PMC8312625_01
Direct microscopic morphology of skin tissue and CSF. (A) Direct wet film microscopy of skin tissue, 400x. (B) Gram stain of skin tissue, 1000x. (C) GMS of skin tissue, 1000x. (D) GMS of CSF after centrifugation, 1000x.
IDR-14-2787-g0001.jpg
PMC8312625_01_IDR-14-2787-g0001.jpg
f0001
Skin tissue wet mount slides demonstrated numerous leukocyte-like spherical sporangia with multiple internal septation (Figure 1A); Gram staining showed round yeast-like fungal spores of varying sizes with unclear internal structures (Figure 1B); Gomori methenamine silver (GMS) stain revealed multiple round sporangia with an endospore-like symmetrical arrangement or morula (Figure 1C). Few spore-like structures were found in the specimen of CSF with GMS, while the other two dyeing methods were negative (Figure 1D).
Colonies and microscopic morphology of cultured skin tissue and CSF specimens. (A) Colonies on CHROMagar Candida medium from skin tissue cultures. (B) Wet film microscopy of skin tissue cultures, 40x. (C) Gram stain of skin tissue cultures, 1000x. (D) Colonies on blood agar from CSF cultures.
IDR-14-2787-g0002.jpg
PMC8312625_01_IDR-14-2787-g0002.jpg
f0002
Three days later, pink and creamy colonies were seen on the CHROMagar Candida plate, which resembled colonies of Candida parapsilosis, while the SDA plate was still negative (Figure 2A). Colony smear showed spherical sporangia in different sizes with characteristic endospore-like mulberry appearance (Figure 2B); Gram staining revealed Gram-positive yeast-like cells without budding or pseudohyphae (Figure 2C). After 5 days of incubation, the CSF specimen showed growth of only two creamy white, yeast-like colonies on blood agar, which had the same microscopic morphology as skin tissue (Figure 2D).