Medical School, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
Hospital do Rim, São Paulo, Brazil.
Int J Dermatol. 2022 Mar;61(3):346-351. doi: 10.1111/ijd.15948. Epub 2021 Oct 11.
Melanized fungi are a distinct group of pathogens that cause infections like chromoblastomycosis and phaeohyphomycosis, especially in a state of immunosuppression including solid organ transplant recipients. Guidelines for the treatment of these infections are lacking, and there is no available standard recommendation.
To evaluate the therapeutic aspects of subcutaneous melanized fungal infections in kidney transplant recipients.
A retrospective medical record was performed for kidney transplant recipients with melanized fungal infection evaluated in a single institution from January 1996 to December 2018.
Eighty-two episodes were noticed in our series. The treatment of subcutaneous phaeohyphomycosis was managed by surgical excision without antifungal therapy in 34 cases (34/68; 50%), and the association of both methods occurred in 18 cases (18/68; 26.5%). A complete surgical excision without antifungal therapy was observed in six (6/14; 42.9%) episodes of chromoblastomycosis, and combined treatment was possible in three (3/14; 21.4%) cases. Five episodes of chromoblastomycosis and 16 episodes of phaeohyphomycosis were managed only with antifungal therapy.
Management depends on the dermatologic lesion, immunosuppression condition, and anatomical cleavage plane. The sample size is still small in order to dictate a guideline, but it can be hard to execute a larger study given the rarity of this group of infections.
黑真菌是一组独特的病原体，可引起黑曲霉病和暗色丝孢霉病等感染，尤其是在包括实体器官移植受者在内的免疫抑制状态下。缺乏这些感染的治疗指南，也没有可用于推荐的标准。
评估肾移植受者皮下黑真菌感染的治疗方面。
对 1996 年 1 月至 2018 年 12 月在一家机构接受评估的肾移植受者进行了黑色素真菌感染的回顾性病历分析。
在我们的系列中发现了 82 例。在 68 例（34/68；50%）中，皮下暗色丝孢霉病的治疗仅通过手术切除而未使用抗真菌治疗，在 18 例（18/68；26.5%）中联合使用了这两种方法。在 14 例（6/14；42.9%）黑曲霉病病例中，仅通过手术切除且不使用抗真菌治疗观察到完全切除，在 3 例（3/14；21.4%）中联合治疗是可行的。5 例黑曲霉病和 16 例暗色丝孢霉病仅接受抗真菌治疗。
治疗取决于皮肤病损、免疫抑制状况和解剖分离平面。为了制定指南，样本量仍然很小，但鉴于此类感染的罕见性，很难进行更大规模的研究。
