Fifty-eight fusaria isolated from 50 Italian patients between 2004 and 2007 were subject to multilocus DNA sequence typing to characterize the spectrum of species and circulating sequence types (STs) associated with dermatological infections, especially onychomycoses and paronychia, and other fusarioses in northern and central Italy. Sequence typing revealed that the isolates were nearly evenly divided among the Fusarium solani species complex (FSSC; n ‫؍‬ 18), the F. oxysporum species complex (FOSC; n ‫؍‬ 20), and the Gibberella (Fusarium) fujikuroi species complex (GFSC; n ‫؍‬ 20). The three-locus typing scheme used for members of the FSSC identified 18 novel STs distributed among six phylogenetically distinct species, yielding an index of discrimination of 1.0. Phylogenetic analysis of the FOSC two-locus data set identified nine STs, including four which were novel, and nine isolates of ST 33, the previously described widespread clonal lineage. With the inclusion of eight epidemiologically unrelated ST 33 isolates, the FOSC typing scheme scored a discrimination index of 0.787. The two-locus GFSC typing scheme, which was primarily designed to identify species, received the lowest discrimination index, with a score of 0.492. The GFSC scheme, however, was used to successfully identify 17 isolates as F. verticillioides, 2 as F. sacchari, and 1 as F. guttiforme. This is the first report that F. guttiforme causes a human mycotic infection, which was supported by detailed morphological analysis. In addition, the results of a pathogenicity experiment revealed that the human isolate of F. guttiforme was able to induce fusariosis of pineapple, heretofore its only known host.

Phaeosphaeriaceae is a family in the order Pleosporales containing numerous plant pathogens, endophytes, lichenised fungi, and environmental saprobes. A novel genus, Tintelnotia is introduced containing two species, one of which caused an eye infection and several nail infections in humans. All species of Tintelnotia produce conidia in soft pycnidia with a wide ostiole. The generic type species is T. opuntiae causing necrotic spots on cactus plants. The isolates of the human opportunist T. destructans showed variable susceptibility pattern to a panel of common antifungal agents. The MICs of amphotericin B, voriconazole, posaconazole and itraconazole were 1 μg/mL, complemented by an in vitro MEC of 16 μg/mL against caspofungin; the MIC of terbinafine was 0.125 μg/mL. The latter compound contributed to the successful therapy in the ocular mycosis refractory to standard antifungal therapy, the benefit of terbinafine should be highlighted as a therapeutic option especially in difficult-to-treat fungal keratitis.

We report a case of onychomycosis caused by Aspergillus versicolor in a 66-year-old female patient. The infection was characterised clinically by yellowish pigmentation of the nail plate and mild nail bed hyperkeratosis of the first left toe. All other nails were normal. Three direct microscopical examinations of nail samples revealed the presence of hyaline hyphae as well as conidiophores. Pure colonies of A. versicolor were found in three cultures. The patient was successfully treated with oral itraconazole. Case reportA 66-year-old female patient was admitted to our institute because of a yellowish pigmentation of the nail plate of the first left toe. The patient stated that she was in good general health, that she was not under treatment with systemic drugs and that the pigmentation appeared 6 months earlier.General physical examination did not reveal any pathological symptoms. Dermatological examination showed a yellowish pigmentation involving the distal portion of the nail plate of the first left toe (Fig. 1). Mild nail bed hyperkeratosis was also observed. All other nails were normal.Laboratory examinations included complete blood count, protein electrophoresis, metabolic tests (glucose, cholesterol, triglycerides and uric acid), renal tests (urea, creatinine and electrolytes), hepatic tests (bilirubin, transaminases, gamma-glutamyltransferase, alkaline phosphatase, cholinesterase, lacticodehydrogenase), inflammatory tests (erythro-sedimentation rate) and urinalysis and all examinations were normal.Bacteriological examinations were negative. A clinical diagnosis of onychomycosis was made. Three direct microscopical examinations of samples obtained from different areas of the affected nail collected on the same day were performed. They revealed the presence of intact and fragmented hyphae: the latter were intertwined and hyaline; very long, thin and smooth conidiophores were also observed (Fig. 2). Pure colonies of Aspergillus versicolor were found in three different cultures (Petri plates with Sabouraud dextrose agar with chloramphenicol, added with cycloheximide) (Fig. 3).Oral itraconazole pulse therapy was given to the patient (200 mg twice daily for 1 week, with 3 weeks off between successive pulses, for four pulses). Itraconazole was chosen because of previous history of urticaria and angio-oedema caused by terbinafine; the latter was used at another dermatological centre because of tinea corporis (Fig. 4). At the end of the therapy, mycological examinations were negative. A 2-year follow-up was negative both clinically and mycologically. Figure 1 Yellowish pigmentation of the distal portion of the nail plate of the first left toe.

On the basis of the present and our earlier findings it can be concluded that there is no dilrerence in the adherence capacity of C. albicans or T mentagrophytes valr granulosum to epithelial cells derived either from patients of mycoses or other forms of dermatoses.