Biomedical subjects

G S de Hoog

Publications and source records attributed to G S de Hoog.

At least 19 recordsLinked to original sources

PubMed2006

Isolation of Exophiala dermatitidis from endotracheal aspirate of a cancer patient.

Exophiala (Wangiella) dermatitidis is a melanised (darkly pigmented) yeast-like organism that has been reported from the environment and wild animals. The organism is a frequent coloniser of lungs of patients with cystic fibrosis and causes occasional disseminated phaeohyphomycosis and fungaemia. Exophiala dermatitidis is distributed worldwide, but cerebral cases are restricted to East Asia. We report a case of 54-year-old Qatari female patient with a known history of cancer, suffering from pulmonary disorder. Culture of endotracheal aspirate revealed the growth of E. dermatitidis concomitant with Candida krusei. The final diagnosis of E. dermatitidis and attribution to genotype B was achieved by sequencing the rDNA internal transcribed spacer (ITS) region. The present case concerns a pulmonary colonisation by E. dermatitidis, similar to that commonly seen in cystic fibrosis patients. For the detection of E. dermatitidis in clinical specimens culturing techniques are required. The patient finally expired with persistent cancer and C. krusei fungaemia. Review of literature and listing of E. dermatitidis cases published after 1992 show a sharp increase in clinical cases during the 1990s.

Bronchoalveolar Lavage Fluid↗

PubMed2006

Genetic identification of the main opportunistic Mucorales by PCR-restriction fragment length polymorphism.

Mucormycosis is a rare and opportunistic infection caused by fungi belonging to the order Mucorales. Recent reports have demonstrated an increasing incidence of mucormycosis, which is frequently lethal, especially in patients suffering from severe underlying conditions such as immunodeficiency. In addition, even though conventional mycology and histopathology assays allow for the identification of Mucorales, they often fail in offering a species-specific diagnosis. Due to the lack of other laboratory tests, a precise identification of these molds is thus notoriously difficult. In this study we aimed to develop a molecular biology tool to identify the main Mucorales involved in human pathology. A PCR strategy selectively amplifies genomic DNA from molds belonging to the genera Absidia, Mucor, Rhizopus, and Rhizomucor, excluding human DNA and DNA from other filamentous fungi and yeasts. A subsequent digestion step identified the Mucorales at genus and species level. This technique was validated using both fungal cultures and retrospective analyses of clinical samples. By enabling a rapid and precise identification of Mucorales strains in infected patients, this PCR-restriction fragment length polymorphism-based method should help clinicians to decide on the appropriate treatment, consequently decreasing the mortality of mucormycosis.

Adult↗

PubMed2005

Microcoding: the second step in DNA barcoding.

After the process of DNA barcoding has become well advanced in a group of organisms, as it has in the economically important fungi, the question then arises as to whether shorter and literally more barcode-like DNA segments should be utilized to facilitate rapid identification and, where applicable, detection. Through appropriate software analysis of typical full-length barcodes (generally over 500 base pairs long), uniquely distinctive oligonucleotide 'microcodes' of less than 25 bp can be found that allow rapid identification of circa 100-200 species on various array-like platforms. Microarrays can in principle fulfill the function of microcode-based species identification but, because of their high cost and low level of reusability, they tend to be less cost-effective. Two alternative platforms in current use in fungal identification are reusable nylon-based macroarrays and the Luminex system of specific, colour-coded DNA detection beads analysed by means of a flow cytometer. When the most efficient means of rapid barcode-based species identification is sought, a choice can be made either for one of these methodologies or for basic high-throughput sequencing, depending on the strategic outlook of the investigator and on current costs. Arrays and functionally similar platforms may have a particular advantage when a biologically complex material such as soil or a human respiratory secretion sample is analysed to give a census of relevant species present.

Biodiversity↗

PubMed2005

Intestinal prevalence of the neurotropic black yeast Exophiala (Wangiella) dermatitidis in healthy and impaired individuals.

