Fungal Lesions Research Articles

Aspergillus flavus-Induced Brain Abscess in an Immunocompetent Child: Case report.

Intracranial aspergillosis is an extremely rare manifestation of invasive aspergillosis in immunocompetent children and is associated with high morbidity and mortality. We report a 12-year-old immunocompetent male child who was referred to the King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia, in May 2010 after a sudden-onset headache and loss of consciousness. Brain imaging revealed a large right space-occupying occipital lesion and the patient underwent a craniotomy and resection. Histopathology of the lesion revealed necrotising granulomatous fungal encephalitis with many hyphae engulfed by multinucleated giant histiocytes. Two days later, a computed tomography scan showed debulking of the fungal mass and the patient was discharged on oral voriconazole. However, imaging at a six-week follow-up showed progression of the abnormality. A residual or persistent fungal brain lesion was suspected. Further neurosurgical resection of the lesion was performed and cultures showed growth of Aspergillus flavus. The patient was treated successfully with antifungal therapy over the following two years.

Isolated vocal cord aspergillosis in a professional flute player – A case report

Abstract Introduction Isolated vocal cord aspergillosis is an extremely rare clinical entity, especially in immunocompetent persons. It is usually seen as part of the systemic infections involving bronchopulmonary region in an immunocompromised patient. Differential diagnosis is important in this condition as clinical features are often simulating to the laryngeal malignancy or premalignant conditions. Aim Early identification and treatment of this rare isolated fungal lesion in the vocal cords prevent spread to other parts of the larynx and outside of the larynx. Case report In this case, a 35-year-old male flute player presented with primary aspergillosis of the vocal cords without affecting other parts of the airway. With the help of histopathological and microbial culture report, it was diagnosed and treated early. Results and discussion Video laryngoscope confirmed pale, whitish, irregular and thickened lesions involving the bilateral vocal cords, whereas histopathological examination showed colonization by both spores and broad septate hyphae without any evidence of malignant cells. Potassium hydroxide (KOH) staining and culture in Sabouraud Dextrose Agar (SDA) revealed fungal growth with bluish green velvety and powdery surface confirmed the fungal growth of Aspergillus fumigatus . Conclusions An isolated fungal infection of the larynx is a rare clinical entity and often simulates a premalignant condition or squamous cell carcinoma. Early identification and treatment of this isolated fungal lesion in the vocal cords are important to prevent spread to other parts of the larynx and outside of the larynx.

Serum Amyloid P Component and Systemic Fungal Infection: Does It Protect the Host or Is It a Trojan Horse?

It is a striking observation that tissue of patients invaded by the deep mycoses often lacks evidence of an inflammatory response. This lack of host response is often attributed to neutropenia secondary to chemotherapy. However, systematic studies do not support this simplistic explanation. However, invasive fungal lesions are characterized by abundant fungal functional amyloid, which in turn is bound by serum amyloid P component (SAP). We postulate that SAP is important in the local immune response in invasive fungal infections. The interaction between fungal functional amyloid, SAP, and the immune response in deep mycoses is discussed.

The Bark-Beetle-Associated Fungus, Endoconidiophora polonica, Utilizes the Phenolic Defense Compounds of Its Host as a Carbon Source.

Norway spruce (Picea abies) is periodically attacked by the bark beetle Ips typographus and its fungal associate, Endoconidiophora polonica, whose infection is thought to be required for successful beetle attack. Norway spruce produces terpenoid resins and phenolics in response to fungal and bark beetle invasion. However, how the fungal associate copes with these chemical defenses is still unclear. In this study, we investigated changes in the phenolic content of Norway spruce bark upon E. polonica infection and the biochemical factors mediating these changes. Although genes encoding the rate-limiting enzymes in Norway spruce stilbene and flavonoid biosynthesis were actively transcribed during fungal infection, there was a significant time-dependent decline of the corresponding metabolites in fungal lesions. In vitro feeding experiments with pure phenolics revealed that E. polonica transforms both stilbenes and flavonoids to muconoid-type ring-cleavage products, which are likely the first steps in the degradation of spruce defenses to substrates that can enter the tricarboxylic acid cycle. Four genes were identified in E. polonica that encode catechol dioxygenases carrying out these reactions. These enzymes catalyze the cleavage of phenolic rings with a vicinal dihydroxyl group to muconoid products accepting a wide range of Norway spruce-produced phenolics as substrates. The expression of these genes and E. polonica utilization of the most abundant spruce phenolics as carbon sources both correlated positively with fungal virulence in several strains. Thus, the pathways for the degradation of phenolic compounds in E. polonica, initiated by catechol dioxygenase action, are important to the infection, growth, and survival of this bark beetle-vectored fungus and may play a major role in the ability of I. typographus to colonize spruce trees.

