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Neoscytalidium is a phytopathogen that is often found in plants and soil. It mostly leads to skin and nail infections, and invasive diseases of the sinuses, lung, and brain have been described mostly in immunocompromised patients. We report a case of a post-renal transplant patient who received anti-thymocyte globulin for induction immunosuppression. A month after her transplant, she presented with fever and new-onset seizures, and computed tomography revealed a brain abscess with mass effects and herniation. The patient underwent abscess drainage and craniectomy. The pathological findings showed filamentous septate hyphae. The surgical culture rapidly grew wool-like colonies with a black reverse on Sabouraud agar. Lactophenol cotton blue staining showing septate branched hyphae with one to two arthroconidia cells with flattened ends. The patient was given a combination of amphotericin B and voriconazole but unfortunately died ten days after the diagnosis. This case highlights Neoscytalidium as a cause of invasive fungal disease in immunocompromised patients that is difficult to treat and is often fatal, even when combined surgical and medical therapies are used as treatment modalities., Highlights • Neoscytalidium spp. is a rare human pathogenic fungal disease that most likely leads to superficial infection. • Immunocompromised host is at particularly higher risk of invasive disease. • This is the fifth case in the literature describing cerebral invasive disease caused by Neoscytalidium spp. • The present case further confirms the aggressiveness of the disease and refractoriness to antifungal therapy. • The diagnoses need to be entertained, especially in an immunocompromised patient and who have history of exposure to agricultural areas.

The effect of treatment regimens on fungal microbiota is unclear in ulcerative colitis (UC) patients. Here, we aimed to clarify the effect of 5-aminosalicylic acid (5-ASA) treatment on gut fungal microbiota in UC patients. Fifty-seven UC patients, including 20 treatment-naïve and 37 5-ASA-treated, were recruited into an exploration study. We compared the gut fungal profiles of these 2 groups of patients using ITS1-2 rDNA sequencing. Ten out of 20 treatment-naïve UC patients were followed up and enrolled for a validation study and underwent a 5-ASA treatment. We assessed the longitudinal differences of fungal microbiota in these patients before and after 5-ASA treatment. Results acquired from the validation study were accordant to those from the exploration study. Ascomycota was the dominant phylum in both noninflamed and inflamed mucosae. At the phylum level, Ascomycota decreased in inflamed mucosae before 5-ASA treatment. At the genus level, pathogens such as Scytalidium, Morchella, and Paecilomyces increased, and Humicola and Wickerhamomyces decreased in inflamed mucosae. After 5-ASA treatment, Ascomycota and Wickerhamomyces increased and Scytalidium, Fusarium, Morchella, and Paecilomyces decreased in both noninflamed and inflamed mucosae. Additionally, the balanced bacteria–fungi correlation was interrupted in inflamed mucosae, and 5-ASA treatment altered group-specific fungal microbiota and restored bacteria–fungi correlation in UC patients. Our results demonstrated that fungal diversity and composition were altered and the bacteria–fungi correlation was restored in inflamed mucosae after 5-ASA treatment.

Onychomycosis is a fungal infection of the nail caused by dermatophytic (99%) and/or non-dermatophytic (1%) (including yeasts) infections of the nailplate. Among the non-dermatophytes, the yeast Candida albicans, Candida tropicalis, and other molds like Scopulariopsis spp., Scytalidium spp., Fusarium spp., and Aspergillus spp. may be responsible. Herein, we report a case of total dystrophic onychomycosis in a 41-year-old female, caused by Syncephalastrum racemosum and its complete improvement with a combination of oral pulse itraconazole and 1064 nm Q-switched Nd-YAG laser. This case is being reported due to the rarity of causative organism for onychomycosis and a novel approach in its treatment.

This study aimed to isolate and characterize filamentous fungi onychomycosis agents in a military population assisted at a hospital outpatient clinic. In onychomycosis, the fungi colonize the subungual region causing thickening, discoloration, or cracking of the nail bed. Samples were collected from patients with clinical sights of onychomycosis. Among 80 samples collected, 50 (62.5%) had positive culture. Isolated dermatophytes (86%) were Trichophyton rubrum (21; 42%), T. mentagrophytes var. interdigitale (19; 38%), and Microsporum gypseum (3; 6%) and non-dermatophyte molds were Fusarium spp. (1; 2%), Scytalidium spp. (1; 2%), and Chaetomium globosum (5; 10%). Minimal inhibitory concentrations (mg/L) of terbinafine, itraconazole, and fluconazole necessary to inhibit 50/90% of the isolates were respectively 0.015/0.06, 0.06/0.12, and 32/32. Etiological agents of onychomycosis in a military hospital are similar as reported in studies for the general population. High prevalence of non-dermatophytic agents was observed, especially for Chaetomium globosum.

Opportunities for alternatives to synthetic textile dyes are of increasing importance as the world looks to minimize its ecological footprint. Fungal pigments within a unique class of wood-rotting (“spalting”) fungi have been under investigation for several years as a possible solution, and have been shown to be ideally suited as textile dye coatings. Unfortunately, the solvent currently in use for these colorants is dichloromethane (DCM), which is an environmental problem as well as a potential human carcinogen. Recently, researchers found that the pigments from Chlorociboria species, Scytalidium cuboideum, and Scytalidium ganodermophthorum could be carried in some natural oils, which opened up a potential method of delivering pigments onto a host of substrates without utilizing DCM. Although the pigments can be carried in oil, no testing has thus far been conducted as to how oil affects the binding properties of the pigments onto textiles, or how the oil might affect the pigments directly. In this paper, the pigments produced by three well-known wood-rotting fungi were carried in raw linseed oil and applied to cotton, polyester, and nylon. Only the red pigment produced visible color change on the textiles. Cotton and polyester showed the greatest color change when the pigments were dripped onto the fabric, while polyester showed the most color when the textile was submerged into the pigment solution. Unfortunately, the colors faded significantly for all the tests except the saturation test. This indicates that while natural oils may be excellent, nontoxic alternative carriers for DCM, the pigments are not stable within them except at very high concentrations, and therefore natural oils—including raw linseed oil—are not ideal for use in conjunction with these pigments.

Background Reports of mixed infections with nondermatophyte molds (NDMs) and dermatophytes in onychomycosis are rare, possibly owing to the inhibition of NDM growth during traditional culture. We sought to determine the prevalence of mixed infections in onychomycosis using molecular identification. Methods Molecular analyses were used to identify infecting organisms directly from at least two serial great toenail samples from each of the 44 patients. Results Mixed infections were present in 41% of the patients (18 of 44). A single coinfecting NDM was the most common mixed infection and was detected in 34% of patients with onychomycosis (15 of 44), with Fusarium oxysporum present in 14% (6 of 44), Scopulariopsis brevicaulis in 9% (4 of 44), Acremonium spp in 2% (1 of 44), Aspergillus spp in 4.5% (2 of 44), and Scytalidium spp in 4.5% (2 of 44). Mixed infections with two NDMs were found in 7% of patients (3 of 44). Conclusions Mixed onychomycosis infections may be more prevalent than previously reported.

We report a systemic mycosis in a German shepherd dog caused by Scytalidium spp. The patient presented for progressive cervical pain and forelimb hemiparesis. Cervical computed tomography revealed lysis associated with multiple vertebrae and a soft tissue mass adjacent to the spinal cord, as well as prescapular lymphadenopathy. Fine needle aspirates of the lymph nodes yielded hyphae, and a subsequent culture obtained a Scytalidium spp. Itraconazole therapy was initiated, but the subject was euthanized three months later due to progressive neurologic disease and discomfort. This appears to be the first report of disseminated disease by this species in veterinary medicine.

Resume Introduction Scytalidium dimidiatum (recemment renomme Neoscytalidium dimidiatum) est un champignon dematie responsable d’infections ungueales et cutanees superficielles. Il peut etre a l’origine d’infections sous-cutanees profondes, surtout chez les sujets immunodeprimes. Nous en rapportons un nouveau cas. Observation Il s’agit d’un patient de 87 ans, sous corticotherapie orale pour une sarcoidose, qui presentait des lesions cutanees chroniques a type de plaques nodulaires violacees ayant debute sur le dos des mains. L’examen anatomopathologique d’une biopsie cutanee trouvait des granulomes a cellules epithelioides avec de nombreux filaments myceliens et de multiples spores. La culture des biopsies permettait la croissance de nombreuses colonies de S. dimidiatum. Un traitement par amphotericine B intraveineuse etait debute, avec une tres bonne efficacite initiale. Discussion La transmission de S. dimidiatum se fait par contact direct ou indirect avec le sol ou les plantes contamines. Ce champignon cause essentiellement des infections ungueales et cutanees superficielles, plus rarement des infections profondes. Ces dernieres surviennent surtout chez l’immunodeprime. La prise en charge est consideree comme difficile. Chez notre patient immunodeprime par la corticotherapie generale, l’amphotericine B semble pour l’instant efficace.

Zusammenfassung. Ein Kollektiv von 40 Kohlengrubenarbeitern, davon 35 mit kulturell gesicherten Fusmykosen und funf mit Nagelinfektionen, bedingt durch Hendersonula toruloidea, Scytalidium hyalinum und Dermatophyten, wurde entweder mit Isoconazolnitrat (TravogenrG) oder Clotrimazol (Canestenr) vier Wochen lang behandelt. Die klinischen Heilungsraten fur die Symptome Juckreiz, Entzundung, Schuppung und Mazeration waren in der Isoconazol-Gruppe bei den Fusinfektionen 89%, 88%, 83% und 83%. In der Clotrimazol-Gruppe lagen die entsprechenden Heilungsraten bei 76%, 71%, 82% und 80%. Der Zwischenzehenbereich war die haufigste Infektlokalisation und konnte auch am leichtesten sowohl mit Clotrimazol wie auch Isoconazol behandelt werden. Die klinische Heilungsrate sechs Wochen nach Behandlung betrug 80% in der Isoconazol-Gruppe und 70% in der Clotrimazol-Gruppe, aber die Differenz konnte nicht statistisch gesichert werden (P > 0.01). Keine der Nagelinfektionen konnte mit den eingesetzten Antimykotika erfolgreich behandelt werden. Summary. A total of 40 coal miners, 35 with culturally proven mycotic infections of the feet and 5 with similarly proven infections of toenails due to Hendersonula toruloidea, Scytalidium hyalinum and dermatophytes, were treated with 1 % cream of either isoconazole nitrate (Travogenr) or clotrimazole (Canestanr) for 4 weeks. The clinical cure rates for the isoconazole-treated group for itching, inflammation, scaling and maceration in the cases of foot infections were 89, 88, 83 and 83% respectively. For the clotrimazole-treated group, the cure rates were 76, 71, 82 and 80% respectively, for the similar symptoms. Toe web was the commonest site of infection and also most easily treated with either clotrimazole or isoconazole. The clinical and mycological cure rates 6 weeks after treatment were 80% for the isoconaz-ole-treated group and 70% for the clotrimazole-treated group but the difference was not statistically significant (P

Background. Dermatomycoses are not diseases requiring compulsory notifications; rather they cause cosmetic defacements. Indian subcontinent with a varied topography is favorable for various fungal infections.Objective. To look for the epidemiological and mycological profile of superficial mycoses in North India.Methods. Three hundred and fifty-one clinical samples of skin, hair, and nail were examined to find the fungal etiology of the dermatomycoses.Results. Dermatomycoses were seen in 215/351 (61.2%) of cases. Most common isolates obtained were nondermatophyte molds (NDMs) (36.1%), followed by dermatophytes (13.8%) and yeasts (8.6%).Aspergillus niger(9%) was the most common mold.Trichophyton rubrum(4.6%) was the most common dermatophyte isolated, while amongst the yeastsNon-albicans Candida(NAC) species were more common (6%). Many other NDMs likeSyncephalastrumspp.,Cunninghamellaspp.,Rhodotorulaspp.,A. terreus, Scytalidiumspp. andScopulariopsisspp. were also isolated.Conclusion. Our study reflects an increasing role of NDMs (thought to be normal laboratory or environmental contaminants) as a causative agent of dermatomycoses, replacing the dermatophytes. Clinician’s awareness of the demographic profile of the population involved along with more studies on dermatomycoses can help in understanding the etiological profile in area, leading to prevention of disease occurrence and cosmetic disfigurement.

After drawing a dose from an closed bevacizumab (Avastin) bottle, a fungus-like foreign body was observed inside. Samples from the vial were cultured in Sabouraud Emmons media. Growth of multiple light brown colonies with dark pigment was observed after 10 days. The species was identified as Scytalidium sp. Vial, analysis reported that the seal was lacking proper identification measures and that the label, batch number and expiry date did not correspond to a genuine product. Chemical analysis showed no protein, but 3% of polyethylene glycol, citrate and ethanol. Counterfeit bevacizumab is a real situation that poses a significant risk for ophthalmology and oncology patients. The medical community should be aware of this situation in order to enforce adequate preventive measures.

Resume Introduction Le Scytalidium est une moisissure endemique dans les regions tropicales et subtropicales. L’objectif de notre travail etait d’evaluer la prevalence des onychomycoses a Scytalidium en Martinique, ainsi que leurs caracteristiques cliniques et epidemiologiques. Patients et methodes Il s’agit d’une etude prospective portant sur 106 patients (46 hommes et 60 femmes), presentant une onychomycose clinique, recrutes dans le Service de Dermatologie du Centre Hospitalier Universitaire de Fort-de-France. Les patients ont beneficie d’un prelevement mycologique et ont ete repartis en deux groupes selon la presence ou non de Scytalidium . L’âge, le sexe, la localisation, l’aspect clinique, la duree d’evolution, les facteurs d’environnement (lieu de residence, jardin, animaux, marche pieds nus, immunodepression) ont ete compares entre les deux groupes par les tests de χ 2 , de Fisher et le test t de Student. Dix sujets temoins sans onychomycose clinique ont eu un prelevement mycologique. Resultats Les onychomycoses a Scytalidium representaient 42 p. 100 des patients inclus (culture pure de Scytalidium hyalinum chez 91 p. 100) et 56 p. 100 des patients apres elimination de ceux dont le resultat etait negatif. La moyenne d’âge etait significativement plus elevee en cas d’onychomycose a Scytalidium (62 versus 54 ans ; p Scytalidium (47 p. 100 versus 14 p. 100 ; p Scytalidium . Commentaires Notre etude confirme l’endemicite du Scytalidium hyalinum en Martinique et l’importance des atteintes plantaires associees. L’existence d’un portage sain, observe chez un sujet temoin, est probablement un element epidemiologique important expliquant la grande frequence de l’affection en milieu tropical.

© 2012 Elsevier 0196-4399/00 (see frontmatter) 31 The clinical presentation of cutaneous fungal infections caused by members of the genus Scytalidium is similar to the clinical manifestation of disease caused by the dermatophyte fungi, except that infections caused by Scytalidium spp. respond poorly to conventional antifungal therapy. Members of the genus Scytalidium are endemic in tropical regions of the world, and their occurrence in Spain is rare. However, in recent years, the number of cases described in Spain and other areas of nonendemicity has been increasing. This increase in reported cases is allegedly due to more frequent travel by individuals to areas of endemicity in the world. We describe a case of cutaneous infection caused by Scytalidium hyalinum in a 32-year-old patient who was born and raised in Sierra Leone but resided in Spain for the last 10 years. He sought medical attention in our dermatology department for the evaluation of skin lesions that were initially thought to be a contact dermatitis caused by exposure to a chemical irritant.

Because onychomycosis requires long-term systemic therapy, it is essential to diagnose the infection accurately. Although in theory this diagnosis should be simple, results achieved in practice are uneven. Clinicians should be aware of the need to collect an adequate specimen and of the possible need for repeat collections. Direct microscopic techniques for examination of nail scrapings include 10% potassium hydroxide (KOH) with Parker ink, 10% KOH with dimethyl sulfoxide, and 10% KOH with Calcofluor white. When interpreting fungal culture results, it should be noted that negative results are frequent and that contaminant yeasts and molds are common, but that nondermatophytes such as Candida, Scopulariopsis, and Scytalidium can infrequently cause onychomycosis.

