In vitro Antifungal Susceptibility of Agents for Superficial Phaeohyphomycosis
Abstract
The selection of fungal isolates resistant to available therapy associated with an increase in the number of immunosuppressed patients has contributed to the incidence of infections caused by dematiaceous fungi. Thus, this study evaluated the therapeutic efficacy of the main antifungal agents currently used in clinical practice in relation to Curvularia spp. and Hortaea werneckii from cases of superficial phaeohyphomycosis from southern Brazil. The susceptibility profile of amphotericin B, fluconazole, itraconazole, terbinafine and voriconazole against dematiaceous fungi (Curvularia lunata, C. pallescens and H. werneckii) was evaluated by microdilution in broth. Terbinafine showed greater efficacy against C. lunata - gemometric mean (GM = 0.38 μg/mL), C. pallescens (MIC = 0.125 μg/mL) and H. werneckii (GM = 0.031 μg/mL) when compared to the other antifungals tested. Most of species showed sensitivity to itraconazole and voriconazole, with a minimum inhibitory concentration (MIC) range from 1 - 8.0 μg/mL and 0.5 - 2.0 μg/mL, respectively. All isolates tested show low sensitivity to fluconazole (MIC range 4 - 16 μg/mL). Although itraconazole is considered gold standard, terbinafine has been showed to be a good alternative for the treatment of superficial phaeohyphomycosis. Lastly, antifungal susceptibility testing is essential to indicate the ideal therapy against these infections.
Downloads
References
Isa-Isa R, García C, Isa M, Arenas R. Subcutaneous phaeohyphomycosis (mycotic cyst). Clin Dermatol. 2012; 30: 425-31. doi: 10.1016/j.clindermatol.2011.09.015
Bay C, González T, Muñoz G, Legarraga P, Vizcaya C, Abarca K. Phaeohyfomycosis nasal por Curvularia spicifera en un paciente pediátrico con neutropenia y leucemia mieloide aguda. Rev Chilena Infectol. 2017; 34: 280-6
Shrivastava A, Tadepalli K, Goel G, Gupta K, Kumar GP. Melanized fungus as an epidural abscess: a diagnostic and therapeutic challenge. Med Mycol Case Rep. 2017; 16: 20-4. Doi: 10.1016/j.mmcr.2017.04.001
Badali H, de Hoog GS, Curfs-Breuker I, Klaassen CHW, Meis JF. Use of amplified fragment length polymorphism to identify 42 clinical Cladophialophora spp., related to cerebral phaeohyphomycosis with in vitro antifungal susceptibility. J Clin Microbiol. 2010; 48: 2350-6. doi: 10.1128/JCM.00653-10
Di Chiacchio N, Noriega LF, Di Chiacchio NG, Ocampo‐Garza J. Superficial black onychomycosis due to Neoscytalidium dimidiatum. J Eur Acad Dermatol Venereol. 2017; 31: e453–e455. doi: 10.1111/jdv.14273
Chen WT, Tu ME, Sun PL. Superficial phaeohyphomycosis caused by Aureobasidium melanogenum mimicking tinea nigra in an immunocompetent patient and review of published reports. Mycopathologia. 2016; 181: 555-60. doi: 10.1007/s11046-016-9989-3
Guarro J, Akiti T, Horta RA, Morizot Leite-Filho LA, Gené J, Ferreira-Gomes S, et al. Mycotic keratitis due to Curvularia senegalensis and in vitro antifungal susceptibilities of Curvularia spp. J Clin Microbiol. 1999; 37: 4170-3.
Lopes JO, Jobim NM. Dermatomycosis of the toe web caused by Curvularia lunata. Rev Inst Med Trop S Paulo. 1998; 40: 327-8.
Queiroz-Telles F, Nucci M, Colombo AL, Tobón A, Restrepo A. Mycoses of implantation in Latin America: an overview of epidemiology, clinical manifestations, diagnosis and treatment. Med Mycol. 2011; 49: 225-36. doi: 10.3109/13693786.2010.539631
Brandt ME, Warnock DW. Epidemiology, clinical manifestations, and therapy of infections caused by dematiaceous fungi. J Chemother. 2003; 15: 36-47.
Falcão EM, Trope BM, Martins NR, Barreiros Mda G, Ramos-E-Silva M. Bilateral tinea nigra plantaris with good response to isoconazole cream: A Case Report. Case Rep Dermatol. 2015; 7: 306-10. doi: 10.1159/000441602
Perusquía-Ortiz AM, Vázquez-González D, Bonifaz A. Opportunistic filamentous mycoses: aspergillosis, mucormycosis, phaeohyphomycosis and hyalohyphomycosis. J Dtsch Dermatol Ges. 2012; 10: 611-21. doi: 10.1111/j.1610-0387.2012.07994.x
Revankar SG, Sutton DA. Melanized fungi in human disease. Clin Microbiol Rev. 2010; 23: 884–28. doi: 10.1128/CMR.00019-10
Veasey JV, De Avila RB, Ferreira MAM de O, Lazzarini R. Reflectance confocal microscopy of tinea nigra: comparing images with dermoscopy and mycological examination results. An Bras Dermatol. 2017; 92: 568-9. doi.org/10.1590/abd1806-4841.20176808
Biancalana FSC, Lyra L, Moretti ML, Schreiber AZ. Susceptibility testing of terbinafine alone and in combination with amphotericin B, itraconazole, or voriconazole against conidia and hyphae of dematiaceous molds. Diagn Microbiol Infect Dis. 2011; 71: 378–85. doi: 10.1016/j.diagmicrobio.2011.08.007
Wong EH, Revankar SG. Dematiaceous molds. Infect Dis Clin North Am. 2016; 30: 165–178. doi: 10.1016/j.idc.2015.10.007
Andrade TS, Castro LG, Nunes RS, Gimenes VM, Cury AE. Susceptibility of sequential Fonsecaea pedrosoi isolates from chromoblastomycosis patients to antifungal agents. Mycoses. 2004; 47: 216-21.
