title: Ten-Year Experience of Cutaneous and/or Subcutaneous Infections Due to Coelomycetes in France.
abstract: Background.  Coelomycetes are rarely but increasingly reported in association with human infections involving mostly skin and subcutaneous tissues, both in immunocompetent and immunocompromised patients. Coelomycetes constitute a heterogeneous group of filamentous fungi with distinct morphological characteristics in culture, namely an ability to produce asexual spores within fruit bodies. Methods.  We included all cases of proven primary cutaneous and/or subcutaneous infections due to coelomycetes received for identification at the French National Reference Center for Invasive Mycoses and Antifungals between 2005 and 2014. Eumycetoma, chromoblastomycosis, and disseminated infections were excluded. Results.  Eighteen cases were analyzed. The median age was 60.5 years. In all cases, patients originated from tropical or subtropical areas. An underlying immunodepression was present in 89% of cases. Cutaneous and/or subcutaneous lesions, mainly nodules, abscesses, or infiltrated plaques, were observed in distal body areas. Isolates of different genera of coelomycetes were identified: Medicopsis (6), Paraconiothyrium (3), Gloniopsis (3), Diaporthe (3), Peyronellaea (2), Lasiodiplodia (1). Lesion treatment consisted of complete (10) or partial (2) surgical excision and/or the use of systemic antifungal therapy, namely voriconazole (5) and posaconazole (4). Literature review yielded 48 additional cases of cutaneous and/or subcutaneous infections due to coelomycetes. Conclusions.  Infectious diseases physicians should suspect coelomycetes when observing cutaneous and/or subcutaneous infections in immunocompromised hosts from tropical areas; a sequence-based approach is crucial for strains identification but must be supported by consistent phenotypic features; surgical treatment should be favored for solitary, well limited lesions; new triazoles may be used in case of extensive lesions, especially in immunocompromised patients.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Service de Dermatologie, Hôpital Tenon; Université Pierre et Marie Curie-Paris VI; Institut National de la Santé et de la Recherche Médicale Unité 938, Saint Antoine Research Center.
authors.forename: Sarah
authors.initials: S
authors.lastname: Guégan
authors.affiliation: Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques; Centre National de la Recherche Scientifique Unité de Recherche Associée 3012, Paris, France.
authors.forename: Dea
authors.initials: D
authors.lastname: Garcia-Hermoso
authors.affiliation: Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques; Centre National de la Recherche Scientifique Unité de Recherche Associée 3012, Paris, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Sitbon
authors.affiliation: CBS-KNAW Fungal Biodiversity Centre , Utrecht , The Netherlands.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Service d'Anatomo-Pathologie , Hôpital Tenon.
authors.forename: Philippe
authors.initials: P
authors.lastname: Moguelet
authors.affiliation: Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques; Centre National de la Recherche Scientifique Unité de Recherche Associée 3012, Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Dromer
authors.affiliation: Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques; Centre National de la Recherche Scientifique Unité de Recherche Associée 3012, Paris, France; Assistance Publique-Hôpitaux de Paris, Centre d'Infectiologie Necker Pasteur, Hôpital Necker-Enfants Malades; Université René Descartes-Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
keywords: Medicopsis romeroi; Paraconiothyrium sp; coelomycetes; cutaneous phaeohyphomycosis; subcutaneous abscess