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Emerging Fungal Infections and Cutaneous Manifestations in Immunosuppressed Patients

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Abstract

Purpose of Review

The goal of this paper is to describe the most pertinent fungal infections found in immunocompromised hospitalized patients and their cutaneous presentations.

Recent Findings

Opportunistic fungi and severe forms of systemic fungal infections are predominantly seen in immunocompromised patients including those with solid organ and stem cell transplant, hematologic malignancies, and acquired immunodeficiency syndrome. Some fungal infections can present with classic skin lesions that can help clinicians to make the appropriate diagnosis and to initiate appropriate antifungal coverage.

Summary

Recognition of cutaneous findings in immunocompromised patients within the hospital is crucial guiding appropriate management of care. Prophylaxis for fungal infections is common in those with prolonged immunosuppression, and while newer regimens have broader coverage, emerging fungal infections still occur in this vulnerable population.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Lockhart SR, Guarner J. Emerging and reemerging fungal infections. Semin Diagn Pathol. 2019;36(3):177–81. https://doi.org/10.1053/j.semdp.2019.04.010.

    Article  PubMed  Google Scholar 

  2. Pemán J, Salavert M. Invasive fungal disease due to Scedosporium, Fusarium and mucorales. Rev Iberoam Micol. 2014;31(4):242–8. https://doi.org/10.1016/j.riam.2014.05.002.

    Article  PubMed  Google Scholar 

  3. Durcan L, O’Dwyer T, Petri M. Management strategies and future directions for systemic lupus erythematosus in adults. Lancet. 2019;393(10188):2332–43. https://doi.org/10.1016/s0140-6736(19)30237-5.

    Article  PubMed  Google Scholar 

  4. Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Type 2 diabetes and its impact on the immune system. Curr Diabetes Rev. 2020;16(5):442–9. https://doi.org/10.2174/1573399815666191024085838.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lemonovich TL. Mold infections in solid organ transplant recipients. Infect Dis Clin North Am. 2018;32(3):687–701. https://doi.org/10.1016/j.idc.2018.04.006.

    Article  PubMed  Google Scholar 

  6. Bhatt VR, Viola GM, Ferrajoli A. Invasive fungal infections in acute leukemia. Ther Adv Hematol. 2011;2(4):231–47. https://doi.org/10.1177/2040620711410098.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Shields BE, Rosenbach M, Brown-Joel Z, Berger AP, Ford BA, Wanat KA. Angioinvasive fungal infections impacting the skin: background, epidemiology, and clinical presentation. J Am Acad Dermatol. 2019;80(4):869–80.e5. https://doi.org/10.1016/j.jaad.2018.04.059.

    Article  PubMed  Google Scholar 

  8. Vazquez L. Antifungal prophylaxis in immunocompromised patients. Mediterr J Hematol Infect Dis. 2016;8(1):e2016040. https://doi.org/10.4084/mjhid.2016.040.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Antinori S, Corbellino M, Parravicini C. Challenges in the diagnosis of invasive fungal infections in immunocompromised hosts. Curr Fungal Infect Rep. 2018;12(1):12–22. https://doi.org/10.1007/s12281-018-0306-0.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Spampinato C, Leonardi D. Candida infections, causes, targets, and resistance mechanisms: traditional and alternative antifungal agents. Biomed Res Int. 2013;2013:204237. https://doi.org/10.1155/2013/204237.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Pedraz J, Delgado-Jiménez Y, Pérez-Gala S, Nam-Cha S, Fernández-Herrera J, García-Diez A. Cutaneous expression of systemic candidiasis. Clin Exp Dermatol. 2009;34(1):106–10. https://doi.org/10.1111/j.1365-2230.2007.02524.x.

    Article  CAS  PubMed  Google Scholar 

  12. White PL, Archer AE, Barnes RA. Comparison of non-culture-based methods for detection of systemic fungal infections, with an emphasis on invasive Candida infections. J Clin Microbiol. 2005;43(5):2181–7. https://doi.org/10.1128/jcm.43.5.2181-2187.2005.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Dichtl K, Seybold U, Wagener J. Serological biomarkers of candidemia: a retrospective evaluation of three assays. Infection. 2019;47(2):217–24. https://doi.org/10.1007/s15010-018-1224-3.

    Article  CAS  PubMed  Google Scholar 

  14. Mikulska M, Balletto E, Castagnola E, Mularoni A. Beta-D-glucan in patients with haematological malignancies. J Fungi. 2021;7(12):1046. https://doi.org/10.3390/jof7121046.

    Article  CAS  Google Scholar 

  15. Hager JL, Mir MR, Hsu S. Candida krusei fungemia in an immunocompromised patient. Dermatol Online J. 2010;16(4):5.

    Article  PubMed  Google Scholar 

  16. •• Guarner J, Brandt ME. Histopathologic diagnosis of fungal infections in the 21st century. Clin Microbiol Rev. 2011;24(2):247–80. https://doi.org/10.1128/cmr.00053-10. A comprehensive resource of morphologic findings and staining tools for a wide variety of fungi.

  17. Cleveland AA, Harrison LH, Farley MM, Hollick R, Stein B, Chiller TM, et al. Declining incidence of candidemia and the shifting epidemiology of Candida resistance in two US metropolitan areas, 2008–2013: results from population-based surveillance. PLoS One. 2015;10(3):e0120452. https://doi.org/10.1371/journal.pone.0120452.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Multani A, Subramanian AK, Liu AY. Successful eradication of chronic symptomatic Candida krusei urinary tract infection with increased dose micafungin in a liver and kidney transplant recipient: case report and review of the literature. Transpl Infect Dis. 2019;21(4):e13118. https://doi.org/10.1111/tid.13118.

    Article  PubMed  Google Scholar 

  19. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of Candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2015;62(4):e1–50. https://doi.org/10.1093/cid/civ933.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Spivak ES, Hanson KE. Candida auris: an emerging fungal pathogen. J Clin Microbiol. 2018;56(2):e01588-17. https://doi.org/10.1128/jcm.01588-17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Černáková L, Roudbary M, Brás S, Tafaj S, Rodrigues CF. Candida auris: a quick review on identification, current treatments, and challenges. Int J Mol Sci. 2021;22(9):4470. https://doi.org/10.3390/ijms22094470.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Mora Carpio AL, Climaco A. Fungemia Candidiasis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. Copyright © 2022, StatPearls Publishing LLC.

    Google Scholar 

  23. Mousavi B, Hedayati MT, Hedayati N, Ilkit M, Syedmousavi S. Aspergillus species in indoor environments and their possible occupational and public health hazards. Curr Med Mycol. 2016;2(1):36–42. https://doi.org/10.18869/acadpub.cmm.2.1.36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Ledoux MP, Guffroy B, Nivoix Y, Simand C, Herbrecht R. Invasive pulmonary aspergillosis. Semin Respir Crit Care Med. 2020;41(1):80–98. https://doi.org/10.1055/s-0039-3401990.

    Article  PubMed  Google Scholar 

  25. Chauvet P, Mallat J, Arumadura C, Vangrunderbeek N, Dupre C, Pauquet P, et al. Risk factors for invasive pulmonary aspergillosis in critically ill patients with coronavirus disease 2019-induced acute respiratory distress syndrome. Crit Care Explor. 2020;2(11):e0244. https://doi.org/10.1097/cce.0000000000000244.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Schimmelpfennig C, Naumann R, Zuberbier T, Ordemann R, Baurmann H, Beyer J, et al. Skin involvement as the first manifestation of systemic aspergillosis in patients after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2001;27(7):753–5. https://doi.org/10.1038/sj.bmt.1702835.

    Article  CAS  PubMed  Google Scholar 

  27. Merad Y, Derrar H, Belmokhtar Z, Belkacemi M. Aspergillus genus and its various human superficial and cutaneous features. Pathogens. 2021;10(6):643. https://doi.org/10.3390/pathogens10060643.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Bernardeschi C, Foulet F, Ingen-Housz-Oro S, Ortonne N, Sitbon K, Quereux G, et al. Cutaneous invasive aspergillosis: retrospective multicenter study of the French invasive-Aspergillosis Registry and literature review. Medicine. 2015;94(26):e1018. https://doi.org/10.1097/md.0000000000001018.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tochigi N, Sadamoto S, Shinozaki M, Wakayama M, Shibuya K. Comparison in quantities from including angles comprising lines of Hypha themselves in histological images between Mucorales and Aspergillus. Med Mycol J. 2019;60(4):85–9. https://doi.org/10.3314/mmj.19-00006.

