Etiologic significance of <i>Aspergillus terreus</i> in primary cutaneous mycosis of an agricultural worker

Abstract

This pilot study was aimed to elucidate the growing role of non-dermatophytic filamentous moulds in the cutaneous lesions of laborers who worked in agriculture field in the villages of Bharauch, Gujarat ,India. Eighteen patients (13 males and 5 females, aged 21 to 46 years) with various skin problems presented to the outpatient department (OPD) of Welfare Hospital and Research Center, and Shashwat Skin Clinic, Bharauch, India were examined for the non-dermatophytic filamentous fungi by using standard mycological techniques. All the specimens were treated in 10 % potassium hydroxide solution of direct microscopy; and cultural isolation was done onto Sabouraud medium with chloramphenicol. The detailed identification of fungal isolates was carried out in “ Narayan” stain. The treatment of patient was attempted with oral administration of itraconazole. Aspergillus terreus was identified in the cutaneous lesion of 1 of the 18 patients both by direct microscopy as well as by cultural isolation. The cinnamon-brown coloured colonies of A. terreus grew in pure culture from the biopsied tissue on Sabouraud dextrose agar with chloramphenicol. In “Narayan” stain, conidial heads of A. terreus were found compact, biseriate, and densely columnar. The patient had received trauma on the skin of right lower leg by wooden splinter while working in the field. The oral administration of itraconazole for 12 weeks showed good clinical response. The demonstration of A. terreus in the skin lesion by direct microscopy and cultural isolation, and good response to antifungal drugs clearly indicated that our patient was suffering with cutaneous mycosis. The patient with chronic cutaneous lesion, history of the skin trauma, and occupational exposure to the soil should be investigated for cutaneous mycosis. The immediate attention to traumatic injury to the skin is highly imperative to prevent the further complications. This seems to be first report of primary cutaneous mycosis due to A. terreus in an immunocompetent patient from this part of India.