title: Cutaneous manifestations of subcutaneous and systemic fungal infections in tropical regions: a retrospective study from a referral center in southern Taiwan.
abstract: BACKGROUND
  Deep cutaneous fungal infections, including subcutaneous mycoses and systemic fungal infection with cutaneous involvement, cause significant morbidity and mortality in light of increasing immunocompromised patients and global warming. Although a few studies reviewed deep fungal infections in temperate regions, a relevant study in tropical regions is lacking. We evaluated features of deep cutaneous fungal infections in southern Taiwan among the tropical regions.
  
  
  METHODS
  We retrospectively reviewed all histopathological specimens with deep cutaneous fungal infections in a single referral center from 2001 to 2014 and successfully identified 23 cases. Medical chart review revealed patient demographic data, clinical presentation, underlying disease, microbiological culture reports, and treatment outcomes.
  
  
  RESULTS
  The average patient age was 52 years. Fourteen cases had primary subcutaneous mycoses, and nine had systemic mycoses. Fifteen patients were immunocompromised, including hematological malignancies. Acquired immune deficiency syndrome (AIDS) and long-term steroid use were most commonly associated with deep fungal infections. The positive culture growth rate was 63%. Fonsecaea sp. was most frequently identified by tissue culture. Aspergillosis, mucormycosis, and disseminated cryptococcosis were particularly fatal.
  
  
  CONCLUSIONS
  Diabetes and long-term steroid use appear as major risk factors for advanced mycoses in this region. Rapid diagnosis with skin biopsy and tissue culture along with appropriate treatment of deep cutaneous fungal infection are necessary.
authors.affiliation: Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Tsai
authors.affiliation: Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Dr Wu Clinic, Kaohsiung, Taiwan.
authors.forename: Wei-Min
authors.initials: WM
authors.lastname: Wu
authors.affiliation: Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Shang-Hung
authors.initials: SH
authors.lastname: Lin
authors.affiliation: Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yi-Chien
authors.initials: YC
authors.lastname: Yang
authors.affiliation: Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Cheng
authors.affiliation: Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ji-Chen
authors.initials: JC
authors.lastname: Ho
authors.affiliation: Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Kwei-Lan
authors.initials: KL
authors.lastname: Liu
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D001203:Ascomycota; D001228:Aspergillosis / Q000150:complications; D003453:Cryptococcosis / Q000150:complications; D003881:Dermatomycoses / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D048909:Diabetes Complications / Q000150:complications*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D040521:Subcutaneous Tissue / Q000382:microbiology; D013624:Taiwan; D016896:Treatment Outcome; D014329:Tropical Climate
chemical_list: D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents