Primary cutaneous aspergillosis – an uncommon opportunistic infection Review of the literature and case presentation

Darr-Foit, Susanne; Schliemann, Sibylle; Scholl, Sebastian; Hipler, Uta‐Christina; Elsner, Peter

doi:10.1111/ddg.13297

Cited by 8 publications

(10 citation statements)

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“…A skin biopsy specimen for a suspected fungal lesion should be taken from the center of the lesion and should reach the subcutaneous fat because Aspergillus tends to invade blood vessels of the dermis and subcutis. 8 In this patient we done the potassium hydroxide with the result shows conidiophores, dichotomously branching and septate hyphae. The hyphae of Aspergillus have a relatively characteristic size (3-6 lm) and morphology (septate with progressive arboreal and dichotomous branching).…”

Section: Discussionmentioning

confidence: 94%

“…Although this latter stage is characteristic of Aspergillus skin lesions, the appearance is not pathognomonic. 8,9 Primary cutaneous aspergillosis may also arising in a wound generally presents with significant fever, a change in the character of the wound surface, swelling, induration, and tenderness. 2 Aspergillus species is a saprophytic mold, which is found in decaying organic matter.…”

Section: Discussionmentioning

confidence: 99%

“…Aspergillus hyphae should have acute-angle branching and frequent septations. 8 Histopathologically by tissue sections, diagnosis can be made by demonstration of nonpigmented septated hyphae that branch at acute angles. Hematoxylin eosin staining of the skin biopsy specimen demonstrated dermal diffuse and nodular granulomatous infiltration with large amounts of lymphocytes, multinucleated giant cell, eosinophil, and neutrophil.…”

Section: Discussionmentioning

confidence: 99%

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Cutaneous Aspergilosis Caused by Aspergillus Flavus: A Case Report

Sheilaadji

Agusni

Astari

et al. 2021

BIKK

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Background: Cutaneous aspergillosis occurs relatively less frequent and therefore remains poorly characterized. Cutaneous aspergillosis can be as primary or secondary infection. Primary cutaneous aspergillosis usually involves sites of skin injury, intravenous catheter, traumatic inoculation, and associated with occlusive dressings. Secondary lesions result from contiguous extension from infected underlying structures or from widespread blood-borne seeding of the skin. Purpose: To know the skin manifestation, efflorence, examination and therapy of cutaneous aspergillosis. Case: A man complaint itchy redness macule and pimples on the right arm since 2 weeks. Initially just felt a little then expands. Patients with post operative brachial injury and uses a cast during one month. On examination there are erythematous macule unsharply marginated with papules. Potassium hydroxide examination, shows conidiophores, dichotomously branching and septate hyphae appropriate description with Aspergillosis Sp. Cultures found grow granular colonies, flat often with radial grooves, yellow at first but quickly becoming bright to dark yellow-green with age, For the identification microscope from the culture specimen there was conidia, phialde, conidiophore and vesicle that suitable with Aspergillus flavus. Patients received itraconazole 2 x 200 mg for 6 weeks and obtained satisfactory results. Discussion: Healthy hosts can develop cutaneous aspergillosis in surgical wounds, by traumatic inoculation, at sites associated with occlusive dressings. In some instances, a presumptive diagnosis of primary cutaneous aspergillosis can be made immediately by examining a potassium hydroxide preparation and culture. Conclusion: Diagnose of cutaneous aspergillosis can establish by potassium hydroxide and culture examination, therapy with itraconazole 2x 200mg give satisfactory results.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cutaneous Aspergilosis Caused by Aspergillus Flavus: A Case Report

Sheilaadji

Agusni

Astari

et al. 2021

BIKK

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“…A complex interaction between occupant behavours and the built environment are thought to affect indoor fungal concentrations and species diversity. [2][3][4][5] Primary cutaneous aspergillosis usually involves sites of skin injury at or near intravenous access catheter sites, at sites of traumatic inoculation, and at sites associated with occlusive dressings, burns, or surgery. Secondary cutaneous lesions result either from contiguous extension to the skin from infected underlying structures or from widespread blood-borne seeding of the skin.…”

Section: Discussionmentioning

confidence: 99%

Aspergillus fumigatus as an agent of cutaneous aspergillosis in immunocompetent patient: A rare case

Setyaningrum

Pratiwi

2019

Dermatol Reports

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Cutaneous aspergillosis occurs relatively less frequent and therefore remains poorly characterized. Previous reports have described cutaneous aspergillosis as primary or secondary infection. Primary cutaneous aspergillosis usually involves sites of skin injury, at or near intravenous access catheter sites, at sites of traumatic inoculation, and at sites associated with occlusive dressings, burns, or surgery. Primary cutaneous aspergillosis almost always seen in immunocompromised patients and the skin involvement occurs due to hematogenous dissemination from a primary focus or contiguous spread from underlying infected tissues. This is a rare case of an-56-years-old-immunocompetence man with chief complaint of wound and swelling at left leg since 1 year ago that worsen in last 2 months. He got a history of scalded by hot water at his left leg 1 year ago and became swollen with multiple wound on its surface. Examination on regio pedis sinistra there is tumor with verrucous surface 10 cm in diameter, hard with multiple uneven edge ulcer 5 cm in diameter and hyperpigmentation macule unsharply marginated arround. Potassium hydroxide examination showed conidiophores dichotomously branching and septated hyphae that suitable with Aspergillosis sp. From cultures there is velvety-dark-green growth. The microscope findings from the culture specimen showed conidophore, metula, vesicle, phialde, and chains of pigmented conidia that suitable with Aspergillus fumigatus. Blood culture examination showed no growth of fungi. HIV rapid test negative results obtained. Patients treated with Itraconazole 2 x 200 mg for 12 weeks and obtained satisfactory result.

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“…In the absence of an appropriate immune response, these infectious propagules will germinate to invade the surrounding tissue at the site of infection; from there, haematogenous dissemination may occur to eventually result in systemic disease. Besides the aforementioned invasive form of aspergillosis, several others exist that may result in chronic or hyper‐inflammatory lung diseases (Kosmidis & Denning, 2015) or even cutaneous affection (Darr‐Foit, Schliemann, Scholl, Hipler, & Elsner, 2017), which makes this fungal infection remarkable in terms of progression. Considering the existence of a pulmonary microbiome or the scenario of co‐infection during aspergillosis, the capability of A. fumigatus to produce antimicrobial agents needs to be taken into account when defining its human virulome (Casadevall, 2006).…”

Section: Introductionmentioning

confidence: 99%

The infectious propagules of Aspergillus fumigatus are coated with antimicrobial peptides

Dümig

Binder

Gaculenko

et al. 2021

Cellular Microbiology

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Fungal spores are unique cells that mediate dispersal and survival in the environment. For pathogenic fungi encountering a susceptible host, these specialised structures may serve as infectious particles. The main causative agent of the opportunistic disease aspergillosis, Aspergillus fumigatus, produces asexual spores, the conidia, that become dissipated by air flows or water currents but also serve as propagules to infect a susceptible host. We demonstrate that the defX gene of this mould encodes putative antimicrobial peptides resembling cysteine‐stabilised (CS)αβ defensins that are expressed in a specific spatial and temporal manner in the course of asexual spore formation. Localisation studies on strains expressing a fluorescent proxy or tagged defX alleles expose that these antimicrobial peptides are secreted to coat the conidial surface. Deletion mutants reveal that the spore‐associated defX gene products delay the growth of Gram‐positive Staphylococcus aureus and demonstrate that the defX gene and presumably its encoded spore‐associated defensins confer a growth advantage to the fungal opponent over bacterial competitors. These findings have implications with respect to the ecological niche of A. fumigatus that serves as a ‘virulence school’ for this human pathogenic mould; further relevance is given for the infectious process resulting in aspergillosis, considering competition with the host microbiome or co‐infecting microorganisms to break colonisation resistance at host surfaces.

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Primary cutaneous aspergillosis – an uncommon opportunistic infection Review of the literature and case presentation

Cited by 8 publications

References 10 publications

Cutaneous Aspergilosis Caused by Aspergillus Flavus: A Case Report

Cutaneous Aspergilosis Caused by Aspergillus Flavus: A Case Report

Aspergillus fumigatus as an agent of cutaneous aspergillosis in immunocompetent patient: A rare case

The infectious propagules of Aspergillus fumigatus are coated with antimicrobial peptides

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