Search Results (711)

There is increasing evidence on the occurrence of Crithidia spp. in patients presenting either cutaneous or visceral leishmaniasis, solely or associated with Leishmania. We analyzed growth, morphology, and temperature tolerance of two C. fasciculata strains, the reference strain COLPROT048 and patient isolate COLPROT606. We also evaluated their co-cultivation with L. braziliensis, macrophage infectivity, and infections in hamsters, BALB/c mice, and sandflies. In culture, both Crithidia strains survived at 32 °C for 96 h, showing major morphological alterations and decreased mitochondrial membrane potential, with ΔΨm reducing to 52% in COLPROT606. At 34 °C, the patient isolate showed an 80% reduction in cell number. Mixed cultivation of Crithidia-Leishmania led to recovery of only Crithidia. In macrophages, C. fasciculata alone was virtually eliminated, and in co-infection only Leishmania was detected. No Crithidia lesion or RNA were found in infected mice or hamsters, while L. braziliensis reached 1145–1625 parasites/mg of tissue. In sandflies, C. fasciculata successfully established infection for up to 7 days, both alone and in coinfections. Amphotericin B IC₅₀ values at 72 h were 4- to 5-fold higher in C. fasciculata strains compared to L. braziliensis. Our results indicate that both C. fasciculata strains are unable to reproduce the pathogenic effect in vitro and in vivo models. Full article

Background: The frequency of necrotising cutaneous and soft tissue infections caused by the Mucorales fungi Apophysomyces and Sakasenaea is increasing. The absence of sophisticated diagnostic technologies in low- and middle-income countries (LMICs) means that detection of cutaneous mucormycosis continues to rely on culture of the infecting pathogens from biopsy and their differentiation based on morphological characteristics. However, Apophysomyces and Sakasenaea are notorious for their failure to sporulate on standard mycological media used for the identification of human pathogenic fungi. Differentiation of these pathogens and their discrimination from Aspergillus fumigatus, the most common mould pathogen of humans, is essential due to their differing sensitivities to the antifungal drugs used to treat mucormycosis. Methods: A murine IgG1 monoclonal antibody, JD4, has been developed that is specific to Apophysomyces species. In Western blotting and enzyme-linked immunosorbent assay (ELISA), mAb JD4 is shown to bind to an extracellular 15 kDa protein, readily detectable in crude antigen extracts from non-sporulating cultures of Apophysomyces. Results: When combined with a Mucorales-specific lateral-flow immunoassay (LFIA), mAb JD4 allows the differentiation of Apophysomyces from Saksenaea species and discrimination from Aspergillus fumigatus. Monoclonal antibody JD4 enables the detection and differentiation of Apophysomyces species from other fungal pathogens that cause rapidly progressive cutaneous and soft tissue mycoses in humans. When this is combined with a rapid LFIA, improvements are offered in the sensitivity and specificity of Mucorales detection based on mycological culture, which remains a gold-standard procedure for mucormycosis detection in LMICs lacking access to more sophisticated diagnostic procedures. Full article