    Article  CAS  PubMed  Google Scholar 

  30. Epstein MD, Segalman KA, Mulholland JH, Orbegoso CM. Successful treatment of primary cutaneous Aspergillus flavus infection of the hand with oral itraconazole. J Hand Surg Am. 1996;21(6):1106–8. https://doi.org/10.1016/s0363-5023(96)80327-3.

    Article  CAS  PubMed  Google Scholar 

  31. Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, et al. Treatment of Aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(3):327–60. https://doi.org/10.1086/525258.

    Article  CAS  PubMed  Google Scholar 

  32. Patterson TF, Thompson GR 3rd, Denning DW, Fishman JA, Hadley S, Herbrecht R, et al. Practice guidelines for the diagnosis and management of Aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63(4):e1–60. https://doi.org/10.1093/cid/ciw326.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Dignani MC, Anaissie E. Human fusariosis. Clin Microbiol Infect. 2004;10:67–75. https://doi.org/10.1111/j.1470-9465.2004.00845.x.

    Article  PubMed  Google Scholar 

  34. Hayashida MZ, Seque CA, Enokihara M, Porro AM. Disseminated fusariosis with cutaneous involvement in hematologic malignancies: report of six cases with high mortality rate. An Bras Dermatol. 2018;93(5):726–9. https://doi.org/10.1590/abd1806-4841.20187476.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Nucci M, Anaissie E. Cutaneous infection by Fusarium species in healthy and immunocompromised hosts: implications for diagnosis and management. Clin Infect Dis. 2002;35(8):909–20. https://doi.org/10.1086/342328.

    Article  PubMed  Google Scholar 

  36. Nucci M, Anaissie E. Fusarium infections in immunocompromised patients. Clin Microbiol Rev. 2007;20(4):695–704. https://doi.org/10.1128/cmr.00014-07.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Seyfarth F, Hipler UC. Fusarium in dermatology. Mycoses. 2010;53(Suppl 1):5–13. https://doi.org/10.1111/j.1439-0507.2009.01837.x.

    Article  PubMed  Google Scholar 

  38. Gupta AK, Baran R, Summerbell RC. Fusarium infections of the skin. Curr Opin Infect Dis. 2000;13(2):121–8.

    Article  PubMed  Google Scholar 

  39. Montone KT. Differentiation of Fusarium from Aspergillus species by colorimetric in situ hybridization in formalin-fixed, paraffin-embedded tissue sections using dual fluorogenic-labeled LNA probes. Am J Clin Pathol. 2009;132(6):866–70. https://doi.org/10.1309/ajcpubq1qfrrx7my.

    Article  CAS  PubMed  Google Scholar 

  40. Varon AG, Nouér SA, Barreiros G, Trope BM, Akiti T, Nucci M. Antimold prophylaxis may reduce the risk of invasive Fusariosis in hematologic patients with superficial skin lesions with positive culture for Fusarium. Antimicrob Agents Chemother. 2016;60(12):7290–4. https://doi.org/10.1128/aac.00636-16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Hunt E. Recognizing mucormycosis in an immunocompromised patient. JAAPA. 2020;33(12):23–5. https://doi.org/10.1097/01.Jaa.0000721656.13462.67.

    Article  PubMed  Google Scholar 

  42. Reid G, Lynch JP 3rd, Fishbein MC, Clark NM. Mucormycosis. Semin Respir Crit Care Med. 2020;41(1):99–114. https://doi.org/10.1055/s-0039-3401992.

    Article  PubMed  Google Scholar 

  43. Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41(5):634–53. https://doi.org/10.1086/432579.

    Article  PubMed  Google Scholar 

  44. Castrejón-Pérez AD, Welsh EC, Miranda I, Ocampo-Candiani J, Welsh O. Cutaneous mucormycosis. An Bras Dermatol. 2017;92(3):304–11. https://doi.org/10.1590/abd1806-4841.20176614.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Menzinger S, Sid’Amar S, Kaya G. Cutaneous mucormycosis resulting from hematogenous dissemination of Rhizomucor pusillus in an immunocompromised patient. Dermatopathology (Basel). 2019;6(4):275–8. https://doi.org/10.1159/000506272.

    Article  PubMed  Google Scholar 

  46. Suthananthan AE, Koek SA, Sieunarine K. Cutaneous mucormycosis in an immunocompromised patient: a case report. J Surg Case Rep. 2017;2017(3):rjx056. https://doi.org/10.1093/jscr/rjx056.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Pappas PG. Cryptococcal infections in non-HIV-infected patients. Trans Am Clin Climatol Assoc. 2013;124:61–79.

    PubMed  PubMed Central  Google Scholar 

  48. Mada PK, Jamil RT, Alam MU. Cryptococcus. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. Copyright © 2022, StatPearls Publishing LLC.

    Google Scholar 

  49. Nowak MA, Putynkowska A, Barańska-Rybak W, Czarnacka K, Dębska-Ślizień MA. Cutaneous cryptococcosis: an underlying immunosuppression? Clinical manifestations, pathogenesis, diagnostic examinations and treatment. Postepy Dermatol Alergol. 2020;37(2):154–8. https://doi.org/10.5114/ada.2020.94833.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Wienemann T, Müller AK, MacKenzie C, Bielor C, Weyers V, Aktas O, et al. Cryptococcal meningoencephalitis in an IgG(2)-deficient patient with multiple sclerosis on fingolimod therapy for more than five years - case report. BMC Neurol. 2020;20(1):158. https://doi.org/10.1186/s12883-020-01741-0.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Singh N, Sifri CD, Silveira FP, Miller R, Gregg KS, Huprikar S, et al. Cryptococcosis in patients with cirrhosis of the liver and posttransplant outcomes. Transplantation. 2015;99(10):2132–41. https://doi.org/10.1097/tp.0000000000000690.

    Article  PubMed  Google Scholar 

  52. Hayashida MZ, Seque CA, Pasin VP, Enokihara M, Porro AM. Disseminated cryptococcosis with skin lesions: report of a case series. An Bras Dermatol. 2017;92(5 Suppl 1):69–72. https://doi.org/10.1590/abd1806-4841.20176343.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Fresco A, Wang J, Krausz A, Chan A, Franco L, Garelik J, et al. Cryptococcus-like changes in the setting of vasculitis. J Cutan Pathol. 2019;46(2):143–7. https://doi.org/10.1111/cup.13380.

    Article  PubMed  Google Scholar 

  54. Wilson J, Gleghorn K, Kelly B. Cryptococcoid Sweet’s syndrome: two reports of Sweet’s syndrome mimicking cutaneous cryptococcosis. J Cutan Pathol. 2017;44(5):413–9. https://doi.org/10.1111/cup.12921.

    Article  PubMed  Google Scholar 

  55. Iinuma S, Takahashi C, Noguchi A, Ishida-Yamamoto A. Rheumatoid vasculitis mimicking cryptococcal infection. Eur J Dermatol. 2021;31(3):417–8. https://doi.org/10.1684/ejd.2021.4055.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2010;50(3):291–322. https://doi.org/10.1086/649858.

    Article  PubMed  Google Scholar 

  57. Lyon GM, Bravo AV, Espino A, Lindsley MD, Gutierrez RE, Rodriguez I, et al. Histoplasmosis associated with exploring a bat-inhabited cave in Costa Rica, 1998–1999. Am J Trop Med Hyg. 2004;70(4):438–42.

    Article  PubMed  Google Scholar 

  58. Xiong XF, Fan LL, Kang M, Wei J, Cheng DY. Disseminated histoplasmosis: a rare clinical phenotype with difficult diagnosis. Respirol Case Rep. 2017;5(3):e00220. https://doi.org/10.1002/rcr2.220.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Doleschal B, Rodhammer T, Tsybrovskyy O, Aichberger KJ, Lang F. Disseminated histoplasmosis: a challenging differential diagnostic consideration for suspected malignant lesions in the digestive tract. Case Rep Gastroenterol. 2016;10(3):653–60. https://doi.org/10.1159/000452203.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Chang P, Rodas C. Skin lesions in histoplasmosis. Clin Dermatol. 2012;30(6):592–8. https://doi.org/10.1016/j.clindermatol.2012.01.004.

    Article  PubMed  Google Scholar 

  61. Saslaw S, Beman FM. Erythema nodosum as a manifestation of histoplasmosis. J Am Med Assoc. 1959;170(10):1178–9. https://doi.org/10.1001/jama.1959.63010100004012b.

