Deep Mycoses Research Articles

JAAD Game Changers: "Diagnosis of deep cutaneous fungal infections: Correlation between skin tissue culture and histopathology".

JAAD Game Changers: "Diagnosis of deep cutaneous fungal infections: Correlation between skin tissue culture and histopathology".

Patterns of Amphotericin B Use and Factors Related to Mortality in a Low-Middle Income Country: An Observational and Longitudinal Study

Background/Objectives: Amphotericin B is indicated in deep systemic fungal infections. The aim was to determine the sociodemographic, clinical and pharmacological variables of a group of Colombian patients treated with amphotericin B and factors associated with mo rtality. Methods: A longitudinal observational retrospective study on the use of amphotericin B in Colombia was conducted between January 2015 and December 2022. The multivariate analysis sought to identify variables related to mortality. Results: A total of 310 patients were identified, with a median age of 44.0 years, and 71.0% were women. Conventional amphotericin B was the most used (74.8%). The main uses were cryptococcosis (38.7%), histoplasmosis (31.9%) and candidiasis (29.4%). More than a third of patients died during hospitalization (40.3%). An increase in the Charlson Comorbidity Index score (HR: 1.13; 95% CI: 1.05–1.22) and in the qSOFA score (HR: 1.34; 95% CI: 1.04–1.73), coinfection by Mycobacterium tuberculosis (HR: 2.09; 95% CI: 1.32–3.31) and the requirement of vasopressors (HR: 4.20; 95% CI: 2.16–8.15) or invasive mechanical ventilation (HR: 2.73; 95% CI: 1.40–5.33) increased the probability of in-hospital death. In contrast, those who received systemic corticosteroids (HR: 0.43; 95% CI: 0.26–0.70) had a lower risk. Conventional amphotericin B is the most used drug mainly treating Cryptococcus neoformans infections. Conclusions: The use of amphotericin B was consistent with clinical practice guideline recommendations. In-hospital mortality was common, and factors such as increased comorbidities, higher qSOFA scores, coinfection with Mycobacterium tuberculosis and invasive procedures like mechanical ventilation were linked to increased mortality.

Development of a Rapid Diagnostic Method for Sporotrichosis

Introduction: Sporotrichosis, a prevalent deep fungal infection in clinical settings, currently lacks rapid and accurate diagnostic methodologies. This study explores a novel rapid diagnosis method for sporotrichosis by combining FTA cards and nested PCR with fungal fluorescence staining. Methods: The study involved skin lesion tissues from 26 patients diagnosed with sporotrichosis (Experimental Group). The Positive Control Group consisted of fungal suspensions from clinical strains of Sporothrix, while the Negative Control Group included fungal solutions of other fungi, namely Trichophyton rubrum, Trichophyton mentagrophyte, and Candida albicans. DNA was extracted from the slurry of skin lesions in the Experimental Group and from fungal suspensions in the Control Group using FTA cards, followed by nested PCR amplification. Subsequently, nested PCR amplification was performed. Histopathological examinations, including HE and fluorescence staining, were conducted on paraffin sections prepared from skin lesion tissues in the Experimental Group. Results: Among the 26 clinical skin lesion tissues in the Experimental Group, 8 cases showed a specific positive band upon nested PCR amplification, resulting in a positive rate of 30.8%. In the Control Group, the fungal solution of the clinical strain of Sporothrix showed a specific positive band upon nested PCR amplification, while all other fungi Negative Control Group tested negative. Histopathological examination revealed granulomatous inflammatory changes in most samples after HE staining. Fluorescence staining detected spores in 17 cases, resulting in a detection rate of 65.4% (17/26). Conclusion: The combination of FTA cards with nested PCR method proved to be simple and rapid but demonstrated a relatively low positive rate. Fungal fluorescence staining significantly improved the sensitivity of detecting sporotrichosis in histopathological examinations, thereby improving the speed and efficiency of diagnosis.

Deep Fungal Infections of Skin and Role of Histopathology in Diagnosis

Abstract Introduction: Deep mycoses acquired by penetrating trauma to the skin can have varied and sometimes atypical morphological presentations resulting in diagnostic dilemmas and delay in treatment onset. Histopathology can be a useful tool in not only diagnosing but also differentiating various deep mycoses. Aims and Objectives: To observe various morphological presentations and histopathological features of deep fungal infections. Materials and Methods: A retrospective multi-centric study was conducted from 2010 to 2020 at 16 centres. The cases with diagnoses of various deep mycoses were included in the study. The patients presenting with cutaneous manifestations were included in the study. Their demographic details, history, presenting signs and symptoms, morphological presentations, histopathological features and treatment details were collected from the case sheets. Results: A total of 124 cases were found from the case records. The most common type was chromoblastomycosis (42) followed by mycetoma (28) and rhinosporidiosis (17). The mean age was 43.76 ± 5.44 years. The average duration of symptoms before presentation was between 2 months to 10 years (average 2.5 ± 1.33 years). Male to female ratio was 1:0.7. Prior history of trauma was recorded in 36% of cases. Chromoblastomycosis cases presented with verrucous to atrophic plaques with black dots on the surface and histopathology findings included pesudoepitheliomatous hyperplasia, epithelioid cell granulomas, copper penny bodies within granulomas and abscesses. Rhinosporidiosis cases had polypoid grape-like lesions in the nose and eyes most commonly with histopathology findings of abundant thick-walled sporangia in dermis packed with thousands of spores. Eumycetoma patients had pigmented, indurated swelling with multiple sinuses discharging black granules and histopathology showed dermal abscesses and foreign body granulomatous reaction with PAS-positive hyphae. Histoplasmosis patients presented with few to multiple nodulo-pustular lesions on skin and palatal ulcers while small basophilic bodies packed in the cytoplasm of histiocytes were noted in histopathology. Phaeohyphomycosis cases presented as deep-seated cystic lesions and biopsy revealed deepithelialized cysts in the dermis or hypodermis with lumen showing necro inflammatory debris and fungal hyphae. Sporotrichosis cases had erythematous, tender nodules and papules either as single lesions or as multiple lesions arranged in a linear fashion and histopathology showed pseudoepitheliomatous hyperplasia of epidermis, loose to well-defined epithelioid cell granulomas and microabscesses. Spores were found in two cases. Cryptococcosis patient had multiple umbilicated lesions resembling giant molluscum contagiosum loose epithelioid cell granulomas and medium-sized spores lying in both intra and extracellularly on histopathology. Penicilliosis patients had nodulo-pustular lesions and histopathology showed an admixture of histiocytes, epithelioid cells, plasma cells, lymphocytes and polymorphs in the dermis with the presence of yeast-like spores in the cytoplasm of histiocytes and epithelioid cells. Entomophthoromycosis cases presented with asymptomatic subcutaneous firm swelling with loss of skin pinchability. Conclusion: Though clinical findings of deep fungal infections are characteristic similar morphology and atypical presentations can be sometimes confusing. Histopathology is useful for confirming the diagnosis.

Impact of Fab1/Vac14 inhibition on β-1,3-glucanase localization at the tip in Saccharomyces cerevisiae

Deep mycosis is a severe fungal disease that could result in fatal outcomes. However, there is still a demand for highly effective and safe antifungal drugs, given the side effects of the existing treatments and the increase in the resistance to them. In this study, we evaluated the involvement of the lipid kinase Fab1 and its activator Vac14 (Fab1/Vac14) in tip growth in Saccharomyces cerevisiae INVSc1, along with their impact on cell proliferation, using a genetic approach to inhibit them. The results revealed that Fab1/Vac14 inhibition suppressed growth and caused an increase in the rate of β-1,3-glucanase (BGL2) fused with emerald green fluorescent protein (EmGFP) (BGL2-EmGFP) localization at the tip. The inhibition of the endocytic pathway using a lysosome inhibitor also resulted in an increased localization of BGL2-EmGFP at the tip. The overexpression of wild-type BGL2-EmGFP, but not that of the inactive mutant BGL2, led to a complete loss of the cell proliferation ability. These findings suggested that the Fab1/Vac14 complex could be a novel target for the development of antifungal drugs based on tip growth regulation, possibly via excessive cell wall degradation.

Electrically-driven drug delivery into deep cutaneous tissue by conductive microneedles for fungal infection eradication and protective immunity

Fungal infections affect over 13 million people worldwide and are responsible for 1.5 million deaths annually. Some deep cutaneous fungal infections may extend the dermal barriers to cause systemic infection, resulting in substantial morbidity and mortality. However, the management of deep cutaneous fungal infection is challenging and yet overlooked by traditional treatments, which only offer limited drug availability within deep tissue. In this study, we have developed an electrically stimulated microneedle patch to deliver miconazole into the subcutaneous layer. We tested its antifungal efficacy using in vitro and ex vivo models that mimic fungal infection. Moreover, we confirmed its anti-fungal and wound-healing effects in a murine subcutaneous fungal infection model. Furthermore, our findings also showed that the combination of miconazole and applied current synergistically stimulated the nociceptive sensory nerves, thereby activating protective cutaneous immunity mediated by dermal dendritic and γδ-T cells. Collectively, this study provides a new strategy for minimally invasive delivery of therapeutic agents and the modulation of the neuro-immune axis in deep tissue.

First report of deep cutaneous fungal infection caused by Nigrograna hydei

First report of deep cutaneous fungal infection caused by Nigrograna hydei

Clinical and Dermoscopic Patterns of Basal Cell Carcinoma and Its Mimickers in Skin of Color: A Practical Summary.

The diagnosis of basal cell carcinoma (BCC) in dark phototypes can be a challenging task due to the lack of relevant clues and its variable presentation. In this regard, there is growing evidence that dermoscopy may benefit the recognition of BCC even for skin of color (SoC). The objective of this review is to provide an up-to-date overview on clinical and dermoscopic patterns of BCC in SoC, also comparing such findings with those of the main clinical mimickers reported in the literature. A comprehensive search of the literature through the PubMed electronic database was carried out in order to identify papers describing the clinical and dermoscopic features of BCC in dark phototypes (IV-VI). By finding macroscopic clinical presentations of BCCs in SoC patients and any possible clinical mimickers considered in the retrieved papers, we built a differential diagnosis list and analyzed the dermoscopic findings of such conditions to facilitate the diagnosis of BCC. BCC in darker skin may present as pigmented nodular lesions, pigmented patches or plaques, ulcers, erythematous nodular lesions, erythematous plaques or patches, or scar-like lesions, depending on its subtype and body site. The differential diagnosis for BCC in patients with SoC includes squamous cell carcinoma, melanoma, nevi, adnexal tumors and sebaceous keratosis. Additionally, it differs from that of Caucasians, as it also includes lesions less common in fair skin, such as dermatosis papulosa nigra, melanotrichoblastoma, and pigmented dermatofibrosarcoma protuberans, and excludes conditions like actinic keratosis and keratoacanthoma, which rarely appear in darker skin. The resulting differences also include infectious diseases such as deep cutaneous mycosis and inflammatory dermatoses. The most prevalent differentiating dermoscopic feature for BCC includes blue, black and gray dots, though arborizing vessels still remain the predominant BCC feature, even in dark phototypes. Diagnostic approach to BCC in dark-skinned patients varies due to the prevalence of dermoscopy findings associated with hyperpigmented structures. Clinicians should be aware of such points of differentiation for a proper management of this tumor in SoC.

