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Ahamad A, Tehreem B, Farooqi M, Maramara B. Case report and literature review: double jeopardy – Exophiala dermatitidis and Mycobacterium canariasense central line-associated bloodstream infection in a patient. Access Microbiol 2022; 4:000347. [PMID: 35812706 PMCID: PMC9260090 DOI: 10.1099/acmi.0.000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Central line-associated bloodstream infection (CLABSI) is the most common nosocomial-acquired infection, affecting 38 000 patients in the USA annually. Approximately 8–10 % of inserted catheters lead to bloodstream infections, and ~25–30 % of infections are associated with mortality. Although proper line maintenance is essential to prevent infection, it is quite a challenge to avoid infection in patients with a long-term catheter. We present a case of a female in her 40s with a previous history of irritable bowel syndrome (IBS) who has had a central line for total parenteral nutrition for the past 2 years. The patient recently visited the emergency room with fever and generalized fatigue. Blood cultures sent to microbiology were positive for black mould, Exophiala dermatitidis. However, after a few days, microbiology reported an additional micro-organism, Mycobacterium canariasense, a pathogen rarely associated with bacteraemia. The patient was administered voriconazole and moxifloxacin for black mould and mycobacterium infection, respectively. We present an unusual case of rare opportunistic organisms causing bacteraemia and fungaemia in a patient with a long-term catheter. CLABSI remains a serious challenge for clinical facilities. Implementation and monitoring of effective strategies can prevent catheter-related bloodstream infections in patients with long-term catheters and can reduce the morbidity and mortality associated with CLABSI.
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Affiliation(s)
- Afrinash Ahamad
- Clinical Laboratory Sciences Program, School of Health Professions, Stony Brook University, Stony Brook, NY, USA
- Department of Neuroscience and Behavior, Stony Brook University, Stony Brook, NY, USA
| | - Bushra Tehreem
- Neonatal-Perinatal Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Maaz Farooqi
- Medical Informatics, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Bennadette Maramara
- Divison of Infectious Disease, Stony Brook Medical Center, Stony Brook, NY, USA
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Itoh N, Murakami H, Ishibana Y, Matsubara Y, Yaguchi T, Kamei K. Challenges in the diagnosis and management of central line-associated blood stream infection due to Exophiala dermatitidis in an adult cancer patient. J Infect Chemother 2021; 27:1360-1364. [PMID: 33888421 DOI: 10.1016/j.jiac.2021.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/03/2021] [Accepted: 04/08/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Exophiala (Wangiella) dermatitidis is a clinically relevant black yeast. Although E. dermatitidis rarely causes human infection, it can cause superficial and deep-seated infections, and cutaneous and subcutaneous diseases. Cases of fungemia and central line-associated bloodstream infections due to E. dermatitidis are extremely uncommon, and their clinical manifestations and prognosis are still not well-known. Herein, we report a case of central line-associated bloodstream infections in a patient with cancer. These infections were caused by melanized yeast that was finally identified as E. dermatitidis via internal transcribed spacer sequencing and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. CASE PRESENTATION A 75-year-old man with thoracic esophageal cancer and early gastric cancer presented with a 1-day history of fever during his hospitalization at our hospital. A central venous port was placed in the patient for total parenteral nutrition. Two E. dermatitidis isolates were recovered from two blood samples drawn at different times from a peripheral vein and this central venous port. The isolate was identified as E. dermatitidis by internal transcribed spacer sequencing and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The central venous port was removed, and the patient was administered micafungin and voriconazole. Although the minimum inhibitory concentrations of E. dermatitidis for voriconazole and minimum effective concentrations for micafungin were 2 μg/mL and 4 μg/m, respectively, the bacteremia was successfully treated. CONCLUSIONS Although no clear treatment guidelines have been proposed for E. dermatitidis infections, immediate removal of central venous catheters is the key to improving central line-associated bloodstream infections.
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Affiliation(s)
- Naoya Itoh
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan; Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Hiromi Murakami
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Yuichi Ishibana
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Yuki Matsubara
- Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Takashi Yaguchi
- Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chiba, 260-8673, Japan
| | - Katsuhiko Kamei
- Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chiba, 260-8673, Japan
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Kumar A, Nandakumar A, Nair S, Singh A, Shashindran N, Thulasidharan S, Subhash K, Ramachandran A, Chowdhary A. Exophiala dermatitidis as a cause of central line associated bloodstream infection in an infant: Case report and literature review. Rev Iberoam Micol 2020; 38:12-15. [PMID: 33279387 DOI: 10.1016/j.riam.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/20/2020] [Accepted: 09/22/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Exophiala dermatitidis is a dematiaceous fungus known to cause superficial, subcutaneous, cutaneous and deep seated infections, and rarely central line associated bloodstream infection (CLABSI). A case of CLABSI due to E. dermatitidis in an infant is described. CASE REPORT Clinical and laboratory data were extracted from patient's chart and laboratory records. The isolate was identified as E. dermatitidis by phenotypic characterization and sequencing of the ITS and LSU regions of the ribosomal DNA. Medline search was done to review all cases of CLABSI due to E. dermatitidis. Among the azoles tested, posaconazole (0.06mg/l), voriconazole (0.03mg/l) and itraconazole (0.03mg/l) showed very low MICs when compared to fluconazole (4mg/l) CONCLUSIONS: As we did not found in the literature any case of CLABSI due to E. dermatitidis in an infant, we report the first one. Sequencing is a mandatory method for accurately identifying this species. Prompt removal of the central line, followed by a treatment with amphotericin B or an azole, seems to be the most effective treatment.
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Affiliation(s)
- Anil Kumar
- Department of Microbiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India.
| | - Aswathy Nandakumar
- Department of Microbiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India
| | - Sajitha Nair
- Department of Paediatrics, Amrita Institute of Medical Sciences, Amrita University, Ponekkara, Kerala, India
| | - Ashutosh Singh
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, India
| | - Nandita Shashindran
- Department of Microbiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India
| | - Swathy Thulasidharan
- Department of Microbiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India
| | - Kiran Subhash
- Department of Microbiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India
| | - Arya Ramachandran
- Department of Microbiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India
| | - Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, India
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Sun Y, Gao L, Yuan M, Yuan L, Yang J, Zeng T. In vitro and in vivo Study of Antifungal Effect of Pyrvinium Pamoate Alone and in Combination With Azoles Against Exophiala dermatitidis. Front Cell Infect Microbiol 2020; 10:576975. [PMID: 33194816 PMCID: PMC7649562 DOI: 10.3389/fcimb.2020.576975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022] Open
Abstract
Infections of Exophiala dermatitidis are often chronic and recalcitrant. Combination therapies with novel compounds and azoles could be an effective solution. Previously, we have demonstrated that pyrvinium pamoate exerted antifungal activity alone and favorable synergy with azoles against planktonic E. dermatitidis. Herein, the underlying antifungal mode of action were investigated. Pyrvinium alone showed sessile MIC50 (SMIC50) of 8->16 μg/ml against E. dermatitidis biofilms. However, synergism of PP with itraconazole, voriconazole, and posaconazole were observed against 16 (88.9%), 9 (50%), and 13 (72.2%) strains of E. dermatitidis biofilms. In accordance with in vitro susceptibilities, pyrvinium alone at concentration of 2 μg/ml resulted in significant growth restriction of planktonic E. dermatitidis. Pyrvinium alone resulted in reduction of biofilm formation. Higher concentration of pyrvinium was associate with more progressive reduction of biofilm mass. The in vivo activity of pyrvinium alone and combined with azoles was evaluated using Galleria mellonella model. Pyrvinium alone significantly improved the survival rate of larvae (P < 0.0001). The combination of pyrvinium and voriconazole or posaconazole acted synergistically in vivo (P < 0.05). Fungal burden determination revealed significant reduction of numbers of colony forming unit (CFU) in larvae treated with pyrvinium-itraconazole and pyrvinium-posaconazole compared to itraconazole or posaconazole alone group, respectively. The effect of pyrvinium on apoptosis, expression of TOR and HSP90, and drug efflux reversal were evaluated by PI/Annexin V staining, Real-Time Quantitative PCR and Rhodamine 6G assay, respectively. Pyrvinium alone or combined with azoles significantly (P < 0.05) increased late apoptosis or necrosis of E. dermatitidis cells. Pyrvinium combined with posaconazole significantly decreased the expression of TOR and Hsp90 compared to posaconazole alone group (P < 0.05). Pyrvinium resulted in significant (P < 0.05) decrease of the efflux of Rhodamine 6G. These findings suggested pyrvinium could be a promising synergist with azoles. The underlying mechanisms could be explained by inducing apoptosis/necrosis, inhibition of drug efflux pumps, and signaling pathways related with stress response and growth control.
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Affiliation(s)
- Yi Sun
- Department of Dermatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, China
| | - Lujuan Gao
- Department of Dermatology, Zhongshan Hospital Fudan University (Xiamen Branch), Xiamen, China
- Department of Dermatology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Mingzhu Yuan
- Department of Clinical Medicine, Yangtze University, Jingzhou, China
| | - Lu Yuan
- Department of Pathology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, China
| | - Ji Yang
- Department of Dermatology, Zhongshan Hospital Fudan University (Xiamen Branch), Xiamen, China
- Department of Dermatology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Tongxiang Zeng
- Department of Dermatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, China
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Iwahashi C, Eguchi H, Hotta F, Uezumi M, Sawa M, Kimura M, Yaguchi T, Kusaka S. Orbital abscess caused by Exophiala dermatitidis following posterior subtenon injection of triamcinolone acetonide: a case report and a review of literature related to Exophiala eye infections. BMC Infect Dis 2020; 20:566. [PMID: 32746887 PMCID: PMC7398408 DOI: 10.1186/s12879-020-05294-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023] Open
Abstract
Background Subtenon injection of triamcinolone acetonide (STTA) has been widely adopted in the clinical setting of ophthalmology and its infectious complications are rare. However, orbital abscess following STTA has been reported in seven cases. Furthermore, although eye infections due to Exophiala species are uncommon, there have been 19 cases to date. E. jeanselmei, E. phaeomuriformis, E. werneckii, and E. dermatitidis have been reported to cause human eye infections; however, to the best of our knowledge, orbital abscess caused by E. dermatitidis has not yet been reported. We describe the first documented case of fungal orbital abscess caused by E. dermatitidis following STTA. We also review the related literature of orbital abscess following STTA, as well as eye infections caused by the four Exophiala species. Case presentation The patient was a 69-year-old Japanese woman with diabetic mellitus. She had a macular oedema in her right eye, which occurred secondary to branch retinal vein occlusion. An orbital abscess caused by E. dermatitidis occurred 4 months after the second STTA for the macular oedema, which was successfully treated by a surgical debridement and systemic administration of voriconazole. Conclusions Our findings in the patient and from our literature survey caution ophthalmologists to the fact that STTA can cause fungal orbital infections, especially in diabetic patients. Furthermore, surgical treatment is one of the most important risk factors.
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Affiliation(s)
- Chiharu Iwahashi
- Department of Ophthalmology, Faculty of Medicine, Kindai University, 377-2, Ohonohigashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Hiroshi Eguchi
- Department of Ophthalmology, Faculty of Medicine, Kindai University, 377-2, Ohonohigashi, Osakasayama-shi, Osaka, 589-8511, Japan.
| | - Fumika Hotta
- Department of Ophthalmology, Faculty of Medicine, Kindai University, 377-2, Ohonohigashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Mayu Uezumi
- Department of Ophthalmology, Sakai City Medical Center, 1-1-1, Ebaraji-cho, Nishi-ku, Sakai City, Osaka, 593-08304, Japan
| | - Miki Sawa
- Department of Ophthalmology, Sakai City Medical Center, 1-1-1, Ebaraji-cho, Nishi-ku, Sakai City, Osaka, 593-08304, Japan
| | - Masatomo Kimura
- Department of Diagnostic Pathology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Takashi Yaguchi
- Medical Mycology Research Center Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8673, Japan
| | - Shunji Kusaka
- Department of Ophthalmology, Faculty of Medicine, Kindai University, 377-2, Ohonohigashi, Osakasayama-shi, Osaka, 589-8511, Japan
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6
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First Report of Environmental Isolation of Exophiala spp. in Malaysia. Curr Microbiol 2020; 77:2915-2924. [PMID: 32661678 DOI: 10.1007/s00284-020-02109-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/29/2020] [Indexed: 12/26/2022]
Abstract
The opportunistic pathogen Exophiala dermatitidis has been frequently isolated from tropical regions of the world. However, there is no report of environmental isolation of Exophiala spp. from Malaysia. The information regarding the ecology of this microbe is important for a better understanding of the opportunism. This study aims to conduct a survey of natural distribution of Exophiala spp. in Malaysia. Forty-seven strains of Exophiala-like was isolated by using selective media. These isolates from the fields were molecularly identified based on the ITS region. The biochemical activity of these microbes was tested by conducting various tests, i.e. DNase test, proteinase activity, and urea hydrolysis. Overall, 22 strains of E. dermatitidis were successfully obtained and identified from burnt tree bark, oil dripped soil sample, hot spring biofilm, railway track stones, tar road contaminated with petrol hydrocarbon, drain and deep mud of Sungai Pinang besides the new discovery from pigeon droppings. A single strain of E. heteromorpha was identified from tar road contaminated with petrol hydrocarbon. Genotypes of the isolated E. dermatitidis were identified by the neighbor-joining tree and grouped into Genotype A, A2 and B. The existence of new Genotype A4 was confirmed by a similar cladogram position in both neighbor-joining and maximum likelihood tree. The survival of E. dermatitidis in the hydrocarbon contaminated environment was studied by supplying engine oil and observing the growth pattern. The results of this study suggest that the opportunistic Exophiala spp. was isolated from nutrient limited and harsh conditions in the natural environment.
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Siqueira IM, Wüthrich M, Li M, Wang H, Las-Casas LDO, de Castro RJA, Klein B, Bocca AL. Early immune response against Fonsecaea pedrosoi requires Dectin-2-mediated Th17 activity, whereas Th1 response, aided by Treg cells, is crucial for fungal clearance in later stage of experimental chromoblastomycosis. PLoS Negl Trop Dis 2020; 14:e0008386. [PMID: 32542003 PMCID: PMC7316354 DOI: 10.1371/journal.pntd.0008386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/25/2020] [Accepted: 05/12/2020] [Indexed: 01/26/2023] Open
Abstract
Chromoblastomycosis (CBM) is a chronic worldwide subcutaneous mycosis, caused by several dimorphic, pigmented dematiaceous fungi. It is difficult to treat patients with the disease, mainly because of its recalcitrant nature. The correct activation of host immune response is critical to avoid fungal persistence in the tissue and disease chronification. CD4+ T cells are crucial for the development of protective immunity to F. pedrosoi infection. Here, we investigated T helper cell response dynamics during experimental CBM. Following footpad injection with F. pedrosoi hyphae and conidia, T cells were skewed towards a Th17 and Th1 phenotype. The Th17 population was the main Th cell subset found in the infected area during the early stages of experimental murine CBM, followed by Th1 predominance in the later stages, coinciding with the remission phase of the disease in this experimental model. Depletion of CD25+ cells, which leads to a reduction of Treg cells in the draining lymph node, resulted in decline in fungal burden after 14 days of infection. However, fungal cells were not cleared in the later stages of the disease, prolonging CBM clinical features in those animals. IL-17A and IFN-γ neutralization hindered fungal cell elimination in the course of the disease. Similarly, in dectin-2 KO animals, Th17 contraction in the course of experimental CBM was accompanied by fungal burden decrease in the first 14 days of infection, although it did not affect disease resolution. In this study, we gained insight into T helper subsets' dynamics following footpad injections of F. pedrosoi propagules and uncovered their contribution to disease resolution. The Th17 population proved to be important in eliminating fungal cells in the early stages of infection. The Th1 population, in turn, closely assisted by Treg cells, proved to be relevant not only in the elimination of fungal cells at the beginning of infection but also essential for their complete elimination in later stages of the disease in a mouse experimental model of CBM.
