First case of chromoblastomycosis due to Phoma insulana | Enfermedades Infecciosas y Microbiología Clínica (English Edition)

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Subscript: other species: 4 C. freundii (3 KPC, 1 VIM), 2 E. coli (2 VIM), 2 K. oxytoca (1 OXA-48, 1 KPC), 1 P. mirabilis (OXA-48) and 1 S. marcescens (VIM)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Patricia Brañas, Marta Gil, Jennifer Villa, María Ángeles Orellana, Fernando Chaves" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Patricia" "apellidos" => "Brañas" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Gil" ] 2 => array:2 [ "nombre" => "Jennifer" "apellidos" => "Villa" ] 3 => array:2 [ "nombre" => "María Ángeles" "apellidos" => "Orellana" ] 4 => array:2 [ "nombre" => "Fernando" "apellidos" => "Chaves" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213005X16303196" "doi" => "10.1016/j.eimc.2016.10.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X16303196?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X18300121?idApp=UINPBA00004N" "url" => "/2529993X/0000003600000002/v2_201802191141/S2529993X18300121/v2_201802191141/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2529993X1830011X" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2016.08.004" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "1595" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Enferm Infecc Microbiol Clin. 2018;36:91-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 393 "formatos" => array:2 [ "HTML" => 292 "PDF" => 101 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Brief report" "titulo" => "A safe an easy method for building consensus HIV sequences from 454 massively parallel sequencing data" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "91" "paginaFinal" => "94" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Validación de un método seguro y sencillo para la elaboración de secuencias consenso del virus de la inmunodeficiencia humana a partir de los datos de secuenciación masiva 454" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1265 "Ancho" => 3000 "Tamanyo" => 194961 ] ] "descripcion" => array:1 [ "en" => "Bootscan of the Sanger sequence (A), NGS-10% consensus sequence (B) and NGS-20% consensus sequence (C), using the REGA HIV-1 Subtyping Tool v. 3.0. 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(c) Abundant pigmented chlamydoconidia (10í); insert: magnification of a chlamydoconidium (scale bar: 10α/4m). (d) Globose picnidium (scale bar: 50α/4m), showing three ostiolae (arrows). (e) Polymorphic cells of the picnidium wall (scale bar: 10α/4m). (f) Abundant small and ellipsoidal conidia (40í); insert: magnification of conidia (scale bar: 5α/4m)." ] ] ] "textoCompleto" => "IntroductionChromoblastomycosis is an infection caused by the traumatic implantation of species of dematiaceous fungi, primarily in the skin and subcutaneous tissues of the lower limbs. The disease generally starts as a cutaneous nodule or papule which gradually increases in the adjacent areas and develops a scaly, greyish surface. After the lesion may evolve into one of the following described clinical forms: the nodular, tumoral, verrucous, cicatricial and plaque types. Histologically, a granulomatous reaction associated with acanthosis and pseudoepitheliomatous hyperplasia in the stratum corneum and epidermis is observed. The fungal structure in infected scales or tissues appears as rounded, dark-brown yeast-like bodies (5•15α/4m in diameter) with thick, planate-dividing walls that are known as sclerotic cells (also referred as “copper pennies,” “fumagoid cells,” “Medlar bodies,” or “muriform cells”).<a class="elsevierStyleCrossRef" href="#bib0080">1</a>Chromoblastomycosis is a frequent disease in countries with tropical and subtropical climates, particularly in Latin America, Africa and Asia. The most frequent causative agents are Fonsecaea pedrosoi, F. compacta, Phialophora verrucosa, Cladophialophora carrionii, and Rhinocladiella aquaspersa. These fungi inhabit the soil and vegetal matter; therefore, the disease is more frequent in rural populations.<a class="elsevierStyleCrossRef" href="#bib0085">2</a>This work describes the case of a patient living in deficient hygienic and socioeconomic conditions who presented a chronic subcutaneous infection compatible with chromoblastomycosis. The identified etiological agent has not been previously associated with this pathology.CaseDuring a health campaign in rural areas organized by the Faculty of Chemical Sciences at the Autonomous University of Oaxaca the patient of this case was addressed. He was an indigent 79-year-old man, resident in Miahuatlan, Oaxaca (Mexico), and was a peasant with a history of chronic alcoholism and smoking. He began his current dermatological illness 27 years ago after the use of tight footwear that caused a laceration on his right heel. From that time, his lesion changed, with progressive thickening, pigmentation and peeling of the local skin. Several small nodules appeared and extended to the foot. The patient applied several empirical and aggressive treatments without improvement. He also sought medical assistance, but the treatment yielded unsatisfactory results. Five years ago, the presence of a progressive ulcerative lesion was detected.On physical examination, pigmented verrucous plaques were observed, predominantly on the anterior side, heel and internal side of the right foot. Moderate oedema and thick, yellow and adherent squamae were noteworthy on the leg. The patient had an ulcer located on the internal side of the lower third of the leg (10cmí5cm), with a well-defined border and a haematopurulent and foetid exudate. Additionally, larvae (miasis) were observed in the ulcer. The patient did not report symptoms localized in the affected zone but manifested asthenia, adynamia and general discomfort. He presented pallor, hearing loss, uncontrolled salivation, involuntary movements of both hands, and urinary incontinence. Authorization to take an image of his lesion was obtained (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a). Additionally, scales and blood samples were collected for mycological study and analysis, respectively.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Laboratory studiesHaematological analysis revealed values within normal parameters.Mycological studyMicroscopic examination of the skin scales with 20% potassium hydroxide showed individual or grouped, brown, thick-walled, planate-dividing round cells, 10α/4mí13α/4m in diameter, compatible with fumagoid cells (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). The scales were cultivated on Sabouraud dextrose agar (SDA) with and without antibiotics at 28°C, with periodic revision. After two weeks, several small, pigmented, downy colonies were observed on SDA without antibiotics. No growth was present on SDA with antibiotics, and these tubes were discarded after three weeks of incubation. Microscopic examination of the primary culture revealed pigmented and irregular hyphae, and swollen cells, insufficient features to identify the fungus (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>c).After observation of fumagoid cells in scales and a dematiaceous fungus in culture, the chromoblastomycosis diagnosis was established. The patient was visited at home and informed about his disease. However, he refused any topical or systemic treatment, and a follow-up visit was not possible. After the final identification of the fungal isolate, a colleague again went to visit the patient around three months later. The neighbours informed about the patient's death due to “cardiac failure”.Morphological studyThe fungus was grown on SDA, on potato dextrose agar (PDA) and on lactrimel agar (LA) for 6 days at 28°C. The microscopic morphology on SDA and PDA was similar to that observed for the primary isolate, but it revealed numerous chlamydoconidia on LA. After four weeks on PDA, many irregular and round pycnidia were observed. The fungus was later grown on malt extract agar (MEA) and on oat agar (OA) for 8 days at 28°C (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>a and b). The size of colony was 7.0 and 6.7cm of diameter, respectively. Microscopic morphology on two media was similar, but only description on OA is done. Abundant globose or piriformis, intercalary, terminal or in chains, of variable size (5•14α/4m diameter) chlamydospores, were observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>c). Numerous globose (200α/4m), piriformis (200α/4mí360α/4m) or irregular pycnidia, with one to three ostioles or pores (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>d) were observed. Polyhedral cells formed the pycnidial wall (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>e). Abundant ellipsoidal, hyaline conidia with one or two polar guttules emerging from picnidia were present (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>f). Conidial matrix whitish was evident. The morphological characteristics were integrated according to Boerema et al.<a class="elsevierStyleCrossRef" href="#bib0090">3</a><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Molecular identificationDNA was extracted from a monosporic culture in Sabouraud dextrose broth using the GeneAll Exgene Plant SV mini kit (GeneAll Biotechnology Co., Ltd., Seoul, Korea). Three PCR reactions were performed to target the ITS region, the actin gene and the beta-tubulin gene, according to the methodology of the Q-bank Fungi database for Phoma and Phoma-like fungi. The amplified fragments were purified using the QIAquick PCR Purification Kit (Qiagen, Hilden, Germany) and sequenced in two directions using an ABI3130/3130xl Genetic Analyzer (Applied Biosystems/Hitachi, Foster City, CA, USA). The sequences were analyzed according to the Q-bank Fungi database. The results of this analysis indicated a high similarity with Phoma insulana CBS 252.92 (ITS and ACT 100%, GenBank GU237810; TUB 99.676%, GenBank GU237618). The molecular and morphological studies were compatible. The nucleotide sequences were deposited in GenBank under the accession numbers KR921746 (ITS), KT163805 (ACT), and KT163806 (TUB). The strain was deposited in the Colección de Microorganismos, Centro de Investigación y Estudios Avanzados, Instituto Politèc)cnico Nacional, Mèc)xico, as CDBB-H-1229.Antifungal susceptibility testingThe microdilution broth testing was performed in duplicate for itraconazole, voriconazole, posaconazole, fluconazole and amphotericin B, following the recommendations of the Clinical Laboratory Standard Institute (CLSI) M-38 A2 for filamentous fungi.