Empirical antitubercular therapy even in endemic area should be started with caution: Missed case of calvarial epidermoid presenting with discharging sinus.

Sir, Spontaneous discharging sinus due to a bony lesion is not an unknown entity. When encountered in endemic areas or developing countries, tubercular osteomyelitis is found to be a leading cause. Occasionally, some bony lesions may mimic tubercular osteomyelitis.[2] We present an unusual case of intradiploic epidermoid of sphenoid ridge that was initially misdiagnosed and treated as tuberculosis. An 11-year-old child presented with complaint of intermittent whitish discharge from right anterior temporal area [Figure 1a] for 4 years without any history of trauma or fever. The pus culture was sterile. Cytology of discharge showed only inflammatory cells but no granuloma. Computed tomography (CT) scan showed a lytic lesion in the sphenoid ridge [Figure ​[Figure1b1b and ​andc].c]. Patient was empirically treated with antitubercular therapy (ATT) drugs as calvarial tuberculosis was suspected clinically. The patient did not respond to ATT and the discharge persisted even after 6 weeks. Figure 1 (a) Whitish discharge from the wound. (b) Computed tomography scan showing hypodense lesion in the right sphenoid ridge intra diploic space. (c) Bone window computed tomography shows expanded lytic lesion of the sphenoid ridge Magnetic resonance image (MRI) acquired at this time showed sharp well-defined margin and uniform diffusion restriction [Figure ​[Figure2a2a–c] that raised suspicion of other lesion. Sinus track was excised completely through a frontotemporal flap. The track was in continuity with the well-defined bony lesion and underneath the bone extradurally [Figure ​[Figure3a3a and ​andbb]. Figure 2 (a) Magnetic resonance axial T2-weighted images depict widening of the intradiploic space with hyperintense soft tissue lesion within it. Small similar signal intensity lesion is seen in the overlying subgaleal tissue, adjacent to the bony lesion which ... Figure 3 (a) Intraoperative image showing subgaleal sinus track and whitish caseous material seen inside the lesion (b). (c) Completely healed lesion at 6 month follow-up The initial histopathology showed inflammatory cells with some stratified squamous epithelium. On careful evaluation, keratin was seen confirming the diagnosis to be epidermiod. ATT was stopped. The child improved, wound healed completely [Figure 3c] and there is no recurrence at 6 months follow-up. Spontaneous discharging sinus from the calvaria has been reported in infections such as tuberculosis, mycetomas, or posttraumatic osteomyelitis and occasionally in epidermoid.[1,2,3] It is important to establish the diagnosis as management differs in each case. The diagnostic dilemma increases as all of them appear as lytic lesion on radiology with subtle differences. Calvarial tuberculosis usually appears as a cone-shaped lytic bony lesion, wider at the inner table or diffuse hypodensity with peripheral enhancement on CT imaging. Enhancing extradural inflammatory collection may be found in some cases.[2] In posttraumatic osteomyelitis, the involved bone is sclerotic with sequestrum. Fungal lesions such as mycetoma appear as punched out lytic lesion with intradural enhancing mass.[1] Calvarial epidermoid commonly appears as a lytic lesion with sclerotic margin on CT scan often eroding the inner table.[3] In our case, the diagnosis was clinched on MRI which showed uniform hyperintense signal on diffusion-weighted images and hypointense on apparent diffusion coefficient map corresponding to restricted diffusion [Figure 2b] and c. Tubercular osteomyelitis shows patchy restriction and lacks uniformity. The modality of treatment differs in each case. In our case, the initial cytological evaluation suggested infection and empirical ATT was started. As the lesion did not respond to ATT, radiology was reevaluated including MRI and complete surgical excision was planned. After thorough discussion with the pathologist, a careful evaluation of the slides showed stratified squamous epithelium with keratin. Therefore, discharging sinus from the calvaria may not necessarily be tubercular even in an endemic area and should be properly evaluated. Cautious evaluation of radiology and histopathology helps establish the correct diagnosis, else the patient may receive unnecessary ATT. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial Support and Sponsorship Nil. Conflicts of Interest There are no conflicts of interest.

