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Spectral Manifestation of Melanized Fungal Infections in Kidney Transplant Recipients: Report of Six Cases

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Abstract

Chromoblastomycosis and phaeohyphomycosis are melanized fungal infections, which affect skin and subcutaneous tissues in immunocompetent and immunosuppressed patients, as solid-organ transplant recipients, respectively. In this present study, we report six cases of melanized fungal infection in kidney transplant recipients. In five cases, culture of tissue specimens identified two cases of Exophiala spp. and three cases of Fonsecaea spp. Molecular identification was performed in three cases based on sequencing of rDNA (ITS region) that revealed the following agents: Exophiala xenobiotica, Exophiala bergeri and Fonsecaea monophora. Clinically, they presented verrucous lesion, erythematous-squamous plaque, nodules and lymphangitic distribution. Histopathological aspect was tuberculous granuloma, with concomitant presence of muriform bodies and hyphae. Some patients presented fungal transepithelial elimination. One patient received only terbinafine. Three patients underwent surgery, and two of them received itraconazole. In these four cases, the infection did not relapse. The other two patients were treated only with itraconazole, one of them is still under treatment and the other one was lost to follow-up. These patients presented clinical and histopathological characteristics ranging from resistant to nonresistant forms.

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References

  1. Queiroz-Telles F, Nucci M, Colombo AL, Tobón A, Restrepo A. Mycoses of implantation in Latin America: an overview of epidemiology, clinical manifestations, diagnosis and treatment. Med Mycol. 2011;49:225–36.

    Article  PubMed  Google Scholar 

  2. Brandt ME, Warnock DW. Epidemiology, clinical manifestations, and therapy of infections caused by dematiaceous fungi. J Chemother. 2003;15(Suppl 2):36–47.

    Article  PubMed  Google Scholar 

  3. Chowdhary A, Guarro J, Randhawa HS, Gené J, Cano J, Jain RK, Kumar S, Khanna G. A rare case of chromoblastomycosis in a renal transplant recipient caused by a non-sporulating species of Rhytidhysteron. Med Mycol. 2008;46:163–6.

    Article  PubMed  Google Scholar 

  4. Ogawa MM, Galante NZ, Godoy P, Fischman-Gompertz O, Martelli F, Colombo AL, Tomimori J, Medina-Pestana JO. Treatment of subcutaneous phaeohyphomycosis and prospective follow-up of 17 kidney transplant recipients. J Am Acad Dermatol. 2009;61:977–85.

    Article  PubMed  Google Scholar 

  5. Revankar SG, Sutton DA. Melanized fungi in human disease. Clin Microbiol Rev. 2012;25:884–928.

    Google Scholar 

  6. Garcia-Diaz JB, Baumgarten K. Phaeohyphomycotic infections in solid organ transplant patients. Semin Respir Infect. 2002;17:303–9.

    Article  PubMed  Google Scholar 

  7. Ajello L, Georg LK, Steigbigel RT, Wang CJ. A case of phaeohyphomycosis caused by a new species of Phialophora. Mycologia. 1974;66:490–8.

    Article  CAS  PubMed  Google Scholar 

  8. Mello e Silva ACC, Neto AS, Galvão CES, Marques SG, Saldanha ACR, Pedroso e Silva CM, Fischman O, da Silva RR, Costa MRSR, Costa JML. Cromoblastomicose produzida por Fonsecaea pedrosoi no Estado do Maranhão. I - Aspectos clínicos, epidemiológicos e evolutivos. Rev Soc Bras Med Trop. 1992;25:37–44.

    Article  PubMed  Google Scholar 

  9. Silva JP, de Souza W, Rozental S. Chomoblastomycosis: a retrospective study of 325 cases on Amazonic region. Mycopathol. 1998–1999;143:171-5.

  10. De Hoog GS, Zeng JS, Harrak MJ, Sutton DA. Exophiala xenobiotica sp. nov., an opportunistic black yeast inhabiting environments rich in hydrocarbons. Antonie Van Leeuwenhoek. 2006;90:257–68.

    Article  PubMed  Google Scholar 

  11. Zeng JS, Sutton DA, Fothergill AW, Rinaldi MG, Harrak MJ, de Hoog GS. Spectrum of clinically relevant Exophiala species in the United States. J Clin Microbiol. 2007;45:3713–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Zeng JS, De Hoog GS. Exophiala spinifera and its allies: diagnostics from morphology to DNA barcoding. Med Mycol. 2008;46:193–208.

    Article  CAS  PubMed  Google Scholar 

  13. Aoyama Y, Nomura M, Yamanaka S, Ogawa Y, Kitajima Y. Subcutaneous phaeohyphomycosis caused by Exophiala xenobiotica in a non-Hodgkin lymphoma patient. Med Mycol. 2009;47:95–9.

    Article  PubMed  Google Scholar 

  14. Morio F, Berre JY, Garcia-Hermoso D, Najafzadeh MJ, de Hoog S, Benard L, Michau C. Phaeohyphomycosis due to Exophiala xenobiotica as a cause of fungal arthritis in an HIV-infected patient. Med Mycol. 2012;50:513–7.

    Article  PubMed  Google Scholar 

  15. Najafzadeh MJ, Sun J, Vicente VA, Klaassen CHW, Bonifaz A, Gerrits-van-den-Ende AHG, Menken SBJ, de Hoog GS. Molecular epidemiology of Fonsecaea species. Emerg Infect Dis. 2011;17:464–9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Xi L, Sun J, Lu C, Liu H, Xie Z, Fukushima K, Takizawa K, Najafzadeh MJ, De Hoog GS. Molecular diversity of Fonsecaea (Chaetothyriales) causing chromoblastomycosis in southern China. Med Mycol. 2009;47:27–33.

    Article  CAS  PubMed  Google Scholar 

  17. Najafzadeh MJ, Rezusta A, Cameo MI, Zubiri ML, Yus MC, Badali H, Revillo MJ, De Hoog GS. Successful treatment of chromoblastomycosis of 36 years duration caused by Fonsecaea monophora. Med Mycol. 2010;48:390–3.

    Article  CAS  PubMed  Google Scholar 

  18. Pindycka-Piaszczyńska M, Krzyściak P, Piaszczyński M, Cieślik S, Januszewski K, Izdebska-Straszak G, Jarząb J, de Hoog S, Jagielski T. Chromoblastomycosis as an endemic disease in temperate Europe: first confirmed case and review of the literature. Eur J Clin Microbiol Infect Dis. 2014;33:391–8.

    Article  PubMed  Google Scholar 

  19. Badali H, Fernández-González M, Mousavi B, Illnait-Zaragozi MT, González-Rodríguez JC, De Hoog GS, Meis JF. Chromoblastomycosis due to Fonsecaea pedrosoi and F. monophora in Cuba. Mycopathologia. 2013;175:439–44.

    Article  PubMed  Google Scholar 

  20. Rinaldi MG. Phaeohyphomycosis. Dermatol Clin. 1996;14:147–53.

    Article  CAS  PubMed  Google Scholar 

  21. Kimura M, McGinnis MR. Fontana-Masson-stained tissue from culture-proven mycoses. Arch Pathol Lab Med. 1998;122:1107–11.

    CAS  PubMed  Google Scholar 

  22. Revankar SG, Patterson JE, Sutton DA, Pullen R, Rinaldi MG. Disseminated phaeohyphomycosis: review of an emerging mycosis. Clin Infect Dis. 2002;34:467–76.

    Article  PubMed  Google Scholar 

  23. Bloomfield BJ, Alexander M. Melanins and resistance of fungi to lysis. J Bacteriol. 1967;93:1276–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Butler MJ, Gardiner RB, Day AW. Fungal melanin detection by the use of copper sulfide–silver. Mycologia. 2005;97:312–9.

    Article  CAS  PubMed  Google Scholar 

  25. Plonka PM, Grabacka M. Melanin synthesis in microorganisms—biotechnological and medical aspects. Acta Biochim Pol. 2006;53:429–43.

    CAS  PubMed  Google Scholar 

  26. Franzen AJ, Cunha MM, Batista EJ, Seabra SH, De Souza W, Rozental S. Effects of tricyclazole (5-methyl-1,2,4-triazol[3,4]benzothiazole), a specific DHN-melanin inhibitor, on the morphology of Fonsecaea pedrosoi conidia and sclerotic cells. Microsc Res Tech. 2006;69:729–37.

    Article  CAS  PubMed  Google Scholar 

  27. Franzen AJ, Cunha MML, Miranda K, Hentschel J, Plattner H, da Silva MB, Salgado CG, de Souza W, Rozental S. Ultrastructural characterization of melanosomes of the human pathogenic fungus Fonsecaea pedrosoi. J Struct Biol. 2008;162:75–84.

    Article  CAS  PubMed  Google Scholar 

  28. Santos AL, Palmeira VF, Rozental S, Kneipp LF, Nimrichter L, Alviano DS, Rodrigues ML, Alviano CS. Biology and pathogenesis of Fonsecaea pedrosoi, the major etiologic agent of chromoblastomycosis. FEMS Microbiol Rev. 2007;31:570–91.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Dermatology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 508, São Paulo, SP, CEP 04038-001, Brazil

    Marilia M. Ogawa, Marcella P. Peternelli & Jane Tomimori

  2. Department of Pathology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil

    Milvia M. S. S. Enokihara

  3. Special Laboratory of Mycology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil

    Angela S. Nishikaku

  4. Department of Pathology, Federal University of Espírito Santo (UFES), Vitória, Brazil

    Sarah Santos Gonçalves

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  1. Marilia M. Ogawa
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  2. Marcella P. Peternelli
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  3. Milvia M. S. S. Enokihara
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  4. Angela S. Nishikaku
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  5. Sarah Santos Gonçalves
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  6. Jane Tomimori
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Correspondence to Marilia M. Ogawa.

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Ogawa, M.M., Peternelli, M.P., Enokihara, M.M.S.S. et al. Spectral Manifestation of Melanized Fungal Infections in Kidney Transplant Recipients: Report of Six Cases. Mycopathologia 181, 379–385 (2016). https://doi.org/10.1007/s11046-016-0005-8

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  • DOI: https://doi.org/10.1007/s11046-016-0005-8

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