseases caused by black fungi. Clin Microbiol Infect 2014;20 Suppl 3:47-75.
Manamgoda DS, Cai L, McKenzie EH, Crous PW, Madrid H, Chukeatirote E, et al. A phylogenetic and taxonomic re-evaluation of the Bipolaris – Cochliobolus – Curvularia complex. Fungal Divers 2012;56:131-44.
Kronen R, Liang SY, Bochicchio G, Bochicchio K, Powderly WG, Spec A. Invasive fungal infections secondary to traumatic injury. Int J Infect Dis 2017;62:102-11.
Giacobbe DR, Riccardi N, Vena A, Bassetti M. Mould infections of traumatic wounds: A brief narrative review. Infect Dis Ther 2020;9:1-15.
Gunasekaran S, Tupaki-Sreepurna A, Thanneru V, Sekar U, Shanthi M, Kindo AJ. A rare case of Curvularia hawaiiensisin the ear following trauma. JMSCR 2017:28154-8.
Garcia-Hermoso D, Valenzuela-Lopez N, Rivero-Menendez O, Alastruey-Izquierdo A, Guarro J, Cano-Lira JF, et al. Diversity of coelomycetous fungi in human infections: A 10-y experience of two European reference centres. Fungal Biol 2019;123:341-9.
Chanyachailert P, Leeyaphan C, Bunyaratavej S, Chongtrakool P. Subcutaneous phaeohyphomycosis from Medicopsis romeroi in a diabetic patient. Med Mycol Case Rep 2019;26:69-72.
Sharma B, Singh PK, Pandey K, Mittal G, Ramesh V, Deb M. Subcutaneous cyst due to Medicopsis romeroi in a diabetic lepromatous leprosy patient: An interesting case report and review from India. J Clin Diagn Res 2017;11:DD01-3.
Jeddi F, Paugam C, Hartuis S, Denis-Musquer M, Sabou M, Lavergne RA, et al. Medicopsis romeroi nodular subcutaneous infection in a kidney transplant recipient. Int J Infect Dis 2020;95:262-4.
Mathuram Thiyagarajan U, Bagul A, Nicholson ML. A nodulo-cystic eumycetoma caused by Pyrenochaeta romeroi in a renal transplant recipient: A case report. J Med Case Rep 2011;5:460.
Fernandes G, Ohri D, Nebhnani D. Multiple eumycetomas caused by Pyrenochaeta romeroi in a renal allograft recipient. Indian J Transplant 2017;11:157-9.
Kulkarni M, Jamale T, Hase N, Ubale M, Keskar V, Jagadish PK. Subcutaneous phaeohyphomycosis caused by pyrenochaeta romeroi in a kidney transplant recipient: A case report. Exp Clin Transplant 2017;15:226-7.
Abdolrasouli A, Gonzalo X, Jatan A, McArthur GJ, Francis N, Azadian BS, et al. Subcutaneous phaeohyphomycosis cyst associated with Medicopsis romeroi in an immunocompromised host. Mycopathologia 2016;181:717-21.
Khan Z, Ahmad S, Kapila K, Ramaswamy NV, Alath P, Joseph L, et al. Pyrenochaeta romeroi: A causative agent of phaeohyphomycotic cyst. J Med Microbiol 2011;60:842-6.
Mohanty JC, Mohanty SK, Sahoo A, Ghosh SK, Pattnaik KL. Eumycetoma caused By Pyrenochaeta romeroi: A case report. Indian J Dermatol 2000;45:76-7.
Abdalla Ahmed S, de Hoog GS, Stevens DA, Fahal AH, Wendy WJ, van de Sande WW. In vitro antifungal susceptibility of coelomycete agents of black grain eumycetoma to eight antifungals. Med Mycol 2015;53:295-301.
Badali H, Chander J, Gulati N, Attri A, Chopra R, Najafzadeh MJ, et al. Subcutaneous phaeohyphomycotic cyst caused by Pyrenochaeta romeroi. Med Mycol 2010;48:763-8.
Chowdhary A, Guarro J, Randhawa HS, Gené J, Cano J, Jain RK, et al. A rare case of chromoblastomycosis in a renal transplant recipient caused by a non-sporulating species of Rhytidhysteron. Med Mycol 2008;46:163-6.
Chander J, Singla N, Kundu R, Handa U, Chowdhary A. Phaeohyphomycosis caused by Rhytidhysteron rufulum and review of literature. Mycopathologia 2017;182:403-7.
Mahajan VK, Sharma V, Prabha N, Thakur K, Sharma NL, Rudramurthy SM, et al. A rare case of subcutaneous phaeohyphomycosis caused by a Rhytidhysteron species: A clinico-therapeutic experience. Int J Dermatol 2014;53:1485-9.
Medasani V, Oudeacoumar P, Ragunathan L. Subcutaneous phaeohyphomycosis of scalp caused by Rhytidysteron rufulum. Int J Sci Res 2020;9:334-7.
Mishra K, Das S, Goyal S, Gupta C, Rai G, Ansari MA, et al. Subcutaneous mycoses caused by Rhytidhysteron species in an immunocompetent patient. Med Mycol Case Rep 2014;5:32-4.
Mudhigeti N, Patnayak R, Kalawat U, Yeddula SR. Subcutaneous Rhytidhysteron infection: A case report from south India with literature review. Cureus 2018;10:e2406.
Thiyagarajan M, Gopal M, Rangasamy G, Ranganathan U. Subcutaneous phaeohyphomycosis caused by Rhytidhysteron rufulum: A case report and review of literature. J Clin Diagn Res 2019;13:DD01-2.
Sarita Y, Ruchi A, Jagdish C, Anuradha C. A rare case report of subcutaneous mycoses by Rhytidhysteron rufulum. Int J Med Res Health Sci 2017;6:12-5.
Tejashree A, Suchetha C, Visakha K, Karthik KM. A rare case of subcutaneous Phaeohyphomycosis caused by Rhytidhysteron rufulum. Indian J Microbiol Res 2017;4:468-70.
Fraser J. Subcutaneous phaeohyphomycosis caused by a black pigmented mould (Rhytidhysteron species) in rural north-western New South Wales, Australia. Rural Remote Health 2020;20:5903.
