Subcutaneous Fungal Infections Research Articles

Management of the fungal infections and challenges associated with it

Fungal infections are becoming more common at an alarming rate, which poses a significant challenge to medical experts. This growth is directly linked to the rise in the number of people with impaired immune systems as a result of modifications to medical practice, including the use of immunosuppressive medications and intense chemotherapy. HIV and other illnesses that impair immunity have also had a role in this issue. Mucous membranes, keratinous tissues, and the skin are all impacted by superficial and subcutaneous fungal infections. This class includes some of the most common skin conditions that impact millions of people globally. They can have crippling consequences on a person's quality of life and, in certain cases, spread to other people or become invasive, even though they are rarely life-threatening. Fungal pathogens employ several tactics to compromise the immune system of the host and escalate infections. The range of antifungal drugs available is used to treat a number of superficial and systemic diseases. The well-established evidence of fungal resistance to most antifungal medicines complicates antifungal therapy and makes disease control challenging. Fungal resistance is caused by a range of genetic alterations, physiological alterations, and selection in the presence of antifungal drugs. The lack of a wide range of antifungal drugs, resistance building, and biofilm-conferred resistance are the main reasons for the need for novel therapeutics and other approaches to enhance treatment outcomes against mycoses.

Mycological profile of subcutaneous skin biopsy samples in suspected subcutaneous mycosis, Are we missing some fungi? A tertiary care hospital based study

Subcutaneous mycosis includes a heterogeneous group of fungal infections that develop at the site of transcutaneous trauma. A rise in surviving population of individuals with co-morbidities together with lapses in infection control practices especially in rural India has led to emergence of myriad species of fungi causing such infections in recent years. This poses a diagnostic challenge to the clinicians. We therefore felt a need to study the mycological profile of subcutaneous tissue biopsies suspected of fungal etiology in our hospital setup. This was a Retrospective cross-sectional observational study conducted for a period of 4 years from Jan 2015 to Jan 2019 in the Department of microbiology, Government medical College Srinagar. A total of 148 specimens of subcutaneous tissue biopsies of patients suspected of localized fungal Infection were processed by microscopy and culture for fungi. Among a total of 148 subcutaneous tissue biopsy samples 76 (51%) were positive for fungi on KOH and culture. Mycological profile revealed that majority of fungi were Dermatophytes (n=22; 29%) and Yeasts (n=21; 28%). Third most common causative fungi isolated were Chromoblastomycetes (n=8; 11%), Phaeohyphomycetes (n=8;11%) and Aspergilli (n=8;11 %) comprising, A.fumigatus (n=11) and A.terreus (n=03), followed by Hyalohypomycetes (n=4;5%), sporotrichosis (n=3;4%) and Zygomycetes (n=4 ;5.3%). : Dermatophytes and yeasts are emerging subcutaneous fungal infections. Active surveillance for all types of fungal infections should be done at all levels to address knowledge gaps that exist in etiology, pathogenesis and manifestations of fungal diseases of skin and subcutaneous tissue.

Subcutaneous mycoses: Endemic but neglected among the Neglected Tropical Diseases in Ethiopia.

Subcutaneous (deep) mycoses are a chronic infectious disease of the skin and underlying structures endemic in tropical countries. The disease has serious medical and socioeconomic consequences for patients, communities and health services in endemic areas. The inclusion of mycetoma and other subcutaneous mycoses in the list of Neglected Tropical Diseases by WHO highlights the need to assess the burden of these diseases and establish control programs where necessary. In Ethiopia no strategies can be devised because of a lack of epidemiologic information. To address this evidence gap, we performed a national rapid assessment of the geographic distribution of subcutaneous mycoses. We conducted a rapid retrospective assessment using hospital records to identify all suspected and confirmed cases of subcutaneous mycoses in 13 referral hospitals across the country between 2015 and 2022. In each hospital the logbooks were reviewed for diagnoses of subcutaneous mycosess, as diagnosed per routine practice. Descriptive analysis was done. From 13 hospitals we extracted 143 cases of subcutaneous mycoses, registered from July 2018 to September 2022. 118 (82.5%) patients were diagnosed as mycetoma, 21 (14.7%) as chromoblastomycosis and the remaining 4 (2.8%) as sporotrichosis. The mean age of patients was 35.8 years (SD = 14.5). 101 (70.6%) patients were male and 96 (67.1%) patients were farmers. 64 (44.8%) cases were from the Tigray regional state. 56 (65.9%) patients had information on diagnostic microscopic evaluation: for mycetoma histopathologic evaluation and fine needle aspiration cytology had a higher positivity rate while for chromoblastomycosis potassium hydroxide (KOH) staining had a better yield. The main clinical presentations were nodules, sinuses and infiltrative plaques on the skin. Radiologic findings of bone involvement was present in some. Mycetoma and other subcutaneous mycoses are endemic in Ethiopia, with cases reported from almost all regions with the highest cases numbers reported from the northern part of the country. A routine program and systems should be developed to identify and document the burden of subcutaneous fungal infections in the country. Diagnosis and treatment guidelines should be developed.

Evaluation of knowledge and experience of fungal infections (mycoses) among clinical doctors in Senegal.

In order to assess the knowledge and experience of fungal infections (FIs) among clinicians in Senegal, a cross-sectional survey was carried out among medical practitioners in Senegal via a questionnaire designed with "Google Forms" between 24 January and 24 April 2022. A total of 100 clinicians responded to the questionnaire. Clinicians in the 31- 40-year-old age group formed the majority of respondents (51%). Male respondents were predominant (72%). Forty-one percent of respondents were general practitioners, 40% were specialist doctors, and the rest were residents. Dermatologists were the most common at 15% (6/40). In terms of clinicians' general knowledge of fungi, FIs and their therapeutic management, an average of 70% correct answers was recorded. The majority (70%) of respondents cared for between two to four different categories of patients at risk of invasive FIs (IFIs) at a time, with diabetes predominating. Eighty percent confirmed that they had been confronted with FIs, including 43% with superficial FIs, 3% with subcutaneous FIs and 5% with IFIs. Thirty-four percent of doctors stated that they had never suspected an IFI. Candidiasis was the most commonly mentioned mycosis by doctors. To support the diagnosis of these FIs, 22% of the clinicians said that they had recourse only to the clinical diagnosis. In total, 79% of clinicians responded that they had never used an antifungal chemoprophylaxis. In addition, 28% and 22% of practicing physicians chose a combination of antifungals for the chemoprophylaxis of invasive candidiasis and invasive aspergillosis, respectively. This survey shows that both clinicians' knowledge and experience of fungi, antifungals, FIs and their therapeutic management, as well as chemoprophylaxis, need to be improved. Indeed, half of the clinicians seem to be unaware of the incidence of FIs, in particular IFIs, which, nevertheless, represent some of the deadliest infectious diseases in the world.

1056 Immune disorders and therapeutic strategies of 18 CARD9-deficient patients with intractable subcutaneous fungal infections

1056 Immune disorders and therapeutic strategies of 18 CARD9-deficient patients with intractable subcutaneous fungal infections

Invasive and Subcutaneous Infections Caused by Filamentous Fungi: Report from a Portuguese Multicentric Surveillance Program.

Invasive fungal infections (IFI) have significantly increased over the past years due to advances in medical care for the at-risk immunocompromised population. IFI are often difficult to diagnose and manage, and can be associated with substantial morbidity and mortality. This study aims to contribute to understanding the etiology of invasive and subcutaneous fungal infections, their associated risk factors, and to perceive the outcome of patients who developed invasive disease, raising awareness of these infections at a local level but also in a global context. A laboratory surveillance approach was conducted over a seven-year period and included: (i) cases of invasive and subcutaneous fungal infections caused by filamentous/dimorphic fungi, confirmed by either microscopy or positive culture from sterile samples, (ii) cases diagnosed as probable IFI according to the criteria established by EORTC/MSG when duly substantiated. Fourteen Portuguese laboratories were enrolled. Cases included in this study were classified according to the new consensus definitions of invasive fungal diseases (IFD) published in 2020 as follows: proven IFI (N = 31), subcutaneous fungal infection (N = 23). Those proven deep fungal infections (N = 54) totalized 71.1% of the total cases, whereas 28.9% were classified as probable IFI (N = 22). It was possible to identify the etiological fungal agent in 73 cases (96%). Aspergillus was the most frequent genera detected, but endemic dimorphic fungi represented 14.47% (N = 11) of the total cases. Despite the small number of cases, a high diversity of species were involved in deep fungal infections. This fact has implications for clinical and laboratory diagnosis, and on the therapeutic management of these infections, since different species, even within the same genus, can present diverse patterns of susceptibility to antifungals.

