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Lazarus JE, Branda JA, Gandhi RG, Barshak MB, Zachary KC, Barczak AK. Disseminated Intravascular Infection Caused by Paecilomyces variotii: Case Report and Review of the Literature. Open Forum Infect Dis 2020; 7:ofaa166. [PMID: 32617367 PMCID: PMC7314584 DOI: 10.1093/ofid/ofaa166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/07/2020] [Indexed: 11/14/2022] Open
Abstract
Paecilomyces variotii is a ubiquitous environmental saprophyte with worldwide distribution. Commonly found in soil and decomposing organic material [1, 2], P. variotii can also be isolated from drinking water [3] and indoor and outdoor air [4-6]. In immunocompetent hosts, P. variotii has been reported as a cause of locally invasive disease including prosthetic valve endocarditis [7, 8], endophthalmitis [9, 10], rhinosinusitis [11, 12], and dialysis-associated peritonitis [13, 14]. In contrast, disseminated infections are more commonly reported in immunocompromised patients, including those with chronic granulomatous disease [15], solid malignancy [16], acute leukemia [17], lymphoma [18], multiple myeloma [19], and after stem cell transplant for myelodysplasia [20]. In 1 case series examining invasive infections by non-Aspergillus molds, P. variotii was the most common cause after Fusarium spp. [21]. Here, we present the case of an immunocompetent patient with extensive intravascular infection involving prosthetic material. We describe successful induction therapy with combination antifungals and extended suppression with posaconazole with clinical quiescence and eventual normalization of serum fungal biomarkers.
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Affiliation(s)
- Jacob E Lazarus
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - John A Branda
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ronak G Gandhi
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Miriam B Barshak
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kimon C Zachary
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Amy K Barczak
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- The Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
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2
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Mandarapu SB, Mukku KK, Raju SB, Chandragiri S. Successful catheter reinsertion in a case of Paecilomyces varioti peritonitis in a patient on continuous ambulatory peritoneal dialysis. Indian J Nephrol 2015; 25:177-9. [PMID: 26060370 PMCID: PMC4446925 DOI: 10.4103/0971-4065.147377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Peritonitis is one of the most common and important complications in patients on continuous ambulatory peritoneal dialysis (CAPD). Fungal peritonitis isreported in 4–8% of peritonitis episodes. Fungal peritonitis due to Paecilomyces species is not common. We report a case of CAPD peritonitis due to P. varioti. We immediately removed the CAPD catheter and IV amphotericin was administered for 4 weeks along with temporary hemodialytic support followed by successful catheter reinsertion.
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Affiliation(s)
- S B Mandarapu
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - K K Mukku
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - S B Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - S Chandragiri
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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3
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Torres R, Gonzalez M, Sanhueza M, Segovia E, Alvo M, Passalacqua W, Saffie A, Elgueta L, Diaz M, Silva F. Outbreak of Paecilomyces variotii peritonitis in peritoneal dialysis patients after the 2010 Chilean earthquake. Perit Dial Int 2014; 34:322-5. [PMID: 24584599 DOI: 10.3747/pdi.2013.00157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ruben Torres
- Nephrology Section Department of Internal Medicine Hospital Clínico Universidad de Chile Biomedical Science Institute (ICBM) Facultad Medicina Universidad de Chile Microbiology Laboratory Hospital Clínico Universidad de Chile Santiago, Chile
| | - Marcela Gonzalez
- Nephrology Section Department of Internal Medicine Hospital Clínico Universidad de Chile Biomedical Science Institute (ICBM) Facultad Medicina Universidad de Chile Microbiology Laboratory Hospital Clínico Universidad de Chile Santiago, Chile
| | - Maria Sanhueza
- Nephrology Section Department of Internal Medicine Hospital Clínico Universidad de Chile Biomedical Science Institute (ICBM) Facultad Medicina Universidad de Chile Microbiology Laboratory Hospital Clínico Universidad de Chile Santiago, Chile
| | - Erico Segovia
- Nephrology Section Department of Internal Medicine Hospital Clínico Universidad de Chile Biomedical Science Institute (ICBM) Facultad Medicina Universidad de Chile Microbiology Laboratory Hospital Clínico Universidad de Chile Santiago, Chile
| | - Miriam Alvo
- Nephrology Section Department of Internal Medicine Hospital Clínico Universidad de Chile Biomedical Science Institute (ICBM) Facultad Medicina Universidad de Chile Microbiology Laboratory Hospital Clínico Universidad de Chile Santiago, Chile
| | - Walter Passalacqua
