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Cutaneous Phaeohyphomycosis of the Right Hand Caused by Exophiala jeanselmei: A Case Report and Literature Review. Mycopathologia 2022; 187:259-269. [PMID: 35314920 PMCID: PMC9124166 DOI: 10.1007/s11046-022-00623-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/01/2022] [Indexed: 02/08/2023]
Abstract
Exophiala spp. is increasingly reported as a pathogen causing the cutaneous, subcutaneous or invasive infection. In this report, we present a case of cutaneous phaeohyphomycosis due to E. jeanselmei on the right hand of a farmer, who suffered from this disease three years ago which had not been definitely diagnosed until he was admitted to our hospital. In our hospital, a potential fungal pathogen was observed by histopathological examination, and then was recovered and identified as E. jeanselmei by sequencing its internal transcribed spacer region. After 4 weeks of antifungal treatment, his hand recovered very well. To investigate the in vitro susceptibility of E. jeanselmei isolates to antifungal agents and compare the characteristics of their related infections among immunocompetent and immunocompromised patients, we reviewed 84 cases published in PubMed database between 1980 and 2020.
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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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Eumycetoma Medical Treatment: Past, Current Practice, Latest Advances and Perspectives. MICROBIOLOGY RESEARCH 2021. [DOI: 10.3390/microbiolres12040066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mycetoma is a neglected tropical disease that is associated with poor communities and socioeconomically impaired individuals in the tropical and sub-tropical areas. Interestingly, the disease is caused by either bacteria (actinomycetoma) or fungus (eumycetoma). The latter form of the disease, eumycetoma, is the most common type in Africa. Eumycetoma is characterized by a prolonged disease duration and low cure rate. The effective case management of eumycetoma largely depends on the accurate diagnosis and identification of the causative agent to the species level and evaluating its susceptibility to the available drugs. This review summarizes the currently available and used antifungal agents for the treatment of eumycetoma and discusses optimizing the newly developed antifungals as a potential second line for eumycetoma treatment.
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Mercier V, Bastides F, Bailly É, Garcia-Hermoso D, Miquelestorena-Standley E, El Baz Z, Marteau E, Vermes E, De Muret A, Bernard L, Desoubeaux G. Successful Terbinafine Treatment for Cutaneous Phaeohyphomycosis Caused by Trematosphaeria grisea in a Heart Transplanted Man: Case Report and Literature Review. Mycopathologia 2020; 185:709-716. [PMID: 32562177 DOI: 10.1007/s11046-020-00467-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/06/2020] [Indexed: 01/19/2023]
Abstract
Phaeohyphomycosis is a chronic infectious disease caused by dematiaceous fungi. It is characterized by the presence of pigmented septate mycelia within tissues. In the case of superficial infection, the lesion(s) chronically evolve(s) toward painless pseudo-tumor(s) of the soft parts. We report herein the original case of a heart transplanted man who exhibited phaeohyphomycosis of the left hand, with no mention of travels in endemic areas. Trematosphaeria grisea was identified as the causative agent, which is quite innovative since this species has been rather described in mycetoma. The antifungal treatment initially based on isavuconazole alone was not sufficient to cure the patient. In contrast, its association with local terbinafine ointment allowed total clinical improvement. This finding is unusual as diagnosis of phaeohyphomycosis caused by T. grisea is uncommon in nontropical countries, and as the outcome appeared successful by the means of add-on therapeutic strategy with terbinafine.
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Affiliation(s)
- Victor Mercier
- Parasitologie - Mycologie et Médecine Tropicale, Hôpital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37044, Tours, France.
| | - Frédéric Bastides
- Médecine Interne Et Maladies Infectieuses, CHU de Tours, Tours, France
| | - Éric Bailly
- Parasitologie - Mycologie et Médecine Tropicale, Hôpital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37044, Tours, France
| | - Dea Garcia-Hermoso
- CNRS, National Reference Center for Invasive Mycoses and Antifungals (NRCMA), Molecular Mycology Unit, UMR2000, Institut Pasteur, Paris, France
| | | | - Zaki El Baz
- Radiologie, CHU de Tours, Chambray-les-Tours, France
| | - Emilie Marteau
- Chirurgie orthopédique Et Traumatologie, CHU de Tours, Chambray-les-Tours, France
| | | | - Anne De Muret
- Anatomie Et Cytologie Pathologiques, CHU de Tours, Chambray-les-Tours, France
| | - Louis Bernard
- Médecine Interne Et Maladies Infectieuses, CHU de Tours, Tours, France
| | - Guillaume Desoubeaux
- Parasitologie - Mycologie et Médecine Tropicale, Hôpital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37044, Tours, France
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Kang RB, Simonson DC, Stoner SE, Hughes SR, Agger WA. The Clinical Presentation of Subcutaneous Phaeohyphomycosis: A Case Series from Yetebon, Ethiopia. Clin Med Res 2017; 15:88-92. [PMID: 29018005 PMCID: PMC5849443 DOI: 10.3121/cmr.2017.1377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/06/2017] [Accepted: 10/03/2017] [Indexed: 11/18/2022]
Abstract
Subcutaneous phaeohyphomycosis is a chronic fungal infection usually found on the lower extremity and feet of agricultural workers in the tropics. It can present with various skin manifestations, verrucous to nodular plaques, and is caused by multiple species of fungi. Laboratory confirmation requires skin samples for pathology and fungal cultures. Cure, often difficult in resource-poor countries, requires months of antifungal therapy. We describe the cases of three men from Ethiopia who were seen and are being treated by American doctors who traveled there on a medical mission.
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Affiliation(s)
- Rachel B Kang
- Department of Medical Education, Gundersen Medical Foundation, La Crosse, Wisconsin, USA
| | - Devin C Simonson
- Department of Podiatry, Gundersen Health System; La Crosse, Wisconsin, USA
| | - Sarah E Stoner
- Department of Microbiology, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Sarah R Hughes
- Department of Pathology, Gundersen Health System, La Crosse, Wisconsin, USA
| | - William A Agger
- Department of Medical Education, Gundersen Medical Foundation, La Crosse, Wisconsin, USA
- Infectious Disease Section, Gundersen Health System, La Crosse, Wisconsin, USA
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Oberlin KE, Nichols AJ, Rosa R, Dejman A, Mattiazzi A, Guerra G, Elgart GW, Abbo LM. Phaeohyphomycosis due toExophialainfections in solid organ transplant recipients: Case report and literature review. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12723] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/18/2017] [Accepted: 02/19/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Kate E. Oberlin
- Department of Dermatology and Cutaneous Surgery; Jackson Health System/University of Miami Miller School of Medicine; Miami FL USA
| | - Anna J. Nichols
- Department of Dermatology and Cutaneous Surgery; Jackson Health System/University of Miami Miller School of Medicine; Miami FL USA
| | - Rossana Rosa
- Department of Medicine; Division of Infectious Diseases; Jackson Health System/University of Miami Miller School of Medicine; Miami FL USA
| | - Adriana Dejman
- Department of Medicine; Division of Nephrology; University of Miami Miller School of Medicine; Miami FL USA
| | - Adela Mattiazzi
- Department of Medicine; Division of Nephrology; University of Miami Miller School of Medicine; Miami FL USA
| | - Giselle Guerra
- Department of Medicine; Division of Nephrology; University of Miami Miller School of Medicine; Miami FL USA
| | - George W. Elgart
- Department of Dermatology and Cutaneous Surgery; Jackson Health System/University of Miami Miller School of Medicine; Miami FL USA
| | - Lilian M. Abbo
- Department of Medicine; Division of Infectious Diseases; Jackson Health System/University of Miami Miller School of Medicine; Miami FL USA
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7
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Phaeohyphomycosis in Transplant Patients. J Fungi (Basel) 2015; 2:jof2010002. [PMID: 29376919 PMCID: PMC5753083 DOI: 10.3390/jof2010002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 12/15/2015] [Accepted: 12/17/2015] [Indexed: 11/17/2022] Open
Abstract
Phaeohyphomycosis is caused by a large, heterogenous group of darkly pigmented fungi. The presence of melanin in their cell walls is characteristic, and is likely an important virulence factor. These infections are being increasingly seen in a variety of clinical syndromes in both immunocompromised and normal individuals. Transplant patients are especially at risk due their prolonged immunosuppression. There are no specific diagnostic tests for these fungi, though the Fontana-Masson stain is relatively specific in tissue. They are generally seen in a worldwide distribution, though a few species are only found in specific geographic regions. Management of these infections is not standardized due to lack of clinical trials, though recommendations are available based on clinical experience from case reports and series and animal models. Superficial infections may be treated without systemic therapy. Central nervous system infections are unique in that they often affect otherwise normal individuals, and are difficult to treat. Disseminated infections carry a high mortality despite aggressive therapy, usually with multiple antifungal drugs. Considerable work is needed to determine optimal diagnostic and treatment strategies for these infections.
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Abstract
Medical treatment of mycetoma depends on its fungal or bacterial etiology. Clinically, these entities share similar features that can confuse diagnosis, causing a lack of therapeutic response due to inappropriate treatment. This review evaluates the response to available antimicrobial agents in actinomycetoma and the current status of antifungal drugs for treatment of eumycetoma.
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Affiliation(s)
- Oliverio Welsh
- Department of Dermatology, Dr. Jose E. Gonzalez University Hospital, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
- * E-mail:
| | - Hail Mater Al-Abdely
- Section of Infectious Diseases, Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mario Cesar Salinas-Carmona
- Department of Immunology, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
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Chowdhary A, Meis J, Guarro J, de Hoog G, Kathuria S, Arendrup M, Arikan-Akdagli S, Akova M, Boekhout T, Caira M, Guinea J, Chakrabarti A, Dannaoui E, van Diepeningen A, Freiberger T, Groll A, Hope W, Johnson E, Lackner M, Lagrou K, Lanternier F, Lass-Flörl C, Lortholary O, Meletiadis J, Muñoz P, Pagano L, Petrikkos G, Richardson M, Roilides E, Skiada A, Tortorano A, Ullmann A, Verweij P, Cornely O, Cuenca-Estrella M. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi. Clin Microbiol Infect 2014; 20 Suppl 3:47-75. [DOI: 10.1111/1469-0691.12515] [Citation(s) in RCA: 216] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 12/13/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022]
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Tong Z, Chen SCA, Chen L, Dong B, Li R, Hu Z, Jiang P, Li D, Duan Y. Generalized subcutaneous phaeohyphomycosis caused by Phialophora verrucosa: report of a case and review of literature. Mycopathologia 2013; 175:301-6. [PMID: 23392822 DOI: 10.1007/s11046-013-9626-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 01/25/2013] [Indexed: 11/29/2022]
Abstract
We report a case of subcutaneous phaeohyphomycosis due to Phialophora verrucosa in a 64-year-old Chinese farmer suffering from CD4+ lymphopenia. He presented with diffuse and infiltrated plaques involving the entire face including the eyes, neck, occiput, and extending to the dorsal regions of his torso. The patient is notable for the discrete multifocal nature of the illness in the absence of disseminated infection and rarity of P. verrucosa as a cause of subcutaneous phaeohyphomycosis.
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Affiliation(s)
- Zhongsheng Tong
- Department of Dermatology, Center for Infectious Skin Diseases, No. 1 Hospital of Wuhan, Wuhan, China.
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11
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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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Lief M, Caplivski D, Bottone E, Lerner S, Vidal C, Huprikar S. Exophiala jeanselmei infection in solid organ transplant recipients: report of two cases and review of the literature. Transpl Infect Dis 2010; 13:73-9. [DOI: 10.1111/j.1399-3062.2010.00552.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Arakaki O, Asato Y, Yagi N, Taira K, Yamamoto YI, Nonaka K, Hosokawa A, Kayo S, Hagiwara K, Uezato H. Phaeohyphomycosis caused by Exophiala jeanselmei in a patient with polymyalgia rheumatica. J Dermatol 2010; 37:367-73. [PMID: 20507409 DOI: 10.1111/j.1346-8138.2010.00819.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An 87-year-old man, a gardener in Okinawa, first noticed a tumor on the dorsum of his right hand in November 2005. He had been taking prednisolone for the treatment of polymyalgia rheumatica since 2000. A nearby dermatologist incised the tumor for pus drainage in February 2006. In April of the same year, the dome-like tumor reappeared. The same treatment was repeated. Because the culture of the pus revealed fungi at that time, terbinafine hydrochloride and minocycline were administrated under the diagnosis of a deep fungal infection. After a short remission, the tumor recurred in November of the same year and in May and August of 2007 regardless of the repeated incision and pus drainage. He was referred to our hospital on 27 September 2007. His first physical examination at our outpatient office showed a skin-colored, well-demarcated, multilocular, cystic subcutaneous tumor on the dorsum of his right hand. Histopathological examination revealed a pseudocyst with fibrous walls of connective tissue. Continuous, bead-like hyphae, positive with periodic acid-Schiff stain and Grocott stain, were found within the pseudocyst. Morphological and molecular biological examinations of the separately cultured specimens identified the causative agent as Exophiala jeanselmei. The entire cyst was removed under local anesthesia, and an artificial dermis made of silicon membrane was applied to the wound. Skin graft was performed in November after confirming no recurrence of the fungal infection. Terbinafine hydrochloride 125 mg/day has continued. No recurrence has been observed up to now.
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Affiliation(s)
- Osao Arakaki
- Division of Dermatology, Department of Organ-oriented Medicine, School of Medicine, University of the Ryukyus, Uehara, Nishihara, Okinawa, Japan.
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Antonucci A, Ghetti P, Iozzo I. Recurrent subcutaneous phaeohyphomycosis caused by Exophiala sp. associated with squamocellular carcinoma. Int J Dermatol 2009; 47:1323-4. [PMID: 19126033 DOI: 10.1111/j.1365-4632.2008.03704.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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WAKAMATSU K, TAKAHATA Y, TOKUHISA Y, MORITA K, MUTO M. Two cases of phaeohyphomycosis due to Exophiala jeanselmei. J Dermatol 2008; 35:178-80. [DOI: 10.1111/j.1346-8138.2008.00441.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Revankar SG, Nailor MD, Sobel JD. Use of terbinafine in rare and refractory mycoses. Future Microbiol 2008; 3:9-17. [DOI: 10.2217/17460913.3.1.9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Terbinafine is the only systemic allylamine antifungal currently available. Its mechanism of action is unique and sets it apart from other agents. Although it is primarily used for dermatophyte infections, such as onychomycosis and tinea pedis, terbinafine has broad in vitro activity against a variety of non-dermatophyte fungal pathogens, including Candida spp. and many molds. In addition, synergistic activity is noted with other antifungals, notably triazoles. Multiple case reports exist of its use for unusual and refractory fungal infections, but no systematic review is available. We review the current literature with regard to in vitro data and clinical experience with terbinafine in the treatment of rare and refractory mycoses.
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Affiliation(s)
- Sanjay G Revankar
- Wayne State University, Division of Infectious Diseases, Harper University Hospital, 3990 John R. St., 5 Hudson Detroit, MI 48201, USA
| | - Michael D Nailor
- Wayne State University, Department of Pharmacy, Detroit Receiving Hospital, 4201 St. Antoine, Detroit, MI 48201, USA
| | - Jack D Sobel
- Harper University Hospital, 3990 John R. St., 5 Hudson, Detroit, MI 48201, USA
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Gabardi S, Kubiak DW, Chandraker AK, Tullius SG. Invasive fungal infections and antifungal therapies in solid organ transplant recipients. Transpl Int 2007; 20:993-1015. [PMID: 17617181 DOI: 10.1111/j.1432-2277.2007.00511.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This manuscript will review the risk factors, prevalence, clinical presentation, and management of invasive fungal infections (IFIs) in solid organ transplant (SOT) recipients. Primary literature was obtained via MEDLINE (1966-April 2007) and EMBASE. Abstracts were obtained from scientific meetings or pharmaceutical manufacturers and included in the analysis. All studies and abstracts evaluating IFIs and/or antifungal therapies, with a primary focus on solid organ transplantation, were considered for inclusion. English-language literature was selected for inclusion, but was limited to those consisting of human subjects. Infectious complications following SOT are common. IFIs are associated with high morbidity and mortality rates in this patient population. Determining the best course of therapy is difficult due to the limited availability of data in SOT recipients. Well-designed clinical studies are infrequent and much of the available information is often based on case-reports or retrospective analyses. Transplant practitioners must remain aware of their therapeutic options and the advantages and disadvantages associated with the available treatment alternatives.
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Affiliation(s)
- Steven Gabardi
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, USA.
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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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Rallis E, Frangoulis E. Successful treatment of subcutaneous phaeohyphomycosis owing to Exophiala jeanselmei with oral terbinafine. Int J Dermatol 2006; 45:1369-70. [PMID: 17076729 DOI: 10.1111/j.1365-4632.2006.03077.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Al-Obaid I, Ahmad S, Khan ZU, Dinesh B, Hejab HM. Catheter-associated fungemia due to Exophiala oligosperma in a leukemic child and review of fungemia cases caused by Exophiala species. Eur J Clin Microbiol Infect Dis 2006; 25:729-32. [PMID: 17033790 DOI: 10.1007/s10096-006-0205-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A case of catheter-associated fungemia due to Exophiala oligosperma in a 3-year-old leukemic child is presented. The etiologic agent was isolated from blood specimens and the catheter tip. The isolate was identified by its morphological characteristics and DNA sequencing of the internal transcribed spacer region of rDNA. Despite initial amphotericin B and itraconazole therapy, the child's fever subsided only after removal of the catheter. A review of the medical literature revealed 29 cases of infection due to Exophiala species. Twenty-three of these 29 patients had a CVC in place when they developed fever or other manifestations of fungemia. Withdrawal of the CVC together with amphotericin B and/or itraconazole therapy generally resulted in a good prognosis.
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Affiliation(s)
- I Al-Obaid
- Department of Microbiology, Al-Sabah Hospital, Shuwaikh, Kuwait
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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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