Cerebral phaeohyphomycosis in an immunodeficient child treated medically with combination antifungal therapy

Trinh, Jane V.; Steinbach, William J.; Schell, Wiley A.; Kurtzberg, Joanne; Giles, Steven S.; Perfect, John R.

doi:10.1080/369378031000137369

Cited by 48 publications

(29 citation statements)

References 18 publications

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“…modesta (n ϭ 1) scribed. Patients with bone marrow and solid organ transplantation and patients who are on steroid therapy are particularly affected (2,13,15,24,31,35,36,51,54,57). Cladophialophora bantiana, a neurotropic fungus, has rarely been isolated from sources other than clinical samples.…”

Section: Discussionmentioning

confidence: 99%

“…The most recent series of 48 patients with brain abscess due to C. bantiana showed that 35 patients (72%) had no risk factors and that only 13 patients (28%) survived the infection, despite combined surgical and antifungal treatment (48). The minority of immunocompromised patients are transplant recipients, intravenous drug abusers, or individuals on steroids (2,13,15,24,31,35,36,51,54,57,59).…”

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confidence: 99%

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Use of Amplified Fragment Length Polymorphism To Identify 42 Cladophialophora Strains Related to Cerebral Phaeohyphomycosis with In Vitro Antifungal Susceptibility

et al. 2010

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The amplified fragment length polymorphism technique has been applied to identify neurotropic chaetothyrialean black yeasts and relatives from clinical sources. Cladophialophora bantiana, C. emmonsii, C. arxii, C. devriesii, and C. modesta, previously identified on the basis of sequencing and phenotypic and physiological criteria, were confirmed by cluster analysis, demonstrating the clear separation of C. bantiana as a rather homogeneous group from the other species. C. bantiana is a neurotropic fungus causing cerebral abscesses with a mortality of up to 70%. Successful therapy consists of neurosurgical intervention and optimal antifungal therapy. Since the latter is not clearly defined in a large series, we tested the in vitro activities of eight antifungal drugs against clinical isolates of C. bantiana (n ‫؍‬ 37), C. modesta (n ‫؍‬ 2), C. arxii (n ‫؍‬ 1), C. emmonsii (n ‫؍‬ 1), and C. devriesii (n ‫؍‬ 1), all of which had caused invasive infections. The resulting MIC 90 s for all neurotropic C. bantiana strains were as follows, in increasing order: posaconazole, 0.125 g/ml; itraconazole, 0.125 g/ml; isavuconazole, 0.5 g/ml; amphotericin B, 1 g/ml; voriconazole, 2 g/ml; anidulafungin, 2 g/ml; caspofungin, 4 g/ml; and fluconazole, 64 g/ml. On the basis of these in vitro results and the findings of previous clinical and animal studies, posaconazole seems to be a good alternative to the standard treatment, amphotericin B, for C. bantiana cerebral infections. The new agent isavuconazole, which is also available as an intravenous preparation, has adequate activity against C. bantiana.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Use of Amplified Fragment Length Polymorphism To Identify 42 Cladophialophora Strains Related to Cerebral Phaeohyphomycosis with In Vitro Antifungal Susceptibility

et al. 2010

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“…Mortality was Ͼ70%. Since that review in 2004, over 50 cases have been reported, with C. bantiana remaining the most frequently seen isolate (131,4,17,16,22,31,40,70,78,93,121,139,170,189,243,244,268,272,276,328,332,341,363,380,399,420,433,448,450,467,476,545,575,636,657,696,700,721,731,733,754,759). A new species, Fonsecaea monophora, has been reported since that time and appears to have a predilection for causing CNS disease, in contrast to its related species, F. pedrosoi (420,721,733).…”

Section: Phaeohyphomycosismentioning

confidence: 99%

Melanized Fungi in Human Disease

2010

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SUMMARY Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes. 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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“…Amphotericin B (AmB) alone or in combination with flucytosine (5FC), VRC, or ITC was not completely satisfactory (14,149). However, the triple combination of AmB, 5FC, and ITC was associated with improved survival in a few cases of systemic phaeohyphomycosis (90 (162)(163)(164). Notably, combination antifungal therapy is recommended for cerebral abscesses when surgery is not possible and for disseminated infections in immunocompromised patients (149).…”

Section: Recommended Diagnostics and Treatment Approachesmentioning

confidence: 99%

Black Yeasts and Their Filamentous Relatives: Principles of Pathogenesis and Host Defense

et al. 2014

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SUMMARY Among the melanized fungi, the so-called “black yeasts” and their filamentous relatives are particularly significant as agents of severe phaeohyphomycosis, chromoblastomycosis, and mycetoma in humans and animals. The pathogenicity and virulence of these fungi may differ significantly between closely related species. The factors which probably are of significance for pathogenicity include the presence of melanin and carotene, formation of thick cell walls and meristematic growth, presence of yeast-like phases, thermo- and perhaps also osmotolerance, adhesion, hydrophobicity, assimilation of aromatic hydrocarbons, and production of siderophores. Host defense has been shown to rely mainly on the ingestion and elimination of fungal cells by cells of the innate immune system, especially neutrophils and macrophages. However, there is increasing evidence supporting a role of T-cell-mediated immune responses, with increased interleukin-10 (IL-10) and low levels of gamma interferon (IFN-γ) being deleterious during the infection. There are no standardized therapies for treatment. It is therefore important to obtain in vitro susceptibilities of individual patients' fungal isolates in order to provide useful information for selection of appropriate treatment protocols. This article discusses the pathogenesis and host defense factors for these fungi and their severity, chronicity, and subsequent impact on treatment and prevention of diseases in human or animal hosts.

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Cerebral phaeohyphomycosis in an immunodeficient child treated medically with combination antifungal therapy

Cited by 48 publications

References 18 publications

Use of Amplified Fragment Length Polymorphism To Identify 42 Cladophialophora Strains Related to Cerebral Phaeohyphomycosis with In Vitro Antifungal Susceptibility

Use of Amplified Fragment Length Polymorphism To Identify 42 Cladophialophora Strains Related to Cerebral Phaeohyphomycosis with In Vitro Antifungal Susceptibility

Melanized Fungi in Human Disease

Black Yeasts and Their Filamentous Relatives: Principles of Pathogenesis and Host Defense

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