Ovine gammaherpesvirus 2 (OvGHV2) is a Macavirus and the cause of sheep-associated malignant catarrhal fever (SA-MCF) in susceptible mammalian hosts worldwide. OvGHV2 may produce typical clinical manifestations of SA-MCF or subclinical infections. Additionally, OvGHV2 is associated with cutaneous lesions in ruminants, with few documented reports of this unusual manifestation worldwide. This paper presents the pathological, immunohistochemical (IHC), and molecular findings observed in outbreaks of OvGHV2-related skin infections in dairy cattle from Southern Brazil. Cutaneous scrapings (n = 35) and biopsies (n = 6) were obtained from dairy cows derived from three farms. All cows (n = 35) developed widespread, ulcerative to scaly and erythematous skin lesions, and had no contact with sheep or goats. The biopsies were evaluated for histopathological diagnosis and then used in IHC analyses designed to detect malignant catarrhal fever virus (MCFV) antigens and to evaluate the inflammatory response. All scrapings and biopsies were used in PCR assays to amplify OvGHV2. Additionally, all biopsies were used in PCR assays to detect bovine gammaherpesvirus 6 (BoGHV6), bovine alphaherpesvirus 1 (BoAHV1), and poxvirus. Histopathology revealed chronic folliculitis in all biopsies. IHC detected intralesional, intracytoplasmic MCFV antigens in most (83.3%; 5/6) of the cutaneous lesions with folliculitis. These skin lesions showed a strong T-cell response, macrophage clusters, and caspase-positive follicular keratinocytes. OvGHV2 DNA was detected in 66.7% (4/6) of the cutaneous biopsies that contained MCFV antigens and in 8.6% (3/35) of the cutaneous scrapings. The DNA of BoGHV6, BoAHV1, and Poxvirus was not amplified from any of the cutaneous biopsies. These findings demonstrated that OvGHV2 was associated with the cutaneous lesions in dairy cows at these farms and represent the first description of OvGHV2-related skin disease in ruminants from Brazil and the entire Latin America. A review of previous cases of skin lesions associated with infections by OvGHV2 revealed that most cases had a histological diagnosis of folliculitis, suggesting that folliculitis may be associated with OvGHV2-related skin infections. Additionally, this investigation contrasts all previous reports of OvGHV2-related skin disease in ruminants, since the infected cows herein identified were not reared concomitantly or within proximity of the asymptomatic reservoir host. Furthermore, the possible form of OvGHV2 dissemination to the susceptible cows during this study is discussed. Full article

Epidermolysis bullosa (EB) is a group of debilitating, genetic skin disorders characterized by excessive skin fragility, blistering, and ulcerations that cause a cyclical wound healing process. EB presents itself in various subtypes, such as EB simplex (EBS), junctional EB (JEB), dystrophic (DEB), and Kindler Syndrome (KS), which all differ in their genetic cause, severity, and harbor different causes of mortality. Of these variants, JEB and DEB are the most severe, with EBS being the mildest form of the disease and KS presenting in extremely rare cases. The JEB variant tends to cause mortality early on in children less than two years of age due to failure to thrive, sepsis from wound infections, and airway obstruction. In the recessive form of DEB (RDEB), cutaneous squamous cell carcinoma (cSCC) is the major cause of death in patients, with one study reporting a mere 4-year survival after the first EB-cSCC diagnosis. Cutaneous SCCs in the setting of RDEB are particularly concerning because they are often more aggressive and show greater metastatic potential, as compared to ultraviolet-induced SCCs. This review aims to explore the pathophysiology of these EB variants as well as their implications for developing cSCCs. It will also discuss elements of the clinical presentation of such lesions in EB patients and the challenges associated with making a definitive diagnosis. Additionally, we will illuminate various diagnostic techniques, current and future management and treatment strategies for both cSCC and EB, and the importance of early screening and education for patients with EB to maximize patient lifespan and quality of life. Full article

Leishmaniasis is a vector-borne parasitic disease caused by Leishmania spp., transmitted to humans by phlebotomine sand flies. The development of Leishmania into infective metacyclic promastigotes occurs within the sand fly gut, where the bacterial microbiota plays a pivotal role in parasite development and transmission dynamics. This study aimed to characterize the gut bacterial composition of phlebotomine sand flies collected from both endemic (Lalla Aaziza) and non-endemic (Marrakech) regions of leishmaniasis in Morocco. We investigated the microbiota of Phlebotomus papatasi, P. sergenti, P. perniciosus, and P. longicuspis, all proven vectors of cutaneous and visceral leishmaniasis in the Old World, including Morocco, as well as Sergentomyia minuta, a potential vector in the Mediterranean basin. Gut bacteria were isolated using conventional microbiological techniques and identified by MALDI-TOF mass spectrometry. Fifteen bacterial strains from three phyla were identified, with Bacillus pumilus being the most frequently detected species. Significant differences in colony-forming unit (CFU) counts and bacterial richness were observed between sand fly species and collection sites. Notably, Bacillus simplex (in P. papatasi), Nocardia ignorata (in P. sergenti), and Serratia spp. (in P. longicuspis) were identified for the first time in these vectors. This study is the first to investigate the gut bacterial composition of sand flies in Morocco, revealing species and locality-dependent differences in microbial communities. The predominance of Bacillus spp., particularly B. pumilus, suggests a potentially influential role in sand fly physiology and vector competence. Furthermore, the novel detection of B. simplex, N. ignorata, and Serratia spp. underscores previously unrecognized microbial associations that warrant further investigation. These findings provide a critical baseline for future studies exploring the microbiota-mediated modulation of sand fly–Leishmania interactions. Full article

