1
|
Maraki S, Katzilakis N, Neonakis I, Stafylaki D, Meletiadis J, Hamilos G, Stiakaki E. Exophiala dermatitidis Central Line-Associated Bloodstream Infection in a Child with Ewing's Sarcoma: Case Report and Literature Review on Paediatric Infections. Mycopathologia 2022; 187:595-602. [PMID: 35994217 DOI: 10.1007/s11046-022-00658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
Exophiala dermatitidis is a dematiaceous, ubiquitous, dimorphic fungus, which can cause a wide range of invasive diseases in both immunocompromised and immunocompetent hosts. Bloodstream infections due to E. dermatitidis are rarely encountered in clinical practice, especially in pediatric patients. We describe a case of central line-associated bloodstream infection due to E. dermatitidis in a 4.5-year-old boy with Ewing's sarcoma. The fungus was isolated from blood specimens taken from the Hickman line. The isolate was identified by its phenotypic characteristics, by MALDI-TOF and by using molecular methods. The infection was successfully treated with voriconazole and catheter removal. The literature was also reviewed on pediatric infections caused by E. dermatitidis, focusing on clinical manifestations and challenges associated with diagnosis and management.
Collapse
Affiliation(s)
- Sofia Maraki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece.
| | - Nikolaos Katzilakis
- Department of Pediatric Hematology-Oncology, University Hospital of Heraklion and Laboratory of Blood Diseases and Childhood Cancer Biology, Medical School, University of Crete, Heraklion, Greece
| | - Ioannis Neonakis
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
| | - Dimitra Stafylaki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Hamilos
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University Hospital of Heraklion and Laboratory of Blood Diseases and Childhood Cancer Biology, Medical School, University of Crete, Heraklion, Greece
| |
Collapse
|
2
|
A fatal neonatal case of fungemia due to Exophiala dermatitidis-case report and literature review. BMC Pediatr 2022; 22:482. [PMID: 35948953 PMCID: PMC9364490 DOI: 10.1186/s12887-022-03518-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 07/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background Systemic infections caused by the black yeast-like fungus Exophiala dermatitidis are rare, but are associated with high mortality especially in immunocompromised patients. We report the first case of E. dermatitidis fungemia in a premature extremely low birth weight (ELBW) neonate who succumbed despite antifungal therapy with liposomal amphotericin (AMB) and fluconazole. A systematic review of all fungemia cases due to E. dermatitidis was also conducted aiming for a better understanding of the risk factors, treatment strategies and outcomes. Case presentation A male, ELBW premature neonate, soon after his birth, developed bradycardia, apnoea and ultimately necrotizing enterocolitis with intestinal perforation requiring surgical intervention. Meanwhile, he had also multiple risk factors for developing bloodstream infection, such as intubation, mechanical ventilation, central venous catheter (CVC), parenteral nutrition, empirical and prolonged antibiotic use. His blood cultures were positive, firstly for Acinetobacter junii and then for Klebsiella pneumoniae together with E. dermatitidis while on fluconazole prophylaxis and antibiotic empiric therapy. Despite the treatment with broad spectrum antibiotics, liposomal AMB and fluconazole, the newborn succumbed. A literature review identified another 12 E. dermatitidis bloodstream infections, mainly in patients with hematologic malignancies and solid organ transplant recipients (61%), with overall mortality 38% despite CVC removal and antifungal therapy. Conclusions Due to the rarity of E. dermatitidis infections, little is known about the characteristics of this yeast, the identification methods and the optimal therapy. Identification by common biochemical tests was problematic requiring molecular identification. Resolution of neonatal fungemia is difficult despite proper antifungal therapy especially in cases with multiple and severe risk factors like the present one. Therapeutic intervention may include CVC removal and treatment for at least 3 weeks with an azole (itraconazole or fluconazole after susceptibility testing) or AMB monotherapy but not echinocandins or AMB plus azole combination therapy.
