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Bhardwaj N, Aggarwal A, Kaur H, Rudramurthy SM, Gupta K. Cerebellar phaeohyphomycosis: a dark enigma. Clin Microbiol Infect 2024; 30:1018-1019. [PMID: 38522844 DOI: 10.1016/j.cmi.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Neha Bhardwaj
- Department of Pathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Aggarwal
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Harsimran Kaur
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kirti Gupta
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Wang WY, Luo HB, Hu JQ, Hong HH. Pulmonary Cladosporium infection coexisting with subcutaneous Corynespora cassiicola infection in a patient: A case report. World J Clin Cases 2022; 10:3490-3495. [PMID: 35611211 PMCID: PMC9048548 DOI: 10.12998/wjcc.v10.i11.3490] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/30/2021] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cladosporium and Corynespora cassiicola (C. cassiicola) infections rarely occur in humans. Mutations in human caspase recruitment domain protein 9 (CARD9) are reported to be associated with fungal diseases. Pulmonary Cladosporium infection coexisting with subcutaneous C. cassiicola infection in a patient with a CARD9 mutation has not been reported in the literature.
CASE SUMMARY A 68-year-old male patient was hospitalized for hypertrophic erythema and deep ulcers on the left upper extremity. He was diagnosed with pneumonia caused by Cladosporium, as identified through bronchoalveolar lavage fluid analysis, and deep dermatophytosis caused by C. cassiicola, as identified through morphological characteristics of the wound secretion culture. He underwent antifungal therapy (voriconazole) and recovered successfully. He carried two mutations in CARD9 (chr9:139266425 and chr9:139262240) and was therefore susceptible to fungal infections.
CONCLUSION This case study is the first to report the coexistence of pulmonary Cladosporium infection and subcutaneous C. cassiicola infection in a patient with CARD9 mutation. Our findings will be helpful in enriching the phenotypic spectrum of fungal infections underlying CARD9 deficiency.
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Affiliation(s)
- Wei-Yi Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou 310006, Zhejiang Province, China
| | - Hong-Bin Luo
- Department of Dermatology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou 310006, Zhejiang Province, China
| | - Jun-Qi Hu
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou 310006, Zhejiang Province, China
| | - Hui-Hua Hong
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou 310006, Zhejiang Province, China
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Radcliffe C, Radcliffe AJ, Azar MM, Grant M. Dematiaceous fungal infections in solid organ transplantation: systematic review and bayesian meta-analysis. Transpl Infect Dis 2022; 24:e13819. [PMID: 35253959 DOI: 10.1111/tid.13819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/03/2022] [Accepted: 02/19/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Dematiaceous fungi cause a number of infectious syndromes referred to as phaeohyphomycosis among both immunocompetent and immunocompromised hosts. We performed a systematic review to characterize these infections in solid organ transplant recipients (SOTR). METHODS We searched PubMed database (last searched 1/6/2022) for English-language reports on dematiaceous fungal infections in SOTR. Included reports needed individualized demographic, treatment, and outcome data; pediatric reports were excluded. A universally applicable bias assessment was performed on reports. Models for infection type and outcome were created using the Bayesian paradigm. RESULTS We included 149 reports on 201 cases of dematiaceous fungal infections in SOTR. The mean age was 54 years, 72% were men, and kidney recipients accounted for 61% of cases. Skin and soft tissue infection (SSTI) was the most common infectious syndrome (73%). Death from infection occurred in 7% of cases (14/201), with disseminated (32%) cases having the highest mortality. Our model for infection type predicted the relative probability of central nervous system infection to be highest in liver recipients. Across all transplant types, higher relative probabilities of disseminated and pulmonary infections occur in the early post-transplant period, and the predicted probabilities for these infection types decreased after 100 months post-transplantation. DISCUSSION We identified SSTI as the most common dematiaceous fungal infections in SOTR. Disseminated infections carried the worst prognosis. The evidence in this review is limited by the heterogeneity of included cases. No funding source was used, and this review's protocol was not registered. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Marwan M Azar
- Yale University School of Medicine, New Haven, CT, USA.,Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew Grant
- Yale University School of Medicine, New Haven, CT, USA.,Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
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Cortés P, Jane Hata D, Libertin C, Meza Villegas DM, Harris DM. Cladophialophora bantiana and Nocardia farcinica infection simultaneously occurring in a kidney transplant recipient: Case report and literature review. IMMUNITY INFLAMMATION AND DISEASE 2021; 9:1146-1152. [PMID: 34129286 PMCID: PMC8589401 DOI: 10.1002/iid3.480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
Solid organ transplant recipients are at increased risk of acquiring devastating infections with unusual pathogens. Nocardia are aerobic actinomycetes that affect the lungs, brain, skin and soft tissue. Cladophialophora species are dematiaceous fungi that overwhelmingly cause infections in the brain. Both organisms carry a high mortality rate. We present the first reported renal transplant case with Cladophialophora bantiana involving the renal allograft with concurrent invasive nocardiosis involving the lungs and brain.
