Fungal Lesions Research Articles

Damaged armour: Ichnotaxonomy and paleoparasitology of bioerosion lesions in osteoderms of Quaternary extinct armadillos

Osteoderms are dermal ossifications present in several vertebrates and assemble a carapace on armadillos. Here we describe ichnotaxonomically two types of bioerosion traces as well as paleopathologically ulcerative lesions on osteoderms of three specimens of Late Pleistocene Holmesina cryptae armadillos (Xenarthra, Cingulata, Pampatheriidae) found in Lapinha Cave, Iramaia municipality, Bahia State, Brazil. The traces are always on the external surface of the osteoderms, none on endoskeleton elements, which are also different from bites and taphonomic process marks. This is evidence of the biological and syn vivo origin of the traces, making them remarkable and useful to access animal health. Karethraichnus minimum isp. nov. are individual holes interpreted as produced by sand flea sessile females, probably from the Tunga genus, based on already described lesions in living armadillos. This trace reveals a paleoparasitism behavior useful for tracking this relation deep in time in armoured animals. Violinichnus punctatus igen. et isp. nov. is formed by consecutive tiny holes, forming an overall elliptical/violin-like shape. This is attributed to lesions produced by the action of fungi over osteoderms, similar to mycose-like dermatophytosis (ringworm) in modern mammal skin. In contrast, the ulcerative lesions are recorded as necrosis of bone material, producing a corrosive-like disruption on the external surface of the osteoderms formed by irregular pits and exposition of spongy bone. These are ulcerative lesions probably produced by secondary infections by microorganisms such as fungi or bacteria, or even a destructive immunological response. This would begin as a more restricted lesion with several potential agents for this: abrasion from the soil, plants; lesions from intraspecific fights or predation; dermatitis; ectoparasites (e.g., mites, ticks, fleas, mosquitoes) or initial mycosis or bacterial infection. Since a bioerosive process cannot be demonstrated and is rather unlikely for the ulcerative lesions, these structures are not considered trace fossils. It is reasonable to assume that the flea lesion Karethraichnus minimum isp. nov. and fungal lesion Violinichnus punctatus igen. et isp. nov. could lead to an ulcerative lesion. As syn vivo traces, all these are tools to access the health of the animals to which the osteoderm belongs. Further support on ectoparasite and infection studies on living armoured animals would even allow inferences regarding extinct populations and interpretations of ancient ecosystems.

Effect of Fe₃O₄ Nanomaterial-Based MRI on the Efficacy of One-Sided Butterfly Sinus Lesions in the Nose.

Fe₃O₄ materials have many crystal forms, and the morphology of their nanomaterials is more diverse. Under the influence of nano-effects, they exhibit unique physical and chemical properties. The synthesized Fe₃O₄ materials with different morphologies have different properties. They are widely used in related fields such as electromagnetics, chemical engineering, catalysis, sensors, acoustics, medicine, environmental protection and so on. Choosing the appropriate contrast agent to display the anatomical characteristics of diseased and normal tissue is an important thing before using MRI (Magnetic Resonance Imaging) technology. At present, Gd-DTPA is a commonly used magnetic contrast agent in clinical practice, but Gd-DTPA has obvious shortcomings, such as short circulation time, non-specific distribution, and high price. In comparison, the superparamagnetic iron oxide nanocrystals have a high specific distribution in living tissues, mainly concentrated in reticular endothelial cells-rich tissues and organs, such as liver, spleen, lymph nodes and bone marrow. This study analyzed the imaging characteristics of 21 patients with unilateral benign sphenoid sinus disease who were confirmed by nasal endoscopic surgery and postoperative pathology. Among the 21 patients with unilateral benign sphenoid sinus lesions, 7 cases of them had cysts. Those with altered sphenoid sinus cavity expansion may be accompanied by thinning of bone resorption. MRI manifested as long T1 and long T₂ irregular spherical signal shadows. 8 cases of them are fungal lesions. MRI showed mixed signals are in the sphenoid sinus, the flaky exudation showed a high signal, and the fungal nodule showed a low T₂WI signal. In the 3 cases of cerebrospinal fluid rhinorrhea, MRI showed a line between the high-signal shadow of the cerebrospinal fluid and the high-signal liquid shadow in the sinuses. High signal and shadow are connected, and other tissues (brain tissue, nasal mucosa) show low signal. Fe₃O₄-based MRI technology can improve imaging quality and diagnostic efficiency.