<a class="elsevierStyleCrossRef" href="#bib0095">4</a> The MICs for P. insulana were: itraconazole and posaconazole, 0.06α/4g/mL; voriconazole 0.25α/4g/mL; fluconazole 16.0α/4g/mL, and amphotericin B 2.0α/4g/mL. Therefore the highest antifungal activity corresponded to itraconazole and posaconazole.DiscussionPhoma (Saccardo 1880; Sacc emend. Boerema & G.J. Bollen) is an anamorphic, complex constituted by dematiaceous fungi. These organisms inhabit soil, organic debris, and water and include species that parasitize other fungi, insects and vertebrates. Approximately 10 species are reported as opportunistic or primary human pathogens.<a class="elsevierStyleCrossRef" href="#bib0100">5</a>In 1970, Bakerspigel (cited in 6 and 7) reported the first case of human infection caused by Phoma (Phoma hibernica). Currently there are at least 30 reports of human infections caused by Phoma spp. as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<a class="elsevierStyleCrossRefs" href="#bib0105">6•13</a><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Different therapeutic resources have been used in clinical cases, most with satisfactory outcomes. In a recent in vitro antifungal susceptibility study, posaconazole and voriconazole showed the best activity against dematiaceous fungi including Phoma isolates. In that study amphotericin B and fluconazole were the least active drugs.<a class="elsevierStyleCrossRef" href="#bib0145">14</a> These last findings are similar to those observed for P. insulana.Five genera of dematiaceous fungi are the main causative agents of chromoblastomycosis in the world. In Mexico the frequency of the agents is: F. pedrosoi (95.8%), C. carrionii (1.1%), P. verrucosa (0.6%), R. aquaspersa (0.2%) and E. spinifera (0.2%).<a class="elsevierStyleCrossRef" href="#bib0150">15</a> Here we inform an additional genus associated with this pathology.In this work we report a case diagnosed as chromoblastomycosis based on the following data: (a) Disease began after skin trauma. (b) The clinical manifestations consisted of lesions with verrucous aspect and chronic evolution. (c) The microscopic examination of scales showed fumagoid cells, fungal structures associated only to chromoblastomycosis. (d) On culture developed several colonies of a dematiaceous fungus, kind of fungi described as etiological agents of phaeohyphomycosis or chromoblastomycosis. Due to patient tm) reluctance, it was not possible to carry out the histopatological study which would reveal in addition fumagoid cells, a tissue response consisted of pseudoepitheliomatous hyperplasia, acanthosis and hyperkeratosis. Accordingly it was not possible prescribe him an appropriate treatment.To the best of our knowledge, this is the first report of chromoblastomycosis caused by P. insulana.Conflict of interestThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres986162" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec953793" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres986163" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec953794" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Case" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Laboratory studies" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Mycological study" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Morphological study" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Molecular identification" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Antifungal susceptibility testing" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack334265" "titulo" => "Acknowledgements" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-07-06" "fechaAceptado" => "2016-08-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec953793" "palabras" => array:5 [ 0 => "Chromoblastomycosis" 1 => "Phoma spp." 2 => "Phoma insulana" 3 => "Chromomycosis" 4 => "Subcutaneous mycosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec953794" "palabras" => array:5 [ 0 => "Cromoblastomicosis" 1 => "Phoma spp." 2 => "Phoma insulana" 3 => "Cromomicosis" 4 => "Micosis subcutáneas" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Chromoblastomycosis is a chronic infection, caused by pigmented fungi affecting skin and subcutaneous tissues characterized by verrucous nodules or plaques. Fonsecaea pedrosoi and Cladophialophora carrionii are the prevalent agents in the endemic areas. Phoma is an uncommon agent of human infection and involved mainly with phaeohyphomycosis cases. The case of a patient with a history of laceration in foot followed by verrucous aspect and scaly lesions, which had evolved for 27 years is presented. On physical examination disease was clinically compatible with chromoblastomycosis and the microscopic examination of scales showed fumagoid cells. On culture a dematiaceous fungus was grown. The agent was confirmed to be Phoma insulana based on its morphology and PCR-sequencing. This fungal agent has not been previously reported in association with this pathology." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La cromoblastomicosis es una infección crónica causada por hongos pigmentados que afecta la piel y el tejido subcutáneo y que se caracteriza por nódulos o placas verrugosas. Fonsecaea pedrosoi y Cladophialophora carrionii son los agentes prevalentes en las áreas endèc)micas. Phoma es un agente raro de infección humana y está involucrado principalmente en casos de feohifomicosis. Se presenta el caso de un paciente con antecedente de laceración en el pie, seguida de lesiones de aspecto verrugoso y descamativas, que evolucionaron durante 27años. En el examen físico la enfermedad fue clínicamente compatible con cromoblastomicosis y el examen microscópico de escamas mostró cèc)lulas fumagoides. En el cultivo creció un hongo dematiáceo. El agente fue confirmado como Phoma insulana en base a su morfología y PCR seguida de secuenciación. Este agente fúngico no ha sido reportado previamente en asociación con esta patología." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 473 "Ancho" => 1802 "Tamanyo" => 198059 ] ] "descripcion" => array:1 [ "en" => "(a) Pigmented verrucous lesions on the foot (arrows), an ulcerative lesion (*) on the lower part of the leg, and yellowish, thick, crusty lesions on the leg are observed. (b) Microscopic examination of scales, showing thick walled, round-to-ovoid brown cells with septa characteristic of fumagoid cells (40í). (c) Microscopic examination with lactophenol blue from primary culture: irregular and pigmented hyphae with internal guttules, chlamydoconidia-like cells and some septate globose structures similar to fumagoid cells (arrows) are observed (scale bar: 10α/4m)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1510 "Ancho" => 2003 "Tamanyo" => 504528 ] ] "descripcion" => array:1 [ "en" => "Culture on OA (a) and MEA (b) after 8 days of growth, showing pigmented, woolly, green olivaceous colonies. (c) Abundant pigmented chlamydoconidia (10í); insert: magnification of a chlamydoconidium (scale bar: 10α/4m). (d) Globose picnidium (scale bar: 50α/4m), showing three ostiolae (arrows). (e) Polymorphic cells of the picnidium wall (scale bar: 10α/4m). (f) Abundant small and ellipsoidal conidia (40í); insert: magnification of conidia (scale bar: 5α/4m)." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "ACited in 6; BCited in 7. Species names are given as reported by authors. The following current taxonomic names were taken from Index Fungorum. Peyronellaea: included in Phoma section Peyronellaea; Phoma cava: Pyrenochaeta cava; Phoma minutispora: Westerdikella minutispora; Pleurophoma pleurospora: Dinemasporium pleurospora; Phoma sorghina: Epicoccum sorghinum; Phoma exigua: Boeremia exigua." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex/age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Underlying factor \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Localization \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Species \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Janke (1956)A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F/49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">• \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lungs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Peyronellaea n. sp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">• \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">• \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bakerspigel et al. (1970)A,B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F/22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Topical steroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Leg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma hibernica \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Griseofulvin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clinical improvement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Young et al. (1973)A,B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F/42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Renal transplant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous, heel \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma sp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Debridement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gordon et al. (1975)A,B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Otherwise healthy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Superficial, ear \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma cava \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Griseofulvin Steroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Punithalingan (1979)A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F/ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral steroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Corneal lesions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma cruris-hominis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">• \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">• \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bakerspigel et al. (1981)A,B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/18 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Otherwise healthy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cutaneous, perioral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma eupyrena \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clotrimazole, 15% zinc oxide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Shukla et al. (1984)A,B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F/18 M/20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Both topical steroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Superficial face Superficial neck \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Both Phoma minutispora \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Both Clotrimazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Both Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baker et al. (1987)A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Diabetes mellitus Cortico-therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous, foot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma minutella \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Debridement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Amputation for gangrene \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stone et al. (1988)A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Otherwise healthy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Forearm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma sp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ketoconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dooley et al. (1989)A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F/56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Renal transplant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Legs, arm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pleurophoma pleurospora \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Miconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rai (1989)A,B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/24 M/19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Both otherwise healthy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Superficial face, neck, hands Superficial face \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Both Phoma sorghina \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Both Miconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Both Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Morris et al. (1995)<a class="elsevierStyleCrossRef" href="#bib0115">8</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F/24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chemotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lung \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma sp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Amphotericin B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hirsh and Schiff (1996)A,B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Otherwise healthy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous, hand \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma sp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ketoconazole, Itraconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rosen et al. (1996)A,B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F/24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Otherwise healthy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cutaneous, facial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pleurophoma (Phoma) sp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ketoconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zaitz et al. (1997)A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cortico-therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous, hand \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma cava \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Amphotericin B, Itraconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arrese et al. (1997)B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cortico-therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cutaneous, plantar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma sp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bifonazole, Ketoconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Failure. Patient lost \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oh et al. (1999)B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Topical steroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma sp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Itraconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Everett et al. (2003)B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F/50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Renal transplant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hand deep compartment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma sp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Debridement, Amphotericin B, Fluconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rishi and Font (2003)B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Globe trauma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Keratitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma sp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Debridement, Keratectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balis et al. (2006)B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acute myeloid, leukaemia, Diabetes Mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lung \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma exigua \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fluconazole, Amphotericin B, Pneumonectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Death \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kalyani et al. (2006)<a class="elsevierStyleCrossRef" href="#bib0120">9</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Renal transplant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous, forearm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma sp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fluconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Errera et al. (2008)B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Penetrating globe injury \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Endophtalmic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma glomerata \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Amphotericin B, Voriconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tullio et al. (2010)B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F/36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Otherwise healthy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nail, toe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma herbarum/Ph. boeremae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Allylamine, Sertaconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Metzger et al. (2010)<a class="elsevierStyleCrossRef" href="#bib0125">10</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Saxophone player \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lungs (Hypersensi-tivity pneumonitis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma sp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Methylprednisolone Cleaning of saxophone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vasoo et al. (2011)<a class="elsevierStyleCrossRef" href="#bib0130">11</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Diabetes Mellitus Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phaeomycotic cysts, forearm and hand \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma sp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Itraconazole, Excision \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Roehm et al. (2012)<a class="elsevierStyleCrossRef" href="#bib0105">6</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F/1 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chemotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Invasive rhinosinusitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma sp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Debridement Amphotericin B Posaconazole Voriconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Death \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jung et al. (2014)<a class="elsevierStyleCrossRef" href="#bib0135">12</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recurrent herpes simplex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Keratitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma glomerata \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Amphotericin B, Natamycin, Fluconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution with opacification \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kumar et al. (2015)<a class="elsevierStyleCrossRef" href="#bib0140">13</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F/79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Contact lens \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Keratitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma sp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Itraconazole, Amphotericin B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Present case \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M/79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chronic alcoholism and smoking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Subcutaneous, foot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Phoma insulana \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Patient lost Death \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1673993.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Literature review of human pathology cases associated with Phoma spp." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chromoblastomycosis: an overview of clinical manifestations, diagnosis and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F. 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Brief report

First case of chromoblastomycosis due to Phoma insulana

Primer caso de cromoblastomicosis causado por Phoma insulana

Francisca Hernández-Hernándeza,

Corresponding author

frank-hh@comunidad.unam.mx

Corresponding author.

, Jaime Vargas-Arzolab, Oliver Pedro Ríos-Cruzb, Erika Córdova-Martíneza, Patricia Manzano-Gayossoa, Aristeo Segura-Salvadorb

a Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de Mèc)xico, Ciudad de Mèc)xico, D.F., Mexico

b Facultad de Ciencias Químicas, Universidad Autónoma ¢Benito Juárez¢, Oaxaca, Mexico

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        "titulo" => "Primer caso de cromoblastomicosis causado por <span class="elsevierStyleItalic">Phoma insulana</span>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Culture on OA &#40;a&#41; and MEA &#40;b&#41; after 8 days of growth&#44; showing pigmented&#44; woolly&#44; green olivaceous colonies&#46; &#40;c&#41; Abundant pigmented chlamydoconidia &#40;10&#237;&#41;&#59; insert&#58; magnification of a chlamydoconidium &#40;scale bar&#58; 10<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m&#41;&#46; &#40;d&#41; Globose picnidium &#40;scale bar&#58; 50<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m&#41;&#44; showing three ostiolae &#40;arrows&#41;&#46; &#40;e&#41; Polymorphic cells of the picnidium wall &#40;scale bar&#58; 10<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m&#41;&#46; &#40;f&#41; Abundant small and ellipsoidal conidia &#40;40&#237;&#41;&#59; insert&#58; magnification of conidia &#40;scale bar&#58; 5<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chromoblastomycosis is an infection caused by the traumatic implantation of species of dematiaceous fungi&#44; primarily in the skin and subcutaneous tissues of the lower limbs&#46; The disease generally starts as a cutaneous nodule or papule which gradually increases in the adjacent areas and develops a scaly&#44; greyish surface&#46; After the lesion may evolve into one of the following described clinical forms&#58; the nodular&#44; tumoral&#44; verrucous&#44; cicatricial and plaque types&#46; Histologically&#44; a granulomatous reaction associated with acanthosis and pseudoepitheliomatous hyperplasia in the stratum corneum and epidermis is observed&#46; The fungal structure in infected scales or tissues appears as rounded&#44; dark-brown yeast-like bodies &#40;5&#8226;15<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m in diameter&#41; with thick&#44; planate-dividing walls that are known as sclerotic cells &#40;also referred as &#8220;copper pennies&#44;&#8221; &#8220;fumagoid cells&#44;&#8221; &#8220;Medlar bodies&#44;&#8221; or &#8220;muriform cells&#8221;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Chromoblastomycosis is a frequent disease in countries with tropical and subtropical climates&#44; particularly in Latin America&#44; Africa and Asia&#46; The most frequent causative agents are <span class="elsevierStyleItalic">Fonsecaea pedrosoi</span>&#44; <span class="elsevierStyleItalic">F&#46; compacta</span>&#44; <span class="elsevierStyleItalic">Phialophora verrucosa</span>&#44; <span class="elsevierStyleItalic">Cladophialophora carrionii</span>&#44; and <span class="elsevierStyleItalic">Rhinocladiella aquaspersa</span>&#46; These fungi inhabit the soil and vegetal matter&#59; therefore&#44; the disease is more frequent in rural populations&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This work describes the case of a patient living in deficient hygienic and socioeconomic conditions who presented a chronic subcutaneous infection compatible with chromoblastomycosis&#46; The identified etiological agent has not been previously associated with this pathology&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case</span><p id="par0020" class="elsevierStylePara elsevierViewall">During a health campaign in rural areas organized by the Faculty of Chemical Sciences at the Autonomous University of Oaxaca the patient of this case was addressed&#46; He was an indigent 79-year-old man&#44; resident in Miahuatlan&#44; Oaxaca &#40;Mexico&#41;&#44; and was a peasant with a history of chronic alcoholism and smoking&#46; He began his current dermatological illness 27 years ago after the use of tight footwear that caused a laceration on his right heel&#46; From that time&#44; his lesion changed&#44; with progressive thickening&#44; pigmentation and peeling of the local skin&#46; Several small nodules appeared and extended to the foot&#46; The patient applied several empirical and aggressive treatments without improvement&#46; He also sought medical assistance&#44; but the treatment yielded unsatisfactory results&#46; Five years ago&#44; the presence of a progressive ulcerative lesion was detected&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">On physical examination&#44; pigmented verrucous plaques were observed&#44; predominantly on the anterior side&#44; heel and internal side of the right foot&#46; Moderate oedema and thick&#44; yellow and adherent squamae were noteworthy on the leg&#46; The patient had an ulcer located on the internal side of the lower third of the leg &#40;10<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#237;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm&#41;&#44; with a well-defined border and a haematopurulent and foetid exudate&#46; Additionally&#44; larvae &#40;miasis&#41; were observed in the ulcer&#46; The patient did not report symptoms localized in the affected zone but manifested asthenia&#44; adynamia and general discomfort&#46; He presented pallor&#44; hearing loss&#44; uncontrolled salivation&#44; involuntary movements of both hands&#44; and urinary incontinence&#46; Authorization to take an image of his lesion was obtained &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a&#41;&#46; Additionally&#44; scales and blood samples were collected for mycological study and analysis&#44; respectively&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Laboratory studies</span><p id="par0030" class="elsevierStylePara elsevierViewall">Haematological analysis revealed values within normal parameters&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Mycological study</span><p id="par0035" class="elsevierStylePara elsevierViewall">Microscopic examination of the skin scales with 20&#37; potassium hydroxide showed individual or grouped&#44; brown&#44; thick-walled&#44; planate-dividing round cells&#44; 10<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m<span class="elsevierStyleHsp" style=""></span>&#237;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m in diameter&#44; compatible with fumagoid cells &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>b&#41;&#46; The scales were cultivated on Sabouraud dextrose agar &#40;SDA&#41; with and without antibiotics at 28<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; with periodic revision&#46; After two weeks&#44; several small&#44; pigmented&#44; downy colonies were observed on SDA without antibiotics&#46; No growth was present on SDA with antibiotics&#44; and these tubes were discarded after three weeks of incubation&#46; Microscopic examination of the primary culture revealed pigmented and irregular hyphae&#44; and swollen cells&#44; insufficient features to identify the fungus &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>c&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">After observation of fumagoid cells in scales and a dematiaceous fungus in culture&#44; the chromoblastomycosis diagnosis was established&#46; The patient was visited at home and informed about his disease&#46; However&#44; he refused any topical or systemic treatment&#44; and a follow-up visit was not possible&#46; After the final identification of the fungal isolate&#44; a colleague again went to visit the patient around three months later&#46; The neighbours informed about the patient&#39;s death due to &#8220;cardiac failure&#8221;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Morphological study</span><p id="par0045" class="elsevierStylePara elsevierViewall">The fungus was grown on SDA&#44; on potato dextrose agar &#40;PDA&#41; and on lactrimel agar &#40;LA&#41; for 6 days at 28<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; The microscopic morphology on SDA and PDA was similar to that observed for the primary isolate&#44; but it revealed numerous chlamydoconidia on LA&#46; After four weeks on PDA&#44; many irregular and round pycnidia were observed&#46; The fungus was later grown on malt extract agar &#40;MEA&#41; and on oat agar &#40;OA&#41; for 8 days at 28<span class="elsevierStyleHsp" style=""></span>&#176;C &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a and b&#41;&#46; The size of colony was 7&#46;0 and 6&#46;7<span class="elsevierStyleHsp" style=""></span>cm of diameter&#44; respectively&#46; Microscopic morphology on two media was similar&#44; but only description on OA is done&#46; Abundant globose or piriformis&#44; intercalary&#44; terminal or in chains&#44; of variable size &#40;5&#8226;14<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m diameter&#41; chlamydospores&#44; were observed &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>c&#41;&#46; Numerous globose &#40;200<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m&#41;&#44; piriformis &#40;200<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m<span class="elsevierStyleHsp" style=""></span>&#237;<span class="elsevierStyleHsp" style=""></span>360<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m&#41; or irregular pycnidia&#44; with one to three ostioles or pores &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>d&#41; were observed&#46; Polyhedral cells formed the pycnidial wall &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>e&#41;&#46; Abundant ellipsoidal&#44; hyaline conidia with one or two polar guttules emerging from picnidia were present &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>f&#41;&#46; Conidial matrix whitish was evident&#46; The morphological characteristics were integrated according to Boerema et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Molecular identification</span><p id="par0050" class="elsevierStylePara elsevierViewall">DNA was extracted from a monosporic culture in Sabouraud dextrose broth using the GeneAll Exgene Plant SV mini kit &#40;GeneAll Biotechnology Co&#46;&#44; Ltd&#46;&#44; Seoul&#44; Korea&#41;&#46; Three PCR reactions were performed to target the ITS region&#44; the actin gene and the beta-tubulin gene&#44; according to the methodology of the Q-bank Fungi database for <span class="elsevierStyleItalic">Phoma</span> and <span class="elsevierStyleItalic">Phoma</span>-like fungi&#46; The amplified fragments were purified using the QIAquick PCR Purification Kit &#40;Qiagen&#44; Hilden&#44; Germany&#41; and sequenced in two directions using an ABI3130&#47;3130xl Genetic Analyzer &#40;Applied Biosystems&#47;Hitachi&#44; Foster City&#44; CA&#44; USA&#41;&#46; The sequences were analyzed according to the Q-bank Fungi database&#46; The results of this analysis indicated a high similarity with <span class="elsevierStyleItalic">Phoma insulana</span> CBS 252&#46;92 &#40;ITS and ACT 100&#37;&#44; GenBank GU237810&#59; TUB 99&#46;676&#37;&#44; GenBank GU237618&#41;&#46; The molecular and morphological studies were compatible&#46; The nucleotide sequences were deposited in GenBank under the accession numbers KR921746 &#40;ITS&#41;&#44; KT163805 &#40;ACT&#41;&#44; and KT163806 &#40;TUB&#41;&#46; The strain was deposited in the Colecci&#243;n de Microorganismos&#44; Centro de Investigaci&#243;n y Estudios Avanzados&#44; Instituto Polit&#232;c&#41;cnico Nacional&#44; M&#232;c&#41;xico&#44; as CDBB-H-1229&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Antifungal susceptibility testing</span><p id="par0055" class="elsevierStylePara elsevierViewall">The microdilution broth testing was performed in duplicate for itraconazole&#44; voriconazole&#44; posaconazole&#44; fluconazole and amphotericin B&#44; following the recommendations of the Clinical Laboratory Standard Institute &#40;CLSI&#41; M-38 A2 for filamentous fungi&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> The MICs for <span class="elsevierStyleItalic">P&#46; insulana</span> were&#58; itraconazole and posaconazole&#44; 0&#46;06<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4g&#47;mL&#59; voriconazole 0&#46;25<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4g&#47;mL&#59; fluconazole 16&#46;0<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4g&#47;mL&#44; and amphotericin B 2&#46;0<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4g&#47;mL&#46; Therefore the highest antifungal activity corresponded to itraconazole and posaconazole&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Phoma</span> &#40;Saccardo 1880&#59; Sacc emend&#46; Boerema &#38; G&#46;J&#46; Bollen&#41; is an anamorphic&#44; complex constituted by dematiaceous fungi&#46; These organisms inhabit soil&#44; organic debris&#44; and water and include species that parasitize other fungi&#44; insects and vertebrates&#46; Approximately 10 species are reported as opportunistic or primary human pathogens&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In 1970&#44; Bakerspigel &#40;cited in 6 and 7&#41; reported the first case of human infection caused by <span class="elsevierStyleItalic">Phoma</span> &#40;<span class="elsevierStyleItalic">Phoma hibernica</span>&#41;&#46; Currently there are at least 30 reports of human infections caused by <span class="elsevierStyleItalic">Phoma</span> spp&#46; as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6&#8226;13</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Different therapeutic resources have been used in clinical cases&#44; most with satisfactory outcomes&#46; In a recent <span class="elsevierStyleItalic">in vitro</span> antifungal susceptibility study&#44; posaconazole and voriconazole showed the best activity against dematiaceous fungi including <span class="elsevierStyleItalic">Phoma</span> isolates&#46; In that study amphotericin B and fluconazole were the least active drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> These last findings are similar to those observed for <span class="elsevierStyleItalic">P&#46; insulana</span>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Five genera of dematiaceous fungi are the main causative agents of chromoblastomycosis in the world&#46; In Mexico the frequency of the agents is&#58; <span class="elsevierStyleItalic">F&#46; pedrosoi</span> &#40;95&#46;8&#37;&#41;&#44; <span class="elsevierStyleItalic">C&#46; carrionii</span> &#40;1&#46;1&#37;&#41;&#44; <span class="elsevierStyleItalic">P&#46; verrucosa</span> &#40;0&#46;6&#37;&#41;&#44; <span class="elsevierStyleItalic">R&#46; aquaspersa</span> &#40;0&#46;2&#37;&#41; and <span class="elsevierStyleItalic">E&#46; spinifera</span> &#40;0&#46;2&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> Here we inform an additional genus associated with this pathology&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In this work we report a case diagnosed as chromoblastomycosis based on the following data&#58; &#40;a&#41; Disease began after skin trauma&#46; &#40;b&#41; The clinical manifestations consisted of lesions with verrucous aspect and chronic evolution&#46; &#40;c&#41; The microscopic examination of scales showed fumagoid cells&#44; fungal structures associated only to chromoblastomycosis&#46; &#40;d&#41; On culture developed several colonies of a dematiaceous fungus&#44; kind of fungi described as etiological agents of phaeohyphomycosis or chromoblastomycosis&#46; Due to patient&#8232;tm&#41; reluctance&#44; it was not possible to carry out the histopatological study which would reveal in addition fumagoid cells&#44; a tissue response consisted of pseudoepitheliomatous hyperplasia&#44; acanthosis and hyperkeratosis&#46; Accordingly it was not possible prescribe him an appropriate treatment&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; this is the first report of chromoblastomycosis caused by <span class="elsevierStyleItalic">P&#46; insulana</span>&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chromoblastomycosis is a chronic infection&#44; caused by pigmented fungi affecting skin and subcutaneous tissues characterized by verrucous nodules or plaques&#46; <span class="elsevierStyleItalic">Fonsecaea pedrosoi</span> and <span class="elsevierStyleItalic">Cladophialophora carrionii</span> are the prevalent agents in the endemic areas&#46; <span class="elsevierStyleItalic">Phoma</span> is an uncommon agent of human infection and involved mainly with phaeohyphomycosis cases&#46; The case of a patient with a history of laceration in foot followed by verrucous aspect and scaly lesions&#44; which had evolved for 27 years is presented&#46; On physical examination disease was clinically compatible with chromoblastomycosis and the microscopic examination of scales showed fumagoid cells&#46; On culture a dematiaceous fungus was grown&#46; The agent was confirmed to be <span class="elsevierStyleItalic">Phoma insulana</span> based on its morphology and PCR-sequencing&#46; This fungal agent has not been previously reported in association with this pathology&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La cromoblastomicosis es una infecci&#243;n cr&#243;nica causada por hongos pigmentados que afecta la piel y el tejido subcut&#225;neo y que se caracteriza por n&#243;dulos o placas verrugosas&#46; <span class="elsevierStyleItalic">Fonsecaea pedrosoi</span> y <span class="elsevierStyleItalic">Cladophialophora carrionii</span> son los agentes prevalentes en las &#225;reas end&#232;c&#41;micas&#46; <span class="elsevierStyleItalic">Phoma</span> es un agente raro de infecci&#243;n humana y est&#225; involucrado principalmente en casos de feohifomicosis&#46; Se presenta el caso de un paciente con antecedente de laceraci&#243;n en el pie&#44; seguida de lesiones de aspecto verrugoso y descamativas&#44; que evolucionaron durante 27<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; En el examen f&#237;sico la enfermedad fue cl&#237;nicamente compatible con cromoblastomicosis y el examen microsc&#243;pico de escamas mostr&#243; c&#232;c&#41;lulas fumagoides&#46; En el cultivo creci&#243; un hongo demati&#225;ceo&#46; El agente fue confirmado como <span class="elsevierStyleItalic">Phoma insulana</span> en base a su morfolog&#237;a y PCR seguida de secuenciaci&#243;n&#46; Este agente f&#250;ngico no ha sido reportado previamente en asociaci&#243;n con esta patolog&#237;a&#46;</p></span>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Pigmented verrucous lesions on the foot &#40;arrows&#41;&#44; an ulcerative lesion &#40;&#42;&#41; on the lower part of the leg&#44; and yellowish&#44; thick&#44; crusty lesions on the leg are observed&#46; &#40;b&#41; Microscopic examination of scales&#44; showing thick walled&#44; round-to-ovoid brown cells with septa characteristic of fumagoid cells &#40;40&#237;&#41;&#46; &#40;c&#41; Microscopic examination with lactophenol blue from primary culture&#58; irregular and pigmented hyphae with internal guttules&#44; chlamydoconidia-like cells and some septate globose structures similar to fumagoid cells &#40;arrows&#41; are observed &#40;scale bar&#58; 10<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m&#41;&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Culture on OA &#40;a&#41; and MEA &#40;b&#41; after 8 days of growth&#44; showing pigmented&#44; woolly&#44; green olivaceous colonies&#46; &#40;c&#41; Abundant pigmented chlamydoconidia &#40;10&#237;&#41;&#59; insert&#58; magnification of a chlamydoconidium &#40;scale bar&#58; 10<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m&#41;&#46; &#40;d&#41; Globose picnidium &#40;scale bar&#58; 50<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m&#41;&#44; showing three ostiolae &#40;arrows&#41;&#46; &#40;e&#41; Polymorphic cells of the picnidium wall &#40;scale bar&#58; 10<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m&#41;&#46; &#40;f&#41; Abundant small and ellipsoidal conidia &#40;40&#237;&#41;&#59; insert&#58; magnification of conidia &#40;scale bar&#58; 5<span class="elsevierStyleHsp" style=""></span>&#945;&#47;4m&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">A</span>Cited in 6&#59; <span class="elsevierStyleSup">B</span>Cited in 7&#46; Species names are given as reported by authors&#46; The following current taxonomic names were taken from Index Fungorum&#46; <span class="elsevierStyleItalic">Peyronellaea</span>&#58; included in <span class="elsevierStyleItalic">Phoma</span> section Peyronellaea&#59; <span class="elsevierStyleItalic">Phoma cava</span>&#58; <span class="elsevierStyleItalic">Pyrenochaeta cava</span>&#59; <span class="elsevierStyleItalic">Phoma minutispora</span>&#58; <span class="elsevierStyleItalic">Westerdikella minutispora</span>&#59; <span class="elsevierStyleItalic">Pleurophoma pleurospora</span>&#58; <span class="elsevierStyleItalic">Dinemasporium pleurospora</span>&#59; <span class="elsevierStyleItalic">Phoma sorghina</span>&#58; <span class="elsevierStyleItalic">Epicoccum sorghinum</span>&#59; <span class="elsevierStyleItalic">Phoma exigua</span>&#58; <span class="elsevierStyleItalic">Boeremia exigua</span>&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex&#47;age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Underlying factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Localization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Species&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Janke &#40;1956&#41;<span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lungs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Peyronellaea</span> n&#46; sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bakerspigel et al&#46; &#40;1970&#41;<span class="elsevierStyleSup">A&#44;B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Topical steroids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma hibernica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Griseofulvin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Young et al&#46; &#40;1973&#41;<span class="elsevierStyleSup">A&#44;B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Renal transplant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous&#44; heel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma</span> sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Debridement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gordon et al&#46; &#40;1975&#41;<span class="elsevierStyleSup">A&#44;B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Otherwise healthy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Superficial&#44; ear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma cava</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Griseofulvin<br>Steroids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Punithalingan &#40;1979&#41;<span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Oral steroids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Corneal lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma cruris-hominis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bakerspigel et al&#46; &#40;1981&#41;<span class="elsevierStyleSup">A&#44;B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;18 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Otherwise healthy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cutaneous&#44; perioral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma eupyrena</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clotrimazole&#44; 15&#37; zinc oxide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Shukla et al&#46; &#40;1984&#41;<span class="elsevierStyleSup">A&#44;B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;18<br><br><br>M&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Both topical steroids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Superficial face<br>Superficial neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Both <span class="elsevierStyleItalic">Phoma minutispora</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Both Clotrimazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Both Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baker et al&#46; &#40;1987&#41;<span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diabetes mellitus<br>Cortico-therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous&#44; foot&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma minutella</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Debridement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Amputation for gangrene&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stone et al&#46; &#40;1988&#41;<span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Otherwise healthy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Forearm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma</span> sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ketoconazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dooley et al&#46; &#40;1989&#41;<span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Renal transplant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Legs&#44; arm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Pleurophoma pleurospora</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Miconazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rai &#40;1989&#41;<span class="elsevierStyleSup">A&#44;B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;24<br><br><br>M&#47;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Both otherwise healthy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Superficial face&#44; neck&#44; hands<br>Superficial face&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Both <span class="elsevierStyleItalic">Phoma sorghina</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Both Miconazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Both Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Morris et al&#46; &#40;1995&#41;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chemotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma</span> sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Amphotericin B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hirsh and Schiff &#40;1996&#41;<span class="elsevierStyleSup">A&#44;B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Otherwise healthy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous&#44; hand&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma</span> sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ketoconazole&#44;<br>Itraconazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rosen et al&#46; &#40;1996&#41;<span class="elsevierStyleSup">A&#44;B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Otherwise healthy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cutaneous&#44; facial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Pleurophoma</span> &#40;<span class="elsevierStyleItalic">Phoma</span>&#41; sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ketoconazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zaitz et al&#46; &#40;1997&#41;<span class="elsevierStyleSup">A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cortico-therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous&#44; hand&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma cava</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Amphotericin B&#44; Itraconazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arrese et al&#46; &#40;1997&#41;<span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cortico-therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cutaneous&#44; plantar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma</span> sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bifonazole&#44; Ketoconazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Failure&#46; Patient lost&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oh et al&#46; &#40;1999&#41;<span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Topical steroids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma</span> sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Itraconazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Everett et al&#46; &#40;2003&#41;<span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Renal transplant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hand deep compartment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma</span> sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Debridement&#44; Amphotericin B&#44; Fluconazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rishi and Font &#40;2003&#41;<span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Globe trauma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Keratitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma</span> sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Debridement&#44;<br>Keratectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balis et al&#46; &#40;2006&#41;<span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Acute myeloid&#44; leukaemia&#44; Diabetes Mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma exigua</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fluconazole&#44; Amphotericin B&#44; Pneumonectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kalyani et al&#46; &#40;2006&#41;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Renal transplant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous&#44; forearm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma</span> sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fluconazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Errera et al&#46; &#40;2008&#41;<span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Penetrating globe injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Endophtalmic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma glomerata</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Amphotericin B&#44; Voriconazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tullio et al&#46; &#40;2010&#41;<span class="elsevierStyleSup">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Otherwise healthy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nail&#44; toe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma herbarum</span>&#47;<span class="elsevierStyleItalic">Ph&#46; boeremae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Allylamine&#44; Sertaconazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Metzger et al&#46; &#40;2010&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Saxophone player&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lungs &#40;Hypersensi-tivity pneumonitis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma</span> sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Methylprednisolone<br>Cleaning of saxophone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vasoo et al&#46; &#40;2011&#41;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diabetes Mellitus<br>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phaeomycotic cysts&#44; forearm and hand&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma</span> sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Itraconazole&#44; Excision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Roehm et al&#46; &#40;2012&#41;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;1 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chemotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Invasive rhinosinusitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma</span> sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Debridement<br>Amphotericin B<br>Posaconazole<br>Voriconazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jung et al&#46; &#40;2014&#41;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Recurrent herpes simplex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Keratitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma glomerata</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Amphotericin B&#44;<br>Natamycin&#44;<br>Fluconazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution with opacification&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kumar et al&#46; &#40;2015&#41;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Contact lens&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Keratitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma</span> sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Itraconazole&#44;<br>Amphotericin B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Present case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chronic alcoholism and smoking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Subcutaneous&#44; foot&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Phoma insulana</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Patient lost<br>Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab1673993.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Literature review of human pathology cases associated with <span class="elsevierStyleItalic">Phoma</span> spp&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chromoblastomycosis&#58; an overview of clinical manifestations&#44; diagnosis and treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Queiroz-Tellez"
                            1 => "P&#46; Esterre"
                            2 => "M&#46; Perez-Blanco"
                            3 => "R&#46;G&#46; Vitale"
                            4 => "C&#46;G&#46; Salgado"
                            5 => "A&#46; Bonifaz"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/13693780802538001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Mycol"
                        "fecha" => "2009"
                        "volumen" => "47"
                        "paginaInicial" => "3"
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                        "link" => array:1 [
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                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "P&#46; Esterre"
                            1 => "A&#46; Andriantsimahavandy"
                            2 => "E&#46;R&#46; Ramarcel"
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                    ]
                  ]
                  "host" => array:1 [
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                      "Revista" => array:6 [
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                            "web" => "Medline"
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                        ]
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            ]
            2 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Phoma</span> identification manual&#46; Differentiation of specific and infra-specific taxa in culture"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46;H&#46; Boerema"
                            1 => "J&#46; De Gruyter"
                            2 => "M&#46;E&#46; Noordeloos"
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                  "host" => array:1 [
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                      "Libro" => array:3 [
                        "fecha" => "2004"
                        "editorial" => "CABI Publishing"
                        "editorialLocalizacion" => "United Kingdom"
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            3 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Reference method for broth dilution antifungal susceptibility testing of yeasts&#46; Approved standard&#44; CLSI document M38-A2"
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
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Article information

ISSN: 2529993X
Original language: English

DOI:10.1016/j.eimce.2016.08.005

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Year/Month	Html	Pdf	Total

2024 November	9	1	10
2024 October	33	5	38
2024 September	29	7	36
2024 August	23	5	28
2024 July	21	5	26
2024 June	12	2	14
2024 May	15	4	19
2024 April	17	6	23
2024 March	27	7	34
2024 February	12	1	13
2024 January	11	3	14
2023 December	34	1	35
2023 November	26	1	27
2023 October	35	3	38
2023 September	19	3	22
2023 August	24	0	24
2023 July	48	1	49
2023 June	41	1	42
2023 May	55	4	59
2023 April	37	1	38
2023 March	51	1	52
2023 February	42	4	46
2023 January	35	0	35
2022 December	48	5	53
2022 November	36	4	40
2022 October	32	5	37
2022 September	30	6	36
2022 August	27	6	33
2022 July	28	7	35
2022 June	19	6	25
2022 May	16	4	20
2022 April	19	7	26
2022 March	32	8	40
2022 February	40	5	45
2022 January	71	12	83
2021 December	43	8	51
2021 November	35	6	41
2021 October	38	13	51
2021 September	17	7	24
2021 August	24	6	30
2021 July	11	9	20
2021 June	11	6	17
2021 May	22	9	31
2021 April	40	23	63
2021 March	18	4	22
2021 February	16	5	21
2021 January	9	10	19
2020 December	9	3	12
2020 November	12	4	16
2020 October	10	3	13
2020 September	11	8	19
2020 August	12	3	15
2020 July	18	5	23
2020 June	9	4	13
2020 May	9	6	15
2020 April	7	3	10
2020 March	6	2	8
2020 February	7	3	10
2020 January	8	2	10
2019 December	7	10	17
2019 November	5	8	13
2019 October	11	4	15
2019 September	14	2	16
2019 August	7	0	7
2019 July	14	4	18
2019 June	31	8	39
2019 May	27	3	30
2019 April	19	2	21
2019 March	1	0	1
2019 February	3	3	6
2019 January	5	3	8
2018 December	6	3	9
2018 November	8	0	8
2018 October	4	6	10
2018 September	12	0	12
2018 August	6	0	6

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