Isolation, identification and susceptibility of Pyrenochaeta romeroi in a case of eumycetoma of the foot in the UK

Cerar, Daša; Malallah, Yassen M; Howard, Susan J.; Bowyer, Paul; Denning, David W.

doi:10.1016/j.ijantimicag.2009.08.004

Cited by 23 publications

(18 citation statements)

References 5 publications

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“…To the best of our knowledge, only 4 cases in a nontransplant setting and 3 cases in transplant recipients have been described to date. [2][3][4][5][6][7][8] Nodulocystic lesion, subcutaneous abscess, and lesions mimicking plantar warts can be caused by this organism and have been described in kidney transplant recipients. Infection with Pyrenochaeta romeroi at multiple sites that cause such extensive lesions have not been described.…”

Section: Discussionmentioning

confidence: 99%

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Kulkarni

Jamale²,

Hase³

et al. 2017

Exp Clin Transplant

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Section: Discussionmentioning

confidence: 99%

“…Voriconazole and posaconazole have been found to be effective in some cases. 4,9 The combination of surgery and antifungal therapy can yield good results. Although not evidence based, a reduction of immunosuppression may quicken the patient's recovery.…”

Section: Discussionmentioning

confidence: 99%

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Kulkarni

Jamale²,

Hase³

et al. 2017

Exp Clin Transplant

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“…Most of the reported cases of P. romeroi infection involved mycetoma patients with a history of residence in India, Senegal or Pakistan. (7)(8)(9) Patients included healthy individuals, renal transplant recipients on immunosuppressive therapy, and acute lymphoblastic leukaemia patients on chemotherapy. (1,7)…”

Section: In Cases Of Pyrenochaeta Infection Inflammatory Markersmentioning

confidence: 99%

“…romeroi has been reported to be resistant, with high MICs, to amphotericin B, fluconazole and caspofungin, (7,8) and the effect of voriconazole was reported to be variable. (1,(6)(7)(8) Itraconazole was shown to be potent by Badali et al, but resistant by Cerar et al (7,8) Since the susceptibility test was unsuccessful in the present case, the choice of itraconazole was empirical.…”

Section: In Cases Of Pyrenochaeta Infection Inflammatory Markersmentioning

confidence: 99%

“…(6,7) Other reports used surgical debridement followed by prolonged use of triazole. (1,8) In a case series of patients with phaeohyphomycosis, itraconazole was demonstrated to be effective in some patients. (1) The present case adds to the evidence provided by the aforementioned case series, (10) which found that prolonged itraconazole therapy leads to improvement in those who fail to respond to surgical treatment alone.…”

Section: In Cases Of Pyrenochaeta Infection Inflammatory Markersmentioning

confidence: 99%

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Subcutaneous abscess due to Pyrenochaeta romeroiin a renal transplant recipient

Chan

Tan²,

Tan³

2014

smedj

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C a s e R e p o r t e64 I NTRO D U C TIO NPyrenochaeta romeroi (P. romeroi) is a saprophytic fungus widely distributed in the environment; it can be found on wood and in plants.(1) The fungal spores of P. romeroi can be inoculated into deeper tissues by trauma, (2,3) and are a rare cause of skin and subcutaneous tissue infections. Herein, we report Singapore's first case of P. romeroi infection involving a 55-year-old renal transplant recipient who developed a chronic necrotising granulomatous skin lesion. The challenges involved in the diagnosis and treatment of this uncommon disease is discussed in this report. CA S E R EPO RTA 55-year-old Chinese man presented to our institution with a slow growing, painless nodular lesion on his left posterior thigh. One year before the current presentation, the patient had undergone a living related donor renal transplantation.For the transplantation, the patient received cyclosporine and thymoglobulin at induction, followed by maintenance immunosuppressive therapy with prednisolone 10 mg once daily, mycophenolate mofetil 250 mg twice daily, and cyclosporin 45 mg once daily. He had an uneventful postoperative recovery, and his transplanted kidney was found to be functioning well with no signs of rejection during follow-up.He did not have diabetes mellitus or a medical history of note, and he denied any history of trauma, soil exposure or participation in gardening activities. Throughout that one year (from renal transplantation to the current presentation), the patient did not show any systemic symptoms and his inflammatory markers (white cell count and C-reactive protein)were unremarkable. For his current presentation, the patient underwent ultrasonography of his left posterior thigh lesion, which revealed a thick-walled cystic mass. Histologic examination of the biopsied specimen showed necrotising granulomatous inflammation with fungal hyphae.The thigh lesion recurred and progressed despite repeated attempts at complete surgical excision over a one-year period. In vitro antifungal susceptibility test was performed, but the results were inconclusive because the fungus failed to grow well in the susceptibility testing medium. Nevertheless, the interpretation of the susceptibility data of this unusual mould (P. romeroi) would be difficult because there was no standardised susceptibility data for moulds other than those of the Aspergillus genus. The patient was started empirically on itraconazole syrup 200 mg twice daily for a period of two years. There was gradual reduction of the lesion size and the lesion remained quiescent in those two years. Throughout the course of treatment, itraconazole serum level was not monitored due to the unavailability of the test at our centre. ABSTRACT An infective aetiology, including fungal infection, should be considered in the differential diagnosis of immunocompromised patients presenting with skin lesions. Dematiaceous fungi are recognised as pathogens in organ transplant recipients. Herein, we describe a rare case of a chronic necrotis...

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Fungi Causing Eumycotic Mycetoma

van de Sande

2023

ClinMicroNow

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Eumycetoma was recognized as a neglected tropical disease by the World Health Organization in 2016. All fungi known to cause eumycetoma belong to the phylum Ascomycota. Madurella mycetomatis is the most common fungal causative agent of eumycetoma. Medicopsis romeroi is a coelomycetous anamorphic fungus. It might be misidentified as Trematosphaeria grisea when cultures lack pycnidia. Neotestudina rosatii has been isolated from soil from tropical countries; it is an ascomycete with spherical, deliquescent asci and rhomboid ascospores with one septum each. The genus Scedosporium comprises a small group of rather variable species. Magnetic resonance imaging and radiology are often used to identify the limits of the lesions and to determine if bone is affected. Antibody detection tests created in‐house have been used in some locations where eumycetoma is endemic.

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Isolation, identification and susceptibility of Pyrenochaeta romeroi in a case of eumycetoma of the foot in the UK

Cited by 23 publications

References 5 publications

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Subcutaneous abscess due to Pyrenochaeta romeroiin a renal transplant recipient

Fungi Causing Eumycotic Mycetoma

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