- Nephrology Section Department of Internal Medicine Hospital Clínico Universidad de Chile Biomedical Science Institute (ICBM) Facultad Medicina Universidad de Chile Microbiology Laboratory Hospital Clínico Universidad de Chile Santiago, Chile
| | - Antonio Saffie
- Nephrology Section Department of Internal Medicine Hospital Clínico Universidad de Chile Biomedical Science Institute (ICBM) Facultad Medicina Universidad de Chile Microbiology Laboratory Hospital Clínico Universidad de Chile Santiago, Chile
| | - Leticia Elgueta
- Nephrology Section Department of Internal Medicine Hospital Clínico Universidad de Chile Biomedical Science Institute (ICBM) Facultad Medicina Universidad de Chile Microbiology Laboratory Hospital Clínico Universidad de Chile Santiago, Chile
| | - Maria Diaz
- Nephrology Section Department of Internal Medicine Hospital Clínico Universidad de Chile Biomedical Science Institute (ICBM) Facultad Medicina Universidad de Chile Microbiology Laboratory Hospital Clínico Universidad de Chile Santiago, Chile
| | - Francisco Silva
- Nephrology Section Department of Internal Medicine Hospital Clínico Universidad de Chile Biomedical Science Institute (ICBM) Facultad Medicina Universidad de Chile Microbiology Laboratory Hospital Clínico Universidad de Chile Santiago, Chile
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4
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Schinabeck MK, Ghannoum MA. Human Hyalohyphomycoses: A Review of Human Infections Due toAcremoniumspp.,Paecilomycesspp.,Penicilliumspp., andScopulariopsisspp. J Chemother 2013; 15 Suppl 2:5-15. [PMID: 14708962 DOI: 10.1179/joc.2003.15.supplement-2.5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Human infections due to opportunistic molds are on the rise. This is due to recent advances in medical technology that have led to increased numbers of patients who are immunosuppressed, receiving broad-spectrum antibiotics, or have indwelling medical devices. In this article, human infections caused by four hyalohyphomycoses, Acremonium spp., Paecilomyces spp., Penicillium spp., and Scopulariopsis spp., will be reviewed. Specific areas of focus will include the epidemiology, mycology, clinical presentations, and treatment options for each of these four hyaline molds.
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Affiliation(s)
- M K Schinabeck
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, Ohio 44106, USA
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5
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Paecilomyces variotii as an Emergent Pathogenic Agent of Pneumonia. Case Rep Infect Dis 2013; 2013:273848. [PMID: 23819077 PMCID: PMC3683431 DOI: 10.1155/2013/273848] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 05/13/2013] [Indexed: 11/21/2022] Open
Abstract
Paecilomyces variotii is a commonly occurring species in air and food, and it is also associated with many types of human infections. Pneumonia due to Paecilomyces variotii has been rarely reported in the medical literature. The authors report a 48-year-old patient with refractory lymphoma who underwent allogenic hematopoietic cell transplantation and developed pneumonia due to Paecilomyces variotii. They also review the published case reports of pneumonia caused by this fungus.
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Abstract
Invasive fungal infections (IFIs) are associated with high morbidity and mortality in immunocompromised patients. Although Aspergillus spp. remain an important cause of IFI, other moulds such as Fusarium spp., dematiaceous fungi and Mucorales have become increasingly prevalent among this patient population. Diagnosis and treatment of invasive mould infections remain a challenge. Because of the poor prognosis associated with IFIs, understanding the activity, efficacy and limitations of the available drugs is critical to select the appropriate antifungal agent on an individualised basis.
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Affiliation(s)
- Marisa H Miceli
- Department of Internal Medicine, Oakwood Hospital and Medical Center, Dearborn, MI, USA
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Gutiérrez F, Masiá M, Ramos J, Elía M, Mellado E, Cuenca-Estrella M. Pulmonary mycetoma caused by an atypical isolate of Paecilomyces species in an immunocompetent individual: case report and literature review of Paecilomyces lung infections. Eur J Clin Microbiol Infect Dis 2005; 24:607-11. [PMID: 16187056 DOI: 10.1007/s10096-005-0013-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The first case of pulmonary fungus ball caused by Paecilomyces species is reported. The diagnosis was established by isolation of the fungus in culture from specimens obtained by percutaneous transthoracic needle aspiration in an immunocompetent individual. The isolate was atypical, as it failed to produce fruiting structures on routine mycological media. Identification was achieved by sequencing polymorphisms of the internal transcriber spacer regions of the ribosomal DNA. The antifungal susceptibility profile was also determined. This report underscores the increasing importance of Paecilomyces species in human infections. Paecilomyces should be included among the etiological agents of pulmonary mycetoma.
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Affiliation(s)
- F Gutiérrez
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Camí de la Almazara S/N, 03203, Elche, Alicante, Spain.
