Dermatophytosis is the most common fungal infectious disease in the world, which is commonly caused by Trichophyton rubrum in China. The traditional therapies for treating dermatophytosis include topical and oral antifungal agents like terbinafine, griseofulvin, and azole antifungal drugs. However, 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) as a new alternative therapy avoids the side effects and drug resistance of traditional antifungal agents. We report two cases diagnosed as kerion and tinea faciei secondary to ulcers with CARD 9 deficiency, both of whom were infected by T.rubrum. They were both successfully treated by ALA-PDT combined with antifungal drugs, providing a feasible strategy for therapeutic choice for adult kerion and ulcer treatment.

Objective: Cutaneous and subcutaneous infectious granuloma (CSIG) is a broad group of inflammatory conditions that share important similarities in granulomatous reaction pattern and nonspecific clinical presentation. Here, we conducted the retrospective study to identify the clinical, pathological, and epidemiological correlations of CSIG cases at a signal center in China. Methods: Data of patients diagnosed with CSIG between January 1, 2011 and December 31, 2015 were retrospectively collected, including socio-demographic information, pathogen diagnosis, clinical features, pathological results, treatment, and prognosis. Results: This study included 256 patients (137 males and 119 females) with a mean age of 52 years. Infections were more common in those aged over 40 years old (76.17%). The most common pathogens were Mycobacterium leprae (26.56%), Sporothrix schenckii (23.83%), and Mycobacterium tuberculosis (15.63%). Mycobacterium marinum (8.98%) accounted for 51.11% of nontuberculous mycobacterial contagion. Lesions were most common in the distal extremities (32.03%). The predominant clinical forms were plaques (61/142, 42.96%) and nodules (41/142, 28.87%). Conclusions: Various pathogens were responsible for the CSIG cases in this study, with M. leprae being the most common. CSIG should be considered as a likely diagnosis for patients with lesions on exposed parts of the body that present as plaques or nodules and has a history of trauma.

2012 Elsevier Ltd. All rights reserved.

Objectives: This report documents the first isolation of rare dematiaceous fungus Brunneofusispora hyalina from a cutaneous lesion in a patient with heterozygous CARD9 variant. The study characterizes this novel pathogen and simulates infection and treatment processes to understand this opportunist and explore therapeutic strategies. Methods: Direct microscopy and histopathology confirmed the fungal infection. By collecting morphological images of the isolate, assessing temperature-dependent growth, performing multi-locus and whole-genome sequencing, and conducting antifungal susceptibility testing, the new pathogen’s virulence and antifungal resistance were comprehensively analyzed. Using CARD9-deficient mice to establish infection models and administer drug treatments. Results: The patient, confirmed by whole-exome sequencing to have a heterozygous CARD9 variant, was diagnosed with phaeohyphomycosis caused by B. hyalina through barcode sequencing. Meanwhile, functional annotation revealed metabolic versatility and enrichment in secondary metabolite pathways, while 395 PHI homologs were identified mainly from plant-pathogenic fungi. The strain exhibited abundant hyphal anastomosis and psychrotolerant growth. Antifungal susceptibility tests using modified agar dilution and broth dilution methods showed low MICs to voriconazole, posaconazole, itraconazole, and terbinafine, with values of 0.5-1 µg/mL, 0.5–2 µg/mL, 1–2 µg/mL, and 0.25–0.5 µg/mL, respectively. However, fluconazole showed a high MIC (128 µg/mL). In contrast, amphotericin B inhibitory concentrations differed substantially between two testing methods, with discrepancies exceeding three twofold dilution titers. In a CARD9 knockout mouse model, B. hyalina caused persistent inflammatory infections without mortality, whereas infection in wild-type mice had self-limiting symptoms. Despite six weeks of combined antifungal therapy, complete eradication of infection was not achieved. Conclusions: B. hyalina is a new opportunistic fungus causing phaeohyphomycosis, particularly in individuals with CARD9 variants. Genomic analysis shows that B. hyalina shares many genes with plant pathogens and lacks specialized human virulence factors, suggesting that host immune vulnerability is key to infection. While antifungal drugs such as triazoles and terbinafine demonstrate low inhibitory concentrations in vitro , combination therapy in mouse models reduces fungal burden but does not completely clear the infection, indicating the necessity for prolonged treatment in immunocompromised hosts. Future exploration may focus on immune restoration and hyperthermia, which may complement antifungal therapy and improve outcomes.

Objective: The objective of the study is to investigate the epidemiological characteristics and influencing factors of hand eczema (HE) among nursing staff in certain regions of Xinjiang during the COVID-19 pandemic.