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Lai SHY, Duque JSR, Chung BHY, Chung TWH, Leung D, Ho RSL, Lee R, Poon RWS, Chua GT, Cheong KN, Chui MMC, Lee M, Tam S, Him AHC, Cheng KF, Ho WWS, Yuen KY, Lee P, Lau YL. Invasive cerebral phaeohyphomycosis in a Chinese boy with CARD9 deficiency and showing unique radiological features, managed with surgical excision and antifungal treatment. Int J Infect Dis 2021; 107:59-61. [PMID: 33872781 DOI: 10.1016/j.ijid.2021.04.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022] Open
Abstract
We report this rare case of cerebral phaeohyphomycosis in a previously healthy Chinese boy, who was found to have caspase recruitment domain family member 9 (CARD9) deficiency. Initial radiological features suggested a neoplastic cerebral lesion, while histopathological examination supplemented by internal transcribed sequencing (ITS) of cerebral tissue confirmed the diagnosis of phaeohyphomycosis. He was treated with intravenous (IV) liposomal amphotericin B and voriconazole, guided by plasma and cerebrospinal fluid (CSF) level monitoring at drug initiation. At the 1 year follow-up, the patient demonstrated near complete neurological and radiological recovery.
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Affiliation(s)
- Sophie H Y Lai
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong
| | - Jaime S Rosa Duque
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong; Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | - Tom Wai-Hin Chung
- Department of Microbiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Daniel Leung
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Ronnie Siu-Lun Ho
- Department of Pathology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Raymand Lee
- Department of Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Rosana W S Poon
- Department of Microbiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Gilbert T Chua
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong; Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kai-Ning Cheong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong; Hong Kong Children's Hospital, Hong Kong
| | | | - Mianne Lee
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Sidney Tam
- Department of Pathology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Andrew Ho Cheuk Him
- Department of Neurosurgery, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - King-Fai Cheng
- Department of Neurosurgery, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wilson Wai-Shing Ho
- Department of Neurosurgery, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kwok-Yung Yuen
- Department of Microbiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Pamela Lee
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong; Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Hong Kong Children's Hospital, Hong Kong
| | - Yu-Lung Lau
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong; Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Hong Kong Children's Hospital, Hong Kong.
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2
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Yang Y, Wang P, Zheng J, Lv G, Mao R, Zhou D. Cerebral fungal abscess resembling high-grade glioma: A case report in an immunocompromised patient. Neurochirurgie 2020; 66:494-496. [PMID: 33053402 DOI: 10.1016/j.neuchi.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/29/2020] [Accepted: 09/02/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Y Yang
- Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, 510080 Guangzhou, Yuexiu District, P.R.China
| | - P Wang
- Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, 510080 Guangzhou, Yuexiu District, P.R.China
| | - J Zheng
- Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, 510080 Guangzhou, Yuexiu District, P.R.China
| | - G Lv
- Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, 510080 Guangzhou, Yuexiu District, P.R.China
| | - R Mao
- Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, 510080 Guangzhou, Yuexiu District, P.R.China
| | - D Zhou
- Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, 510080 Guangzhou, Yuexiu District, P.R.China.
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Velasco J, Revankar S. CNS Infections Caused by Brown-Black Fungi. J Fungi (Basel) 2019; 5:jof5030060. [PMID: 31295828 PMCID: PMC6787688 DOI: 10.3390/jof5030060] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 12/20/2022] Open
Abstract
Central nervous system (CNS) infections caused by brown-black or dematiaceous fungi are distinctly rare and represent a small proportion of infections termed phaeohyphomycoses. However, these are becoming more commonly reported. Though many fungi have been implicated in disease, most cases are caused by only a few species, Cladophialophora bantiana being the most common. Most of the fungi described are molds, and often cause infection in immunocompetent individuals, in contrast to infection with other more common molds such as Aspergillus, which is usually seen in highly immunocompromised patients. Diagnosis is challenging, as there are no specific tests for this group of fungi. In addition, these infections are often refractory to standard drug therapies, requiring an aggressive combined surgical and medical approach to improve outcomes, yet mortality remains high. There are no standardized treatments due to a lack of randomized clinical trials, though guidelines have been published based on available data and expert opinion.
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Affiliation(s)
- Jon Velasco
- Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA
| | - Sanjay Revankar
- Division of Infectious Diseases, Department of Medicine, Wayne State University, 3990 John R. Street, 5 Hudson, Detroit, MI 48201, USA.
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Aljuboori Z, Hruska R, Yaseen A, Arnold F, Wojda B, Nauta H. Fungal brain abscess caused by "Black Mold" (Cladophialophora bantiana) - A case report of successful treatment with an emphasis on how fungal brain abscess may be different from bacterial brain abscess. Surg Neurol Int 2017; 8:46. [PMID: 28480108 PMCID: PMC5402337 DOI: 10.4103/sni.sni_448_16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/03/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Central nervous system infection with Cladophialophora bantiana (Black Mold) is rare. It carries a high mortality rate, that is more than 70%, despite multimodal therapy. Case Description: We present a rare case of “black mold” fungal brain abscess that was successfully treated with good patient outcome. The case is unusual because there were two fungal brain abscesses located bilaterally symmetrically in the mesial frontal lobes, and the response to different treatment strategies was well documented by over 25 magnetic resonance imaging (MRI) scans. Initial attempts to treat these lesions by repeated surgical excision and systemic amphotericin B was followed by continued growth rather than resolution. We realized that the application of treatment principles learned from bacterial brain abscess may not transpose intuitively to the treatment of fungal brain abscess. Therefore, a new treatment strategy was adopted that avoided further attempts at resection in favor of long-term oral voriconazole and repeated intracavitary aspiration and instillation of amphotericin B on an outpatient basis. Without further resection, the lesions stabilized and the aspirates eventually sterilized, however, the enhancing capsule never resolved on MRI scans. All treatment was stopped after 1 year. The apparently sterilized lesions have been followed for an additional 3 years without further growth, and the patient remains functionally, intellectually, and behaviorally normal. Conclusion: We conclude that, in the case of fungal abscess, it may be preferable to sterilize the lesion in situ rather than attempting to achieve resolution on imaging studies by repeated surgical resection of the capsule which can be counterproductive. This strategy accepts that the capsule may be important to the patient's immune defense against the fungus. Helping that defense barrier with intracapsular and systemic antifungal agents, rather than capsular removal, may be the better strategy for patients in whom early aggressive resection has failed. The basis for the apparent differences in the response of fungal versus bacterial brain abscess to surgical resection is discussed in the light of pathological findings from this and other cases.
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Affiliation(s)
- Zaid Aljuboori
- Department of Neurological Surgery, University of Louisville SOM, Louisville, Kentucky, USA
| | - Rob Hruska
- Department of Neurological Surgery, University of Louisville SOM, Louisville, Kentucky, USA
| | - Alae Yaseen
- Department of Pathology, University of Louisville SOM, Louisville, Kentucky, USA
| | - Forest Arnold
- Department of Medicine, University of Louisville SOM, Louisville, Kentucky, USA
| | - Barbara Wojda
- Kentuckiana Infectious Disease Consultants, PSC, Louisville, Kentucky, USA
| | - Haring Nauta
- Department of Neurological Surgery, University of Louisville SOM, Louisville, Kentucky, USA
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Jung NY, Kim E. Cerebral phaeohyphomycosis: a rare cause of brain abscess. J Korean Neurosurg Soc 2014; 56:444-7. [PMID: 25535526 PMCID: PMC4273007 DOI: 10.3340/jkns.2014.56.5.444] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/01/2014] [Accepted: 10/22/2014] [Indexed: 11/27/2022] Open
Abstract
Cerebral phaeohyphomycosis (CP) is a very rare but serious form of central nervous system fungal infection that is caused by dematiaceous fungi. It is commonly associated with poor prognosis irrespective of the immune status of the patient. In this study, the authors describe the first case of CP in Korea that occurred in a 75-year-old man without immunodeficiency and showed favorable outcome after surgical excision and antifungal therapy. In addition, the authors herein review the literature regarding characteristics of this rare clinical entity with previously reported cases.
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Affiliation(s)
- Na-Young Jung
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Ealmaan Kim
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Vachhani JA, Lee WC, Desanto JR, Tsung AJ. Magnetic resonance spectroscopy imaging characteristics of cerebral Blastomycosis. Surg Neurol Int 2014; 5:80. [PMID: 24949223 PMCID: PMC4061578 DOI: 10.4103/2152-7806.133306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 03/14/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Blastomycosis is a dimorphic fungus that is endemic to the midwest and southwestern United States. Involvement of the central nervous system (CNS) is thought to only represent 5-10% of cases of disseminated Blastomycosis. CASE DESCRIPTION A 54-year-old Caucasian female presented to the Neurosurgery service with a 1-day history of progressive right sided hemiparesis. Magnetic resonance imaging (MRI) demonstrated a 2 × 4 cm heterogeneous intracranial mass lesion involving the left motor cortex and extending into the ipsilateral parietal lobe. Single-voxel magnetic resonance spectroscopy (MRS) over the enhancing area demonstrated diminished N-acetyl aspartate (NAA) to creatine ratio (1.10), normal choline to NAA ratio (0.82), normal choline to creatine ratio (0.9), and a diminished myoinositol to creatine ratio (0.39). There appeared to be peaks between 3.6 and 3.8 ppm over the enhancing area that were not present in the contralateral normal brain and thought to represent a "trehalose" peak. Due to worsening symptoms and uncertain preoperative diagnosis, the patient underwent a left fronto-parietal craniotomy for open surgical biopsy with possible resection approximately one month after presentation. Pathological analysis confirmed the diagnosis of Blastomycosis. CONCLUSION We present the second documented case of intracranial Blastomycosis with MRS imaging. There appears to be a characteristic peak between 3.6 and 3.8 ppm that is thought to represent a "trehalose" peak. This peak is rather specific to fungi and can be helpful in differentiating fungal abscesses from pyogenic abscesses and malignant neoplasms.
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Affiliation(s)
- Jay A Vachhani
- Department of Neurosurgery, Illinois Neurological Institute, Peoria, Illinois, 530 NE Glen Oak Avenue, Peoria, IL 61637, USA
| | - William C Lee
- Department of Neurosurgery, Illinois Neurological Institute, Peoria, Illinois, 530 NE Glen Oak Avenue, Peoria, IL 61637, USA
| | - Jeffrey R Desanto
- Department of Radiology, Central Illinois Radiological Associates, University of Illinois, College of Medicine, Peoria, Illinois, 530 NE Glen Oak Avenue, Peoria, IL 61637, USA
| | - Andrew J Tsung
- Department of Neurosurgery, Illinois Neurological Institute, Peoria, Illinois, 530 NE Glen Oak Avenue, Peoria, IL 61637, USA
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Kourbeti IS, Mylonakis E. Fungal central nervous system infections: prevalence and diagnosis. Expert Rev Anti Infect Ther 2014; 12:265-73. [PMID: 24392732 DOI: 10.1586/14787210.2014.874282] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fungal infections of the central nervous system (CNS) are rare but they pose a significant challenge. Their prevalence spans a wide array of hosts including immunosuppressed and immunocompetent individuals, patients undergoing neurosurgical procedures and those carrying implantable CNS devices. Cryptococcus neoformans and Aspergillus spp. remain the most common pathogens. Magnetic resonance imaging can help localize the lesions, but diagnosis is challenging since invasive procedures may be needed for the retrieval of tissue, especially in cases of fungal abscesses. Antigen and antibody tests are available and approved for use in the cerebrospinal fluid (CSF). PCR-based techniques are promising but they are not validated for use in the CSF. This review provides an overview on the differential diagnosis of the fungal CNS disease based on the host and the clinical syndrome and suggests the optimal use of diagnostic techniques. It also summarizes the emergence of Cryptococcus gatti and an unanticipated outbreak caused by Exserohilum rostratum.
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Affiliation(s)
- Irene S Kourbeti
- Infectious Disease Division, Alpert Medical School and Brown University, Rhode Island Hospital, RI, USA
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Jelinek AG, Fuller C, Baykal A, Stogner-Underwood K, Richard H, Arkun K. Headaches and hemiparesis in an immunocompetent inmate. Neuropathology 2013; 34:314-7. [PMID: 24354458 DOI: 10.1111/neup.12084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Abstract
Infection of the central nervous system can be life-threatening and hence requires early diagnostic support for its optimal management. Routine definitive laboratory diagnostic tests can be time-consuming and delay definitive therapy. Noninvasive imaging modalities have established themselves in the diagnosis of various neurologic diseases. In this article, a pragmatic review of the current role of magnetic resonance spectroscopy in the diagnosis and management of intracranial infections is addressed.
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Affiliation(s)
- Rakesh K Gupta
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India.
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Cerebral phaeohyphomycosis in a patient with neurosarcoidosis on chronic steroid therapy secondary to recreational marijuana usage. Case Rep Radiol 2013; 2013:191375. [PMID: 23533904 PMCID: PMC3600140 DOI: 10.1155/2013/191375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 01/28/2013] [Indexed: 12/04/2022] Open
Abstract
Cerebral phaeohyphomycosis is often a fatal disease that typically takes a hematogenous spread after inhalation or accidental skin inoculation of pathogens. We present a patient with a history of heavy marijuana smoking while being on chronic steroid therapy for treatment of neurosarcoidosis who was found to have multiple brain abscesses from Curvularia sp. This is a ubiquitous soil-dwelling dematiaceous fungus that is generally thought to affect solely plants, but there is increasing evidence in the literature of it affecting humans and animals. We review the radiographic findings of neurosarcoidosis and cerebral phaeohyphomycosis as well as the pathophysiology of dematiaceous fungi infections.
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Rosow L, Jiang J, Deuel T, Lechpammer M, Zamani A, Milner D, Folkerth R, Marty F, Kesari S. Cerebral phaeohyphomycosis caused by Bipolaris spicifera after heart transplantation. Transpl Infect Dis 2011; 13:419-23. [DOI: 10.1111/j.1399-3062.2011.00610.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes, including chromoblastomycosis, mycetoma, and phaeohyphomycosis. [corrected]. Many are soil organisms and are generally distributed worldwide, though certain species appear to have restricted geographic ranges. Though they are uncommon causes of disease, melanized fungi have been increasingly recognized as important pathogens, with most reports occurring in the past 20 years. The spectrum of diseases with which they are associated has also broadened and includes allergic disease, superficial and deep local infections, pneumonia, brain abscess, and disseminated infection. For some infections in immunocompetent individuals, such as allergic fungal sinusitis and brain abscess, they are among the most common etiologic fungi. Melanin is a likely virulence factor for these fungi. Diagnosis relies on careful microscopic and pathological examination, as well as clinical assessment of the patient, as these fungi are often considered contaminants. Therapy varies depending upon the clinical syndrome. Local infection may be cured with excision alone, while systemic disease is often refractory to therapy. Triazoles such as voriconazole, posaconazole, and itraconazole have the most consistent in vitro activity. Further studies are needed to better understand the pathogenesis and optimal treatment of these uncommon infections.
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Recurrent Soft Tissue Infection 70 Years After Initial Trauma. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181f5e9ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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