Seventeen years of subcutaneous infection by Aspergillus flavus; eumycetoma confirmed by immunohistochemistry.
Chronic subcutaneous infections caused by Aspergillus species are considered to be extremely rare. Because these fungi are among the most common laboratory contaminants, their role as eumycetoma causative agents is difficult to ascertain. Here, we report the first case of A. flavus eumycetoma confirmed by isolation, molecular identification and immunohistochemical analysis. Patient was a 55-year-old male from Sudan suffering from eumycetoma on his left foot for a period of 17 years. He developed swelling, sinuses and white grain discharge was observed. He has been operated nine times and was treated with several regimens of ketoconazole and itraconazole without improvement. Initial diagnosis based on histology and radiology was Scedosporium eumycetoma. However, examination of the biopsy revealed A. flavus, which was identified by molecular analysis and MALDI-TOF MS. Immunohistochemistry using antibody directed against Aspergillus species was positive. Because of the earlier treatment failures with ketoconazole and itraconazole, therapy with voriconazole was initiated. However, in vitro susceptibility testing yielded a lower Minimum Inhibitory Concentration (MIC) value for itraconazole (0.25 μg ml(-1) ) than for voriconazole (1 μg ml(-1) ). Based on the presented results, A. flavus can be considered as one of the agents of white-grain eumycetoma.
Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan.|CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands.|Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands.
Sarah A
SA
Ahmed
Mycology Laboratory, Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
Manal A
MA
Abbas
Human Histopathology and Animal Models Unit, Institute Pasteur, Paris, France.
Gregory
G
Jouvion
CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands.|Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands.|Directorate General of Health Services, Ibri Hospital, Ministry of Health, Muscat, Oman.
Abdullah M S
AM
Al-Hatmi
CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands.|Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands.|Basic Pathology Department, Federal University of Paraná, Curitiba, Brazil.|Biological Sciences Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia.
G Sybren
GS
de Hoog
CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands.
Anna
A
Kolecka
Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan.
El Sheikh
el S
Mahgoub
D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D001231:Aspergillus flavus / Q000276:immunology / Q000302:isolation & purification*; D002908:Chronic Disease; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D005533:Foot Dermatoses / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007150:Immunohistochemistry; D017964:Itraconazole / Q000494:pharmacology / Q000627:therapeutic use; D007654:Ketoconazole / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008271:Mycetoma / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D011859:Radiography; D021681:Scedosporium / Q000302:isolation & purification; D040521:Subcutaneous Tissue / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology; D013397:Sudan; D065819:Voriconazole / Q000494:pharmacology / Q000627:therapeutic use
D000935:Antifungal Agents; D017964:Itraconazole; D065819:Voriconazole; D007654:Ketoconazole
Aspergillus flavus; eumycetoma; immunohistochemistry; molecular identification; white grain