Two white collar proteins protect fungal cells from solar UV damage by their interactions with two photolyases in Metarhizium robertsii.

The photolyases PHR1 and PHR2 enable photorepair of fungal DNA lesions in the forms of UV-induced cyclobutane pyrimidine dimer (CPD) and (6-4)-pyrimidine-pyrimidone (6-4PP) photoproducts, but their regulation remains mechanistically elusive. Here, we report that the white collar proteins WC1 and WC2 mutually interacting to form a light-responsive transcription factor regulate photolyase expression required for fungal UV resistance in the insect-pathogenic fungus Metharhizum robertsii. Conidial UVB resistance decreased by 54% in Δwc1 and 67% in Δwc2. Five-hour exposure of UVB-inactivated conidia to visible light resulted in photoreactivation rates of 30% and 9% for the Δwc1 and Δwc2 mutants, contrasting to 79%-82% for wild-type and complemented strains. Importantly, abolished transcription of phr1 in Δwc-2 and of phr2 in Δwc1 resulted in incapable photorepair of CDP and 6-4PP DNA lesions in UVB-impaired Δwc2 and Δwc1 cells respectively. Yeast two-hybrid assays revealed interactions of either WC protein with both PHR1 and PHR2. Therefore, the essential roles for WC1 and WC2 in both photorepair of UVB-induced DNA lesions and photoreactivation of UVB-inactivated conidia rely upon their interactions with, and hence transcriptional activation of, PHR1 and PHR2. These findings uncover a novel WC-cored pathway that mediates filamentous fungal response and adaptation to solar UV irradiation.

CryptoCEST: A promising tool for spatially resolved identification of fungal brain lesions and their differentiation from brain tumors with MRI

Infectious brain lesions caused by the pathogenic fungi Cryptococcus neoformans and C. gattii, also referred to as cryptococcomas, could be diagnosed incorrectly as cystic brain tumors if only based on conventional magnetic resonance (MR) images. Previous MR spectroscopy (MRS) studies showed high local concentrations of the fungal disaccharide trehalose in cryptococcomas. The aim of this study was to detect and localize fungal brain lesions caused by Cryptococcus species based on Chemical Exchange Saturation Transfer (CEST) MR imaging of endogenous trehalose, and hereby to distinguish cryptococcomas from gliomas. In phantoms, trehalose and cryptococcal cells generated a concentration-dependent CEST contrast in the 0.2 – 2 ppm chemical shift range, similar to glucose, but approximately twice as strong. In vivo single voxel MRS of a murine cryptococcoma model confirmed the presence of trehalose in cryptococcomas, but mainly for lesions that were large enough compared to the size of the MRS voxel. With CEST MRI, combining the more specific CEST signal at 0.7 ppm with the higher signal-to-noise ratio signal at 4 ppm in the CryptoCEST contrast enabled localization and distinction of cryptococcomas from the normal brain and from gliomas, even for lesions smaller than 1 mm3. Thanks to the high endogenous concentration of the fungal biomarker trehalose in cryptococcal cells, the CryptoCEST contrast allowed identification of cryptococcomas with high spatial resolution and differentiation from gliomas in mice. Furthermore, the CryptoCEST contrast was tested to follow up antifungal treatment of cryptococcomas. Translation of this non-invasive method to the clinic holds potential for improving the differential diagnosis and follow-up of cryptococcal infections in the brain.

Value of Hounsfield Units in the Evaluation of Isolated Sphenoid Sinus Lesions.