Aguas Y, Hincapie M, Fernández-Ibáñez P, Polo-López MI. Solar photocatalytic disinfection of agricultural pathogenic fungi (Curvularia sp.) in real urban wastewater. Sci Total Environ. 2017; 607-608:1213–24. doi.org/10.1016/j.scitotenv.2017.07.085
Shannon PL, Ramos-Caro FA, Cosgrove BF, Flowers FP. Treatment of tinea nigra with terbinafine. Cutis. 1999; 64: 199-201.
Bonifaz A, Gómez-Daza F, Paredes V, Ponce RM. Tinea versicolor, tinea nigra, white piedra, and black piedra. Clin Dermatol. 2010; 28: 140-5. doi: 10.1016/j.clindermatol.2009.12.004
Rangel LP, Moreira OC, Livramento GN, Britto C, Alviano DS, Alviano CS. et al. Putative role of an ABC transporter in Fonsecaea pedrosoi multidrug resistance. Int J Antimicrob Agents. 2012; 40: 409-15. doi.org/10.1016/j.ijantimicag.2012.07.010
Ellis MB. Dematiaceous hyphomycetes. 1th ed. England: Common wealth Mycological Institute; 1971. p. 608.
Sivanesan A. Graminicolous species of Bipolaris, Curvularia, Drechslera, Exserohilum and their teleomorphs. Mycological Papers. 1987; 158: 1-261.
Lima A, Furtado M. Espécies do género Curvularia (fungos anamórficos: hyphomycetes) na ilha de Santiago, Cabo Verde. Portugaliae Acta Biol. 2007; 22: 145-56.
CLSI, M38-A2. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi; approved standard-second edition. Clinical and Laboratory Standards Institute, Wayne, PA. 2008.
CLSI, M27-A3. Reference Method for Broth Dilution Antifungal Susceptibility Testing of 304 Yeasts. Third Edition. Clinical and Laboratory Standards Institute, Wayne, PA. 2008.
CLSI, M27-S4. Reference method for broth dilution antifungal susceptibility testing of yeasts: fourth informational supplement. Clinical and Laboratory Standards Institute, Wayne, PA. 2012.
Halliday CL, Chen SC, Kidd SE, Van Hal S, Chapman B, Heath CH. et al. Antifungal susceptibilities of non-Aspergillus filamentous fungi causing invasive infection in Australia: support for current antifungal guideline recommendations. Int J Antimicrob Agents. 2016; 48: 453-8. doi: 10.1016/j.ijantimicag.2016.07.005
Araujo R, Oliveira M, Amorim A, Sampaio-Maia B. Unpredictable susceptibility of emerging clinical moulds to tri-azoles: review of the literature and upcoming challenges for mould identification. Eur J Clin Microbiol Infect Dis. 2015; 34: 1289-01. doi: 10.1007/s10096-015-2374-1
Fleck R, Hof H. Breakpoints for posaconazole susceptibility testing: background and discussion about the need of establishing values. Mycoses. 2008; 51: 1-4. doi: 10.1111/j.1439-0507.2008.01568.x
Yew SM, Chan CL, Lee KW, Na SL, Tan R, Hoh CC. et al. A five-year survey of dematiaceous fungi in a tropical hospital reveals potential opportunistic species. Plos One. 2014; 9: e104352. doi: 10.1371/journal.pone.0104352
Shobana CS, Mythili A, Homa M, Galgóczy L, Priya R, Babu SYR. et al. In vitro susceptibility of filamentous fungi from mycotic keratitis to azole drugs. J Mycol Med. 2015; 25: 44-9. doi: 10.1016/j.mycmed.2014.10.024
Nizam TM, Binting RA, Saari SM, Kumar TV, Muhammad M, Satim H. et al. In vitro antifungal activities against molds isolated from dermatological specimens. Malays J Med Sci. 2016; 23: 32–9.
Da Cunha KC, Sutton DA, Fothergill AW, Gené J, Cano J, Madrid H. et al. In vitro antifungal susceptibility and molecular identity of 99 clinical isolates of the opportunistic fungal genus Curvularia. Diagn Microbiol Infect Dis. 2013; 76: 168-74. doi: 10.1016/j.diagmicrobio.2013.02.034
Krizsán K, Tóth E, Nagy LG, Galgóczy L, Manikandan P, Chandrasekaran M. et al. Molecular identification and antifungal susceptibility of Curvularia australiensis, C. hawaiiensis and C. spicifera isolated from human eye infections. Mycoses. 2015; 58: 603-9. doi: 10.1111/myc.12367
Ng KP, Soo-Hoo TS, Na SL, Tay ST, Hamimah H, Lim PC. et al. The mycological and molecular study of Hortaea werneckii isolated from blood and splenic abscess. Mycopathologia. 2005; 159: 495-5.
Formoso A, Heidrich D, Felix CR, Tenório AC, Leite BR, Pagani DM. et al. Enzymatic activity and susceptibility to antifungal agents of Brazilian environmental isolates of Hortaea werneckii. Mycopathologia. 2015; 180: 345-52. doi: 10.1007/s11046-015-9920-3
Copyright (c) 2020 Journal of the Portuguese Society of Dermatology and Venereology
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles in this journal are Open Access under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).
