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66 Ochroconis de Hoog and Arx
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Recently, the genus Ochroconis has undergone taxonomic revision, and the most relevant species, Ochroconis
gallopava, was transferred to the new genus Verruconis (Samerpitak et al., 2014). Ochroconis species are
mesophilic saprobes, with an optimum growth temperature between 15 and 30
o
at 37
C. Nevertheless, some species have been isolated from clinical specimens, such as Ochroconis tshaw-
ytschae, O. mirabilis, O. cordanae, O. olivacea and O. ramosa (Samerpitak et al., 2014; Seyedmousavi et al.,
2014; Giraldo et al., 2014b). Note: Species described in the literature from clinical cases as O. constricta or
O. humicola are probably O. musae (Samerpitak et al., 2014).
Giraldo et al. (2014b) reported on the occurrence of Ochroconis and Verruconis species in clinical specimens from the United States. Verruconis gallopava was the most common species (69%), followed by
Ochroconis mirabilis (22%). Other species isolated were O. cordanae, O. olivacea and O. ramosa. The most
common anatomical site of isolation was the lower respiratory tract (59%), followed by superficial (22%)
and deep tissues (20%) (Giraldo et al., 2014b).
RG-1 organisms
Morphological description: Colonies restricted, velvety to funiculose, brown to olivaceous, often with rustbrown reverse. Hyphae smooth- or somewhat rough-walled, pale olivaceous. Conidiophores slightly or
conspicuously differentiated, cylindrical, often flexuose, producing conidia on scattered, cylindrical to conical
denticles. After detachment an inconspicuous frill often remains both on the denticle and on the conidium
base. Conidia one to four-celled, pale olivaceous-brown, smooth- or rough-walled, ellipsoidal, cylindrical,
clavate or cuneiform. Maximum growth temperature around 33
to Verruconis).
o
C (thermophilic members were transferred
o
C and an inability to grow
Molecular identification: Giraldo et al. (2014b) used sequence analyses of the 18S, ITS, D1/2, ACT and
β-tubulin genes, while Seyedmousavi et al. (2014), used ITS sequence analysis to identify species.
Antifungal susceptibility: (Table 66.1).
Table 66.1. Ochroconis species very limited data (Australian national data); MIC μg/mL.
Antifungal No. ≤0.016 0.03 0.06 0.125 0.25 0.5 1 2 4 8 16 32 ≥64
AmB 4 1 1 2
ISAV 1 1 1
VORI 4 3 1
POSA 4 3 1
ITRA 4 1 1 1 1
References: Samerpitak et al. (2014); Seyedmousavi et al. (2014); Giraldo et al. (2014b); de Hoog et al. (2015).
DOI: 10.1079/9781800622340.0066
© CAB International 2023. Descriptions of Medical Fungi (eds S. Kidd, C.Halliday and D. Ellis) 186
67 Onychocola canadensis Sigler
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Onychocola canadensis is an uncommon cause of distal and lateral subungual or white superficial onychomycosis. However, it may sometimes be present in an abnormal-appearing nail as an insignificant finding,
not acting as a pathogen.
RG-2 organism
Morphological description: Colonies grow slowly and are velvety to lanose, white to yellowish, with a
brownish reverse (Fig. 67.1). Arthroconidia are cylindrical to broadly ellipsoidal, one- or two-celled, hyaline
to subhyaline, 4-16 x 2-5 μm in size, forming long chains (Fig. 67.1). Older cultures may show broad, brown,
rough-walled hyphae.
Key features: Slow growing, white, arthroconidial mould isolated from nails.
References: Sigler and Congly (1990); Sigler et al. (1994); Gupta et al. (1998); de Hoog et al. 2015).
10 ˜m
Fig. 67.1. Onychocola canadensis culture and arthroconidia.
DOI: 10.1079/9781800622340.0067
© CAB International 2023. Descriptions of Medical Fungi (eds S. Kidd, C.Halliday and D. Ellis)
187
68 Paecilomyces variotii Bain
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The genus Paecilomyces may be distinguished from the closely related genus Penicillium by having long
slender divergent phialides and colonies that are never typically green. Paecilomyces variotii is a common
environmental mould that is widespread in composts, soils and food products. It is known from substrates
including food, indoor air, wood, soil and carpet dust. However, P. variotii is an emerging causative agent of
mycotic keratitis and of hyalohyphomycosis in the immunocompromised patient. Note: Paecilomyces lilaci-
nus was transferred to Purpureocillium lilacinum (Luangsa-ard et al., 2011); and Paecilomyces marquandii
has been transferred to Marquandomyces marquandii (Mongkolsamrit et al., 2020).
RG-2 organism
Morphological description: Colonies are fast growing, powdery to suede-like, funiculose or tufted, and
yellow-brown or sand coloured (Fig. 68.1). Conidiophores bearing dense, verticillately arranged branches
bearing phialides. Phialides are cylindrical or ellipsoidal, tapering abruptly into a rather long and cylindrical
neck. Conidia are subspherical, ellipsoidal to fusiform, hyaline to yellow, smooth-walled, 3-5 x 2-4 μm and
are produced in long divergent chains (Fig. 68.2). Chlamydospores are usually present, singly or in short
chains, brown, subspherical to pyriform, 4-8 μm in diameter, thick-walled to slightly verrucose.
Molecular identification: Molecular phylogeny based on 18S rDNA sequences was done by Luangsa-ard
et al. (2011). ITS sequencing is recommended for identification.
Key features: Yellow-brown colony pigmentation, cylindrical phialides, and presence of chlamydospores.
Fig. 68.1. Paecilomyces variotii culture.
© CAB International 2023. Descriptions of Medical Fungi (eds S. Kidd, C.Halliday and D. Ellis) 188
(a) (b) (c)
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10 ˜m
Fig. 68.2. Paecilomyces variotii showing (a) conidiophores and phialides, (b) conidia and (c) terminal
chlamydospores.
10 ˜m5 ˜m
Antifungal susceptibility: (Table 68.1).
Table 68.1. Paecilomyces variotii, limited data (Australian national data); MIC μg/mL.
Antifungal No. ≤0.016 0.03 0.06 0.125 0.25 0.5 1 2 4 8 16 32 ≥64
AmB 39 1 8 8 9 7 4 2
ISAV 8 1 1 1 5
VORI 37 2 2 1 3 4 24 1
POSA 36 5 7 7 3 8 4 2
ITRA 39 4 2 7 9 9 6 1 1
References: Samson (1974); Domsch et al. (2007); Houbraken et al. (2010); de Hoog et al. (2015).
DOI: 10.1079/9781800622340.0068
Descriptions of Medical Fungi 189
X.Z. Liu et al.
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Synonymy: Cryptococcus laurentii (Kufferath) Skinner.
A phylogenetic review by Liu et al. (2015) reclassified Cryptococcus laurentii as Papiliotrema laurentii. P.
laurentii is an emerging opportunistic pathogen, causing disease in patients with impaired cell-mediated
immunity (e.g. HIV-infected patients or those with haematologic malignancies), in those using steroids or
chemotherapeutic agents, and in those with invasive devices. Human infections due to P. laurentii have been
reported as fungaemia, central nervous system infection, skin and soft-tissue infections, and pneumonia,
among others (Morales-Lopez and Garcia-Effron, 2021).
RG-1 organism
Culture: Colonies (SDA) are cream coloured, often becoming a deeper orange-yellow with age, with a smooth
mucoid texture.
Microscopy: Spherical and elongated budding yeast-like cells or blastoconidia, 2.0-5.5 x 3.0-7.0 μm. No
pseudohyphae present.
India ink preparation: Positive − narrow but distinct thin capsules are present.
Germ tube formation: Negative.
Physiological tests: (+ Positive, − Negative, v Variable, w Weak, s Slow, n not done).
Fermentation: Absent.
Growth reactions:
Glucose + L-Sorbose v myo-Inositol +
Sucrose + L-Rhamnose + DL-Lactate +
Raffinose + D-Xylose + D-Gluconate +
Melibiose + L-Arabinose + 2-Keto-D-gluconate +
Galactose + D-Arabinose + D-Glucosamine +
Lactose + D-Ribose + N-Acetyl-D-glucosamine +
Trehalose + Glycerol v D-Glucuronate +
Maltose + Erythritol + Nitrate –
Melezitose + Ribitol + Urease +
Methyl-α-D-glucoside + Galactitol v 0.1% Cycloheximide –
Soluble starch + D-Mannitol + Growth at 35oC +
Cellobiose + D-Glucitol + Growth at 37oC v
Comment: Some strains of Papiliotrema laurentii may develop brown pigment on bird seed agar and turn
CGB media somewhat blue, similar to Cryptococcus gattii. However P. laurentii assimilates both lactose and
melibiose while C. gattii does not.
Molecular identification: ITS sequencing may be used for accurate species identification.
MALDI-ToF MS: Able to accurately identify this species (Fraser et al., 2016).
© CAB International 2023. Descriptions of Medical Fungi (eds S. Kidd, C.Halliday and D. Ellis) 190
Antifungal susceptibility: (Table 69.1).
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Table 69.1. Papiliotrema laurentii, very limited (Australian national data); MIC μg/mL.
Antifungal No. ≤0.016 0.03 0.06 0.125 0.25 0.5 1 2 4 8 16 32 ≥64
AmB 8 1 2 3 1 1
FLU 8 1 1 4 2
VORI 7 2 1 2 1 1
POSA 6 1 1 2 1 1
ITRA 8 1 2 2 1 2
5FC 8 8
References: Barnett et al. (1983); Fonseca et al. (2011); de Hoog et al. (2020).