    Article  CAS  PubMed  Google Scholar 

  62. Azar MM, Hage CA. Laboratory diagnostics for histoplasmosis. J Clin Microbiol. 2017;55(6):1612–20. https://doi.org/10.1128/jcm.02430-16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Durkin M, Witt J, Lemonte A, Wheat B, Connolly P. Antigen assay with the potential to aid in diagnosis of blastomycosis. J Clin Microbiol. 2004;42(10):4873–5. https://doi.org/10.1128/jcm.42.10.4873-4875.2004.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Rajeshwari M, Xess I, Sharma MC, Jain D. Acid-fastness of histoplasma in surgical pathology practice. J Pathol Transl Med. 2017;51(5):482–7. https://doi.org/10.4132/jptm.2017.07.11.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Azar MM, Hage CA. Clinical perspectives in the diagnosis and management of histoplasmosis. Clin Chest Med. 2017;38(3):403–15. https://doi.org/10.1016/j.ccm.2017.04.004.

    Article  PubMed  Google Scholar 

  66. Carey A, Gorris ME, Chiller T, Jackson B, Beadles W, Webb BJ. Epidemiology, clinical features, and outcomes of coccidioidomycosis, Utah, 2006–2015. Emerg Infect Dis. 2021;27(9):2269–77. https://doi.org/10.3201/eid2709.210751.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Sondermeyer Cooksey GL, Nguyen A, Vugia D, Jain S. Regional analysis of coccidioidomycosis incidence - California, 2000–2018. MMWR Morb Mortal Wkly Rep. 2020;69(48):1817–21. https://doi.org/10.15585/mmwr.mm6948a4.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Brown J, Benedict K, Park BJ, Thompson GR 3rd. Coccidioidomycosis: epidemiology. Clin Epidemiol. 2013;5:185–97. https://doi.org/10.2147/clep.S34434.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Garcia Garcia SC, Salas Alanis JC, Flores MG, Gonzalez Gonzalez SE, Vera Cabrera L, Ocampo CJ. Coccidioidomycosis and the skin: a comprehensive review. An Bras Dermatol. 2015;90(5):610–9. https://doi.org/10.1590/abd1806-4841.20153805.

    Article  PubMed  Google Scholar 

  70. Gabe LM, Malo J, Knox KS. Diagnosis and management of coccidioidomycosis. Clin Chest Med. 2017;38(3):417–33. https://doi.org/10.1016/j.ccm.2017.04.005.

    Article  PubMed  Google Scholar 

  71. Saenz-Ibarra B, Prieto VG, Torres-Cabala CA, Huen A, Nagarajan P, Tetzlaff MT, et al. Coccidioidomycosis involving lungs and skin: a mimicker of metastatic disease. Am J Dermatopathol. 2018;40(3):e41–3. https://doi.org/10.1097/dad.0000000000000986.

    Article  PubMed  Google Scholar 

  72. Saubolle MA. Laboratory aspects in the diagnosis of coccidioidomycosis. Ann N Y Acad Sci. 2007;1111:301–14. https://doi.org/10.1196/annals.1406.049.

    Article  PubMed  Google Scholar 

  73. Bolognia JL, Schaffer JV, Cerroni L. Dermatology. Elsevier; 2018.

    Google Scholar 

  74. Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Geertsma F, Hoover SE, et al. 2016 Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis. Clin Infect Dis. 2016;63(6):e112–46. https://doi.org/10.1093/cid/ciw360.

    Article  PubMed  Google Scholar 

  75. Truong J, Ashurst JV. Pneumocystis jirovecii pneumonia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. Copyright © 2022, StatPearls Publishing LLC.

    Google Scholar 

  76. Choukri F, Menotti J, Sarfati C, Lucet JC, Nevez G, Garin YJ, et al. Quantification and spread of Pneumocystis jirovecii in the surrounding air of patients with Pneumocystis pneumonia. Clin Infect Dis. 2010;51(3):259–65. https://doi.org/10.1086/653933.

    Article  CAS  PubMed  Google Scholar 

  77. Hennessey NP, Parro EL, Cockerell CJ. Cutaneous Pneumocystis carinii infection in patients with acquired immunodeficiency syndrome. Arch Dermatol. 1991;127(11):1699–701.

    Article  CAS  PubMed  Google Scholar 

  78. • Bateman M, Oladele R, Kolls JK. Diagnosing Pneumocystis jirovecii pneumonia: a review of current methods and novel approaches. Med Mycol. 2020;58(8):1015–28. https://doi.org/10.1093/mmy/myaa024. A helpful review article of epidemiology and novel tools for diagnosing Pneumocystis jirovecii.