A screening of 2300 samples of faeces from humans with and without underlying disease revealed that the black yeast Exophiala dermatitidis is present at a frequency of 5.2 per thousand (n=12). Eight individuals positive for the fungus had diarrhoea at the moment of its isolation, out of 11 where relevant information was available. Judging from repeated isolation over several weeks in one patient, the organism is able to persist in the human intestinal tract.

Adult↗

PubMed2005

Invasive chromoblastomycosis and sinusitis due to Phialophora verrucosa in a child from northern Africa.

We report on a severe, verrucous facial mycosis and sinusitis in a 12-year-old Libyan girl. Her disease started with verrucous, hyperkeratotic plaques and subcutaneous violet nodules of unknown origin on her face and upper extremities. Despite topical antimycotic therapy she needed in-hospital treatment because of severely progressive tumorous cutaneous and nasal lesions. Microscopic examination of scale samples taken from the upper extremities and the face revealed brown, thick-walled fungal elements. Under the assumption of a chromoblastomycosis, an oral treatment with itraconazole and fluorocytosin was initiated, with significant improvement of the lesions. The aetiological agent was identified as Phialophora verrucosa.

Antifungal Agents↗

PubMed2005

Internal transcribed spacer rRNA gene-based phylogenetic reconstruction using algorithms with local and global sequence alignment for black yeasts and their relatives.

Sequences of rRNA gene internal transcribed spacer (ITS) of a standard set of black yeast-like fungal pathogens were compared using two methods: local and global alignments. The latter is based on DNA-walk divergence analysis. This method has become recently available as an algorithm (DNAWD program) which converts sequences into three-dimensional walks. The walks are compared with, or fit to, each other generating global alignments. The DNA-walk geometry defines a proper metric used to create a distance matrix appropriated for phylogenetic reconstruction. In this work, the analyses were carried out for species currently classified in Capronia, Cladophialophora, Exophiala, Fonsecaea, Phialophora, and Ramichloridium. Main groups were verified by small-subunit rRNA gene data. DNAWD applied to ITS2 alone enabled species recognition as well as phylogenetic reconstruction reflecting clades discriminated in small-subunit rRNA gene phylogeny, which was not possible with any other algorithm using local alignment for the same data set. It is concluded that DNAWD provides rapid insight into broader relationships between groups using genes that otherwise would be hardly usable for this purpose.

Algorithms↗

PubMed2004

[Cutaneous alternariosis. Clinical diagnosis and therapeutic options].

Localized skin infections caused by the pigmented fungi of the genus Alternaria are being increasingly observed. In the past, primarily patients receiving long-term glucocorticoid therapy were likely to have this mycosis, which is commonly traumatic, but now it is frequently encountered in organ transplantation patients. Possible therapeutic options and differential diagnosis are discussed by means of two case reports--a female renal transplant patient infected by A. alternata and a patient with iatrogenic Cushing syndrome infected by A. infectoria. Histopathological differentiation from other fungal infections may be difficult but is of therapeutic and prognostic significance. Finding short hyphae in tissue sections is an important clue. Since A. infectoria shows little conidial growth in culture, rDNA ITS sequencing offers another diagnostic possibility. Therapy has not yet been standardized. Along with surgical intervention, systemic itraconazole is the usual choice.

Aged↗

PubMed2004

Population structure and evolutionary origins of Microsporum canis, M. ferrugineum and M. audouinii.

The recurrent evolutionary emergence of asexual lineages within sexual zoo- and anthropophilic dermatophyte species living in animal-frequented soil is likely to be triggered by changes in ecological niche, i.e., shifts of host animal. Subsequent adaptation to the new host species is noted. Sometimes geographic isolation or intrinsic host factors like human race may also play a role in speciation. In the present study, we elaborate concepts of speciation in dermatophytes using the Microsporum canis complex as an example. The group consists of a cluster of phylogenetically closely related anamorphs: the anthropophilic taxa Microsporum audouinii and M. ferrugineum, and the zoophilic taxon M. canis. The sexually reproducing species underlying this complex is Arthroderma otae. The study is done by an analysis of the population structure of about 200 isolates and using intergenic spacers, non-translated regions of genes as well as hypervariable microsatellite markers that are known to evolve at high mutation rates. The results suggest that sympatric speciation took place already during the period where mating ability was maintained and thus that strictly clonal fungal species emerged in Africa and led to genetically isolated clonal species elsewhere.