Background Laser treatment has emerged as a novel treatment modality for onychomycosis. Objective We sought to determine thermal response and optical effects of a submillisecond neodymium:yttrium-aluminum-garnet (Nd:YAG) 1064-nm laser on common fungal nail pathogens, and the clinical efficacy and safety of the Nd:YAG 1064-nm laser on onychomycotic toenails. Methods A 4-part in vitro and in vivo study was conducted using a Nd:YAG 1064-nm laser. The first portion evaluated 3 different nail pathogens in suspension at 7 heat and time exposures. The second and third parts of the study irradiated pure fungal colonies. The final portion involved an in vivo treatment of toenails over 5 treatment sessions. Results A fungicidal effect for Trichophyton rubrum was seen at 50°C after 15 minutes, and for Epidermophyton floccosum at 50°C after 10 minutes. Limited growth of Scytalidium was seen at 55°C after 5 minutes. No inhibition was observed after laser treatment of fungal colonies or suspensions. In vivo treatment of toenails showed no improvement in Onychomycosis Severity Index score. Limitations The Nd:YAG 1064-nm laser was the only laser tested. Conclusions Laser treatment of onychomycosis was not related to thermal damage or direct laser effects. In vivo treatment did not result in onychomycosis cure.

A 13-year-old Moroccan boy in The Netherlands developed fever and a lesion resembling ecthyma gangrenosum on the abdomen during cytostatic drug treatment for a lymphoblastic B-cell lymphoma. Scytalidium dimidiatum was cultured from blood and the abdominal skin lesion. The patient was successfully treated with amphotericin B. The fungus Scytalidium dimidiatum is a fairly common plant pathogen in tropical and subtropical countries and is known to cause dermatomycoses in humans in these areas. This case demonstrates that it is necessary to be aware that immigrants from these areas can import their own fungal flora, some members of which may cause life-threatening disease in the case of patients with immune suppression.

FUNDAMENTO: As dermatomicoses causadas por fungos filamentosos não dermatófitos são infecções raras, exceto as onicomicoses, cuja prevalência vem crescendo nos últimos anos. Dentre esses agentes etiológicos destacam-se o Scytalidium dimidiatum e o S. hyalinum, fungos emergentes responsáveis por micoses em unhas e pele. OBJETIVO: Investigar as características epidemiológicas das onicomicoses e micoses de outras localizações causadas pelos fungos do gênero Scytalidium, utilizando-se como parâmetros sexo, idade e localizações das lesões. MÉTODOS: Avaliaram-se 81 amostras com cultura positiva para o gênero em estudo, oriundas de 74 pacientes encaminhados ao Laboratório de Investigação em Dermatologia (ID) situado na cidade do Rio de Janeiro (RJ), no período de 1997 a 2006. As amostras foram submetidas a confirmação diagnóstica por exame direto e cultura. RESULTADOS: A prevalência de onicomicoses por Scytalidium spp. foi de 0,87%, entre as idades de 41 e 60 anos (48,64%). Em relação à localização das lesões, os pés foram mais acometidos (91,36%), com predomínio do hálux esquerdo. No exame direto, as estruturas mais encontradas foram hifas hialinas; na cultura, a espécie S. dimidiatum foi a mais frequente. CONCLUSÃO: As onicomicoses por Scytalidium spp. são raras e o S. dimidiatum foi a espécie mais isolada neste laboratório no período em estudo. BACKGROUND: Dermatomycoses caused by non-dermatophyte filamentous fungi are rare infections, except for onychomycosis, whose prevalence has increased over the past few years. Among these etiologic agents, we highlight Scytalidium dimidiatum and S. hyalinum, emergent fungi that cause mycoses that affect the nails and skin. OBJECTIVE: To investigate the characteristics of onychomycosis and other mycoses caused by the fungi Scytalidium spp, using sex, age and site of infection as parameters. METHODS: Eighty-one samples were evaluated showing positive culture for Scytalidium spp, obtained from 74 patients referred to the Laboratory of Investigation in Dermatology (ID) located in the city of Rio de Janeiro, RJ, between 1997 and 2006. The samples were submitted to diagnostic confirmation through direct exam and culture. RESULTS: The prevalence of onychomycosis caused by Scytalidium spp. was of 0,87%. The most prevalent age was between 41-60 years (48.64%). Regarding the site of infection, the feet (91.36%) were most affected, with predominance of the left hallux. Hyaline hyphae were the most common structures in direct examination and the species S. dimidiatum was the most frequent in culture. CONCLUSION: Onychomycosis caused by Scytalidium spp. is rare and S. dimidiatum was the most isolated species in this laboratory during the period of the study.

Nondermatophyte onychomycosis account for 2% to 12% of all nail fungal infections and can be caused by a wide range of fungi, mainly Scopulariopsis brevicaulis, Aspergillus versicolor, A. flavus, A. niger, A. fumigatus, Fusarium solani, F. oxysporum and Scytalidium spp. Among the predisposing factors are footwear, hyperhidrosis, local trauma, peripheral circulatory disease, and immunosuppression. These nondermatophyte fungi lack the keratinolytic capacity of dermatophytes, but they still can infect alone or in combination with the latter. Because most are considered laboratory contaminants, special criteria have been created for the correct diagnosis of nondermatophyte onychomycosis. The etiologic agent does not determine the clinical pattern of nail invasion, but superficial onychomycosis is frequently observed; leukonychia and melanonychia can also be clinical manifestations.

Objectives The objective of this work was to evaluate the in vitro activity of amphotericin B, itraconazole, voriconazole, posaconazole, caspofungin and terbinafine against clinical isolates of Scytalidium dimidiatum and Scytalidium hyalinum. Methods Microdilution testing was performed in accordance with the CLSI M38-A method on 17 S. dimidiatum and 15 S. hyalinum clinical isolates. Results The MIC ranges of voriconazole, posaconazole, itraconazole, terbinafine, caspofungin and amphotericin B were 16 mg/L, 0.06-2 mg/L, 0.06-8 mg/L and 0.06-1 mg/L, respectively. Conclusions Amphotericin B and voriconazole exhibit the lowest MICs for Scytalidium spp. Voriconazole could be a promising agent for the treatment of these refractory infections.

The presence of medically important fungi was studied in hallux nails scrapings obtained from 504 students (204 males, 300 females) of three universities in Cali. Specimens were examined by direct microscopic examination and fungal culture. Medically important fungi were found in 49 (9.7%) students, 24 (4.8%) had onychomycosis while the rest did not have nail lesions. Trichophyton rubrum was the most commonly isolated fungi in students with lesions, where as T. mentagrophytes predominated in healthy nails. Most of the students with fungi were males. The prevalence of fungi was higher in individuals between 26 and 35 years. No association was observed between fungi and practicing sports or undergoing pedicures. These results suggest that dermatophytes can be found in healthy hallux nails, which can be reservoirs of pathogenic fungi.

A case of subcutaneous infection caused by Scytalidium synanamorph of Nattrassia mangiferae is reported in a 24-year-old female suffering from subacute discoid lupus erythematosus. Lesions were seen on the palm of the left hand and dorsal aspect of the right hand. Histopathology of the biopsied specimen revealed light brown hyphae and single celled structures along with many inflammatory cells. The patient showed marked improvement with oral chloroquin and itraconazole orally and ketoconazole cream topically.

Purpose: To describe the presentation and treatment of a case of an atypical reticular corneal infiltrate with surrounding immune-like ring in a young woman caused by Scytalidium fungal species. Methods: Interventional case report describing the clinical appearance, course, and treatment of Scytalidium keratitis. Results: A 21-year-old female equestrian with a history of soft contact lens wear was noted to have persistent keratitis and photophobia of the right eye after an injury with a volleyball. Although initially culture negative and responsive to topical steroids, the keratitis persisted, and repeat corneal scrapings and cultures revealed Scytalidim species. Treatment with topical amphotericin B 0.15% and oral fluconazole 200 mg twice daily eradicated the infection, and the patient had a final best-corrected visual acuity of 20/20. Conclusion: Scytalidium species fungal organisms can cause an indolent keratitis. Intensive oral and topical antifungal therapy was successful in eradicating the infection.

Nondermatophyte molds are fungi found in soil and decaying plant debris and are generally considered to be uncommon or secondary pathogens of diseased nails. Prevalence rates of onychomycoses caused by nondermatophyte molds range between 1.45 percent and 17.60 percent. The most common nondermatophyte molds associated with nail disease are Scopulariopsis, Scytalidium, Fusarium, Aspergillus and Onychocola canadensis. Syncephalastrum racemosum, a nondermatophyte mold, belongs to the class Zygomycetae. Only one well-documented case of human disease attributed to this organism has been described. We describe a 45-year-old man with culture proven toenail onychomycosis due to Syncephalstrum racemosum.

We report a case of onychomycosis caused by Scytalidium dimidiatum (syn., Hendersonula toruloidea) in a patient who did not live in an endemic area. This nondermatophyte mold may produce disease indistinguishable from dermatophyte fungi, but it does not respond to current systemic antimycotic therapy. Distal subungual onychomycosis, lateral onycholysis followed by lateral nail plate invasion, and chronic paronychia are common nail presentations.

We describe a case of invasive fungal sinusitis caused by Scytalidium dimidiatum in a lung transplant recipient. Treatment was complicated by renal failure with amphotericin B therapies. Following 6 months of voriconazole treatment, the patient remained radiographically and clinically stable for a short time before dying of respiratory failure precipitated by graft rejection.

Background: Scytalidium dimidiatum and S hyalinum are molds responsible for human skin and nail infections in tropical areas. Objective: We sought to examine the epidemiology of cutaneous infections caused by Scytalidium species in a temperate country. Methods: We conducted a retrospective study of patients with Scytalidium spp. infection diagnosed in our laboratory in Paris, France, from 1994 to 1999. Results: Cutaneous Scytalidium infections were diagnosed in 332 patients, all of whom were from the tropics, especially the West Indies and Africa. S hyalinum and S dimidiatum were isolated in 53.6% and 43.9% of cases, respectively, and were associated with dermatophytes in 30 patients. Skin and nail lesions were found in, respectively, 65.3% and 34.7% of cases, and the feet were involved in 90.6% of cases. Conclusion: Cutaneous infections caused by Scytalidium species are far from rare in France, a temperate country, and must not be mistaken for dermatophytosis, given the resistance of S hyalinum and S dimidiatum to most antifungal drugs. Mycologic examination is, thus, required to identify Scytalidium spp in patients returning from or residing in tropical areas. (J Am Acad Dermatol 2003;48:852-6.)

We report on a case of subcutaneous infection of the arm caused by the coelomycetous fungus Nattrassia mangiferae (formerly Hendersonula toruloidea) in a steroid-dependent diabetic man with chronic obstructive lung disease. The man was a resident of Arizona, where the fungus is known to be endemic on Eucalyptus camaldulensis and on citrus trees. Diagnosis of fungal infection was made by observation of narrow hyphal filaments by histopathology of biopsy specimens and isolation of a fast-growing black mold which demonstrated hyphae and arthroconidia of varying widths typical of the Scytalidium synanamorph (S. dimidiatum). The formation of pycnidia, which at maturity expressed conidia with a central median dark band, allowed for the confirmation of the isolate as N. mangiferae. Remission of the lesions occurred following intravenous therapy with amphotericin B, followed by topical clotrimazole treatment. We use this patient's case report as an opportunity to review the literature on cases of deep infection caused by Scytalidium species, to evaluate the antifungal susceptibilities of a spectrum of Scytalidium isolates, and to review the taxonomy of Scytalidium species isolated from human infections.

The authors present a case report of a subcutaneous phaeohypomycosis of the foot in an immuno-suppressed patient. The lesion was caused by Scytalidium dimidiatum, a dematiaceous fungus, which has only been reported to cause three previous similar lesions. To our knowledge, this is the first reported case of this fungus causing a deep-seated mycoses in the United States. A review of the literature concerning this organism is also presented.

