Monograph
On
Dematiaceous fungi
A guide for description of dematiaceous fungi fungi of
medical importance, diseases caused by them, diagnosis
and treatment
By
Mohamed Refai and Heidy Abo El-Yazid
Department of Microbiology, Faculty of Veterinary Medicine,
Cairo University
2014
1
Preface
The first time I saw cultures of dematiaceous fungi was in the laboratory of Prof. Seeliger in Bonn,
1962, when I attended a practical course on moulds for one week. Then I handled myself several
cultures of black fungi, as contaminants in Mycology Laboratory of Prof. Rieth, 1963-1964, in
Hamburg. When I visited Prof. DE Varies in Baarn, 1963. I was fascinated by the tremendous
number of moulds in the Centraalbureau voor Schimmelcultures, Baarn, Netherlands. On the
other hand, I was proud, that El-Sheikh Mahgoub, a Colleague from Sundan, wrote an
internationally well-known book on mycetoma. I have never seen cases of dematiaceous
fungal infections in Egypt, therefore, I was very happy, when I saw the collection of
mycetoma cases reported in Egypt by the eminent Egyptian Mycologist, Prof. Dr Mohamed
Taha, Zagazig University.
To all these prominent mycologists I dedicate this monograph.
Prof. Dr. Mohamed Refai, 1.5.2014
Heinz Seeliger
Heinz Rieth
El-Sheikh Mahgoub
Gerard de Vries,
Mohamed Taha
2
Contents
1. Introduction
2. Description of dematiaceous
fungi
2. 1. The genus Alternaria
2.2. The genus Aurobasidium
2.3. The genus Bipolaris
2.4. The genus Cladosporium
2.5. The genus Cladophialophora
2.6. The genus Cheatomium
2.7. The genus Coniothyrium
4
6
2. 30. The genus Rhinocladiella
2. 31. The genus Scedosporium
83
86
6
11
16
20
24
28
31
2. 32. The genus Scytalidium
2.33. The genus Stachybotrys
2. 34. The genus Stemphylium
2.35. The genus Ulocladium
2. 36. The genus Wangiella
2. 37. The genus Xylohypha
89
91
93
94
96
98
99
2.8.The genusParaconiothyrium
2.9. The genus Curvularia
2.10. The genus Epicoccum
2.11. The genus Exophiala
32
33
36
38
2.12. The genus Drechslera
44
2.13. The genus Exserohilum
2.14. The genus Fonseceae
2.15. The genus Hortaea
2.16. The genus Lasiodiplodia
2.17. The genus Lecythophora
45
47
51
53
54
2.18. The genus Leptosphaeria
2.19. The genus Madurella
2.20. The genus Myrothecium
2.21. The genus Nattrassia
2.22.The genus Ochroconis
2.23. The genus Phialemonium
2.24. The genus Phialophora
3. Diseases caused by
dematiacaeous fungi
3. 1. Phaeohyphomycosis
3.1.1. Skin infections
3.1.2. Nail infections
3.1.3. Eye infections
3.1.4. Respiratory phaeohyphomycosis
3.1.5. Central nervous system infection
3.1.6. Disseminated pheohyphomycosis
3.2. Chromomycosis
3.3. Mycetoma
4. Dematiaceous fungi in Egypt
5. Mycotoxicoses
5.1. Alternariosis
5.2. Facial eczema (Pithomycotoxicosis)
5.3. Stachybotryotoxicosis
56
58
61
62
64
67 6. Laboratory diagnosis
69
2. 25. The genus Phoma
73 7. Treatment
2.26. The genus Pithomyces
2. 27. The genus Pyrenochaeta
75
2.28. The genus Pythium
2. 29. The genus Ramichloridium
99
99
103
103
106
108
111
115
118
120
122
122
122
124
125
126
76 8. Contamination and deterioration by
dematiaceous fungi
79
127
81 9. References
133
3
1. Introduction
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).
4
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.
5
2. Description
importance
of
dematiaceous
fungi
of
medical
2. 1. The genus Alternaria
The genus Alternaria currently contains around 300 species. Alternaria is a
wide-spread dematiaceous fungus commonly isolated from plants, soil, food,
and indoor air environment.. At least 20% of agricultural spoilage is caused
by Alternaria species; most severe losses may reach up to 80% of yield. Many
human health disorders can be caused by these fungi, which grow on skin
and mucous membranes, including on the eyeballs and within the respiratory
tract. Allergies are common, but serious infections are rare, except in people
with compromised immune systems. Species of Alternaria are often prolific
producers of a variety of toxic compounds. The terms alternariosis
and alternariatoxicosis are used for disorders in humans and animals caused
by a fungus in this genus.
2.1.1. Alternaria alternata (Fr.) Keissl. (1912)
Synonyms: Alternaria tenuis Nees 1917
Macrosporium fasciculatum Cooke & Ellis (1817),
Torula alternata Fr. (1832),
Alternaria fasciculata Jones & Grout (1897),
Alternaria rugosa McAlpine (1896)
Morphology
Alternaria species grow rapidly producing flat, downy to woolly colonies,
covered by grayish, short, aerial hyphae. The surface is greyish white at the
beginning which later darkens and becomes greenish black or olive brown with
a light border. Microscopically, the fungus develops septate, brown hyphae.
Conidiophores are also septate and brown in colour, occasionally producing a
zigzag appearance. They bear simple or branched large conidia, which have
both transverse and longitudinal septations (muriform conidia). They are dark
in colour, elongated and found in chains. The conidia may be observed singly
or in acropetal chains and may produce germ tubes. They are ovoid to
obclavate, darkly pigmented, muriform, smooth or roughened. The end of the
conidium nearest the conidiophore is round while it tapers towards the apex.
6
The species can be divided into three groups according to the number of
conidia on the conidiophore:
Noncatenatae with single conidia;
Brevicatenatae with short chains containing three to five conidia;
Longicatenatae with long chains containing 10 spores or more.
Alternaria alternata belongs to the last group.
The microscopic differences between Alternaria species are not significant,
and the character of every species varied depending on the conditions of
growth. So, the identification of species is very difficult.
Alternaria alternata
A. tenuissima
7
A. infectoria
A. triticina
8
Pathogenicity :
Alternaria spp. have emerged as opportunistic pathogens particularly in
patients with immunosuppression, such as the bone marrow transplant
patients They are one of the causative agents of phaeohyphomycosis. Cases
of onychomycosis, sinusitis, ulcerated cutaneous infections, and keratitis, as
well as visceral infections and osteomyelitis due to Alternaria have been
reported. In immunocompetent patients, Alternaria colonizes the paranasal
sinuses, leading to chronic hypertrophic sinusitis. In immunocompromised
patients the colonization may end up with development of invasive disease. It
is among the causative agents of otitis media in agricultural field workers.
1. Allergy
Alternaria is a major aeroallergen in many parts of the world. Sensitivity to
Alternaria has been increasingly recognized as a risk factor for the
development and persistence of asthma, asthma severity, and potentially fatal
asthma exacerbations. Cases with IgE-mediated sensitivity to Alternaria who
developed an acute, life-threatening asthma attack were reported. Alternaria
alternata is one of the most important fungi that can cause asthma and rhinitis.
Not only the intact spores can produce and transfer the allergens, the
fragmented hyphae and spores also can transfer the allergens. In the United
State, almost 3.6% of the population are sensitive to Alternaria alternata in the
skin test. So, the asthma caused by Alternaria alternata is a big problem to
human.
2. alternarioses
The published literature contains 210 reported cases of human alternarioses
between 1933 and the present day. The most frequent clinical manifestations
are :
I.
II.
Cutaneous and subcutaneous infections (74.3%). The most important
risk factors for cutaneous and subcutaneous infections are solid organ
transplantation and Cushing's syndrome,
Oculomycosis (9.5%). Exposure to soil and garbage is common in all
cases of oculomycosis, with corticotherapy being a risk factor in 50% of
these cases.
9
III.
IV.
V.
Invasive and non-invasive rhinosinusitis (8.1%). The most important risk
factors for rhinosinusitis are bone marrow transplants.
Immunosuppression is frequently associated with cutaneous and
subcutaneous infections and rhinosinusitis.
Previous contact with soil and/or trauma to the nails is associated with
most cases of onychomycosis.
.
Recently reported cases:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Cutaneous alternariosis with chronic granulomatous disease (6)
Cutaneous infection with Alternaria triticina in a bilateral lung transplant
recipient.7
Alternaria alternata infection associated osteomyelitis of maxilla: a rare
disease entity.8
Corneal transplant infection due to Alternaria alternata: A Case Report.9
Deep cutaneous mycosis due to Alternaria infectoria after liver transplantation:
successful treatment with fluconazole.10
Alternaria alternata invasive fungal infection in a patient with Fanconi's anemia
after an unrelated bone marrow transplant.11
The importance of genus Alternaria in mycotoxins production and human
diseases12
Exposure to Alternaria alternata in US homes is associated with asthma
symptoms14
Phaeohyphomycosis caused by Alternaria infectoria in a renal transplant
recipient15
Phaeohyphomycoses, Emerging Opportunistic Diseases in Animals16
Alternaria infectoria brain abscess in a child with chronic granulomatous
disease.17
Fungal meningoencephalitis caused by Alternaria: a clinical case.18
11
2.2. The genus Aurobasidium
The genus Aureobasidium includes 14 species and one variety. Among
these, Aureobasidium pullulans is the only well-known species. Aureobasidum
pullulans is a black yeast-like species that is particularly known for its
biotechnological significance as a producer of the biodegradable extracellular
polysaccharide (EPS) pullulan (poly-α-1,6-maltotriose). This component is a
promising biomaterial, and is currently used among others for the packaging of
food and drugs. Its biotechnological potential is also seen in the production of
a variety of hydrolytic enzymes.
2.2.1. Aureobasidium pullulans (de Bary) G. Arnaud, 1918
Synonyms: Dematium pullulans de Bary 1884)
Pullularia pullulans (de Bary) Berkhout (1923)
Anthostomella pullulans (de Bary) F.T. Benn (1928)
Hormonema pullulans (de Bary) Lagerb. & Melin (1932)
Aureobasidium pullulans (De Bary)., Ribaldi & Corte (1957)
Phymatotrichum baccarum Oudem (1900)
Dematoidium nigrescens Stautz (1931)
Perfect stage: Guignardia pullulans
Colonies are fast growing, smooth, covered with slimy masses of
conidia, cream or pink to brown or black. Hyphae are hyaline and septate,
frequently becoming dark-brown with age and undergoing holothallic
transformation to form chains of 1- to 2-celled, thick-walled, darkly pigmented
arthroconidia commonly called chlamydoconidia. Conidia are hyaline to subhyaline hyphae. Conidia are hyaline, smooth-walled, single-celled, ellipsoidal
but of variable shape and size (8-12 x 4-6 um).
Different colonial morphologies of Aurobasidium pullulans
11
A. pullulans yeast colonies yeast cells
mould phase
Mycelium
Aurobasidium pullulans varieties31:
Four varieties of the species A. pullulans with somewhat different ecology are
recognised:
1. Aurobasidium pullulans var. pullulans from slightly osmotic substrates and
the phyllosphere;
2. Aurobasidium pullulans var. melanogenum from watery habitats;
3. Aurobasidium pullulans var. subglaciale from glacial habitats; and
4. Aurobasidium pullulans var. namibiae, which was described on the basis of only
one strain isolated from dolomitic marble in Namibia.
1. A. pullulans var. pullulans (Viala & Boyer 1891),
Synonyms:
Dematium pullulans de Bary 1884
Aureobasidium pullulans (de Bary) Arn. var. aubasidani Yurlova in
Yurlova & de Hoog 1997
Candida malicola D.S. Clark & R.H. Wallace 1955
Dematoidium nigrescens Stautz 1931
12
2. A. pullulans var. melanogenum Hermanides-Nijhof (1977),
Synonyms:
Torula schoenii Roukhelman 1937
Pullularia fermentans Wynne & Gott var. schoenii (Roukhelman)
Wynne & Gott 1956
3. A. pullulans var. subglaciale Zalar, de Hoog & Gunde-Cimerman (2008)
13
4. A. pullulans var. namibiae Zalar, de Hoog & Gunde-Cimerman (2008)
Pathogenecity
Aureobasidium pullulans is capable of causing a variety of diseases in
humans. The fungus is most often found in damp places either inside the
home or in the environment. Chronic human exposure via humidifiers or air
conditioners can lead to hypersensitivity pneumonitis (extrinsic allergic
alveolitis) or "humidifier lung". This condition is characterized acutely
by dyspnoea, cough, fever, chest infiltrates, and acute inflammatory reaction.
The condition can also be chronic, and lymphocyte-mediated. The chronic
condition is characterized radiographically by reticulonodular infiltrates in the
lung, with apical sparing. It is a rare cause of disease and is more likely to
occur in immunosuppressed patients.
The list of signs and symptoms mentioned in various sources
for Aureobasidium pullulans exposure includes the following symptoms:
Pneumonia
Asthma
Dermatitis
Keratitis
Respiratory system irritation
Digestive symptoms
Respiratory symptoms
Skin symptoms
Urinary symptoms
Allergy symptoms
Sinusitis
Peritonitis
Skin infection
Fungal infection
Hypersensitivity pneumonia
14
Cases recently reported
1.
Grain dust originating from organic and conventional farming as a potential source of
biological agents causing respiratory diseases in farmers.32
2.
Aureobasidium pullulans infection in a patient with chronic lymphocytic leukemia33
3.
Multiple rare opportunistic and pathogenic fungi in persistent foot skin infection 34
4.
Aureobasidium pullulans keratitis35
5.
Outbreak of hypersensitivity pneumonitis in an industrial setting36
6.
Extended fungal skin infection due to Aureobasidium pullulans.37
7.
Sauna takers disease in Indoor Allergens: Assessing and Controlling Adverse Health
Effects.38
8.
Association between sensitization to Aureobasidium pullulans (Pullularia sp) and
severity of asthma39
9.
Humidifier lung and humidifier fever. 40
10.
Disseminated nosocomial fungal infection byAureobasidium
pullulans var. melanigenum: a case Report.41
11.
Cutaneous infection of a porcupine (Erethizon dorsatum) by Aureobasidium
pullulans.42
12.
Outbreak of Aureobasidium species. Lower respiratory tract Infections caused by re
use of single‐use stopcocks during bronchoscopy43
13.
Identification and possible disease mechanisms of an under-recognized
fungus, Aureobasidium pullulans44
14.
Hypersensitivity pneumonitis secondary to residential exposure to Aureobasidium
pullulans in 2 siblings45
15.
Aureobasidium pullulans infection: Fungemia in an infant and a review of human
cases.46.
16.
Catheter-related septicemia due to Aureobasidium pullulans.47
17.
Fungi and allergic lower respiratory tract diseases48
18.
Subcutaneous mycosis and fungemia by Aureobasidium pullulans: a rare pathogenic
fungus in a post allogeneic BM transplant patient49
15
2. 3. The genus Bipolaris
Bipolaris is a large genus of dematiaceous hyphomycetes with more than 100
species, most of them being saprobes in soil and pathogens of plants, while
some of the saprobic species are potentially able to infect humans and
animals. The typical morphological features of Bipolaris species include rapidly
growing dark colonies, geniculate conidiophores with sympodial
conidiogenesis, and large conidia with transverse distosepta, usually without a
protuberant hilum (a basal scar indicating the point of attachment in the
conidiogenous cell) and with bipolar germination.
Colonies on potato dextrose agar at 25°C are initially white, soon becoming
gray to black with a black reverse. Rapid growth. Texture is woolly to
cottony. Hyphae are septate and dark. Conidiophores may be up to 150 µm in
length, are sympodial, geniculate, simple or branched, bearing conidia through
pores or openings (poroconidia). Conidia have 2 to 5 transverse distosepta or
pseudosepta (septa that do not extend to the cell wall with cells inclosed within
sacs) and 3 to 6 cells. They measure approximately 14-40 x 6-11 µm. A
flattened hilum or point of attachment is seen on the basal cell. Conidia
germinate from both poles (bipolar).
Clinically relevant Bipolaris species are B. australiensis, B. hawaiiensis, B.
spicifera, and, to a lesser extent, B. papendorfii. These fungi are able to infect
both immunocompetent and immunosuppressed patients, mainly in tropical
and subtropical areas.
16
2.3.1. Bipolaris spicifera (Bainier) Subram., (1971)
Synonyms:
Brachycladium spiciferum Bainier, (1908)
Brachysporium spiciferum (Bainier) Corbetta, (1963)
Curvularia spicifera (Bainier) Boedijn, (1909)
Dendryphion spiciferum (Bainier) Sacc. & Traverso,(1910)
Drechslera spicifera (Bainier) Arx, (1970)
Helminthosporium spiciferum (Bainier) Nicot, (1953)
Bipolaris spicifera
2.3.2. Bipolaris australiensis Tsuda & Ueyama (1981)
Synonyms: Drechslera australiensis M.B. Ellis,(1971)
Drechslera australiensis (Bugnic.) Subram. & B.L. Jain, (1966)
Helminthosporium australiense Bugnic., (1956)
Bipolaris australiensis
17
2.3.3. Bipolaris hawaiiensis (M.B. Ellis) Uchida & Aragaki (1979)
Synonyms: Helminthosporium hawaiiense Bugnic., (1955) disseminated disease
and C. boppii, C. emmonsii and C. saturnica causing cutaneous infections.92
Bipolaris hawaiiensis
Pathogenicity:
Bipolaris is one of the causative agents of phaeohyphomycosis. Bipolaris can
infect both immunocompetent and immunocompromised host. Bipolaris may
be also pathogenic to certain plant species, particularly to Graminiae and also
to animals, such as the dog. It may cause nasal mycotic granuloma in the
cattle. Bipolaris may also be isolated as a laboratory contaminant.
Diseases caused by Bipolaris:
Skin Infections
Nose Infections
General Body Infections
If Bipolaris gets into the bloodstream it can lead to endocarditis.
Respiratory infections are a potential source of entry into the bloodstream.
Peritonitis is a huge potential problem from this mold.
The most common reaction to Bipolaris is skin infections. It affects the skin through
open wounds. The mold spores attack the wound, making it impossible to cure with
antibiotics.
Bipolaris is also linked to severe immune disorders. The toxins that are released
from this mold put continual stress on the immune system making it difficult to fight
off illness.
18
Recently reported cases:
1. Emerging agents of Phaeohyphomycosis: pathogenic species of Bipolaris and
Exserohilum.19
2. Phaeohyphomycosis caused by the fungal genera Bipolaris and Exserohilum. A
report of 9 cases and review of the literature.20
3. Onset of an outbreak of Bipolaris hawaiiensis fungal endophthalmitis after intravitreal
injections of triamcinolone.21
4. Fatal Bipolaris spicifera infection in an immunosuppressed child22
5. Fungal endophthalmitis associated with compounded products.23
6. An outbreak of fungal endophthalmitis after intravitreal injection of compounded
combined bevacizumab and triamcinolone.24
7. Corneal abscess caused by Bipolaris spicifera.25
8. Bipolaris hawaiiensis as etiologic agent of allergic bronchopulmonary mycosis: first
case in a paediatric patient.26
9. Cerebral phaeohyphomycosis caused by Bipolaris spicifera after heart
transplantation.27
10. Cerebral and renal phaeohyphomycosis in a dog infected with Bipolarisspecies.28
11. Fatal fungal endarteritis caused by Bipolaris spicifera following replacement of the
aortic valve29
12. A set of 104 isolates from human clinical samples from the United States, revealed
that the most common anatomical sites where isolates were recovered were the
nasal region (30.7%), skin (19.2%), lungs (14.4%), and eyes .(12.5%).30
2.4. The genus Cladosporium
19
The genus Cladosporium was established in 1816 by Link. Due to the very
brief, imprecise circumscription of the genus Cladosporium in the past,
numerous superficially similar pigmented, holoblastic hyphomycetes with
amero- to phragmosporous conidia formed in acropetal chains have been
placed in Cladosporium, which made this genus very heterogeneous and
polyphyletic. A recently published checklist contains data for
772 Cladosporium names, i.e., valid, invalid, legitimate and illegitimate species
and varieties.50 Reasons for this vast number of taxa probably reside in the
imprecise, wide circumscription of this genus in literature, the strong
morphological variability of most species, and the occurrence of some species
on a wide range of substrates.