Radiologic findings of fungal sinus disease are generally opacification in paranasal computed tomography (CT) images. The Hounsfield unit (HU) is a standardized objective unit that is also suitable for measuring remodeling and opacifications on CT scans of bone sections of patients with chronic rhinosinusitis. We hypothesized that HU values could provide valuable information in isolated sphenoid sinus lesions before surgery. Between 2012 and 2019, 35 patients underwent functional endoscopic sinus surgery for sphenoid sinus lesions. Tissues obtained from the sphenoid sinus were divided into two groups, fungal and nonfungal, according to the findings of histopathologic examinations. HU values were measured in sphenoid sinus sections on paranasal CT scans of these two groups. Differences in mean and maximum HU values between the two groups were statistically significant (p < .05). The maximum HU values calculated from the sphenoid sinus were 435.08 and 196.23 (p ≤ .05) in the fungal group and nonfungal group, respectively. The mean HU values calculated from the sphenoid sinus were 64.31 and 29 (p ≤ .05) in the fungal and nonfungal groups, respectively. At the maximum cutoff value of 241, the sensitivity and specificity of the HU maximum were 84.6% and 77.3%, respectively. At the mean cutoff value of 41.5, the sensitivity and specificity of the HU mean were 76.9% and 86.4%, respectively. HU is an objective value used in radiographic density measurement. The HU values were higher in fungal lesions than in nonfungal inflammations, and they are useful in preoperative measurement.

Clinicopathological Study of Fungal and Parasitic lesions in Histopathology -An institutional experience; Are special stains Obligatory?

Clinicopathological Study of Fungal and Parasitic lesions in Histopathology -An institutional experience; Are special stains Obligatory?

Clinicopathological analysis of fungal lesions with unique presentations in immunocompetent adults – A case series from a tertiary care hospital in North Karnataka

Clinicopathological analysis of fungal lesions with unique presentations in immunocompetent adults – A case series from a tertiary care hospital in North Karnataka

Fungal lesion of the sphenoid sinus with contralateral paresis of the abducens nerve

Fungal lesion of the sphenoid sinus with contralateral paresis of the abducens nerve

Clinicopathological spectrum of fungal infections in a Tertiary Care Centre

Introduction: Fungal lesions are common in immunocompromised patients like Diabetic Mellitus, patients on anticancer drug and radiotherapy, HIV and transplant recipients. Although tissue culture being the gold standard for diagnosing fungal infections, histopathological examination gives better idea about tissue invasion. Materials and Methods: This study was done over 47 cases for a period of four years. This study was done to analyze the clinicopathological spectrum of fungal infections, morphology and their distribution according to age, sex and site of involvement in histopathological specimens in our hospital setup. Results: In this study, the most common fungal organism was found to be Phaeohypomycosis and most of these cases of phaeohypomycosis presented as ganglion and dermoid cyst .Most common site was foot. Conclusion: In this study we attempted to determine the etiological diagnosis of fungal infections in histopathological specimens received in our department. Keywords: Fungal lesions, Dermoid cyst, Ganglion, Gomori methenamine silver stain, Immunocompromised patients, Phaeohypomycosis.

Vitrectomy combined with intravitreal antifungal therapy for posttraumatic fungal endophthalmitis in eastern China

BackgroundTo evaluate the effect and prognostic factors of vitrectomy combined with intravitreal antifungal therapy for posttraumatic fungal endophthalmitis in Eastern China.MethodsWe retrospectively reviewed the medical records of patients who developed fungal endophthalmitis after penetrating ocular trauma at an ophthalmic center in Eastern China. All patients underwent vitrectomy and intravitreal injection of antifungal drugs.ResultsThirty-five patients (35 eyes) were included. Twelve eyes suffered plant trauma, 17 eyes metal trauma, and 6 eyes other trauma. The culture results for all 35 eyes showed filamentous fungi, including Aspergillus in 26 eyes (74.3%). Twenty-three eyes underwent vitrectomy once and 12 eyes were treated twice. Four eyes were iridectomized because of a fungal lesion behind the iris. Fungal endophthalmitis was effectively controlled in 33 eyes (94.3%), whereas 2 eyes were ultimately enucleated. Visual acuity was significantly better after treatment than before treatment (P = 0.0006). According to the preoperative vision, the affected eyes were divided into two groups: group 1A (light perception) and group 1B (better than light perception). The final visual acuity in group 1B was significantly better than that in group 1A (P = 0.0289).ConclusionsVitrectomy combined with intravitreal antifungal therapy is an effective treatment for posttraumatic fungal endophthalmitis. Preoperative visual acuity is a significant factor affecting the prognosis of visual acuity.

Pneumothorax following rupture of lung cavity due to aspergillosis in a critically ill patient

The incidence of fungal infection in intensive care units have been increasing over the years and Aspergillosis is one of the common fungal infections in the ICUs. It is a challenge for critical care experts to diagnose fungal infections on time and initiate appropriate management strategy to prevent adverse outcomes. Fungal infections may be notorious in not being diagnosed with a chest X ray alone as fungal infections related cavitary lesions may not always be seen in a chest X ray, necessitating the need of a CT Scan early on in the course of the illness. A chest CT scan may further be justified if the patient is not responding to a protracted course of higher antibiotics. Any delay in diagnosis may lead to poor outcome. Here we present a case who underwent subtotal gastrectomy for adenocarcinoma of stomach and presented one month later with fever, cough and shortness of breath. The patient was subsequently managed in the ICU but later expired following pneumothorax due to rupture of lung cavity associated with aspergillosis.&#x0D; Bangladesh Crit Care J September 2020; 8(2): 131-133

Sphenoid sinus aspergilloma clinically mimicking as malignancy\u2014a case report

BackgroundFungal sphenoid sinusitis mimicking as malignant tumor and invading the pituitary fossa is an uncommon entity. This report aims to highlight radiological salient features to help differentiate fungal lesion from malignant tumor in sphenoidal sinus mass lesions.Case presentationWe intend to report a case of middle-aged female who presented with gradual progressive diminution of vision since 3 years complicated with acute attack of unilateral headache and numbness. Computed tomography (CT) showed hyperdense lesion involving the sphenoid sinus extending into pituitary fossa and bilateral cavernous sinuses with smooth bony remodeling. Lesion appeared hypointense on T2-weighted and hyperintense on T1-weighted images on magnetic resonance imaging (MRI). Surgical excision of the lesion was done and pathological examination showed fungal hyphae and aspergillus fumigatus species on culture after 2 weeks of incubation. Post-operative CT revealed empty sinuses with surrounding bone remodeling.ConclusionCombination of T1 hyperintensity, T2 hypointensity, and hyperdense sinus is a strong predictor of fungal mass lesion involving sphenoid sinus.

Phaeoacremonium species detected in fine needle aspiration: a rare case report

BackgroundFine needle aspiration cytology (FNAC) with rapid on-site evaluation has a great potential for the diagnosis of fungal lesions and other opportunistic infections. Fungal infections have been in increasing trend in the past two decades due to immunosuppression, travel, and environmental exposure. Human disease caused by Phaeoacremonium species is rare and was first reported in 1974 as subcutaneous tissue infection in a renal transplant recipient.Case presentationWe report a case of subcutaneous tissue swelling in a 67-year-old male, wherein FNAC was done with incidental detection of the fungus (Phaeoacremonium spp).ConclusionThere are very few reported cases of subcutaneous infection in humans by Phaeoacremonium spp. Clinical suspicion and FNAC can play an important role in early detection of the fungus, prevent spread, and facilitating early treatment.

Beyond Skin Tumors: A Systematic Review of Mohs Micrographic Surgery in the Treatment of Deep Cutaneous Fungal Infections.

