Türkiye'de sunulan ilk vaka; Immunocompetent hasta daChaetomium globosum türünün etken olduğu tırnak onikomikozu.

Yıl 2017, Cilt: 74 Sayı: 1, 71 - 78, 01.03.2017

Fatma Özakkaş Rabiye Altınbaş Hafize Sav Mert Ahmet Kuşkucu Kenan Midilli Nuri Kiraz

Öz

25 yaşında kadın hastanın sağ ayak başparmağındaki distal subungual onikomikoz rapor olarak sunuldu. Tırnak muayenesi laboratuvarımızda yapıldı ve hastada distal subungual onikomikoz saptandı. %20 KOH kullanılarak yapılan direkt mikroskobik incelemede; septalı hifler gözlemlendi. Hastadan alınan tırnak örnekleri Sabouraud’s Dextrose Agara ekildi ve 25 °C’de, bir hafta bekletildi. Fungal büyüme saptandıktan sonra direkt preparat hazırlandı, kahverengi septalı hifler, perithecia, limon benzeri askosporlar görüldü. Etken sekanslama ve konvansiyonel yöntemle Chaetomium globosum olarak tanımlandı. M38-A2 yöntemi kullanılarak amfotericin B, fluconazole, itraconazole, miconazole, ketoconazole, flucytosine voriconazole MİK değerleri sırasıyala 4->64, 1-0, 125, 0,125->64, 0,5 μg/mL olarak belirlendi. Chaetomium globosum için fluorocytosine ve fluconazole dirençli olarak saptanırken miconazole ve ketoconazole MİK değerleri en etkili olarak saptandı. Hasta günlük 250 mg/gün oral itraconazole ve amorolfin %5 tırnak cilası kullandı ve 12 haftada iyileşme kayıt edildi

Anahtar Kelimeler

chaetomium, onikomikoz

The first Turkish case of onychomycosis caused by Chaetomium globosum in an immunocompetent patient

Öz

It was reported as a case of distal subungual onychomycosis of the thumb of the right foot of a 25-year-old female patient in this article. Nail was examined in our laboratory and it was detected distal subungual onycomycosis. In direct microbiological examination septate hyphae was observed by using 20% KOH. Scraping of nail taken from patient was cultured on two Sabouraud’s Dextrose Agar with cycloheximide and without cycloheximide and it was keept at 25 °C for one week. After growth of fungal was detected slide cultures were prepared and brown-colored septated hyphae, perithecia, lemon-shaped ascospores were observed by light microscopy. The causative agent was identified as Chaetomium globosum. It was determnied by using M38-A2 microdilution method, minimum inhibitory concentration values of, amphotericin B fluconazole, itracanozole, miconazole, ketoconazole, flucytosine voriconazole were determined as 4->64, 1-0.125, 0.125->64-0.5 μg/mL, respectively. Fluorocytosine and fluconazole were determined as resistant for Chaetomium globosum while miconazole and ketoconazole MIC values was determined as the best effective antifungal. The patient was treated by using oral itraconazole daily 250 mg /a day and local application of amorolfine 5% nail lacquer was used and it was seen to heal in 12 weeks

Anahtar Kelimeler

chaetomium, onychomycosis, antifungal susceptibiltiy

Kaynakça

• Fernández MS, Rojas FD, Cattana ME, Sosa Mde L, Mangiaterra ML, Giusiano GE. Aspergillus terreus complex: an emergent opportunistic agent of Onychomycosis. Mycoses,2013; 56 (4): 477-81.
• Hwang SM, Suh MK, Ha GY. Onychomycosis due to nondermatophytic molds. Ann Dermatol ,2012; 24 (2): 175-80.
• Cuomo CA, Untereiner WA, Li-Jun Ma, Grabherr M, Birren BW. Draft genome sequence of the cellulolytic fungus Chaetomium globosum. Genome Announc, 2015; 26; 3(1): pii:e00021-15.
• Udagawa S, Muroi T, Kurata H, Sekita S, Yoshihira K, Natori S, et al. The production of chaetoglobosins, sterigmatocystin, omethylsterigmatocystin, and chaetocin by Chaetomium spp. and related fungi. Can J Microbiol, 1979; 25 (2): 170-7.
• Kane J, Summerbell R, Sigler L, Krajden S, Land J. Laboratory Handbook of Dermatophytes. 9th, USA: Star Publishing Company, 1997.
• Samson RA, Houbraken J, Thrane U, Frisvad JC, Andersen B. Food and Indoor Fungi. Netherlands: CBS-KNAW Fungal Biodiversity Centre, 2010.
• Nielsen KF, Gravesen S, Nielsen PA, Andersen B, Thrane U, Frisvad JC. Production of mycotoxins on artificially and naturally infested building materials. Mycopathologia, 1999;145(1):43-56.
• de Hoog GS, Guarro J, Figueras MJ. Atlas of Clinical Fungi: The Ultimate Benchtool for Diagnostics. 4th. Netherlands: CBS-KNAW Fungal Biodiversity Centre, 2015.
• Serena C, Ortoneda M, Capilla J, Pastor FJ, Sutton DA, Rinaldi MG, et al. In vitro activities of new antifungal agents against Chaetomium spp. and inoculum standardization. Antimicrob Agents Chemother, 2003; 47 (10): 3161-4.
• Lindsley MD, Hurst SF, Iqbal NJ, Morrison CJ. Rapid identification of dimorphic and yeast-like fungal pathogens using specific DNA probes. J Clin Microbiol, 2001; 39 (10): 3505-11.
• Anonymous. Clinical and Laboratory Standards Institute. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Filamentous Fungi. CLSI Document M38-A2. USA: Clinical and Laboratory Standards Institute, Wayne, PA, 2008.
• Falcón CS, Falcón Ma del Mar S, Ceballos JD, Florencio VD, Erchiga VC, Ortega SS. Onychomycosis by Chaetomium spp. Mycoses, 2009; 52 (1): 77-9.
• Kim DM, Lee MH, Suh MK, Ha GY, Kim H, Choi JS. Onychomycosis caused by Chaetomium globosum. Ann Dermatol, 2013; 25 (2): 232-6.
• Aspiroz C, Gené J, Rezusta A, Charlez L, Summerbell RC. First Spanish case of onychomycosis caused by Chaetomium globosum. Med Mycol, 2007; 45 (3): 279-82.
• Stiller MJ, Rosenthal S, Summerbell RC, Pollack J, Chan A Onychomycosis of the toenails caused by Chaetomium globosum. J Am Acad Dermatol, 1992; 26 (5 Pt 1): 775-6.
• Hattori N, Adachi M, Kaneko T, Shimozuma M, Ichinohe M, Iozumi K. Case report. Onychomycosis due to Chaetomium globosum successfully treated with itraconazole. Mycoses, 2000; 43(1-2): 89-92.
• Lagacé J, Cellier E. A case report of a mixed Chaetomium globosum/trichophyton mentagrophytes onychomycosis. Med Mycol Case Rep, 2012; 16; 1(1): 76-8.
• Hay RJ, Baran R. Onychomycosis: a proposed revision of the clinical classification. J Am Acad Dermatol, 2011; 65 (6): 1219-27.
• Guarro J, Soler L, Rinaldi MG. Pathogenicity and antifungal susceptibility of Chaetomium species. Eur J Clin Microbiol Infect Dis, 1995;14 (7): 613-8.
• Finch JJ, Warshaw EM. Toenail onychomycosis: current and future treatment options. Dermatol Ther, 2007; 20 (1): 31-46.