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Martin CA, Roberts S, Greenberg RN. Voriconazole treatment of disseminated paecilomyces infection in a patient with acquired immunodeficiency syndrome. Clin Infect Dis 2002; 35:e78-81. [PMID: 12228840 DOI: 10.1086/342302] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2001] [Revised: 04/23/2002] [Indexed: 11/03/2022] Open
Abstract
We describe a patient with poorly controlled, multidrug-resistant human immunodeficiency virus disease who developed >20 skin lesions caused by Paecilomyces lilacinus. The lesions failed to improve during treatment with oral itraconazole, amphotericin B, and amphotericin B lipid complex but improved during treatment with voriconazole.
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Affiliation(s)
- Craig A Martin
- Pharmacy Services, University of Kentucky Medical Center, Lexington, USA
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Korzets A, Weinberger M, Chagnac A, Goldschmied-Reouven A, Rinaldi MG, Sutton DA. Peritonitis due to Thermoascus taitungiacus (Anamorph Paecilomyces taitungiacus). J Clin Microbiol 2001; 39:720-4. [PMID: 11158134 PMCID: PMC87803 DOI: 10.1128/jcm.39.2.720-724.2001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The first case of human disease due to the thermophilic ascomycete Thermoascus taitungiacus (the teleomorph of Paecilomyces taitungiacus) is presented. T. taitungiacus was recovered from four dialysate fluid specimens of a 57-year-old patient undergoing chronic peritoneal dialysis. Identification was based upon cylindrical conidia, reddish orange nonostiolate ascomata, lack of growth at 20 degrees C, thermotolerance, and ascospores that appeared pale yellow, elliptical, thick walled, and predominately echinulate by light microscopy but irregularly verrucose by scanning electron microscopy.
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Affiliation(s)
- A Korzets
- Department of Nephrology, Golda Campus, Beilinson Campus, Rabin Medical Center, Petach-Tikva, Israel
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Alscher DM, Nohe EP, Rumpf D, Pauli-Magnus C, Knabbe1 C, Kuhlmann U, Tang TM. Moulds in Containers with Biological Wastes as a Possible Source of Peritonitis in Two Patients on Peritoneal Dialysis. Perit Dial Int 1998. [DOI: 10.1177/089686089801800614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Dominik M. Alscher
- Department of Internal Medicine Division of General Internal Medicine and Nephrology Robert Bosch Krankenhaus Department of Diagnostic Medicinel Clinical Laboratory Stuttgart, Germany
| | - Elisabeth Pfinder Nohe
- Department of Internal Medicine Division of General Internal Medicine and Nephrology Robert Bosch Krankenhaus Department of Diagnostic Medicinel Clinical Laboratory Stuttgart, Germany
| | - Dietrich Rumpf
- Department of Internal Medicine Division of General Internal Medicine and Nephrology Robert Bosch Krankenhaus Department of Diagnostic Medicinel Clinical Laboratory Stuttgart, Germany
| | - Christiane Pauli-Magnus
- Department of Internal Medicine Division of General Internal Medicine and Nephrology Robert Bosch Krankenhaus Department of Diagnostic Medicinel Clinical Laboratory Stuttgart, Germany
| | - Cornelius Knabbe1
- Department of Internal Medicine Division of General Internal Medicine and Nephrology Robert Bosch Krankenhaus Department of Diagnostic Medicinel Clinical Laboratory Stuttgart, Germany
| | - Ulrich Kuhlmann
- Department of Internal Medicine Division of General Internal Medicine and Nephrology Robert Bosch Krankenhaus Department of Diagnostic Medicinel Clinical Laboratory Stuttgart, Germany
| | - Thomas Met Tang
- Department of Internal Medicine Division of General Internal Medicine and Nephrology Robert Bosch Krankenhaus Department of Diagnostic Medicinel Clinical Laboratory Stuttgart, Germany
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11
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Itin PH, Frei R, Lautenschlager S, Buechner SA, Surber C, Gratwohl A, Widmer AF. Cutaneous manifestations of Paecilomyces lilacinus infection induced by a contaminated skin lotion in patients who are severely immunosuppressed. J Am Acad Dermatol 1998; 39:401-9. [PMID: 9738773 DOI: 10.1016/s0190-9622(98)70315-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND New opportunistic fungal infections cause significant morbidity and death in patients who are severely immunocompromised. Cutaneous lesions may be the first clinical manifestation and give the clue to early diagnosis. OBJECTIVE The purpose of this study was to describe the clinical and histologic manifestations of Paecilomyces lilacinus infection in patients who are severely immunosuppressed. METHODS Within a 3-month period, we observed 5 patients with allogenic bone marrow transplantation and 4 patients with aplasia after chemotherapy for hematologic malignancies who developed skin eruptions caused by invasive P lilacinus. RESULTS The skin lesions began in 7 cases during or shortly after recovery of pancytopenia. Most of the skin lesions were located on the lower extremities. The cutaneous manifestations were highly variable including erythematous macules, nodules, pustules, vesicular lesions, and necrotic crusts. In 3 biopsy specimens, histologic examination revealed hyphae in periodic acid-Schiff-stained sections. In all patients P lilacinus was isolated from skin tissue samples. P lilacinus was identified from all lesions either by skin biopsy or needle aspiration from clinically evident lesions. In 3 additional cases, the patient's hands were colonized without skin lesions. The source of the epidemic outbreak was finally traced down to several contaminated lots of a topical moisturizing agent. Two patients died; one patient had septic lesions in the eye and kidney as the result of P lilacinus. CONCLUSION Clinical and histologic findings of P lilacinus infection with cutaneous manifestations in patients who are severely immunosuppressed are summarized. P lilacinus is resistant to all systemic antimycotics available, and in general, recovery of immunosuppression is necessary to eradicate the mold. Contaminated topical dermatologic agents should be included in the differential diagnosis as a source for severe epidemic cutaneous manifestations of fungal infection in patients who are severely immunosuppressed. This fact implies that additional safety guidelines are necessary for topical dermatologic agents used for patients who are severely immunosuppressed.
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Affiliation(s)
- P H Itin
- Department of Dermatology, University of Basel, Switzerland
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Aguilar C, Pujol I, Sala J, Guarro J. Antifungal susceptibilities of Paecilomyces species. Antimicrob Agents Chemother 1998; 42:1601-4. [PMID: 9660991 PMCID: PMC105653 DOI: 10.1128/aac.42.7.1601] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/1997] [Accepted: 04/13/1998] [Indexed: 02/08/2023] Open
Abstract
The MICs and minimum fungicidal concentrations (MFCs) of amphotericin B, miconazole, itraconazole, ketoconazole, fluconazole, and flucytosine for 52 isolates of Paecilomyces species were evaluated by the broth microdilution method, largely based on the recommendations of the National Committee for Clinical Laboratory Standards (document M27-A). The fungal isolates tested included 16 P. variotii, 11 P. lilacinus, 9 P. marquandii, 6 P. fumosoroseus, 4 P. javanicus, and 2 P. viridis isolates and 1 isolate of each of the following species: P. carneus, P. farinosus, P. fulvus, and P. niveus. The MFCs and the MICs at which 90% of isolates were inhibited (MIC90s) for the six antifungal agents were remarkably high; the MIC50s indicated that amphotericin B, miconazole, itraconazole, and ketoconazole had good activities, while fluconazole and flucytosine demonstrated poor efficacy. The ranges of the MICs were generally wider and lower than those of the MFCs. There were significant susceptibility differences among the species. All species with the exception of P. variotii were highly resistant to fluconazole and flucytosine; P. variotii was susceptible to flucytosine. Amphotericin B and the rest of the azoles showed good activity against P. variotii, while all the antifungal agents assayed showed low efficacy against P. lilacinus.
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Affiliation(s)
- C Aguilar
- Unitat de Microbiologia, Facultat de Medicina, Universitat Rovira i Virgili, Reus, Tarragona, Spain
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Shin JH, Lee SK, Suh SP, Ryang DW, Kim NH, Rinaldi MG, Sutton DA. Fatal Hormonema dematioides peritonitis in a patient on continuous ambulatory peritoneal dialysis: criteria for organism identification and review of other known fungal etiologic agents. J Clin Microbiol 1998; 36:2157-63. [PMID: 9650991 PMCID: PMC105020 DOI: 10.1128/jcm.36.7.2157-2163.1998] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
We report a fatal case a fungal peritonitis caused by the yeast-like dematiaceous mould Hormonema dematioides in a 45-year-old woman. The woman had a 13-year history of insulin-dependent diabetes mellitus and had been on continuous ambulatory peritoneal dialysis for chronic renal failure. H. dematioides was repeatedly isolated from the dialysate culture specimens collected on days 3, 9, 16, and 20 of her hospital stay. Preliminary culture reports on day 7 of the growth of a yeast-like fungus, a probable Candida species, prompted the administration of fluconazole (FLU). Intraperitoneal and intravenous FLU failed to eliminate the mould, and the patient expired on day 21 of her hospital stay. We use this case to present what appears to be the first report of fungal peritonitis due to H. dematioides, to provide laboratorians with criteria for differentiating this organism from the similar mould Aureobasidium pullulans and from various yeast genera, and to provide a review of known fungal taxa inciting peritonitis.
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Affiliation(s)
- J H Shin
- Department of Clinical Pathology, Chonnam University Medical School, Kwangju, Korea
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