Fatal Endocarditis in a Neonate Caused by the Dematiaceous Fungus<i>Phialemonium obovatum</i>: Case Report and Review of the Literature

Gavin, Patrick J.; Sutton, Deanna A.; Katz, Ben Z.

doi:10.1128/jcm.40.6.2207-2212.2002

Cited by 34 publications

(26 citation statements)

References 22 publications

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“…Consequently, they also may cause fungus balls of the maxillary sinus. Phialemonium dimorphosum, a hyaline filamentous fungus and a synonym of Phialemonium curvatum, is known to trigger invasive disease in immunocompromised patients (9,10) and has also been found in localized infections (8,15,19,24). In view of these facts, it appears reasonable to add Phialemonium to the list of potential causes of fungal sinusitis and fungus balls.…”

Section: Vol 41 2003 Detection Of Fungi From Fungus Balls 583mentioning

confidence: 99%

Detection and Identification of Fungi from Fungus Balls of the Maxillary Sinus by Molecular Techniques

et al. 2003

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The aim of this study was to find a reliable method for the detection and identification of fungi in fungus balls of the maxillary sinus and to evaluate the spectrum of fungi in these samples. One hundred twelve samples were obtained from patients with histologically proven fungal infections; 81 samples were paraffinembedded tissue sections of the maxillary sinus. In 31 cases, sinus contents without paraffin embedding were sent for investigation. PCR amplification with universal fungal primers for 28S ribosomal DNA and amplicon identification by hybridization with species-specific probes for Aspergillus fumigatus, Aspergillus flavus, Aspergillus niger, Aspergillus terreus, Aspergillus glaucus, Pseudallescheria boydii, Candida albicans, and Candida glabrata were performed for all samples. Furthermore, PCR products were sequenced. Fresh samples were also cultivated. Fungal DNA was detected in all of the fresh samples but only in 71 paraffin-embedded tissue samples (87.7%). Sequence analysis was the most sensitive technique, as results could be obtained for 28 (90.3%) fresh samples by this method in comparison to 24 (77.4%) samples by hybridization and 16 (51.6%) samples by culture. However, sequence analysis delivered a result for only 36 (50.7%) of the paraffin-embedded specimens. Hybridization showed reliable results for A. fumigatus, which proved to be the most common agent in fungus balls of the maxillary sinus. Other Aspergillus species and other genera were rarely found.Aspergillus spp. is the most commonly reported cause of fungal sinusitis and fungus balls of the sinuses, followed by dematiaceous fungi (5). Since the viability of fungal elements in fungus balls is poor, fungi frequently fail to grow from hyphae-rich material obtained during surgery. Furthermore, other limitations, such as slow growth of many relevant fungi, delayed production, lack of characteristic fruiting bodies or macroconidia, special nutritional requirements of certain fungi, and similarities in macromorphology or micromorphology or both at the genus level, may prevent their detection and identification. Histopathology reveals matted, dense conglomerations of hyphae separated from, but adjacent to, the respiratory mucosa of the sinus. Distinct features such as fruiting bodies (e.g., Aspergillus heads) and characteristic conidia or spores are rarely produced in vivo; thus, exact identification at the species level by histopathology is rendered nearly impossible. This might be the reason why it is still unclear as to how many of these infections are actually caused by Aspergillus species and what species of other fungi are common causes of fungus balls of the maxillary sinus. To our knowledge, there exist no data concerning the epidemiology of fungus balls of the maxillary sinus in Europe.PCR is a sensitive method which can be used to detect viable as well as nonviable fungal pathogens. Several fungus-specific primers have been described. A variety of PCR protocols for human samples have also been published, including panfungal PCR ass...

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Section: Vol 41 2003 Detection Of Fungi From Fungus Balls 583mentioning

confidence: 99%

Detection and Identification of Fungi from Fungus Balls of the Maxillary Sinus by Molecular Techniques

et al. 2003

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“…Phialemonium is often mistaken as a yeast on Gram stains of blood and CSF specimens, and similar phenomena have been observed in cases of infection caused by Fusarium and Acremonium (4,7). In recent years, molecular diagnostic tools such as PCR have been used to analyze fungal pathogens, especially Aspergillus and Candida species (8).…”

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confidence: 60%

“…In this case, the only theoretical factor that might raise doubts about the patient's complete immunological integrity was his occupation, bringing him in frequent contact with chickens, and the head trauma at the age of 19. In reported Phialemonium infection cases, the filamentous fungus is isolated mainly from blood samples obtained from patients with primary fungemia (3)(4)(5). In the current case, the diagnosis of meningitis caused by P. curvatum was confirmed by CSF culturing, but the blood cultures were negative.…”

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confidence: 62%

“…The majority of Phialemonium infections are invasive, and the most frequent infections include peritonitis endocarditis, osteomyelitis, and cutaneous infections of wounds that may occur after a burn (2)(3)(4)(5)(6). In this case, the only theoretical factor that might raise doubts about the patient's complete immunological integrity was his occupation, bringing him in frequent contact with chickens, and the head trauma at the age of 19.…”

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Infective Meningitis Caused by Phialemonium curvatum

Zou

et al. 2014

J Clin Microbiol

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bInfections caused by rarely encountered fungal pathogens have increased in recent decades. Phialemonium species are widely distributed in the environment and are also involved in human infections, affecting both immunocompromised and immunocompetent patients. The present study describes a case of meningitis caused by Phialemonium curvatum. CASE REPORTA 42-year-old male patient was admitted to the hospital for continuous headache without nausea and fever, with a maximum temperature of 39°C during the past 30 days. He was a poultry farmer and had experienced head trauma at the age of 19. The patient was conscious and claimed acroanesthesia. He denied any systemic disease, history of immunosuppression, or recent travel. When the patient was first admitted to the hospital, his physical examination showed that he had stable vitals, the neurological assessments were unremarkable, and no neck stiffness was noted. A routine blood test revealed a white blood cell (WBC) count of 11.6 ϫ 10 9 /liter (53.7% neutrophils and 36.3% lymphocytes). The first lumbar puncture was performed under local anesthesia, revealing 110 ϫ 10 6 /liter WBCs, 0.3 g/liter protein, 3.1 mmol/liter glucose, and 117 mmol/liter chloride. The pressure of the cerebrospinal fluid (CSF) was 250 mmH 2 O. CSF cytology demonstrated the presence of approximately 70% lymphocytes and 30% neutrophilic granulocytes. A computed tomography scan of the head and a chest radiograph showed no alterations. Cranial magnetic resonance imaging was normal. An echocardiogram revealed that the left ventricle had a normal size and function, and no vegetation was detected. In addition, a serum test for human immunodeficiency virus (HIV) was negative. Aricine staining and India ink staining of the CSF were also negative. He was initially diagnosed with viral encephalitis and tuberculous meningitis and received antiviral therapy (ganciclovir, 0.25 g twice a day) for 10 days, as well as a standard 15-day course of antituberculosis therapy (isoniazid, 0.9 g/24 h, rifampin, 0.6 g once a day [q.d.], and pyrazinamide, 0.25 g three times a day [t.i.d.]). However, the treatment had little effect, and the patient still complained of a heavy headache. Measurements of CSF and blood (1-3)-␤-D-glucan were 151 pg/ml and 466 pg/ml, respectively (with a cutoff value of Ͻ100 pg/ml). The later culture test showed that the four blood cultures were negative. Two of the CSF cultures became positive after 4 days of incubation in blood culture bottles (BacT/Alert, aerobic bottle; bioMérieux) without antibiotics. Subculturing of the positive CSF cultures revealed mold growth after 72 h of incubation. On traditional Sabouraud agar, the colonies were white, reaching 10 to 15 mm in diameter after 10 days at 25°C. Colonies were cream colored, and small areas of the colonies became light yellow after 30 days (Fig. 1). Microscopically, vegetative hyphae and conidia were hyaline. Accumulation of hyaline conidia was observed at the apex, and most of them were allantoid (Fig. 2). Scanning electron microscopy (...

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“…Brain abscesses due to Cladophialophora bantiana are the commonest form of systemic phaeohyphomycosis [7]. Other localized deep forms of infections, such as arthritis [8], endocarditis [9], and osteomyelitis [10], have been rarely reported. Cladophialophora devriesii is a very rare pathogen and reported to have caused fatal dissemination [11] [12].…”

Section: Discussionmentioning

confidence: 99%

Femoral osteomyelitis due to Cladophialophora arxii in a patient with chronic granulomatous disease

et al. 2009

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Fungal infections in patients with chronic granulomatous disease (CGD) are a poor prognostic factor. We describe the first case of CGD with femoral osteomyelitis due to Cladophialophora arxii, which is a member of dematiaceous group. The causative fungus was identified on the basis of its morphological characteristics, growth temperature profile and nucleotide sequence on the ITS region of the ribosomal gene. The patient was successfully treated with surgical debridement, subsequent administration of itraconazole and interferon-γ . Shigemura et al.3

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Fatal Endocarditis in a Neonate Caused by the Dematiaceous FungusPhialemonium obovatum: Case Report and Review of the Literature

Cited by 34 publications

References 22 publications

Detection and Identification of Fungi from Fungus Balls of the Maxillary Sinus by Molecular Techniques

Detection and Identification of Fungi from Fungus Balls of the Maxillary Sinus by Molecular Techniques

Infective Meningitis Caused by Phialemonium curvatum

Femoral osteomyelitis due to Cladophialophora arxii in a patient with chronic granulomatous disease

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