DOI: 10.1079/9781800622340.0069
Descriptions of Medical Fungi 191
complex
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Recently Paracoccidioides brasiliensis has been recognised as two species: P. brasiliensis and P. lutzii
(Theodoro et al., 2012; Teixeira et al., 2014). P. brasiliensis/lutzii is geographically restricted to areas of South
and Central America. The two species are morphologically very similar; conidia of P. lutzii are elongated
whereas those from P. brasiliensis are pyriform. Molecular confirmation is recommended. A novel, unculti-
vated strain of P. brasiliensis reported to cause cutaneous lesions in dolphins has been moved recently to a
new species, Paracoccidioides cetii (Vilela et al., 2021).
WARNING: RG-3 organism
Cultures of Paracoccidioides brasiliensis/lutzii represent a biohazard to laboratory personnel and should be
handled with extreme caution in a Class II Biological Safety Cabinet (BSCII).
Molecular identification: ITS sequencing is helpful (Imai et al., 2000) however immunodominant antigen
Gp43 (GP43) is recommended for barcoding (Vilela et al., 2021).
Morphological description: Colonies at 25
be flat, wrinkled and folded, glabrous, suede-like or downy in texture, white to brownish with a tan or brown
reverse. Microscopically, a variety of conidia may be seen, including pyriform microconidia, arthroconidia
and chlamydospores. However, none of these are characteristic of the species, and most strains may grow for
long periods of time without the production of conidia.
On BHI blood agar at 37
o
C, the mycelium converts to the yeast phase and colonies are white to tan, moist
and glabrous and become wrinkled, folded and heaped. Microscopically, numerous large, 20-60 μm, round,
narrow base budding yeast cells are present. Single and multiple budding occurs, the latter are thick-walled
cells that form the classical “steering wheel” or “mickey mouse” structures that are diagnostic for this fungus,
especially in methenamine silver-stained tissue sections (Fig. 70.1).
Key features: Clinical history, tissue pathology, culture identification with conversion to yeast phase at 37
however molecular identification is now recommended for identification.
o
C are slow growing and variable in morphology. Colonies may
o
C,
© CAB International 2023. Descriptions of Medical Fungi (eds S. Kidd, C.Halliday and D. Ellis) 192
(a)
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(b)
20 ˜m
Fig. 70.1. Paracoccidioides brasiliensis/litzii showing multiple, narrow base, budding yeast cells (a) in a Grocott-
Gomori’s methenamine silver-stained tissue section and (b) in a calcofluor white stained wet mount.
20 ˜m
Antifungal susceptibility: (Table 70.1).
Table 70.1. Paracoccidioides brasiliensis, very limited data (McGinnis et al., 1997); MIC μg/mL. Antifungal susceptibility
testing not recommended.
Antifungal Range Antifungal Range
FLU ≤0.125-64 AmB 0.03-4
ITRA ≤0.03-1 VORI ≤0.03-2
References: Chandler et al. (1980); McGinnis (1980); Rippon (1988); Bagagli et al. (2008); Desjardins et al.
(2011); de Hoog et al. (2015).
DOI: 10.1079/9781800622340.0070
Descriptions of Medical Fungi 193
Y. Graser, Dukik & de Hoog
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Synonymy: Microsporum cookei Ajello; Nannizzia cajetana Borelli.
Based on a recent taxonomic revision of the dermatophytes the genus Paraphyton has been created for
three species (de Hoog et al., 2017). Paraphyton cookei is a geophilic fungus which has also been isolated
from the hair of small mammals showing no clinical lesions. Infection has been reported in rodents, dogs and
rarely in humans. It is not known to invade hair in vivo but produces hair perforations in vitro. P. cookei has
a worldwide distribution.
RG-1 organism
Morphological description: Colonies are flat, spreading, buff to pale brown, powdery to suede-like, with a
slightly raised and folded centre and some radial grooves. Reverse pigment dark reddish-brown (Fig. 71.1).
Numerous large, 30-65 x 10-15 μm, very thick-walled, echinulate (rough) ellipsoidal macroconidia with
predominantly five to six septa but may be from two to eight septa (Fig. 71.1). Occasional spirals may be
seen. Moderate numbers of mainly slender clavate with some pyriform microconidia are present.
Confirmatory tests
Vitamin free agar (Trichophyton agar No.1): Good growth indicating no special nutritional requirements,
pinkish-buff coloured, suede-like colony with a deep magenta red reverse.
Hair perforation test: Positive.
Key features: The macroconidia of Paraphyton cookei are quite characteristic and diagnostic; the thick walls
and usually larger size of the macroconidia distinguish it from Nannizzia gypsea.
Molecular identification: ITS sequencing is recommended.
References: Rebell and Taplin (1970); Rippon (1988); Graser et al. (2008); Cafarchia et al. (2013); de Hoog
et al. (2015, 2017).
© CAB International 2023. Descriptions of Medical Fungi (eds S. Kidd, C.Halliday and D. Ellis) 194
Fig. 71.1. Paraphyton cookei culture and macroconidia.
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DOI: 10.1079/9781800622340.0071
20 ˜m
Descriptions of Medical Fungi 195
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