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Affiliation(s)
- Pedro Cortés
- Division of Community Internal Medicine, Mayo Clinic Jacksonville, Florida, USA
| | - D Jane Hata
- Division of Laboratory Medicine and Pathology, Mayo Clinic Jacksonville, Florida, USA
| | - Claudia Libertin
- Division of Infectious Diseases, Mayo Clinic Jacksonville, Florida, USA
| | - Diana M Meza Villegas
- Division of Laboratory Medicine and Pathology, Mayo Clinic Jacksonville, Florida, USA
| | - Dana M Harris
- Division of Community Internal Medicine, Mayo Clinic Jacksonville, Florida, USA
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Shields BE, Rosenbach M, Brown-Joel Z, Berger AP, Ford BA, Wanat KA. Angioinvasive fungal infections impacting the skin. J Am Acad Dermatol 2019; 80:869-880.e5. [DOI: 10.1016/j.jaad.2018.04.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 01/19/2023]
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Kantarcioglu AS, Guarro J, De Hoog S, Apaydin H, Kiraz N. An updated comprehensive systematic review of Cladophialophora bantiana and analysis of epidemiology, clinical characteristics, and outcome of cerebral cases. Med Mycol 2018; 55:579-604. [PMID: 28007938 DOI: 10.1093/mmy/myw124] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 11/01/2016] [Indexed: 12/28/2022] Open
Abstract
Cladophialophora bantiana is a phaeoid fungus that only rarely has been isolated from sources other than the human brain. It has a particular tropism for the central nervous system (CNS). We have integrated and updated large-scale data related to several aspects of C. Bantiana and reviewed all the available reports on its cerebral infections, focusing on their geographical distribution, infection routes, immune status of infected individuals, type and location of infections, clinical manifestations and treatment and outcome, briefly looking over the spectrum of other disease entities associated with C. bantiana, that is, extra-cerebral and animal infections and on the environmental sources of this fungus. Among the agents of phaeohyphomycosis, a term used to describe an infection caused by a dark pigmented fungus, C. bantiana has some significant specific features. A total of 120 case reports were identified with a significantly higher percentage of healthy subjects than immune-debilitated patients (58.3% vs. 41.7%). Infections due to C. bantiana occur worldwide. The main clinical manifestations are brain abscess (97.5%), coinfection of brain tissue and meninges (14.2%) and meningitis alone (2.5%). Among immunocompetent patients, cerebral infection occurred in the absence of pulmonary lesions. The mortality rate is 65.0% regardless of the patient's immune status. The therapeutic options used include surgery or antifungals alone, and the combination of both, in most cases the fatal outcome being rapid after admission. Since the fungus is a true pathogen, laboratory workers should be made aware that BioSafety Level-3 precautions might be necessary.
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Affiliation(s)
- A Serda Kantarcioglu
- Mycology Unit, Department of Medical Microbiology, Cerrahpasa Medical Faculty, 343098 Cerrahpasa, Istanbul, Turkey
| | - Josep Guarro
- Unitat de Microbiologia, Facultat de Medicina i Ciencies de la Salut, IISPV, Universitat Rovira i Virgili, E-43201 Reus, Spain
| | - Sybren De Hoog
- Centraalbureau voor Schimmelcultures, Utrecht, and Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
| | - Hulya Apaydin
- Department of Neurology, Cerrahpasa Medical Faculty, 34098 Cerrahpasa, Istanbul, Turkey
| | - Nuri Kiraz
- Mycology Unit, Department of Medical Microbiology, Cerrahpasa Medical Faculty, 343098 Cerrahpasa, Istanbul, Turkey
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Reynaud Q, Dupont D, Nove-Josserand R, Durupt S, Persat F, Ader F, Grenet D, Durieu I. Rare and unusual presentation of Cladophialophora infection in a pulmonary transplant cystic fibrosis patient. Transpl Infect Dis 2017; 19. [PMID: 28994224 DOI: 10.1111/tid.12789] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 11/26/2022]
Abstract
A 35-year-old woman with severe cystic fibrosis was admitted for sudden loss of strength in both legs, revealing a myelitis. The medullary lesion biopsy revealed phaeohyphomycosis caused by Cladophialophora species. Myelitis caused by Cladophialophora bantiana is a rare disease associated with high mortality.
