Search Results (71)

Superficial fungal infections (SFIs) remain a common dermatological issue in the pediatric population, with varying prevalence across regions and age groups. This study aimed to assess the epidemiology of SFIs among children and adolescents in northern Poland in the years 2019 to 2024. A retrospective analysis was conducted on 1237 patients under 18 years of age who underwent direct mycological examination and culture, due to suspicion of SFIs. Data were evaluated based on age, gender, infection site, fungal species identified, and place of residence. The prevalence of SFIs in the studied population was 21.4%. The most frequently isolated fungi were Microsporum canis and Trichophyton rubrum complex. Infection patterns varied by age: tinea capitis and tinea cutis glabrae predominated in younger children, while adolescents were more affected by tinea pedis and onychomycosis. A higher proportion of positive results was observed in rural patients, although more urban dwellers were tested. Species distribution also varied with gender and place of residence. No significant change in SFI prevalence or pathogen profile was observed over the study period. This study provides updated insights into the epidemiology of SFIs in Polish children, highlighting the influence of demographic and environmental factors. The findings underscore the importance of accurate diagnosis and suggest a need for further research into behavioral and socio-economic contributors to infection patterns. Full article

The EORTC/MSGERC definition lacks sufficient sensitivity for diagnosing invasive pulmonary aspergillosis (IPA) in patients with autoimmune inflammatory rheumatic diseases (AIIRDs). We hypothesized that the partial fulfillment of the EORTC/MSGERC definition can improve its diagnostic sensitivity. This retrospective observational study included patients with AIIRDs on immunosuppressive therapy who underwent serum galactomannan antigen testing for suspected IPA. Patients who fulfilled the clinical features or mycological evidence as per the EORTC/MSGERC definition were considered as having “potential IPA.” We compared the clinical characteristics of 364 patients who were categorized into 3 groups—potential IPA (n = 29), proven/probable IPA (n = 24), and non-IPA (n = 311; not meeting any definition). The potential and proven/probable IPA groups had significantly lower survival rates than the non-IPA group (p < 0.001). The potential IPA (adjusted hazard ratio [aHR], 2.0; 95% confidence interval [CI], 1.1–3.8) and proven/probable IPA (aHR, 2.6; 95% CI, 1.4–4.9) were independent risk factors for mortality. Compared with the EORTC/MSGERC definition, our proposed criteria improved sensitivity based on the diagnosis at the end of observation (50.0%, 100.0%, respectively). The characteristics and mortality rates of patients were similar between the potential and proven/probable IPA groups. Using these criteria for clinical diagnosis may provide high sensitivity. Full article

Background/Objectives: Invasive pulmonary aspergillosis (IA) is a common infectious disease in patients with hematological diseases. The prevention, early detection, and establishment of treatment strategies for IA are important. The serum galactomannan antigen (GM) mycological test for IA diagnosis, included in the mycology criteria of the European Organization for Research and Treatment of Cancer-Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycosis Study Group (EORTC/MSG), is widely used because of its high sensitivity and specificity. However, false-positive results are a concern. Methods: We retrospectively analyzed all GM tests performed at our department in the clinical practice setting between April 2003 and January 2012. Results: Of the 330 cases and 2155 samples analyzed, 540 (25%) were positive (≥0.5). Among the underlying diseases, positivity rates were the highest for multiple myeloma (MM), with 61.3%. By type, positivity rates for IgG, IgA, Bence-Jones protein, and IgD were 71.7%, 33.3%, 57.1%, and 34.6%, respectively. Seventeen out of eighteen cases that were GM-positive at MM diagnosis were false positives, according to the 2008 EORTC/MSG criteria. The IgG and GM values were not directly correlated. Of the seventeen false-positive cases identified, two developed IA during anti-myeloma treatments, and GM values did not become negative during the treatment in most cases. Conclusions: Although subclinical IA may be included in a higher GM index, the results may be prone to false positives; particularly in IgG-type MM, the results should thus be interpreted cautiously. Full article