  79. Brakemeier S, Pfau A, Zukunft B, Budde K, Nickel P. Prophylaxis and treatment of Pneumocystis jirovecii pneumonia after solid organ transplantation. Pharmacol Res. 2018;134:61–7. https://doi.org/10.1016/j.phrs.2018.06.010.

    Article  CAS  PubMed  Google Scholar 

  80. Lehman JS, Kalaaji AN. Role of primary prophylaxis for pneumocystis pneumonia in patients treated with systemic corticosteroids or other immunosuppressive agents for immune-mediated dermatologic conditions. J Am Acad Dermatol. 2010;63(5):815–23. https://doi.org/10.1016/j.jaad.2009.11.588.

    Article  PubMed  Google Scholar 

  81. Amber KT, Lamberts A, Solimani F, Agnoletti AF, Didona D, Euverman I, et al. Determining the incidence of pneumocystis pneumonia in patients with autoimmune blistering diseases not receiving routine prophylaxis. JAMA Dermatol. 2017;153(11):1137–41. https://doi.org/10.1001/jamadermatol.2017.2808.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Weyant RB, Kabbani D, Doucette K, Lau C, Cervera C. Pneumocystis jirovecii: a review with a focus on prevention and treatment. Expert Opin Pharmacother. 2021;22(12):1579–92. https://doi.org/10.1080/14656566.2021.1915989.

    Article  PubMed  Google Scholar 

  83. Mazi PB, Rauseo AM, Spec A. Blastomycosis. Infect Dis Clin North Am. 2021;35(2):515–30. https://doi.org/10.1016/j.idc.2021.03.013.

    Article  PubMed  Google Scholar 

  84. Schwartz IS, Kauffman CA. Blastomycosis. Semin Respir Crit Care Med. 2020;41(1):31–41. https://doi.org/10.1055/s-0039-3400281.

    Article  PubMed  Google Scholar 

  85. Mason AR, Cortes GY, Cook J, Maize JC, Thiers BH. Cutaneous blastomycosis: a diagnostic challenge. Int J Dermatol. 2008;47(8):824–30. https://doi.org/10.1111/j.1365-4632.2008.03732.x.

    Article  PubMed  Google Scholar 

  86. •• Villacorta Cari E, Leedy N, Ribes JA, Soria J, Myint T. Risk factors of severe blastomycosis and comparison of diagnosis and outcomes between immunocompetent and immunocompromised patients. Mycoses. 2022;65(2):239–46. https://doi.org/10.1111/myc.13409. An important study investigating risk factors and clinical outcomes in patients with severe blastomycosis infection.

  87. Caldito EG, Ajiboye O, Flores E, Antia C, Demarais P. The importance of skin exam in chronic pulmonary blastomycosis. IDCases. 2020;20:e00812. https://doi.org/10.1016/j.idcr.2020.e00812.

    Article  Google Scholar 

  88. Bonifaz A, Morales D, Morales N, Mercadillo P, González GM, Hernández-Hernández F, et al. Cutaneous blastomycosis. An imported case with good response to itraconazole. Rev Iberoam Micol. 2016;33(1):51–4. https://doi.org/10.1016/j.riam.2015.05.001.

    Article  PubMed  Google Scholar 

  89. Patel AJ, Gattuso P, Reddy VB. Diagnosis of blastomycosis in surgical pathology and cytopathology: correlation with microbiologic culture. Am J Surg Pathol. 2010;34(2):256–61. https://doi.org/10.1097/PAS.0b013e3181ca48a5.

    Article  PubMed  Google Scholar 

  90. Han JJ, Lake E. Cutaneous blastomycosis and systemic findings. J Dermatol Nurses Assoc. 2020;12(6):298–301. https://doi.org/10.1097/jdn.0000000000000574.

    Article  Google Scholar 

  91. Lopes L, Borges-Costa J, Soares-Almeida L, Filipe P, Neves F, Santana A, et al. Cutaneous alternariosis caused by Alternaria infectoria: three cases in kidney transplant patients. Healthcare (Basel). 2013;1(1):100–6. https://doi.org/10.3390/healthcare1010100.

    Article  PubMed  Google Scholar 

  92. Gomes J, Vilarinho C, Duarte MdL, Brito C. Cutaneous phaeohyphomycosis caused by Alternaria alternata unresponsive to itraconazole treatment. Case Rep Dermatol Med. 2011;2011:385803. https://doi.org/10.1155/2011/385803.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Jebari M, Mtibaa L, Abid R, Hannechi S, Souid H, Battikh R, et al. Unusual location of cutaneous alternariosis in an immunocompetent patient. IDCases. 2022;27:e01356. https://doi.org/10.1016/j.idcr.2021.e01356.

    Article  PubMed  Google Scholar 

  94. • Vazirani J, Westall GP, Snell GI, Morrissey CO. Scedosporium apiospermum and Lomentospora prolificans in lung transplant patients - a single center experience over 24 years. Transpl Infect Dis. 2021;23(3):e13546. https://doi.org/10.1111/tid.13546. A retrospective study investigating epidemiology and clinical course of Scedosporium and Lomentospora fungal infections within lung transplant recipients.

  95. Guerrero A, Torres P, Duran MT, Ruiz-Díez B, Rosales M, Rodriguez-Tudela JL. Airborne outbreak of nosocomial Scedosporium prolificans infection. Lancet. 2001;357(9264):1267–8. https://doi.org/10.1016/s0140-6736(00)04423-8.

    Article  CAS  PubMed  Google Scholar 

  96. Seidel D, Hassler A, Salmanton-García J, Koehler P, Mellinghoff SC, Carlesse F, et al. Invasive Scedosporium spp. and Lomentospora prolificans infections in pediatric patients: analysis of 55 cases from FungiScope® and the literature. Int J Infect Dis. 2020;92:114–22. https://doi.org/10.1016/j.ijid.2019.12.017.

    Article  CAS  PubMed  Google Scholar 

  97. Luplertlop N, Muangkaew W, Pumeesat P, Suwanmanee S, Singkum P. Distribution of Scedosporium species in soil from areas with high human population density and tourist popularity in six geographic regions in Thailand. PLoS One. 2019;14(1):e0210942. https://doi.org/10.1371/journal.pone.0210942.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. Ramirez-Garcia A, Pellon A, Rementeria A, Buldain I, Barreto-Bergter E, Rollin-Pinheiro R, et al. Scedosporium and Lomentospora: an updated overview of underrated opportunists. Med Mycol. 2018;56(suppl_1):102–25. https://doi.org/10.1093/mmy/myx113.

    Article  PubMed  Google Scholar 

  99. Uenotsuchi T, Moroi Y, Urabe K, Tsuji G, Koga T, Matsuda T, et al. Cutaneous Scedosporium apiospermum infection in an immunocompromised patient and a review of the literature. Acta Derm Venereol. 2005;85(2):156–9. https://doi.org/10.1080/00015550410024553.

    Article  PubMed  Google Scholar 

  100. DeSimone MS, Crothers JW, Solomon IH, Laga AC. Scedosporium and Lomentospora infections are infrequent, difficult to diagnose by histology, and highly virulent. Am J Clin Pathol. 2021;156(6):1044–57. https://doi.org/10.1093/ajcp/aqab070.

    Article  PubMed  Google Scholar 

  101. Chen SC, Halliday CL, Hoenigl M, Cornely OA, Meyer W. Scedosporium and Lomentospora infections: contemporary microbiological tools for the diagnosis of invasive disease. J Fungi. 2021;7(1):23. https://doi.org/10.3390/jof7010023.

    Article  CAS  Google Scholar 

  102. Yang F, Sun Y, Lu Q. The synergistic effect of minocycline and azole antifungal drugs against Scedosporium and Lomentospora species. BMC Microbiol. 2022;22(1):21. https://doi.org/10.1186/s12866-021-02433-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  103. Gorai S, Saha M, Madhab V, Mitra S. Talaromycosis (Penicilliosis): a rare, opportunistic systemic fungal infection. Indian J Dermatol. 2019;64(4):331–3. https://doi.org/10.4103/ijd.IJD_70_17.

    Article  PubMed  PubMed Central  Google Scholar 

  104. Narayanasamy S, Dat VQ, Thanh NT, Ly VT, Chan JF, Yuen KY, et al. A global call for talaromycosis to be recognised as a neglected tropical disease. Lancet Glob Health. 2021;9(11):e1618–22. https://doi.org/10.1016/s2214-109x(21)00350-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  105. Karo FA, Kembaren T, Saragih R, Sembiring E, Ginting F, Ginting Y. Cutaneous penicilliosis due to penicillium marneffei infection in human immunodeficiency virus infected patients. IOP Conf Ser Earth Environ Sci. 2018;125:012060. https://doi.org/10.1088/1755-1315/125/1/012060.