Assessing the Threat of Amphibian Chytrid Fungus in the Albertine Rift: Past, Present and Future.

Batrachochytrium dendrobatidis (Bd), the cause of chytridiomycosis, is a pathogenic fungus that is found worldwide and is a major contributor to amphibian declines and extinctions. We report results of a comprehensive effort to assess the distribution and threat of Bd in one of the Earth’s most important biodiversity hotspots, the Albertine Rift in central Africa. In herpetological surveys conducted between 2010 and 2014, 1018 skin swabs from 17 amphibian genera in 39 sites across the Albertine Rift were tested for Bd by PCR. Overall, 19.5% of amphibians tested positive from all sites combined. Skin tissue samples from 163 amphibians were examined histologically; of these two had superficial epidermal intracorneal fungal colonization and lesions consistent with the disease chytridiomycosis. One amphibian was found dead during the surveys, and all others encountered appeared healthy. We found no evidence for Bd-induced mortality events, a finding consistent with other studies. To gain a historical perspective about Bd in the Albertine Rift, skin swabs from 232 museum-archived amphibians collected as voucher specimens from 1925–1994 were tested for Bd. Of these, one sample was positive; an Itombwe River frog (Phrynobatrachus asper) collected in 1950 in the Itombwe highlands. This finding represents the earliest record of Bd in the Democratic Republic of Congo. We modeled the distribution of Bd in the Albertine Rift using MaxEnt software, and trained our model for improved predictability. Our model predicts that Bd is currently widespread across the Albertine Rift, with moderate habitat suitability extending into the lowlands. Under climatic modeling scenarios our model predicts that optimal habitat suitability of Bd will decrease causing a major range contraction of the fungus by 2080. Our baseline data and modeling predictions are important for comparative studies, especially if significant changes in amphibian health status or climactic conditions are encountered in the future.

Incidentaloma adrenal

Con el uso creciente de las tecnologías en imágenes diagnósticas, se han descubierto lesiones adrenales en pacientes sin sospecha o manifestaciones clínicas de una enfermedad originada en las glándulas suprarrenales, hallazgo conocido como incidentaloma suprarrenal. Estas lesiones pueden ser benignas como los mielolipomas, infecciones por hongos y micobacterias o lesiones infrecuentes como los schwanomas. También se pueden encontrar adenomas, los cuales pueden ser productores de hormonas o no productores. Finalmente, se pueden encontrar lesiones malignas, como carcinomas adrenales. Ante la presencia de un incidentaloma suprarrenal con tamaño mayor de 4 centímetros, irregularidad en los bordes, alta atenuación de la lesión (en unidades Hounsfield) y un bajo porcentaje de lavado en el estudio contrastado se favorece el diagnóstico de carcinoma, en cuyo caso el manejo es quirúrgico, una vez se haya descartado la producción hormonal (verbigracia feocromocitoma). Ahora bien, si la lesión no sugiere malignidad, la siguiente pregunta que se debe contestar es si el incidentaloma es productor o no de hormonas. En este sentido se debe evaluar la posibilidad de síndrome de Cushing (mediante una prueba de supresión con dosis bajas de dexametasona), feocromocitoma (con medición de metanefrinas en orina o en plasma) y si es hipertenso descartar hiperaldosteronismo primario midiendo la relación aldosterona/ renina. Acorde a estos resultados se definirá la conducta quirúrgica o el seguimiento clínico e imaginológico.