In addition to being keratinophilic, dermatophytes are characterized by the following: (1) production and tolerance of an alkaline pH in culture media, (2) resistance to 500 p.g/ml or less of cycloheximide, and (3) sensitivity to 20 p.gjml or less of griseofulvin. These properties are useful to devise special culture media for their selective isolation and recognition. Most media for general diagnostic mycology are available commercially. The standard medium for growing dermatophytes is Sabouraud's dextrose agar containing chloramphenicol and cycloheximide, which inhibit bacteria and saprophytic fungi, respectively. Four-percent glucose is added to Sabouraud's dextrose agar. Dermatophytes do not necessarily grow best on this agar, but for consistency, colonial morphology is determined on this medium. The addition of cycloheximide inhibits saprophytic fungi such as Scytalidium and Hendersonula (Natrassia), Scopulariopsis brevicaulis, Candida species, and Cryptococcus neoformans. Therefore a second medium without this antifungal agent should be included to avoid elimination of some relevant fungi, especially when nail specimens are being cultured. Media containing cycloheximide and chloramphenicol are commercially known as Mycobiotic or Mycosel agar (BBL, Baltimore, Md.). For poorly sporulating dermatophytes (for example, Trichophyton rubrum), a I: 10 dilution of 2% Sabouraud's dextrose agar is used to stimulate the pro

The Form-genus Scytalidium was established by Pesante1 in 1957 to accommodate dematiaceous hyphomycetes producing fission arthroconidia. The nomenclatural type for the genus was an isolate from rotting Platanus, Scytalidium lignicola. Microscopical examination of this fungus revealed small, hyaline fission arthroconidia together with larger, brown conidia, which in the original description are termed chlamydoconidia. During the last 20 years a number of fungi currently classified within this genus have been reported to be human pathogens.

Sir, Onychomycosis is most often caused by dermatophytes, particularly Trichophytum rubrum and T. mentagrophytes, which account for approximately 90% of nail infections (1, 2). Candida species, especially C. albicans and C. parapsilosis, are the major yeasts responsible for onychomycosis (1). Other fungi may occasionally be responsible for infection, including species of Scopulariopsis, Fusarium, Scytalidium, Aspergillus and Onychocola canadensis (1, 3). In this paper we report a case of Aspergillus tamarii onychomycosis in a child.

•Hendersonula toruloidea and Scytalidium hyalinumare opportunistic organisms that can produce tinea pedis, tinea manuum, and tinea unguium. These infections, which clinically mimic those caused by dermatophytes but are caused by nondermatophyte agents, are correctly calleddermatomycoses. When examined microscopically with potassium hydroxide, the agents of these disorders resemble those of dermatophytosis, showing narrow, septate, branching hyphae. It, therefore, becomes important to culture samples taken from sites with these tineas on cycloheximide-free agars even if they are potassium hydroxide-positive to rule out nondermatophyte mycoses. Correct identification becomes imperative since neitherH toruloideanorS hyalinumresponds to conventional therapy. We review these diseases with emphasis on clinical appearance and differentiation from dermatophytosis. We also report four cases ofS hyalinuminfection of the nail or feet. (Arch Dermatol.1991;127:1041-1044)

Ketoconazole is an effective treatment for chronic superficial candidiasis as well as chronic dermatophytosis. In the latter group of infections the best results were obtained in patients with tinea corporis who were not responsive to griseofulvin. It is possible to maintain some patients with chronic mucocutaneous candidiasis in remission without using prophylactic ketoconazole, although relapses may occur. However, the responses of patients with Hendersonula and Scytalidium infections as well as those with subcutaneous mycoses, such as eumycetoma, were disappointing. Patients who have an inadequate response to ketoconazole may also have subnormal serum levels of the drug and the value of such estimations in routine management needs further evaluation.

Scytalidium hyalinum is a hyaline species of the genus Scytalidium. It first was described as a cause of skin and nail infection in humans. In this report, the authors describe the first case of subcutaneous hyphomycosis with multiple cyst formation caused by this fungus. The patient is a 54-year old man who has Reiter's syndrome, liver cirrhosis, and coronary artery disease. He was receiving azathioprine and prednisone for arthritis. The pathology, mycology, and clinical course are discussed.