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Affiliation(s)
- Quitterie Reynaud
- Cystic Fibrosis Adult Referral Care Center, Department of Internal Medicine, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Damien Dupont
- Institut de Parasitologie et de Mycologie médicale, Hospices Civils de Lyon, Lyon, France
| | - Raphaële Nove-Josserand
- Cystic Fibrosis Adult Referral Care Center, Department of Internal Medicine, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Stephane Durupt
- Cystic Fibrosis Adult Referral Care Center, Department of Internal Medicine, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Florence Persat
- Institut de Parasitologie et de Mycologie médicale, Hospices Civils de Lyon, Lyon, France
| | - Florence Ader
- Service de Maladie Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, France
| | | | - Isabelle Durieu
- Cystic Fibrosis Adult Referral Care Center, Department of Internal Medicine, Hospices Civils de Lyon, Université de Lyon, Lyon, France
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Gschwend A, Dégot T, Denis J, Sabou AM, Jeung MY, Zapata E, Porzio M, Renaud-Picard B, Herbrecht R, Kessler R. Brain abscesses caused by Cladophialophora bantiana
in a lung transplant patient: A case report and review of the literature. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/30/2017] [Accepted: 06/29/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Anthony Gschwend
- Service de Pneumologie; Nouvel Hôpital Civil; Hôpitaux Universitaires de Strasbourg; Fédération de Médecine Translationnelle (FMTS); Strasbourg France
| | - Tristan Dégot
- Service de Pneumologie; Nouvel Hôpital Civil; Hôpitaux Universitaires de Strasbourg; Fédération de Médecine Translationnelle (FMTS); Strasbourg France
| | - Julie Denis
- Laboratoire de Parasitologie et Mycologie Médicale; Plateau Technique de Microbiologie; Hôpitaux Universitaires de Strasbourg; Strasbourg France
- Institut de Parasitologie et de Pathologie Tropicale; EA 7292; Fédération de Médecine Translationnelle (FMTS); Université de Strasbourg; Strasbourg France
| | - Alina M. Sabou
- Laboratoire de Parasitologie et Mycologie Médicale; Plateau Technique de Microbiologie; Hôpitaux Universitaires de Strasbourg; Strasbourg France
- Institut de Parasitologie et de Pathologie Tropicale; EA 7292; Fédération de Médecine Translationnelle (FMTS); Université de Strasbourg; Strasbourg France
| | - Mi Young Jeung
- Service de Radiologie B; Nouvel Hôpital Civil; Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Emilie Zapata
- Service de Pneumologie; Nouvel Hôpital Civil; Hôpitaux Universitaires de Strasbourg; Fédération de Médecine Translationnelle (FMTS); Strasbourg France
| | - Michele Porzio
- Service de Pneumologie; Nouvel Hôpital Civil; Hôpitaux Universitaires de Strasbourg; Fédération de Médecine Translationnelle (FMTS); Strasbourg France
| | - Benjamin Renaud-Picard
- Service de Pneumologie; Nouvel Hôpital Civil; Hôpitaux Universitaires de Strasbourg; Fédération de Médecine Translationnelle (FMTS); Strasbourg France
- EA 7293 Stress Vasculaire et Tissulaire en Transplantation; Université de Strasbourg; Strasbourg France
| | - Raoul Herbrecht
- Service d'Hématologie et d'Oncologie; Hôpital de Hautepierre; Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Romain Kessler
- Service de Pneumologie; Nouvel Hôpital Civil; Hôpitaux Universitaires de Strasbourg; Fédération de Médecine Translationnelle (FMTS); Strasbourg France
- EA 7293 Stress Vasculaire et Tissulaire en Transplantation; Université de Strasbourg; Strasbourg France
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Lahiri Mukhopadhyay S, Mahadevan A, Bahubali VH, Dawn Bharath R, Prabhuraj AR, Maji S, Siddaiah N. A rare case of multiple brain abscess and probably disseminated phaeohyphomycosis due to Cladophialophora bantiana in an immunosuppressed individual from India. J Mycol Med 2017; 27:391-395. [PMID: 28478966 DOI: 10.1016/j.mycmed.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/28/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
Cladophialophora bantiana, a dematiaceous neurotropic mold causes rare and lethal brain abscess, commonly in immunocompetent hosts. We report a rare and probably a case of disseminated infection with this black mold in an immunosuppressed individual from India. A 55-year-old diabetic male presented with severe headache, blurred-vision, behavioural abnormalities, eye-pain and ear-discharge. He was undergoing treatment for hypertension, prostatomegaly and obstructive pulmonary disease. He was on steroids for the past six years for uveitis. Haematology reports indicated elevated WBC and platelet count. He was negative for HIV, hepatitis, autoimmune antibodies and tumour markers. CD4 count was within normal limits. Brain magnetic resonance imaging revealed multiple ring-enhancing lesions and oedema in the left tempero-parietal region. Chest X-ray showed irregular consolidations in right paracardiac region and confluence in both lungs. Positron Emission Tomography of whole body revealed multiple lesions in brain, lungs, lymph nodes and C3-vertebrae. Histopathology of the lung lesion showed non-tuberculous infectious pathology and brain lesions showed necrosis with occurrence of pigmented hyphal fungi. The pus aspirated during surgical excision of brain lesions grew black mold, identified as C. bantiana. Although patient was started on intravenous Voriconazole, he succumbed to the infection after 7 days. The lesion was initially suspected to be of tuberculous etiology, and the lesions in lungs were also suggestive of malignancy, which was however ruled out by histopathological examination. Such diagnostic dilemmas are common in the infection caused by Cladophialophora, which can cause treatment delay and death. Early diagnosis is therefore mandatory for the rapid treatment and survival of patients.
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Affiliation(s)
- S Lahiri Mukhopadhyay
- Department of neuromicrobiology, National institute of mental health and neuro sciences (NIMHANS), Bangalore, India
| | - A Mahadevan
- Department of neuropathology, NIMHANS, Bangalore, India
| | - V H Bahubali
- Department of neuromicrobiology, National institute of mental health and neuro sciences (NIMHANS), Bangalore, India
| | - R Dawn Bharath
- Department of neuroimaging & interventional radiology, NIMHANS, Bangalore, India
| | - A R Prabhuraj
- Department of neurosurgery, NIMHANS, Bangalore, India
| | - S Maji
- Department of neuromicrobiology, National institute of mental health and neuro sciences (NIMHANS), Bangalore, India
| | - N Siddaiah
- Department of neuromicrobiology, National institute of mental health and neuro sciences (NIMHANS), Bangalore, India.
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Chakrabarti A, Kaur H, Rudramurthy SM, Appannanavar SB, Patel A, Mukherjee KK, Ghosh A, Ray U. Brain abscess due toCladophialophora bantiana: a review of 124 cases. Med Mycol 2015; 54:111-9. [DOI: 10.1093/mmy/myv091] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/08/2015] [Indexed: 11/12/2022] Open
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Mansour A, Jordan K. Disseminated Cladophialophora bantiana disease in a patient with prediabetes. BMJ Case Rep 2014; 2014:bcr-2014-206426. [PMID: 25398915 DOI: 10.1136/bcr-2014-206426] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cladophialophora bantiana, a dematiaceous fungus from the family Phaeohyphomycetes, is highly neurotropic and primarily reported as a rare cause of brain abscess. Pulmonary infection and disease outside the central nervous system is extremely rare, particularly in immunocompetent patients. We report an unusual case of disseminated cladosporiosis in a young man with a new diagnosis of prediabetes but no other identifiable risk factors for disease. Fungal cultures were positive for C. bantiana from brain abscess aspiration, vertebral bone cultures and subcarinal lymph node biopsy. Although the patient demonstrated initial good response to surgical debridement of brain abscesses plus antifungal therapy, he eventually expired from septic shock secondary to C. bantiana pneumonia and recurrent brain abscesses 2 years after initial diagnosis.
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Affiliation(s)
- Anas Mansour
- Department of Internal Medicine, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Kim Jordan
- Department of Internal Medicine, Riverside Methodist Hospital, Columbus, Ohio, USA
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Brandt ME, Warnock DW. Epidemiology, Clinical Manifestations, and Therapy of Infections Caused by Dematiaceous Fungi. J Chemother 2013; 15 Suppl 2:36-47. [PMID: 14708965 DOI: 10.1179/joc.2003.15.supplement-2.36] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The dematiaceous (brown-pigmented) fungi are a large and heterogenous group of moulds that cause a wide range of diseases including phaeohyphomycosis, chromoblastomycosis, and eumycotic mycetoma. Among the more important human pathogens are Alternaria species, Bipolaris species, Cladophialophora bantiana, Curvularia species, Exophiala species, Fonsecaea pedrosoi, Madurella species, Phialophora species, Scedosporium prolificans, Scytalidium dimidiatum, and Wangiella dermatitidis. These organisms are widespread in the environment, being found in soil, wood, and decomposing plant debris. Cutaneous, subcutaneous, and corneal infections with dematiaceous fungi occur worldwide, but are more common in tropical and subtropical climates. Infection results from traumatic implantation. Most cases occur in immunocompetent individuals. Dematiaceous moulds are also important causes of invasive sinusitis and allergic fungal sinusitis. Infection is thought to follow inhalation. Although cerebral infection is the commonest form of systemic phaeohyphomycosis, other localized deep forms of the disease, such as arthritis, and endocarditis, have been reported. Disseminated infection is uncommon, but its incidence is increasing, particularly among immunocompromised individuals. Scedosporium prolificans is the most frequent cause. A number of dematiaceous fungi are neurotropic, including Cladophialophora bantiana, Ramichloridium mackenziei, and Wangiella dermatitidis. Although cases have occurred in immunocompromised persons, cerebral phaeohyphomycosis is most common in immunocompetent individuals with no obvious risk factors. Most forms of disease caused by dematiaceous fungi require both surgical and medical treatment. Itraconazole is currently the most effective antifungal agent for chromoblastomycosis and subcutaneous phaeohyphomycosis, while ketoconazole remains useful for mycetoma. Extensive surgical debridement combined with amphotericin B treatment is recommended for chronic invasive sinusitis. Long-term treatment with itraconazole has led to improvement or remission in some patients that had failed to respond to amphotericin B. Allergic fungal sinusitis requires surgical removal of impacted mucin combined with postoperative oral corticosteroids. Antifungal treatment is not usually of benefit, but post-operative itraconazole may reduce the need for reoperation. The clinical outcome of cerebral and other deep-seated forms of phaeohyphomycosis is dismal, with long-term survival being reported only when complete surgical resection of discrete lesions is possible. The development of new antifungal agents and combination treatment may help to improve the management of these infections.
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Affiliation(s)
- M E Brandt
- Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Cladosporium Esophagitis After Liver Transplantation. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2011. [DOI: 10.1097/ipc.0b013e3181f5eadb] [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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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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Abstract
The biota of black fungi in humid indoor environments was established using a protocol that consisted of non-selective and selective isolation procedures. In total, 113 samples were taken from bathrooms of residences in The Netherlands, Germany and Austria. Samples were processed either (i) directly by culturing on agar media, or (ii) by pre-incubating samples for enrichment in mineral solutions with perlite granules under constant toluene atmosphere for three months. Dilutions from the latter were then cultured and incubated as were those directly plated to agar media. Black colonies were selected and identified by sequencing the rDNA Internal Transcribed Spacer (ITS) region. Twenty-eight strains of black fungi were found in 26 positive samples without enrichment, and 42 strains were isolated from 38 positive samples after enrichment in toluene. The great majority of black fungal species were members of the order Chaetothyriales, which is the main order of melanized human opportunistic pathogens. Cladosporium species (Capnodiales) were the most frequent isolates when no enrichment was applied, as opposed to Exophiala species (Chaetothyriales) with enrichment. The enrichment method provides insight into a fungal biota commonly occurring in homes which has previously been overlooked. Several species have been previously known only from cutaneous infections and could suggest that bathrooms are a likely reservoir of these fungi.
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Affiliation(s)
- X Lian
- Centraalbureau voor Schimmelcultures Fungal Biodiversity Centre, Utrecht, The Netherlands
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Use of amplified fragment length polymorphism to identify 42 Cladophialophora strains related to cerebral phaeohyphomycosis with in vitro antifungal susceptibility. J Clin Microbiol 2010; 48:2350-6. [PMID: 20421439 DOI: 10.1128/jcm.00653-10] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The amplified fragment length polymorphism technique has been applied to identify neurotropic chaetothyrialean black yeasts and relatives from clinical sources. Cladophialophora bantiana, C. emmonsii, C. arxii, C. devriesii, and C. modesta, previously identified on the basis of sequencing and phenotypic and physiological criteria, were confirmed by cluster analysis, demonstrating the clear separation of C. bantiana as a rather homogeneous group from the other species. C. bantiana is a neurotropic fungus causing cerebral abscesses with a mortality of up to 70%. Successful therapy consists of neurosurgical intervention and optimal antifungal therapy. Since the latter is not clearly defined in a large series, we tested the in vitro activities of eight antifungal drugs against clinical isolates of C. bantiana (n = 37), C. modesta (n = 2), C. arxii (n = 1), C. emmonsii (n = 1), and C. devriesii (n = 1), all of which had caused invasive infections. The resulting MIC(90)s for all neurotropic C. bantiana strains were as follows, in increasing order: posaconazole, 0.125 microg/ml; itraconazole, 0.125 microg/ml; isavuconazole, 0.5 microg/ml; amphotericin B, 1 microg/ml; voriconazole, 2 microg/ml; anidulafungin, 2 microg/ml; caspofungin, 4 microg/ml; and fluconazole, 64 microg/ml. On the basis of these in vitro results and the findings of previous clinical and animal studies, posaconazole seems to be a good alternative to the standard treatment, amphotericin B, for C. bantiana cerebral infections. The new agent isavuconazole, which is also available as an intravenous preparation, has adequate activity against C. bantiana.
