Successful Treatment of Systemic and Local Infections Due to Exophiala Species

Gold, Wayne L.; Vellend, Hillar; Salit, Irving E.; Campbell, Iivi; Summerbell, Richard C.; Rinaldi, Michael G.; Simor, Andrew E.

doi:10.1093/clinids/19.2.339

Cited by 53 publications

(43 citation statements)

References 17 publications

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“…Disseminated infection is the most uncommon manifestation of infection caused by melanized fungi. In a review of 72 cases (627), most patients were immunocompromised, though occasional patients without known immunodeficiency or risk factors developed disseminated disease as well (3,24,73,76,95,105,119,171,208,238,242,246,288,291,308,321,345,386,389,397,400,402,403,409,423,424,435,471,485,516,538,543,550,557,578,593,595,596,612,621,627,640,647,672,688,712,713,740,…”

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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“…Multiple reports describe the infection of organ transplant recipients on high-dose steroids and other immunosuppressive agents by Exophiala species (9,25,26,27). In addition, partial defects in cell-mediated immunity have been associated with both human infection and infection in animal models (16,17).…”

Section: Presented At the 102nd General Meeting Of The American Sociementioning

confidence: 99%

“…They found that terbinafine was the most active drug against all of the isolates. Others have reported susceptibility to commonly used antifungal agents as well (9,18; D. Whittle and I. S. Kominos, Letter, Clin. Infect.…”

Section: Presented At the 102nd General Meeting Of The American Sociementioning

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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“…More often chromoblastomycotic agents are described: Alternaria spp. [7], A. alternata [8,9] [ 19,201, E. spinifera [21], Phialophora parasitica [22], Phialemonium dimorphosporum or I? cuwatum and I?…”

Section: Discussionmentioning

confidence: 99%

Phaeohyphomycotic soft tissue disease caused by Pleurophomopsis lignicola in a kidney transplant patient

Farina

Punithaligham

Ruggenenti

et al. 1997

Journal of Medical Microbiology

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A 44-year-old immunocompromised man presented with multiple tissue abscesses, covering the entire left limb. A dematiaceous fungus compatible with Pleurophomopsis lignicola Petrak was isolated from the diseased tissue in pure culture. This is the second reported isolation of this fungus from man and the first report of fatal soft tissue infection. A detailed morphological description of the isolate is provided.

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Successful Treatment of Systemic and Local Infections Due to Exophiala Species

Cited by 53 publications

References 17 publications

Melanized Fungi in Human Disease

Melanized Fungi in Human Disease

Exophiala oligospermaCausing Olecranon Bursitis

Phaeohyphomycotic soft tissue disease caused by Pleurophomopsis lignicola in a kidney transplant patient

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