Mucormycosis as a complication of COVID-19 coronavirus infection: eye symptoms

COVID-19 causes an immunosuppressive condition and increases the risk of secondary infections, including fungal diseases such as mucormycosis (MM), so doctors should be aware of the possibility of MM development in COVID-19 patients. Since no specific complaints or clinical symptoms exist and the disease is rare, especially in developed countries with a moderate climate, it is often impossible to diagnose MM at the initial examination. Therefore, the detection of the pathogen (mycelium zygomycetes) plays a key role in the diagnosis. Over 70 % of MM patients experience eye damages. According to the literature, the most common manifestations thereof are blepharoptosis, ophthalmoplegia, exophthalmos, injection and conjunctival chemosis. Quite often, the patients have eye pains, orbital cellulitis or phlegmon of the orbit, accompanied by a decrease in vision. For the effective treatment of this severe infectious COVID-19 complication, which takes the form of deep and aggressive mycosis, an interdisciplinary approach is necessary. The complex treatment should make use of antimycotic agents and symptomatic therapy, and, essentially, surgical rehabilitation of infection foci by removing the affected necrotic tissues. The prognosis is always very serious.

Design, Synthesis, and Activity Evaluation of Novel Benzazole Bifunctional Antifungal Inhibitors with an LDH Carrier.

Fungal infections maintain a close relation with the body's immune function. In this study, three series of benzazole compounds were designed as dual-target (PD-L1/CYP51) inhibitors using the skeleton splicing approach; their molecular structures were synthesized and evaluated accordingly. Among them, the compounds 9a-2, 12a-2, and 12b-1 exhibited potent antifungal activity and dual-target inhibition ability. Especially, the compound 12a-2 simultaneously exerted excellent bifunctional effects of fungal inhibition and immune activation. Moreover, a layered double hydroxide (LDH) carrier was also successfully constructed based on an infection microenvironment to improve the bioavailability and the targeting of compound 12a-2. This significantly accelerated the recovery process of deep and shallow fungal infections. In conclusion, this study expanded the development horizon of antifungal drugs and provided a novel drug delivery route for treating fungal infections.

Artificial Intelligence in Infectious Skin Disease

AbstractBackgroundInfective and infectious dermatological diseases, which range from minor diseases like impetigo to serious diseases like deep fungal infections, pose significant public health issues. Given the growth of drug‐resistant microorganisms, it is critical to investigate novel techniques in dermatology. Artificial Intelligence (AI) has shown promising results in improving the diagnosis, treatment, and management of infectious skin disorders. This has the potential to significantly improve dermatological treatment by combining physician experience with data‐driven insights.ObjectiveThis review will look into the existing uses and future possibilities of AI technologies in infectious dermatology, including machine learning and deep learning. Its goal is to highlight major advances, identify gaps in understanding and technical advancement, and recommend viable future research directions.MethodsA comprehensive literature search of the scientific literature was performed using well‐known databases such as PubMed, Google Scholar, and Embase. A specific set of phrases relevant to AI and infectious dermatology was used to ensure a thorough search. Articles were picked based on their relevance, timeliness, and quality, with a particular emphasis on research demonstrating how AI is being utilized to prevent, detect, diagnose, or manage infectious skin disorders.ResultsAI has made significant contributions to the management of infection in dermatology. It has improved diagnostic accuracy, predictive modeling of drug resistance, and individualized care regimens. Deep learning is used to evaluate clinical images, predictive models are developed to forecast antibiotic resistance, and AI‐powered diagnostic tools for uncommon infections. The assessment also throws light on AI's role in pandemic preparedness and response.

Cutaneous and Osseous Histoplasmosis caused by Histoplasma capsulatum var. duboisii in a Seemingly Immunocompetent Young Senegalese Woman

African histoplasmosis is a rare deep mycosis caused by Histoplasma capsulatum var duboisii. It can affect various organs such as the skin, lymph nodes, and bones. The diagnosis is often delayed due to its similarity to certain diseases such as tuberculosis, cryptococcosis, pyogenic abscesses, and even neoplasia. We report a case of cutaneous and osseous histoplasmosis caused by H. capsulatum var. duboisii in a seemingly immunocompetent 19-year-old senegalese woman who presented with chronic disseminated cutaneous abscesses, some of which had fistulised, and umbilicated papules on the face. The radiograph of the right forearm showed a metaphyso-diaphyseal osteolytic lesion of the ulna. Histology after biopsy of a facial papule confirmed the diagnosis of histoplasmosis caused by H. capsulatum var duboisii. The patient's condition improved with fluconazole treatment.

