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Kutane Alternariose

Diagnostik, Klinik und Therapie

Cutaneous alternariosis

Clinical diagnosis and therapeutic options

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Zusammenfassung

Lokalisierte Hautinfektionen durch melanisierte Hyphomyzeten der Gattung Alternaria werden zunehmend beobachtet. Während von der meist traumatisch bedingten Mykose früher vornehmlich Patienten unter Langzeitglukokortikoidtherapie betroffen waren, wird nun insbesondere über Erkrankungen bei organtransplantierten Patienten berichtet. Vorgestellt werden 2 Patienten mit einer kutanen Alternariose. Anhand dieser Fallbeschreibungen werden die Diagnostik, die möglichen Therapieoptionen und die Differenzialdiagnostik dargestellt. Histopathologisch kann die Abgrenzung von einer kutanen Manifestation einer anderen Mykose schwierig, aber therapeutisch und prognostisch bedeutsam sein. Der Nachweis kurzer Hyphen in Gewebeschnitten weist auf eine Schimmelpilzinfektion hin. Die exakte Erregerdifferenzierung kann von Bedeutung für die Therapie sei. Da insbesondere A. infectoria in Kultur kaum Konidien entwickelt, stellt die Sequenzierung der rDNA-ITS-Region eine weitere Möglichkeit der Differenzierung dar. Eindeutige Therapieempfehlungen liegen für Alternaria-Infektionen bislang nicht vor. Neben der anzustrebenden chirurgischen Intervention wird vorwiegend Itraconazol systemisch eingesetzt.

Abstract

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.

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Notes

  1. Der Stamm wurde in die CBS-Kultursammlung unter der Nummer 109803 aufgenommen.

  2. Der Stamm wurde in die CBS-Kultursammlung unter der Nummer 113400 aufgenommen.

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Authors and Affiliations

  1. Zentrum für Dermatologie und Andrologie, Justus-Liebig-Universität, Gießen

    P. Mayser, W. Thoma & K. Wiedemeyer

  2. Robert Koch-Institut, Berlin

    M. Seibold & K. Tintelnot

  3. Centraalbureau voor Schimmelcultures, Utrecht

    G. S. de Hoog

  4. Zentrum für Dermatologie und Andrologie, Justus-Liebig-Universität, Gaffkystraße 14, 35385 , Gießen

    P. Mayser

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  1. P. Mayser
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  2. W. Thoma
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  4. K. Tintelnot
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  6. G. S. de Hoog
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Correspondence to P. Mayser.

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Mayser, P., Thoma, W., Seibold, M. et al. Kutane Alternariose. Hautarzt 55, 1137–1142 (2004). https://doi.org/10.1007/s00105-004-0773-9

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