Deep cutaneous fungal infections (DCFIs) can cause significant morbidity in immunocompromised patients and often fail medical and standard surgical treatments because of significant subclinical extension. Although rarely considered in this setting, Mohs micrographic surgery (MMS) offers the advantages of comprehensive margin control and tissue conservation, which may be beneficial in the treatment of DCFIs that have failed standard treatment options. To review the benefits, limitations, and practicality of MMS in patients with DCFIs. A systematic review of PubMed and EMBASE was conducted to identify all cases of fungal skin lesions treated with MMS. Eight case reports were identified consisting of a total of 8 patients. A majority of patients had a predisposing comorbidity (75%), with the most common being a solid organ transplant (n = 3, 37.5%). The most commonly diagnosed fungal infection was phaeohyphomycosis (n = 5, 62.5%), followed by mucormycosis (n = 2, 25%). No recurrence or complication post-MMS was noted at a mean follow-up of 11.66 months. Although not a first-line treatment, MMS can be considered as an effective treatment alternative for DCFIs in cases of treatment failure and can be particularly helpful in areas where tissue conservation is imperative.

Possible control of acute outbreaks of a marine fungal pathogen by nominally herbivorous tropical reef fish

Primary producers in terrestrial and marine systems can be affected by fungal pathogens threatening the provision of critical ecosystem services. Crustose coralline algae (CCA) are ecologically important members of tropical reef systems and are impacted by coralline fungal disease (CFD) which manifests as overgrowth of the CCA crust by fungal lesions causing partial to complete mortality of the CCA host. No natural controls for CFD have been identified, but nominally herbivorous fish could play a role by consuming pathogenic fungi. We documented preferential grazing on fungal lesions by adults of six common reef-dwelling species of herbivorous Acanthuridae and Labridae, (surgeonfish and parrotfish) which collectively demonstrated an ~ 80-fold higher grazing rate on fungal lesions relative to their proportionate benthic coverage, and a preference for lesions over other palatable substrata (e.g. live scleractinian coral, CCA, or algae). Furthermore, we recorded a ~ 600% increase in live CFD lesion size over an approximately 2-week period when grazing by herbivorous fish was experimentally excluded suggesting that herbivorous reef fish could control CFD progression by directly reducing biomass of the fungal pathogen. Removal rates may be sufficient to allow CCA to recover from infection and explain historically observed natural waning behaviour after an outbreak. Thus, in addition to their well-known role as determinants of macroalgal overgrowth of reefs, herbivorous fish could thus also be important in control of diseases affecting crustose coralline algae that stabilize the foundation of coral reef substrata.

The Added Value of Longitudinal Imaging for Preclinical In Vivo Efficacy Testing of Therapeutic Compounds against Cerebral Cryptococcosis.

Brain infections with Cryptococcus neoformans are associated with significant morbidity and mortality. Cryptococcosis typically presents as meningoencephalitis or fungal mass lesions called cryptococcomas. Despite frequent in vitro discoveries of promising novel antifungals, the clinical need for drugs that can more efficiently treat these brain infections remains. A crucial step in drug development is the evaluation of in vivo drug efficacy in animal models. This mainly relies on survival studies or postmortem analyses in large groups of animals, but these techniques only provide information on specific organs of interest at predefined time points. In this proof-of-concept study, we validated the use of noninvasive preclinical imaging to obtain longitudinal information on the therapeutic efficacy of amphotericin B or fluconazole monotherapy in meningoencephalitis and cryptococcoma mouse models. Bioluminescence imaging enabled the rapid in vitro and in vivo evaluation of drug efficacy, while complementary high-resolution anatomical information obtained by magnetic resonance imaging of the brain allowed a precise assessment of the extent of infection and lesion growth rates. We demonstrated a good correlation between both imaging readouts and the fungal burden in various organs. Moreover, we identified potential pitfalls associated with the interpretation of therapeutic efficacy based solely on postmortem studies, demonstrating the added value of this noninvasive dual imaging approach compared to standard mortality curves or fungal load endpoints. This novel preclinical imaging platform provides insights in the dynamic aspects of the therapeutic response and facilitates a more efficient and accurate translation of promising antifungal compounds from bench to bedside.

In the evaluation of patients with skull base osteomyelitis, does 18F-FDG PET CT have a role?

To evaluate the diagnostic performance of regional fluorine-18 fluorodeoxyglucose (F-FDG) positron emission tomography-computed tomography (PET-CT) in patients with skull base osteomyelitis (SBO) and to compare with magnetic resonance imaging (MRI) whenever available. A total of 77 patients (male:female = 56:21; mean age 66.4 ± 9.4 years) with clinically suspected SBO, who underwent regional F-FDG PET-CT were included in this retrospective study. F-FDG PET-CT images were analyzed for presence, localization and intensity of FDG uptake. Diagnostic performance of F-FDG PET-CT was analyzed based on histopathology, culture, and clinical/imaging follow-up. The agreement analysis between F-FDG PET-CT and MRI findings was performed in 56 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of F-FDG PET-CT for diagnosing SBO were 96.7, 93.3, 98.3, 87.5, and 96.1%, respectively. The average SUVmax of the lesions was 5.9 ± 3.5. The SUVmax of the fungal lesions was lower than that of bacterial lesions with P-value of <0.001. On comparing variables like C-reactive protein, erythrocyte sedimentation rate, and SUVmax for prediction of recurrence/progression, by plotting an ROC curve, the SUVmax was found to be an independent prognostic marker. 56 out of 77 patients had undergone both F-FDG PET-CT and MRI. The agreement analysis between the modalities showed almost perfect agreement for delineation of soft tissue and bony involvement with κ values of 0.82 and 0.81, respectively. F-FDG PET-CT is a sensitive tool in evaluation of patients with SBO. It shows a very good agreement with the MRI. It plays a critical role in treatment response evaluation.

Fungal lesion length and expansion rate for the root pathogen Armillaria ostoyae in Douglas‐fir affecting root colonization and damage

AbstractPlant lesions affect disease impact, progression and host resistance. Root lesions caused by Armillaria ostoyae (Romagn.) Herink were inspected on 24‐ to 34‐year‐old planted Douglas‐fir (Pseudotsuga menziesii (Mirb.) Franco) pulled from the soil in five locations. Four hundred seventy‐nine lesions were measured for length (mm), expansion rate (mm/year) and lesion type. Lesion types were patch lesions on a root side, girdled lesions covering the root circumference and root collar lesions on the stem below ground. Non‐linear mixed modelling revealed that fungal lesion length at girdled and collar lesions increased but the expansion rate slowed as a power function of time, indicating increasing secondary inoculum and host resistance. Average fungal lesion expansion rate in girdled root and collar lesions was 127 mm the first year which then declined non‐linearly to 26 mm/year after 10 years. Fungal lesion length in patch lesions showed little change after the first year of infection. For girdled and collar lesions, fungal lesion length increased with tree size at the time of infection. Sites with a longer frost‐free period had shorter girdled root and stem lesions, probably because of more active host defence. Results indicate that mortality would be rare from one infection event. Furthermore, patch lesions pose a lower risk of mortality than other lesions because of a lower fungal lesion expansion rate and secondary inoculum. Tree size, lesion position, lesion type and fungal lesion expansion rate need to be considered when assessing the risk of lesions to individual tree survival. Techniques to minimize the disease impact are discussed.

Study of Fungal Lesions Presenting as Forearm Swelling

Study of Fungal Lesions Presenting as Forearm Swelling

How Long Do We Need to Treat an Invasive Mold Disease in Hematology Patients? Factors Influencing Duration of Therapy and Future Questions.

Treatment duration for invasive mold disease (IMD) in patients with hematological malignancy is not standardized and is a challenging subject in antifungal stewardship. Concerns for IMD relapse during subsequent reinduction or consolidation chemotherapy or graft versus host disease treatment in hematopoietic stem cell transplant recipients often results in prolonged or indefinite antifungal treatment. There are no validated criteria that predict when it is safe to stop antifungals. Decisions are individualized and depend on the offending fungus, site and extent of IMD, comorbidities, hematologic disease prognosis, and future plans for chemotherapy or transplantation. Recent studies suggest that FDG-PET/CT could help discriminate between active and residual fungal lesions to support decisions for safely stopping antifungals. Validation of noninvasive biomarkers for monitoring treatment response, tests for quantifying the "net state of immunosuppression," and genetic polymorphisms associated with poor fungal immunity could lead to a personalized assessment for the continued need for antifungal therapy.