Coated Microneedle System for Delivery of Clotrimazole in Deep-Skin Mycoses.

Mycoses of the skin are infectious diseases caused by fungal microorganisms that are generally treated with topical agents. However, such therapy is often ineffective and has to be supported by oral use of active substances, which, in turn, can cause many side effects. A good alternative for the treatment of deep-skin mycoses seems to be microneedles (MNs). The aim of this research was to fabricate and evaluate the properties of innovative MNs coated with a hydrogel as potential carriers for clotrimazole (CLO) in the treatment of deep fungal skin infections. A 3D printing technique using a photo-curable resin was employed to produce MNs, which were coated with hydrogels using a dip-coating method. Hydrogels were prepared with carbopol EZ-3 Polymer (Lubrizol) in addition to glycerol and triisopropanolamine. Clotrimazole was introduced into the gel as the solution in ethanol or was suspended. In the first step of the investigation, a texture analysis of hydrogels was prepared with a texture analyzer, and the drug release studies were conducted with the use of automatic Franz diffusion cells. Next, the release profiles of CLO for coated MNs were checked. The last part of the investigation was the evaluation of the antifungal activity of the prepared systems, and the inhibition of the growth of Candida albicans was checked with the diffusion and suspended-plate methods. The texture profile analysis (TPA) for the tested hydrogels showed that the addition of ethanol significantly affects the following studied parameters: hardness, adhesiveness and gumminess, causing a decrease in their values. On the other hand, for the gels with suspended CLO, better spreadability was seen compared to gels with dissolved CLO. The presence of the active substance did not significantly affect the values of the tested parameters. In the dissolution study, the results showed that higher amounts of CLO were released for MNs coated with a hydrogel containing dissolved CLO. Also, microbiological tests proved its efficacy against fungal cultures. Qualitative tests carried out using the diffusion method showed that circular zones of inhibition of fungal growth on the plate were obtained, confirming the hypothesis of effectiveness. The suspension-plate technique confirmed the inhibitory effect of applied CLO on the growth of Candida albicans. From the analysis of the data, the MNs coated with CLO dissolved in hydrogel showed better antifungal activity. All received results seem to be helpful in developing further studies for MNs as carriers of antifungal substances.

Impurity profile analysis of amphotericin B using on-line two-dimensional high performance liquid chromatography-quadrupole time-of-flight mass spectrometry

Amphotericin B (AmB) is a polyene-macrolide antimicrobial drug with a broad antibacterial spectrum and remarkable efficacy against deep fungal infections. It binds to ergosterol on the fungal cell membrane and alters its permeability, thereby destroying the membrane. AmB is a multicomponent antimicrobial medication that contains a wide range of impurities, rendering quality analysis extremely difficult. In the current Chinese Pharmacopoeia (Edition 2020) and European Pharmacopoeia (EP10.3), high performance liquid chromatography (HPLC) is applied to examine related substances in AmB. However, this technique presents a number of issues. For instance, the mobile phases used in the HPLC method described in both references contain nonvolatile inorganic salts, which cannot be coupled with a mass spectrometry (MS) detector. In addition, because the mobile phases used have a low pH, the component/impurities of AmB drug can easily be degraded or interconverted during the analytical process, leading to reduced analytical accuracy. Therefore, the accuracy and sensitivity of this method must be improved. In this study, a method based on on-line two-dimensional high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (2D HPLC-Q TOF/MS) was developed to analyze the impurity profile of AmB in accordance with the Chinese Pharmacopoeia (Edition 2020) and European Pharmacopoeia (EP10.3). The method combines on-line dilution and a multiple-capture HPLC system to achieve the efficient separation of AmB component/impurities. It also resolves the issue of poor solvent compatibility in 2D HPLC, increases the analytical flux, enhances the automation capability, reduces the mutual conversion of AmB and its impurities during the analytical process, and increases the detection sensitivity of the method. MS was also used to determine the structural inference of unstable components and impurities. An XBridge Shield C18 column (250 mm×4.6 mm, 3 μm) was used for first-dimensional-liquid chromatography with gradient elution using methanol-acetonitrile-4.2 g/L citric acid monohydrate solution (10∶30∶60, v/v/v, pH 4.7) as mobile phase A and methanol-acetonitrile-4.2 g/L citric acid monohydrate solution (12∶68∶20, v/v/v, pH 3.9) as mobile phase B. An Xtimate C8 column (10 mm×2.1 mm, 5 μm) was used as the trap column, and trapping and desalting were performed using 10 mmol/L ammonium formate aqueous solution containing 0.1% formic acid-acetonitrile (95∶5, v/v). An Xtimate C8 column (250 mm×2.1 mm, 5 μm) was used for second-dimensional-liquid chromatography with gradient elution using 10 mmol/L ammonium formate aqueous solution containing 0.1% formic acid-acetonitrile (95∶5, v/v) and 10 mmol/L ammonium formate aqueous solution containing 0.1% formic acid-acetonitrile (5∶95, v/v) as mobile phases. The data were collected in positive-ion mode. In this study, the structures of six impurities in amphotericin B were inferred, according to the fragmentation, the MS and MS2 spectra of each impurity. The developed method can be used to quickly and sensitively analyze the impurity profile of AmB. Furthermore, the research results on impurity profiles can be applied to guide improvements in AmB production.

