Brain abscess due toCladophialophora bantiana: a review of 124 cases

Abstract

Brain abscess caused by Cladophialophora bantiana is a rare disease associated with high mortality due to delay in diagnosis and absence of standardized therapy. We reviewed 124 culture proven C. bantiana brain abscess cases; 103 cases published in English literature during 1952 through 2014 and 21 unpublished cases from our reference center. The majority (57.3%) of the patients was from Asian countries especially from India (62/124, 50%). The diagnosis of the cases was delayed with mean duration 115 days after developing symptoms. The disease was nearly equally distributed in immunocompetent and immunosuppressed hosts but associated with significantly higher mortality (77.1%) in later group. Complete excision of brain lesion in immunocompetent host led to significantly better survival (43.7%). Though all commercially available antifungal drugs have been used in these patients, amphotericin B deoxycholate or lipid preparations were most commonly (62.83%) prescribed agent. None of the drugs used was found to be independently associated with improved outcome. In vitro antifungal susceptibility testing of 13 isolates of our center, demonstrated good activity to voriconazole, posaconazole, and itraconazole, but these triazoles were prescribed in only 29.2% patients. Increased awareness with early suspicion of the disease, and aggressive medical and surgical approach in treating these patients may improve the outcome.

Combination of Amphotericin B and Flucytosine against Neurotropic Species of Melanized Fungi Causing Primary Cerebral Phaeohyphomycosis

“…bantiana causes severe infections, mainly in immunocompetent hosts worldwide, with a general preference for warm and humid climates. The species causes cerebral abscesses almost exclusively, with a high mortality rate (up to 70%) (1,5,7,16). R. mackenziei causes cerebral infections mostly in debilitated patients, with a mortality rate of almost 100% if infections remain untreated; even in patients treated with surgery and antifungal therapy, mortality is almost 65%.…”

“…erebral phaeohyphomycosis is a rare but frequently fatal fungal infection due mainly to neurotropic black fungi belonging to the ascomycete order Chaetothyriales: Cladophialophora bantiana, Rhinocladiella mackenziei, and Exophiala dermatitidis (1)(2)(3)(4)(5). Other opportunistic pathogens from this group of environmental fungi (i.e., Cladophialophora modesta, Exophiala asiatica, Fonsecaea monophora, and Fonsecaea pugnacius) are being encountered as causal agents of this infection (6,7).…”

Cladophialophora bantiana osteomyelitis in a renal transplant patient

“…It is a strongly neurotropic fungus which mostly causes life-threatening cerebral phaeohyphomycosis [1]. A recent review of 124 C. bantiana brain abscess cases showed an equal distribution in immunocompetent and immunocompromised hosts with a significantly higher mortality in the latter group [2]. Complete excision of the brain lesions in immunocompetent hosts led to significant better survival.…”

Successful Treatment of Cerebral Pheohyphomycosis Caused by Cladophialophora bantiana Infection in a Solid Organ Transplant Patient: A Case Report and a Review of Literature

“…In one study by Chakrabarti et al, researchers revealed that the majority of these cases were found in males who came from Asian countries [13]. Interestingly, C. bantiana infection was nearly equally distributed in the immunocompetent and the immunosuppressed hosts [13]. The most common symptom was headaches, followed by hemiparesis, seizures, and altered sensorium [13,14].…”

“…Interestingly, C. bantiana infection was nearly equally distributed in the immunocompetent and the immunosuppressed hosts [13]. The most common symptom was headaches, followed by hemiparesis, seizures, and altered sensorium [13,14].…”