Department of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh, India.
Department of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh, India.
J Mycol Med. 2021 Sep;31(3):101135. doi: 10.1016/j.mycmed.2021.101135. Epub 2021 Apr 3.
Mycetoma is a slowly progressive, chronic granulomatous infection of skin and subcutaneous tissues with involvement of underlying fasciae and bones, usually affecting extremities. In India, among mycetoma, the eumycetoma constitutes about 35% of cases. Hereby, we report the first case of eumycetoma caused by uncommon fungus, Aspergillus candidus.
A 61 year old female presented to the Department of Dermatology with history of swelling of right foot associated with multiple firm nodules of approx. 1.5 × 1.5 cm each over dorsum of foot with discharging sinus containing white color granules. Biopsy of lesion on right foot on direct KOH examination revealed septate hyphae. Histopathology examination showed a histiocytic granuloma with fungal elements. Culture on Sabouraud Dextrose Agar grew white mycelial colonies which were identified to be Aspergillus species phenotypically. Genetic sequencing using Internal transcribed spacer gene, beta tubulin gene and Calmodulin gene was done and the isolate was identified to be Aspergillus candidus. Lesion was excised and patient was started on itraconazole.
Timely identification and starting of antifungal treatment can help in reducing morbidity due to eumycetoma to a large extent. As newer and newer species of fungi are emerging as significant causative agents of human infections, it is pertinent to report such findings from epidemiological point of view.
足菌肿是一种皮肤和皮下组织的慢性进行性肉芽肿性感染，伴有深部筋膜和骨骼的累及，通常影响四肢。在印度，真菌性足菌肿约占 35%。在此，我们报告首例由罕见真菌棘孢曲霉引起的真菌性足菌肿。
一名 61 岁女性因右足肿胀伴多个约 1.5×1.5cm 的坚实结节就诊于皮肤科，结节位于足背，伴有排脓窦道，窦道内含有白色颗粒。右足病变的直接 KOH 检查显示有分隔菌丝。组织病理学检查显示为组织细胞性肉芽肿，伴有真菌成分。沙氏琼脂培养长出白色丝状菌落，经表型鉴定为曲霉属。通过内部转录间隔区基因、β-微管蛋白基因和钙调蛋白基因的遗传测序，鉴定为棘孢曲霉。切除病变组织，开始给予伊曲康唑治疗。
及时识别并开始抗真菌治疗可以在很大程度上减少真菌性足菌肿的发病率。随着越来越多的新型真菌成为人类感染的重要病原体，从流行病学角度报告这些发现是很有必要的。