Collapse
|
3
|
Najafzadeh MJ, Dolatabadi S, Vicente VA, de Hoog GS, Meis JF. In vitro activities of 8 antifungal drugs against 126 clinical and environmental Exophiala isolates. Mycoses 2021; 64:1328-1333. [PMID: 34411353 DOI: 10.1111/myc.13364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Exophiala is the main genus of black fungi comprising numerous opportunistic species. Data on antifungal susceptibility of Exophiala isolates are limited, while infections are potentially fatal. MATERIALS AND METHODS In vitro activities of eight antifungal drugs (AMB, five azoles, two echinocandins) against 126 clinical (n = 76) and environmental (n = 47) isolates from around the world were investigated. E. oligosperma (n = 58), E. spinifera (n = 33), E. jeanselmei (n = 14) and E. xenobiotica (n = 21) were included in our dataset. RESULTS The resulting MIC90 s of all strains were as follows, in increasing order: posaconazole 0.063 μg/ml, itraconazole 0.125 μg/ml, voriconazole and amphotericin B 1 μg/ml, isavuconazole 2 μg/ml, micafungin and caspofungin 4 μg/ml, and fluconazole 64 μg/ml. Posaconazole, itraconazole and micafungin were the drugs with the best overall activity against Exophiala species. Fluconazole could not be considered as a treatment choice. No significant difference could be found among antifungal drug activities between these four species, neither in clinical nor in environmental isolates. CONCLUSION Antifungal susceptibility data for Exophiala spp. are crucial to improve the management of this occasionally fatal infection and the outcome of its treatment.
Collapse
Affiliation(s)
- Mohammad Javad Najafzadeh
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Vania Aparecida Vicente
- Bioprocess Engineering and Biotechnology Graduate Program, Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Gerrit Sybren de Hoog
- Center of Expertise in Mycology, Radboudumc/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jacques F Meis
- Bioprocess Engineering and Biotechnology Graduate Program, Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil.,Center of Expertise in Mycology, Radboudumc/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| |
Collapse
|
4
|
Sekiguchi R, Urabe N, Sakamoto S, Sasaki M, Homma S, Kishi K. Exophiala dermatitidis pneumonia with bronchiectasis required prolonged voriconazole treatment. Respirol Case Rep 2021; 9:e00783. [PMID: 34084534 PMCID: PMC8144837 DOI: 10.1002/rcr2.783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022] Open
Abstract
Exophiala dermatitidis is a black fungus that rarely causes respiratory infection. We report a case of E. dermatitidis pneumonia with bronchiectasis that relapsed after 11 months of voriconazole (VRCZ) treatment in a rheumatoid arthritis (RA) patient with bronchiectasis. A 65-year-old woman with RA and abnormal findings on chest radiography was referred for assessment of chronic cough and increased sputum production. She underwent bronchoscopy, and E. dermatitidis was identified from bronchoalveolar lavage fluid (BALF). Exophiala dermatitidis chronic lower respiratory tract infection and pneumonia were diagnosed. Although her condition improved after 11 months of VRCZ treatment, chest computed tomography (CT) images showed worsening at five months after the cessation of VRCZ treatment and E. dermatitidis was again detected in BALF. Re-administration of VRCZ for two years improved symptoms and chest CT images, and her condition is currently stable. In patients with bronchiectasis, E. dermatitidis pneumonia might require prolonged antifungal treatment.
Collapse
Affiliation(s)
- Ryo Sekiguchi
- Department of Respiratory MedicineToho University Omori Medical CenterTokyoJapan
| | - Naohisa Urabe
- Department of Respiratory MedicineToho University Omori Medical CenterTokyoJapan
| | - Susumu Sakamoto
- Department of Respiratory MedicineToho University Omori Medical CenterTokyoJapan
| | - Masakazu Sasaki
- Department of Clinical LaboratoryToho University Omori Medical CenterTokyoJapan
| | - Sakae Homma
- Department of Advanced and Integrated Interstitial Lung Disease ResearchToho University School of MedicineTokyoJapan
| | - Kazuma Kishi
- Department of Respiratory MedicineToho University Omori Medical CenterTokyoJapan
| |
Collapse
|
5
|
Teymuri M, Shams-Ghahfarokhi M, Razzaghi-Abyaneh M. Inhibitory effects and mechanism of antifungal action of the natural cyclic depsipeptide, aureobasidin A against Cryptococcus neoformans. Bioorg Med Chem Lett 2021; 41:128013. [PMID: 33811994 DOI: 10.1016/j.bmcl.2021.128013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/22/2021] [Accepted: 03/28/2021] [Indexed: 02/08/2023]
Abstract
Cryptococcosis is an opportunistic fungal infection caused mainly by Cryptococcus neoformans. The aim of the present study was to evaluate the inhibitory effect of aureobasidin A on C. neoformans with special focus on its mode of action. The effect of aureobasidin A on cell membrane ergosterol content, cell wall permeability, membrane pumps activities, the total oxidant status (TOS) and melanin production was evaluated. Cytotoxicity and cell hemolysis, and laccase (LacI) and β1,2-xylosyltransferase (Cxt1p) gene expression were also evaluated. Aureobasidin A reduced melanin production and increased extracellular potassium leakage at 0.5 × MIC concentration. This peptide has no effect on fungal cell wall integrity. Cell membrane ergosterol content was decreased by 29.1% and 41.8% at 0.5 × MIC and 1 × MIC concentrations (2 and 4 µL/mL) in aureobasidin A treated samples, respectively. TOS level was significantly increased without activation of antioxidant enzymes. Lac1 gene was over-expressed (11.7-fold), while Cxt1p gene was down regulated (0.2-fold) following treatment with aureobasidin A. Overall, our results indicated that aureobasidin A inhibits C. neoformans growth by targeting different sites in fungal cells and it may be considered as a promising compound to use as an antifungal in treatment of clinical cryptococcosis.
Collapse
Affiliation(s)
- Mostafa Teymuri
- Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14115-331, Iran
| | - Masoomeh Shams-Ghahfarokhi
- Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14115-331, Iran.
| | | |
Collapse
|
6
|
Sun Y, Gao L, Yuan M, Yuan L, Yang J, Zeng T. In vitro and in vivo Study of Antifungal Effect of Pyrvinium Pamoate Alone and in Combination With Azoles Against Exophiala dermatitidis. Front Cell Infect Microbiol 2020; 10:576975. [PMID: 33194816 PMCID: PMC7649562 DOI: 10.3389/fcimb.2020.576975] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022] Open
Abstract
Infections of Exophiala dermatitidis are often chronic and recalcitrant. Combination therapies with novel compounds and azoles could be an effective solution. Previously, we have demonstrated that pyrvinium pamoate exerted antifungal activity alone and favorable synergy with azoles against planktonic E. dermatitidis. Herein, the underlying antifungal mode of action were investigated. Pyrvinium alone showed sessile MIC50 (SMIC50) of 8->16 μg/ml against E. dermatitidis biofilms. However, synergism of PP with itraconazole, voriconazole, and posaconazole were observed against 16 (88.9%), 9 (50%), and 13 (72.2%) strains of E. dermatitidis biofilms. In accordance with in vitro susceptibilities, pyrvinium alone at concentration of 2 μg/ml resulted in significant growth restriction of planktonic E. dermatitidis. Pyrvinium alone resulted in reduction of biofilm formation. Higher concentration of pyrvinium was associate with more progressive reduction of biofilm mass. The in vivo activity of pyrvinium alone and combined with azoles was evaluated using Galleria mellonella model. Pyrvinium alone significantly improved the survival rate of larvae (P < 0.0001). The combination of pyrvinium and voriconazole or posaconazole acted synergistically in vivo (P < 0.05). Fungal burden determination revealed significant reduction of numbers of colony forming unit (CFU) in larvae treated with pyrvinium-itraconazole and pyrvinium-posaconazole compared to itraconazole or posaconazole alone group, respectively. The effect of pyrvinium on apoptosis, expression of TOR and HSP90, and drug efflux reversal were evaluated by PI/Annexin V staining, Real-Time Quantitative PCR and Rhodamine 6G assay, respectively. Pyrvinium alone or combined with azoles significantly (P < 0.05) increased late apoptosis or necrosis of E. dermatitidis cells. Pyrvinium combined with posaconazole significantly decreased the expression of TOR and Hsp90 compared to posaconazole alone group (P < 0.05). Pyrvinium resulted in significant (P < 0.05) decrease of the efflux of Rhodamine 6G. These findings suggested pyrvinium could be a promising synergist with azoles. The underlying mechanisms could be explained by inducing apoptosis/necrosis, inhibition of drug efflux pumps, and signaling pathways related with stress response and growth control.
Collapse
Affiliation(s)
- Yi Sun
- Department of Dermatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, China
| | - Lujuan Gao
- Department of Dermatology, Zhongshan Hospital Fudan University (Xiamen Branch), Xiamen, China
- Department of Dermatology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Mingzhu Yuan
- Department of Clinical Medicine, Yangtze University, Jingzhou, China
| | - Lu Yuan
- Department of Pathology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, China
| | - Ji Yang
- Department of Dermatology, Zhongshan Hospital Fudan University (Xiamen Branch), Xiamen, China
- Department of Dermatology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Tongxiang Zeng
- Department of Dermatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, China
| |
Collapse
|
7
|
Ramprasad A, Rastogi N, Xess I, Singh G, Ranjan P, Jadon R, Ray A, Vikram N. Disseminated phaeohyphomycosis by Exophiala jeanselmei. QJM 2020; 113:275-277. [PMID: 31711223 DOI: 10.1093/qjmed/hcz298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 10/15/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Ramprasad
- Division of Infectious Diseases, Department of Medicine and Microbiology, New Delhi, India
| | - N Rastogi
- Division of Infectious Diseases, Department of Medicine and Microbiology, New Delhi, India
| | - I Xess
- Department of Microbiology, New Delhi, India
| | - G Singh
- Department of Microbiology, New Delhi, India
| | - P Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - R Jadon
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - A Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - N Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
8
|
Yoshida T, Tachita T, Fujinami H, Oshima Y, Sasaki H, Marumo Y, Narita T, Ito A, Ri M, Kusumoto S, Ishida T, Komatsu H, Iida S. Exophiala dermatitidis Fungemia Diagnosed Using Time-of-flight Mass Spectrometry during Chemotherapy for Malignant Lymphoma and Successful Treatment with Voriconazole. Intern Med 2019; 58:2219-2224. [PMID: 30996161 PMCID: PMC6709338 DOI: 10.2169/internalmedicine.2082-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/13/2019] [Indexed: 01/01/2023] Open
Abstract
Infectious diseases, including those caused by fungi, remain important issues in patients receiving malignant lymphoma chemotherapy. We herein report a rare case of Exophiala dermatitidis fungemia during chemotherapy in a 67-year-old woman admitted to our hospital. She had a fever that could not be resolved despite antifungal therapy. Yeast-like fungi were detected in blood culture samples, but biochemical identification was difficult. E. dermatitidis, a black mold, was identified using time-of-flight mass spectrometry. The patient finally improved after her treatment was switched to voriconazole. Fungal infection is difficult to diagnose and treat, but this novel approach can improve patients' outcomes.
Collapse
Affiliation(s)
- Takashi Yoshida
- Division of Hematology & Oncology, Nagoya City University Hospital, Japan
- Department of Clinical Oncology, Nagoya Memorial Hospital, Japan
| | - Takuto Tachita
- Division of Hematology & Oncology, Nagoya City University Hospital, Japan
| | - Haruna Fujinami
- Division of Hematology & Oncology, Nagoya City University Hospital, Japan
| | - Yoshiko Oshima
- Division of Hematology & Oncology, Nagoya City University Hospital, Japan
| | - Hirokazu Sasaki
- Division of Hematology & Oncology, Nagoya City University Hospital, Japan
| | - Yoshiaki Marumo
- Division of Hematology & Oncology, Nagoya City University Hospital, Japan
| | - Tomoko Narita
- Division of Hematology & Oncology, Nagoya City University Hospital, Japan
| | - Asahi Ito
- Division of Hematology & Oncology, Nagoya City University Hospital, Japan
| | - Masaki Ri
- Division of Hematology & Oncology, Nagoya City University Hospital, Japan
| | - Shigeru Kusumoto
- Division of Hematology & Oncology, Nagoya City University Hospital, Japan
| | - Takashi Ishida
- Division of Hematology & Oncology, Nagoya City University Hospital, Japan
| | - Hirokazu Komatsu
- Division of Hematology & Oncology, Nagoya City University Hospital, Japan
| | - Shinsuke Iida
- Division of Hematology & Oncology, Nagoya City University Hospital, Japan
| |
Collapse
|
9
|
Gülmez D, Doğan Ö, Boral B, Döğen A, İlkit M, de Hoog GS, Arikan-Akdagli S. In vitro activities of antifungal drugs against environmentalExophialaisolates and review of the literature. Mycoses 2018; 61:561-569. [DOI: 10.1111/myc.12779] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/23/2018] [Accepted: 03/24/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Dolunay Gülmez
- Department of Medical Microbiology; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Özlem Doğan
- Department of Medical Microbiology; Faculty of Medicine; Hacettepe University; Ankara Turkey
- Medical Microbiology Department; Haydarpaşa Numune Hospital; Istanbul Turkey
| | - Barış Boral
- Department of Medical Microbiology; Faculty of Medicine; Hacettepe University; Ankara Turkey
- Department of Medical Microbiology; Faculty of Medicine; Çukurova University; Adana Turkey
| | - Aylin Döğen
- Department of Pharmaceutical Microbiology; Faculty of Pharmacy; Mersin University; Mersin Turkey
| | - Macit İlkit
- Department of Medical Microbiology; Faculty of Medicine; Çukurova University; Adana Turkey
| | - G. Sybren de Hoog
- Westerdijk Fungal Biodiversity Institute; Utrecht The Netherlands
- Center of Expertise in Mycology Radboudumc/CWZ; Nijmegen The Netherlands
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology; Faculty of Medicine; Hacettepe University; Ankara Turkey
| |
Collapse
|
10
|
Invasive Fungal Infection Caused by Exophiala dermatitidis in a Patient After Lung Transplantation: Case Report and Literature Review. Mycopathologia 2018; 184:107-113. [DOI: 10.1007/s11046-018-0275-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/27/2018] [Indexed: 12/20/2022]
|
11
|
Lang R, Minion J, Skinner S, Wong A. Disseminated Exophiala dermatitidis causing septic arthritis and osteomyelitis. BMC Infect Dis 2018; 18:255. [PMID: 29866071 PMCID: PMC5987487 DOI: 10.1186/s12879-018-3171-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/28/2018] [Indexed: 01/25/2023] Open
Abstract
Background Exophiala dermatitidis is a melanized fungus isolated from many environmental sources. Infections caused by Exophiala species are typically seen in immunocompromised hosts and manifest most commonly as cutaneous or subcutaneous disease. Systemic infections are exceedingly rare and associated with significant morbidity and mortality Case presentation A 28-year-old female originally from India presented with fevers, chills, weight loss and increasing back pain. She had a recent diffuse maculopapular rash that resulted in skin biopsy and a tentative diagnosis of sarcoidosis, leading to administration of azathioprine and prednisone. An MRI of her spine revealed a large paraspinal abscess requiring surgical intervention and hardware placement. Cultures from the paraspinal abscess grew a colony of dark pigmented mold. Microscopy of the culture revealed a melanized fungus, identified as Exophiala dermatitidis. Voriconazole was initially utilized, but due to relapse of infection involving the right iliac crest and left proximal humerus, she received a prolonged course of amphotericin B and posaconazole in combination and required 7 separate surgical interventions. Prolonged disease stability following discontinuation of therapy was achieved. Conclusions Described is the first identified case of disseminated Exophiala dermatitidis causing osteomyelitis and septic arthritis in a patient on immunosuppressive therapy. A positive outcome was achieved through aggressive surgical intervention and prolonged treatment with broad-spectrum antifungal agents.
