International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 05 Issue 24, December, 2013

Pages: 61-63

Date of Publication: 31-Dec-2013


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PHAEOHYPHOMYCOSIS - A RARE INFECTION WITH TWO DIFFERENT CLINICAL PRESENTATION

Author: Volga Harikrishnan, Sonti Sulochana, Meenakshi Sundaram, Aruna Gnanaguruparan, Chitra Srinivasan

Category: Healthcare

Abstract:Phaeohyphomycosis is rare mycotic infections caused by melanized fungi. We report two cases of phaeohyphomycosis with different clinical scenario but with typical similar histopathological features.

Keywords: phaeohyphomycosis, melanised fungi

Full Text:

INTRODUCTION

Phaeohyphomycosis is caused by ubiquitous fungai and it can occur in any forms like septate hyphae, pseudohyphae, and yeast forms in tissue.  Clinical manifestations of the disease range from localized superficial infections of the stratum corneum to subcutaneous cysts (phaeomycotic cyst) to invasion of the brain.

CASE REPORT

Case 1

A 70 year old male presented with swelling in the dorsum of right little finger for 2 months duration. The lesion was associated with pain which was intermittent and pricking type. History of trauma (Thorn injury) was present. He was non- diabetic and had no other systemic or underlying disease. Clinically the case diagnosed as sebaceous cyst.

Case 2

An immunodeficient, 50 year old female presented with swelling in the left hand for 3 weaks duration. The lesion was not associated with pain. No history of trauma present. She was diabetic for the past 15 years.

PATHOLOGICAL FINDINGS

Gross features

Both cases showed typical similar gross features.  No contents were present. Inner surface of the cyst was brownish, case 1 showed fine nodularity in addition. Wall showed whitish and yellowish areas.

Microscopic features:

Sections from both cases showed fibrocollagenous cyst (Fig 1) wall lined by granulomas composed of epitheliod cells, foreign body and Langhan giant cells. The wall contains aggregates of foamy histiocytes, mixed inflammatory cell infiltrate and necrosis. Pigmented and branching fungal hyphae (Fig 2 &3) seen.

We did Periodic acid schiff (PAS) stain for both cases which showed branching and septate fungal hyphae morphologically consistent with Phaeohyphomycetes (Fig 4).

Ziehl-Nielsen staining was done for acid fast bacilli and it was negative for tubercle bacilli

DISCUSSION

The dematiaceous (brown-pigmented) fungi are heterogenous group of moulds that cause a wide range of diseases including phaeohyphomycosis, chromoblastomycosis and eumycotic mycetoma (1).

Phaeohyphomycosis, is a rare infection, although the number of cases has been increasing in recent years (2). These fungi are found in soil, wood and plant as saprophytes. The presence of melanin in their cell walls may be a virulence factor for these fungi (3).

Typically, phaeohyphomycosis follows traumatic implantation (4) of the fungus by a wooden splinter, as in one of our case. The primary risk factor is decreased host immunity, although cases in apparently immunocompetent patients (5) have been reported.

The spectrum of the disease includes superficial, cutaneous, subcutaneous and systemic infection (6).

Etiologic agents include Exophiala, Phoma, Bipolaris, Phialophora, Colletotrichum, Curvularia, Alternaria, Exserohilum, and Phialemonium sp (7).

Rarely it can cause fatal disease as reported by (8) .He reported a case of cerebral phaehyphomycosis in a patient with neurosarcoidosis  with the history of marijuana smoking and chronic steroid therapy.

The common manifestations clinically are cystic lesions as seen in our cases or abscesses (9).

Most forms of disease caused by dematiaceous fungi require both medical and surgical treatment. The most effective antifungal agent for subcutaneous phaeohyphomycosis is Itraconazole. Complete surgical resection can also be done for discrete lesions (1).

CONCLUSION

Since it is a rare fungal infection, the incidence has been increasing irrespective of immune status of the patient. We have presented two case reports with different clinical presentation one in immunocompetent individual, with trauma history and another one, immunodeficient patient without any triggering factor. Histopathological examination of tissue section along with special stain plays an important role in the diagnosis of Phaeohyphomycosis.

References:

  1. Brandt  ME ,Warnock DW. Epidemiology, clinical manifestations, and therapy of infections caused by dematiaceous fungi. J Chemother. 2003 Nov; 15 Suppl 2:36-47.
  2. Vasquez-del-Mercado et al. Subcutaneous phaehyphomycosis due to Curvularia lunata in renal transplant patient.Rev Iberoam Micol.2013 Apr-Jun;30(2):116-8
  3. Sanjay G. Revankar, Jan E. Patterson, Deanna A. Sutton, Disseminated Phaeohyphomycosis:Review of an Emerging Mycosis, Clinical Infectious Diseases 2002; 34:467–76.
  4. Madhavan Manoharan, Natarajan Shanmugam, Saveetha Veeriyan. A Rare Case of a Subcutaneous Phaeomycotic Cyst with a Brief Review of Literature. Malaysian J Med Sci. Apr-Jun 2011; 18(2): 80-83.
  5. Devesh Mishra, Maneesh Singal, Mahaveer Singh Rodha. Subcutaneous Phaeohyphomycosis of Foot in an Immunocompetent Host. J Lab Physicians, 2011 Jul; 3(2):122-4. doi: 10.4103/0974-2727.86848
  6. McGinnis MR, Chromoblastomycosis and phhaehyphomycosis: new concepts, diagnosis, and mycology. J Am Acad Dermatol.1983 Jan; 8(1):1-16.
  7. Isa-Isa R, Garcia C, Isa M, Arenas R. Subcutaneous phaeohyphomycosis (mycotic cyst). Clin Dermatol. 2012 Jul-Aug; 30(4):425-31.
  8. Gongidi P et al. Cerebral phaehyphomycosis in a patient with neurosarcoidosis on chronic steroid therapy secondary to recreational marijuana usage, Case Rep Radiol.2013; 2013:191375.
  9. Yoon Ya et al. Subcutaneous phaehyphomycosis caused by Exophiala salmonis. Ann Lab Med.2012 Nov; 32(6); 438-41.

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Best Article Award

A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Leow Jun Xian and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. entitled "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression
Egg a day tied to lower risk of heart disease
88 Percent Of Delhi Population Has Vitamin D Deficiency: ASSOCHAM Report

List of Awardees

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


Awardees of COVID-19 Research

Woman Researcher Award

A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

A Study by Rashmi Jain et al. entitled "Current Consensus Review Article on Drugs and Biologics against nCOVID-19 – A Systematic Review" published in Vol 12 issue 09

Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19


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