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Kucukkaya IC, Gulsever CI, Dolas I, Genc GE, Kuskucu MA, Sabanci PA, Erturan Z. First case of Rhinocladiella mackenziei brain abscess in Turkey: Case report and review of the literature. Mycoses 2023; 66:755-766. [PMID: 37165906 DOI: 10.1111/myc.13601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023]
Abstract
Rhinocladiella mackenziei is a highly neurotropic fungus, mainly reported from the Middle East. However, in recent years, there have been some cases from outside this region. We described an additional fatal case of R. mackenziei cerebral infection for the first time from Turkey and made a literature review of all previously reported cases. During 34 years (1988-2022), there have been 42 R. mackenziei brain abscess cases. Most patients have been reported from Saudi Arabia (n = 14, 33.3%). It is noteworthy that 40.5% of patients, including our case, were immunocompetent at initial diagnosis and mostly presented with a single lesion (n = 10, 23.8%). The most frequent comorbidities were solid organ transplant (n = 9, 21.4%), diabetes mellitus (n = 6, 14.3%), malignancy (n = 6, 14.3%) and prior surgery (n = 3, 7.1%). The most commonly used initial antifungal regimen were amphotericin B together with itraconazole (n = 9, 21.4%), combinations of lipid preparations of amphotericin B, voriconazole and/or posaconazole (n = 9, 21.4%) and amphotericin B alone (n = 8, 19%). Although both surgical procedures and antifungal medication in the majority of patients were performed, mortality rates remained high (90.4%). The area at risk of R. mackenziei cerebral abscess cases extends to other countries. Clinicians should be aware of this emerging disease and take a detailed travel history in patients with atypical and undocumented brain abscesses. Our case confirms the hypothesis that this fungus might spread more widely than previously predicted regions.
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Affiliation(s)
| | - Cafer Ikbal Gulsever
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilyas Dolas
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gonca Erkose Genc
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mert Ahmet Kuskucu
- Department of Medical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
- İş-Bank Center for Infectious Diseases, Department of Medical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Pulat Akin Sabanci
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zayre Erturan
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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AlOtaibi TM, Gheith OA, Alobaid K, Nair P, Eldein SMZ, Mahmoud TS, Halim MA, Aboatya HH, Balaha MA, Atea KA, Nagib AM, Al-Hatmi AMS, Sadon A, Meis JF, Zahab M. Disseminated Rhinocladiella mackenziei infection in a kidney transplant recipient: A case report and literature review. J Mycol Med 2021; 31:101196. [PMID: 34418686 DOI: 10.1016/j.mycmed.2021.101196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/07/2021] [Accepted: 08/08/2021] [Indexed: 12/11/2022]
Abstract
Rhinocladiella mackenziei is a rare fungal pathogen which belongs to a large group of pigmented fungi causing phaeohyphomycosis. R. mackenziei primarily infects the brain and leads to high fatality rates among both immunocompetent and immunocompromised individuals. Among solid organ transplant recipients, the infection may disseminate to extra-neuronal sites, necessitating comprehensive radiologic imaging. Here we describe a new case of R. mackenziei infection in a renal transplant patient involving the brain and renal allograft. She received liposomal amphotericin B and voriconazole but no surgical intervention. Ultimately, the patient died after two months of hospital stay. A review of all reported cases of transplant patients infected with R. mackenziei is also presented.
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Affiliation(s)
| | - Osama A Gheith
- Hamed Alessa Organ Transplant Center, Shuwaikh, Kuwait; Urology and Nephrology Center, Mansoura University, Egypt
| | - Khaled Alobaid
- Mycology Reference Laboratory, Mubarak Al-Kabeer hospital, Jabriya 46307, Kuwait.
| | - Prasad Nair
- Hamed Alessa Organ Transplant Center, Shuwaikh, Kuwait
| | | | | | | | | | | | - Khalid A Atea
- Hamed Alessa Organ Transplant Center, Shuwaikh, Kuwait
| | - Ayman Maher Nagib
- Hamed Alessa Organ Transplant Center, Shuwaikh, Kuwait; Urology and Nephrology Center, Mansoura University, Egypt
| | - Abdullah M S Al-Hatmi
- Natural and Medical Sciences Research Center, University of Nizwa, 616 Nizwa, Oman; Department of Biological Sciences and Chemistry, College of Arts and Sciences, University of Nizwa, Nizwa 616, Oman; Centre of Expertise in Mycology Radboud University Medical Centre/ Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Amal Sadon
- Hamed Alessa Organ Transplant Center, Shuwaikh, Kuwait
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Mohamed Zahab
- Hamed Alessa Organ Transplant Center, Shuwaikh, Kuwait
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Mohammadi R, Mohammadi A, Ashtari F, Khorvash F, Hakamifard A, Vaezi A, Javidnia J, Meis JF, Badali H. Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei in Persian Gulf region: A case and review. Mycoses 2018; 61:261-265. [PMID: 29205524 DOI: 10.1111/myc.12734] [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: 09/26/2017] [Revised: 11/22/2017] [Accepted: 11/26/2017] [Indexed: 12/16/2022]
Abstract
Cerebral phaeohyphomycosis is frequently a fatal disease caused by truly neurotropic dematiaceous fungi. Although rare, this infection occurs especially among immunocompetent patients, and the clinical symptoms are often misdiagnosed as a cerebral tumour or bacterial brain abscess. The appropriate diagnosis and therapy of cerebral infections by melanized fungi are very challenging if they are caused by mysterious fungi with unknown ecological niche. We reported the second case of cerebral phaeohyphomycosis due to Rhinocladiella mackenziei in Iran and the first culture-confirmed case. In this report, the differential diagnosis and histopathological findings are discussed and a review of the literature is provided.
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Affiliation(s)
- Rasoul Mohammadi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abdolrasoul Mohammadi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Ashtari
- Department of Neurology, School of Medicine, Isfahan Neurology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzin Khorvash
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afsane Vaezi
- Student Research Committee Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Javad Javidnia
- Student Research Committee Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
| | - Hamid Badali
- Department of Medical Mycology and Parasitology/Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Yusupov N, Merve A, Warrell CE, Johnson E, Curtis C, Samandouras G. Multiple brain abscesses caused by Rhinocladiella mackenziei in an immunocompetent patient: a case report and literature review. Acta Neurochir (Wien) 2017; 159:1757-1763. [PMID: 28365816 DOI: 10.1007/s00701-017-3141-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
Abstract
Primary cerebral phaeohyphomycosis due to Rhinocladiella mackenziei is an extremely rare infection carrying more than 80% mortality, with most cases reported from the Middle East region. This darkly pigmented black yeast is highly neurotropic, aggressive and refractory to most antifungal agents. Here we present an immunocompetent elderly male, presenting with multiple brain abscesses, with R. mackenziei confirmed by nuclear ribosomal repeat region sequencing, who was successfully treated by surgical debridement and intravenous voriconazole. To our knowledge this is the first case reported from the United Kingdom. We also present a review of all such cases so far reported in the English literature world-wide, which we believe is a step further to understanding the pathogenesis and establishing effective treatment of this rare, yet often fatal disease.
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Affiliation(s)
- Natan Yusupov
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK
| | - Ashirwad Merve
- Department of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK
| | - Clare E Warrell
- Department of Microbiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, 60 Whitfield St, London, W1T 4EU, UK
| | | | - Carmel Curtis
- Department of Microbiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, 60 Whitfield St, London, W1T 4EU, UK
| | - George Samandouras
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK.
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Didehdar M, Gokanian A, Sofian M, Mohammadi S, Mohammadi R, Aslani N, Haghani I, Badali H. First fatal cerebral phaeohyphomycosis due to Rhinocladiella mackenziei in Iran, based on ITS rDNA. J Mycol Med 2015; 25:81-6. [PMID: 25637429 DOI: 10.1016/j.mycmed.2014.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 11/05/2014] [Accepted: 11/19/2014] [Indexed: 11/30/2022]
Abstract
Black yeast-like fungi and relatives as agents of cerebral phaeohyphomycosis are often encountered in human fatal brain abscesses and lead to almost 100% mortality despite the application of antifungal and surgical therapy. We report to our knowledge the first case of brain infection due to Rhinocladiella mackenziei in a 54-year-old immunocompetent male in Iran where R. mackenziei has not been reported previously. The initial diagnosis was brain fungal infection because of pigmented, irregular, branched, septated hyphae based on histopathological staining. The patient was treated with intravenous amphotericin B deoxycholate (0.5mg/kg/day) combined with oral itraconazole (200mg twice daily), nevertheless, his neurological function deteriorated rapidly and ultimately the patient died due to respiratory failure later two weeks. R. mackenziei was identified based on the sequencing of internal transcribed spacer (ITS rDNA region) (KJ140287). Therefore, considerable attention for this life-threatening infection is highly recommended.
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Affiliation(s)
- M Didehdar
- Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran; Department of Medical Mycology and Parasitology, Arak University of Medical Sciences, Arak, Iran
| | - A Gokanian
- Department of Surgery and cerebral, Arak University of Medical Sciences, Arak, Iran
| | - M Sofian
- Tuberculosis and pediatric infectious Research Center, Arak University of Medical Sciences, Arak, Iran
| | - S Mohammadi
- Laboratory of Valiaasr Hospital, Arak University of Medical Sciences, Arak, Iran
| | - R Mohammadi
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - N Aslani
- Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - I Haghani
- Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - H Badali
- Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran.
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Al-Tawfiq JA, Boukhamseen A. Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei (formerly Ramichloridium mackenziei): Case presentation and literature review. J Infect Public Health 2011; 4:96-102. [DOI: 10.1016/j.jiph.2011.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 01/10/2011] [Accepted: 01/16/2011] [Indexed: 10/18/2022] Open
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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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Cerebral phaeohyphomycosis caused by Rhinocladiella mackenziei in a woman native to Afghanistan. J Clin Microbiol 2010; 48:3451-4. [PMID: 20592148 DOI: 10.1128/jcm.00924-10] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rhinocladiella mackenziei is a recognized cause of endemic cerebral phaeohyphomycosis in the Middle East area. Surgical resection of the abscesses and posaconazole treatment have improved the ominous prognosis of this disease. We describe the case of a native Afghan woman living in France who presented with brain abscesses due to R. mackenziei.
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Taj-Aldeen SJ, Almaslamani M, Alkhalf A, Al Bozom I, Romanelli AM, Wickes BL, Fothergill AW, Sutton DA. Cerebral phaeohyphomycosis due toRhinocladiella mackenziei(formerlyRamichloridium mackenziei): a taxonomic update and review of the literature. Med Mycol 2010; 48:546-56. [DOI: 10.3109/13693780903383914] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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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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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