Collapse
Affiliation(s)
- Raynell Lang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Minion
- Regina Qu'Appelle Health Region, Department of Laboratory Medicine, University of Saskatchewan, College of Medicine, Regina, Saskatchewan, Canada
| | - Stuart Skinner
- Division of Infectious Diseases, Department of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada.,4E - ID Clinic, Regina General Hospital, 1440 14th Avenue Regina, Regina, Saskatchewan, Canada
| | - Alexander Wong
- Division of Infectious Diseases, Department of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada. .,4E - ID Clinic, Regina General Hospital, 1440 14th Avenue Regina, Regina, Saskatchewan, Canada.
| |
Collapse
|
12
|
Combination of Amphotericin B and Terbinafine against Melanized Fungi Associated with Chromoblastomycosis. Antimicrob Agents Chemother 2018; 62:AAC.00270-18. [PMID: 29581111 DOI: 10.1128/aac.00270-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/15/2018] [Indexed: 11/20/2022] Open
Abstract
Our in vitro studies showed that a combination of amphotericin B and terbinafine had synergistic effects against the majority of melanized fungi associated with chromoblastomycosis (CBM) and similar infections, including those with Cladophialophora carrionii, Cladophialophora arxii, Exophialadermatitidis, Exophialaspinifera, Fonsecaea monophora, Fonsecaea nubica, Fonsecaea pedrosoi, and Phialophora verrucosa. This drug combination could provide an option for the treatment of severe or unresponsive cases of CBM, particularly in cases due to species of Fonsecaea and Cladophialophora.
Collapse
|
13
|
Silva WC, Gonçalves SS, Santos DWCL, Padovan ACB, Bizerra FC, Melo ASA. Species diversity, antifungal susceptibility and phenotypic and genotypic characterisation of Exophiala spp. infecting patients in different medical centres in Brazil. Mycoses 2017; 60:328-337. [PMID: 28139861 DOI: 10.1111/myc.12597] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/08/2016] [Accepted: 12/10/2016] [Indexed: 01/25/2023]
Abstract
The Exophiala genus is responsible for many superficial and invasive infections resulting from black fungi. Identification of Exophiala at the species level is based on morphological observations complemented by molecular tests. The aim of this study was to identify 23 clinical isolates of Exophiala spp. and evaluate the antifungal susceptibility to seven different agents. Molecular identification was based on an analysis of ITS region of rDNA using genomic databases. The micromorphology was evaluated by microculture and scanning electron microscopy. The susceptibility tests were performed using the antifungal agents 5-fluorocytosine (5-FC), amphotericin B (AMB), itraconazole (ITC), voriconazole (VRC), posaconazole (PSC), caspofungin (CFG) and terbinafine (TRB). The ITS analysis identified 100% of the following isolates as: E. dermatitidis (8), E. xenobiotica (6), E. bergeri (4), E. oligosperma (3), E. spinifera (1) and E. mesophila (1). The antifungal susceptibility tests showed that the triazoles compounds were in vitro the most active agents against Exophiala. ITS sequencing enabled the accurate identification of the 23 tested isolates. The triazoles, particularly itraconazole and posaconazole, exhibited MIC values lower than AMB, CAS and 5-FC. Although the guidelines do not indicate AMB for treatment against Exophiala spp., this study showed activity for all of the tested species, except E. mesophila.
Collapse
Affiliation(s)
- Wendy C Silva
- Laboratório Especial de Micologia, Disciplina de Infectologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sarah S Gonçalves
- Centro de Investigações em Micologia Médica (CIMM), Departamento de Patologia, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Daniel W C L Santos
- Laboratório Especial de Micologia, Disciplina de Infectologia, Universidade Federal de São Paulo, São Paulo, Brazil.,Hospital do Rim - Fundação Oswaldo Ramos, São Paulo, Brazil
| | - Ana Carolina B Padovan
- Laboratório Especial de Micologia, Disciplina de Infectologia, Universidade Federal de São Paulo, São Paulo, Brazil.,Departamento de Microbiologia e Imunologia, Instituto de Ciências Biomédicas, Universidade Federal de Alfenas, Alfenas, Brazil
| | - Fernando C Bizerra
- Laboratório Especial de Micologia, Disciplina de Infectologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Analy S A Melo
- Laboratório Especial de Micologia, Disciplina de Infectologia, Universidade Federal de São Paulo, São Paulo, Brazil
| |
Collapse
|
14
|
Combination of Amphotericin B and Flucytosine against Neurotropic Species of Melanized Fungi Causing Primary Cerebral Phaeohyphomycosis. Antimicrob Agents Chemother 2016; 60:2346-51. [PMID: 26833164 DOI: 10.1128/aac.02526-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/28/2016] [Indexed: 01/13/2023] Open
Abstract
Primary central nervous system phaeohyphomycosis is a fatal fungal infection due mainly to the neurotropic melanized fungiCladophialophora bantiana,Rhinocladiella mackenziei, andExophiala dermatitidis.Despite the combination of surgery with antifungal treatment, the prognosis continues to be poor, with mortality rates ranging from 50 to 70%. Therefore, a search for a more-appropriate therapeutic approach is urgently needed. Ourin vitrostudies showed that with the combination of amphotericin B and flucytosine against these species, the median fractional inhibitory concentration (FIC) indices for strains ranged from 0.25 to 0.38, indicating synergy. By use of Bliss independence analysis, a significant degree of synergy was confirmed for all strains, with the sum ΔE ranging from 90.2 to 698.61%. No antagonism was observed. These results indicate that amphotericin B, in combination with flucytosine, may have a role in the treatment of primary cerebral infections caused by melanized fungi belonging to the orderChaetothyriales Furtherin vivostudies and clinical investigations to elucidate and confirm these observations are warranted.
Collapse
|
15
|
Yang F, Ding S, Liu W, Liu J, Zhang W, Zhao Q, Ma X. Antifungal activity of 40 TCMs used individually and in combination for treatment of superficial fungal infections. JOURNAL OF ETHNOPHARMACOLOGY 2015; 163:88-93. [PMID: 25625353 DOI: 10.1016/j.jep.2015.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/05/2015] [Accepted: 01/18/2015] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE A series of 40 important Traditional Chinese Medicines (TCMs), which were reported effective in treating superficial fungal infections of the skin in Chinese clinical trial publications and Chinese Herbal Classics, were chosen for the investigation of the individual and combination antifungal properties against 8 superficial fungal strains in vitro. MATERIALS AND METHODS Plant preparations were followed the theory of TCM by using sterile water boiled with plant material at 100°C to produce water decoction of the tested sample. The minimum inhibitory concentration (MIC) of each plant for each fungus was determined. For the compatibility investigation, both invariable (same amounts of each tested TCM) and variable (different amounts of each tested TCM) combinations were evaluated. RESULTS All the tested TCMs demonstrated varying degrees of antifungal activities against one or more of the tested superficial fungi, and 16 of which were effective on all of the fungi. Strong antifungal activities were exhibited by water decoction of 7 TCMs with MIC at about 100μg/ml, and among these effective antifungal extracts, 4 TCMs including Melaphis chinensis, Polygonum cuspidatum, Punica granatum and Schisandra chinensis showed the significantly inhibitory activities against all of the fungi with MICs among 50μg/ml. Most of the invariable combinations of the above-mentioned 4 TCMs showed synergic effects against 4 of the least susceptible fungi strains, especially the invariable combination of Punica granatum, Melaphis chinensis and Schisandra chinensis, with the MIC at 23.4μg/ml. However, their further variable combinations investigation demonstrated that only the combination of 7.5g Punica granatum with 10g Melaphis chinensis and 7.5g Schisandra chinensis showed synergic effect with the MIC at19.5μg/ml. CONCLUSIONS The present study aimed the discovery of therapeutically useful agents for treatment of superficial fungal infections. Findings suggested that the combination of 3 TCMs including Punica granatum, Melaphis chinensis and Schisandra chinensis showed potential antifungal activity and thus appeared to be promising agents in preventing superficial fungal skin infectious in a natural way through herbal resources. The synergic effects of invariable and variable combinations of the tested TCMs threw a light on our further animal model and clinical practice as well as the bio-guided isolation and identification of the antifungal compounds.
Collapse
Affiliation(s)
- Fengqin Yang
- School of Laboratory Medicine, Ningxia Medical University, Yinchuan 750004, China
| | - Shuqin Ding
- School of Laboratory Medicine, Ningxia Medical University, Yinchuan 750004, China
| | - Wei Liu
- The Fourth People׳s Hospital of Ningxiahui Autonomous Region, Yinchuan 750001, China
| | - Junwen Liu
- Higher Vocational Technical School, Ningxia Medical University, Yinchuan 750004, China
| | - Wei Zhang
- School of Laboratory Medicine, Ningxia Medical University, Yinchuan 750004, China
| | - Qipeng Zhao
- Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, Ningxia Medical University, Yinchuan 750004, China
| | - Xueqin Ma
- Key Laboratory of Hui Ethnic Medicine Modernization, Ministry of Education, Ningxia Medical University, Yinchuan 750004, China.
| |
Collapse
|
16
|
Exophiala dermatitidis pneumonia successfully treated with long-term itraconazole therapy. J Infect Chemother 2014; 20:446-9. [DOI: 10.1016/j.jiac.2014.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/22/2014] [Accepted: 02/27/2014] [Indexed: 11/18/2022]
|
17
|
Venkateshwar S, Ambroise MM, Asir GJ, Mudhigeti N, Ramdas A, Authy K, Shivaprakash MR, Kanungo R. A rare case report of subcutaneous phaeohyphomycotic cyst caused by Exophiala oligosperma in an immunocompetent host with literature review. Mycopathologia 2014; 178:117-21. [PMID: 24902578 DOI: 10.1007/s11046-014-9762-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 05/22/2014] [Indexed: 10/25/2022]
Abstract
We report a rare case of phaeohyphomycotic cyst in an immunocompetent patient caused by Exophiala oligosperma. This fungus is earlier known to cause infections in the immunocompromised. Identification of black fungi at species level is more challenging by conventional methods, and hence final identification of the fungi was based on sequencing of rDNA. The patient was managed with surgical excision. To the best of our knowledge, this is the first case report of E. oligosperma human infection from India.
Collapse
Affiliation(s)
- Sithara Venkateshwar
- Department of Pathology, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
Combinations of terbinafine or caspofungin with amphotericin B, posaconazole, or itraconazole were studied as potential treatments against 18 isolates of Mucor irregularis in vitro. Synergism of the combinations of terbinafine with amphotericin B, posaconazole, and itraconazole against 38.9, 33.3, and 44.4% of the strains studied was observed. In contrast, synergism of the combinations of caspofungin with amphotericin B, posaconazole, and itraconazole against 99.4, 66.7, and 99.4% of the strains studied was observed. Furthermore, no antagonism was observed.
Collapse
|
19
|
Schemuth H, Dittmer S, Lackner M, Sedlacek L, Hamprecht A, Steinmann E, Buer J, Rath PM, Steinmann J. In vitroactivity of colistin as single agent and in combination with antifungals against filamentous fungi occurring in patients with cystic fibrosis. Mycoses 2012; 56:297-303. [DOI: 10.1111/myc.12022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
20
|
In vitro susceptibility of environmental isolates of Exophiala dermatitidis to five antifungal drugs. Mycopathologia 2012; 175:455-61. [PMID: 23229615 DOI: 10.1007/s11046-012-9597-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
Abstract
Several dematiaceous fungi frequently isolated from nature are involved in cases of superficial lesions to lethal cerebral infections. Antifungal susceptibility data on environmental and clinical isolates are still sparse despite the advances in testing methods. The objective of this study was to examine the activities of 5-flucytosine, amphotericin B, itraconazole, voriconazole and terbinafine against environmental isolates of Exophiala strains by minimum inhibition concentration (MIC) determination. The strains were obtained from hydrocarbon-contaminated soil, ant cuticle and fungal pellets from the infrabuccal pocket of attine gynes. Broth microdilution assay using M38-A2 reference methodology for the five antifungal drugs and DNA sequencing for fungal identification were applied. Terbinafine was the most active drug against the tested strains. It was observed that amphotericin B was less effective, notably against Exophiala spinifera, also studied. High MICs of 5-flucytosine against Exophiala dermatitidis occurred. This finding highlights the relevance of studies on the antifungal resistance of these potential opportunistic species. Our results also contribute to a future improvement of the standard methods to access the drug efficacy currently applied to black fungi.
Collapse
|