Fungal Olecranon Bursitis in an Immunocompetent Patient by Knoxdaviesia dimorphospora sp. nov.: Case Report and Review

Mycopathologia. 2018 Apr;183(2):407-415. doi: 10.1007/s11046-017-0211-z. Epub 2017 Oct 9.

Abstract

Bursitis is a common medical condition that can occur either with or without infection. We present a case of fungal olecranon bursitis in an immunocompetent individual caused by the new species Knoxdaviesia dimorphospora. It is a dematiaceous filamentous fungus characterized by the production of two different conidia: hyaline and cylindrical, which rise up from phialidic conidiogenous cells located in the upper part of differentiated and unbranched conidiophores, and pale brown and ellipsoidal conidia produced by phialidic conidiogenous cells which are born directly on hyphae. In addition to its morphological peculiarities, the novelty of the fungus was confirmed by sequence analysis of the internal transcribed spacer (ITS) regions and D1/D2 domains of the 28S of the nuclear rRNA gene. The fungal infection was confirmed by cytological examination and repeated cultures. The infection was resolved by surgical debridement and drainage, and the patient presented a complete functional recovery 3 months later. The in vitro antifungal susceptibility to this new human opportunist is provided, terbinafine being the drug with the most potent activity.

Keywords: Ascomycota; Bursal infection; Microascales; Mould; Olecranon.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Ascomycota / classification
  • Ascomycota / cytology
  • Ascomycota / genetics
  • Ascomycota / isolation & purification*
  • Bursitis / diagnosis*
  • Bursitis / pathology*
  • Bursitis / surgery
  • Cluster Analysis
  • Cytological Techniques
  • DNA, Fungal / chemistry
  • DNA, Fungal / genetics
  • DNA, Ribosomal / chemistry
  • DNA, Ribosomal / genetics
  • DNA, Ribosomal Spacer / chemistry
  • DNA, Ribosomal Spacer / genetics
  • Debridement
  • Drainage
  • Humans
  • Male
  • Microbiological Techniques
  • Microscopy
  • Middle Aged
  • Mycoses / diagnosis*
  • Mycoses / pathology*
  • Mycoses / surgery
  • Olecranon Process / pathology*
  • Phylogeny
  • RNA, Ribosomal, 28S / genetics
  • Sequence Analysis, DNA
  • Treatment Outcome

Substances

  • DNA, Fungal
  • DNA, Ribosomal
  • DNA, Ribosomal Spacer
  • RNA, Ribosomal, 28S