Fungal Infections of Implantation: More Than Five Years of Cases of Subcutaneous Fungal Infections Seen at the UK Mycology Reference Laboratory.

Subcutaneous fungal infections, which typically result from traumatic introduction (implantation) of fungal elements into the skin or underlying tissues, can present as a range of different clinical entities including phaeohyphomycosis, chromoblastomycosis, subcutaneous nodules or masses, and genuine eumycetoma. Here, we mined our laboratory information management system for such infections in humans and domestic animals for the period 2016–2022, including (i) fungal isolates referred for identification and/or susceptibility testing; (ii) infections diagnosed at our laboratory using panfungal PCR approaches on infected tissue; and (iii) organisms cultured in our laboratory from biopsies. In total, 106 cases were retrieved, involving 39 fungal species comprising 26 distinct genera. Subcutaneous infections with Alternaria species were the most frequent (36 cases), which possibly reflects the ubiquitous nature of this common plant pathogen. A substantial proportion of Alternaria spp. isolates exhibited reduced in vitro susceptibility to voriconazole. Notably, a significant number of subcutaneous infections were diagnosed in renal and other solid organ transplant recipients post transplantation, suggesting that humans may harbour “inert” subcutaneous fungal elements from historical minor injuries that present as clinical infections upon later immunosuppression. The current study underscores the diversity of fungi that can cause subcutaneous infections. While most organisms catalogued here were responsible for occasional infections, several genera (Alternaria, Exophiala, Phaeoacremonuim, Scedosporium) were more frequently recovered in our searches, suggesting that they possess virulence factors that facilitate subcutaneous infections and/or inhabit natural niches that make them more likely to be traumatically inoculated.

Rare presentation of Aspergillus as cystic swelling in pre-maxillary region

<p class="abstract">Subcutaneous fungal infections are caused by penetration of the causative fungi into the subcutaneous layer and usually present as single, localised non-tender nodular swelling. The diagnostic process is a vital dynamic process that requires effective communication and efficient collaboration. Aspergillus hyphae invade host tissues through release of various toxins like proteases, phospholipases, hemolysins, gliotoxin, aflatoxin, phthioic acid and other toxins. Under general anesthesia and proper aseptic conditions using Moure incision surgical debulking of the pre-maxillary mass was done and post-operatively oral antifungal medication was started. Multiple cystic swelling was sent for histopathological examination and found to be non-invasive Aspergillus fungal infection. Subcutaneous form of aspergillosis manifest as subcutaneous fungal infection. We presented an unusual case report of 45 years old immunocompetent female with cystic presentation of aspergillosis involving premaxillary region.</p>

Case report: Subcutaneous fungal cyst resembling as benign tumor

Background: Subcutaneous fungal infections are caused by penetration of the causative fungi into the subcutaneous layer and usually localized. Phaeohyphomycosis is mycotic infection, which can caused by different fungal organism and commonly presenting as subcutaneous cysts. The diagnosis can obly be made by histopathological examination, and the entity should be considered in the clinical differential diagnosis of every cystic lesion in the skin. Case description: Subcutaneous fungal infections are caused by penetration of the causative fungi into the subcutaneous layer and usually localized. We report a 65 years old woman with chief complaint of mass at gluteal sinistra with tenderness pain since 4 month before admission and come to the oncology surgery department. Physical exam are single nodule at gluteal sinistra, tenderness pain, no difference in skin color. Laboratory findings are normal hemoglobin and leucocyte. CT scan with contrast showed enhancing solid mass 2.06 × 4.95 cm at gluteal sinistra. Biopsy excision of the mass, pathological finding are atypical and pleomorphic cell, hyperchromatic, eosinophilic cytoplasm, foamy macrophage, hyphae and microspore separated until mature fat tissue and muscle, also found giant cell and xanthoma cell. After that we confirmed with Periodic Acid Schiff (PAS) stain. So, the patient come to Tropic Infection department. A diagnosis of phaeohypomycotic cyst was made. Discussion:The term of phaeohypomycotic was described by Allejo et al. in 1974. The most common lesion are cutaneous and subcutaneous cyst resembling as benign tumor, sebaceous or abscess. It saprophytes and occurring in soil, decaying in wood, and vegetation. Phialopora are the most common isolated fungi. Infection is usually as a result of traumatic implantation. In this case there is no history of trauma, but the trauma could be so trivial and not noticed. Surgical procedure is the only way to remove the subcutaneous cyst. But, it should be followed with antifungal therapy. In this case we give 6 months treatment with itraconazole 200mg b.i.d. and give significant outcome and no recurrence. Conclusion: This case emphasizes the importance of considering subcutaneous fungal cysts in the differential diagnosis of subcutaneous cystic nodules, especially on the extremities.

Skin Fungal Infections in Children: Diagnostic Challenges

Children are usually affected by superficial mycoses; however, subcutaneous mycoses are rarer and difficult to diagnose since their presentation, risk factors, epidemiology, and probably pathophysiology sometimes differ from adults. This article provides an updated overview of skin fungal infections affecting children, their clinical manifestations, and practical approaches for a correct diagnosis and management. Skin fungal infections in children have increased in number in the last decades. The majority of children suffer from one at least one time during infancy. This is probably the result of changing lifestyles, and immunosuppression (such as HIV, transplants, neoplastic diseases, and iatrogenic immunosuppression). Children can suffer from a superficial fungal infection (skin, nails, and hair), which usually is easily diagnosed and amenable to treatment; but subcutaneous fungal infections may cause difficulties in diagnosis and treatment. The incidence rate is increasing at an alarming rate and available treatments should be chosen carefully in order to avoid future resistance.

Photodynamic therapy treatment of superficial fungal infections: A systematic review.

Fungal infections in skin, hair and nails affect up to 25 % of the global population. Conventional antifungal treatment is effective but due to resistance, treatment failure, drug interactions, and treatment related toxicity, there is a need for alternative treatments. Photodynamic therapy (PDT) has shown antimicrobial properties and is used increasingly for fungal infections. This review investigates the reported efficacy and side effects of PDT of superficial mycoses. Pubmed and Embase were searched 26-01-2020 for "superficial fungal infections" and "photodynamic therapy" in "Human subjects" using a predefined search string. Criteria for inclusion were: clinical trials and cases involving PDT-treated patients with primary fungal infections in skin, hair and nails. Criteria for exclusion were: languages other than English, animal models, in vitro trials, secondary fungal infections, reviews and guidelines. 541 records were identified and 34 papers fulfilled the criteria. PDT of onychomycosis (n = 380 patients) found treatment with methylene blue (MB) photosensitizer (PS) more efficacious with complete cure rates of 70 %-80 % than 5-aminolevulinic acid (ALA)-PDT (mycological cure rates of 17 %-57 %) and methyl aminolevulinate (MAL)-PDT (mycological cure rate of 32 %). Other PDT-treated fungal diseases included (n = 55): foot infections (n = 19), tinea cruris (n = 10), scalp infections (n = 2), Malassezia infections (n = 9) and subcutaneous fungal infections (n = 15) achieved promising effect. PDT-treatment of superficial mycoses can be efficacious as salvage therapy. In the light of increasing resistance and few licensed treatment alternatives, larger randomized controlled trials investigations and optimization of the PDT-treatment protocol are warranted to evaluate PDT's potential as a future antifungal treatment.

Histopathological features of subcutaneous mycosis: a retrospective study

Background: Subcutaneous fungal infection is commonly seen in tropical and subtropical countries particularly in India. The lesions are usually presented as swelling, in the localized form. Subcutaneous mycosis is caused by penetration of causative fungi into the subcutaneous tissue. Histopathology is one of the main tools of diagnosis in mycology as it has the advantages of early diagnosis compared to culture, low cost and it provides a presumptive identification of the infecting fungus. It also gives information about tissue reaction and supplement culture report. It gives the idea about the fungus isolated in culture is contaminant or pathogenic. Many a times tissue might be sent in formalin as fungal infection is not suspected clinically. Role of histopathologist is very important in diagnosing these subcutaneous fungal lesions. Material &Methods: A retrospective study was conducted on subcutaneous fungal infections seen between January 2014 to December 2018 in the Department of pathology, IGMC&RI, Puducherry. Twenty-two patients with biopsy proven subcutaneous fungal infections were included in the study. In the present study, the varied histopathological features like type of inflammatory response, presence of granulomas, necrosis, eosinophils and abscess formation were seen in the tissue sections. Results: The most common histopathology feature was giant cell reaction seen in 21 (95.5%) cases, followed by epithelioid cell granuloma in 13(59%) cases and areas of necrosis in 13 (59%) cases. Eight (36%) cases showed numerous eosinophilic infiltration 10(46%) cases of scant eosinophils and 4 (18%) cases showed absent eosinophils. These fungal structures were identified in H&E stain itself in 13 (59%) cases. Conclusion: Histopathological study is most important in subcutaneous mycosis as most of the time diagnosis is unsuspected and delayed because of its rarity and varied presentation. Fungal infection should be suspected in cases with localized cystic swelling. High index of suspicion, careful microscopic examination and special stains are important for accurate diagnosis.

The ROLE OF HERBAL ANTIFUNGAL AGENTS FOR THE MANAGEMENT OF FUNGAL DISEASES: A SYSTEMATIC REVIEW

Nowadays, fungal infection of skin is one of the most common dermatological problems worldwide. It has been investigated that 40 million people suffer from fungal infections. Superficial and subcutaneous fungal infections affect the skin, keratinous tissues, and mucous membranes. The dermatophytic infections, superficial candidiasis of the mouth, skin, or genital tract and infections due to Malassezia, such as pityriasis versicolor and Malassezia folliculitis are the main afflicting conditions. Systemic fungal infections may be caused by either an opportunistic organism that infects an at-risk host or may be associated with a more invasive organism or may be endemic to a specific geographical area. The most frequently encountered pathogens are Candida albicans and Aspergillus spp. but other fungi such as non-albicans Candida spp. are increasingly important in causing systemic fungal infections. There are numerous antifungal agents used clinically to treat fungal infections, i.e., azoles, allylamines, echinocandins, griseofulvin, and flucytosine. The course to modern treatment has not been without its problems and complications, particularly the drug resistances. Phytochemistry of various plant species has indicated that the phytochemicals could be a better source of medicine as compared to synthetically produced drugs. Natural medicines from a plant origin are still used as therapeutic agents, especially for treating bacterial, fungal, viral, protozoal, helminthic infections, etc. This review focuses on the use of plant constituents to prevent fungal infections caused by various pathogens. Hence, it will be proved beneficial for the drug industries.

Subcutaneous Phaeohyphomycosis Due to Pyrenochaeta romeroi Mimicking a Synovial Cyst.

Opportunistic subcutaneous fungal infections are increasing nowadays due to the growing number of medical conditions causing immunosuppression, especially organ transplant. The incidence rate of subcutaneous phaeohyphomycosis is very low. Most studies found are case reports. They showed a wide variation of clinical presentations. Pyrenochaeta romeroi, a fungus from the Dematiaceae group is a saprophyte found in soil and plants and a possible causative agent of phaeohyphomycosis. We present a rare case of subcutaneous phaeohyphomycosis caused by P. romeroi mimicking a synovial cyst in a diabetic patient.

Pyrenochaeta romeroi causing subcutaneous phaeohyphomycotic cyst in a diabetic female

Opportunistic subcutaneous fungal infections are increasing in present times due to increasing incidence of many medical conditions causing immunosupression like diabetes, AIDS, organ transplant recipients and anticancer therapy. Pyrenochaeta romeroi, a fungus from the dematiaceae group, first described by Borelli in 1959, is saprophyte to soil and plants.We present a rare case of subcutaneous phaeohyphomycotic cyst in a diabetic female caused by P. romeroi.

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.

Asexual propagation of a virulent clone complex in a human and feline outbreak of sporotrichosis.

Sporotrichosis is one of the most frequent subcutaneous fungal infections in humans and animals caused by members of the plant-associated, dimorphic genus Sporothrix. Three of the four medically important Sporothrix species found in Brazil have been considered asexual as no sexual stage has ever been reported in Sporothrix schenckii, Sporothrix brasiliensis, or Sporothrix globosa. We have identified the mating type (MAT) loci in the S. schenckii (strain 1099-18/ATCC MYA-4821) and S. brasiliensis (strain 5110/ATCC MYA-4823) genomes by using comparative genomic approaches to determine the mating type ratio in these pathogen populations. Our analysis revealed the presence of a MAT1-1 locus in S. schenckii while a MAT1-2 locus was found in S. brasiliensis representing genomic synteny to other Sordariomycetes. Furthermore, the components of the mitogen-activated protein kinase (MAPK)-pheromone pathway, pheromone processing enzymes, and meiotic regulators have also been identified in the two pathogens, suggesting the potential for sexual reproduction. The ratio of MAT1-1 to MAT1-2 was not significantly different from 1:1 for all three Sporothrix species, but the population of S. brasiliensis in the outbreaks originated from a single mating type. We also explored the population genetic structure of these pathogens using sequence data of two loci to improve our knowledge of the pattern of geographic distribution, genetic variation, and virulence phenotypes. Population genetics data showed significant population differentiation and clonality with a low level of haplotype diversity in S. brasiliensis isolates from different regions of sporotrichosis outbreaks in Brazil. In contrast, S. schenckii isolates demonstrated a high degree of genetic variability without significant geographic differentiation, indicating the presence of recombination. This study demonstrated that two species causing the same disease have contrasting reproductive strategies and genetic variability patterns.

Subcutaneous (deep) fungal infections.

Fungal infection is a common clinical problem in dermatology. While most cases in practice are superficial infections, invasive subcutaneous mycoses are important to recognize and treat, as these conditions often have significant morbidity and mortality. Deep fungi demonstrate species-specific syndromes and may be identified by clinical and histological features in addition to serological evaluation and culture. Identification of the common innoculation subcutaneous mycoses, as well as those associated with pulmonary primary infection and dissemination to the skin is important, as treatments vary by organism and clinical setting. This overview will help to identify the key dermatological presentations of subcutaneous fungal infection, and the clues they give to cause.

Rare Fungal Infections in Children: An Updated Review of the Literature

An increasing trend of reports of rare fungal diseases has been observed to be mainly associated with the substantial increase of high-risk immunocompromised children, as well as with the selective pressure of antifungal drugs. On the other hand, recent reports have shown that several species of these rare fungi may also cause infections in immunocompetent children without obvious underlying conditions. The clinical spectrum of these infections, and most importantly their outcome, varies greatly, implying for a rather heterogenic group of pediatric infections. Various types of superficial and subcutaneous fungal infections, as well as systemic and disseminated life-threatening infections, have been reported. Prompt diagnosis and appropriate treatment of rare fungal diseases in children remains a great challenge. Several treatment options have been used, ranging from localized to combination treatment with extensive surgical excision and long-term antifungal therapy. We review contemporary data of rare fungal infections in pediatric patients focusing on epidemiology, mycology, management and outcome, published during the last three years.

Molecular Identification of Melanised Non-Sporulating Moulds: A Useful Tool for Studying the Epidemiology of Phaeohyphomycosis

Subcutaneous infections caused by melanised fungi have been increasingly reported among transplant patients, and these infections have the potential for blood and visceral dissemination. Some moulds, such as Mycelia sterilia, cannot grow and sporulate on different media, making their identification impossible by conventional methods. The fast and accurate identification of melanised fungi at the species level is important because species may have tropism to different organs and different susceptibilities to antifungal agents. Molecular tools have been reported to be helpful for the species identification of non-sporulating moulds. Our goal was to identify the species of M. sterilia isolates obtained from clinical samples of transplant patients using sequences of ITS and the D1/D2 regions of rDNA. Clinical samples were obtained from eight kidney transplant recipients who developed subcutaneous fungal infections. The diagnosis was confirmed by histopathology and conventional culture. Histopathology showed septated, melanised hyphae, and the cultures identified non-sporulating fungi. Therefore, the DNA from the M. sterilia isolates was subjected to PCR amplification and sequencing of the ITS and D1/D2 regions. Genus/species identification was obtained by comparison with gene banks. We obtained the following identifications: Alternaria sp. (2), Cochliobolus lunatus/Curvularia lunata (2), Cochliobolus hawaiiensis/Bipolaris hawaiiensis (1), Ochroconis sp. (1), Medicocopsis romeroi/Pyrenochaeta romeroi (1) and Nigrograna mackinnonii/Pyrenochaeta mackinnonii (1).