Acrophialophora levis brain abscess in a kidney transplant patient: A case report and review of the literature

Modlin, Chelsea E.; Collins, Lauren F; Burd, Eileen M.; Lockhart, Shawn R.; Lyon, G. Marshall

doi:10.1016/j.mmcr.2020.03.002

Cited by 7 publications

(24 citation statements)

References 13 publications

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“…As a result, we reviewed 228 published reports. We identified and included 149 reports on 201 cases of dematiaceous fungal infections in SOT recipients 21–169 . The majority (134/149; 90%) of included reports scored ≥ 2 of three possible points on our bias assessment (Table S4).…”

Section: Resultsmentioning

confidence: 99%

Dematiaceous fungal infections in solid organ transplantation: Systematic review and Bayesian meta‐analysis

Radcliffe

Azar

et al. 2022

Transplant Infectious Dis

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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 Englishlanguage 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.

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Section: Resultsmentioning

confidence: 99%

Dematiaceous fungal infections in solid organ transplantation: Systematic review and Bayesian meta‐analysis

Radcliffe

Azar

et al. 2022

Transplant Infectious Dis

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“…Acrophialophora infections are rare; there are only 13 documented infections to date, with the first diagnosis occurring in 1981 (Table 1) [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Out of these, 10 were caused by A. fusispora, two were caused by A. levis, and one was caused by an unspecified Acrophialophora species.…”

Section: Review Raritymentioning

confidence: 99%

“…ITRA may have decreased efficacy in the treatment of Acrophialophora CNS involvement due to its limited activity in cerebrospinal fluid [6].…”

Section: Azole Medicationsmentioning

confidence: 99%

“…In-vitro sensitivity assays may be carried out via colorimetric microdilution [7] or broth microdilution [6].…”

Section: Guidelines For Treatmentmentioning

confidence: 99%

“…Case studies of patients with Acrophialophora infections reveal several risk factors. Transplant patients are at higher risk of infection, and multiple instances of infection have been reported in lung and kidney transplant patients [ 6 ]. Other identified risk factors include HIV/AIDS, cancer, CF, keratitis, neutropenia, pneumonia, and the use of immunosuppressant drugs.…”

Section: Reviewmentioning

confidence: 99%

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Acrophialophora: A Comprehensive Review of Clinical Guidelines and Diagnosis

Bhattaru¹,

Blanchard²,

Kunamneni³

et al. 2023

Cureus

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Acrophialophora is a saprotrophic genus of fungi found in both temperate and tropical regions. The genus is comprised of 16 species, with the subspecies A. fusispora and A. levis necessitating the most clinical concern. Acrophialophora is an opportunistic pathogen with a broad range of clinical manifestations; the fungus has been implicated in cases of fungal keratitis, lung infection, and brain abscess. Acrophialophora infection is particularly of concern for immunocompromised patients, who often present with a more severe disease course involving disseminated infection and may not exhibit typical symptoms. Early diagnosis and therapeutic intervention are critical to the successful clinical management of Acrophialophora infection. Guidelines for antifungal treatment have yet to be established, partially due to the lack of documented cases. Aggressive use of antifungal agents and long-term treatment is required, especially in immunocompromised patients and patients with systemic involvement, due to the potential for morbidity and mortality. In addition to outlining the rarity and epidemiology of the disease, this review provides an overview of the diagnosis and clinical management of Acrophialophora infection to facilitate an early diagnosis and appropriate interventions.

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Mycophenolate/prednisone/tacrolimus

2020

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Acrophialophora levis brain abscess in a kidney transplant patient: A case report and review of the literature

Cited by 7 publications

References 13 publications

Dematiaceous fungal infections in solid organ transplantation: Systematic review and Bayesian meta‐analysis

Dematiaceous fungal infections in solid organ transplantation: Systematic review and Bayesian meta‐analysis

Acrophialophora: A Comprehensive Review of Clinical Guidelines and Diagnosis

Mycophenolate/prednisone/tacrolimus

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