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Affiliation(s)
- Isaque Medeiros Siqueira
- Molecular Pathology Post-Graduate Program, School of Medicine, University of Brasília, Brasília, Brazil
| | - Marcel Wüthrich
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
| | - Mengyi Li
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
| | - Huafeng Wang
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
| | | | | | - Bruce Klein
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
- Department of Internal Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
- Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, United States of America
| | - Anamelia Lorenzetti Bocca
- Department of Cell Biology, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
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Untereiner WA, Naveau FA. Molecular systematics of the Herpotrichiellaceae with an assessment of the phylogenetic positions ofExophiala dermatitidisandPhialophora americana. Mycologia 2019. [DOI: 10.1080/00275514.1999.12060994] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Wendy A. Untereiner
- MUCL Culture Collection, Université Catholique de Louvain, Place Croix du Sud 3, B-1348 Louvain-la-Neuve, Belgium
| | - Françoise A. Naveau
- MUCL Culture Collection, Université Catholique de Louvain, Place Croix du Sud 3, B-1348 Louvain-la-Neuve, Belgium
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Kirchhoff L, Olsowski M, Rath PM, Steinmann J. Exophiala dermatitidis: Key issues of an opportunistic fungal pathogen. Virulence 2019; 10:984-998. [PMID: 30887863 PMCID: PMC8647849 DOI: 10.1080/21505594.2019.1596504] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The black yeast Exophiala dermatitidis is an opportunistic pathogen, causing phaeohyphomycosis in immunosuppressed patients, chromoblastomycosis and fatal infections of the central nervous system in otherwise healthy Asian patients. In addition, it is also regularly isolated from respiratory samples from cystic fibrosis patients, with rates varying between 1% and 19%.Melanin, as part of the cell wall of black yeasts, is one major factor known contributing to the pathogenicity of E. dermatitidis and increased resistance against host defense and anti-infective therapeutics. Further virulence factors, e.g. the capability to adhere to surfaces and to form biofilm were reported. A better understanding of the pathogenicity of E. dermatitidis is essential for the development of novel preventive and therapeutic strategies. In this review, the current knowledge of E. dermatitidis prevalence, clinical importance, diagnosis, microbiological characteristics, virulence attributes, susceptibility, and resistances as well as therapeutically strategies are discussed.
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Affiliation(s)
- Lisa Kirchhoff
- Institute of Medical Microbiology, Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Maike Olsowski
- Institute of Medical Microbiology, Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Peter-Michael Rath
- Institute of Medical Microbiology, Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
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10
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Hagiya H, Maeda T, Kusakabe S, Kawasaki K, Hori Y, Kimura K, Ueda A, Yoshioka N, Sunada A, Nishi I, Morii E, Kanakura Y, Tomono K. A fatal case of Exophiala dermatitidis disseminated infection in an allogenic hematopoietic stem cell transplant recipient during micafungin therapy. J Infect Chemother 2019; 25:463-466. [PMID: 30679025 DOI: 10.1016/j.jiac.2018.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/14/2018] [Accepted: 12/23/2018] [Indexed: 01/14/2023]
Abstract
Exophiala dermatitidis is a dematiaceous fungus that is increasingly becoming the cause of fungal infection in immunocompromised patients. However, the risk factors and optimal treatment modality for E. dermatitidis infection are unknown to date. Herein, we present a fatal case of E. dermatitidis infection in an adult patient that developed after allogeneic hematopoietic stem cell transplantation for chronic active Epstein-Barr virus infection. The dematiaceous fungus caused a breakthrough fungemia despite prophylactic administration of micafungin. Although the patient was intensively treated with liposomal-amphotericin B and voriconazole, serum level of beta-D-glucan continuously increased, and the patient eventually died because of cerebral hemorrhage. An autopsy found multiple involvements of the fungal infection at the bilateral lungs, thoracic cavities, diaphragm, and thyroid. To the best of our knowledge, this is the first reported case of E. dermatitidis infection involving these tissues as determined via autopsy. This case highlights the importance of attention for Exophiala infection in immunocompromised individuals in those given antifungal therapy with echinocandins.
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Affiliation(s)
- Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital, Osaka, Japan.
| | - Tetsuo Maeda
- Department of Hematology, