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Subcutaneous phaeohyphomycosis due to Phaeoacremonium parasiticum in a patient with Chronic Granulomatous Disease

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dc.contributor.authorCarvalho, Dinah
dc.contributor.authorSabino, Raquel
dc.contributor.authorVeríssimo, Cristina
dc.contributor.authorSimões, Helena
dc.contributor.authorLopes Silva, Susana
dc.contributor.authorMarques, Tiago
dc.contributor.authorJaneiro, João
dc.contributor.authorMarques Lito, Luis
dc.contributor.authorMelo Cristino, José
dc.date.accessioned2021-12-29T16:47:56Z
dc.date.available2021-12-29T16:47:56Z
dc.date.issued2021
dc.descriptionAbstract publicado em J Fungi. 2021;7(11):213-14 (P252). https://doi.org/10.3390/jof7110pt_PT
dc.description.abstractObjectives: Phaeoacremonium parasiticum is a ubiquitous dematiaceous mold that rarely causes infection in humans. Its spectrum of disease ranges from subcutaneous infections to disseminated disease. The majority of those reported few cases involve immunocompromised patients. Chronic granulomatous disease (CGD) is an inherited disorder affecting nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex. CGD patients are susceptible to a broad spectrum of opportunistic infections, being fungal infections a major determinant of survival. We report a case of Subcutaneous phaeohyphomycosis due to P. parasiticum in a young adult with CGD. Material and methods: A 28-year-old male patient with autossomic recessive CGD, due to mutations in CYBA, is followed in Primary Immunodeficiency Center since childhood. He has been under prophylaxis with itraconazole, cotrimoxazole and IFNg and tapering oral steroids, started for granulomatous colitits 2 years earlier. In a regular visit to the clinical center, he complained of persistent pain on his left leg with no history of recent injury in the affected area and without external inflammatory signs. An ultrasound was performed after 2 weeks revealing a heterogeneous liquid of slightly irregular contour in the sinus of the left anterior tibial muscle with heterogeneity of the adjacent muscle. This piomiositis collection was punctured, under ultrasound control, with drainage of about 7cm3 of hemato-purulent exsudate that was promptly processed for bacteriology (aerobic and anaerobic) and mycology studies. Results: Cultures for bacteria were sterile. Culture on Sabouraud was positive after 5 days of incubation, showing slow growing and initially white colonies. Microscopic examination showed hyaline, septate mycelium with long, thin conidiophores and curved, aseptate conidia.The fungus was initially identified as an Acremonium sp. and was sent to the Mycology Reference Laboratory for molecular identification and antifungal susceptibility testing. Its identification was performed by sequencing the internal transcribed spacer (ITS) region of ribosomal DNA, being the isolate identified as Phaeoacremonium parasiticum (100% homology). After 3 weeks incubation, coloration of the colonies emerged, becoming greyish black upon subculture, with velvety texture and black reverse. Microscopically, pigmented hyphae with tapering, funnel-shaped phialides were observed, and conidia were hyaline and oblong, forming clusters at the tip of the phialides. At this point, macroscopic and microscopic morphology was consistent with Phaeoacremonium species. Susceptibility pattern showed low minimal inhibitory concentrations (MIC) to posaconazole and voriconazole, and higher MIC values to anidulafungin and amphotericin B. The patient has improved under voriconazol therapy (200 mg; bid) Conclusions: Phaeoacremonium parasiticum is an uncommon infection and its appropriate identification is often difficult because morphologically, the genus Phaeoacremonium show morphological features resembling both Acremonium and Phialophora genera. Molecular identification is determinant to confirm morphology, as many species have indistinguishable characteristics that may lead to incorrect antifungal options. Also, susceptibility testing should be done for these so rare fungi as optimal treatment has not yet been clearly defined.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.urihttp://hdl.handle.net/10400.18/7835
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherMDPIpt_PT
dc.subjectPhaeoacremonium parasiticumpt_PT
dc.subjectChronic Granulomatous Diseasept_PT
dc.subjectInfecções Sistémicas e Zoonosespt_PT
dc.titleSubcutaneous phaeohyphomycosis due to Phaeoacremonium parasiticum in a patient with Chronic Granulomatous Diseasept_PT
dc.typeconference object
dspace.entity.typePublication
oaire.citation.conferencePlaceAberdeen, Escócia (UK)pt_PT
oaire.citation.title10th Trends in Medical Mycology, European Confederation of Medical Mycology (ECMM), 8-11 October 2021pt_PT
rcaap.rightsrestrictedAccesspt_PT
rcaap.typeconferenceObjectpt_PT

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