Intra-abdominal and gastrointestinal mucormycosis are less frequent than rhino-orbito-cerebral and pulmonary mucormycosis, but highly lethal. Their diagnosis remains challenging due to the non-specific clinical presentation. We collected English-language cases of intra-abdominal and gastrointestinal mucormycosis in non-haematological and non-neonatal patients published up to October 2024. This review analysed the epidemiological, clinical, and therapeutic charts of 290 cases. A proportion of 53.4% were reported from India and the USA. The main predisposing conditions were diabetes, solid organ transplant, ICU, and corticosteroid treatment. The most common site was the stomach (53.8%). Gastrointestinal perforation, skin breakdown, and abdominal wall infection were sources of intra-abdominal localisation. The most common symptoms were abdominal pain, vomiting, and gastrointestinal bleeding. The diagnosis relied on histology (93.8%), mycology with microscopy and culture (38.8%), and molecular methods (9.9%). Mortality (52.9%) was lower when treatment was intravenous amphotericin B, combined or not with surgery. Prompt treatment, essential for a favourable outcome, relies on early suspicion and diagnosis. Gastrointestinal and intra-abdominal mucormycosis should also be suspected in patients admitted in ICU with ventilation/nasogastric tube and corticosteroids and those with abdominal trauma or surgery, presenting abdominal distension, pain, and GI bleeding. Mycological diagnosis including direct examination, culture and Mucorales qPCR on tissue should assist with rapid diagnosis and thus treatment. Full article

Conventional diagnosis of fungal infections of the skin, nail, and hair requires both expertise in mycology and prolonged cultures. We evaluated a new molecular tool based on an innovative technology, the DendrisKIT^®DP, combining a pan-fungal PCR, a DNA chip and a decision algorithm using machine learning, for the diagnosis of superficial fungal infections directly from clinical samples. It enables the simultaneous detection of Candida albicans and twelve dermatophytes, providing faster results than conventional techniques. Among 85 clinical samples (50 skin scrapings, 29 nail specimens, and 6 hair specimens) routinely tested by microscopic examination and cultures that were retrospectively tested by the DendrisKIT^®DP, we found a sensitivity of 83.9% and a specificity of 88.9%. This performance appeared satisfactory compared to microscopy and culture, and results were achieved much faster than with cultures, saving time for patient management. Moreover, thanks to the continuous improvement in the identification algorithm due to enriching the database, its performance is likely to be further enhanced. Full article

The investigation of the fungal etiologies of otomycoses is a rare occurrence in Senegal. The present study aspires to ascertain the profile of these mycoses within the confines of Ziguinchor. Conducted from 3 February 2021 to 31 August 2022, this retrospective descriptive study encompassed a total of 82 patients presenting with clinically suspected otomycosis within the otolaryngology (ENT) department of the Ziguinchor Peace Hospital (ZPH). In this study, two samples were collected from the external auditory canal (EAC) of each patient using sterile swabs. These samples were first observed by direct microscopy and then cultured at 30 °C on Sabouraud chloramphenicol with or without cycloheximide. The identification of the isolates was based on their macroscopic, microscopic, and physiological characteristics. The mycological examination was positive in 70 patients, with a prevalence of 85.37%. The most prevalent fungal isolates were Aspergillus section Nigri (30%), Aspergillus section Flavi (20%), and Candida albicans/Candida dubliniensis (10%). Of the clinical signs examined, auricular pruritus (p = 1.7033 × 10⁻⁶) was the only one to demonstrate a positive correlation with the onset of otomycosis. These results indicate that fungal agents play a significant role in the pathogenesis of otitis externa, underscoring the importance of mycological diagnosis in ensuring optimal patient management. Full article

Microsporum canis, a zoophilic dermatophyte, infects the stratum corneum and keratinized tissues like hair and nails in cats and dogs, with cats serving as the primary reservoir. Most human infections arise from animal contact. We present the case of a girl aged 8 with skin scalp lesions persisting for two months. Several scalp lesions, with a maximum diameter of 4 cm, presented as erythematous plaques with superficial scaling, yellow crusts, and edematous areas with purulent exudate. Dermoscopy revealed yellow crusts on an erythematous background, along with white scales, pustules, broken hairs, and comma hairs. Ultraviolent-enhanced fluorescence dermoscopy (UEFD) showed slight celadon green fluorescence, which enhanced the diagnosis and further helped to monitor the treatment. The PCR test confirmed the presence of M. canis. Treatment included topical ciclopirox and oral terbinafine. Lesions on the scalp and noticeable hair regrowth were observed in the areas of hair loss after two months. Kerion celsi can result in severe alopecia. To prevent scarring associated with hair loss in children, early mycological diagnostics, supported by dermoscopy and UEFD, is recommended. Full article

Live-cell imaging generally requires pretreatment with fluorophores to either monitor cellular functions or the dynamics of intracellular processes and structures. We have recently introduced full-field optical coherence tomography for the label-free live-cell imaging of fungi with potential clinical applications for the diagnosis of invasive fungal mold infections. While both the spatial resolution and technical set up of this technology are more likely designed for the histopathological analysis of tissue biopsies, there is to our knowledge no previous work reporting the use of a light interference-based optical technique for direct mycological examination and monitoring of intracellular processes. We describe the first application of dynamic full-field optical transmission tomography (D-FF-OTT) to achieve both high-resolution and live-cell imaging of fungi. First, D-FF-OTT allowed for the precise examination and identification of several elementary structures within a selection of fungal species commonly known to be responsible for invasive fungal infections such as Candida albicans, Aspergillus fumigatus, or Rhizopus arrhizus. Furthermore, D-FF-OTT revealed the intracellular trafficking of organelles and vesicles related to metabolic processes of living fungi, thus opening new perspectives in fast fungal infection diagnostics. Full article

Background: Invasive aspergillosis (IA) is a significant cause of morbidity and mortality in patients with haematological malignancies. Accurate diagnosis of IA is challenging due to non-specific symptoms and the impact of antifungal prophylaxis on biomarker sensitivity. Methods: This retrospective study evaluated the diagnostic performance of three serum biomarkers: Aspergillus Galactomannan Ag VirClia Monotest^® (VirClia), Wako β-D-Glucan Test^® (Wako BDG), and MycoGENIE Real-Time PCR^® (MycoGENIE PCR). True positives were defined as patients with proven or probable IA (n = 14), with a positive Platelia Aspergillus Antigen^® (Platelia) serving as a mycological criterion. True negatives were identified as patients with a positive Platelia assay but classified as non-probable IA (n = 10) and outpatients who consistently tested negative with the Platelia test throughout the study period (n = 20). Results: Most patients diagnosed with proven or probable IA were acute myeloid leukaemia or myelodysplastic syndrome patients receiving mould-active antifungal prophylaxis or treatment (71%). VirClia demonstrated high sensitivity (100%) for detecting IA, with a specificity of 83%. Wako BDG and MycoGENIE PCR showed lower sensitivities for IA (57% and 64%, respectively). MycoGENIE PCR detected Aspergillus spp. and Mucorales in two patients. Conclusions: Accurate diagnosis of IA remains challenging, especially in patients who have received mould-active antifungal treatment. VirClia showed comparable performance to Platelia, suggesting its potential for routine use. However, Wako BDG and MycoGENIE PCR results were less favourable in our study cohort. Nevertheless, MycoGENIE PCR detected two probable co-infections with Aspergillus spp. and Mucorales. Full article

Onychomycosis is a recalcitrant fungal infection of the nail unit that can lead to secondary infections and foot complications. Accurate pathogen identification by confirmatory testing is recommended to improve treatment outcomes. In this study, we reviewed the records of 710,541 patients whose nail specimens were sent to a single molecular diagnostic laboratory between 2015 and 2024. PCR testing revealed a more comprehensive spectrum of pathogens than previously reported, which was corroborated by the demonstration of fungal invasion on histopathology. Consistent with our current understanding, the T. rubrum complex (54.3%) are among the most common pathogens; however, a significant portion of mycology-confirmed diagnoses were caused by the T. mentagrophytes complex (6.5%), Aspergillus (7.0%) and Fusarium (4.5%). Females were significantly more likely to be infected with non-dermatophytes molds (NDMs; OR: 2.0), including Aspergillus (OR: 3.3) and Fusarium (OR: 2.0), and yeasts (OR: 1.5), including Candida albicans (OR: 2.0) and C. parapsilosis (OR 1.6), than males. The T. mentagrophytes complex became more prevalent with age, and conversely the T. rubrum complex became less prevalent with age. Patients aged ≥65 years also demonstrated a higher likelihood of contracting onychomycosis caused by NDMs (OR: 1.6), including Aspergillus (OR: 2.2), Acremonium (OR: 3.5), Scopulariopsis (OR: 2.9), Neoscytalidium (OR: 3.8), and yeasts (OR: 1.8), including C. albicans (OR: 1.9) and C. parapsilosis (OR: 1.7), than young adults. NDMs (e.g., Aspergillus and Fusarium) and yeasts were, overall, more likely to cause superficial onychomycosis and less likely to cause dystrophic onychomycosis than dermatophytes. With regards to subungual onychomycosis, Aspergillus, Scopulariopsis and Neoscytalidium had a similar likelihood as dermatophytes. The advent of molecular diagnostics enabling a timely and accurate pathogen identification can better inform healthcare providers of appropriate treatment selections and develop evidence-based recommendations. Full article

Introduction: It has long been accepted that trauma is one of the most important and frequent predisposing factors for onychomycoses. However, the role of direct trauma in the pathogenesis of fungal nail infections has only recently been elucidated in a series of 32 cases of post-traumatic single-digit onychomycosis. The importance of repeated trauma due to foot and toe abnormalities was rarely investigated. Aimof the study: This is a multicenter single-author observational study over a period of 6 years performed at specialized nail clinics in three countries. All patient photographs taken by the author during this period were screened for toenail alterations, and all toe onychomycosis cases were checked for whether they contained enough information to evaluate potential foot and toe abnormalities. Particular attention was paid to the presence of hallux valgus, hallux valgus interphalangeus, hallux erectus, inward rotation of the big toe, and outward rotation of the little toe, as well as splay foot. Only cases with unequivocal proof of fungal nail infection by either histopathology, mycologic culture, or polymerase chain reaction (PCR) were accepted. Results: Of 1653 cases, 185 were onychomycoses, proven by mycologic culture, PCR, or histopathology. Of these, 179 involved at least one big toenail, and 6 affected one or more lesser toenails. Three patients consulted us for another toenail disease, and onychomycosis was diagnosed as a second disease. Eight patients had a pronounced tinea pedum. Relatively few patients had a normal big toe position (n = 9). Most of the cases had a mild to marked hallux valgus (HV) (105) and a hallux valgus interphalangeus (HVI) (143), while hallux erectus was observed in 43 patients, and the combination of HV and HVI was observed 83 times. Discussion: The very high percentage of foot and toe deformations was surprising. It may be hypothesized that this is not only a pathogenetically important factor but may also play an important role in the localization of the fungal infection, as no marked hallux deviation was noted in onychomycoses that affected the lesser toes only. As the management of onychomycoses is a complex procedure involving the exact diagnosis with a determination of the pathogenic fungus, the nail growth rate, the type of onychomycosis, its duration, and predisposing factors, anomalies of the toe position may be important. Among the most commonly mentioned predisposing factors are peripheral circulatory insufficiency, venous stasis, peripheral neuropathy, immune deficiency, and iatrogenic immunosuppression, whereas foot problems are not given enough attention. Unfortunately, many of these predisposing and aggravating factors are difficult to treat or correct. Generally, when explaining the treatment of onychomycoses to patients, the importance of these orthopedic alterations is not or only insufficiently discussed. In view of the problems encountered with the treatment of toenail mycoses, this attitude should be changed in order to make the patient understand why there is such a low cure rate despite excellent minimal inhibitory drug concentrations in the laboratory. Full article

This is the first description of cutaneous mucormycosis in buffalo in the Brazilian Amazon biome. All buffalo showed apathy, inappetence, weight loss, reluctance to move, and prolonged sternal decubitus. Of the four affected animals, two died 15 and 30 days after the appearance of clinical signs. In the initial phase, the skin lesions were rounded areas with dry central regions, sensitive to palpation, with protruding edges and diameters ranging from 8 cm to 15 cm. These areas of necrosis were isolated or coalescing and present mainly on the limbs and sides. In an advanced stage of the disease, there was detachment of the skin from the necrotic areas with extensive wound formation, which sometimes exposed the subcutaneous tissue. The histopathology of the skin showed a multifocal inflammatory infiltrate composed of intact and degenerated eosinophils surrounded by epithelioid macrophages. At the center of these areas was a focally extensive area of epidermal ulceration characterized by intact and degenerated neutrophils, the necrosis of epithelial cells, and the accumulation of fibrin and erythrocytes. The mycological culture was positive for Rhizopus sp. The diagnosis of cutaneous dermatitis caused by Rhizopus sp. was based on clinical signs, macroscopic and histopathological findings, and the identification of the fungus by mycological and molecular techniques. Full article

Chromoblastomycosis (CBM) is a chronic neglected fungal disease, usually met in tropical areas. French Guiana is a South American territory with limited epidemiological data. This retrospective study concerned all patients with CBM proven by at least one paraclinical examination and diagnosed in French Guiana between 1950 and 2023. In total, 23 patients were included, mostly males (87%) of Creole origin, living in the coastal region (87%) and involved in outdoor occupations (74%). Lesions were mostly observed on the lower limbs (78.3%), with a median time to diagnosis of four years. Laboratory tests included positive direct microscopic examinations (78.3%) and mycological cultures (69.6%), identifying 14 cases of Fonsecaea pedrosoi and one case of Exophiala janselmei. Various treatments were employed, including antifungals, surgery and combinations of both. In conclusion, CBM in French Guiana involves a different population than other subcutaneous mycoses such as Lobomycosis or Paracoccidioidomycosis, mostly found in the forest hinterland. Surgery should be recommended for recent and limited lesions. Itraconazole and terbinafine should systematically be proposed, either in monotherapy or in combination with surgery or cryotherapy. Full article

Based on the literature data, the incidence of superficial and invasive non-dermatophyte mold infection (NDMI) has increased. Many of these infections are undiagnosed or misdiagnosed, thus causing inadequate treatment procedures followed by critical conditions or even mortality of the patients. Accurate diagnosis of these infections requires complex mycological analyses and operator skills, but simple, fast, and more efficient mycological tests are still required to overcome the limitations of conventional fungal diagnostic procedures. In this study, software has been developed to provide an efficient mycological diagnosis using a trained convolutional neural network (CNN) model as a core classifier. Using EfficientNet-B2 architecture and permanent slides of NDM isolated from patient’s materials (personal archive of Prof. Otašević, Department of Microbiology and Immunology, Medical Faculty, University of Niš, Serbia), a multi-CNN model has been trained and then integrated into the diagnostic tool, with a 93.73% accuracy of the main model. The Grad-CAM visualization model has been used for further validation of the pattern recognition of the model. The software, which makes the final diagnosis based on the rule of the major method, has been tested with images provided by different European laboratories, showing an almost faultless accuracy with different test images. Full article

To limit the spread of bovine ringworm, control measures such as movement restrictions are highly recommended. In this context, calves at auction markets in Styria, Austria, displaying skin lesions characteristic for bovine ringworm, are excluded from the auctions. To investigate whether these clinical assessments correspond to laboratory diagnosis, a total of 166 samples taken from skin lesions assigned to the three clinical categories ‘ringworm very likely (v), likely (l) or unlikely (u)’ were mycologically examined using microscopy, culture, and nested PCR followed by amplicon sequencing. Further, the relationships of isolated dermatophytes were determined through multi-locus sequence typing (MLST). Overall, a high agreement between clinical assessment and laboratory results were observed with microscopy and nested PCR, providing more consistent results and molecular detection possessing an analytical sensitivity superior to that of cultural isolation (culture 21.7% vs. nested PCR 48.2%). Phylogenetic analyses revealed that most of the isolated dermatophytes belong to a unique Trichophyton verrucosum MLST genotype. In conclusion, clinical assessments were largely confirmed through laboratory diagnosis with nested PCR and sequencing, providing rapid, sensitive, and species-specific detection of dermatophytes in calves at auction markets displaying skin lesions typical for ringworm; this seems to be predominantly caused by a single Trichophyton verrucosum strain. Full article