Ocular fungal infections

[extracted from abstract] Fungal infections of the eye continue to be an important cause of ocular morbidity and loss of vision, particularly in the developing world [1]. These infections have increased in recent decades due to broad-spectrum antibiotic use, the growing number of patients undergoing procedures that lead to immunosuppression, postoperative infection, trauma, and prolonged corticosteroid use [2]. Ocular fungal infections are categorized by the anatomical location of the infection. These infections can occur around the eye (ocular adnexa), or in the eye, including the anterior and posterior segments of the eye [3]. Major pathogenic fungi of the eye include Aspergillus, Candida spp., Cryptococcus species, and Coccidioides spp., Fusarium, Penicillium, Pseudallescheria, dimorphic fungi as Histoplasma capsulatum, Blastomyces dermatitidis, Sporothrix spp., and Coccidioides spp. (C.immitis and C. posadasii) [3,4]. The diagnosis of ocular fungal infections can be difficult because of non-specific clinical manifestations. However, in recent years it has been improved by laboratory and diagnostic techniques, and the recognition of the clinical signs of ocular fungal infections [4]. This has increased the frequency of correct diagnosis and prevalence of these diseases. Because of this, it is important to maintain to knowledge of new developments in the diagnosis and management of infectious diseases of the eye. In this setting, in this Special Issue, articles have been published describing novel findings and reviews on the epidemiology, diagnosis, and treatment of ocular fungal infections, with a special focus on infections in ocular adnexa, endophthalmitis, keratitis, and ocular sporotrichosis.Campus Lima Centr

Two simultaneous mycetomas caused by Fusarium verticillioides and Madurella mycetomatis

Mycetoma is a chronic granulomatous disease, classified into eumycetoma caused by fungi and actinomycetoma due to aerobic filamentous actinomycetes. Mycetoma can be found in geographic areas near the Tropic of Cancer. Mexico is one of the countries in which actinomycetoma is endemic. We report an extraordinary case of an adult male with double eumycetoma caused by Madurella mycetomatis and Fusarium verticillioides on both feet

Refractory onychomycosis due to Trichophyton rubrum: combination therapy with itraconazole and terbinafine

Objectives: Evaluate the efficacy and tolerability of itraconazole plus terbinafine for refractory onychomycosis. This is a prospective clinical trial. Patients with proven Trychophyton rubrum onychomycosis of toenails were enrolled; the treatment consisted of weekly administration: itraconazole 200mg/day and terbinafine 250mg/day, for four months. Results: Thirty-two patients with onychomycosis were studied. Twenty-eight cases had distal subungual onychomycosis and 4 total dystrophic onychomycosis. At the end of the follow-up 17/32 patients had clinical and mycologic cure (53.12%), 5 had clinical improvement only (15.6%), and 10 (31.2%) failed. Conclusion: Weekly alternate therapy with itraconazole + terbinafine represents a safe rescue treatment

Molecular Identification, Antifungal Susceptibility, and Geographic Origin of Clinical Strains of Sporothrix schenckii Complex in Mexico

Abstract:SporotrichosisisasubcutaneousmycosiscausedbySporothrixschenckiicomplex. Thedisease hasbeenreportedworldwide.However,theincidenceoftheetiologicalagentvariesinitsgeographic distribution. We studied 39 clinical isolates of Sporothrix schenckii from diverse regions in Mexico, collectedfrom1998to2016.Molecularidentificationwasperformedbysequenceanalysisofthepartial calmodulin gene. In vitro antifungal susceptibility to amphotericin B (AMB), itraconazole (ITC), voriconazole (VRC), posaconazole (PSC), fluconazole (FLC), terbinafine (TRB), caspofungin (CSF), anidulafungin (ANF), and micafungin (MCF) was evaluated. Thirty-eight isolates of S. schenckii complexweredividedintofivesupportedcladesinaphylogenetictree. Thepredominantclinicalform waslymphocutaneous(92.3%),fixedcutaneous(5.1%),anddisseminated(2.5%). Terbinafineexhibited the best in vitro antifungal activity, while fluconazole was ineffective against Sporothrix schenckii complex. Our results showed diverse geographic distribution of clinical isolates in eight states; definitive identification was done by CAL gen PCR-sequencing. In Mexico, S. schenckii is considered to be an etiological agent of human sporotrichosis cases, and lymphocutaneous is the most prevalent form of the disease. This study revealed four clades of S. schenckii sensu stricto by phylogenetic analysis. Furthermore, we report one case of S. globosa isolated from human origin from the North of Mexico

Esporotricosis del pabellón auricular. Comunicación de un caso atípico simulando una celulitis bacteriana

Auricular sporotrichosis. Atypical case report simulating bacterial cellulitis Sporotrichosis is the most common subcutaneous or implantation mycosis in Mexico. The case of a preauricular cutaneous-fixed sporotrichosis simulating atypical bacterial cellulitis is reported in an elderly patient with no history of trauma. The biopsy showed a suppurative granuloma with scarce yeast. Sporothrix schenckii was identified in the culture and confirmed by molecular biology. She was treated with itraconazole and a clinical and mycological cure was obtained. The case of atypical presentation is presented, coming from a semi-arid zone with extreme weather. Key words: Sporotrichosis; Sporothrix schenckii; fixed-cutaneous; bacterial cellulitis; itraconazole; PCR Palabras clave: Esporotricosis; Sporothrix schenckii; cutánea-fija, celulitis bacteriana; itraconazol, RPC

Molecular Epidemiology of Fonsecaea Species

These fungi disperse slowly, leading to changes in structure at different geographic locations

Mycetoma: experience of 482 cases in a single center in Mexico

Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013). A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11%) were actinomycetomas and 38 cases (7.88%) were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3:1. The mean age was 34.5 years old (most ranged from 21 to 40 years). The main affected localization was lower and upper limbs (70.74% and 14.52% respectively). Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported). The main clinical presentation was as tumorlike soft tissue swelling with draining sinuses (97.1%). Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21%) and Actinomadura madurae (8.7%); meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii) were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico