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Neoscytalidium spp. superficial infections in Madrid

Abstract number: P1735

Mohedano R.B., Cuétara M.S., Aguilar A., Vazquez S., Rey-Cao S., Gallego M., Wilhelmi I.

Objective:Neoscytalidium dimidiatum(N. dimidiatum) (synamorph Nattrassia mangiferae, formerly known as Hendersonula toruloidea) is a dematiaceous plant pathogen that can cause endemic (geographical restricted to tropical and subtropical areas) superficial skin and nail infections, clinically indistinguible from Trichophyton (rubrum and interdigitale). In temperate zones, infections have been noted in immigrants from endemic areas. In areas with important immigration such as most European countries, misdiagnosis of this infection is possible if cycloheximide is not withdrawn from the usual culture medium. The objective of this work was to show the epidemiology of N. dimidiatum species in a temperate European capital (Madrid).

Methods: Retrospective study (from 2003 to 2009). After a dermatological suspicion, scrapings from nails and skin (soles, palms, toe and finger webs) and in one case a subcutaneous nodule were planted on Sabouraud agar slants and dishes supplemented with cloramphenicol and cycloheximide and in media without cycloheximide. Media were incubated at 25°C for up to 30 days. Samples were examined after treatment with treatment with potassium hydroxide. Neoscytalidium species were identified according to usual macroscopic and microscopic.

Results:Neoscytalidium spp. superficial infections were diagnosed in 8 immigrants from endemic areas; a subcutaneous infection (plantar granuloma) was diagnosed in a Spanish patient with no history of travels, but who had close contact (at work) with immigrants.

The table shows the infected sites, species responsible of the infection and geographical origin. In our population direct examination showed sinuous and irregular hyphae in bright field illumination.

No dermatophytes were either visualized or cultured. The response to treatment (oral/topical) was unsatisfactory.

Conclusions: In Spain Neoscytalidium spp. is a uncommon agent of dermatomycoses, and misdiagnosis could explain that although immigration is high, this species is only occasionally identified. This is the first autochtonous N. dimidiatum infection in Madrid probably due to close contact of the patient with immigrants with clinical infection due to this agent. Another important and widely documented issue is the very poor response to treatment. In European areas such as London and Paris these infections show an ascending incidence linked to expertise of clinical mycologists and clinical suspicion of dermatologists.

Age/SexOriginSolesToe-websToenails/FingernailsSubcutaneous noduleTTO
43/MSpain+--/-+yes
65/FGuinea+++/--yes
24/FColombia--+/+-yes
37/FCameroon+++/--yes
40/FBrazil+++/--yes
39/FGuinea--+/--no
54/FRep. Dom--+/--no
35/FGuinea-++/--yes
31/FCameroon--+/--no
Sex: M = male; F = female; TTO: topical and oral treatment.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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