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Fica A, Diaz MC, Luppi M, Olivares R, Saez L, Baboor M, Vasquez P. Unsuccessful Treatment with Voriconazole of a Brain Abscess due to Cladophialophora bantiana. ACTA ACUST UNITED AC 2009; 35:892-3. [PMID: 14723373 DOI: 10.1080/00365540310016736] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cladophialophora bantiana is a dematiaceous fungus, associated with brain abscess in normal or immunosuppressed patients. We report a case of CNS infection in this agent unsuccessfully treated by surgery and various antifungal compounds including high doses of voriconazole (6 mg/kg bid). No adverse effects related to this compound were observed.
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Affiliation(s)
- Alberto Fica
- Sección Infectología, Hospital Clinico U de Chile, Santiago, Chile.
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18
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Li DM, de Hoog GS. Cerebral phaeohyphomycosis--a cure at what lengths? THE LANCET. INFECTIOUS DISEASES 2009; 9:376-83. [PMID: 19467477 DOI: 10.1016/s1473-3099(09)70131-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cerebral phaeohyphomycosis is a fungal infection of the brain typically caused by Cladophialophora bantiana, Exophiala dermatitidis, and Rhinocladiella mackenziei, all of which belong to the order Chaetothyriales. The disease results in black, necrotic brain tissue, black pus, and black cerebrospinal fluid. Pathogens usually reach the brain through the bloodstream or lymphatic fluid and occasionally through direct spreading or accidental inoculation. Patients can present with hemiparesis, tonic spasm, headache, fever, sensory variation, cerebral irritation, and even psychotic behavioural changes. Radiological images are characterised by ring-enhanced signs and hyperdense and hypodense lesions. Pathological features frequently include black-to-brown necrotic tissue or dark-coloured pus, granulomatous inflammation, giant cell vasculitis, and pigmented fungal elements, which are easily seen on a direct potassium hydroxide smear, a rapid method for diagnosis. Black fungi can be cultured from a biopsy specimen. Combined antifungal chemotherapy, surgical debridement, and careful immunological interventions are strongly recommended to eradicate these intractable infections.
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Affiliation(s)
- Dong Ming Li
- Peking University Third Hospital, Beijing, China.
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19
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Central Nervous System Infections in Transplant Recipients by Cladophialophora bantiana. South Med J 2008; 101:292-6. [DOI: 10.1097/smj.0b013e318164e289] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Garzoni C, Markham L, Bijlenga P, Garbino J. Cladophialophora bantiana: a rare cause of fungal brain abscess. Clinical aspects and new therapeutic options. Med Mycol 2008; 46:481-6. [DOI: 10.1080/13693780801914906] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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21
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Adeyemi OA, Lie O, Bernstein R, Littell NG, Muro K, Patil D, Noskin GA. Woman with Multiple Brain Abscesses. Clin Infect Dis 2007. [DOI: 10.1086/522659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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22
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Abstract
Fungal infections in solid organ transplant recipients continue to be a significant cause of morbidity and mortality. Candida spp. and Aspergillus spp. account for most invasive fungal infections. The incidence of fungal infection varies with type of solid organ transplant. Liver transplant recipients have highest reported incidence of candida infections while lung transplant recipients have highest rate of Aspergillus infections. Recent epidemiological studies suggest the emergence of resistant strains of candida as well as mycelial fungi other than Aspergillus in these patients. The current review incorporates the recent changes in the epidemiology of fungal infections in solid organ transplant recipients and highlights the newer data on the diagnosis, prophylaxis and treatment of fungal infections in these patients.
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Affiliation(s)
- Fernanda P Silveira
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
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23
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Petrini B, Farnebo F, Hedblad MA, Appelgren P. Concomitat late soft tissue infections byCladophialophora bantianaandMycobacterium abscessusfollowing tsunami injuries. Med Mycol 2006; 44:189-92. [PMID: 16519023 DOI: 10.1080/13693780500294949] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A Swedish man and woman sustained severe soft tissue injuries during the tsunami catastrophe in Thailand in December 2004, and subsequently received partial thickness skin grafts after multiple surgical revisions. Four to six weeks post trauma they displayed signs of purulent infections in the non-traumatized, virtually intact skin outside the resection margins. Skin biopsies revealed granulomatous reactions and pigmented fungal hyphae were observed in specimens from the male patient. Cladophialophora bantiana and Mycobacterium abscessus were recovered concomitantly from samples obtained from both patients. Antifungal treatment was given with voriconazole for one month, after which no fungal growth was detected on biopsies. Antimycobacterial treatment was given with clarithromycin and amikacin. The symptoms gradually subsided in the male patient, but recurrent abscesses were noted with the female patient, from which M. abscessus was recovered despite prolonged antibiotic therapy.
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Affiliation(s)
- Björn Petrini
- Departments of Clinical Microbiology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
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24
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Lyons MK, Blair JE, Leslie KO. Successful treatment with voriconazole of fungal cerebral abscess due to Cladophialophora bantiana. Clin Neurol Neurosurg 2005; 107:532-4. [PMID: 16202830 DOI: 10.1016/j.clineuro.2004.11.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Revised: 11/04/2004] [Accepted: 11/22/2004] [Indexed: 11/30/2022]
Abstract
We report the first successfully treated case of Cladophialophora bantiana cerebral abscess with the relatively new antifungal agent voriconazole. Infection with this organism is often fatal. A 64-year-old man presented to our institution with progressive neurologic symptoms due to a brain abscess. A stereotactic brain biopsy confirmed the pathogen as C. bantiana. We discuss the successful treatment of this patient, and review the pharmacological actions of voriconazole and the literature on the treatment of this organism. Previously considered a rare cause of cerebral abscess, C. bantiana fungal infections have become more common in recent years. Aggressive and continuous treatment with voriconazole may offer an improved chance of survival in these patients.
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Affiliation(s)
- Mark K Lyons
- Department of Neurological Surgery, Mayo Clinic Scottsdale, Mayo Clinic College of Medicine, 13600 East Shea Boulevard, Scottsdale, AZ 85259, USA.
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25
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Levin TP, Baty DE, Fekete T, Truant AL, Suh B. Cladophialophora bantiana brain abscess in a solid-organ transplant recipient: case report and review of the literature. J Clin Microbiol 2004; 42:4374-8. [PMID: 15365048 PMCID: PMC516289 DOI: 10.1128/jcm.42.9.4374-4378.2004] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cerebral phaeohyphomycosis caused by Cladophialophora bantiana is a rare disease. We describe a heart and bilateral lung transplant recipient who was unsuccessfully treated for a C. bantiana brain abscess. This report compares the present case to those of other solid-organ transplant recipients with the same infection and to those of patients who did not receive transplants.
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Affiliation(s)
- Todd P Levin
- Department of Medicine, Temple University Hospital, Philadelphia, PA, USA.
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26
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Abstract
PURPOSE OF REVIEW Fungal infections caused by rare fungi have increased in recent years. This may be due to the increase in the number of immunocompromised patients. Some rare fungi are geographically restricted, but with globalization and travel these infections are seen worldwide. The aim of this review is to address recent advances in the management of some uncommon fungal infections. RECENT FINDINGS Dematiaceous fungi (Phaeohyphomycetes) have been reported in both immunocompromised and immunocompetent individuals. Cerebral involvement and disseminated disease are associated with high mortality rates. Surgical excision and broad-spectrum triazole antifungal therapy are associated with better outcomes. Mucormycosis in diabetic and immune-suppressed patients is associated with high mortality. Early radical surgical debridement and amphotericin B-based regimens are a key to success. Basidiobolomycosis has recently been reported to cause chronic granulomatous infection of the gastrointestinal tract. Treatment with itraconazole and surgical resection is associated with favourable outcomes. Invasive fusariosis in cancer patients is typically resistant to most antifungal agents, but recent data have suggested a response to voriconazole. Voriconazole also demonstrated activity against Scedosporium apiospermum, but was less active against Scedosporium prolificans. Amphotericin B and itraconazole are currently the treatments of choice for the southeast Asian fungus, Penicillium marneffie. SUMMARY Parallel to the increased number of patients susceptible to invasive infections has been an increase in the number of broad-spectrum antifungal agents allowing for better therapeutic options. High-quality data are lacking because of the rarity of such infections. In future, new triazoles and echinocandins will probably replace amphotericin B as the first therapeutic choice for many uncommon fungal infections.
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Affiliation(s)
- Hail M Al-Abdely
- Section of Infectious Diseases, Department of Medicine, King Faisal Specialist Hospital and Research Center, Saudi Arabia.
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27
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Kantarcioglu AS, de Hoog GS. Infections of the central nervous system by melanized fungi: a review of cases presented between 1999 and 2004. Mycoses 2004; 47:4-13. [PMID: 14998393 DOI: 10.1046/j.1439-0507.2003.00956.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Several types of infections of the central nervous system by melanized fungi can be distinguished: (a) single-organ infection of the cerebrum, (b) extension into the cerebrum from adjacent cavities, (c) fungal presence in the cerebrospinal fluid, or (d) meningitis. The fungal order Chaetothyriales (containing Exophiala-like black yeasts and relatives) is particularly rich in fungi causing cerebral infections. Cases by the main agents, Cladophialophora bantiana, Exophiala dermatitidis, and Ramichloridium mackenziei, published during the last 5 years are reviewed. Most of these infections prove to be fatal. Resection of the lesions in combination with antimycotic therapy may reduce mortality.
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Affiliation(s)
- A S Kantarcioglu
- Department of Microbiology and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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28
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Abliz P, Fukushima K, Takizawa K, Nishimura K. Identification of pathogenic dematiaceous fungi and related taxa based on large subunit ribosomal DNA D1/D2 domain sequence analysis. ACTA ACUST UNITED AC 2004; 40:41-9. [PMID: 14734185 DOI: 10.1016/s0928-8244(03)00275-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The nucleotide sequences of the D1/D2 domains of large subunit (26S) ribosomal DNA for 76 strains of 46 species of pathogenic dematiaceous fungi and related taxa were determined. Intra-species sequence diversity of medically important dematiaceous fungi including Phialophora verrucosa, Fonsecaea pedrosoi, Fonsecaea compacta, Cladophialophora carrionii, Cladophialophora bantiana, Exophiala dermatitidis, Exophiala jeanselmei, Exophiala spinifera, Exophiala moniliae, and Hortaea werneckii were extremely small; as few as 0 changes were detected in C. bantiana, Fonsecaea and Exophiala species, 1 bp in C. carrionii and H. werneckii, and 2 bp in P. verrucosa. Inter-species nucleotide diversity between most species was higher. These data suggested that the D1/D2 domain is sufficiently variable for identification of pathogenic dematiaceous fungi and relevant species. The phylogenetic trees constructed from the sequence data revealed that most human pathogenic species formed a single cluster and that Cladosporium and Phialophora species were distributed polyphyletically into several clusters.
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Affiliation(s)
- Paride Abliz
- Research Center for Pathogenic Fungi and Microbial Toxicoses, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8673, Japan
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29
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Revankar SG, Sutton DA, Rinaldi MG. Primary Central Nervous System Phaeohyphomycosis: A Review of 101 Cases. Clin Infect Dis 2004; 38:206-16. [PMID: 14699452 DOI: 10.1086/380635] [Citation(s) in RCA: 240] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2003] [Accepted: 09/01/2003] [Indexed: 11/03/2022] Open
Abstract
Phaeohyphomycosis refers to infections caused by darkly pigmented fungi. These fungi rarely cause life-threatening disease. We reviewed 101 cases of culture-proven primary central nervous system phaeohyphomycosis reported in the English-language literature from 1966 to 2002. The most frequently isolated species was Cladophialophora bantiana. The next most frequent isolate was Ramichloridium mackenziei, seen exclusively in patients from the Middle East. More than one-half of the cases occurred in patients with no known underlying immunodeficiency. Mortality rates were high regardless of immune status. Therapy is not standardized, although the combination of amphotericin B, flucytosine, and itraconazole may improve survival rates. Newer azoles, such as voriconazole, also have a broad spectrum of activity against these fungi, although clinical experience is limited. Complete excision of brain lesions may provide better results than simple aspiration. An aggressive medical and surgical approach is warranted in treating these infections to optimize outcomes.
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Affiliation(s)
- Sanjay G Revankar
- Dallas Veterans Affairs Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas 75216, USA.
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30
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Abstract
Fungi are ubiquitous in the environment. Opportunistic fungal pneumonias in the immunocompromised host continue to increase most commonly due to Aspergillus sp. Affected patients are usually hematopoietic stem cell and lung transplant recipients. Clinical presentation is protean, and the diagnosis is challenging. Culture of respiratory specimens has limited utility. The detection of circulating fungal antigens and DNA seems promising, but more studies are needed. Value of prophylactic strategies or preemptive therapy remains contentious. New antifungal drugs for managing invasive pulmonary aspergillosis continue to emerge, with better safety, efficacy, and pharmacologic profiles.
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Affiliation(s)
- Remzi Bag
- Baylor College of Medicine, Houston, Texas, USA.
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