Background: Skin mycoses affect approximately 10% of the global population, and the range of effective topical antifungal agents remains limited. Voriconazole (VRC) is a broad-spectrum triazole with proven efficacy against drug-resistant fungal infections. This study aimed to develop and optimize VRC-loaded microemulsion (ME) polymer gels (Carbopol^®-based) for cutaneous delivery. Selected formulations also contained menthol (2%) as a penetration enhancer and potential synergistic antifungal agent. Methods: A comprehensive screening was performed using pseudoternary phase diagrams to identify stable oil/surfactant/co-surfactant/water systems. Selected MEs were prepared with triacetin, Etocas™ 35, and Transcutol^®, then gelled with Carbopol^®. Formulations were characterized for pH, droplet size, polydispersity index (PDI), and viscosity. In vitro VRC release was assessed using diffusion cells, while ex vivo permeation and skin deposition studies were conducted on full-thickness human skin. Rheological behavior (flow curves, yield stress) and texture (spreadability) were evaluated. Antifungal activity was tested against standard strain of Candida albicans and clinical isolates including a fluconazole-resistant strain. Results: The optimized ME (pH ≈ 5.2; droplet size ≈ 2.8 nm) was clear and stable with both VRC and menthol. Gelation produced non-Newtonian, shear-thinning hydrogels with low thixotropy, favorable for topical application. In ex vivo studies, performed with human skin, both VRC-loaded gels deposited the drug in the epidermis and dermis, with no detectable amounts in the receptor phase after 24 h, indicating retention within the skin. Menthol increased VRC deposition. Antifungal testing showed that VRC-containing gels produced large inhibition zones against C. albicans, including the resistant isolate. The VRC–menthol gel exhibited significantly greater inhibition zones than the VRC-only gel, confirming synergistic activity. Conclusions: ME-based hydrogels effectively delivered VRC into the skin. Menthol enhanced drug deposition and demonstrated synergistic antifungal activity with voriconazole. Full article

Background: Purpureocillium lilacinum (P. lilacinum) is an emerging filamentous fungus known to cause opportunistic infections, particularly in immunocompromised patients. Formerly known as Paecilomyces lilacinus, this pathogen is widespread in the environment and can lead to a range of infections, from superficial skin lesions to invasive diseases. This article presents a case of deep cutaneous hyalohyphomycosis caused by P. lilacinum in a liver transplant patient, followed by a review of the literature focusing on new antifungal agents. Methods: We reported a brief case description followed by a narrative review of the literature regarding P. lilacinum cutaneous and lymphangitic infections in immunocompromised patients. Results: We conducted a review of the literature over the past 20 years, focusing on the clinical features, diagnostic challenges, and therapeutic outcomes of cutaneous and lymphangitic P. lilacinum infections in immunocompromised hosts. Conclusions: This review highlights the critical importance of early diagnosis through the analysis of biopsy samples using standard microbiological and histological techniques, complemented by innovative molecular biology methods. We also emphasise the role of appropriate antifungal treatment, despite the absence of an established standard of care, particularly in high-risk patients. Furthermore, we review and discuss the current lack of a standardised therapeutic regimen and the potential of novel antifungal agents as promising treatment options for P. lilacinum infections. Full article

Cutaneous leishmaniasis (CL) is a vector-borne zoonotic disease affecting the skin and mucous membranes of animals and humans. While CL is commonly diagnosed and studied in humans in Panama, limited information exists on its occurrence in domestic animals and their potential role as reservoirs. In this study, samples from twelve domestic animals (ten dogs and two horses) with suspected CL lesions were collected between 2021 and 2025 in endemic regions of Panama and evaluated using multiple diagnostic methods. Leishmania infection was confirmed in six of them (50%): five dogs and one horse. Three dogs were infected with Leishmania (Viannia) braziliensis, representing the first molecularly confirmed cases of this species in dogs from Panama and Central America. Two dogs tested positive for Leishmania (Leishmania) infantum, though epidemiological evidence suggests these were imported cases. Notably, Leishmania (Mundinia) martiniquensis was identified in a horse, marking the first report of this species in equines in Central America. These findings indicate a broader diversity of Leishmania species circulating in domestic animals than previously recognized and highlight their potential role in sustaining transmission cycles. The study underscores the need for enhanced surveillance of animal reservoirs to better understand the epidemiology and public health risks of CL in Panama. Full article

Mycobacterium marinum and Mycobacterium leprae are zoonotic mycobacteria causing chronic cutaneous infections that challenge host immunity and tissue integrity. Reactive oxygen species (ROS) play a complex role in the host defense system. While essential for pathogen elimination and intracellular signaling, excessive ROS can lead to immune dysregulation and impaired tissue healing. This review explores M. marinum and M. leprae pathogenesis through the role of ROS in redox imbalances, immunity, and cutaneous wound healing. Physiological ROS levels are vital for T-cell activation and differentiation. However, excessive ROS production, particularly in innate immune cells, can lead to T-cell suppression. M. leprae infection is associated with a significant reduction in key antioxidants such as glutathione (GSH), GSH peroxidase (GSH-Px), and GSH reductase (GR), a reduction that correlates with disease severity. For M. marinum, disrupting the pathogen’s redox balance through thioredoxin reductase (TrxR) inhibition sensitizes bacteria to ROS damage, reducing bacterial load. Overall, redox imbalance is central to the pathogenesis and persistence of cutaneous mycobacterial infections, compromising host defense and impairing tissue repair. Restoring and maintaining proper redox homeostasis, potentially by exploring the role of GSH as an antioxidant, represents a promising adjunct treatment to improve host outcomes in these challenging dermatological conditions. Full article

The COVID-19 pandemic has highlighted intricate associations between SARS-CoV-2 infection and autoimmune skin diseases (ASDs). This review examines the bidirectional relationship between COVID-19 and ASDs including hidradenitis suppurativa, psoriasis, atopic dermatitis, alopecia areata, autoimmune bullous diseases, cutaneous and systemic lupus erythematosus, systemic sclerosis, dermatomyositis, and lichen planus. Current evidence indicates that SARS-CoV-2 may precipitate or worsen ASDs via mechanisms such as molecular mimicry, dysregulated cytokine signaling, and enhanced Th1/Th17 immune responses, leading to loss of self-tolerance and autoantibody production. Epidemiological studies have identified increased incidence and flares of psoriasis, hidradenitis suppurativa, and other ASDs following both COVID-19 infection and vaccination, with mRNA vaccines associated with a higher risk of flare in hidradenitis suppurativa compared with non-mRNA vaccines. Notably, severe COVID-19 is associated with a greater risk of new-onset autoimmune disease, and patients with pre-existing inflammatory skin conditions may have increased susceptibility to SARS-CoV-2 infection but experience less severe COVID-19 courses. These findings underscore the need for ongoing surveillance and mechanistic studies to clarify the immunopathogenic links between SARS-CoV-2 and ASDs and inform management strategies for affected patients in the context of both infection and vaccination. Full article

Background/Objectives: Leishmania spp. are protozoan parasites transmitted by female sandflies (Phlebotomus or Lutzomyia). Clinical manifestations depend on species and host immunity. While cutaneous and visceral forms prevail, mucocutaneous involvement—particularly isolated nasal septum leishmaniasis—is rare and frequently misdiagnosed as an inflammatory, infectious, or neoplastic condition. Risk factors associated with mucocutaneous leishmaniasis include systemic or local immunodeficiency, prior renal transplantation, treatment with chronic inhaled steroids, residence in endemic areas or travel to such regions, and previous Leishmania infections. Immunosuppressed patients are at higher risk for atypical presentations and delayed diagnosis, which can result in extensive tissue destruction. Early clinical suspicion, histopathological confirmation, and prompt therapy are essential to prevent permanent mucosal damage. Therefore, a multidisciplinary approach is needed for adequate evaluation and effective treatment. Methods: A 67-year-old man with rheumatoid arthritis on methotrexate reported a two-year history of right-sided nasal obstruction and ulceration that failed to respond to antibiotics. He did not present systemic symptoms. Results: Facial CT revealed a septal deviation; the patient underwent septoplasty, and biopsy confirmed Leishmania amastigotes. Serology (rK39 immunochromatographic test) was positive. He was treated with liposomal amphotericin B at 4 mg/kg/day for five days, followed by miltefosine at 100 mg/day orally for 14 days. At an eight-week follow-up, the nasal mucosa was fully healed, obstruction was resolved, and there was no evidence of recurrence. Conclusions: Although nasal septum leishmaniasis is uncommon, it should be considered in the differential diagnosis of chronic nasal lesions, especially in immunocompromised patients or those from endemic regions. Definitive diagnosis requires biopsy with histological or molecular confirmation. Combined liposomal amphotericin B and miltefosine therapy yields high cure rates and prevents mucosal destruction. Early recognition is critical to avoid diagnostic delays and long-term sequelae. Full article

Background. The use of zygomatic implants (ZIs) provides a highly predictable treatment option for rehabilitation in patients with severe atrophic maxillae. However, these long implants can potentially cause a number of more serious complications than those seen with conventional dental implants. The aim of this study is to report a case of peri-zygomatic cutaneous fistula following placement of monolateral double zygomatic implants and to analyse the available literature on this complication. Methods. The 55-year-old patient was treated with placement of 3 ZIs, two on the left side. Left periorbital swelling with pain appeared 10 days after surgery with progressive worsening of symptoms. After antibiotic treatment, she developed a left cutaneous fistula with purulent discharge. CT showed two ZIs on the left side with the apical portions in close contact with a 1 cm-wide portion of resorbed zygomatic external cortex and a layer of granulation tissue. Results: Due to the limited amount of bone involved by the fixation tip, the left ZIs were removed and the skin fistula repaired. The patient healed without complications but required prosthesis replacement. Conclusions. After conducting a literature review, peri-zygomatic fistulas seem to be more common in patients with two ZIs placed on the same zygoma. In this case, the amount of available zygomatic bone is relatively limited; the bone drill holes can often be too close together and cause overheating, leading to inter-implant bone resorption and infection, with further orbito-zygomatic fistula development. The authors identified the lack of distance between ZI fixtures as one of the main causes of extraoral ZI infection. Full article

Visceral disseminated varicella-zoster virus infection (VD-VZV) involves the hematogenous spread of VZV from the skin to the internal organs. Though rare, it is potentially life-threatening, predominantly affecting immunocompromised individuals. Diagnosis is often delayed due to nonspecific symptoms mimicking other viral illnesses. While the vesicular rash is a hallmark sign, it is absent in approximately 5% of cases. Visceral involvement may precede cutaneous lesions, complicate early recognition, and increase the risk of severe complications. This scoping review screened 594 articles of which 153 met the inclusion criteria, yielding 156 individual cases. Patients were predominantly male (53.8%), with a mean age of 42.3 years. The overall mortality rate was 25.0%. Multiple organs were involved in 46.1% of cases. The most frequently affected were the lungs (56%), liver (44%), heart (16%), kidneys (11%), pancreas (11%), stomach (10%), and esophagus (6%). Antivirals were administered in 89.1% of cases, while corticosteroids were used in 22.4%, with no significant impact on outcomes. Early diagnosis, achieved in 65.4% of patients, was significantly associated with survival (p = 0.043). Mortality was significantly associated with underlying comorbidities (p = 0.004), especially autoimmune diseases requiring immunosuppression (p = 0.048). Septic shock or multi-organ dysfunction (MODS), hepatitis, acute kidney injury, and acute liver failure were linked to higher mortality in univariate analysis. Multivariate analysis identified comorbidities (p < 0.001), septic shock/MODS (p = 0.008), and acute liver failure (p = 0.039) as independent predictors of mortality. Patients with septic shock/MODS had over twice the risk of death (OR = 2.24; p = 0.008). This review underscores the diagnostic challenges and high mortality of VD-VZV. Early recognition and timely administration of antiviral treatment appear critical for survival. Greater clinical awareness and further research are needed to guide management. Full article

Cutaneous Leishmaniasis (CL) is a tropical disease endemic in many regions of Latin America. Its clinical diagnosis is often supported by histopathological analysis of skin biopsies; however, parasite detection by microscopy can be challenging, particularly in chronic or pauciparasitic lesions, leading to inconclusive results. Objective: This study aimed to evaluate the utility of polymerase chain reaction (PCR) as a confirmatory diagnostic tool for CL in formalin-fixed, paraffin-embedded (FFPE) biopsies with inconclusive histopathology. Methods: We analyzed 16 FFPE skin biopsy samples from patients with clinical suspicion of CL. All cases underwent routine histopathological evaluation using hematoxylin and eosin staining and were classified as inconclusive. DNA was extracted and PCR was performed, targeting the ITS1 and miniexon regions of Leishmania spp. Results: PCR successfully amplified Leishmania DNA in 8 (50%) out of 16 samples when both targets were utilized, confirming infection. These findings highlight the additional benefits of molecular tools in cases with inconclusive histopathology, thereby enhancing diagnostic accuracy and enabling species-level identification in certain instances. Conclusions: PCR proved to be a valuable diagnostic complement to histopathology in clinically and histologically suspected cases of CL without visible parasites. Its implementation may improve diagnostic accuracy and timely treatment in endemic areas. Full article

Brazilian porcupinepox virus (BPoPV) is a recently described pathogen associated with severe cutaneous and systemic disease in Coendou spp. porcupines, posing potential conservation and zoonotic risks. Given the solitary behavior of porcupines and the unclear mechanisms of BPoPV transmission, this study investigated the presence of BPoPV DNA in porcupines and their associated ectoparasites (ticks and lice). We analyzed ticks and lice collected from 17 porcupines (C. longicaudatus and C. spinosus), with or without clinical signs of BPoPV infection. Ectoparasites were identified morphologically, separated into distinct pools for ticks and lice by host, and screened by PCR. BPoPV DNA was detected in all symptomatic porcupines and their ectoparasites—including Amblyomma longirostre, A. sculptum ticks, and Eutrichophilus spp. lice—except for one tick pool. Notably, an asymptomatic, BPoPV-negative porcupine harbored A. longirostre ticks that tested positive for the virus. Sequencing confirmed 100% identity with the BPoPV reference strain. These findings suggest that Eutrichophilus lice, A. sculptum, and particularly A. longirostre ticks may play a role in BPoPV transmission. Further studies are needed to elucidate whether these ectoparasites act as biological or mechanical vectors and to assess the zoonotic potential of BPoPV in contact with humans and domestic animals. Full article