Evolution of the Immune Response to Chronic Airway Colonization with Aspergillus fumigatus Hyphae.

Airway colonization by the mold Aspergillus fumigatus is common in patients with underlying lung disease and is associated with chronic airway inflammation. Studies probing the inflammatory response to colonization with A. fumigatus hyphae have been hampered by the lack of a model of chronic colonization in immunocompetent mice. By infecting mice intratracheally with conidia embedded in agar beads (Af beads), we have established an in vivo model to study the natural history of airway colonization with live A. fumigatus hyphae. Histopathological examination and galactomannan assay of lung homogenates demonstrated that hyphae exited beads and persisted in the lungs of mice up to 28 days postinfection without invasive disease. Fungal lesions within the airways were surrounded by a robust neutrophilic inflammatory reaction and peribronchial infiltration of lymphocytes. Whole-lung cytokine analysis from Af bead-infected mice revealed an increase in proinflammatory cytokines and chemokines early in infection. Evidence of a Th2 type response was observed only early in the course of colonization, including increased levels of interleukin-4 (IL-4), elevated IgE levels in serum, and a mild increase in airway responsiveness. Pulmonary T cell subset analysis during infection mirrored these results with an initial transient increase in IL-4-producing CD4(+) T cells, followed by a rise in IL-17 and Foxp3(+) cells by day 14. These results provide the first report of the evolution of the immune response to A. fumigatus hyphal colonization.

Enhanced resistance to blister blight in transgenic tea (Camellia sinensis [L.] O. Kuntze) by overexpression of class I chitinase gene from potato (Solanum tuberosum).

Tea is the second most consumed beverage in the world. A crop loss of up to 43 % has been reported due to blister blight disease of tea caused by a fungus, Exobasidium vexans. Thus, it directly affects the tea industry qualitatively and quantitatively. Solanum tuberosum class I chitinase gene (AF153195) is a plant pathogenesis-related gene. It was introduced into tea genome via Agrobacterium-mediated transformation with hygromycin phosphotransferase (hpt) gene conferring hygromycin resistance as plant selectable marker. A total of 41 hygromycin resistant plantlets were obtained, and PCR analysis established 12 plantlets confirming about the stable integration of transgene in the plant genome. Real-time PCR detected transgene expression in four transgenic plantlets (T28, C57, C9, and T31). Resistance to biotrophic fungal pathogen, E. vexans, was tested by detached leaf infection assay of greenhouse acclimated plantlets. An inhibitory activity against the fungal pathogen was evident from the detached leaves from the transformants compared with the control. Fungal lesion formed on control plantlet whereas the transgenic plantlets showed resistance to inoculated fungal pathogen by the formation of hypersensitivity reaction area. This result suggests that constitutive expression of the potato class I chitinase gene can be exploited to improve resistance to fungal pathogen, E. vexans, in economical perennial plantation crop like tea.

Coccidioidomycosis and other systemic mycoses of marine mammals stranding along the central California, USA coast: 1998-2012.

A wide range of systemic mycoses have been reported from captive and wild marine mammals from North America. Examples include regionally endemic pathogens such as Coccidioides and Blastomyces spp., and novel pathogens like Cryptococcus gattii, which appear may have been introduced to North America by humans. Stranding and necropsy data were analyzed from three marine mammal stranding and response facilities on the central California coast to assess the prevalence, host demographics, and lesion distribution of systemic mycoses affecting locally endemic marine mammals. Between 1 January 1998 and 30 June 2012, >7,000 stranded marine mammals were necropsied at the three facilities. Necropsy and histopathology records were reviewed to identify cases of locally invasive or systemic mycoses and determine the nature and distribution of fungal lesions. Forty-one animals (0.6%) exhibited cytological, culture- or histologically confirmed locally invasive or systemic mycoses: 36 had coccidioidomycosis, two had zygomycosis, two had cryptococcosis, and one was systemically infected with Scedosporium apiospermum (an Ascomycota). Infected animals included 18 California sea lions (Zalophus californianus), 20 southern sea otters (Enhydra lutris nereis), two Pacific harbor seals (Phoca vitulina richardsi), one Dall's porpoise (Phocoenoides dalli), and one northern elephant seal (Mirounga angustirostris). Coccidioidomycosis was reported from 15 sea lions, 20 sea otters, and one harbor seal, confirming that Coccidioides spp. is the most common pathogen causing systemic mycosis in marine mammals stranding along the central California coast. We also report the first confirmation of C. gattii infection in a wild marine mammal from California and the first report of coccidioidomycosis in a wild harbor seal. Awareness of these pathogenic fungi during clinical care and postmortem examination is an important part of marine mammal population health surveillance and human health protection. Temporal-spatial overlap may be observed for pathogenic mycoses infecting coastal marine mammals and adjacent human populations.

Spectrum of fungal and parasitic infections on fine needle aspiration cytology.

The incidence many fungal and parasitic lesions are on the rise over the decades. In this study, we have analyzed the spectrum of fungal and parasitic lesions diagnosed on fine needle aspiration cytology (FNAC) in a tertiary health care center. This is a retrospective study conducted in the period three years and included all cases of fungal and parasitic lesions in the body (superficial and deep) identified on FNAC. There were total of 125 cases comprising of 59 parasitic cases and 66 fungal infections over this period. The various organisms were confirmed by special stains whenever required. In the parasitic group a cysticercosis (43), hydatid (8), filariasis (5), toxoplasmosis (1), leishmaniasis (1), and amoebiasis (1) were identified. The fungal infections included aspergillosis (36), mucormycosis (6), histoplasmosis (3), cryptococcus (4), and candidiasis (2). About a total of 15 cases were broadly classified as fungal infection only. FNAC is an easy, reliable, and minimally invasive method to diagnose and categorize the various fungal and parasitic lesions in the body for early and definitive treatment.

Subcutaneous Fungal Cyst Masquerading as Benign Lesions - A Series of Eight Cases.

Subcutaneous fungal infections are caused by penetration of the causative fungi into the subcutaneous layer and are usually localised. We present a series of eight cases with subcutaneous fungal cystic lesions masquerading as benign lesions. A retrospective study was conducted on subcutaneous fungal infections seen between January 2007 to July 2014 in the Department of Pathology. Eight patients with biopsy proven subcutaneous fungal infection were included. We collected and analysed their demographic, clinical and histopathological details. Among eight patients, six were male and two were female. The mean age was 47 years (Range: 21-70). All the eight patients presented with non-tender cystic swelling. The size of the swellings varied from a minimum of 3x3 cm to maximum of 10x4 cm. Out of eight, hand was involved in three, forearm in one, elbow in two, leg in one and foot in one. On H&E staining, all the cases showed fibro collagenous cyst wall, lined by histiocytes, granulomatous reaction, foreign body type of giant cells with acute and chronic inflammatory infiltrate containing fungal elements. Six were identified as hyalohyphomycosis and two were identified as phaeohyphomycotic cysts based on pigmentation of hyphae. Fungal infection should be suspected in all subcutaneous cystic lesions. Excised tissue should always be sent for culture and histopathology.

Clinical characteristics and obstetrical principals at HIV-infected women in Saint Petersburg

Objective: to determine the clinical course of HIV infection, pregnancy and delivery in HIV-infected women. Materials and Methods: the analysis of 1483 clinical records of the HIV-infected women, who were delivered in specialized infectious and obstetric department in Clinical infectious diseases hospital named after S.P. Botkin in 2011-2013. Results: Average age of patients - 28,2 ± 1,2 years. Vast majority of women (78,5 %) knew about the diagnosis “HIV-infection” before pregnancy. The sexual way of transmission dominated (67,6 %) among patients with the detected mechanism of HIV-transmission. Full three-step ARV prevention was performed in 82,4 % (1222) cases. The average amount of patients with 4th stage of HIV infection was 49,2 % (730), thus the number of women in labor with the 4th stage of HIV infection increased from 19,4 to 55,6 % in 2011-2013. There is a high percentage of the coinfection of HIV infection and chronic viral hepatitis C or B + C (50,8 %). The most frequent complications of pregnancy and labour at the HIV-infected women are: iron deficiency anemia, chronic placentary insufficiency, eclampsy, premature discharge of amniotic fluid. Every third pregnant has a combination of these pregnancy complications. Frequency of premature birth was 23,5 %. The majority of pregnant women had vaginal labors (67,3 %) Cesarean sections were performed in 32,7 % cases. Conclusion: In St. Petersburg in 2011-2013 significantly increased the number of women with clinically significant manifestations of HIV infection on the 4th stage of secondary diseases. The most frequent clinical manifestations of 4A stage of HIV infection were fungal (candidiasis) lesion of the mucous genitals, mouth and viral (HSV) lesions of the skin and mucous membranes. The major complications of pregnancy in HIV-infected women are anemia and chronic placental insufficiency. Almost one in four pregnancies ends premature birth. Remains high percentage of cesarean sections, including those caused by infectious indications.

The resistance of a North American bat species (Eptesicus fuscus) to White-nose Syndrome (WNS).

White-nose Syndrome (WNS) is the primary cause of over-winter mortality for little brown (Myotis lucifugus), northern (Myotis septentrionalis), and tricolored (Perimyotis subflavus) bats, and is due to cutaneous infection with the fungus Pseudogymnoascus (Geomyces) destructans (Pd). Cutaneous infection with P. destructans disrupts torpor patterns, which is thought to lead to a premature depletion of body fat reserve. Field studies were conducted at 3 WNS-affected hibernation sites to determine if big brown bats (Eptesicus fuscus) are resistant to Pd. Radio telemetry studies were conducted during 2 winters to determine the torpor patterns of 23 free-ranging E. fuscus hibernating at a site where Pd occurs. The body fat contents of free-ranging E. fuscus and M. lucifugus during hibernation at 2 different WNS-affected sites were also determined. The numbers of bats hibernating at the same site was determined during both: a) 4–7 years prior to the arrival of Pd, and, b) 2–3 years after it first appeared at this site. The torpor bouts of big brown bats hibernating at a WNS-affected site were not significantly different in length from those previously reported for this species. The mean body fat content of E. fuscus in February was nearly twice that of M. lucifugus hibernating at the same WNS-affected sites during this month. The number of M. lucifugus hibernating at one site decreased by 99.6% after P. destructans first appeared, whereas the number of E. fuscus hibernating there actually increased by 43% during the same period. None of the E. fuscus collected during this study had any visible fungal growth or lesions on their skin, whereas virtually all the M. lucifugus collected had visible fungal growth on their wings, muzzle, and ears. These findings indicate that big brown bats are resistant to WNS.

PC.54 A rare presentation of Malassezia fungaemia with liver abscess in preterm neonate

We present a 24 week old male infant weighing 758 gram with significant surfactant deficient respirtory distress. He was extubated on day 19 and remained on BIPAP until he was...

Retinal Neovascularization and Endogenous Fungal Endophthalmitis in Intravenous Drug Users

Intravenous heroin abuse in persons aged 12 or older has nearly doubled between the years of 2002 and 2012.1 Intravenous drug users (IVDU) are a high-risk group for developing endogenous fungal endophthalmitis (EFE), with Candida albicans being the most commonly identified causative organism.2 EFE is a potentially blinding disease in which the causative organism reaches the eye through hematogenous dissemination. The frequency of chorioretinitis and endophthalmitis in patients with documented fungemia ranges from 2–26% and 0–6%, respectively.3 Factors contributing to poor visual outcomes include macular involvement, subretinal and choroidal neovascularization, retinal detachment, and insufficient or delayed treatment.4,5 However, to our knowledge, this is the first case series characterizing retinal neovascularization as a potentially blinding complication of EFE in IVDU.

Perspectives of breeding fungal diseases resistant cultivars of nectarine (Prunus persica (L.) Batsch. subsp. nectarina (Ait.) Shof.)

There are allocated some forms of distant hybrids with weak degree of fungal diseases lesion (Taphrina deformans (Berk.) Tul., Sphaerotheca pannosa (Lev.) var. persicae Woron., Clasterosporium carpophilum Aderh., Monilia cinerea Bonord. и Monilia fructigena Fr.) that are of practical interest for breeding such cultivars of peach and nectarine that will resist these pathogens.

Leprosy, Paracoccidioidomycosis, And Squamous Cell Carcinoma: Diagnostic Disability or Health System Failure?

Although public protocols have achieved widespread leprosy and paracoccidiodomycosis control, advanced cases can still be detected. This case report presents a strong association between these two infectious diseases and malignant neoplasms and prompts reflection on this apparent failure of the public health system to monitor the progress of these endemic diseases. Man, 48, diagnosed with leprosy and paracoccidioidomycosis in 2002 was seen at Centro Goiano de Doenças da Boca in 2011. He evidenced sessile and hypopigmented lesions in the perioral and nasal region along with nasal cartilage loss causing total obstruction of the upper airways. Histological examination of biopsy tissue revealed squamous cell carcinoma associated with fungal lesions. The patient was referred to a specialized oncology and infectious diseases service and died 6 months after starting treatment.

Regulation of Copper Homeostasis and Biotic Interactions by MicroRNA 398b in Common Bean

MicroRNAs are recognized as important post-transcriptional regulators in plants. Information about the roles of miRNAs in common bean (Phaseolus vulgaris L.), an agronomically important legume, is yet scant. The objective of this work was to functionally characterize the conserved miRNA: miR398b and its target Cu/Zn Superoxide Dismutase 1 (CSD1) in common bean. We experimentally validated a novel miR398 target: the stress up-regulated Nodulin 19 (Nod19). Expression analysis of miR398b and target genes –CSD1 and Nod19- in bean roots, nodules and leaves, indicated their role in copper (Cu) homeostasis. In bean plants under Cu toxicity miR398b was decreased and Nod19 and CSD1, that participates in reactive oxygen species (ROS) detoxification, were up-regulated. The opposite regulation was observed in Cu deficient bean plants; lower levels of CSD1 would allow Cu delivery to essential Cu-containing proteins. Composite common bean plants with transgenic roots over-expressing miR398 showed ca. 20-fold higher mature miR398b and almost negligible target transcript levels as well as increased anthocyanin content and expression of Cu-stress responsive genes, when subjected to Cu deficiency. The down-regulation of miR398b with the consequent up-regulation of its targets was observed in common bean roots during the oxidative burst resulting from short-time exposure to high Cu. A similar response occurred at early stage of bean roots inoculated with Rhizobium tropici, where an increase in ROS was observed. In addition, the miR398b down-regulation and an increase in CSD1 and Nod19 were observed in bean leaves challenged with Sclerotinia scleortiorum fungal pathogen. Transient over-expression of miR398b in Nicotiana benthamiana leaves infected with S. sclerotiorum resulted in enhanced fungal lesions. We conclude that the miR398b-mediated up-regulation of CSD and Nod19 is relevant for common bean plants to cope with oxidative stress generated in abiotic and biotic stresses.

Lateral Rectus Palsy Associated with Isolated Sphenoid Sinus Fungal Lesion

Lateral Rectus Palsy Associated with Isolated Sphenoid Sinus Fungal Lesion Fungal sinusitis of isolated sphenoid sinus is a rare entity. Most of the sufferers referred with complications since the primary manifestations are non-characteristic. Occasionally the patients present with ophthalmic signs and symptoms most commonly proptosis and diplopia. We describe a sixty year old woman presenting with headache and diplopia. On examination there was right lateral rectus palsy and further studies revealed isolated right sphenoidal sinusitis, for which she underwent endoscopic sphenoidotomy. Histopathology revealed Aspergillus species. All the symptoms completely resolved one month post-surgery and the patient has been symptom free till date. Hence a prompt diagnosis and treatment of isolated sphenoidal sinusitis is of utmost importance since it has non characteristic manifestations. Non-invasive fungal sinusitis is best treated with sphenoidotomy. Abducens nerve palsy could be implicated to sphenoid fungal sinusitis since the patient condition improved promptly following sphenoidotomy.