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Tiouiri Benaissa H.,Service de Maladies Infectieuses | Ammari L.,Service de Maladies Infectieuses | Aoun K.,Institute Pasteur | Mokni M.,Service de dermatologie | And 3 more authors.
Journal de Mycologie Medicale

Eumycetoma is a chronic, necrotizing infection of fungal origin that usually occurs on a lower extremity, especially the foot. We describe the first case in Tunisia of eumycetoma of the hand due to Pseudallescheria boydii. Case report: A 48-year-old agricultural worker presented with a swelling and painless cutaneous nodules of the right hand and wrist that drained spontaneously. No trauma of the hand was noted. Examination of the hand revealed multiple crusted sinus tracts in the palm and on the back of the hand. The right hand appeared swollen and deformed. There was no adenopathy or fever. Radiographic examination showed bone involvement with destruction of the wrist bones. The diagnosis of eumycetoma was confirmed by histological evidence (stained sections) that showed granules containing fungal hyphae and positive culture for P. boydii. Initially, treatment with ketoconazole (400. mg daily for 14 months) failed. The patient subsequently received itraconazole (400. mg daily for 18 months) and a marked improvement was obtained. Six years after treatment was stopped, there had been no recurrence, but bone involvement resulted in permanent deformity with wrist ankylosis. © 2010 Elsevier Masson SAS. Source

Patassi A.A.,Service des Maladies Infectieuses et de Pneumologie | Saka B.,Service de dermatologie | Landoh D.E.,British Petroleum | Kotosso A.,Service des Maladies Infectieuses et de Pneumologie | And 7 more authors.
BMC Research Notes

Background: Infection with Penicillium marneffei is a common opportunistic infection in Southeast Asia where it is endemic. We report a case of Penicillium marneffei infection with fatal outcome in a Togolese woman infected with Human Immunodeficiency Virus (HIV). Case presentation. A 45-years-old patient, infected with Human Immunodeficiency Virus had consulted for ongoing febrile pneumonia since two weeks. Clinical examination revealed fever of 38.5°C, dyspnea, pulmonary syndrome condensation and papulo-nodular of "molluscum contagiosum" like lesions located on the face, arms, neck and trunk. Sputum smear was negative for tuberculosis. The chest radiograph showed reticulonodular opacities in the right upper and middle lobes and two caves in the right hilar region. The CD4 count was 6 cells/mm3 after a year of antiretroviral treatment (Zidovudine-Lamivudine-Efavirenz). She was treated as smear negative pulmonary tuberculosis after a lack of gentamicin and amoxicillin plus clavulanic acid response. Culture of skin samples and sputum had revealed the presence of P. marneffei. A treatment with ketoconazole 600 mg per day was initiated. After two weeks of treatment, there was a decrease in the size and number of papules and nodules, without any new lesions. We noted disappearance of cough and fever. The chest X-ray showed a decrease of pulmonary lesions. There was no reactivation of P. marneffei infection but the patient died from AIDS after two years of follow up. Conclusion: We report a case of P. marneffei infection in a HIV-infected patient in a non-endemic country. Clinicians should think of P. marneffei infection in all HIV-infected patients with "molluscum contagiosum" like lesions. © 2013 Patassi et al.; licensee BioMed Central Ltd. Source

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