Dematiaceous Fungi Are an Increasing Cause of Human Disease

“…They are generally associated with phaeohyphomycosis, which encompasses a heterogeneous group of infections that are histologically defined by the presence of yeast-like or hyphal forms of the fungus in superficial subcutaneous locations or disseminated systemic disease. The increased detection of Exophiala species as agents of human disease is also believed to be related to the increased number of immunocompromised hosts (2,10,24,26,27). We report an unusual case of olecranon bursitis attributed to the newly recognized species Exophiala oligosperma (7).…”

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confidence: 99%

Exophiala oligospermaCausing Olecranon Bursitis

Bossler¹,

Richter²,

Chávez³

et al. 2003

J Clin Microbiol

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A 62-year-old male with a history of Wegener's granulomatosis and immunosuppressive therapy presented with chronic olecranon bursitis. A black velvety mould with brown septate hyphae and tapered annellides was isolated from a left elbow bursa aspirate and was identified as an Exophiala species. Internal transcribed sequence rRNA sequencing showed the isolate to be identical to Exophiala oligosperma. The patient was successfully treated with aspiration and intrabursal amphotericin B.Exophiala species are dematiaceous, or dark-pigmented, dimorphic hyphomycetes that are found at low density in relatively extreme microniches, such as oligotrophic waters or preservative-treated wood. The species most commonly involved in human infection are Exophiala jeanselmei complex members, Exophiala spinifera, and Exophiala dermatitidis, with other species at low frequency (4, 6, 28). They are generally associated with phaeohyphomycosis, which encompasses a heterogeneous group of infections that are histologically defined by the presence of yeast-like or hyphal forms of the fungus in superficial subcutaneous locations or disseminated systemic disease. The increased detection of Exophiala species as agents of human disease is also believed to be related to the increased number of immunocompromised hosts (2,10,24,26,27). We report an unusual case of olecranon bursitis attributed to the newly recognized species Exophiala oligosperma (7).(Presented at the 102nd General Meeting of the American Society for Microbiology, 21 May 2002 [abstract F-80] .)Case report. A 62-year-old male with Wegener's granulomatosis presented to the University of Iowa rheumatology clinic in July 2001 with chronic painless left elbow swelling. The patient was known to rest his elbows on a sink while irrigating his sinuses twice daily for chronic sinusitis. The elbow was not warm or erythematous. Raised scabbed areas were observed on the skin over the olecranon process that had been present for at least 8 months. The patient exhibited no other signs of infection, and his white blood cell count was within normal limits. The patient's vasculitis had been treated with prednisone, 20 mg daily, which was tapered to 5 mg every other day, and cyclophosphamide, 100 mg daily, for several months. The olecranon bursa was aspirated, and 15 ml of fluid was removed.No organisms were seen on Gram or calcofluor white stains. Fungal cultures on potato dextrose agar initially grew yeastlike colonies that developed into an olivaceous black velvety mould with aerial hyphae and a black reverse (Fig. 1). Microscopically, the hyphae were septate and pale brown. Conidia were formed in small clusters both from intercalary loci along undifferentiated hyphae and from tapered annellidic conidiogenous cells (Fig. 2), features characteristic of Exophiala species. Two subsequent aspirations from the left olecranon bursa ϳ1 month apart (3 and 7 weeks after the initial aspiration) also grew Exophiala species.The isolate was submitted for species identification to the Fungus Testing Laborator...

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“…In recent years they have been highly recognized as important pathogens in immunocompromised individuals, and infections with these organisms have been reported in SOT recipients [4]. Underlying diabetes mellitus may also play a role in their causation [5]. Our patient was immunocompromised as he underwent Renal Transplantation (RT) twice with Triple immunosuppression, along with development of PTDM.…”

Section: Discussionmentioning

confidence: 97%

Pheohyphomycosis in Renal Transplant Recipient Presenting as a Rare Case of Submandibular Salivary Gland Swelling

Patel¹,

Vanikar²,

Trivedi

2016

JCDR

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A 37-year-old renal transplant recipient underwent Live Donor Renal Transplant (LDRT) with mother's kidney in 2006. He lost this graft to chronic rejection after 2 years inspite of triple immunosuppression of Tacrolimus 0.04 mg/kg/day, Azathioprine 50 mg/day, and Prednisone 10 mg/day. He underwent second transplantation in 2009 with wife's kidney (haplo-identical). He had been maintaining stable graft function with serum creatinine around 1.4 mg/dL with the same triple immunosuppression. At 3 years post-transplant he developed Post-Transplantation Diabetes Mellitus (PTDM) with complains of dysuria and urinary retention. Ultrasonography of abdomen and MRI were suggestive of prostatic abscess. About 120ml of pus was drained out by trans-urethroscopy and was subjected to microbiological studies. E.coli sensitive to Meropenom and Levoflox were isolated. He was treated with these drugs.Three months later he complained of swelling in the left submandibular region. On examination a well-defined, non-tender and freely mobile lump of size 3x3cm was observed in the left submandibular region. Fine needle aspiration cytology (FNAC) showed polymorphonuclear cells, lymphoctes, macrophages and foreign body giant cells along with aseptate fungal hyphae and buds [Table/ Fig-1]. Excision biopsy of tissue showed salivary glands with large number of foreign body giant cells forming granulomas, scattered areas of necrosis with nuclear debris and aseptate fungal hyphae and buds [Table/ Fig-2] with haematoxylineosin stain and Periodic acid-Schiff stain [Table /Fig-3,4]. He was treated with antifungal agent Voriconazole.Over a follow-up of 2 years he was asymptomatic, and had stable graft function with S.Cr of 1.35 mg/dL on Sirolimus 1 mg/day and Prednisone 5mg/day. Keywords: ABSTRACTRenal transplant patients are at high risk of developing various infections causing morbidity and mortality. Invasive fungal infection has been recognized as a significant complication of organ transplantation. The major fungal infections in these patients are due to candida, aspergillus and mucormycosis. However, infection because of infrequently encountered fungi like hyaline molds, dematiaceous filamentous fungi and zygomycetes are increasing in immunocompromised hosts. Dematiaceous fungi are recognized pathogens in organ transplant recipients with skin and soft tissue infection. We report the case of a 37-year-old man, a renal transplant recipient who developed an asymptomatic dematiaceous fungal infection in submandibular salivary gland. He recovered after excision and antifungal therapy.

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Dematiaceous Fungi Are an Increasing Cause of Human Disease

Cited by 129 publications

References 55 publications

Phaeohyphomycosis: a clinical-epidemiological and diagnostic study of eighteen cases in Rio Grande do Sul, Brazil

Phaeohyphomycosis: a clinical-epidemiological and diagnostic study of eighteen cases in Rio Grande do Sul, Brazil

Exophiala oligospermaCausing Olecranon Bursitis

Pheohyphomycosis in Renal Transplant Recipient Presenting as a Rare Case of Submandibular Salivary Gland Swelling

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