Clinical impact of fungal colonization of burn wounds in patients hospitalized in the intensive care unit: a retrospective cohort study

BackgroundInvasive fungal infections in burn victims significantly increase mortality and hospitalization. The effect of fungal burn wound colonization has not been established.MethodsAll adult patients hospitalized in the intensive care unit...

A Case of Deep Cutaneous Mycosis Caused by Purpureocillium lilacinum

Purpureocillium lilacinum, previously known as Paecilomyces lilacinus, is a saprophytic fungus typically found in soil and decaying vegetation. Although it is infrequently pathogenic to humans, recent reports of P. lilacinum infections, primarily affecting the skin and eyes, have shown an increase. This report details a cutaneous infection caused by P. lilacinum in an 89-year-old woman. She presented with a 3-month history of an erythematous patch and nodule on her right forearm. A skin biopsy revealed inflammation, granuloma, and fungal organisms in the dermis. Periodic acid-Schiff (PAS) staining confirmed the presence of fungal elements. The fungal culture of the medium produced colonies with a velvety pink and brown hue. PCR testing on these cultured samples identified P. lilacinum. The patient received a 2-week course of oral itraconazole (200 mg/day), which improved her symptoms. However, ongoing antifungal treatment was necessary. Additionally, due to a recent myocardiac infarction, the patient required a statin. A MIC test was conducted to identify an antifungal drug compatible with statin therapy.

Difficult path to the diagnosis of chromomycosis

Chromomycosis is a slowly occurring mycosis of subcutaneous adipose tissue and skin. Most often, cases of the disease are recorded in countries with a tropical and subtropical climate. In the Russian Federation, the disease occurs sporadically. Very rarely (2 cases out of 100) malignant transformation into squamous cell carcinoma occurs. The article presents a clinical case of chromomycosis. A description is given of a patient in whom squamous cell carcinoma was detected at the onset of the disease, which was the reason for treatment by oncologists. Six months later, the patient had a relapse in the area of the postoperative scar and a focus in the area of the right hand. Repeated biopsy with histological examination made it possible to establish the correct diagnosis. Interest in the above clinical case was caused by the detection of chromomycosis in a resident of the city of Saint Petersburg, who was not in endemic areas, was not engaged in agricultural work, and denied the primary injury. Our patient experienced a rapid malignancy of the focus, after surgical treatment, a recurrence of deep mycosis occurred. A good effect was obtained from systemic antimycotic therapy.

Deep Fungal Infections of the Upper Extremity - A Review.

Deep fungal infections are rare in the upper extremity. Vessel and nerve infection, synovitis, tenosynovitis, myofasciitis, arthritis and osteomyelitis have been discovered in literature. Treatment in most cases includes surgical procedure and antifungal agent use. Amputation is the final, most devastating for patient's functionality, solution. Intravenous antifungal drugs, frequently followed by oral administration, are important ancillary agents both for the initial treatment and the prevention of recurrence. We therefore performed a review of the current literature, in order to assemble the dispersed results of different studies and clarify the various aspects of upper extremity fungal infections.

