Empiric antifungal therapy in patients with cutaneous and subcutaneous phaeohyphomycosis

Abstract

We encountered two cases of phaeohyphomycosis caused by Exophiala jeanselmei and E. oligosperma that were treated with fosravuconazole and terbinafine, respectively. Our cases were successfully treated with empiric therapy before the pathogen’s species or antifungal sensitivity had been determined. We summarized 32 cases of cutaneous and subcutaneous phaeohyphomycosis caused by Exophiala species in Japan. The patients received antifungals, including itraconazole, terbinafine, voriconazole, and fosravuconazole, and the treatment success rates of these monotherapies were 77% (17/22), 67% (8/12), 100% (5/5), and 50% (1/2), respectively. Although the broad‐spectrum azole antifungal itraconazole is the first choice for treatment, terbinafine at 125 mg/day might exert the same efficacy. Fosravuconazole is a novel broad‐spectrum azole and a moderate inhibitor of Cyp3A4 that causes fewer drug interactions than itraconazole and voriconazole, indicating a promising drug for this disease.

utaneous verrucose phaeohyphomycosis due to Exophiala oligosperma in an immunocompetent host

“…Voriconazole and posaconazole, the newly introduced third-generation drugs affecting ergosterol biosynthesis, have been used more frequently in clinical settings in recent years in some reports [18]. A Japan study summarized 32 cases of cutaneous and subcutaneous phaeohyphomycosis caused by Exophiala species and described empiric therapy with antifungals, including itraconazole, terbinafine, voriconazole, and fosravuconazole, and the treatment success rates of these monotherapies were 77% (17/22), 67% (8/12), 100% (5/5), and 50% (1/2), respectively [18]. Another study compared was YeastOne® colorimetric antifungal panels with Laboratory Standards Institute (CLSI) M38-A2 reference broth microdilution method for nine antifungals against 67 dematiaceous fungi.…”

Phaeohyphomycosis: A Review

“…Other causative species are E. lecaniicorni (6.9%) and Exophiala spp. [18,19]. This genus is saprophytic, isolated from oligotrophic, humid, and hot environments [15,20].…”

“…The history of fungal implantation by trauma in exposed areas is relevant as it is reported in most phaeohyphomycosis cases, where a primary nodular lesion is formed, subsequently growing into a subcutaneous abscess [18]. This inoculation process is observed mainly in farmers, agriculture, and livestock workers.…”

Species Diversity, Distribution, and Phylogeny of Exophiala with the Addition of Four New Species from Thailand

“…Accordingly, E . jeanselmei has been found in Asia, Europe, North America, the Oceania region, and South America [ 6 , 17 , 27 , 31 , 32 , 33 , 34 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ]. However, nine species ( E. arunalokei , E .…”

“…There are 26 Exophiala species (41.3%) that have been reported as causal agents of human diseases [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , …”