Phaeohyphomycosis and onychomycosis due toChaetomiumspp., including the first report ofChaetomium brasilienseinfection (original) (raw)
Chaetomium species have been rarely described as aetiological agents of invasive and dermatomycotic infections in humans. The majority of cases have been reported within the last two decades. Treatment failed in most of these cases. In this paper we present two cases in which Chaetomium spp. can be clearly identifi ed as an aetiological agent in pathological conditions. In the fi rst report, we describe a new aetiological agent, Chaetomium brasiliense , which was implicated in a case of otitis externa in a patient with spinocellular carcinoma basis cranii. The patient had been repeatedly treated for relapsing otitis externa and had previously undergone surgery several times for otitis media. The fungal aetiology was confi rmed by repeated positive culture and histologic studies. The second case involved onychomycosis with strikingly brown nail discoloration due to Chaetomium globosum in an otherwise healthy patient. The nail lesion was successfully cured by oral terbinafi ne. The determination of both species was supported by sequencing of rDNA regions. The morphological aspect of Chaetomium spp. identifi cation is also discussed. In vitro antifungal susceptibility tests demonstrated that both isolates were susceptible to terbinafi ne and azole derivates except fl uconazole. Amphotericin B was effective only against the C. brasiliense strain. We review the literature to summarize clinical presentations, histologic fi ndings, and treatment strategies. Keywords otitis externa , nail discoloration , antifungal agents , disc diffusion method , cancer patient Reliable and simplifi ed criteria for the identifi cation of NDFF dermatomycotic infections are an indispensable foundation for the diagnosis and treatment of this problematic clinical entity. It is important to note that only a reduced number of antifungal drugs effective against dermatophytes have action spectra that include NDFF [6]. The term phaeohyphomycosis refers to a heterogenous group of mycotic infections that are caused by a group of fungi containing melanin pigments in their cell wall. They are called phaeoid fungi (rather then dematiaceous) which also includes members of the genus Chaetomium. While there is a variety of defi nitions, the one based upon histopathological fi nding is the one most frequently accepted in medical mycology. Employing this defi nition, phaeohyphomycoses encompass cutaneous, subcutaneous and systemic infections in which the aetiological agent develops
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