    Article  Google Scholar 

  106. Widaty S, Santoso ID, Ricky D, Yunihastuti E, Rihatmadja R, Wahyuningsih R. Talaromycosis clinically and histopathologically mimicking histoplasmosis in an immunocompromised patient. Dermatol Online J. 2020;26(9):5.

    Article  Google Scholar 

  107. Sirisanthana T, Supparatpinyo K, Perriens J, Nelson KE. Amphotericin B and itraconazole for treatment of disseminated Penicillium marneffei infection in human immunodeficiency virus-infected patients. Clin Infect Dis. 1998;26(5):1107–10. https://doi.org/10.1086/520280.

    Article  CAS  PubMed  Google Scholar 

  108. Supparatpinyo K, Schlamm HT. Voriconazole as therapy for systemic Penicillium marneffei infections in AIDS patients. Am J Trop Med Hyg. 2007;77(2):350–3.

    Article  CAS  PubMed  Google Scholar 

  109. Buchta V, Bolehovska R, Hovorkova E, Cornely OA, Seidel D, Zak P. Saprochaete clavata invasive infections - a new threat to hematological-oncological patients. Front Microbiol. 2019;10:2196. https://doi.org/10.3389/fmicb.2019.02196.

    Article  PubMed  PubMed Central  Google Scholar 

  110. Leoni M, Riccardi N, Rotulo GA, Godano E, Faraci M, Bandettini R, et al. Magnusiomyces clavatus infection in a child after allogeneic hematotopoetic stem cell transplantation: diagnostic and therapeutic implications. Med Mycol Case Rep. 2019;23:65–7. https://doi.org/10.1016/j.mmcr.2018.12.005.

    Article  PubMed  Google Scholar 

  111. Döğen A, Kaplan E, Öksüz Z, Serin MS, Ilkit M, de Hoog GS. Dishwashers are a major source of human opportunistic yeast-like fungi in indoor environments in Mersin, Turkey. Med Mycol. 2013;51(5):493–8. https://doi.org/10.3109/13693786.2012.738313.

    Article  CAS  PubMed  Google Scholar 

  112. Ulu-Kilic A, Atalay MA, Metan G, Cevahir F, Koç N, Eser B, et al. Saprochaete capitata as an emerging fungus among patients with haematological malignencies. Mycoses. 2015;58(8):491–7. https://doi.org/10.1111/myc.12347.

    Article  PubMed  Google Scholar 

  113. El Zein S, Hindy J-R, Kanj SS. Invasive Saprochaete infections: an emerging threat to immunocompromised patients. Pathogens. 2020;9(11):922.

    Article  PubMed  PubMed Central  Google Scholar 

  114. Gurrieri F, Corbellini S, Piccinelli G, Turra A, Morello E, Malagola M, et al. Management of invasive infections due to a rare arthroconidial yeast, Saprochaete capitata, in two patients with acute hematological malignancies. Vaccines. 2021;9(11):1289. https://doi.org/10.3390/vaccines9111289.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  115. •• Donnelly JP, Chen SC, Kauffman CA, Steinbach WJ, Baddley JW, Verweij PE, et al. Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis. 2020;71(6):1367–76. https://doi.org/10.1093/cid/ciz1008. A very useful article detailing diagnostic imaging and risk factors of common invasive fungal diseases.

  116. Parahym AM, Rolim Neto PJ, da Silva CM, Domingos Ide F, Gonçalves SS, Leite EP, et al. Invasive infection due to Saprochaete capitata in a young patient with hematological malignancies. Braz J Microbiol. 2015;46(2):527–30. https://doi.org/10.1590/s1517-838246220120447.

    Article  PubMed  PubMed Central  Google Scholar 

  117. Noster J, Koeppel MB, Desnos-Olivier M, Aigner M, Bader O, Dichtl K, et al. Bloodstream infections caused by Magnusiomyces capitatus and Magnusiomyces clavatus: epidemiological, clinical, and microbiological features of two emerging yeast species. Antimicrob Agents Chemother. 2022;66(2):e0183421. https://doi.org/10.1128/aac.01834-21.

    Article  PubMed  Google Scholar 

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Varghese, J.A., Guhan, S. & Zheng, L. Emerging Fungal Infections and Cutaneous Manifestations in Immunosuppressed Patients. Curr Derm Rep 12, 69–81 (2023). https://doi.org/10.1007/s13671-023-00386-9

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