Cutaneous Paecilomyces lilacinus infections in immunocompromised and immunocompetent patients

Abstract

Paecilomyces is a genus of saprophytic fungus that has been associated, in rare instances, with human disease. We report two cases in which Paecilomyces lilacinus was isolated from cutaneous and subcutaneous lesions in an immunocompromised and an immunocompetent host. The first case was a subcutaneous infection due to P. lilacinus in a patient with a renal transplant and diabetes mellitus. The second case was an immunocompetent young woman who developed a cutaneous infection, with no identified predisposing factors. A biopsy from each patient provided an initial diagnosis of fungal elements in the tissues under examination and multiple positive fungal cultures were obtained from the tissue biopsy samples. Both microscopic and macroscopic examinations of the biopsy revealed the presence of P. lilacinus. Each of the two cases was successfully treated with oral ketoconazole (200 mg/day) and itraconazole. We also review previously reported cases in which the clinical history and response to therapy were noted.

Skin Immune Response of Immunocompetent and Immunosuppressed C57BL/6 Mice After Experimental Subcutaneous Infection Caused by Purpureocillium lilacinum

“…However, both groups presented lesions at the site of infection, dermatitis, and in some cases, keratitis. The results of this work go in line with those obtained by Permi et al (2011); Saghrouni et al (2013), andBassiri-Jahromi (2014), whose histopathological analysis of the skin biopsies of immunocompetent and immunosuppressed patients infected with P. lilacinum revealed the formation of granulomatous reactions, in which inflammatory infiltrates are mainly composed of polymorphonuclear and macrophages. We also observed ulcerated lesions at the site of infection in mice, as well as the formation of multifocal and mixed inflammatory infiltrates, that differed between immunocompetent (CI) and immunosuppressed (SI) groups with respect to severity-more pronounced in SI.…”

Evaluation of the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry Bruker Biotyper for identification of Penicillium marneffei, Paecilomyces species, Fusarium solani, Rhizopus species, and Pseudallescheria boydii

“…Although invasive aspergillosis represents the most common opportunistic mold infection, less commonly encountered molds, such as Fusarium Paecilomyces , and Zygomycetes have increasingly been reported to cause invasive mold infections ( Schalk et al, 2006 ; Malani and Kauffman, 2007 ; Hsiue et al, 2010b ; Bassiri-Jahromi, 2014 ). Infections caused by non- Aspergillus molds are associated with a substantially worse outcome than invasive aspergillosis ( Schalk et al, 2006 ; Malani and Kauffman, 2007 ; Hsiue et al, 2010b ; Bassiri-Jahromi, 2014 ), which is most likely attributed both to the significant immunodeficient state of these patients and the intrinsically less susceptibility of these organisms to antifungal agents ( Schalk et al, 2006 ; Malani and Kauffman, 2007 ; Hsiue et al, 2010b ; Bassiri-Jahromi, 2014 ). Penicillium marneffei has become a well-recognized pathogen in humans and is an important emerging public health threat ( Duong, 1996 ; Hsueh et al, 2000 ; Hung et al, 2012 ; Lee et al, 2012 ).…”

“…A history of recent travel in Southeast Asia, the southern part of China, Thailand, Vietnam, or Indonesia is common among patients with P. marneffei infection outside Asia ( Supparatpinyo et al, 1994 ; Larsson et al, 2012 ; Hu et al, 2013 ). Due to the life-threatening entity of infections caused by these non- Aspergillus molds, prompt diagnosis and appropriate antifungal treatments are crucial ( Duong, 1996 ; Schalk et al, 2006 ; Malani and Kauffman, 2007 ; Hsiue et al, 2010b ; Bassiri-Jahromi, 2014 ).…”