title: A dark strain in the Fusarium solani species complex isolated from primary subcutaneous sporotrichioid lesions associated with traumatic inoculation via a rose bush thorn.
abstract: Fusarium species are hyaline hyphomycetes widely distributed in nature and documented agents of both superficial and systemic infections in humans. In this paper, we report a darkly-pigmented and initially non-sporulating isolate in the Fusarium solani species complex (FSSC) causing a post-traumatic sporotrichoid infection in an otherwise healthy, male patient. Sequencing of multiple loci showed that the isolate represented an otherwise unknown lineage, possibly corresponding to a separate species, within the multi-species F. solani complex. In prolonged culture, the non-sporulating isolate produced revertant wild-type subcultures with typical Fusarium conidiation. This suggests that the original dense, dark, non-sporulating isolate was a host-adapted form selected in vivo for characters compatible with human pathogenicity. The production of such forms by Fusarium species is increasingly recognized now that sequencing has allowed the identification of highly atypical isolates. In vitro antifungal susceptibility of the isolate was investigated against seven conventional and two newly approved antifungal agents. The isolate showed in vitro resistance to amphotericin B, but appeared susceptible to itraconazole and terbinafine. A cure was ultimately achieved with combined terbinafine/itraconazole therapy with prolonged itraconazole follow-up therapy.
authors.affiliation: Department of Microbiology and Clinical Microbiology, Cerrahpasa Medical Faculty, Deep Mycosis Laboratory, Istanbul University, Istanbul, Turkey. s.kantarcioglu@superonline.com
authors.forename: A Serda
authors.initials: AS
authors.lastname: Kantarcioglu
authors.forename: Richard C
authors.initials: RC
authors.lastname: Summerbell
authors.forename: Deanna A
authors.initials: DA
authors.lastname: Sutton
authors.forename: Ayhan
authors.initials: A
authors.lastname: Yücell
authors.forename: Ebru
authors.initials: E
authors.lastname: Sarikaya
authors.forename: Gültekin
authors.initials: G
authors.lastname: Kaner
authors.forename: Aydin
authors.initials: A
authors.lastname: Iscimen
authors.forename: Kemal
authors.initials: K
authors.lastname: Altas
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000494:pharmacology; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000235:genetics; D004359:Drug Therapy, Combination; D005656:Fungal Proteins / Q000235:genetics; D005670:Fusarium / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology; D006801:Humans; D017964:Itraconazole / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D009281:Naphthalenes / Q000494:pharmacology / Q000627:therapeutic use; D010860:Pigments, Biological / Q000096:biosynthesis; D012319:RNA Polymerase II / Q000235:genetics; D017422:Sequence Analysis, DNA; D012867:Skin / Q000293:injuries*; D013172:Spores, Fungal / Q000254:growth & development; D013174:Sporotrichosis / Q000175:diagnosis* / Q000382:microbiology; D000077291:Terbinafine; D016896:Treatment Outcome; D014946:Wound Infection / Q000382:microbiology*
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D004275:DNA, Ribosomal; D021903:DNA, Ribosomal Spacer; D005656:Fungal Proteins; D009281:Naphthalenes; D010860:Pigments, Biological; D017964:Itraconazole; D000666:Amphotericin B; D012319:RNA Polymerase II; D000077291:Terbinafine