Unusual dermatomycoses caused by Nannizzia nana : the geophilic origin of human infections
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ORIGINAL PAPER
Unusual dermatomycoses caused by Nannizzia nana: the geophilic origin of human infections Sebastian Gnat1 · Dominik Łagowski1 · Aneta Nowakiewicz1 · Mariusz Dyląg2 Received: 8 January 2020 / Accepted: 23 March 2020 © The Author(s) 2020
Abstract Background Fungal infections of the skin, hair, and nails are the largest and most widespread group of all mycoses. Nannizzia nana is a relatively rare etiological factor of dermatomycosis in humans, as it usually affects animals, e.g. pigs and boars. In addition to the zoophilic nature, there are also reports of the geophilic reservoir of this dermatophyte species. Objective In this study, we present symptomatic infections with N. nana aetiology in humans reported recently in Poland. Interestingly, these cases had a non-specific clinical picture and occurred as skin lesions on the neck and foot as well as onychomycosis of the toenails. From the medical history, the patients had no contact with pigs. Methods Diagnostics of these infections was performed with a combination of classical phenotypic and molecular genomic methods. The genomic diversity of the isolates was determined using the MP-PCR method. In vitro antifungal susceptibility tests against itraconazole, ketoconazole, terbinafine and naftifine hydrochloride were also performed. Results Nannizzia nana has been identified as an etiological factor of dermatomycosis. Moreover, heterogeneity of the genomes was revealed for the obtained strains. In vitro activities of antifungal agents showed that isolates were susceptible to all tested drugs. The patients were treated with oral terbinafine and topical ketoconazole cream, which led to a complete recovery. Conclusions In conclusion, the cases studied by us may indicate that the infrequency of N. nana infections may not necessarily be related to the low infectivity of this fungal agent, but they are rather associated with misdiagnosis. Furthermore, N. nana reservoirs should also be sought in soil. Keywords Nannizzia nana · Onychomycosis · Superficial infection · Diagnostics · Genetic diversity
Introduction Dermatophytes are keratinophilic fungi that affect nails, hairs, and skin of humans, warm-blooded animals, and others [1, 2]. Approximately, 20–25% of the global human population is infected with a dermatophyte at least once per lifetime [3, 4]. About 30 clinically relevant dermatophyte
* Sebastian Gnat [email protected] 1
Department of Veterinary Microbiology, Faculty of Veterinary Medicine, Institute of Biological Bases of Animal Diseases, University of Life Sciences in Lublin, Akademicka 12, 20‑033 Lublin, Poland
Department of Mycology and Genetics, Faculty of Biological Sciences, Institute of Genetics and Microbiology, University of Wroclaw, Przybyszewskiego 63/77, 51‑148 Wroclaw, Poland
2
species are known, but their taxonomy has been controversial because of the incongruence of phenotypic and molecular characters [5, 6]. The genus Nannizzia was introduced by Stockdale [7] with Nannizzia incurvata Stockdale 1961 as a type
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