Cutaneous manifestations of deep mycoses in Nigeria: a systematic review.

Deep mycoses are serious fungal diseases commonly associated with the immunocompromised but can also present in the immunocompetent following severe exposure to fungal pathogens. Included in this group are subcutaneous and systemic fungal infections. Reviews highlighting skin involvement in patients with deep mycosis in the Nigerian setting are sparse in the literature. This systematic review summarized the clinical presentation, risk factors, and diagnosis of deep mycosis presenting with cutaneous manifestations in Nigerians. This was a systematic review conducted following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. PubMed, Google Scholar, and the African Journal Online database were searched from inception to February 2024 to identify published articles from Nigeria on deep mycoses with cutaneous manifestations. We included single case reports and case series on cutaneous involvement in deep fungal infections in Nigeria. Review articles, guidelines, meta-analyses, animal studies, and fungal studies not relating to the Nigerian setting were excluded. We identified 16 well-documented articles on deep cutaneous mycoses published in Nigeria over the past six decades which amounted to 137 cases; 102 (74.5%) cases were reported before the year 2000, while the remainder were published within the past two decades. The 137 cases were majorly histoplasmosis (n = 87, 63.5%) and eumycetoma (n = 19, 13.9%) and predominant risk factors, farming (n = 13, 9.5%) and diabetes mellitus (n = 3, 2.2%), The diagnosis of cases was predominantly via histopathology (n =131, 95.6%) with a few cases diagnosed by fungal culture (n = 15, 10.9%), and antigen assay (n = 1, 0.7%) respectively. Twenty-one (15.3%) were clinically diagnosed as cancers including a case of carcinoma of the skin, and one each (0.7%) as skin tuberculosis or neurofibromatosis but all histologically confirmed as deep cutaneous mycoses. The decline of reports on deep cutaneous mycoses in recent times suggests neglect or a low index of suspicion from attending clinicians. This is further buttressed in the misdiagnosis of cases as other clinical entities. Ensuring a histological diagnosis of skin lesions, especially in at-risk patients will mitigate these gaps.

Knowledge, attitudes, and practices of dentists regarding mucormycosis as a possible orofacial manifestation of COVID-19 in postpandemic times: A cross-sectional study

Introduction: Mucormycosis, also known as black fungus, is a rare but serious fungal infection usually seen in immunocompromised hosts. There are cluster of cases being reported and diagnosed as mucormycosis in treated COVID-19 patients in the postpandemic times. The aim of the present study was to assess awareness among dentists regarding mucormycosis and other possible oral manifestations of COVID-19 in the postpandemic times and the associated complications. Materials and Methods: In the present cross-sectional study, a well-structured questionnaire composed of a total of 17 closed-ended questions was used to cover questions to assess awareness among dentists regarding the possible oral manifestations of post-COVID-19. Furthermore, statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 21.0 (IBM, Chicago, IL, USA), while the Chi-square test and Pearson’s correlation coefficient were used to analyze the data statistically. Results: The Chi-square test was used to analyze the association of the knowledge, attitude, and practice scores regarding COVID-19 and the academic qualification of the participants revealed that despite having sufficient information (knowledge and attitude scores), no significant difference (P = 0.7288) was observed in the practices of the participants irrespective of their academic qualification. On analyzing the data further, though, a significant positive correlation was observed between all the components of the knowledge, attitude, and practice scores of the participants (P = 0.0001) using Pearson’s correlation coefficient. Conclusion: From the findings of the present study, it could be concluded that dentists were well aware of the possible oral manifestations of COVID-19, including mucormycosis, though the possibility of increasing awareness among dentists regarding the multidisciplinary approach required for the management of deep fungal infections such as mucormycosis cannot completely be ruled out. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and procedural skills, Systems-based practice, Medical knowledge.