Based on re-assessments of morphological features and molecular data,
human pathogenic species were separated from the genus and are now
known to be species of Cladophialophora, which differ in their morphology
(conidiophores lacking or semi-macronematous, hila not coronate, less
pigmented) and physiology (inability to liquefy gelatin).
A monographic revision of the hyphomycete genus Cladosporium was
published by Bensch et al. (2012)51. Based on morphological and molecular
characteristics, only 169 species were recognized. All other names previousl;y
given to Cladosporium species were considered as synonyms.
Cladosporium Link, 1832.
Synonyms: Sporocladium Chev., 1826.
Heterosporium Klotzsch, 1832,
Heterosporium Klotzsch ex Cooke, 1877.
Myxocladium Corda, 1837.
Didymotrichum Bonord., 1851.
Acrosporella Riedl & Ershad, 1977
Type species: C. herbarum (Pers.: Fr.) Link (Clements & Shear 1931).
Teleomorph: Davidiella Crous & U. Braun, 2003
Morphology:
The colony is compact, olive-black, has well-defined darker margin and the
surface is covered with short brown-green aerial mycelium. The reverse of the
colony is black. Most of the Cladosporium spp. do not grow at temperatures
above 35°C . Microscopically, the fungus produces chains of branching
21
conidia by acropetalous (distal) budding. The length of the chains and conidial
size differ with individual species. The dark spores are 1- or 2-celled and occur
in long, branching chains that arise from a dark conidiophore. The youngest
spore is at the top of the chain. The slightest movement will disrupt the chains,
making microscope mounts of the whole structure nearly impossible. The best
way to recognize the genus is by the prominent scars on the spores where the
adjacent ones were attached.The most important Cladosporium species are:
2.4.1. Cladosporium herbarum (Pers.: Fr.) Link, 1832.
Synonyms: 1. Acladium heterosporum Wallr., (1833)
2. Cladosporium alnicola Corda, (1837)
3. Cladosporium caricicola Corda, (1837)
4. Cladosporium condylonema Pass., (1889)
5. Cladosporium entoxylinum Corda, (1837)
6. Cladosporium epimyces Cooke, (1882)
7. Cladosporium fasciculatum Corda, (1837)
8. Cladosporium fuligineum Bonord., (1864)
9. Cladosporium graminum Corda, (1837)
10. Cladosporium nodulosum Corda, (1837)
11. Cladosporium tomentosum Corda, (1837)
12. Cladosporium typharum Desm., (1834)
13. Dematium epiphyllum Pers., (1801)
14. Dematium fuscum Pers., (1822)
15. Dematium gramineum Pers.(1822)
16. Helminthosporium acuum P. Karst., (1892)
17. Helminthosporium compactum P. Karst., (1892)
18. Helminthosporium flexuosum Corda, (1837)
19. Helminthosporium herbarum Schwein., (1832)
20. Helminthosporium phyllophilum P. Karst. (1884)
21. Helminthosporium vesiculosum Thüm.,(1877)
22. Helmisporium acuum P. Karst. (1892)
23. Helmisporium compactum P. Karst. (1892)
24. Helmisporium flexuosum Corda (1837)
25. Helmisporium herbarum Schwein. (1832)
26. Heterosporium caulicola Ellis & Everh., (1894)
27. Heterosporium cladasparioides Ellis & Everh. (1894)
28. Heterosporium cladosporioides Ellis & Everh., (1894)
29. Heterosporium cytisi Ranoj., (1910)
21
C. herbarum (Mycobank)
C. cladosporioides
C. sphaerospermum
2.4.2. Cladosporium cladosporioides (Fresen.) G.A. de Vries, 1952.
Synonyms:
1. Penicillium cladosporioides Fresen., (1850)
2. Hormodendrum cladosporioides (Fresen.) (1880)
3. Cladosporium hypophyllum Fuckel, (1870)
4. Monilia humicola Oudem., (1902)
2.4.3. Cladosporium sphaerospermum Penz., 1882.
Synonyms: Torula lichenopsis Höhn., (1927)
Significabce of Cladosporium
Species of Cladosporium are cosmopolitan in distribution and commonly
encountered on all kinds of plant, fungal and other debris, are frequently
isolated from soil, food, paint, textiles and other organic matters.
Some species of this genus are plant pathogenic, i.e., they are causal
agents of leaf spots and other lesions, or they occur as hyperparasites
on other fungi.
Some species have a medical relevance in clinical laboratories and may
cause allergic lung mycoses.
Cladosporium species have also been known to colonize and ruin crops
or food, as on frozen meat.
Cladosporium species also produce compounds associated with the
characteristic mould smell.
22
One species of Cladosporium are used to produce enzymes which are
used in the manufacturing of pharmaceuticals. Most classically, these
enzymes transform certain steroid compounds into progesterone, a
hormone used in birth control.
Pathogenicity
Cladosporium species are causative agents of:
Skin lesions: Cladosporium carrionii is considered as an agent of
chromoblastomycosis which is a subcutaneous infection characterized by verrucous
lesions and the formation of brown, sclerotic fission cells, which look like copper
pennies, in tissues.
Keratitis: wide variety of corneal infections, irritations and inflammations],
Onychomycosis
Sinusitis: an inflammation of the paranasal sinuses which may be associated with
viral respiratory infections and seasonal allergic problems or hay fever
pulmonary infections
Brain abscesses: Cladophialophora bantiana is the most common and dangerous
neurotropic fungus which causes brain abscess. The infection which is caused due
to this fungus is risky, not only to the patient due to the poor prognosis, but also to
the clinician because of the difficulty in its management as well as to the laboratory
personnel who handle it
Cases recently reported:
1. Microfungal contaminants on mobile phones of health services vocational school
students in marmaris52
2. Harmful biological agents at museum workposts.53
3. Some chronic rhinosinusitis patients have elevated populations of fungi in their
sinuses.54
4. Fungi and allergic lower respiratory tract diseases55
5. Phaeohyphomycotic dermatitis in a giant panda (Ailuropoda melanoleuca) caused
by Cladosporium cladosporioides.56
6. The occurrence of molds in patients with chronic sinusitis.57
7. Unusual causes of fungal rhinosinusitis: a study from a tertiary care centre in South
India.58
8. Differences in fungi present in induced sputum samples from asthma patients and
non-atopic controls: a community based case control study59
9. Allergic bronchopulmonary mycosis due to fungi other than Aspergillus: a global
overview.60
10. Acute meningitis caused by Cladosporium sphaerospermum61
11. Keratitis-associated fungi form biofilms with reduced antifungal drug susceptibility.62
12. Cutaneous and systemic pathogenicity of a clinical isolate of
Cladosporium sphaerospermum in a murine model.63
23
2.5. The genus Cladophialophora
Cladophialophora is a genus of black yeast-like fungi comprising a number of
clinically highly significant species in addition to environmental taxa. The
genus has previously been characterized by branched chains of ellipsoidal to
fusiform conidia. However, this character was shown to have evolved several
times independently in the order Chaetothyriales. On the basis of a multigene
phylogeny
(nucLSU,
nucSSU, RPB1),
most
of
the
species
of Cladophialophora (including its generic type C. carrionii) belong to a
monophyletic group comprising two main clades (carrionii- and bantianaclades). The genus includes species causing chromoblastomycosis and other
skin infections, as well as disseminated and cerebral infections, often in
immunocompetent individuals.
The genus has been expanded to encompass several other clinically
significant species, including the neurotropic fungi C. bantiana and C.
modesta causing
brain
infections, C.
devriesii and C.
arxii causing
disseminated disease and C. boppii, C. emmonsii and C. saturnica causing
cutaneous infections.92
Pathogenicity
Cladophialophora spp.
and mycetoma:
cause
phaeohyphomycosis, chromoblastomycosis
Cladophialophora bantiana: causes cerebral phaehyphomycosis in the
form of brain abscesses, for which the clinical course is usually fatal. It
may also cause skin lesions.
Cladophialophora boppii: causes chromoblastomycosis
Cladophialophora carrioinii : causes chromoblastomycosis
Cladophialophora devriesii: to causes disseminated
phaehyphomycosis.
24
Description of important Cladophialophora species
2.5.1. Cladophialophora bantiana de Hoog, Kwon-Chung & McGinnis,
(1995)
Synonyms: Torula bantiana Sacc., in Saccardo, (1912)
Cladosporium bantianum (Sacc.) Borelli, (1960)
Xylohypha bantiana (Sacc.) McGinnis, Borelli, Padhye & Ajello, (1986)
Cladosporium trichoides Emmons Binford, Thompson & Gorham, (1952)
Cladosporium bantianum (Sacc.) Borelli, (1960)
Cladosporium trichoides var. chlamydosporum Kwon-Chung, (1978)
In culture, the colony is black with a velvety texture or dark grey in colour,
depending on the type of agar medium it is grown on. It grows slowly under
temperatures ranging from 14-42 °C with optimal growth around 30 °C. It can
be distinguished from other species of the genus Cladophialophora by the
presence of urease activity. Microscopically, the fungus produces
predominantly hyphal growth both in vivo and in vitro, that consists of dark
coloured largely unbranched, wavy chains of conidia, individually 5–10 µm in
length. The dark colour is due to the presence of the dark pigment melanin.
Cladophialophora bantiana
25
2.5.2. Cladophialophora carrionii de Hoog, Kwon-Chung & McGinnis,
(1995)
Synonyms: Cladosporium carrionii Trejos (1954)
Cladophialophora ajelloi Borelli (1980)
Colonies are slow growing, reaching 3-4 cm in diameter after one month, with
a compact suede-like to downy surface and are olivaceous-black in color.
Microscopically, the fungus produces ascending to erect, olivaceous-green,
apically branched, elongate conidiophores producing branched acropetal
chains of smooth-walled conidia. Conidia are pale olivaceous, smooth-walled
or slightly verrucose, limoniform to fusiform, 1.5-3.0 x 2.0-7.0 µm in size.
Bulbous phialides with large collarettes and minute, hyaline conidia are
occasionally formed on nutritionally poor media. Maximum growth temperature
35-37C.
Cladophialophora carrionii
2.5.3. Cladophialophora modesta McGinnis, de Hoog & Haase (1999)
2.5.4. Cladophialophora devriesii (Padhye et Ajello) de Hoog et al., 1995
Synonyms: Cladosporium devriesii Padhye & Ajello, (1984)
2.5.5. Cladophialophora arxii Tintelnot et al., (1995)
26
2.5.6.Cladophialophora boppii (Borelli) de Hoog, Kwon-Chung &
McGinnis, ((1995)
Synonym: Taeniolella boppii Borelli, (1983))
Cladophialophora devriesii
Cladophialophora modesta
Recently reported cases
Cladophialophora arxii Cladophialophora boppii
1. Cladophialophora bantiana brain abscess: A case with long survival in metropolitan
France64
2. Phaeohyphomycosis caused by Cladophialophora bantiana.65
3. Canine eumycetoma caused by Cladophialophora bantiana in a Maltese: case report
and literature review.66
4. Cladophialophora (Xylohypha) bantiana--an unusual cause of septic arthritis67
5. Brain abscess caused by Cladophialophora bantiana in China68
6. Cutaneous phaeohyphomycosis due to Cladophialophora bantiana69
7. Cerebral phaeohyphomycosis due to Cladophialophora bantiana in a Huacaya
alpaca (Vicugna pacos).70
8. Cerebellar Cladophialophora bantiana infection in a patient with marginal zone
lymphoma treated with immunochemotherapy including rituximab71
9. Cladophialophora bantiana brain abscess in an immunocompetent patient72
10. Focal pulmonary granuloma caused by Cladophialophora bantiana in a domestic
short haired cat.73
11. Disseminated Cladophialophora bantiana infection in an idiopathic thrombocytopenic
purpura patient: a case report.74
12. Necrotizing pyogranulomatous meningoencephalitis with intralesional fungal hyphae,
consistent with Cladophialophora bantiana75
13. Cutaneous phaeohyphomycosis caused by Cladophialophora bantiana in a scar after
treatment with intralesional corticosteroid injections76
14. Chromoblastomycosis caused by Cladophialophora carrionii in a child from India78
27
15. A fatal case of prostatic abscess in a post-renal transplant recipient caused by
Cladophialophora carrionii.77
16. Corneal chromoblastomycosis caused by Cladophialophora carrionii after cataract
surgery80
17. Cladophialophora carrionii: an aetiological agent of cutaneous chromoblastomycosis
from a non-endemic area, North India81
18. Sub-cutaneous phaeohyphomycosis caused by Cladophialophora devriesii in a
United Kingdom resident82
19. Femoral osteomyelitis due to Cladophialophora arxii in a patient with chronic
granulomatous disease83
20. Systemic mycosis caused by a new Cladophialophora species84
21. Subcutaneous phaeohyphomycosis caused by Cladophialophora boppii85
22. Toenail infection by Cladophialophora boppii.86
23. Pulmonary Cladophialophora boppii infection in a lung transplant recipient: case
report and literature review87
24. Cladophialophora (Xylohypha) bantiana--an unusual cause of septic arthritis.89
25. Fatal cerebral abscess caused by Cladophialophora bantiana.91
2. 6. The genus Cheatomium
The genus Chaetomium contains about 95 species. Chaetomium spp. are
contaminants but they are also encountered as causative agents of infections
in humans. A few cases of fatal deep infections due to Chaetomium
atrobrunneum have been reported in the immunocompromised host. Other
clinical syndromes include brain abscess, peritonitis, and onychomycosis.
Morphology
Colonies are rapidly growing, cottony and white in colour initially. Mature
colonies become grey to olive in colour. From the reverse, the colour is tan to
red or brown to black. Microscopically. the fungus shows septate hyphae,
perithecia, asci and ascospores. Perithecia are large, dark brown to black in
color, fragile, globose to flask shaped and have filamentous, hair-like, brown to
black appendages (setae) on their surface. Perithecia have ostioles (small
rounded openings) and contain clavate to cylindrical asci, which rapidly
dissolve to release one-celled, olive brown in color, and lemon shaped
ascospores, which are 4 to 8 in number.
28
2.6.1. Chaetomium globosum Kunze (1829)
Synonym:
Chaetomium kunzeanum Zopf (1881)
Chaetomium affine Corda (1840)
Chaetomium setosum Bainier (1887)
Chaetomium barbatum Traaen (1914)
Chaetomium subterraneum Swift & Povah (1929)
Chaetomium japonicum Saito & Okasaki
Chaetomium globosum
2.6.2. Chaetomium brasiliense Bat. & Pontual,1948
Synonyms: Chaetomium hamatum Bat. & Pontual1948.
Chaetomium repandum Bat. & Pontual, 1948
Chaetomium velutinum L.M, 1949.
Chaetomium alboarenulum Ames, 1963
Chaetomium congoense Ames, 1963
Chaetomium leucophora Ames, 1963
Chaetomium perpulchrum Ames, 1963
29
Pathogenicity :
Chaetomium spp. are among the fungi causing infections wholly referred to
as phaeohyphomycosis. Fatal deep mycoses due to Chaetomium
atrobrunneum have been reported in an immunocompromised host. Brain
abscess, peritonitis, cutaneous lesions, and onychomycosis may also develop
due to Chaetomium spp.
Recently reported cases:
1. A case report of a mixed Chaetomium globosum/Trichophyton mentagrophytes
onychomycosis.178
2. Fungal keratitis caused by Chaetomium atrobrunneum.179
3. Phaeohyphomycosis and onychomycosis due to Chaetomium spp., including the first
report of Chaetomium brasiliense infection.180
4. Non-dermatophyte moulds as skin and nail foot mycosis agents: Phoma
herbarum, Chaetomium globosum and Microascus cinereus.181
5. Onychomycosis due to ascomycete Chaetomium globosum: a case report.182
6. Clavispora lusitaniae and Chaetomium atrobrunneum as rare agents of
cutaneous infection.183
7. Three isolations of Chaetomium globosum from erythematous epilation of canine
skin.184
8. Onychomycosis by Chaetomium spp.185
9. Chromoblastomycosis caused by Chaetomium funicola: a case report from Western
Panama.186
10. Invasive chaetomium infection in two immunocompromised pediatric patients.187
31
2. 7. The genus Coniothyrium
2.7.1. Coniothyrium fuckelii Sacc., (1878)
Synonyms:
Clisosporium fuckelii (Sacc.) Kuntze, (1898)
Microsphaeropsis fuckelii (Sacc.) Boerema, (2003)
Paraconiothyrium fuckelii (Sacc.) Verkley & Gruyter (2012)
Significance:
Coniothyrium fuckelii was reported as a cause of liver infection
and Coniothyrium species was reported as a cause of phaeohyphomycosis :
1. Liver infection caused by Coniothyrium fuckelii in a patient . 278
2. Phaeohyphomycosis caused by Coniothyrium279
.
31
2.8. The genus Paraconiothyrium
2.8.1. Paraconiothyrium cyclothyrioides Verkley (2004)
Significance:
Paraconiothyrium cyclothyrioides was reported as a cause of Cutaneous
Phaeohyphomycosis:
1. Cutaneous phaeohyphomycosis caused by Paraconiothyrium
cyclothyrioides. 280
2. Triple cutaneous mycosis (Cunninghamella bertholletiae, Phomopsis
spp. and Paraconiothyrium spp.) in an immonucompromised patient: a
Martinican case report281.
32
2.9. The genus Curvularia
The genus Curvularia contains several species, most of them are facultative
pathogens of plants, and cereals in tropical or subtropical areas, while the
remaining few are found in temperate zones. Curvularia may cause infections
in both humans and animals.
Morphology
Curvularia produces rapidly growing, woolly colonies on potato dextrose agar
at 25°C. From the front, the color of the colony is white to pinkish gray initially
and turns to olive brown or black as the colony matures. From the reverse, it is
dark brown to black. Curvularia produces septate, brown hyphae, brown
conidiophores, which are simple or branched and are bent at the points where
the conidia originate. The conidia are straight or pyriform, brown, multiseptate
with transverse septa, and have dark basal protuberant hila. The central cell is
typically darker and enlarged compared to the end cellsin and usually gives
the conidium a curved appearance.
The number of the septa in the conidia, the shape of the conidia (straight or
curved), the colour of the conidia (dark vs pale brown), existence of dark
median septum, and the prominence of geniculate growth pattern are the
major microscopic features that help in differentiation ofCurvularia spp. among
each other. For instance, the conidia of Curvularia lunata have 3 septa and 4
cells, while those of Curvularia geniculate mostly have 4 septa and 5 cells.
Curvularia can be easily distinguished from Bipolaris and Drechslera spp.
since the conidia are non-distoseptate, that is, septate from edge to edge of
the conidial wall. The teleomorphic state of the type species Curvularia
lunata is Cochliobolus lunatus.
33
2.9.1. Curvularia lunata (Wakker) Boedijn, 127 (1933)
Synonyms:
Acrothecium lunatum Wakker, (1898)]
Helminthosporium curvulum Sacc., (1916)
Helmisporium curvulum Sacc. (1916)
Curvularia lunata.
Pathogenicity
C. lunata is the most commonly encountered species. Importantly, the
infections may develop in patients with intact immune system. However,
similar to several other fungal genera, Curvularia has recently emerged also
as an opportunistic pathogen that infects immunocompromised hosts
Curvularia spp. are among the causative agents of:
1. phaeohyphomycosis,
2. wound infections,
3. mycetoma,
4. onychomycosis,
5. keratitis,
6. allergic sinusitis,
7. cerebral abscess,
8. cerebritis,
9. pneumonia,
10. allergic bronchopulmonary disease,
11. endocarditis,
12. dialysis-associated peritonitis, and
13. disseminated infections may develop due to Curvularia spp.
34
Recently reported cases
1. Curvularia infections: case reports and a review of the spectrum of disease along
with therapeutic options.93
2. Curvularia dermatomycosis in a jersey heifer: a case report94
3. Curvularia lunata: A rare cause of black-grain eumycetoma95
4. Curvularia abscess of the brainstem.96
5. Subcutaneous phaeohyphomycosis due to Curvularia lunata in a renal transplant
patient97
6. Curvularia brain abscess.98
7. Curvularia endophthalmitis following open globe injuries99
8. Cutaneous Curvularia infection of the forearm.100
9. Curvularia lunata endophthalmitis. 1101
10. Curvularia keratomycosis in a dog.102
11. Eosinophilic fungal rhinosinusitis due to the unusual pathogen Curvularia
inaequalis. 103
12. Human Curvularia infections: Report of five cases and review of the
literature.104
13. Fatal cerebral phaeohyphomycosis due to Curvularia lunata in an
immunocompetent patient105
35
2.10. The genus Epicoccum
Epicoccum is a dematiaceous mould widely distributed and commonly isolated
from air, soil and foodstuff. It is found also in some animals and textiles. It is
the common causative agent of leaf spots of various plants. There are no
documented
cases
of Epicoccum infection
in
humans
or
animals. Epicoccum is occasionally isolated from clinical samples.
However, Epicoccum has not been documented as a pathogen and these
isolates are considered as contaminants. The genus Epicoccum contains a
single species, Epicoccum purpurascens.
Morphology
Epicoccum grows rapidly and produces woolly to cottony or felty colonies on
potato dextrose agar at 25°C. The colonies are yellow to orange, orange to red
or pink initially and become greenish brown to black by aging. Epicoccum may
produce a diffusable pigment which turns the colour of the inoculated medium
to yellow, orange, red or brown. Black dots (100-2000 µm in diameter) may be
observed macroscopically on the colony surface. These are the tufts of hyphae
which have conidiophores on their surface. These tufts of hyphae are cushionshaped and nonconvoluted and are called sporodochia. Microscopically, the
fungus develops septate, short and yellow to brown in color hyphae. The
conidiophores that originate on hyphae form clusters, branch repeatedly and
are visible as dense masses and give rise to conidia, which are round, nonseptate, and pale in color. Mature conidia are rough, verrucose to warty, and
brown to black in color. They contain multiple transverse and vertical septa
and have a funnel-shaped base and attachment scar that is formed from
aggregated conidiophores on the sporodochium.
2.10.1. Epicoccum purpurascens Ehrenb., Sylvae (1818)
Synonyms:
Epicoccum versicolor var. purpurascens Rabenh. (1844)
Epicoccum nigrum Link (1816)
Epicoccum neglectum Desm. (1842)
Epicoccum granulatum Penz. (1882)
Thyrococcum humicola R.E. Buchanan (1911)
Epicoccum oryzae S. Ito & Iwadare, (1934)
Toruloidea tobaica Szilvinyi (1936)
Epicoccum mezzettii Goid. (1937
36
2.10.2. Epicoccum nigrum Link (1916)
Synonyms:
Epicoccum vulgare Corda (1837)
Epicoccum versicolor Rabenh (1844)
Epicoccum versicolor var. nigrum (Link) Rabenh (1844
Epicoccum purpurascens Ehrenb. (1818)
Epicoccum neglectum Desm (1842)
Epicoccum granulatum Penz. (1882)
Thyrococcum humicola R.E. Buchanan (1911)
Epicoccum oryzae S. Ito & Iwadare (1934)
Toruloidea tobaica Szilvinyi (1936)
Epicoccum mezzettii Goid. (1937)
Culture of Epicoccum nigrum.
Pathogenicity
Epicoccum is a cause of:
1.
2.
3.
4.
5.
Upper and lower respiratory tract disease.
Phaeohyphomycosis,
skin disease,
allergic fungal sinusitis.
Hypersensitivity pneumonitis
37
Recently reported cases:
1. Effect of proteolytic activity of Epicoccum purpurascens major allergen, Epi p1 in
allergic inflammation.386
2. Identification of Epicoccum purpurascens allergens by two-dimensional
immunoblotting and mass spectrometry.387
3. Biosynthesis of silver nanoparticles by the endophytic fungus Epicoccum nigrum and
388
their activity against pathogenic fungi.
.
2.11. The genus Exophiala
Exophiala is a genus that consists of more than 30 species. Traditionally,
these fungi are considered dematiaceous dimorphic fungi, due to their
phenotypic characteristics at the beginning of colony formation as “black
yeasts, and when the cultures mature, brown hyphae are formed which bear
conidiogenous cells referred to as annellides, a typical characteristic of this
genus of fungi.
Exophiala species are differentiated from Phialophora and Wangiella by the
formation of annelides rather than phialides.
Members of the genus Exophiala are difficult to classify and identify. Several
species have marked phenetic characteristics, such as the large conidiophores
of E. spinifera, or the thermotolerance and absence of nitrite assimilation in E.
dermatitidis. The majority of species, however, are morphologically variable,
due to their passage through complicated life cycles where diagnostic features
are variably expressed and, conversely, very similar microscopic structures
can be expressed in phylogenetically remote species. In recent years
diagnostic approaches have been supplemented by molecular tools,
particularly sequence data of the rRNA internal transcribed spacer (ITS)
regions.
Colonies are initially smooth, greenish-grey to black, mucoid and yeast-like,
becoming raised and developing tufts of aerial mycelium with age, often
becoming dome-shaped and suede-like in texture. Reverse is olivaceousblack. Numerous ellipsoidal, yeast-like, budding cells are usually present,
especially in young cultures. Scattered amongst these yeast-like cells are
larger, inflated, subglobose to broadly ellipsoidal cells (germinating cells)
38
which give rise to short torulose hyphae that gradually change into unswollen
hyphae. Conidia are formed on lateral pegs either arising apically or laterally at
right or acute angles from essentially undifferentiated hyphae or from strongly
inflated detached conidia. Conidiogenous pegs are 1-3 µm long, slightly
tapering and imperceptibly annellate. Conidia are hyaline, smooth, thin-walled,
broadly ellipsoidal, 3.2-4.4 x 1.2-2.2 µm, and with inconspicuous basal scars.
Cultures grow at 37C but not at 40C.
The followings are the main Exophiala species:
2.11.1. Exophiala jeanselmei (Langeron) McGinnis & A.A. Padhye (1977)
Synonyms:
Torula jeanselmei Langeron, (1928)
Pullularia jeanselmei (Langeron) Dodge, (1935)
Phialophora jeanselmei (Langeron) Emmons (1945)
Exophiala jeanselmei var. jeanselmei (1977)
2.11.2. Exophiala spinifera (H.S. Nielsen & Conant) McGinnis (1977)
Synonyms: Phialophora spinifera (1968)
Rhinocladiella spinifera (H.S. Nielsen & Conant) de Hoog, (1977)
39
Exophiala spinifera
2.11.3. Exophiala dermatitidis (Kano) de Hoog (1977)
Synonyms: Hormiscium dermatitidis Kano (1934)
Fonsecaea dermatitidis (Kano) Carrion (1950)
Hormodendrum dermatitidis(Kano) Conant (1954)
Phialophora dermatitidis (Kano) C.W.Emmons (1963)
Wangiella dermatitidis (Kano) McGinnis (1977)
2.11.4. Exophiala pisciphila McGinnis & Ajello (1974)
Synonymm: Aureobasidium salmonis (J.W. Carmich.) Borelli (1969)
41
2.11.5. Exophiala salmonis Carmich. (1966)
Synonyms: Aureobasidium salmonis (J.W. Carmich.) Borelli (1969)
Exophiala salmonis on the blood agar
41
2.11.6. Exophiala hongkongensis Woo, Ngan, Tsang, Ling, Chan, Leung,
Yuen, Lau (2013)
2.11.7. Exophiala xenobiotica de Hoog, J.S. Zeng, Harrak & Deanna A.
Sutton (2006))
Pathogenicity
Exophiala species are causative agents of :
1. mycetoma (especially for E. jeanselmei)
2. localized cutaneous infections
3. subcutaneous cysts,
4. endocarditis
5. keratitis
6. cerebral and disseminated infections.
7. Phaeohyphomycosis
8. mycetoma
42
Recently reported cases:
1. Clinical spectrum of exophiala infections and a novel Exophiala species,
Exophiala hongkongensis122
2. Massive contamination of Exophiala dermatitidis and E. phaeomuriformis in railway
stations in subtropical Turkey123
3. Exophiala dermatitidis endocarditis on native aortic valve in a postrenal transplant
patient and review of literature on E. dermatitidis infections.124
4. Pulmonary infection caused by Exophiala dermatitidis in a patient with multiple
myeloma: A case report and a review of the literature.125
5. Exophiala xenobiotica aerocystitis in a Queensland grouper Epinephelus lanceolatus
(Bloch)126
6. Exophiala jeanselmei keratitis: case report and review of literature.127
7. A case of phaeohyphomycosis caused by Exophiala oligosperma successfully
treated with local hyperthermia.128
8. A case of phaeohyphomycosis of the face caused by Exophiala oligosperma in an
immunocompromised host.129
9. Eumycetoma of the foot caused by Exophiala jeanselmei in a Guinean woman.130
10. Subcutaneous phaeohyphomycosis caused by Exophiala equina, with susceptibility
to eight antifungal drugs.131
11. An unusual case of eumycetoma caused by Exophiala jeanselmei after a sea urchin
injury.132
12. Cutaneous and mucosal phaeohyphomycosis caused by Exophiala spinifera in a
pregnant patient: case report and literature review133
13. Chronic disfiguring facial lesions in an immunocompetent patient due to
Exophiala spinifera: a case report and review of literature.134
14. A case of Exophiala spinifera infection in Southern Brazil: Molecular identification
and antifungal susceptibility.135
15. Cutaneous phaeohyphomycosis caused by Exophiala spinifera in a patient with
systemic lupus erythematosus.136
16. Subcutaneous phaeohyphomycosis due to Exophiala spinifera in an
immunocompromised host.137
17. Exophiala spinifera as a cause of cutaneous phaeohyphomycosis: case study and
review of the literature.138
18. Development of IgG antibodies to Exophiala dermatitidis is associated with
inflammatory responses in patients with cystic fibrosis.139
43
2.12. The genus Drechslera
Drechslera is a cosmopolitan dematiaceous fungus primarily isolated from
plants and soil. The Drechslera or Helminthosporium species are imperfect
filamentous fungi belonging to the class Deuteromycetes. The genus includes
a dozen of phytopathogenic species causing crop diseases grouped under the
term helminthosporiose.
The colonies are dark brown to black. The brown geneculate conidiophores
are simple or branched and produce small, brown multicellular conidia in a
sympodial mode. These isolated conidia are cylindrical or ellipsoidal, with
2.12.1. Drechslera biseptata (Sacc. & Roum.) M.J. Richardson & E.M.
Fraser, (1968)
Synonyms:
Helminthosporium biseptatum Sacc. & Roum. (1881)
Brachysporium biseptatum (Sacc. & Roum.) Sacc., (1886)
Marielliottia biseptata (Sacc. & Roum.) Shoemaker (1999)
Helminthosporium biforme Mason & Hughes, (1948)
Drechslera biforme (Mason & Hughes) Subram. & B.L. Jain (1966)
Pathogenicity
McGinnis et. al. (1986)106 have reviewed the Drechslera isolates from human
and animal disease and concluded that all pathogenic species are today
considered as members of the genera Bipolaris and Exserohilum.
However, Drechslera biseptata has recently been reported from a brain
abscess.
44
2.13. The genus Exserohilum
The genus is characterized by its conidia, which are ellipsoidal, distoseptate,
and have a protruding and truncate hilum. The genus Exserohilum may be
differentiated from the closely related genera Bipolaris and Drechslera by
forming conidia with a strongly protruding truncate hilum (i.e. exserted hilum).
The hilum is defined as "a scar on a conidium at the point of attachment to the
conidiophore". In Drechslera species, the hilum does not protrude whereas
in Bipolaris species the hilum protrudes only slightly.
2.13.1. Exserohilum rostratum (Drechsler) K.J. Leonard & Suggs (1974)
Synonyms: Helminthosporium rostratum Drechsler (1923)
Bipolaris rostrata (Drechsler) Shoemaker (1959)
Drechslera rostrata (Drechsler) M.J. Richardson & E.M. Fraser (1968)
Luttrellia rostrata (Drechsler) Gornostai, Vodorosli, Griby (1978)
Helminthosporium halodes Drechsler (1923)
Morphology
Exserohilum rostratum grows rapidly on potato dextrose agar and produces
woolly colonies that are pale initially but quickly become dark gray, to bluishblack to brownish-black with a black reverse. Hyphae are septate and brown.
Conidiophores are long, septate, simple (non-branched), geniculate, and
become paler near the apex. Conidia are various shades of brown and may
range from less than 80 to greater than 100 µ in length, may be straight to
distinctly curved, and contain 1 to over 12 septa. The feature all species share
is a strongly protruding hilum from the basal cell. Conidia may be slow to form
in culture.
45
Three species of Exserohilum have been recognized as human
pathogens: Exserohilum rostratum, E. longirostratum and E. mcginnisii.
Pathogenecity
The infections reported to be caused by Exserohilum species are:
1.
2.
3.
4.
5.
6.
7.
sinusitis
skin infections
cerebral abscesses
keratitis
osteomyelitis
prosthetic valve endocarditis
disseminated infection
Cases recently reported:
1. Exserohilum and the compounding pharmacy: pushing the envelope of virulence.188
2. Insights into fungal pathogenesis from the iatrogenic epidemic
of Exserohilum rostratum fungal meningitis.189
3. Rapid identification of antifungal compounds against Exserohilum rostratum using
high throughput drug repurposing screens.190
4. Mycotic keratitis caused by concurrent infections of Exserohilum mcginnisii and
Candida parapsilosis.191
5. Fungal disease following contaminated steroid injections: Exserohilum is ready for
its close-up.192
6. Exserohilum infections associated with contaminated steroid injections: a
clinicopathologic review of 40 cases.193
7. Real-world experience in the midst of an Exserohilum meningitis outbreak.194
8. Galactomannan testing for early diagnosis of Exserohilum rostratum infection.195
9. Real-time treatment guidelines: considerations during the Exserohilum rostratum
outbreak in the United States.196
10. Iatrogenic Exserohilum infection of the central nervous system: mycological
identification and histopathological findings.197
11. Exserohilum infection in an immunocompromised neonate.198
12. Keratomycosis caused by Exserohilum rostratum.199
46
2.14. The genus Fonseceae
The genus Fonsecaea is defined morphologically by the presence of indistinct
melanised conidiophores with blunt, scattered denticles bearing conidia singly
or in short chains that eventually become branched. de Hoog et al. (2004)107
revised the genus on the basis of ribosomal DNA internal transcribed spacer
(ITS) sequence data recognising two species; F. pedrosoi and F.
monophora. The previously described species F. compacta was found to be
a morphological variant of F. pedrosoi. Morphologically, F. pedrosoi and F.
monophora are very similar and can best be distinguished by genetic analysis.
According to AFLP fingerprinting, Fonsecaea isolates clustered in 5 groups
corresponding with F. pedrosoi, F. monophora, and F. nubica: the latter 2
species each comprised 2 groups, and F. pedrosoi appeared to be of
monophyletic origin (Najafzadeh et al., 2011)108
Colonies are slow growing, flat to heaped and folded, suede-like to downy,
olivaceous to black with black reverse. Conidiogenous cells pale olivaceous,
arranged in loosely branched systems, with prominent denticles. Conidia pale
olivaceous, clavate to ellipsoidal, in short chains, subhyaline, smooth and thinwalled, 3.5-5 x 1.5-2 µm. F. monophora on average has slightly longer
conidial chains and slightly shorter denticles than F. pedrosoi. All strains grow
at 37C but not at 40C.
2.14.1. Fonsecaea pedrosoi (Brumpt) Negroni (1936)
Synonyms: Hormodendrum pedrosoi Brumpt, (1922)
Acrotheca pedrosoi (Brumpt) Fonseca & Leão (1923)
Trichosporum pedrosoi (Brumpt) Brumpt (1927)
Trichosporum pedrosianum (Brumpt) M. Ota (1927)
Gomphinaria pedrosoi (Brumpt) C.W. Dodge (1935)
Hormodendroides pedrosoi (Brumpt) M. Moore & F.P. Almeida (1936)
Phialophora pedrosoi (Brumpt) Redaelli & Cif: 592 (1941)
Carrionia pedrosoi (Brumpt) Bric.-Irag (1942)
Rhinocladiella pedrosoi (Brumpt) Schol-Schwarz (1968)
Hormodendrum algeriense Montpell (1927)
Hormodendrum rossicum Jacz. & Merlin (1929)
Hormodendrum compactum Carrion (1935)
Phialoconidiophora guggenheimia M. Moore & F.P. Almeida (1936)
Fonsecaea compactum (Carrion) Carrion (1940)
Fonsecaea pedrosoi var. communis Carrion (1940)
Rhinocladiella compacta Carrion ex de Hoog, (1977)
47
2.14.2. Fonsecaea compacta (Carrion) Carrion (1940)
Synonyms: Hormodendrum compactum Carrion (1935)
Phialoconidiophora compacta (Carrion) M. Moore & F.P. Almeida (1936)
Fonsecaea compactum (Carrion) Carrion (1940)
Phialophora compacta (Carrion) Redaelli & Cif., Granul (1942)
Rhinocladiella compacta (Carrion) Schol-Schwarz (1968) [
Rhinocladiella compacta Carrion ex de Hoog (1977)
Hormodendrum pedrosoi Brumpt, (1922)
Hormodendrum algeriense Montpell (1927)
Hormodendrum rossicum Jacz. & Merlin (1929)
Phialoconidiophora guggenheimia M. Moore & F.P. Almeida (1936)
Fonsecaea pedrosoi var. communis Carrion (1940)
48
2.14.3. Fonsecaea monophora (M. Moore & F.P. Almeida) de Hoog,
Vicente & D. Attili, (2004)
Synonyms: Botrytoides monophora M. Moore & F.P. Almeida, (1936)
Pathogenicity
Fonsecaea is one of the causative agents of:
1. Chromoblastomycosis presents with papules and verrucose cauliflower-like lesions
most commonly on lower extremities.
2. Paranasal sinusitis.
3. Keratitis
4. Septic arthritis and osteomyelitis
5. Cerebral phaeohyphomycosis
Recently reported cases:
1. Fonsecaea nubica sp. nov, a new agent of human chromoblastomycosis revealed
using molecular data.140
2. Chromoblastomycosis caused by Fonsecaea: clinicopathology, susceptibility and
molecular identification of seven consecutive cases in southern China.141
3. Cerebral phaeohyphomycosis caused byFonsecaea monophora.142
4. Fonsecaea multimorphosa sp. nov, a new species ofChaetothyriales isolated from a
feline cerebral abscess.143
5. Fonsecaea pedrosoi: a rare etiology in fungal keratitis.144
6. Chromoblastomycosis mimicking tuberculosis verrucosa cutis: Look for copper
pennies145
49
7. Fungal infections of the central nervous system in the immunocompetent host 146
8. . Chromoblastomycosis in Australia: an historical perspective.147
9. Subcutaneous phaeohyphomycosis of the face presenting as
rhinoentomophthoramycosis.148
10. A. Revisiting the clinical and histopathological aspects of patients with
chromoblastomycosis from the Brazilian Amazon region.149
11. Chromoblastomycosis due to Fonsecaea pedrosoi and F. monophora in Cuba.150
12. Opportunistic Fonsecaea pedrosoi brain abscess in a patient with non-cirrhotic portal
fibrosis-induced hypersplenism--a novel association.151
13. Chromoblastomycosis caused by Fonsecaea: clinicopathology, susceptibility and
molecular identification of seven consecutive cases in Southern China.152
14. Chromoblastomycosis in Mainland China: a systematic review on clinical
characteristics153
15. Septic arthritis and osteomyelitis due to the chromoblastomycosis
agent Fonsecaea pedrosoi.154
16. Clinical, epidemiological and mycological report on 65 patients from the Eastern
Amazon region with chromoblastomycosis.155
17. A rare concomitant tubercular and Fonsecaea pedrosoi fungal infection of the skull
base.156
18. . A refractory case of chromoblastomycosis due to Fonsecaea monophora with
improvement by photodynamic therapy.157
51
2.15. The genus Hortaea
Hortaea werneckii is the only species of the genus. It is a dematiaceous yeast
that inhabits the soil, particularly in tropical and subtropical climates. It is
halophilic and has also been isolated from saltwater fish.
Hortaea werneckii is the causative agent of Tinea nigra. Tinea nigra is a
superficial infection of stratum corneum. The infection is mostly acquired via
direct inoculation of the fungus onto the skin due to contact with soil, wood,
and decaying vegetation. The lesions of tinea nigra are usually located on
palms but may occasionally involve other parts of the body, such as soles of
the feet. These lesions are typically brown to black, flat, not scaly, and with
irregular contours.
2.15.1.Hortaea werneckii (HORTA) Nishim. & Miyaji (1984)
Synonyms : Cladosporium werneckii HORTA 1921
Dematium werneckii DODGE 1935
Pullularia werneckii DE VRIES 1952
Exophiala werneckii (Horta) Arx, 180 (1970)
Phaeoannellomyces werneckii (Horta) McGinnis & Schell (1979)
Pullularia fermentans var. leaoi E.S. Wynne & Gott (1956)
The growth of H. werneckii in liquid media is often yeast-like, although it can
switch to filamentous growth. The mechanism of the switch is not known. The
cells appear brown because of melanin production.
The colonies of Hortaea werneckii grow slowly and are initially pale in color,
moist, shiny, and yeast-like. In time, these colonies become velvety, olive
black, and are covered with a thin layer of mycelium. From the reverse, the
color is black.
Microscopicically,
septate hyphae, (bicellular) yeast-like conidia, and
chlamydospores are observed. The yeast-like conidia (2-5 x 5-10 µm) are the
initial structures observed in the early phase of the colony development. These
cells have a round end and a tapered and elongated annelidic neck part. They
are hyaline initially and become pale olivaceous in time. Septate, thick-walled,
and brown hyphae (up to 6 µm wide) are formed as the colony ages. The
annelloconidia are formed at intercalary and lateral annellidic points along the
hyphae.
51
Hortaea
werneckii yeast colonies and cells
mould colonies
Recently reported cases:
mycelium
1. Bilateral Tinea Nigra of palm: a rare case report from Eastern India.158
2. Tinea nigra in an unusual anatomic location159
3. Tinea nigra: successful treatment with topical butenafine160.
4. Spontaneous cure in a case of Tinea nigra.161
5. Tinea nigra and dermoscopy.162
6. Dermoscopy improves diagnosis of tinea nigra: a study of 50 cases.163
7. Study of the dermatoscopic pattern of tinea nigra: report of 6 cases.164
8. Tinea nigra palmaris: a clinical case in Argentina165
9. Tinea nigra by Hortaea werneckii, a report of 22 cases from Mexico.166
10. A case of tinea nigra palmaris in Okinawa,167
11. Tinea nigra: report of twelve cases in Venezuela.168
12. The mycological and molecular study of Hortaea werneckii isolated from blood and
splenic abscess.169
13. The first isolation of Hortaea werneckii from a household guinea pig.177
52
2.16. The genus Lasiodiplodia
The genus Lasiodiplodia is a plant pathogen with a very wide host range. It
causes rotting and dieback in most species it infects. It is a common post
harvest fungus disease of citrus known as stem-end rot. On rare occasions it
has been found to cause Fungal keratitis, lesions on nail and subcutaneous
tissue. Colonies are grey to black, fluffy with abundant aerial mycelium;
reverse black. Pycnidia are simple or compound, often aggregated, stromatic,
ostiolate, up to 5 mm wide. Conidiophores are hyaline, simple, sometimes
septate, rarely branched cylindrical, arising from the inner layers of cells lining
the pycnidial cavity. Conidiogenous cells are hyaline, simple, cylindrical to
subobpyriform, holoblastic, annellidic. Conidia are initially unicellular, hyaline,
granulose, subovoid to ellipsoide-oblong, thick-walled, base truncate; mature
conidia one-septate, cinnamon to fawn, often longitudinally striate, 20-30 x 1015 µm.
2.16.1. Lasiodiplodia theobromae (Pat.) Griffon & Maubl (1909)
Synonyms:
Botryodiplodia theobromae Pat. (1892)
Diplodia theobromae (Pat.) W. Nowell (1923)
Lasiodiplodia tubericola Ellis & Everh. (1896)
Lasiodiplodia nigra Appel & Laubert (1907)
Pathogenicity
Lasiodiplodia theobromae has been associated with mycotic keratitis,
lesions on nail and subcutaneous tissue..
Recently reported cases:
1. Lasiodiplodia theobromae keratitis: a case report and review of literature.285
53
2. Maxillary sinusitis caused by Lasiodiplodia theobromae.286
3. Lasiodiplodia theobromae pneumonia in a liver transplant recipient.287
4. Mycotic keratitis and endophthalmitis caused by unusual
fungi:Lasiodiplodia theobromae288
2.17. The genus Lecythophora
The genus Lecythophora contains 6 species, with two species of medical
interest; L
hoffmannii and L.
mutabilis.
Lecythophora
spp are
a
filamentous fungus which is normally found as a commensal on rotting
vegetation . Colonies are flat, smooth, moist, pink to orange, with regular and
sharp margin; reverse pink. Hyphae are narrow, hyaline, producing conidia
laterally from small collarettes directly on the hyphae, or from lateral cells
which are sometimes arranged in dense groups; lateral cells flask-shaped or
nearly cylindrical. Collarettes are unpigmented, about 1.5 µm wide. Conidia
are hyaline, smooth and thin walled, broadly ellipsoidal to cylindrical or
allantoid, 3.0-3.5 x 1.5-2.5 µm, produced in slimy heads.
2.17.1. Lecythophora mutabilis (Beyma) Gams & McGinnis(1983)
Synonyms:
Margarinomyces mutabilis J.F.H. Beyma (1944)
Phialophora mutabilis (J.F.H. Beyma) Schol-Schwarz (197
2.17.2. Lecythophora hoffmannii (JBeyma) Gams & McGinnis (1983
Synonyms:
Margarinomyces hoffmannii J.F.H. Beyma *1939)
Phialophora hoffmannii (J.F.H. Beyma) Schol-Schwarz (1970)
Sporotrichum foliicola Oudem (1902)
Phialophora aurantiaca J.F.H. Beyma (1939)
Aureobasidium foliicolum (Oudem.) G.M. Muell. (1964)
Cephalosporium candidum var. arachnoides Sukapure & Thirum (1966)
54
Pathogenecity
Lecythophora hoffmannii has been associated with cases of:
1.
2.
3.
4.
subcutaneous infections,
keratitis,
sinusitis,
peritonitis.
5. gluteal abscess;
Dogs are thought to become infected from ingesting or inhaling conidial spores
while foraging, through skin wounds or when eating small amphibians and
reptiles. In dogs, chronic diarrhea is usually reported as a symptom of
infection, although lymphadenopathy and osteomyelitis have been reported[5].
Cases recently reported:
1. Lecythophora hoffmannii isolated from a case of canine osteomyelitis in Japan. 109
2. Scytalidium dimidiatum and Lecythophora hoffmannii: unusual causes of fungal
infections in a patient with AIDS110
3. Mixed infection caused by Lecythophora canina sp. nov. and Plectosphaerella
cucumerina in a German shepherd dog11
4. Recurrent Lecythophora mutabilis keratitis and endophthalmitis after deep anterior
lamellar keratoplasty112
5. Septic shock induced by Lecythophora mutabilis in a patient with mitochondrial
encephalomyopathy113
6. Lecythophora mutabilis prosthetic valve endocarditis in a diabetic patient.114
55
2.18. The genus Leptosphaeria
Leptosphaeria is a dematiaceous filamentous fungus found in the soil. It
has currently three defined species. Leptosphaeria species grows in its
teleomorphic phase. Colonies of Leptosphaeria grow slowly. The texture is
woolly and the front color is dark olive with a gray margin. The reverse color is
dark olive to black and is again surroundered by a grayish margin.
Microscopically, hyphae, cleistothecia, asci, and ascospores are observed.
Cleistothecia are without ostioles, globose to subglobose, and black in color.
They carry the asci inside. Asci are clavate to cylindrical and bitunicate. Each
ascus carries 8 ascospores inside. Ascospores are 4- to 9-celled, hyaline or
pigmented, fusoid to curved, and with a constriction at each
septum. Leptosphaeria thompkinsii forms ascospores with 6 septa and pointed
ends while ascospores of Leptospheria senegalensis have 4 septa and
rounded ends.
2.18.1. Leptosphaeria coniothyrium (Fuckel) Sacc. (1875)
Synonyms:
1.
2.
Sphaeria coniothyrium Fuckel (1870)
Melanomma coniothyrium (Fuckel) L. Holm (1957)
Diapleella coniothyrium (Fuckel) M.E. Barr(1986)
Kalmusia coniothyrium (Fuckel) Huhndorf (1992)
2.18.2. Leptosphaeria senegalensis Segretain, Baylet, Darasse &
Camain (1959)
Synonyms: Leptosphaeria thompkinsii El-Ani (1966)
2.18.3. Leptosphaeria thompkinsii El-Ani (1966)
Colonies of Leptosphaeria spp.
56
Microscopic features of Leptosphaeria spp.
Pathogenicity
Leptosphaeria spp. are the among the causative agents of:
1. mycetoma and
2. phaeohyphomycosis.
Leptosphaeria senegalensis mycetoma is seen mostly in Central Africa.
In cases with mycetoma, black and soft grains with pale centers are
observed. These grains are irregular in shape and about 1 mm in
diameter.
Recently reported cases:
1.Leptosphaeria Senegalensis Causing Mycetoma Pedis in Madras 283
2. Mycetoma in Yemen: clinicoepidemiologic and histopathologic study284
57
2.19. The genus Madurella
Madurella is a dematiaceous filamentous fungus found in soil, particularly in
tropical and subtropical areas of Africa, India, and South America. The
genus Madurella has two species; Madurella mycetomatis and Madurella
grisea.
2.19.1. Madurella mycetomatis (Laveran) Brumpt (1905)
Synonyms: Streptothrix mycetomatis Laveran (1902)
Madurella mycetomi (Laveran) Brumpt (1905)
Madurella americana Gammel, (1927)
Madurella ikedae Gammel (1927)
Madurella ikedai Gammel (1927)
Colonies are slow growing, flat and leathery at first, white to yellow to
yellowish-brown, becoming brownish, folded and heaped with age and the
formation of aerial mycelia. A brown diffusable pigment is characteristically
produced in primary cultures. Although most cultures are sterile, two types of
conidiation have been observed, the first being flask-shaped phialides that
bear rounded conidia, the second being simple or branched conidiophores
bearing pyriform conidia (3-5 um) with truncated bases. The optimum
temperature for growth of this mould is 37C.
58
2.19.2. Madurella grisea Mackinnon, Ferrada & Montemart (1949)
Colonies are slow growing, dark, leathery, folded with radial grooves and with
a light brown to greyish surface mycelium. With age colonies become dark
brown to reddish-brown and have a brownish-black reverse. Microscopically
cultures are sterile although hyphae of two widths have been described, thin at
1 to 3 um in width or broad at 3 to 5 um in width. The optimum temperature of
growth for M. grisea is 30C, it does not grow at 37C.
Pathogenicity
Madurella is pathogenic for humans and causes infections. Madurella spp. are
among the causative agents of human mycetoma.
Recently reported cases:
1. Mycetoma foot due to Madurella mycetomatis.227
2. Mycetoma caused by Madurella mycetomatis: a neglected infectious burden.228
3. Madurella mycetomatis infection following allogenic stem cell transplantation for
aplastic anemia.229
4. Eumycetoma by Madurella mycetomatis with 30 years of evolution: therapeutic
challenge.230
5. Clinical profile and management of craniocerebral Madurellamycetoma..231
6. Madurella mycetomatis as an agent of brain abscess: case report and review of
literature.232
7. Clinical profile and management of craniocerebral Madurella mycetoma.233
8. Mycetoma caused by Madurella mycetomatis: a completely neglected medico-social
dilemma.234
59
9. Peripheral blood mononuclear cells of mycetoma patients react differently
to Madurella mycetomatis antigens than healthy endemic controls235
10. Oral cavity eumycetoma: a rare and unusual condition.236
11. Madura foot237
12. A histopathological exploration of the Madurella mycetomatis grain.238
13. . A Rare Presentation of Concurrent Scedosporium apiospermum and Eumycetoma
in an Immunocompetent Host.239
14. In vitro antifungal activity of isavuconazole against Madurellamycetomatis.240
15. Mycetoma. Craniocerebral maduromycosis.241
16. Phylogenetic analysis of the complete mitochondrial genome of
Madurella mycetomatis confirms its taxonomic position within the order
Sordariales.242
17. Eumycetoma243
18. Analysis of 18 Tunisian cases of mycetoma at the Sousse hospital (1974-2010)244
19. MRI findings in cranial eumycetoma.245
20. New species of Madurella, causative agents of black-grain mycetoma.246
21. Mycetomas diagnosed in Senegal from 2008 to 2010247
22. Madurella mycetomatis mycetoma treated successfully with oral posaconazole.248
23. A chronic, destructive mycetoma infection in a diabetic foot in Saudi Arabia. 249
24. In vitro susceptibility of Madurella mycetomatis to posaconazole and terbinafine250
25. The safety and efficacy of itraconazole for the treatment of patients with eumycetoma
due to Madurella mycetomatis.251
26. Clinical and epidemiological features of mycetoma in Morocco252
27. Mycetoma in Tunisia: a 15-case series253
28. Bilateral mycetoma--a case report.254
29. Madurella mycetoma--a rare case with cranial extension.255
61
2.20. The genus Myrothecium
This genus contains 8 species. The Myrothecium species are ubiquitous plant
pathogens, but are also found on many substrates containing cellulose such
as paper, cotton, textiles and plant debris. The Myrothecia have a significant
industrial interest in the production of cellulase and are used as a biopesticide
to control weeds and nematode population.
The fungus produces moist black or green colonies surrounded by a flaky
white margin. The conidiophores, aggregated in superficial pads
(sporodochia), bear cylindrical and densely grouped hyaline phialides. The
unicellular and smooth conidia, fusiform or cylindrical, have a fan appendix
Their moist colonies are black or green surrounded by a flaky white margin.
The conidiophores, aggregated in superficial pads (sporodochia), bear
cylindrical and densely grouped hyaline phialides. The unicellular and smooth
conidia, fusiform or cylindrical, have a fan appendix.
2.20.1. Myrothecium verrucaria (Alb. & Schwein.) Ditmar, (1813)
Synonyms:
Peziza verrucaria Alb. & Schwein., (1805)
Gliocladium fimbriatum J.C. Gilman & E.V. Abbott, (1927)
Metarhizium glutinosum S.A. Pope, Mycologia 36: 343 (1944)
Myrothecium verrucaria
61
2.20.2. Myrothecium roridum Tode, (1790)
Synonyms: Dacrydium roridum (Tode) Link, (1809)
Gliocladium nigrum Moreau & V. Moreau, (1941)
Myrothecium roridum
Pathogenecity
They have a pathogen capacity related to the production of mycotoxins
(trichothecenes, Deoxytrichoverrins, etc.).
2.21. The genus Nattrassia
2.21.1. Nattrassia mangiferae (Syd. & P. Syd.) B. Sutton & Dyko (1989)
Synonyms:
Dothiorella mangiferae Syd. & P. Syd (1916)
Fusicoccum mangiferae (Syd.&P.Syd.) Johnson, Slippers & Wingf. (2005)
Fusicoccum mangiferum (Syd.& P.Syd.) Johnson, Slippers & Wingf. (2005)
Fusicoccum mangiferae (Syd.& P.Syd.) Johnson, Slippers & Wingf., (2005)
Neofusicoccum mangiferae (Syd.& P.Syd.) Crous, Slippers & Phillips (2006)
Fusicoccum eucalypti Sousa da Câmara (1929)
Hendersonula cypria Nattrass (1937)
Exosporina fawcettii E.E. Wilson (1947)
Hendersonula agathidis H.E. Young (1948)
62
Microscopic morphology of the Scytalidium dimidiatum synanamorph of Nattrassia mangiferae showing
chains of one- to two-celled, darkly pigmented arthroconidia.
Cultures are effuse, hairy, dark grey to blackish-brown, or white to greyish,
with a cream-coloured to deep ochraceous-yellow colony reverse. Colourless
(hyaline) Microscopically, the fungus shows chains of one- to two-celled,
darkly pigmented arthroconidia, 3.5-5 x 6.5-12 µm, produced by the holothallic
fragmentation of undifferentiated hyphae.
Pathogenecity: Nattrassia mangiferae is a recognised agent of:
1.
2.
3.
4.
5.
6.
onychomycosis
Dermatomycosis
Keratitis
Cerebral phaeohyphomycosis
Disseminated infection
endophthalmitis.
Recently reported cases
A case of sinusitis caused by nattrassia mangiferae in iran328
Nattrassia mangiferae keratitis after laser in situ keratomileusis329
An uncommon agent of onychomycosis.330
Dermatomycoses caused by Nattrassia mangiferae in Sao Paulo, Brazil. 331
Nattrassia mangiferae causing fungal keratitis.332
Onychomycosis in São Paulo, Brazil.333
First case of cerebral phaeohyphomycosis caused by Nattrassia mangiferae in
Iran.334
8. Nattrassia mangiferae keratitis after laser in situ keratomileusis.335
9. Disseminated infection with Nattrassia mangiferae in an immunosuppressed
patient.336
10. Case report. Nattrassia mangiferae endophthalmitis.337
338
11.
Post-traumatic fatal Nattrassia mangiferae orbital infection.
1.
2.
3.
4.
5.
6.
7.
63
2.22.The genus Ochroconis
The genus Ochroconis lacks a known sexual state and thus belongs to the
Fungi Imperfecti. It is generally classified as a dematiaceous (dark-walled)
fungus. It contains the following species:
2.22.1. Ochroconis gallopava (W.B. Cooke) de Hoog (1983)
Synonyms: Diplorhinotrichum gallopavum W.B. Cooke (1964)
Dactylaria gallopava (W.B. Cooke) G.C. Bhatt & W.B. Kendr. (1968)
Dactylaria constricta var. gallopava (W.B. Cooke) Salkin & Dixon, (1987)
Colonies are smooth to suede-like, dry, flat, tobacco-brown to brownish-black
with a dark brown diffusible pigment. Hyphae are brown with relatively thick
walls. Conidiophores are mostly cylindrical to acicular, sometimes poorly
differentiated, bearing a few conidia at the tip. Conidia are two-celled,
subhyaline to pale brown, smooth-walled to verrucose, cylindrical to clavate,
constricted at the septum, 11-18 x 2.5-4.5 µm in size, with the apical cell wider
than the basal cell. A remnant of a denticle may also be seen at the conidial
base. Optimum growth at 35C, tolerant to 40C.
64
2.22.2. Ochroconis anomala
2.22.3. Ochroconis constricta
Synonyms:
Dactylaria constricta var. constricta
Heterosporium terrestre .
Scolecobasidium constrictum
2.22.4. Ochroconis humicola
Synonyms: Scolecobasidium humicola
O. constricta
O. humicola
Health significance
1. Epidemic fatal encephalitis in fowls, turkeys, and poults
2. In human, Ochroconis gallopava’s most common targets are respiratory
system and central nervous system and also affects skin, joints, muscles,
liver, spleen, thyroid, and other parts of the body.
3. Ochroconis gallopava cause phaeohyphomycosis which is a tissue infection
forming scab-like black colored lesions in affected organs including
skin, acute or chronic inflammation, microabscess, fibrosis, granuloma, and
necrosis as well.
65
Economic significanc215
Ochroconis anomala is in 2012. It was isolated from the black stains that
appeared on the walls of Lascaux Cave in France. The species was
discovered along with a closely related O. lascauxensis. The species are
regarded as a threat to the prehistoric paintings of the cave. The fungus was
honoured as one of the "Top 10 New Species" discovered in 2012 selected by
the International
Institute
for
Species
Explorationat Arizona
State
University among more than 140 nominated species. The uniqueness is its
recent emergence and serious threat to the cave painting. The selection was
declared on 22 May 2013.
An example of the cave painting in the Lascaux Cave
Recently reported cases:
1. Disseminated Ochroconis gallopava infection in a heart transplant patient. 200
2. Ochroconis gallopava infection in a patient with chronic granulomatous disease: case
report and review of the literature.201
3. First report of subcutaneous phaeohyphomycosis caused
byOchroconis tshawytschae in an immunocompetent patient. 202
4. Ochroconis gallopava: a dematiaceous mold causing infections in transplant
recipients. 203
5. Ochroconis gallopava peritonitis in a cardiac transplant patient on continuous
ambulatory peritoneal dialysis.204
6. Ochroconis calidifluminalis, a sibling of the neurotropic pathogen O. gallopava,
isolated from hot spring.205
7. Transplant-associated Ochroconis gallopava infections. 206
8. Epidemiology of central nervous system mycoses. 207
9. Pathogenicity of Ochroconis gallopava isolated from hot springs in Japan and a
review of published reports. 208
10. Fatal systemic phaeohyphomycosis caused by Ochroconis gallopavum in a dog
(Canis familaris).209
66
11. Rapid identification of Ochroconis gallopava by a loop-mediated isothermal
amplification (LAMP) method. 210
12. Pemphigus patient with pulmonary fungal infection caused byOchroconis gallopava:
the first case report in China211
13. Infections due to dematiaceous fungi in organ transplant recipients: case report and
review. 212
14. Phaeohyphomycosis caused by Dactylaria (human dactylariosis): report of a case
with review of the literature. 213
15. Subcutaneous abscesses caused by Ochroconis gallopavum214
16. Two new species of the genus Ochroconis, O. lascauxensis and O. anomala isolated
from black stains in Lascaux Cave, France.215
2.23. The genus Phialemonium
The genus was created to accommodate taxa intermediate to
Acremonium and Phialophora. It contains several species, of which 2 species
have health significance, namely P. curvatum and P. obovatum. This genus is
characterized by its abundance of adelophialides and few discrete phialides
with no signs of collarettes.
2.23.1. Phialemonium curvatum W. Gams & W.B. Cooke (1983)
Synonym: Phialemoniopsis curvata H. Perdomo, D. García, Gené, Cano & Guarro (2013)
67
2.23.2. Phialemonium obovatum W. Gams & McGinnis (1983)
Pathogenecity
1.
2.
3.
4.
5.
6.
7.
Arthritis
Endocarditis
Endophthalmitis
Subcutaneous infection
Infection in patients undergoing hemodialysis.
Infection of the lower spine
respiratory system
Recently reported cases:
1. Phialemonium infection complicating chronic suppurative otitis media.339
2. Phialemonium obovatum keratitis after penetration injury of the cornea.340
3. Phialemonium curvatum fungaemia in an immunocompromised patient: case report.341
4. Phialemonium curvatum infection after phacoemulsification: a case report.342
5. Molecular and phenotypic characterization of Phialemonium and Lecythophora isolates
from clinical samples.343
6. Infections due to Phialemonium species: case report and review.344
7. Pulmonary Phialemonium curvatum phaeohyphomycosis in a standard poodle dog.345
8. Lung infection due to opportunistic fungus, Phialemonium obovatum, in a bone marrow
transplant recipient: an emerging infection with fungemia and Crohn disease-like
involvement of the gastrointestinal tract.346
9. Fatal endocarditis in a neonate caused by the dematiaceous
fungus Phialemonium obovatum: case report and review of the literature.347
10. Phialemonium curvatum infection after bone marrow transplantation.348
11. Disseminated infection with Phialemonium obovatum in a German shepherd dog.349
12. Osteolytic phaeohyphomycosis caused by Phialemonium obovatum350
68
2.24. The genus Phialophora
The genus Phialophora contains more than 40 species, most are saprophytes
commonly found in soil or on decaying wood. Morphological features, such as
the shape of the collaretes, organization of the phialides, existence of
chlamydospores, and biochemical features, such as the assimilation of
melibiose help in differentiation of the species from each other. However, the
following
species
have
been
documented
as
causing
either
chromoblastomycosis or phaeohyphomycosis :
1.
2.
3.
4.
5.
6.
7.
8.
Phialophora americana
Phialophora bubakii
Phialophora europaea
Phialophora parasitica
Phialophora reptans
Phialophora repens
Phialophora richardsiae
Phialophora verrucosa
Morphology
Colonies of Phialophora grow moderately slowly and attain a diameter of 2 3
cm following an incubation of 7 days at 25°C. The texture is wooly to velvety
and may be heaped and granular in some strains. From the front, the color is
initially white and later becomes dark grey-green, brown or black. From the
reverse, it is iron grey to black. Microscopically, members of the
genus Phialophora produce clusters of single-celled conidia in basipetal
succession from characteristic flask-shaped or cylindrical phialides which have
distinctive collarettes. Conidia are hyaline to olivaceous brown, smoothwalled, ovoid to cylindrical or allantoid, and usually aggregate in slimy heads at
the apices of the phialides, which may be solitary, or in a brush-like
arrangement.
69
2.24.1. Phialophora verrucosa Medlar (1915)
Synonyms: Phialophora calyciformis G. Sm. (1962)
Cadophora richardsiae Nannf (1934)
Cadophora brunnescens R.W. Davidson (1935)
Phialophora richardsiae (Nannf.) Conant (1937)
Cadophora richardsiae Nannf (1934)
Cadophora brunnescens R.W. Davidson (1935)
Phialophora calyciformis G. Sm (1962)
Pleurostomophora richardsiae (Nannf.) Mostert, Gams & Crous, (2004)
P. verrucosa.
2.24.2. Phialophora richardsiae (Nannf.) Conant (1937)
Synonyms: Cadophora richardsiae Nannf. (1934)
Pleurostomophora richardsiae (Nannf.) Mostert, Gams & Crous, (2004)
Cadophora brunnescens R.W. Davidson (1935)
Phialophora calyciformis G. Sm (1962)
Phialophora verrucosa
71
2.24.3. Phialophora parasitica Ajello, Georg & C.J.K. Wang (1974)
Synonym:
Haeoacremonium parasiticum (Ajello, Georg & Wang) W. Gams, Crous & Wingf.(1996)
Phialophora parasitica
2.24.4. Phialophora repens (Davidson) Conant (1935)
Synonyms:
Cadophora repens Davidson, (1935)
Pleurostomophora repens (Davidson) Mostert, Gams & Crous (2004)
Phialophora repens
71
2.24.5. Phialophora europaea de Hoog, Mayser & Haase, (2000)
Synonym: Cyphellophora europaea (de Hoog, Mayser & Haase) Réblová & Unter., (2013)
Phialophora europaea
Pathogenicity
Phialophora species cause the following clinical forms:
1. cutaneous infections,
2. nail infections
3. subcutaneous cysts,
4. keratitis,
5. endocarditis,
6. arthritis,
7. osteomyelitis,
8. cerebral infection,
9. fatal hemorrhage, and
10. disseminated infection. Phialophora europaea has been isolated from cutaneous and
nail infections in North-western Europe
Recently reported cases:
1. Phialophora verrucosa as a cause of deep infection following total knee arthroplasty.
216
2. Generalized chromomycosis caused by Phialophoraverrucosa. 217
3. Generalized subcutaneous phaeohyphomycosis caused by Phialophora verrucosa:
report of a case and review of literature.218
4. Recalcitrant primary subcutaneous phaeohyphomycosis due to
Phialophora verrucosa.219
5. In vitro activities of nine antifungal drugs against 81Phialophora and Cyphellophora
isolates. 220
6. Endophthalmitis caused by Phialophora verrucosa: a case report and literature
review of Phialophora ocular infections. 221
72
7. Endophthalmitis caused by Phialophora verrucosa and Streptococcus intermedius: a
case report. 222
8. Chromoblastomycosis Caused by Phialophora richardsiae.223
9. Chronic fistula of the forefoot in a Moroccan man: bone chromomycosis due
to Phialophora verrucosa.224
10. Subcutaneous phaeohyphomycosis (mycotic cyst.225
11. A new species, Phialophora europaea, causing superficial infections in humans. 226
2. 25. The genus Phoma
Phoma is a dematiaceous filamentous fungus that inhabits the soil and plant
material. Phoma species are cosmopolitan in nature and are common
plant.pathogens. Phoma species may rarely cause infections in humans. The
genus Phoma contains several species. Colour of the colony, morphology of
the conidia, existence and structure of chlamydospores help in differentiation
of the species from each other.
2.25.1. Phoma herbarum Westend.,(1852)
Synonyms:
Phoma oleracea Sacc., (1880)]
Aposphaeria violacea Bertel, (1904)
Phoma pigmentivora Massee,(1911)
Phoma hibernica Grimes, M. O'Connor & Cummins, (1932)
Phoma lignicola Rennerf (1937)
Pyrenochaeta mali M.A. Sm., (1963)
Morphology
Phoma develops rapidly growing flat, spreading, powdery to velvety, and often
largely submerged colonies in the medium. Colonies are initially white and
later become olive grey in colour with an occasional tint of pink. The reverse is
dark brown to black. Some species (particularly, Phoma crurishominis and Phoma herbarum) produce a reddish-purple to yellowish-brown
diffusable pigment which is readily visible from the reverse. Microscopically,
the fungus develops septate, hyaline to brown hyphae, round to pyriform large
pycnidia, have one to several openings (ostioles) on their surface from which
the conidia are released outside. Conidia are unicellular, hyaline, and ovalshaped. Each conidium typically has two oil droplets inside.
73
Some Phoma species produce brown chlamydospores that are arranged
singly or in chains. These chlamydospores may be unicellular or multicellular
as in Alternaria.
Colonies of phoma species
Pycnidia of Phoma.
Pathogenicity
Phoma species may cause:
1.
2.
3.
4.
cutaneous,
subcutaneous,
corneal or
systemic.
Recently reported cases:
1. Screening of different species of Phoma for the synthesis of silver nanoparticles351
2. Unusual mould infection in the human stratum corneum.352
3. Subcutaneous phaeohyphomycosis caused by Phoma cruris-hominis in renal
transplant patient.353
4. Subcutaneous abscess caused by Phoma sp. resembling Pyrenochaeta rameroi.
Uniques fungal infection occuring in immunosuppressed recipient of renal
allograft.354
74
2.26. The genus Pithomyces
The genus Pithomyces contains 15 species commonly found on litter and soil,
however, one species, Pithomyces chartarum is often involved with facial
eczema of sheep.
2.26.1. Pithomyces chartarum (Berk. & M.A. Curtis) M.B. Ellis (1960)
Synonyms: Sporidesmium chartarum Berk. & M.A. Curtis (1874)
Piricauda chartarum (Berk. & M.A. Curtis) R.T. Moore (1959)
Sporidesmium bakeri Syd. & P. Syd. (1914)
Colonies are fast growing, dark grey to black, suede-like to downy and
produce darkly pigmented, multicellular conidia (phragmo- or dictyoconidia)
formed on small peg-like branches of the vegetative hyphae. Conidia are
broadly elliptical, pyriform, oblong, and commonly echinulate or
verrucose. Spores (conidia) produced at the apex of short side branches of
the vegetative filaments, dark brown, 2- to several-celled. When the spores are
released they retain a small portion of the cell that produced them. The spores
of P. chartarum, the most commonly isolated species, have both longitudinal
and transverse walls.
Pathogenecity
Pithomyces chartarum occurs worldwide but is a problem predominantly where
farm animals are intensively grazed, especially in New Zealand. The spores of
the fungus release the mycotoxin sporidesmin in the gastrointestinal tract,
75
causing a blockage in the bile ducts that leads to injury of
the liver. Bile, chlorophyll and other waste products consequently build up in
the bloodstream causing photo sensitivity of the skin especially that exposed
to direct sunlight. This in turn causes severe skin irritation that the animal
attempts to relieve by rubbing its head against available objects, resulting in
peeling of the skin.
Recently reported cases:
1. Mycotoxicoses of ruminants and horses355
2. The effect of zinc oxide and elemental zinc boluses on the concentrations of Zn in
serum and faeces, and on providing protection from natural Pithomyces chartarum
challenge in sheep.356
3. First case of pithomycotoxicosis (facial eczema) in the Netherlands358
4. Pithomycotoxicosis (facial eczema) in ruminants in the Azores, Portugal. 359
5. Putative sporidesmin toxicity in an Eastern Grey kangaroo (Macropus giganteus). 360
2. 27. The genus Pyrenochaeta
Pyrenochaeta is a filamentous fungus that inhabits the soil and plant debris,
particularly in tropical climates. The genus Pyrenochaeta contains four active
species;
1.
2.
3.
4.
Pyrenochaeta romeroi.
Pyrenochaeta keratinophila
Pyrenochaeta mackinnonii,
Pyrenochaeta unguis-hominis,
Many isolates previously identified as Madurella grisea have been
reidentified as Pyrenochaeta romeroi,
some authorities believe that Pyrenochaeta romeroi should be
classified in the genus Phoma.
Morphology
Colonies grow moderately rapidly. They are flat and woolly to cottony; the
color is white initially and becomes olivaceous green to olivaceous gray;
everse is dark. Microscopically, there are septate, hyaline to subhyaline
76
hyphae, pycnidia, and conidia. Pycnidia are globose to flask-shaped,
ostiolate, brown to black and have setae. Phialides arise from the inner lining
of the pycnidia. Conidia (2-4 x 1-2 µm) are one-celled, oval to cylindrical,
hyaline, and straight or slightly curved
2.27.1. Pyrenochaeta romeroi Borelli (1959)
Synonym: Medicopsis romeroi (Borelli) Gruyter, Verkley & Crous (2012)
Colony of Pyrenochaeta romeroi
Pycnidium
ellipsoidal to bacilliform conidia
2.27.2. Pyrenochaeta keratinophila Verkley, C. Ferrer & Gené (2009)266
Pyrenochaeta keratinophila pycnidium
mycelium
77
conidia
Pathogenicity
1. Pyrenochaeta romeroi has been isolated from cases with mycetoma. The grains are
soft, irregular, and black with a subhyaline center.
2. Pyrenochaeta unguis-hominis has been isolated from the infected nails of some
cases.
Recently reported cases:
1. Pyrenochaeta keratinophila sp. nov., isolated from an ocular infection in Spain. 266
2. Subcutaneous phaeohyphomycotic cyst caused by Pyrenochaeta romeroi. 267
3. Molecular diagnosis and therapeutic experience of
subcutaneous Pyrenochaeta romeroi infection: a case report and review of the
literature.268
4. Draft Genome Sequence of Dematiaceous Coelomycete Pyrenochaeta sp. Strain UM
256, Isolated from Skin Scraping269
5. Phaeohyphomycosis caused by Pyrenochaeta romeroi mimicking a plantar wart in a
kidney transplant recipient.270
6. Pyrenochaeta romeroi: a causative agent of phaeohyphomycotic cyst.271
7. Subcutaneous phaeohyphomycotic cyst caused by Pyrenochaeta romeroi.272
8. Isolation, identification and susceptibility of Pyrenochaetaromeroi in a case of
eumycetoma of the foot in the UK.273
9. New pyrenochaeta species causing keratitis274
78
2.28. The genus Pythium
Pythium spp. are plant pathogens that produce motile oospores. Organisms of
this genus are sometimes called aquatic fungi, but they really are not
considered to be true fungi. The genus Pythium contains over 120
morphological species with a unique degree of ecological specialization that
include important plant pathogens, parasites of a diversity of organisms in
aerial and water environments and saprophytes that subsist on dead organic
material. Pythium species are often studied as part of medical mycology due
to their ability to produce a chronic granulomatous process in which one sees
hyphal structures. The disease is sometimes called "swamp cancer" due to its
association with water exposure. In animals they cause cutaneous lesions in
cats and dogs, in horses rhere may be bone involvement. Pythyum insidiosum
is the agent of swamp cancer of horses and phythiosis in man. Pythium, like
others in the family Pythiaceae, are usually characterized by their production
of coenocytic hyphae, hyphae without septations. Oogonia generally contain a
single oospore. Antheridia contain an elongated and club-shaped antheridium
2.28.1. Pythium insidiosum De Cock, L. Mend., A.A. Padhye, Ajello &
Kaufman (1987)
Synonym: Hyphomyces destruens C.H. Bridges & C.W. Emmons (1961)
79
Pathogenecity:
Pythyum insidiosum causes the followings:
1.
2.
3.
4.
Vascular pythiosis
Cutaneous pythiosis
gastrointestinal pythiosis
keratitis
Recently reported cases:
1. In vitro susceptibility of zoospores and hyphae of Pythium insidiosum to
antifungals.361
2. Photodynamic Therapy in Pythium insidiosum - An In Vitro Study of the Correlation
of Sensitizer Localization and Cell Death.362
3. Vascular pythiosis in a thalassemic patient presenting as bilateral leg ulcers. 363
4. Cutaneous pythiosis in two dogs from Wisconsin, USA.364
5. Evaluation for the clinical diagnosis of Pythium insidiosum using a single-tube nested
PCR.365
6. Canine gastrointestinal pythiosis treatment by combined antifungal and
immunotherapy and review of published studies.366
7. Long-term follow-up after successful treatment of Pythium insidiosum keratitis in
Israel.367
8. Pathology of nasal infection caused by Conidiobolus lamprauges
and Pythium insidiosum in sheep.368
9. Iron chelation therapy as a treatment for Pythium insidiosum in an animal model.369
10. Pythiosis of the digestive tract in sheep.370
11. [Pythium insidiosum ocular infection].371
12. Outbreak of Pythium keratitis during rainy season: a case series.372
13. Treatment of pythiosis in equine limbs using intravenous regional perfusion of
amphotericin B.373
14. Treatment of intestinal pythiosis in a dog with a combination of marginal excision,
chemotherapy, and immunotherapy.374
15. Equine pythiosis: report in crossed bred (Criole Venezuelan) horses.375
16. Dual infection with Pythium insidiosum and Blastomyces dermatitidis in a dog.376
81
2. 29. The genus Ramichloridium
Ramichloridium contains about 25 species that are usually associated with
forest litter and rotting wood, however the genus contains one species of
medical interest : Ramichloridium schulzeri .The remaining species of
medical importance were considered as synonyms of Rhinocladiella as in:
1. Ramichloridium cerophilum: synonym of Rhinocladiella aquaspersa
1. Ramichloridium mackenziei synonym of Rhinocladiella mackenziei
2. Ramichloridium obovoidea: synonym of R. mackenziei
3. Ramichloridium obovoiedum: synonym of R. mackenziei
Colonies grow moderately rapidly, consisting of a compact, flat, submerged,
pale orange, locally with some powdery, brownish aerial mycelium; reverse
pink to orange. Conidiophores are erect, straight, unbranched, thick-walled,
reddish-brown, up to 250 µm high, gradually becoming paler towards the apex,
of variable length, elongating sympodially during conidiogenesis, with
scattered, pimple-shaped conidium bearing denticles which have unpigmented
scars. Conidia are subhyaline, smooth-walled or slightly rough-walled,
ellipsoidal, obovoidal or fusiform, 6.5-10.0 x 3-4 µm, usually with an acuminate
base and unpigmented scars.
2.29.1. Ramichloridium schulzeri (Sacc.) de Hoog (1977)
Synonyms:
Chloridium schulzerii (Sacc.) Sacc. (1884)
Psilobotrys schulzerii Sacc. (1884) (1884)
Psilobotrys schulzeri Sacc. (1884)
Chloridium schulzeri (Sacc.) Sacc (1886)
Rhinocladiella schulzeri (Sacc.) Matsush. (1975)
Acrotheca acuta Grove, (1916)
Rhinotrichum multisporum Doguet, (1952)
Myrmecridium schulzeri (Sacc.) Arzanlou, W. Gams & Crous, (2007)
81
Pathogenecity
Ramichloridium schulzeri is one of the causes of phaeohyphomycosis.
Recently reported cases:
1.
Aspiration cytology of brain abscess from a fatal case of cerebral
phaeohyphomycosis due to Ramichloridium mackenziei.275
2.
Cerebral phaeohyphomycosis caused by Ramichloridium mackenziei in the
Eastern Province of Saudi Arabia.276
3.
Successful therapy of cerebral phaeohyphomycosis due to
Ramichloridium mackenziei with the new triazole posaconazole.277
82
2. 30. The genus Rhinocladiella
Rhinocladiella is a cosmopolitan fungus which can be found in soil,
herbaceous
substrates,
and
decaying
wood. The genus
Rhinocladiella comprises 8 species, 3 of which are accepted
namely, Rhinocladiella
aquaspersa,
Rhinocladiella
atrovirens and
Rhinocladiella mackenziei , while the remaining five species have been
obsolete and have been only considered by experts as synonyms for a few
species under Fonsecaea and Exophiala genera.
1. Rhinocladiella aquaspersa
2. Rhinocladiella atrovirens
3. Rhinocladiella mackenziei
4. Rhinocladiella compactum
a synonym of Fonsecaea compacta
5. Rhinocladiella mansonii
a synonym of Exophiala castellanii
6. Rhinocladiella pedrosoi
a synonym of Fonsecaea pedrosoi
7. Rhinocladiella schulzeri
a synonym of Ramichloridium schulzeri
8. Rhinocladiella spinifera
a synonym of Exophiala spinifera
2.30.1. Rhinocladiella aquaspersa (Borelli) Schell, McGinnis & Borelli
(1983)
Synonym: Acrotheca aquaspersa Borelli (1972)
Colonies are slow growing, velvety, dark green to black in colour.
Microscopically, septate hyphae, black, thin-walled, slightly roughened
hyphae. Conidiophore are poorly differentiated with__ branched, thick-walled,
brown intercalary conidiogenous cells, cylindrical in the apical part
of __ conidiophore. Conidia are hyaline having thin, ellipsoidal walls.
__
83
2.30.2. Rhinocladiella mackenziei (Campb. & Al-Hedaithy) Arzanlou &
Crous (2007)
Synonym: Ramichloridium mackenziei C.K. Campb. & Al-Hedaithy (1993)
2.30.3. Rhinocladiella atrovirens Nannf., (1934)
Melanchlenus eumetabolus Calandron (1953]
Melanchlenus cumetabolus Calandron (1953)
84
Health significance:
Rhinocladiella species are causative agents of Chromoblastomycosis.
Recently reported cases:
1. Chromoblastomycosis caused by Rhinocladiella aquaspersa.256
2. The first case of phaeohyphomycosis caused by Rhinocladiella basitona in an
immunocompetent child in China.257
3. Cerebral phaeohyphomycosis due to Rhinocladiellamackenziei (formerly
Ramichloridium mackenziei): case presentation and literature review.258
4. Rhinocladiella mackenziei as an emerging cause of cerebral phaeohyphomycosis in
Pakistan: a case series259
5. Co-existence of cerebral infection with Rhinocladiellamackenziei and primary central
nervous system lymphoma in a HIV-negative patient.260
6. Cerebral phaeohyphomycosis caused by Rhinocladiella mackenziei in a woman
native to Afghanistan.261
7. First autochthonous case of Rhinocladiella mackenziei cerebral abscess outside the
Middle East.262
8. Cerebral phaeohyphomycosis due to Rhinocladiellamackenziei (formerly
Ramichloridium mackenziei): a taxonomic update and review of the literature. 263
9. In vitro activities of antifungal drugs against Rhinocladiellamackenziei, an agent of
fatal brain infection.264
10. Cerebral Phaeohyphomycosis Caused by Rhinocladiella mackenziei in a Woman
Native to Afghanistan.265
85
2. 31. The genus Scedosporium
The genus Scedosporium contains two species:
1. Scedosporium apiospermum
2. Scedosporium prolificans.
Pseudallescheria boydii is the telemorph of Scedosporium apiospermum. No
sexual form (telemorph) is known for Scedosporium prolificans.
2.31.1. Scedosporium apiospermum (Sacc. ) Castell. & Chalm (1919)
Synonyms:
Monosporium apiospermum Sacc.(1911)
Aleurisma apiospermum (Sacc.) Maire, (1921)
Actinomyces albus Tarozzi (1909)
Monosporium sclerotiale Pepere (1914)
Dendrostilbella boydii Shear, (1922)
Glenospora clapieri Catanei, (1927)
Acremonium suis Bakai, Bolezni Svinei, Kiev: 198 (1967)
Polycytella hominis C.K. Campb. (1987)
Scedosporium apiospermum
2.31.2. Scedosporium prolificans (Hennebert & B.G.Desai) E.Guého & de
Hoog (1991)
Synonyms: Scedosporium inflatum Malloch & Salkin (1984)
Lomentospora prolificans Hennebert & B.G. Desai (1974)
86
scedosporium prolificans
Morphology
Colonies of Scedosporium prolificans grow rapidly at 25°C and mature within 5
days. The texture is cottony and moist (yeast-like) initially which later becomes
flat with fine, short, mycelial tufts. From the front, the color is light gray to black
and becomes dark gray to black as the colony matures. The reverse is gray to
black. Septate hyaline hyphae, conidiogenous cells (annelides), and conidia
are visualized. Annelides (conidiogenous cells) may arise directly from hyphae
or are formed at the tips of the conidiophores. These annelides are flaskshaped and have a swollen base part and an elongated neck. Conidia (2-5 x
3-13 µm) are unicellular, oval-shaped, olive to brown, and have a slightly
narrowed, truncated base. They are formed in clusters at the apices of the
annelides. In addition, some isolates may produce round, thick-walled conidia
which arise directly from the hyphae.
Colonies of Scedosporium prolificans are darker compared to those
of Scedosporium apiospermum. The inflated conidiogenous cells (annelides)
and slightly wider conidia of Scedosporium prolificans, and the inability
of Scedosporium prolificans to assimilate ribitol, xylitol, and L-arabinitol also
help in differentiation of the two species. Besides, unlike Scedosporium
apiospermum, Scedosporium prolificans does not convert to a sexual form.
Differentiation of these two species has been achievable also by PCR assay
and hybridization probes
Pathogenicity
Scedosporium prolificans is an emerging opportunistic fungal pathogen that
causes :
87
1.
2.
3.
4.
5.
6.
7.
Subcutaneous infections,
Osteomyelitis, and arthritis
Disseminated phaeohyphomycosis
Pneumonia
Meningoencephalitis
Endocarditis
Ocular infections (keratouveitis)
Recently reported cases:
1. Battery of rockets "Scedosporium apiospermum" in mycotic keratitis289
2. ESCMID and ECMM joint guidelines on diagnosis and management of
hyalohyphomycosis: Fusarium spp.,Scedosporium spp. and others.290
3. Impact of Scedosporium apiospermum complex seroprevalence in patients with
cystic fibrosis.291
4. Matrix-assisted laser desorption ionization-time of flight mass spectrometry for fast
and accurate identification of Pseudallescheria/Scedosporium species.292
5. Infective endocarditis and meningitis due to Scedosporium prolificans in a renal
transplant recipient.293
6. Scedosporium prolificans immunomes against human salivary immunoglobulin A294
7. Successful prevention of scedosporiosis after lung transplantation in a cystic fibrosis
patient by combined local and systemic triazole therapy.295
8. Locally extensive angio-invasive Scedosporium prolificans infection following
resection for squamous cell lung carcinoma.296
9. Scedosporium apiospermum brain abscesses in an immunocompetent man with
silicosis297
10. Management of Scedosporium apiospermum in a pre- and post-lung transplant
patient with cystic fibrosis.298
11. Diabetic foot ulcer due to scedosporium apiospermum299
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 literature301
14. . Nebulized voriconazole in infections with Scedosporium apiospermum - Case report
and review of the literature.302
15. Sporotrichoid eruption in a patient after lung
transplantation.Scedosporium apiospermum fungal thrombophlebitis and
sporotrichoid nodules303
16. Scedosporium aurantiacum brain abscess after near-drowning in a survivor of a
tsunami in Japan.304
17. Fungal keratitis caused by Scedosporium apiospermum: first report from Turkey305.
18. Scedosporium prolificans endogenous endophthalmitis.306
19. infection caused by Scedosporium apiospermum in immune-compromised patients.
Report of two cases.307
88
2. 32. The genus Scytalidium
Scytalidium is a genus that has a widespread distribution and contains 18
species. Scytalidium dimidiatum causes onychomycosis in tea leaf pluckers
2.32.1. Scytalidium dimidiatum (Penz.) B. Sutton & Dyko (1989)
Synonyms:
Torula dimidiata Penz., Michelia (1882)
Fusicoccum dimidiatum (Penz.) D.F. Farr (2005)
Neoscytalidium dimidiatum (Penz.) Crous & Slippers(2006
Hendersonula toruloidea Nattrass (1933)
Pathogenecity
Scytalidium dimidiatum causes
1.
2.
3.
4.
5.
onychomycosis
Subcutaneous infection
keratitis.
Cerebral phaeohyphomycosis
Disseminated fungal infection
Recently reported cases:
1. Scytalidium and scytalidiosis: what's new in 2012?308
2. Subcutaneous infection spread by Scytalidium (Neoscytalidium) dimidiatum309
3. . Successful eradication of Scytalidium dimidiatum-induced ungual and cutaneous
infection with voriconazole.310
4. . Epidemiological aspects of patients with ungual and cutaneous lesions caused
by Scytalidium spp.311
5. Intermittent posaconazole regimen to treat superficial
Scytalidium dimidiatum infection.312
89
6. Nattrassia mangiferae causing fungal keratitis.313
7. . In vitro activity of fluconazole, itraconazole, voriconazole and terbinafine against
fungi causing onychomycosis.314
8. . Genotyping and in vitro antifungal susceptibility of
Neoscytalidium dimidiatum isolates from different origins. 315
9. Invasive Scytalidium dimidiatum infection in an immunocompetent adult.316
10. Invasive infection in a young immunocompetent soldier caused
by Scytalidium dimidiatum317
11. Cerebral phaeohyphomycosis caused by Scytalidium dimidiatum: a case report from
India.318
12. Disseminated fungal infection in a renal transplant recipient involving Macrophomina
phaseolina and Scytalidium dimidiatum: case report and review of taxonomic
changes among medically important members of the Botryosphaeriaceae. 319
13. [Non-dermatophytic moulds: onychomycosis in four patients infected with the human
immunodeficiency virus320
14. In vitro susceptibility of isolates of Scytalidium spp. from superficial lesions against
posaconazole321
15. In vitro activity of amphotericin B, itraconazole, voriconazole, posaconazole,
caspofungin and terbinafine against Scytalidium dimidiatum and clinical isolates.322
16. . Onychomycosis by Scytalidium dimidiatum in green tea leaf pluckers: report of two
cases.323
17. In vitro activity of voriconazole against dermatophytes, Scopulariopsis brevicaulis
and other opportunistic fungi as agents of onychomycosis324
18. . Onychomycosis by Scytalidium dimidiatum: report of two cases in Santa Catarina,
Brazil.325
19. Fusicoccum arbuti sp. nov. causing cankers on pacific madrone in western North
America with notes on Fusicoccum dimidiatum, the correct name
for Scytalidium dimidiatum and Nattrassia mangiferae.326
20. Scedosporium prolificans fungaemia in a patient with acute lymphoblastic
leukaemia327
91
2.33. The genus Stachybotrys
The genus Stachybotrys has a widespread distribution, and contains about 50
species. The name comes from the Greek words "stakhus" (ear of grain, stalk,
stick; αχυς) or "stachy" (progeny) and "botrus" (cluster or bunch as in
grapes, trusses; βότ υ ).The most infamous species, S. chartarum and S.
chlorohalonata are frequently associated with poor indoor air quality that arises
after fungal growth on water-damaged building materials.
Stachybotrys produces cottony, rapidly growing colonies which are white
initially and turn to black by aging. Microscopically, the fungus develops
septate hyphae, which appear hyaline initially and become darkly pigmented
with age. The conidiophores which may be simple or branched, bear phialides
at their apices. They are hyaline or pigmented, cylindrical in shape, and have
swollen upper portions. They form clusters of 3 to 10. The conidia (4.5 x 9 µm)
are oval, hyaline or pigmented, 1-celled, and in clusters
Stachybotrys produces trichothecene mycotoxins known as satratoxins. These
toxins may lead to pathological changes in animal and human tissues.
2.33.1. Stachybotrys chartarum (Ehrenb.) S. Hughes (1958)
Synonyms: Stilbospora chartarum Ehrenb. (1818)
Oidium chartarum (Ehrenb.) Link (1824)
Oospora chartarum (Ehrenb.) Wallr., (1833)
Stachybotrys atra Corda, (1837)
Sporocybe lobulata Berk (1841)
Synsporium biguttatum Preuss, (1849)
Stachybotrys alternans Bonord., (1851)
Stachybotrys atra var. brevicaulis Verona, (1839)
Stachybotrys atra f. lobulata Verona, (1839)
Stachybotrys atra var. brevicaule Verona (1939)
Stachybotrys lobulata var. angustispora Moreau & V. Moreau (1841)
91
Pathogenecity:
1.
2.
3.
4.
Hypersensitivity pneumonitis
Rhinitis
Allergy
Irritation to various areas including the eyes, mucous membranes of the mouth, nose
and throat,
5. Vomiting, and bleeding in the lungs and nose
Recently reported cases:
1. Stachybotrys eucylindrospora isolated from foreign material following a traumatic eye
injury.377
2. TLR9-dependent
IL-23/IL-17
is
required
for
the
generation
of
378
Stachybotrys chartarum-induced hypersensitivity pneumonitis.
3. Allergen of the month--Stachybotrys chartarum379
4. Satratoxin-G from the black mold Stachybotrys chartarum induces rhinitis and
apoptosis of olfactory sensory neurons in the nasal airways of rhesus monkeys. 380
5. Recurrence of Stachybotrys chartarum during mycological and toxicological study of
bioaerosols collected in a dairy cattle shed.381
6. Stachybotrys chartarum-induced hypersensitivity pneumonitis is TLR9 dependent.382
7. Stachybotrys chartarum: Current knowledge of its role in disease. 383
8. Quantification of siderophore and hemolysin from Stachybotrys chartarum strains,
including a strain isolated from the lung of a child with pulmonary hemorrhage and
hemosiderosis.384
9. Initial characterization of the hemolysin stachylysin from Stachybotrys chartarum. 385
92
2. 34. The genus Stemphylium
Stemphylium is a dematiaceous filamentous fungus that is widely distributed
on decaying vegetation and in the soil. It is commonly considered as a
contaminant. The only well-known species included in the genus
is Stemphylium macrosporoideum.
Morphology
Colonies of Stemphylium grow rapidly, they are velvety to cottony in texture,
gray, brown, or brownish-black in colour. Reverse is black. Microscopically, the
fungus develops septate hyphae, which are pale brown to brown in colour.
Conidiophores are black, may be simple or branched, bear a number of
vesicular swellings or nodes. Conidiogenous cells are terminally located and
percurrent (the proliferation which grows through the tip of the conidiogenous
cell). Conidia (12-20 x 15-30 µm) are solitary, light brown to black in color, and
rough- or smooth-walled. They are oblong or subspherical, rounded at the tips
and have transverse and vertical septations (=muriform conidia) with a typical
constriction at the central septum. They have thickened scars at their base
2.34.1.Stemphylium macrosporoideum (Berk.) Sacc., (1881)
Synonyms:
Epochnium macrosporoideum Berk., (1838)
Acrospeira macrosporoidea (Berk.) Wiltshire, (1838)
Hyphelia castaneae Wallr., (1833)
Hyphelia castanea Wallr., (1833)
Pathogenicity
1. Some people may experience hay fever or asthma. Produces similar allergens that
are associated with Alternaria.
2. Rare cases reported of phaeohyphomycotic sinusitis.
93
2.35. The genus Ulocladium
Ulocladium is a dematiaceous filamentous fungus that inhabits the soil and
decaying herbaceous plants. It is widely distributed in nature and may be
isolated from paper, textiles, and wood as well. Ulocladium is commonly
considered as a contaminant. It may very rarely cause human disease.
Species of this genus contain both plant pathogens and food spoilage agents.
Other species contain enzymes that are biological control agents. Some
members of the genus can invade homes and are a sign of moisture because
the mold requires water to thrive. They can cause plant diseases or hay fever
and more serious infections in immuno-suppressed individuals.
Morphology
Species of Ulocladium resemble those of genus Alternaria with which they
were once included. But Ulocladium, unlike Alternaria, do not
produce alternariols, tenuazonic acid, altersolanols, or macrosporin.
Colonies of Ulocladium grow moderately rapidly. At 25°C and on potato
dextrose agar, the colonies are wooly to cottony. From the front and the
reverse, the color is olive brown to black .Microscopically, the fungus develops
septate brown hyphae, brown conidiophores, and conidia. Conidiophores are
simple or branched, smooth, strongly geniculate (bent at the points where the
conidia are produced, leading to a zigzag appearence; "bent knee") and bear
the conidia. Conidia (13-30 x 6-19 µm) are brown to black, round to oval in
shape, smooth or rough and verrucous. They are usually egg-shaped and
have a narrower base compared to its apex. These conidia are typically
muriform and have transverse and longitudinal septations. They are solitary
(Ulocladium botrytis) or may form short chains (Ulocladium chartarum). When
chains are produced, a tubular, short outgrowth is formed on the conidia at the
point of secondary conidium formation
The genus Ulocladium has two active species:
1. Ulocladium chartarum
2. Ulocladium botrytis
94
2.35.1. Ulocladium chartarum (Preuss) E.G. Simmons (1967)
Synonyms:Alternaria chartarum Preuss (1848)
Sporidesmium polymorphum var. chartarum (Preuss) Cooke (1875)
Alternaria stemphylioides Bliss (1944)
Ulocladium chartarum
2.35.2. Ulocladium botrytis Preuss (1851)
Synonyms:
Stemphylium botryosum var. ulocladium Sacc. (1886)
Stemphylium botryosum var. botrytis (Preuss) Lindau, (1908)
Alternaria botrytis (Preuss) Woudenberg & Crou (2013)
Alternaria abietis Tengwall (1924)
Ulocladium botrytis
95
Pathogenicity
Ulocladium spp. may cause phaeohyphomycosis and particularly
subcutaneous infections.
Recently reported cases:
1. Identification of allergens homologous to Alt a 1 from Stemphylium botryosum
and Ulocladium botrytis.389
2. An unusual phaeoid fungi: Ulocladium, as a cause of chronic allergic fungal
sinusitis.390
3. Ulocladium atrum Keratitis.391
2. 36. The genus Wangiella
Wangiella is a dematiaceous, cosmopolitan fungus that inhabits the soil and
plant material. Wangiella may cause various infections in humans.The genus
Wangiella contains only one species, Wangiella dermatitidis, where multiple
conidial forms were used for its classification in other genera such as:
annellides, giving it the key characteristic of the genus Exophiala.
phialides having collarettes, giving it the characteristic of species
of Phialophora
yeast forms that are suggestive of the black yeast
genus Phaeococcomyces.
The name Wangiella was based upon
the production of phialides without distinct collarettes
molecular data suggesting that the species dermatitidis is distinctive
enough to merit its own genus.
Accordingly the following names are considered as synonyms:
Exophiala dermatitidis
,Fonsecaea dermatitidis ,Hormiscium dermatitidis ,
Hormodendrum dermatitidis , Phialophora dermatitidis
96
2.36.1. Wangiella dermatitidis (Kano) McGinnis 1977
Synonyms: Hormiscium dermatitidis Kano 1934
Exophiala dermatitidis KANO 1937
Fonsecaea dermatitidis (Kano) Carrion 1950
Hormodendrum dermatitidis(Kano) Conant 1954
Phialophora dermatitidis(Kano) C.W.Emmons 1963
Colonies are slow growing, initially black and yeast-like, becoming
suede-like, olivaceous grey and mould-like with age. The initial yeast-like
phase is characterized by unicellular, ovoid to elliptical, budding yeast-like
cells. The yeast-like cells are hyaline and thin-walled when young and
becoming darkly pigmented and thick-walled when mature. With the
development of mycelium or the mould-like stage, flask-shaped to cylindrical
phialides without distinctive collarettes are produced. Conidia are hyaline to
pale brown, one-celled, round to obovoid, 2.0-4.0 x 2.5-6.0 um, smooth-walled
and accumulate in slimy balls (glioconidia) at the apices of the phialides or
down their sides.
Wangiella dermatitidis yeast
development of mycelia
Wangiella dermatitidis is a pathogen of humans that causes a disease known
as phaeohyphomycosis, mostly associated with dermatotropic forms of
disease. It is being reported with increasing frequency as a systemic pathogen
with a marked neurotropic tendency. Predisposing factors for the systemic
forms include cystic fibrosis, lymphocytic leukemia, diabetes mellitus,
bronchiectasis, rheumatoid arthritis and catheterization. Initiation of both the
dermatotropic and systemic disease forms is attributed to the traumatic
implantation of the fungus into tissue, although in some cases the route of
infection is unknown and pulmonary entry has not been ruled out
97
Recently reported cases:
1. Comparative Genomic and Transcriptomic Analysis of Wangiella dermatitidis, a
Major Cause of Phaeohyphomycosis and a Model Black Yeast Human Pathogen. 170
2. Adaptation of the black yeast Wangiella dermatitidis to ionizing radiation: molecular
and cellular mechanisms.171
3. RNA interference of WdFKS1 mRNA expression causes slowed growth, incomplete
septation and loss of cell wall integrity in yeast cells of the polymorphic, pathogenic
fungus Wangiella (Exophiala) dermatitidis.172
4. Unusual presentation of onychomycosis caused
by Exophiala(Wangiella) dermatitidis.173
5. . Exophiala (Wangiella) dermatitidis and cystic fibrosis - Prevalence and risk
factors.174
6. The treatment of pulmonary Wangiella dermatitidis infection with oral voriconazole.175
7. Roles of the pH signaling transcription factor PacC
in Wangiella(Exophiala) dermatitidis.176
2. 37. The genus Xylohypha
Species in this genus
1. Xylohypha bantiana (obsolete)
This obsolete species is a synonym of Cladophialophora bantiana
2. Xylohypha emmonsii (obsolete)
This obsolete species is a synonym of Cladophialophora bantiana
98
3. Diseases caused by dematiacaeous fungi
3. 1. Phaeohyphomycosis
Synonyms: Cerebral chromomycosis, chromoblastomycosis, chromomycosis,
cladosporiosis, phaeomycotic cyst, phaeosporotrichosis, subcutaneous mycotic cyst
The term phaeohyphomycosis (from the Greek phaios, meaning dark or
darkish) was introduced by Ajello et al. in 1974 to designate infections by
phaeoid or pigmented filamentous fungi that contain melanin in their walls.
The fungus often occurs on the skin where it forms nodules and cysts but is
also capable of invading deeper tissues and even the brain. The fungal
infection usually results when a contaminated material such as a splinter or
plant matter enters the skin, usually through a cut. The dark pigmented fungi
occur mostly in tropical and subtropical areas and can be found in soil and
rotting vegetation.
3.1.1. Skin infections
Phaeohyphomycosis of the skin typically begins as a single red nodule, usually
on the extremities. In the immunocompetent person, an indolent, painless
expansion in the skin and subcutaneous tissue occurs and can occasionally
develop well-formed cysts. In immunosuppressed patients local progression
and extension can occur rapidly producing scaly, crusty skin lesions or ulcers.
99
Tinea nigra
Lesions on the leg and foot caused by cutaneous Alternaria infectoria infection
1. Cutaneous Phaeohyphomycosis caused by Paraconiothyrium cyclothyrioides.280
2.
Bipolaris cutaneous fungal infection of 3 weeks duration involving the lower extremity.393
3.
Infiltrating plaques, with a verrucoid appearance, occupying the back of hands (a) and
forearms caused by Alternaria alternata394
111
Pheohyphomycetic cysts on the leg and finger
1. Skin of a dog with cutaneous infection due to Alternaria infectoria.
2.
a poorly defined, raised, subcutaneous swelling on the bridge of the nose.
111
Recently reported cases
Bilateral Tinea Nigra of palm: a rare case report from Eastern India.158
Tinea nigra in an unusual anatomic location159
Tinea nigra palmaris: a clinical case in Argentina165
Tinea nigra by Hortaea werneckii, a report of 22 cases from Mexico.166
A case of tinea nigra palmaris in Okinawa,167
Tinea nigra: report of twelve cases in Venezuela.168
Cutaneous Infection with Alternaria triticina in a Bilateral Lung Transplant Recipient.7
Cutaneous alternariosis with chronic granulomatous disease (6)
Cutaneous infection of a porcupine (Erethizon dorsatum) by Aureobasidium
pullulans.42
10. Cutaneous phaeohyphomycosis due to Cladophialophora bantiana69
11. Cutaneous phaeohyphomycosis caused by Cladophialophora bantiana in a scar after
treatment with intralesional corticosteroid injections76
12. Cladophialophora carrionii: an aetiological agent of cutaneous chromoblastomycosis
from a non-endemic area, North India81
13. Cutaneous phaeohyphomycosis caused by Paraconiothyrium cyclothyrioides. 280
14. Cutaneous Curvularia infection of the forearm.100
15. Cutaneous and mucosal phaeohyphomycosis caused by Exophialaspinifera in a
pregnant patient: case report and literature review133
16. Cutaneous phaeohyphomycosis caused by Exophiala spinifera in a patient with
systemic lupus erythematosus.136
17. Cutaneous pythiosis in two dogs from Wisconsin, USA.364
18. Subcutaneous mycosis and fungemia by Aureobasidium pullulans: a rare pathogenic
fungus in a post allogeneic BM transplant patient49
19. Sub-cutaneous phaeohyphomycosis caused by Cladophialophora devriesiiin a
United Kingdom resident82
20. Subcutaneous phaeohyphomycosis due to Curvularia lunata in a renal transplant
patient97
21. Subcutaneous phaeohyphomycosis caused by Exophiala equina, with susceptibility
to eight antifungal drugs.131
22. Subcutaneous phaeohyphomycosis due to Exophiala spinifera in an
immunocompromised host.137
23. Subcutaneous phaeohyphomycosis of the face presenting as
rhinoentomophthoramycosis.148
24. Subcutaneous abscesses caused by Ochroconis gallopavum214
25. Subcutaneous phaeohyphomycosis (mycotic cyst.224
26. Subcutaneous abscess caused by Phoma sp. resembling Pyrenochaeta rameroi.
Uniques fungal infection occuring in immunosuppressed recipient of renal
allograft.354
27. Subcutaneous phaeohyphomycotic cyst caused by Pyrenochaeta romeroi. 267
28. Pyrenochaeta romeroi: a causative agent of phaeohyphomycotic cyst.271
29. Subcutaneous infection spread by Scytalidium (Neoscytalidium) dimidiatum309
1.
2.
3.
4.
5.
6.
7.
8.
9.
112
3.1.2. Nail infections
Onychomycosis due to ascomycete Chaetomium globosum: a case report.182
Onychomycosis by Chaetomium spp.185
An uncommon agent of onychomycosis.330
Onychomycosis in São Paulo, Brazil.333
. Onychomycosis by Scytalidium dimidiatum in green tea leaf pluckers: report of two
cases.323
6. . Onychomycosis by Scytalidium dimidiatum: report of two cases in Santa Catarina, Brazil.325
7. Unusual presentation of onychomycosis caused
by Exophiala(Wangiella) dermatitidis.173
1.
2.
3.
4.
5.
3.1.3. Eye infections
Dematiaceous fungi are a particularly significant cause of fungal keratitis in
tropical areas, and most cases are associated with trauma from funguscontaminated plant material. Clinical features typically include redness,
photophobia, and decreased visual acuity accompanied with a yellow-white
infiltrate typically limited to the central cornea.
113
Recently reported cases:
1.
Aureobasidium pullulans keratitis35
2. Fungal endophthalmitis associated with compounded products.23
3. An outbreak of fungal endophthalmitis after intravitreal injection of compounded
combined bevacizumab and triamcinolone.24
4. Corneal abscess caused by Bipolaris spicifera.25
5. Corneal chromoblastomycosis caused by Cladophialophora carrionii after cataract
surgery80
6. Fungal keratitis caused by Chaetomium atrobrunneum.179
7. Curvularia lunata endophthalmitis. 1101
8. Exophiala jeanselmei keratitis: case report and review of literature.127
9. Mycotic keratitis caused by concurrent infections of Exserohilum mcginnisii and
Candida parapsilosis.191
10. Keratomycosis caused by Exserohilum rostratum.199
11. Lasiodiplodia theobromae keratitis: a case report and review of literature.285
12. [Mycotic keratitis and endophthalmitis caused by unusual
fungi:Lasiodiplodia theobromae].288
13. Nattrassia mangiferae keratitis after laser in situ keratomileusis329
14. Nattrassia mangiferae causing fungal keratitis.332
114
15. Nattrassia mangiferae keratitis after laser in situ keratomileusis.335
16. Case report. Nattrassia mangiferae endophthalmitis.337
17. Phialemonium obovatum keratitis after penetration injury of the cornea.340
18. Endophthalmitis caused by Phialophora verrucosa: a case report and literature
review of Phialophora ocular infections. 220
19. Endophthalmitis caused by Phialophora verrucosa and Streptococcus intermedius: a
case report. 221
20. Pyrenochaeta keratinophila sp. nov., isolated from an ocular infection in Spain.266
21. Outbreak of Pythium keratitis during rainy season: a case series.372
22. Scedosporium prolificans endogenous endophthalmitis.306
Commonly isolated fungi 395
115
3.1.4. Respiratory phaeohyphomycosis:
Sinusitis caused by dematiaceous fungi, especially species of Bipolaris,
Exserohilum, Curvularia and Alternaria is increasingly being reported,
especially in patients with a history of allergic rhinitis or immunosuppression.
This is a fairly recent concept, similar in presentation to allergic
bronchopulmonary aspergillosis (ABPA), which is typically seen in patients
with
asthma
or
cystic
fibrosis.
The
most
common
fungi
are Bipolarisand Curvularia species. Therapy is primarily systemic steroids,
usually prednisone at 0.5 mg/kg/d for 2 weeks, followed by a slow taper over 2
to 3 months or longer, if necessary. Itraconazole has been used as a steroid
sparing agent, but its efficacy is not clear, and routine use of itraconazole is
not specifically recommended.
Non-allergic pulmonary disease with the black molds usually occurs in
immunocompromised patients and may be due to a wide variety of species
commonly
found
in
the
environment
(including Bipolaris,
Ochroconis (Dactylaria), Fonsecaea, and Chaetomium species). However,
cases in immunocompetent patients may also be seen.[ It is extremely
important to perform proper identification of the black mold from nonsterile
sites like fluid from bronchoalveolar lavage (BAL). The growth
of Cladosporium, species even in lung transplant recipients, is unlikely to be
causing disease, but other black molds like Dactylariawould cause much more
concern about potentially invasive lung disease or dissemination.
Maxillary sinus mycetoma
Pneumonia due to Pseudoallescheria boydii
116
Recently reported cases:
1.
Outbreak of hypersensitivity pneumonitis in an industrial setting36
2.
Hypersensitivity pneumonitis secondary to residential exposure to Aureobasidium
pullulans in 2 siblings45
3. Bipolaris hawaiiensis as etiologic agent of allergic bronchopulmonary mycosis: first
case in a paediatric patient.26
4. Some chronic rhinosinusitis patients have elevated populations of fungi in their
sinuses.54
5. Unusual causes of fungal rhinosinusitis: a study from a tertiary care centre in South
India.58
6. Differences in fungi present in induced sputum samples from asthma patients and
non-atopic controls: a community based case control study59
7. Allergic bronchopulmonary mycosis due to fungi other than Aspergillus: a global
overview.60
8. Pulmonary Cladophialophora boppii infection in a lung transplant recipient: case
report and literature review87
9. Pulmonary infection caused by Exophiala dermatitidis in a patient with multiple
myeloma: A case report and a review of the literature.125
10. Maxillary sinusitis caused by Lasiodiplodia theobromae.286
11. Lasiodiplodia theobromae pneumonia in a liver transplant recipient.287
12. A case of sinusitis caused by nattrassia mangiferae in iran328
13. Pulmonary Phialemonium curvatum phaeohyphomycosis in a Standard Poodle
dog.345
14. Lung infection due to opportunistic fungus, Phialemonium obovatum, in a bone
marrow transplant recipient: an emerging infection with fungemia and Crohn diseaselike involvement of the gastrointestinal tract.346
15. An unusual phaeoid fungi: Ulocladium, as a cause of chronic allergic fungal
sinusitis.390
16. The treatment of pulmonary Wangiella dermatitidis infection with oral voriconazole.175
117
3.1.5. Central nervous system infection
Although rare, CNS infection is one of the best-described and frequently fatal
syndromes produced by the dematiaceous molds. A retrospective analysis of
101 reported cases of CNS phaeohyphomycoses found that over half occurred
in immunocompetent patients, with Cladophialophora bantiana the most
common species isolated. Disease is also caused by Ramichloridium
mackenziei, Ochroconis gallopavum (Dactylaria gallopavum), Wangiella
dermatitidis, Bipolaris spicifera, B. hawaiiensis, and Chaetomium species.
CNS infection from dematiaceous molds typically presents with indolent
headache, low-grade fever, and development of focal neurological signs.
Often, it requires surgical intervention and the use of a combination of
antifungal agents for successful management.
MRI of the brain (TZ-weighted), showing Hematoxylin-eosin stain of brain tissue showing hyphae with
a mass located in the region of
occasional swollen walls and branching
the posteriorright basal ganglia and posterior
temporal lobe with surrounding edema.
118
Brain; cat. Cross-sections of the rostral Myriads of oblong, septate, branching hyphae and
cerebrum and
meninges. Wella few macrophage
demarcated areas of black discoloration
and softening caused by C. bantiana.116
Recently reported cases:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Alternaria infectoria brain abscess in a child with chronic granulomatous
disease.17
Fungal meningoencephalitis caused by Alternaria: a clinical case.18
Cerebral phaeohyphomycosis caused by Bipolaris spicifera after heart
transplantation.27
Cerebral and renal phaeohyphomycosis in a dog infected with Bipolaris
species.28
Acute meningitis caused by Cladosporium sphaerospermum61
Cladophialophora bantiana brain abscess: A case with long survival in
metropolitan France64
Brain abscess caused by Cladophialophora bantiana in China68
Cerebral phaeohyphomycosis due to Cladophialophora bantiana in a Huacaya
alpaca (Vicugna pacos).70
Cerebellar Cladophialophora bantiana infection in a patient with marginal zone
lymphoma treated with immunochemotherapy including rituximab 71
Cladophialophora bantiana brain abscess in an immunocompetent patient72
Necrotizing pyogranulomatous meningoencephalitis with intralesional fungal
hyphae, consistent with Cladophialophora bantiana75
Cladophialophora bantiana brain abscess: A case with long survival in
metropolitan France88
Brain abscess caused by Cladophialophora bantiana in China.90
119
14.
Fatal cerebral abscess caused by Cladophialophora bantiana.92
Curvularia Abscess of the Brainstem.96
16.
Curvularia brain abscess.98
17.
Fatal cerebral phaeohyphomycosis due to Curvularia lunata in an immunecompetent patient105
18.
Cerebral phaeohyphomycosis caused byFonsecaea monophora.142
19.
Fonsecaea multimorphosa sp. nov, a new species ofChaetothyriales isolated
from a feline cerebral abscess.143
20.
Fungal infections of the central nervous system in the immunocompetent
host146
21.
Madurella mycetomatis as an agent of brain abscess: case report and review
of literature.232
22.
Clinical profile and management of craniocerebral Madurella mycetoma.233
23.
Mycetoma. Craniocerebral maduromycosis.241
24. Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei
(formerly Ramichloridium mackenziei): case presentation and literature
review.258
25. Cerebral phaeohyphomycosis due to
Rhinocladiella mackenziei(formerly Ramichloridium mackenziei): a taxonomic
update and review of the literature263
26. Aspiration cytology of brain abscess from a fatal case of cerebral
phaeohyphomycosis due to Ramichloridiummackenziei.275
27.
Cerebral phaeohyphomycosis caused by Ramichloridiummackenziei in the
Eastern Province of Saudi Arabia.
28.
Cerebral phaeohyphomycosis due to Rhinocladiellamackenziei (formerly
Ramichloridium mackenziei): case presentation and literature review.258
29.
Rhinocladiella mackenziei as an emerging cause of cerebral
phaeohyphomycosis in Pakistan: a case series259
30.
Co-existence of cerebral infection with Rhinocladiellamackenziei and primary
central nervous system lymphoma in a HIV-negative patient.260
31.
Cerebral phaeohyphomycosis caused by Rhinocladiella mackenziei in a
woman native to Afghanistan.261
32.
First autochthonous case of Rhinocladiella mackenziei cerebral abscess
outside the Middle East.262
33.
Cerebral phaeohyphomycosis due to Rhinocladiellamackenziei (formerly
Ramichloridium mackenziei): a taxonomic update and review of the
literature.263
34.
Cerebral phaeohyphomycosis caused by Rhinocladiella mackenziei in a
woman native to Afghanistan.265
35.
Scedosporium aurantiacum brain abscess after near-drowning in a survivor of
a tsunami in Japan.304
36.
Cerebral phaeohyphomycosis caused by Scytalidiumdimidiatum: a case
report from India.318
15.
.(
111
3.1.6. Disseminated pheohyphomycosis
This is the most uncommon manifestation of infection seen with dematiaceous
fungi. There are case reports of several different dematiaceous molds that
have caused disseminated disease, including Bipolaris species and Wangiella
dermatitidis. In a recent review, most patients were immunocompromised,
though occasional patients without known immunodeficiency or risk factors
developed disseminated disease as well, and infections have occurred with
contaminated devices or biological products. In contrast to most invasive mold
infections, blood cultures are positive in over half the cases of disseminated
phaeohyphomycosis -- this is likely related to adventitial yeast forms in tissue.
Systemic pheohyphomycosis (cerebral)117
Systemic pheohyphomycosis (pulmonary)117
Recently recorded cases:
1.
2.
3.
4.
5.
Alternaria alternata invasive fungal infection in a patient with Fanconi's
anemia after an unrelated bone marrow transplant.11
Disseminated nosocomial fungal infection by Aureobasidium
pullulans var. melanigenum: a case Report.41
Aureobasidium pullulans infection: Fungemia in an infant and a review
of human cases.46.
Catheter-related septicemia due to Aureobasidium pullulans.47
Disseminated Cladophialophora bantiana infection in an idiopathic
thrombocytopenic purpura patient: a case report.74
111
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Systemic mycosis caused by a new Cladophialophora species84
Invasive chaetomium infection in two immunocompromised pediatric
patients.187
Disseminated
infection
with Nattrassia mangiferae in
an
immunosuppressed patient.336
Disseminated Ochroconis gallopava infection in a heart transplant
patient. 200
Fatal systemic phaeohyphomycosis caused by Ochroconis gallopavum
in a dog (Canis familaris).209
Disseminated infection with Phialemonium obovatum in a German
shepherd dog.349
Phialophora verrucosa as a cause of deep infection following total knee
arthroplasty. 215
Invasive infection in a young immunocompetent soldier caused
by Scytalidium dimidiatum317
Disseminated fungal infection in a renal transplant recipient involving
Macrophomina phaseolina and Scytalidiumdimidiatum: case report and
review of taxonomic changes among medically important members of
the Botryosphaeriaceae.319
Scedosporium prolificans fungaemia in a patient with acute
lymphoblastic leukaemia327
112
Cases of disseminated pheohyphomycosis reported in the literature396
113
114
3.2. Chromomycosis:
The term chromoblastomycosis was first used initially to describe cases of
polymorphic fungal disease of the lower limbs presenting with nodules or
verrucous plaques with hyperkeratosis and acanthosis of the affected
epithelial tissues, which could develop into complications such as ulceration,
lymphedema and squamous cell carcinoma. The term blastomycosis gives the
impression that the cause of this disease is a yeast. As various species of
moulds are involved as causes, the term chromomycosis seems to be
reasonable.
The causative agents generally have a cosmopolitan distribution, the illness is
reported more frequently in countries with tropical and subtropical climates,
especially among people living in rural areas, not wearing shoes and therefore
in whom plant wounds or other contaminated materials are common and
repetitive. The disease is very common in Mexico Cuba, Dominican Republic,
Venezuela, Colombia and Ecuador, Australia and South Africa. Several
dematiaceous fungi cause chromoblastomycosis. Fonsecaea pedrosoi is the
most common causative organism, although disease is also caused
by Cladosporium and Phialaphora species.
Most lesions are located in exposed areas, mainly in lower limbs. The initial
lesion appears at the site of inoculation, and usually it is a small, elevated,
erythematous, non-pruritic papule. Over time other lesions in the same area
or in adjacent areas, with involvement of local lymph vessels appear, the
lesions tend to hypertrophy, increased desquamation and skin a reddish color
to gray is appreciated. There may be peripheral spread and/ or scarring in the
center of the lesions, but more often, these grow and clump together looking
like cauliflower and may ulcerate as the lesions located in areas exposed to
trauma, are frequently associated with secondary bacterial infections causing
purulent exudate of foul smell.
115
Multiple, scaly erythematous plaques, with ulcers and erosions on the left shin. 79
Immages: Rubén López Martínez and Francisca Hernández Hernández Faculty of Medicine, UNAM
116
Chromomycosis118
Chromomycosis119
Recently reported cases
1. Cladophialophora carrionii: an aetiological agent of cutaneous chromoblastomycosis
from a non-endemic area, North India.81
2. Fonsecaea nubica sp. nov, a new agent of human chromoblastomycosis revealed
using molecular data
3. Chromoblastomycosis caused by Fonsecaea: clinicopathology, susceptibility and
molecular identification of seven consecutive cases in southern China.141
4. Chromoblastomycosis in Australia: an historical perspective.147
5. Revisiting the clinical and histopathological aspects of patients with
chromoblastomycosis from the Brazilian Amazon region149
6. Chromoblastomycosis due to Fonsecaea pedrosoi and F. monophora in Cuba.150
7. Chromoblastomycosis caused by Fonsecaea: clinicopathology, susceptibility and
molecular identification of seven consecutive cases in Southern China 152
8. Chromoblastomycosis in Mainland China: a systematic review on clinical
characteristics153
9. Septic
arthritis
and
osteomyelitis
due
to
the
chromoblastomycosis
agent Fonsecaea pedrosoi.154
10. Clinical, epidemiological and mycological report on 65 patients from the Eastern
Amazon region with chromoblastomycosis155
11. A refractory case of chromoblastomycosis due to Fonsecaea monophora with
improvement by photodynamic therapy.157
12. . Generalized chromomycosis caused by Phialophora verrucosa.217
13. Chromoblastomycosis Caused by Phialophora richardsiae.223
14. Chromoblastomycosis caused by Rhinocladiella aquaspersa.256
117
3.3. Mycetoma
Mycetoma (Madura foot) is a chronic infection characterized by the
development of tumifactions and sinuses. The infection most often occurs in
the feet but may appear on the hands or buttocks. The organism occasionally
invades the body producing lesions in the brain, the meninges and other
internal organs, including the bones. The disease occurs most frequently in
tropical and subtropical zones.
The numerous fungi that have been isolated from cases of maduromycosis
belong to several genera. These fungi produce black granules in the lesions.
The dematiaceous fungi causing this disease fall in the genera:Madurella,
Phialophora , Curvularia , Pyrenochaeta, Leptosphaeria and others.
Mycetoma in a horse
Mycetoma in man
118
The Mycetoma Research Center
University of Khartoum,WHO MYCETOMA
Madura Foot: A Tropical Foot Disease
- Waterloo, Ontario Podiatric Care
Recently reported cases
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Eumycetoma of the foot caused by Exophiala jeanselmei in a Guinean woman.130
Curvularia lunata: A rare cause of black-grain eumycetoma94
An unusual case of eumycetoma caused by Exophiala jeanselmei after a sea
urchin injury.132
Mycetoma foot due to Madurella mycetomatis.227
Mycetoma caused by Madurella mycetomatis: a neglected infectious burden.228
Madurella mycetomatis infection following allogenic stem cell transplantation for
aplastic anemia229
Eumycetoma by Madurella mycetomatis with 30 years of evolution: therapeutic
challenge230
Clinical profile and management of craniocerebral Madurellamycetoma.231
Clinical profile and management of craniocerebral Madurellamycetoma.233
Mycetoma caused by Madurella mycetomatis: a completely neglected medicosocial dilemma.234
Peripheral blood mononuclear cells of mycetoma patients react differently
to Madurella mycetomatis antigens than healthy endemic controls.235
Oral cavity eumycetoma: a rare and unusual condition236
Madura foot237
. A histopathological exploration of the Madurella mycetomatis grain.238
A
Rare
Presentation
of
Concurrent
Scedosporium
apiospermum
and Madurella grisea Eumycetoma in an Immunocompetent Host. Case report239
. In vitro antifungal activity of isavuconazole against Madurellamycetomatis.240
Craniocerebral maduromycosis.241
Phylogenetic analysis of
the complete mitochondrial genome of
Madurella mycetomatis confirms its taxonomic position within the order
Sordariales.242
Eumycetoma243
119
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
Analysis of 18 Tunisian cases of mycetoma at the Sousse hospital (1974-2010)244
MRI findings in cranial eumycetoma245
New species of Madurella, causative agents of black-grain mycetoma.246
[Mycetomas diagnosed in Senegal from 2008 to 2010247
Madurella mycetomatis mycetoma treated successfully with oral posaconazole248
A chronic, destructive mycetoma infection in a diabetic foot in Saudi Arabia. 249
In vitro susceptibility of Madurella mycetomatis to posaconazole and terbinafine.250
The safety and efficacy of itraconazole for the treatment of patients with
eumycetoma due to Madurella mycetomatis.251
Clinical and epidemiological features of mycetoma in Morocco252
Mycetoma in Tunisia: a 15-case series253
Bilateral mycetoma--a case report.254
Madurella mycetoma--a rare case with cranial extension.255
Leptosphaeria Senegalensis Causing Mycetoma Pedis in Madras283
Mycetoma in Yemen: clinicoepidemiologic and histopathologic study284
4. Dematiaceous fungi in Egypt
Although dematiaceous fungi have been isolated from the air of slaughter
house398 as well as from poultry feeds399, maduromycosis was only reported
by El Mofty et al. (1956) and El Zawahry (1967) and Abdei-Aal (1974)400. Recently,
cases were published by Taha (2014)401
.
121
Collection of cases of mycetoma presented by Prof. Dr. M. Taha, Zagazig University, Egypt401
121
5. Mycotoxicoses
5.1. Alternariosis
The principle Alternaria mycotoxins that have been shown to occur naturally
are tenuazonic acid, alternariol monomethyl ether, alternariol, altenuene, and
altertoxin I. Iso-altenuene and altertoxin II have not been found in crops to
date. AAL-toxins are structurally related to fumonisins. Alternaria toxins exhibit
both acute and chronic effects. The LD50 values for alternariol monomethyl
ether, alternariol, altenuene, and altertoxin I in mice is reported as 400, 400,
50 and 200 mg/kg b. w. respectively. Those for tenuazonic acid are 162 and
115 mg/kg b.w. (i.v.) for male and female mice respectively.Alternaria toxins
have been implicated in animal and in human health disorders. Cases of death
in rabbits and poultry have been reported as a result of toxic action
of Alternaria spp. found in the fodder and feed.
Tenuazonic acid has been most studied. Its principle mode of action appears
to be the inhibition of protein synthesis by suppression of the release of newly
formed proteins from the ribosomes into the supernatant fluid. It exhibits
antitumor, antiviral and antibacterial activity.
Alternariol and alternariol monomethyl ether show foetotoxic and teratogenic
effects in mice, including a synergistic effect when a combination of the toxins
was administered. Most Alternaria mycotoxins exhibit considerable cytotoxic
activity, including mammalian toxicity. The altertoxins are of a particular
concern due to their mutagenic activity. Altertoxin III exhibits mutagenic activity
that is approximately one tenth of that of aflatoxin B1, while altertoxins I and II
show lower mutagenicity.
5.2. Facial eczema (Pithomycotoxicosis)
Facial eczema is a disease caused by the toxin of Pithomyces chartarum that
mainly affects ruminants such as cattle, sheep, deer, goats and South
American camelids (alpaca, llamas). The fungus is a saprophytic mould which
lives on any dead litter lying at the base of pastures. This mould is present in
pastures all year round but only becomes a problem at certain times when
122
high ground temperatures coincide with high humidity and moisture. Under
these conditions the mould grows rapidly producing many new hyphae which
produce clusters of spores, which spread by wind throughout the pasture.
The spores produce a toxin called sporidesmin. When grazing animals ingest
spores from the pasture, the toxin is absorbed in the gut from the spores into
the bloodstream and then transported to the liver. Here the toxin causes
inflammation of the bile duct which eventually closes, not allowing bile to be
excreted into the small intestine. The bile then seeps back into the liver and
bloodstream. The damaged liver cannot rid the body of wastes and a
breakdown product of chlorophyll accumulates in the tissues. This results in
the animal becoming photosensitive, and it tends to seek shade away from
direct sunlight. If exposed to sunlight this results in immediate and severe
inflammation of the skin on exposed non pigmented parts of the body. From
the time the animal ingests toxic levels of spores to the appearance of the first
symptoms is usually about ten days.
In cows the first signs are a drop in milk production immediately after grazing
toxic pasture. Later cows become restless at milking time, seek shade and lick
their udders as photosensitisation develops. Skin lesions appear on
unpigmented skin, especially the escutcheon, inside the hind legs, the udder
and teats, and the coronets.
123
5.3. Stachybotryotoxicosis
In the late 1930s, stachybotryotoxicosis was reported in humans working
on farms in Russia. People who were affected are those who handled hay or
feed grain infested with Stachybotrys chartarum. Some of the individuals who
were infected had burned the straw or even slept on straw-filled mattresses
that had rampant growth of Stachybotrys chartarum. The infested straw can be
described as black in colour from growth of the fungus. Common symptoms in
humans that have stachybotryotoxicosis were rashes, especially in areas
subject to perspiration, dermatitis, pain and inflammation of the mucous
membranes of the mouth and throat, conjunctivitis, a burning sensation of the
eyes and nasal passages, tightness of the chest, cough, bloody rhinitis, fever,
headache, and fatigue.
The workers who were infected developed symptoms within two to three days
of exposure to the fungus. Some members of the Russian teams investigating
this disease rubbed the fungus onto their skin to determine its direct toxicity.
The fungus induced local and systemic symptoms similar to those observed in
naturally occurring cases.
S. chartarum produces a variety of macrocylic trichothecenes and
related trichoverroids: roridin E and L-2; satratoxins F, G, and H; isosatratoxins
F, G, and H; verrucarins B and J; and the trichoverroids, trichoverrols A and B
and trichoverrins A and B. The satratoxins are generally produced in greater
amounts than the other trichothecenes, but all compounds are produced in low
quantities.
Macrocyclic trichothecenes are highly toxic compounds with a potent
ability to inhibit protein synthesis. Numerous studies have demonstrated the
toxicity of toxins from S. chartarum on animals and animal and human cells.
Satratoxin G was the most cytotoxic of eight trichothecenes tested on
mammalian cells, even more toxic than the well known T-2 toxin associated
with alimentary toxic aleukia. Other researchers have also reported the high
toxicity of satratoxins compared to other trichothecenes. The LD50 in mice for
satratoxins is ~1 mg/kg (32).
In addition, S. chartarum produces nine phenylspirodrimanes
(spirolactones and spirolactams) and cyclosporin, which are potent
124
immunosuppressive agents. It was suggested that the combination of
trichothecenes and these immunosuppressive agents may be responsible for
the observed high toxicity of this fungus. New biologically active compounds
are still being discovered in cultures of S. chartarum, e.g. atranones A-G,
dolabellane diterpenes and stachylysin, a hemolysin (compounds that lyse
erythrocytes), and a hydroxamate siderophore. They suggest these
compounds could be pathogenicity factors involved in pulmonary hemorrhage
in infants exposed to S. chartarum.
6. Laboratory diagnosis
Unlike other more common fungal infections, there are no simple diagnostic
tests to identify these fungi, particularly to the species level. No routine
serologic, antigen or polymerase chain reaction (PCR) methods are available,
which is at least partly due to the tremendous diversity of these pathogens.
However, studies have begun to examine the potential of identifying species
within this diverse group of fungi using PCR of highly conserved regions of
ribosomal DNA.
Currently, the diagnosis of infection due to dematiaceous fungi relies on
pathologic examination of clinical specimens and careful gross and
microscopic examination of cultures.
In the case of mycetoma the presence of black mycotic granules or
grains can establish the diagnosis of mycetoma due to dematiaceous
fungi. Histologically, they appear to be composed of fungal cells
surrounded by a dense extracellular matrix composed primarily of a
melanin compound, which gives it a dark color.
Chromomycosis is characterized by the production of characteristic dark
sclerotic bodies in tissue, which are thick walled with septae.
125
Phaeohyphomycosis does not have such pathognomonic features,
though the histologic appearance is often characterized by irregular
hyphal elements and beaded, yeast-like forms.
7. Treatment
7.1. Tinea nigra: topical therapy (azoles or keratolytics)
7.2. Onychomycosis: Itraconazole and terbinafine are the most commonly
used systemic agents, and may be combined with topical therapy for refractory
cases.
7.3. Subcutaneous Lesions: Surgical excision alone has been successful in
a number of cases, including in immunocompromised patients. Oral systemic
therapy with an azole in conjunction with surgery is also frequently employed
and has been used successfully, especially in immunocompromised patients.
7.4. Chromoblastomycosis: Cryotherapy, itraconazole, or the combination
resulted in the largest number of cures. For small lesions, surgery alone may
be effective. A variety of other treatments have also been successful, including
ketoconazole, flucytosine, local heat therapy and amphotericin B.
7.5. Mycetoma: requires prolonged systemic antifungal therapy in addition to
surgery using ketoconazole, itraconazole, voriconazole or posaconazole
7.6. Central Nervous System Infection: Combination of amphotericin
B, flucytosine and itraconazole
7.7. Disseminated Infection:
The mortality rate is >70%, despite aggressive antifungal therapy. There are
no antifungal regimens associated with improved survival in disseminated
infection, including multiple combination therapies. Amphotericin B may be
useful for severe disease, though some species are resistant. Lipid
formulations will likely play an important role for such infections, as reduced
toxicity combined with the potential for increased
126
8. Contamination and deterioration by dematiaceous fungi
Dematiaceous fungi cause several plant diseases causing great losses in
grains like corn and wheat, fruits like apples, oranges, banana etc, vegetables
like tomato, onions, potato etc. They also contaminate and deteriorate woods,
leather, papers, meat, cheese etc. It is out of the scope of this monograph to
discuss this problem and the following pictures are only examples for the
actions of dematiaceous fungi.
Bipolaris, Southern corn leaf blight and stalk rot (Bipolaris maydis )...
127
Tan spot of wheat ,Pyrenophora tritici120
Cladosporium kernel rot of corn
Darkening lesions on tomato leaves, Stemphylium solani
128
Cladosporium
Mouldy vegetables
129
Mouldy fruits
Mouldy nuts
131
Mouldy cheese
Mouldy meat
131
Mouldy bread
Mouldy books
Mouldy paints
132
9. References
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2. Pastor FJ , Guarro J. Alternaria infections: laboratory diagnosis and relevant clinical features. Clin
Microbiol Infect. 2008, 14 (8):734-46.
3. Alternaria alternate, http://eol.org/pages/11942139/overview
4. Bush RK, Prochnau JJ. Alternaria-induced asthma. J Allergy Clin Immunol. 2004;113(2):227-34.
5. European Mycotoxins Awareness Network. www.mycotoxins.com.
6. Takeshi Uenotsuchi, Yoichi Moroi, Kazunori Urabe, Shuji Fukagawa, Gaku Tsuji, Tetsuo Matsuda,
Masutaka Furue. Cutaneous alternariosis with chronic granulomatous disease. European Journal of
Dermatology. 15, 5, 406-8, 2005, Clinical report
7. González-Vela MC, Armesto S, Unda-Villafuerte F, Val-Bernal JF.
Cutaneous Infection with Alternaria triticina in a Bilateral Lung Transplant Recipient. Actas
Dermosifiliogr. 2014. pii: S0001 7310(13)00402-X. doi: 10.1016/j.ad.2013.11.003.
8. Chhabra, V, Rastogi, S, Barua, M, Kumar S. Alternaria alternata infection associated osteomyelitis of
maxilla: a rare disease entity. Indian J Dent Res. 2013 (5):639-41
9. Konidaris V, Mersinoglou A, Vyzantiadis TA, Papadopoulou D, Boboridis KG, Ekonomidis P. Corneal
Transplant Infection due to Alternaria alternata: A Case Report. Case Rep Ophthalmol
Med. 2013;2013:589620. doi: 10.1155/2013/589620
10. Alhmali N, Lindenlaub P, Ghebremedhin B, Franke I, Gollnick H, Bonnekoh B. Deep cutaneous
mycosis due to Alternaria infectoria after liver transplantation: successful treatment with fluconazole.
Eur J Dermatol. 2013 23(1):100-2.
11. Ferreira Ide S, Teixeira G, Abecasis M. Alternaria alternata invasive fungal infection in a patient with
Fanconi's anemia after an unrelated bone marrow transplant. Clin Drug Investig. 2013 Feb;33 Suppl
1:S33-6.
1
12. Pavón Moreno MÁ , González Alonso I, Martín de Santos R, García Lacarra T. The importance of
genus Alternaria in mycotoxins production and human diseases. Nutr Hosp. 2012 27(6):1772-81.
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