Pyrenochaeta romeroi: a causative agent of phaeohyphomycotic cyst

Khan, Ziauddin; Ahmad, Suhail; Kapila, Kusum; Ramaswamy, Noorni V.; Alath, Preetha; Joseph, Leena; Chandy, Rachel

doi:10.1099/jmm.0.029520-0

Cited by 27 publications

(44 citation statements)

References 21 publications

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“…S2 Antifungal susceptibility. Antifungal susceptibility testing results for the previously described pleosporalean agents of eumycetoma were broadly concordant with previous reports (26)(27)(28). With the exception of R. rufulum, all of the species tested (including E. grisea and E. paragrisea) exhibited high MICs with caspofungin ( Table 2 (26,28).…”

Section: Resultssupporting

confidence: 78%

Novel Taxa Associated with Human Fungal Black-Grain Mycetomas: Emarellia grisea gen. nov., sp. nov., and Emarellia paragrisea sp. nov

et al. 2016

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cEumycetoma is a debilitating, chronic, fungal infection that is endemic in India, Indonesia, and parts of Africa and South and Central America. It remains a neglected tropical disease in need of international recognition. Infections follow traumatic implantation of saprophytic fungi and frequently require radical surgery or amputation in the absence of appropriate treatment. Several fungal species can cause black-grain mycetomas, including Madurella spp. (Sordariales), Falciformispora spp., Trematosphaeria grisea, Biatriospora mackinnonii, Pseudochaetosphaeronema larense, and Medicopsis romeroi (all Pleosporales). We performed phylogenetic analyses based on five loci on 31 isolates from two international culture collections to establish the taxonomic affiliations of fungi that had been isolated from cases of black-grain mycetoma and historically classified as Madurella grisea. Although most strains were well resolved to species level and corresponded to known agents of eumycetoma, six independent isolates, which failed to produce conidia under any conditions tested, were only distantly related to existing members of the Pleosporales. Five of the six isolates shared >99% identity with each other and are described as Emarellia grisea gen. nov. and sp. nov; the sixth isolate represents a sister species in this novel genus and is described as Emarellia paragrisea. Several E. grisea isolates were present in both United Kingdom and French culture collections and had been isolated independently over 6 decades from cases of imported eumycetoma. Four of the six isolates involved patients that had originated on the Indian subcontinent. All isolates were all susceptible in vitro to the azole antifungals, but had elevated MICs with caspofungin. D escribed over 3,000 years ago in the Atharva Veda, and present in Mesoamerica during the pre-Hispanic period (1), mycetoma has preponderance for men of working age and children (2). Eumycetoma (fungal mycetoma), which is acquired after traumatic inoculation usually on exposed body sites, is characterized by a chronic progressive destruction of soft tissue and adjoining structures with associated tumefaction and purosanguineous sinuses that drain fungal grains (2-5). Without adequate treatment, the infection eventually invades the skeletal system, and clinical and mycological cure is impossible without extensive debridement/amputation (2-5). The extruded grains are either pale or dark (black), depending on the etiological agent (4, 5). Historically, the most common agents of black-grain eumycetoma were classified within the genus Madurella (Sordariales), which is characterized by organisms that produce dark gray, brown or black colonies, and dematiaceous hyphae which either remain sterile or sporulate only very reluctantly (4). The absence of conidiogenesis in isolates recovered from most black-grain mycetoma infections has historically hindered accurate species identification, and it was only recently that molecular approaches have demonstrated that Madurella mycetomatis (6) (Sord...

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Section: Resultssupporting

confidence: 78%

Novel Taxa Associated with Human Fungal Black-Grain Mycetomas: Emarellia grisea gen. nov., sp. nov., and Emarellia paragrisea sp. nov

et al. 2016

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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%

Untitled

Kulkarni

Jamale²,

Hase³

et al. 2017

Exp Clin Transplant

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“…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%

“…without the use of antifungals). (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.…”

Section: In Cases Of Pyrenochaeta Infection Inflammatory Markersmentioning

confidence: 99%

“…it is usually due to the introduction of fungal spores into deeper tissues by trauma, typically in exposed areas of the body. (3,6,7) P. romeroi has been isolated from cases of mycetoma, in which the fungi is characterised by the production of soft, irregular, black grains with a subhyaline center. (2,4,5) In those cases, the lesions were found to develop slowly after trauma and were typically localised to cutaneous and subcutaneous tissues.…”

Section: Ca S E R Epo Rtmentioning

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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Pyrenochaeta romeroi: a causative agent of phaeohyphomycotic cyst

Cited by 27 publications

References 21 publications

Novel Taxa Associated with Human Fungal Black-Grain Mycetomas: Emarellia grisea gen. nov., sp. nov., and Emarellia paragrisea sp. nov

Novel Taxa Associated with Human Fungal Black-Grain Mycetomas: Emarellia grisea gen. nov., sp. nov., and Emarellia paragrisea sp. nov

Untitled

Subcutaneous abscess due to Pyrenochaeta romeroiin a renal transplant recipient

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