Alleles↗

PubMed2004

Infections of the central nervous system by melanized fungi: a review of cases presented between 1999 and 2004.

Several types of infections of the central nervous system by melanized fungi can be distinguished: (a) single-organ infection of the cerebrum, (b) extension into the cerebrum from adjacent cavities, (c) fungal presence in the cerebrospinal fluid, or (d) meningitis. The fungal order Chaetothyriales (containing Exophiala-like black yeasts and relatives) is particularly rich in fungi causing cerebral infections. Cases by the main agents, Cladophialophora bantiana, Exophiala dermatitidis, and Ramichloridium mackenziei, published during the last 5 years are reviewed. Most of these infections prove to be fatal. Resection of the lesions in combination with antimycotic therapy may reduce mortality.

Adolescent↗

PubMed2004

Phylogeny and typification of Madurella mycetomatis, with a comparison of other agents of eumycetoma.

The genus Madurella, described for non-sporulating agents of human mycetoma, is proven to be heterogeneous on the basis of rDNA small subunit (SSU) and Internal Transcribed Spacer (ITS) sequencing data. Madurella mycetomatis, the main agent of mycetoma in arid zones of Central and East Africa, probably belongs to the ascomycete order Sordariales. Madurella mycetomatis, the generic type species, is neotypified. Madurella grisea, with worldwide occurrence, is likely to be a member of the order Pleosporales, just as the mycetoma agents of Leptosphaeria, Pseudochaetosphaeronema, and Pyrenochaeta. Neotestudina rosatii belongs to the order Dothideales. Judging from ITS data, M. mycetomatis and N. rosatii are species complexes. The ex-type strain of N. rosatii, from a human mycetome, has an ITS sequence that deviates from that of environmental strains of the species.

DNA Primers↗

PubMed2004

Central nervous system infection due to Penicillium chrysogenum.

Penicillium chrysogenum was isolated from three subsequent cerebrospinal fluid (CSF) specimens of a 73-year-old male patient without immunological compromise. The isolated was tested against five antifungal agents according to the NCCLS M38-P macrodilution method. MICs were determined as follows: amphotericin B (AMB), 2 microg ml(-1); fluconazole (FLZ), 8 microg ml(-1); itraconazole (ITZ), 1 microg ml(-1); flucytosine (5FC), 0.125 microg ml(-1); and terbinafine (TRB), 0.06 microg ml(-1). The patient has been cured with FLZ.

Aged↗

PubMed2003

In vitro activity of amphotericin B and itraconazole in combination with flucytosine, sulfadiazine and quinolones against Exophiala spinifera.

The combined effects of antifungal and antibiotic drugs against Exophiala spinifera were evaluated in vitro by the chequer-board method, calculated as a fractional inhibitory concentration (FIC) index. Amphotericin B was combined with flucytosine and ciprofloxacin, whereas itraconazole was combined with ciprofloxacin, levofloxacin, lomefloxacin and sulfadiazine. Synergic effects were observed for the combinations of itraconazole with ciprofloxacin and levofloxacin, and amphotericin B with ciprofloxacin and flucytosine. No antagonism was observed for any combination tested.

Amphotericin B↗

PubMed2003

A new meristematic fungus, Pseudotaeniolina globosa.

A new species of Pseudotaeniolina, a genus of anamorphic, melanized fungi with meristematic development, is described. The species is compared to morphologically similar taxa among which are Trimmatostroma and Coniosporium. Its novelty is supported by SSU (small subunit) and ITS (internal transcribed spacer) rDNA sequence data.

Ascomycota↗

PubMed2003

Molecular diversity of oligotrophic and neurotropic members of the black yeast genus Exophiala, with accent on E. dermatitidis.

