Disseminated Ochroconis gallopavum Infection in a Chronic Lymphocytic Leukemia: A Case Report and Review of the Literature on Hematological Malignancies

Fukushima, Noriyasu; Mannen, Kotaro; Okamoto, Sumiaki; Shinogi, Taro; Nishimoto, Katsutaro; Sueoka, Eisaburo

doi:10.2169/internalmedicine.44.879

Cited by 21 publications

(17 citation statements)

References 15 publications

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“…E. dermatitidis, in contrast, is commonly seen in immunocompetent patients, particularly from Asia (13,349,565). A variety of other molds were reported in disseminated disease, including E. oligosperma, Chaetomium perlucidum, O. gallopava, Lecythophora mutabilis, P. parasiticum, B. spicifera, Exserohilum sp., E. spinifera, and Curvularia lunata (25,64,85,207,256,335,417,451,536,741,788). Interestingly, peripheral eosinophilia has been observed in 9% of cases, and these were generally due to Bipolaris and Curvularia.…”

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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Section: Phaeohyphomycosismentioning

confidence: 99%

Melanized Fungi in Human Disease

2010

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“…Although Ochroconis spp. have traditionally been regarded as a cause of deep infections in birds and other animals there have been multiple reports implicating these fungi, particularly Verruconis gallopava and Ochroconis constricta , as pathogens in humans .…”

Section: Black Fungal Species With Clinical Relevancementioning

confidence: 99%

“…The majority of these reports have been in two patient populations: those that have received transplants , and those with haematological malignancies undergoing chemotherapy . Infections in these two groups presented as a combination of both pulmonary and extra‐pulmonary disease, particularly involving the brain, spleen, skin and other organ sites.…”

Section: Black Fungal Species With Clinical Relevancementioning

confidence: 99%

“…Infections in these two groups presented as a combination of both pulmonary and extra‐pulmonary disease, particularly involving the brain, spleen, skin and other organ sites. Although a number of patients with extra‐pulmonary disease have survived , it is more frequently associated with poor clinical outcomes . Other risk factors are HIV and chronic granulomatous disease .…”

Section: Black Fungal Species With Clinical Relevancementioning

confidence: 99%

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ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi

Chowdhary

Meis

Guarro

et al. 2014

Clinical Microbiology and Infection

298

253

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The aetiological agents of many invasive fungal infections are saprobes and opportunistic pathogens. Some of these fungi are darkly pigmented due to melanin production and traditionally have been named 'dematiaceous'. The melanized fungi cause a wide array of clinical syndromes ranging from superficial to deep-seated infections. Diagnosis relies on histopathological examination of clinical specimens and on examination of cultures. Sequencing is recommended for accurate species identification, especially for unusual or newly described pathogens. In cases of mycetoma and chromoblastomycosis, pathognomonic histological findings are useful and the Fontana-Masson stain, specific for melanin, usually confirms the diagnosis. There are no standardized therapies but voriconazole, posaconazole and itraconazole demonstrate the most consistent in vitro activity against this group of fungi. Oral itraconazole has been considered the drug of choice, given the extensive clinical experience with this drug. However, voriconazole may presumably be superior for central nervous system infections because of its ability to achieve good levels in the cerebrospinal fluid. Posaconazole is a well-tolerated alternative drug, backed by less clinical experience but with excellent salvage treatment results after failure of other antifungals. Amphotericin B has been useful as alternative therapy in some cases. Combination antifungal therapy is recommended for cerebral abscesses when surgery is not possible and for disseminated infections in immunocompromised patients.

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“…The conidia are hyaline, clavate, and two celled. Verruconis is remote from other fungi and can easily be recognized by ITS sequencing (Jenney et al 1998;Malani et al 2001;Fukushima et al 2005;Hollingsworth et al 2007). Isolation of the fungus is recommended to confirm the diagnosis.…”

Section: Rhinocladiella (Chaetothyrialesmentioning

confidence: 99%