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We describe a case of catheter-associated Wangiella (Exophiala) dermatitidis fungemia in a human immunodeficiency virus-infected child who was successfully treated with antifungal therapy and catheter removal. Catheter-associated W. dermatitidis fungemia appears to be distinct from previously described cases of disseminated infection with organ involvement. Wangiella (Exophiala) dermatitidis is a dematiaceous yeastlike mold found in the environment. It is a well-known cause of local and disseminated pheohyphomycosis but is an uncommon cause of fungemia. In this report, we describe a case of central venous catheter-associated W. dermatitidis fungemia in a human immunodeficiency virus (HIV)-infected child and review the recent literature on this type of infection. The clinical features of catheter-associated W. dermatitidis fungemia appear to be distinct from those of previously described cases of disseminated infection with deep organ involvement. A 3-year-old male with stage C-3 (2) vertically acquired HIV type 1 infection was admitted to our hospital for evaluation of fever and a positive blood culture. He had previously been hospitalized multiple times for opportunistic infections, including Pneumocystis carinii pneumonia, and was receiving a continuous zidovudine infusion through a central venous catheter because of progressive HIV-associated central nervous system disease. One month before admission, he had been treated for penicillin-resistant Streptococcus pneumoniae sepsis. Three days before admission, he was seen as an outpatient because of new onset of fever to 38.9ЊC. Blood cultures were drawn from the central venous catheter and from a peripheral vein, and vancomycin therapy was started. Three days later, yeastlike fungi were found in one of the catheter blood cultures, and he was admitted for further evaluation. He was afebrile at the time of admission. Physical examination revealed a I/VI degree systolic ejection murmur at the left midsternal border, hepatomegaly, spastic quadriparesis, and facial diplegia, all of which were present before admission and thought to be due to his underlying HIV infection. The leukocyte count on admission was 7,600 cells per l, with a differential of 61% neutrophils, 24% band forms and 9% lymphocytes. A recent CD4 ϩ T-cell count was 334 cells per l. Hepatic enzyme levels were elevated (aspartate aminotransferase, 580 IU/ml; alanine aminotransferase, 102 IU/ml) but unchanged from previous values. Blood cultures were drawn from the central venous catheter and a peripheral vein. Vancomycin treatment was discontinued, and amphotericin B treatment was started. Three days later, yeastlike fungi were again recovered from the catheter and peripheral venous blood cultures. All of these isolates were later identified as W. dermatitidis (see below).

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The carbohydrate composition of the cell walls of Paecilomyces persicinus P-10 Ml was monitored daily for 6 days to detect any changes during growth and cephalosporin C production. Walls were isolated after mechanical breakage, sonication, and exposure to detergent. Major quantitative changes in cell wall carbohydrate composition accompanied a decrease in both cell weight and antibiotic production. Glucosamine content remained relatively constant in the 24-to 96-h cell walls and increased markedly in the 120-and 144-h preparations. The non-nitrogenous carbohydrate cell wall component, however, decreased significantly in the 48-and 120-h cell walls. Gas-liquid chromatographic analysis of the non-nitrogenous carbohydrate cell wall fraction revealed the presence of glucose, the major component, mannose, galactose, and minute quantities of arabinose. Except for glucose, which was found to decrease moderately in the 120-and 144-h cell walls, the neutral sugars did not vary significantly with time. Compositional analyses have been carried out on isolated cell walls of a wide variety of fungi. Members of the fungal form class Deuteromycetes, which have been extensively studied, possess hyphal walls largely composed of a complex mixture of carbohydrates. Glucose and N-acetylglucosamine have been consistently identified as major cell wall carbohydrate components in these fungi, along with lesser amounts of mannose and galactose (7, 8). Noticeably lacking have been investigations of the chemical characterization of fungal cell walls during growth. Such studies are of interest, since they may reveal correlations between fungal cell wall chemistry and the growth process. Additionally, the relationship of cell wall composition to various cellular activities may be evident. This paper examines changes in the cell wall carbohydrates of a strain of Paecilomyces persicinus P10 Ml during growth and cephalosporin C production. MATERIALS AND METHODS Organism and growth. P. persicinus P-10 Ml was grown on Sabouraud maltose agar slants (Difco Laboratories) at 28°C for at least 10 days. Inocula were prepared by growing P. persicinus P-10 Ml in two stages in 250-ml Erlenmeyer flasks containing 50 ml of Sabouraud maltose broth (Difco). Flasks were incubated at 28°C on a rotary shaker (model G-25 Psychrotherm; New Brunswick Scientific Co.