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Mycetoma is chronic granulomatous infection of skin and subcutaneous tissue caused by both bacteria and fungi. We report a case of mycetoma caused by Scedosporium apiospermum in the right foot of a 45-year-old farmer in north India. The patient had a history of trauma in the sole of the right foot followed by discharge of white granules along with...
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... Gram's staining, presence of pus cells was seen. No acid fast structure was seen. On 10% KOH wet mount, hya- line fungal hyphae were seen (Figure 3). The white-colored granules oozing out were 0.5 to 1 mm in size without any cement-like matrix. The granules were processed for Gram's staining but failed to reveal any filamentous struc- ture. On hematoxylin and eosin staining, fungal hyphae were observed (Figure 4). On Sabouraud's dextrose agar, texture of the growth was cottony and moist initially, which became flat with fine, short, mycelial tufts later. On obverse view, color of the colony was light gray, which became dark gray to black as the colony matured. Reverse was gray to black at 25°C in the biochemical oxygen demand ...
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Background
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Chromoblastomycosis is a chronic fungal infection of the epidermis, dermis and subcutaneous tissue, in which the most common etiologic agent in Brazil is Fonsecaea pedrosoi. In more advanced cases we found many difficulties in their treatment, and therefore, we report a case of extensive and severe chromoblastomycosis, with therapeutical failure of...
Background
Mycetoma is a chronic granulomatous infection involving cutaneous and subcutaneous tissues. It is endemic in tropical and subtropical areas, but sporadic cases have been reported also in countries of temperate climate. The purpose of this paper is to review the cases of mycetoma in European subjects (and presumably acquired in Europe), t...
Mycetoma is an uncommon, chronic granulomatous infection of skin and subcutaneous tissues with involvement of underlying fasciae and bones in majority of cases. Lower extremities are the most common site involved by mycetoma. The classical triad consists of formation of multiple draining sinuses, presence of discharging grains and tumefaction of af...
Citations
... Scedosporium species are human pathogenic moulds. They are the agents of eumycetoma [1][2][3][4][5], a chronic deep fungal infection of the skin and subcutaneous tissues, and are responsible for a broad spectrum of localised and life-threatening disseminated infections in immunocompetent and immunocompromised individuals [6][7][8][9][10] affecting numerous organs of the body ( Figure 1A), including the bones and joints [11][12][13], the central nervous system [14][15][16][17], the eyes [18][19][20][21][22][23][24], the lungs [14,[25][26][27][28][29][30][31][32][33], the sinuses [34][35][36], and other body sites [37][38][39] of cystic fibrosis patients [8,28,[40][41][42], haematopoietic stem cell and solid organ transplant recipients [31,[43][44][45][46][47], hospitalised patients with COVID-19 [48], victims of near-drowning following natural disasters [14,15,30,49,50], and persons with traumatic injuries [51][52][53][54][55]. Recently assigned to the high-(eumycetoma-causative agents) and moderate-priority pathogen groupings by the World Health Organisation [56], Scedosporium diseases have an overall all-cause mortality rate of 42-46% [56]. ...
Scedosporium species are human pathogenic fungi, responsible for chronic, localised, and life-threatening disseminated infections in both immunocompetent and immunocompromised individuals. The diagnosis of Scedosporium infections currently relies on non-specific CT, lengthy and insensitive culture from invasive biopsy, and the time-consuming histopathology of tissue samples. At present, there are no rapid antigen tests that detect Scedosporium-specific biomarkers. Here, we report the development of a rapid (30 min) and sensitive (pmol/L sensitivity) lateral-flow device (LFD) test, incorporating a Scedosporium-specific IgG1 monoclonal antibody (mAb), HG12, which binds to extracellular polysaccharide (EPS) antigens between ~15 kDa and 250 kDa secreted during the hyphal growth of the pathogens. The test is compatible with human serum and allows for the detection of the Scedosporium species most frequently reported as agents of human disease (Scedosporium apiospermum, Scedosporium aurantiacum, and Scedosporium boydii), with limits of detection (LODs) of the EPS biomarkers in human serum of ~0.81 ng/mL (S. apiospermum), ~0.94 ng/mL (S. aurantiacum), and ~1.95 ng/mL (S. boydii). The Scedosporium-specific LFD (ScedLFD) test therefore provides a potential novel opportunity for the detection of infections caused by different Scedosporium species.
... Scedosporium species are human pathogenic moulds. They are the agents of eumycetoma [1][2][3][4][5], a chronic deep fungal infection of the skin and subcutaneous tissues, and are responsible for a broad spectrum of localised and life-threatening disseminated infections in immunocompetent and immunocompromised individuals [6][7][8][9][10] affecting numerous organs of the body ( Figure 1A), including the bones and joints [11][12][13], the central nervous system [14][15][16][17], the eyes [18][19][20][21][22][23][24], the lungs [14,[25][26][27][28][29][30][31][32][33], the sinuses [34][35][36], and other body sites [37][38][39] of cystic fibrosis patients [8,28,[40][41][42], hematopoietic stem-cell and solid organ transplant recipients [31,[43][44][45][46][47], hospitalised patients with COVID-19 [48], victims of near-drowning following natural disasters [14,15,30,49,50], and in persons with traumatic injuries [51][52][53][54][55]. Recently assigned to the high (eumycetoma-causative agents) and moderate priority pathogen groupings by the World Health Organisation [56], Scedosporium diseases have an overall all-cause mortality rate of 42-46% [56]. ...
Scedosporium species are human pathogenic fungi, responsible for chronic, localised, and life-threatening disseminated infections in both immunocompetent and immunocompromised individuals. Diagnosis of Scedosporium infections currently relies on non-specific CT, lengthy and insensitive culture from invasive biopsy, and time-consuming histopathology of tissue samples. At present, there are no rapid antigen tests that detect Scedosporium-specific biomarkers. Here we report the development of a rapid (30 min) and sensitive (pmol/L sensitivity) lateral-flow device (LFD) test, incorporating a Scedosporium-specific IgG1 monoclonal antibody (mAb), HG12, which binds to extracellular polysaccharide (EPS) antigens of between ~15 kDa and 250 kDa secreted during hyphal growth of the pathogens. The test is compatible with human serum, and allows the detection of the Scedosporium species most-frequently reported as agents of human disease (Scedosporium apiospermum, Scedosporium aurantiacum, and Scedosporium boydii), with limits of detection (LOD) of the EPS biomarkers in human serum of ~0.81 ng/mL (S. apiospermum), ~0.94 ng/mL (S. aurantiacum), and ~1.95 ng/mL (S. boydii). The Scedosporium-specific LFD (ScedLFD) test therefore provides a potential novel opportunity for the detection of infections caused by different Scedosporium species.
... Case 5 was identified as S. apiospermum, which has been reported in some cases in the world, in both immunosuppressed and immunocompetent individuals.11,[28][29][30] Our isolate was obtained from white grains from the secretion of the left foot in an immunocompetent patient, who is a farmer from a dry region of Lara state. ...
Mycetoma is a chronic granulomatous, subcutaneous disease endemic in tropical and subtropical countries. It is currently a health problem in rural areas of Africa, Asia and South America. Nine cases of mycetoma were analysed in a retrospective study. All isolates were identified by morphological features. The level of species identification was reached by molecular tools. Definitive identification of fungi was performed using sequence analysis of the ITS of the ribosomal DNA region and the ribosomal large-subunit D1/D2. Identification of actinomycetes was accomplished by the 16S rRNA gene sequence. Six unusual clinical isolates were identified: Aspergillus ustus, Cyphellophora oxyspora, Exophiala oligosperma, Madurella pseudomycetomatis, Nocardia farcinica and Nocardia wallacei. The prevalence of mycetoma in Venezuela remains unknown. This study represents the first report in the literature of mycetoma caused by unusual pathogens identified by molecular techniques.
... 31,32 Pale stained (or un-stained) grains are characteristic for infections due to Scedosporium boydii (formerly Pseudallescheria boydii), Scedosporium apiospermum (white grains), Acremonium spp., Fusarium spp., Neotestudina rosatii, Aspergillus nidulans, Aspergillus flavus as well as Microsporum ferrugineum and Microsporum audouinii. [33][34][35][36] Yellow-brown grains are typically for Nocardia brasiliensis, Nocardia otitidiscaviarum (formerly Nocardia caviae), 37 Actinomadura madurae and Streptomyces somaliensis. ...
Mycetoma is a chronic putrid infection of the cutaneous and subcutaneous tissue concerning predominantly the feet, and more rarely other body parts. Mycetoma can be caused by both fungi (eumycetoma) and bacteria (actinomycetoma). Mode of infection is an inoculation of the causative microorganism via small injuries of the skin. The clinical correlate of both forms of mycetoma is tumescence with abscesses, painless nodules, sinuses and discharge. The latter is commonly serous-purulent and contains grains (filamentous granules) which can be expressed for diagnostic purposes. Distinctive for both eumycetoma and actinomycetoma, are the formation of grains. Grains represent microcolonies of the microorganism in vivo in the vital tissue. The most successful treatment option for eumycetomas offers itraconazole in a dosage of 200 mg twice daily. This triazole antifungal is considered as 'gold standard' for eumycetomas. Alternatively, the cheaper ketoconazole was widely used, however, it was currently stopped by the FDA. Actinomycetomas should be treated by the combination of trimethoprim-sulphamethoxazole (co-trimoxazole 80/400 to 160/800 mg per day) and amikacin 15 mg/kg body weight per day. Mycetomas are neglected infections of the poor. They are more than a medical challenge. In rural areas of Africa, Asia and South America mycetomas lead to socio-economic consequences involving the affected patients, their families and the society in general.
© 2015 European Academy of Dermatology and Venereology.
... Diabetic foot ulcer due to scedosporium apiospermum 299 12. White grain mycetoma caused by Scedosporium apiospermum in North India: a case report. 300 13. Scedosporium apiospermum: An unreported cause of fungal sporotrichoid-like lymphocutaneous infection in Australia and review of the literature 301 14. . ...
The dematiaceous fungi are usually defined as those that have melanin or melanin-like pigment in the wall of the hyphae and/or spores and can cause a variety of infections in humans known as phaeohyphomycosis (phaeo is Greek for "dark").
Over 100 species and 60 genera of dematiaceous, or pigmented fungi have been implicated in human diseases. The vast majority are filamentous fungi or moulds, though a few yeast species are also important pathogens. Though they represent a very heterogeneous group of fungi, the distinguishing characteristic common to all these various species is the presence of melanin in their cell walls, which imparts the dark colour to their conidia or spores and hyphae. The colonies are typically brown to black in colour as well.
Dematiaceous fungi are generally found in soil or associated with plants and distributed worldwide. Those causing the specific conditions of mycetoma and chromoblastomycosis are primarily found in tropical regions. Exposure is thought to be from inhalation or minor trauma, which may not even be noticed by the patient.
The taxonomy and nomenclature of dematiaceous fungi undergo constant revision and are controversial. Thus, a single organism may be identified by a variety of names in the recent and historical literature, a circumstance that contributes to confusion for clinicians and for all but the most dedicated mycologists. This monograph does not attempt to deal definitively with the difficult questions of mycological classification and nomenclature of dematiaceous fungi, but alternative names or appropriate synonyms will be given in each case. Identification of these fungi is based mostly upon morphology. Important structures include annellides (Phaeoannellomyces, Exophiala), phialides (Phialophora, Wangiella), adelophialides (Phialemonium without collarettes, Lecythophora with collarettes), differentiation of conidiophores (Cladosporium) and conidial hilum, septation and germination (Bipolaris, Drechslera, Exserohilum).
A variety of infectious syndromes are attributed to dematiaceous fungi Two unique conditions, mycetoma and chromoblastomycosis, are caused by a small number of species and are usually seen in tropical regions.
• Mycetoma is commonly associated with chronic swelling and draining sinus tracts, usually of the lower extremities. It can be debilitating and difficult to treat.
• Chromoblastomycosis often presents with verrucous lesions that may occur anywhere on the body, but usually on the lower extremities. This is a chronic, slowly progressive subcutaneous mycosis. Minor trauma typically precedes the lesions. Initially, nodular lesions are present, which may progress over years to form large, verrucous plaques.
• Phaeohyphomycosis is a term that encompasses many clinical syndromes due to a wide variety of fungi. Conditions include superficial infections such as keratitisand subcutaneous nodules, allergic diseases, and invasive infections such as brain abscess and disseminated disease.
Relatively little is known regarding the pathogenic mechanisms by which many of these fungi cause disease, particularly in immunocompetent individuals. One of the likely candidate virulence factors is the presence of melanin in the cell wall, which is common to all dematiaceous fungi.
There are several mechanisms proposed by which melanin may act as a virulence factor :
• It is thought to confer a protective advantage by scavenging free radicals and hypochlorite that are produced by phagocytic cells in their oxidative burst that would normally kill most organisms.
• Melanin may bind to hydrolytic enzymes, thereby preventing their action on the plasma membrane.
Although Scedosporium species and Lomentospora prolificans are uncommon causes of invasive fungal diseases (IFDs), these infections are associated with high mortality and are costly to treat with a limited armamentarium of antifungal drugs. In light of recent advances, including in the area of new antifungals, the present review provides a timely and updated overview of these IFDs, with a focus on the taxonomy, clinical epidemiology, pathogenesis and host immune response, disease manifestations, diagnosis, antifungal susceptibility, and treatment. An expansion of hosts at risk for these difficult-to-treat infections has emerged over the last two decades given the increased use of, and broader population treated with, immunomodulatory and targeted molecular agents as well as wider adoption of antifungal prophylaxis. Clinical presentations differ not only between genera but also across the different Scedosporium species. L. prolificans is intrinsically resistant to most currently available antifungal agents, and the prognosis of immunocompromised patients with lomentosporiosis is poor. Development of, and improved access to, diagnostic modalities for early detection of these rare mold infections is paramount for timely targeted antifungal therapy and surgery if indicated. New antifungal agents (e.g., olorofim, fosmanogepix) with novel mechanisms of action and less cross-resistance to existing classes, availability of formulations for oral administration, and fewer drug-drug interactions are now in late-stage clinical trials, and soon, could extend options to treat scedosporiosis/lomentosporiosis. Much work remains to increase our understanding of these infections, especially in the pediatric setting. Knowledge gaps for future research are highlighted in the review.
Scedosporium apiospermum is a mold that is usually found in soil and polluted water, but has also been linked to contaminated ambient air in hospitals. This fungus typically behaves as a rare opportunistic pathogen affecting immunocompromised patients in whom disseminated disease can readily occur, causing shock and multiorgan failure. We report the first case of cutaneous Scedosporium apiospermum infection in a patient with rheumatoid arthritis treated with a Janus kinase inhibitor. We also reviewed other cutaneous manifestations of Scedosporium apiospermum reported between 2003 and 2022.
Helminthiasis is a common infestation in children, caused by Ascaris, Trichuris , and hookworm, residing commonly in the gastrointestinal tract, but also the liver and various other organs in severe cases. Herbal medicines are used worldwide for the treatment of helminthiasis, there are fewer or no side effects as compared to well-known synthetic medicines. Medicinal plants such as Euphorbia helioscopia, Baliospermum montanum, Carica papaya, Cynodon dactylon, Artemisia pallens , and Anacardium occidentale have traditionally been used in the treatment of helminthiasis and are considered to contain anthelmintic compounds. In folk medicine, anthelmintic plants have been used as an important traditional herbal medicine due to the vast array of bioactive compounds found in them.
The zoonotic parasitic infection and diseases caused as a result of echinococci have been identified as serious causative agents that effect human infections caused by endoparasites but normally developed a high level of resistance to the synthetic drugs coupled with their cost and inaccessibility to most people dwelling in the developing countries. Therefore, there is a need to search for sustainable, cheap, and green drugs without adverse effects. The utilization of medicinal, their phytochemical constituents and derivatives has been identified as an alternative source of natural drugs that could be used for the management of several diseases and disorders affecting mankind including infections caused by endoparasites such as echinococci. Hence, this chapter provides a general overview of the effect of phytochemicals derived from medicinal plants for the treatment of echinococci. The modes of action, the life cycle, and some molecular techniques are highlighted. Further recommendations and suggestions that could lead to the discovery of novel drugs are also discussed.