Analysis of ITS rDNA of the black yeast Exophiala dermatitidis revealed a close phylogenetic relationship to the meristematic fungus Sarcinomyces phaeomuriformis. As most strains of S. phaeomuriformis have a yeast-like phenotype corresponding to the anamorph genus Exophiala, a new combination in Exophiala is proposed. On the basis of ITS sequence, M-13 fingerprint and SSU intron data, two main entities could be distinguished within E. dermatitidis. One of these (B) contained prevalently strains from environmental sources, while the other (A) mainly comprised strains from clinical sources. This may be due to a difference in virulence. All strains from severe brain and disseminated infections in East Asia clustered in group A. However, strains of group A caused a relatively mild fungemia in patients outside East Asia.

Brain Diseases↗

PubMed2003

Fatal pulmonary scedosporiosis.

We report on a case of scedosporiosis in a 72-year-old German woman. Her disease started with a purulent ulceration of unknown course at her left foot. Soon after onset of oral antibacterial therapy she needed in-hospital treatment because of an acute pneumonia. The infection progressed despite the application of different antibiotics. Microscopic examination of tracheal fluid revealed fungal hyphae and therefore treatment with itraconazole was initiated. However, the patient developed renal failure, required mechanical ventilation and finally died in treatment-resistant septic shock. Post-mortem Scedosporium apiospermum was cultured from lung tissue taken during autopsy. This is the fourth case of human infection caused by Scedosporium species diagnosed in our laboratory during the last 4 years.

Aged↗

PubMed2003

Species diversity and polymorphism in the Exophiala spinifera clade containing opportunistic black yeast-like fungi.

A monophyletic group of black yeast-like fungi containing opportunistic pathogens around Exophiala spinifera is analyzed using sequences of the small-subunit (SSU) and internal transcribed spacer (ITS) domains of ribosomal DNA. The group contains yeast-like and annellidic species (anamorph genus Exophiala) in addition to sympodial taxa (anamorph genera Ramichloridium and Rhinocladiella). The new species Exophiala oligosperma, Ramichloridium basitonum, and Rhinocladiella similis are introduced and compared with their morphologically similar counterparts at larger phylogenetic distances outside the E. spinifera clade. Exophiala jeanselmei is redefined. New combinations are proposed in EXOPHIALA: Exophiala exophialae for Phaeococcomyces exophialae and Exophiala heteromorpha for E. jeanselmei var. heteromorpha.

Ascomycota↗

PubMed2003

Exophiala oligosperma causing olecranon bursitis.

A 62-year-old male with a history of Wegener's granulomatosis and immunosuppressive therapy presented with chronic olecranon bursitis. A black velvety mould with brown septate hyphae and tapered annellides was isolated from a left elbow bursa aspirate and was identified as an Exophiala species. Internal transcribed sequence rRNA sequencing showed the isolate to be identical to Exophiala oligosperma. The patient was successfully treated with aspiration and intrabursal amphotericin B.

Bursa, Synovial↗

PubMed2002

Molecular taxonomy of the alternaria and Ulocladium species from humans and their identification in the routine laboratory.

The Alternaria and Ulocladium species reported from humans are studied taxonomically using rDNA internal transcribed spacer (ITS) sequence data. The ITS variability within the genus is relatively limited. The two most important, longicatenate species, Alternaria alternata and A. infectoria, clearly differ in their ITS domains, due to a 26-bp insert in ITS1 of the latter species. A number of taxa inhabiting particular plant species, such as A. longipes on tobacco and A. mali on apple, but also the common saprobic species A. tenuissima cannot reliably be distinguished from A. alternata using this method. The large number of described noncatenate, obligatory plant pathogens are extremely rare as agents of human disease; clinical routine identification does not need to include these taxa. The predictivity of a simplified polymerase chain reaction-restriction fragment length polymorphism procedure of rDNA for the recognition of the relevant species or species aggregates is established in a randomized test. The method was found to be rapid and cost-effective. Its efficacy extended to the identification of sterile and meristematic Alternaria strains, some of them previously classified in genera such as Chmelia and Botryomyces. Microscopic morphology and some additional tests remain necessary to allow identification of the aggregates of potential etiological agents of human disease. About 14% of the sequences deposited in GenBank were found to be misidentified. Alternaria infectoria is one of the most common clinical Alternaria species, despite its low degree of melanization. The lack of pigmentation has frequently led to misidentification of such isolates.

Alternaria↗