Fine-needle aspiration of subcutaneous phaeohyphomycosis caused by Wangiella dermatitidis

Comparative Ecology of Capsular Exophiala Species Causing Disseminated Infection in Humans

Exophiala spinifera and Exophiala dermatitidis (Fungi: Chaetothyriales) are black yeast agents potentially causing disseminated infection in apparently healthy humans. They are the only Exophiala species producing extracellular polysaccharides around yeast cells. In order to gain understanding of eventual differences in intrinsic virulence of the species, their clinical profiles were compared and found to be different, suggesting pathogenic strategies rather than coincidental opportunism. Ecologically relevant factors were compared in a model set of strains of both species, and significant differences were found in clinical and environmental preferences, but virulence, tested in Galleria mellonella larvae, yielded nearly identical results. Virulence factors, i.e., melanin, capsule and muriform cells responded in opposite direction under hydrogen peroxide and temperature stress and thus were inconsistent with their hypothesized role in survival of phagocytosis. On the basis of physiological profiles, possible natural habitats of both species were extrapolated, which proved to be environmental rather than animal-associated. Using comparative genomic analyses we found differences in gene content related to lipid metabolism, cell wall modification and polysaccharide capsule production. Despite the fact that both species cause disseminated infections in apparently healthy humans, it is concluded that they are opportunists rather than pathogens.

Cytohistomorphology of subcutaneous phaeohypomycosis

Phaeohypomycosis is a clinical syndrome caused by melanised or dematiaceous fungi characterized by the presence of brown mycelial structures in tissue section. These fungi are associated with a repertoire of the clinical manifestations that includes superficial and deep local infection to disseminated infection. Herein, we describe the clinical and fine-needle aspiration cytology and histopathologic features of a case of subcutaneous phaeohypomycosis.

Intestinal prevalence of the neurotropic black yeast Exophiala (Wangiella) dermatitidis in healthy and impaired individuals

A screening of 2300 samples of faeces from humans with and without underlying disease revealed that the black yeast Exophiala dermatitidis is present at a frequency of 5.2 per thousand (n=12). Eight individuals positive for the fungus had diarrhoea at the moment of its isolation, out of 11 where relevant information was available. Judging from repeated isolation over several weeks in one patient, the organism is able to persist in the human intestinal tract.

beta-Glucosylated proteins in the cell wall of the black yeast Exophiala (Wangiella) dermatitidis

Wild-type cells of the pathogenic black yeast Exophiala (Wangiella) dermatitidis grown in a low-pH ascorbate medium became less melanized and less resistant to Zymolyase. This was accompanied by increased staining with fluorescently labelled concanavalin A. The sugar composition of wild-type and mutant cell walls was, except for the presence of galactose, similar to that of Saccharomyces cerevisiae. Digestion of mutant cell walls with laminarinase released galactomannoproteins. In addition, the released cell wall proteins contained glucose and reacted with affinity-purified 1,6-beta-glucan antiserum, indicating that they are linked to 1,6-beta-glucan. It is proposed that 1,6-beta-glucosylated cell wall proteins generally occur among ascomycetes.

Pathogenicity of strains of the black yeast Exophiala (Wangiella) dermatitidis: an evaluation based on polymerase chain reaction

Strains of Exophiala dermatitidis, mainly originating from patients with systemic neurotropic mycosis in Asia and from the lungs of patients with cystic fibrosis (CF) in Europe, were analysed by ribotyping of the small subunit rDNA and by random amplification of polymorphic DNA (RAPD). A characteristic banding pattern for the species was found after restriction analysis of amplified fragments V9 and ITS4. The small subunit rDNA gene of five strains was about 1800 base pairs (bp) long, while in 16 strains its length was about 3000 bp. Using RAPD, seven populations could be distinguished. European CF strains as well as Asian strains from systemic mycoses are mainly distributed over two populations, one of which contained both CF strains and a systemic strain. It is concluded that the two clinical pictures are caused by genetically similar strains. The differences in pathogenicity may be explained by immunological differences in the hosts or by differences in exposure to the fungal propagules.

Clinical and mycological spectra of Wangiella dermatitidis infections

The article reviews 37 cases of phaeohyphomycosis from the world literature up to 1992 accepted as being caused by Wangiella dermatitidis. The various clinical aspects of these infections are characterized, and the nomenclatural implications in the history of this emerging pathogen are discussed.

Nutritional physiology and selective isolation of Exophiala dermatitidis

The nutritional physiology of ten strains of Exophiala dermatitidis was investigated. The growth reactions to lactose, citrate, nitrate, nitrite, lysine, creatine and creatinine differ from those found in closely related black yeasts. In addition, it is the only Exophiala species which is able to grow at 40 degrees C. A selective medium containing meso-erythritol as sole carbon source was evaluated. This medium is particularly useful for the isolation of black yeasts from lungs of patients with cystic fibrosis as well as from the environment.

Fungal melanonychia: ungual phaeohyphomycosis caused by Wangiella dermatitidis

A 51-year-old female Japanese patient developed black pigmentation affecting both big toe-nails. Direct potassium hydroxide examination of the nail tissue demonstrated clusters of spherical dematiaceous cells, toruloid hyphae, and septate hyphae. Wangiella dermatitidis was repeatedly isolated from the affected toe-nail lesions. This case represents the first documented case of ungual phaeohyphomycosis, 'fungal melanonychia,' caused by the dematiaceous fungus W. dermatitidis. The patient was successfully treated with a topical solution of bifonazole.