Infection with Drechslera hawaiiensis. Case report and literature review

Abstract

This article reports an orofacial infection caused by Drechslera hawaiiensis that normally is mortal to the patient. The case was surgically treated in Cali - Colombia in 1984 by teeth removal, and osteototomy of affected bone in the hard palate and the base of the vomer bone. Twenty years later the patient resulted infected by Dreschslera curvularia but survived both infections. A literature review (Pubmed - 2011) showed that only another case report by Drechslera hawaiiensis the patient survived. This other case was reported in the Anderson Hospital Institute in 1984. It is unknown if there is a chronic infection stage and the transmission mode of this pathogen. In patients with chronic symptoms affecting the paranasal sinuses and nasal cavity it is possible to suspect this rare disease.
 Key words: Oral facial infection, mycotic infection, Drechslera hawaiiensis.

Endoscopic endonasal resection of a Drechslera hawaiiensis sphenoid fungal ball

“…Present case 26 Currently under surveillance after surgery and antifungal therapy. Good outcome at the last follow-up Álvarez [2] 19 Resolution after 4 surgeries and antifungal therapy (7 years follow-up after last intervention, asymptomatic) Fryen et al [7] 20 Resolution after surgery and antifungal therapy (6 months follow-up, with improvement of initial symptoms) Fuste et al [8] * 31 Death 11 days after admission for antibiotic therapy Young et al [25] 15 Resolution after 4 surgeries and antifungal therapy (1 year follow-up, with improvement of initial symptoms) Morton et al [16] * 18 Resolution after surgery and antifungal therapy Washburn et al [24] 31 Recurrence after three surgeries and antifungal therapy (17 months follow-up, stable with medical treatment) Maskin et al [14] 24 Resolution after three surgeries and antifungal therapy (16 months follow-up after last intervention, stable with bilateral amaurosis) Castelnuovo et al [3] 39 Resolution after surgery and antifungal therapy (2 years follow-up, asymptomatic) Salcedo et al [18] 10 Resolution after surgery and antifungal therapy (23 months follow-up, with disease-free CT)…”

“…D. hawaiiensis is infrequent but potentially life-threatening. [ 2 , 10 ] In vitro studies of the susceptibility of the isolate to various antifungal agents must be carried out, as amphotericin B, miconazole, clotrimazole, and 5-fluorocytosine are the most commonly used antifungals for Hawaiiensis species. [ 9 , 25 ]…”