Cutaneous Aspergillosis Research Articles

Cutaneous aspergillosis in goats and its therapeutic management by tamarind (Tamarindus indica) seed outer coat powder

Cutaneous aspergillosis in goats and its therapeutic management by tamarind (<i>Tamarindus indica</i>) seed outer coat powder

Primary cutaneous aspergillosis in a renal allograft recipient

Cutaneous fungal infection due to aspergillus is relatively less known. Mostly it occurs due to Aspergillus flavus. This entity should be included in differential diagnosis of cutaneous fungal infections

LB1565 Primary cutaneous aspergillosis in a patient with CARD9 deficiency

Aspergillus species, a common saprophytic mold, seldom acts as a pathogen in immunocompetent hosts, and primary cutaneous involvement is even less. Herein, we report a patient of primary cutaneous aspergillosis harboring CARD9 mutations. The 45-year-old patient presented with a 37-year history of skin lesions on the face. The lesion was a soy-sized rash on his left eyelid at the age of 8, which slowly enlarged and progressed during the past 3 years. Physical examination revealed erythematous plaques with clear border on his face and nose. Direct microscopic examination showed slender, septate, branched hyphae. A biopsy specimen revealed mixed inflammatory infiltrations with septate hyphae noted in multinuclear giant cells. From tissue cultures, Aspergillus fumigatus was isolated and identified. The patient denied any immunosuppressive conditions, and results of routine laboratory examinations were generally normal. A CT scan excluded pulmonary aspergillosis. Therefore, the diagnosis of primary cutaneous aspergillosis was made on the basis of the above findings. The patient responds well to oral itraconazole and is still under treatment. To study the reason for the prolonged infection and identify the genetic background in this seemingly immunocompetent patient, we screened mutations in several related genes. Sanger sequencing of CARD9 showed that the patient harbored a homozygous frame shift mutation in exon 6 (c.819_820insG, p.D274fsX60), leading to premature termination codons. His son was asymptomatic and heterozygous carrier of the same mutation. CARD9, mainly expressed in myeloid cells, is a key adaptor in the downstream signaling of several C-type lectin receptors, and mediates anti-fungal immunity by forming a complex with BCL10 and MALT1. This is, to our knowledge, the first report that linked cutaneous aspergillosis to CARD9 mutations. This work enriches both the phenotypic spectrum of CARD9 deficiencies and the genetic background of primary cutaneous aspergillosis.

Rash in an Extremely Low Birth Weight Infant

Primary cutaneous aspergillosis (PCA) is one of several invasive fungal infections that have increased in incidence in the last four decades. We present a case of an extremely low birth weight infant born at 24 weeks gestation diagnosed with cutaneous aspergillosis, highlighting the risk factors and clinical findings associated with neonatal PCA. Additionally, we discuss use of serum galactomannan testing as well as combination amphotericin B and voriconazole therapy.

Cutaneous aspergillosis in a boy with acute leukemia: the lessons from a “simple” case

Fungal infections are among the most serious infectious complications in immunosuppressed patients. Primary cutaneous aspergillosis is a relatively rare manifestation and is usually described in patients with underlying malignant hematological diseases, AIDS, allogenic stem cell transplantation, solid organ transplantation, etc. We present a clinical case of a 12-year-old boy with acute lymphoblastic leukemia initially diagnosed as primary cutaneous aspergillosis caused by Aspergillus flavus . The retrospective analysis demonstrates that a small solitary pulmonary nodule could be a possible portal of entry. This means that we could consider the disease as an early stage invasive aspergillosis, which is successfully treated with voriconazole.

497 Primary cutaneous aspergillosis (PCA) at the site of a skin abrasion covered with cyanoacrylate skin protectant in a neonate

497 Primary cutaneous aspergillosis (PCA) at the site of a skin abrasion covered with cyanoacrylate skin protectant in a neonate

Two case with primary cutaneous aspergillosis caused by uncleanliness.

Two case with primary cutaneous aspergillosis caused by uncleanliness.

Cytomorphological Diagnosis of Isolated Cutaneous Aspergillosis in an Immunocompetent Host.

Cytomorphological Diagnosis of Isolated Cutaneous Aspergillosis in an Immunocompetent Host.

Simultaneous primary invasive cutaneous aspergillosis in two preterm twins: case report and review of the literature

BackgroundPrimary invasive cutaneous aspergillosis is a rare fungal infection that occurs mostly in immunocompromised patients. Newborns of very low birth weight present a high risk for this type of infection due to an immaturity of the cutaneous barrier and of the immune system.Case presentationWe describe here a case of simultaneous invasive cutaneous aspergillosis in two preterm twins. Two male preterm bichorionic biamniotic twins (A & B) were born at a general hospital by spontaneous normal delivery at 24 weeks and 6 days of gestation. They were transferred to our hospital where they receive surfactant, antibiotics and hydrocortisone. Six days later, twin A showed greenish lesions in the umbilical region. The spectrum of antibiotic therapy was broadened and fluconazole was added. The umbilical catheters of the two twins were removed and replaced by epicutaneo-cava venous catheters and the cultures were positive for Aspergillus fumigatus. Fluconazole was replaced in both twins by liposomal amphotericin B and the incubators were changed. The serum galactomannan was also positive for both twins. At day 10, yellowish lesions appeared in the abdominal region in twin B. He died on day 18 following complications related to his prematurity. Concerning the twin A, serum galactomannan was negative on day 30; liposomal amphotericin B was stopped 1 week later, with a relay by econazole (cream). His condition improved and on day 66 he was transferred for follow-up at the general hospital where he was born.ConclusionThe source of contamination by A. fumigatus was not identified, but other similar cases from the literature include construction work at or near the hospital, oximeter sensors, latex finger stalls, non-sterile gloves, humidifying chambers of incubators, bedding and adhesive tapes. The skin fragility of preterm newborns is an excellent potential entry point for environmental fungal infections. These cases highlight the importance of suspecting primary cutaneous aspergillosis in extremely low birth weight neonates with rapidly progressive necrotic lesions.

Dermatopathologic emergencies part I

In dermatopathology, there are several conditions which must be addressed emergently. While some conditions necessitate emergent intervention because of the pathology of the cutaneous manifestations, others require recognition of the underlying serious systemic conditions represented by the cutaneous signs and symptoms. We describe the desquamating disorders (Staphylococcal scalded skin syndrome, Stevens–Johnson syndrome/toxic epidermal necrolysis, and edema-related desquamation), erythema multiforme, cutaneous aspergillosis, tinea/Candida overlying fractures, rickettsial infections, and eczema herpeticum as diseases which should be addressed immediately upon presentation because of the seriousness and rapidity of progression of their pathology. Moreover, porphyria cutanea tarda, Birt-Hogg-Dube syndrome, Muir-Torre syndrome, and acquired ochronosis may exemplify conditions where the cutaneous signs serve as warnings for severe systemic disease that may not be emergencies in isolation, but can indicate rapid occult development of destructive and sometimes deadly noncutaneous pathology. The literature review was conducted using searches in Pubmed and references to textbooks on the subjects.

Clinical Dermatology and Drug Discovery, relevance of Secondary Metabolites in Aspergillus nidulans and Primary Cutaneous Aspergillosis

Clinical Dermatology and Drug Discovery, relevance of Secondary Metabolites in Aspergillus nidulans and Primary Cutaneous Aspergillosis

Diol-Based Polymer Microparticles for Treatment of Cutaneous Aspergillosis in an Immunocompromised Murine Model

BackgroundLocal delivery of antifungals may allow for high concentrations of therapeutic directly in wound beds infected with invasive fungi. In this work, microparticles (MPs) fabricated from a novel biodegradable polymer synthesized from 1,10-decanediol (DD) and fumaric acid were leveraged for the local delivery of voriconazole (VRC) in a murine model of cutaneous aspergillosis. In addition to controlled local delivery of VRC, the MPs also degrade into byproducts which themselves have bioactivity against fungal viability and promote host wound healing.MethodsThe in vitro release kinetics of VRC-loaded MPs were measured over 6 days in PBS at 37oC under mild agitation. Immunocompromised BALB/c mice with 5 mm full thickness cutaneous defects infected with A. fumigatus were treated with: Group 1) no infection, no treatment; Group 2) no treatment; Group 3) unloaded blank MPs; and Group 4) VRC-loaded MPs (n = 10 per group). Six days after treatment (nine days after initial infection), mice were euthanized. Wound bed size, fungal wound bed CFU, and histological presence of fungi were evaluated to determine the effects of MPs on wound healing and infection.ResultsMPs were capable of releasing VRC at concentrations above A. fumigatus MIC for at least six days. Mice treated with VRC-loaded MPs had significantly decreased wound size than mice with no treatment (64.2% vs. 19.4% wound reduction, P = 0.002) and were not significantly different than uninfected controls (64.2% vs. 58.1%, P = 0.497). Although wound healing was increased with VRC-loaded MPs, total fungal burden was not significantly different between infected groups.ConclusionDiol-based MPs are capable of local delivery of VRC to treat infected wound beds in an immunocompromised murine model of cutaneous aspergillosis. VRC-loaded MPs restored normal wound healing. As fungal burden was unchanged, the exact mechanism of enhanced wound healing needs to be further explored.Disclosures D. P. Kontoyiannis, Pfizer: Research Contractor, Research support and Speaker honorarium; Astellas: Research Contractor, Research support and Speaker honorarium; Merck: Honorarium, Speaker honorarium; Cidara: Honorarium, Speaker honorarium; Amplyx: Honorarium, Speaker honorarium; F2G: Honorarium, Speaker honorarium

Primary Cutaneous Aspergillosis after Tattoo Removal Using a 1,064-nm Q-Switched Nd:YAG Laser in an Immunocompetent Patient.

Primary Cutaneous Aspergillosis after Tattoo Removal Using a 1,064-nm Q-Switched Nd:YAG Laser in an Immunocompetent Patient.

Factors affecting patient outcome in primary cutaneous aspergillosis.

Primary cutaneous aspergillosis (PCA) is an uncommon infection of the skin. There is a paucity of organized literature regarding this entity in regard to patient characteristics, associated Aspergillus species, and treatment modalities on outcome (disease recurrence, disease dissemination, and mortality).We reviewed all published reports of PCA from 1967 to 2015. Cases were deemed eligible if they included the following: patient baseline characteristics (age, sex, underlying condition), evidence of proven or probable PCA, primary treatment strategy, and outcome.We identified 130 eligible cases reported from 1967 to 2015. The patients were predominantly male (63.8%) with a mean age of 30.4 ± 22.1 years. Rates of PCA recurrence, dissemination, and mortality were 10.8%, 18.5%, and 31.5%, respectively. In half of the cases, there was an association with a foreign body. Seven different Aspergillus species were reported to cause PCA. Systemic antifungal therapy without surgery was the most common form of therapy (60% of cases). Disease dissemination was more common in patients with underlying systemic conditions and occurred on average 41.4 days after PCA diagnosis (range of 3-120 days). In a multivariate linear regression model of mortality including only patients with immunosuppressive conditions, dissemination and human immunodeficiency virus/acquired immune deficiency syndrome were statistically significantly associated with increased mortality.Nearly one-third of patients with PCA die with the disease. Dissemination and host status are critical in patient outcome.

Rare primary cutaneous aspergillosis in critically ill neonate

Rare primary cutaneous aspergillosis in critically ill neonate

A manifestation of cutaneous aspergillosis in immunocompetent host: A rare presentation as forearm mass lesion

The Aspergillus species is a ubiquitous fungus, which can cause pathogenic and opportunistic fungal infections in the immunocompromised. This is an atypical occurrence in the host with an otherwise normal immune status. We report a case of an immunocompetent 45-year-old patient who developed cutaneous aspergillosis with a very benign course presenting simply with a gradually enlarging mass and none of the classical signs and symptoms. All prior laboratory examinations failed to detect or reproduce the organism or establish a diagnosis. Surgery was both diagnostic and therapeutic, to remove the mass which causes the patient pain and limitation of activity. This was to our advantage because the fungal elements were very well encapsulated and the mass was a well-organized conglomeration of cystic abscesses that even prolonged chemotherapy alone might not succeed in eradicating the infection.

Cytodiagnosis of primary cutaneous aspergillosis in an immunocompetent host.

Cytodiagnosis of primary cutaneous aspergillosis in an immunocompetent host.

Cutaneous Invasive Aspergillosis: Retrospective Multicenter Study of the French Invasive-Aspergillosis Registry and Literature Review.

Invasive aspergillosis (IA) has poor prognosis in immunocompromised patients. Skin manifestations, when present, should contribute to an early diagnosis. The authors aimed to provide prevalence data and a clinical and histologic description of cutaneous manifestations of primary cutaneous IA (PCIA) and secondary CIA (SCIA) in a unique clinical series of IA and present the results of an exhaustive literature review of CIA. Cases of proven and probable IA with cutaneous manifestations were retrospectively extracted from those registered between 2005 and 2010 in a prospective multicenter aspergillosis database held by the National Reference Center for Invasive Mycoses and Antifungals, Pasteur Institute, France. Patients were classified as having PCIA (i.e., CIA without extracutaneous manifestations) or SCIA (i.e., disseminated IA). Among the 1,410 patients with proven or probable IA, 15 had CIA (1.06%), 5 PCIA, and 10 SCIA. Hematological malignancies were the main underlying condition (12/15). Patients with PCIA presented infiltrated and/or suppurative lesions of various localizations not related to a catheter site (4/5), whereas SCIA was mainly characterized by disseminated papules and nodules but sometimes isolated nodules or cellulitis. Histologic data were available for 11 patients, and for 9, similar for PCIA and SCIA, showed a dense dermal polymorphic inflammatory infiltrate, with the epidermis altered in PCIA only. Periodic acid Schiff and Gomori-Grocott methenamine silver nitrate staining for all but 2 biopsies revealed hyphae compatible with Aspergillus. Aspergillus flavus was isolated in all cases of PCIA, with Aspergillus fumigatus being the most frequent species (6/10) in SCIA. Two out 5 PCIA cases were treated surgically. The 3-month survival rate was 100% and 30% for PCIA and SCIA, respectively. Our study is the largest adult series of CIA and provides complete clinical and histologic data for the disease. Primary cutaneous IA should be recognized early, and cases of extensive necrosis should be treated surgically; its prognosis markedly differs from that for SCIA. Any suppurative, necrotic, papulonodular, or infiltrated skin lesion in an immunocompromised patient should lead to immediate biopsy for histologic analysis and mycological skin direct examination and culture.

A Case of Primary Cutaneous Aspergillosis of the Dorsum of Hand Due to Aspergillus niger Manifested by Edematous Lesion

A Case of Primary Cutaneous Aspergillosis of the Dorsum of Hand Due to Aspergillus niger Manifested by Edematous Lesion

Non-toxic agarose/gelatin-based microencapsulation system containing gallic acid for antifungal application.

Aspergillus niger (A. niger) is a common species of Aspergillus molds. Cutaneous aspergillosis usually occurs in skin sites near intravenous injection and approximately 6% of cutaneous aspergillosis cases which do not involve burn or HIV-infected patients are caused by A. niger. Biomaterials and biopharmaceuticals produced from microparticle-based drug delivery systems have received much attention as microencapsulated drugs offer an improvement in therapeutic efficacy due to better human absorption. The frequently used crosslinker, glutaraldehyde, in gelatin-based microencapsulation systems is considered harmful to human beings. In order to tackle the potential risks, agarose has become an alternative polymer to be used with gelatin as wall matrix materials of microcapsules. In the present study, we report the eco-friendly use of an agarose/gelatin-based microencapsulation system to enhance the antifungal activity of gallic acid and reduce its potential cytotoxic effects towards human skin keratinocytes. We used optimal parameter combinations, such as an agarose/gelatin ratio of 1:1, a polymer/oil ratio of 1:60, a surfactant volume of 1% w/w and a stirring speed of 900 rpm. The minimum inhibitory concentration of microencapsulated gallic acid (62.5 µg/ml) was significantly improved when compared with that of the original drug (>750 µg/ml). The anti-A. niger activity of gallic acid -containing microcapsules was much stronger than that of the original drug. Following 48 h of treatment, skin cell survival was approximately 90% with agarose/gelatin microcapsules containing gallic acid, whereas cell viability was only 25-35% with free gallic acid. Our results demonstrate that agarose/gelatin-based microcapsules containing gallic acid may prove to be helpful in the treatment of A. niger-induced skin infections near intravenous injection sites.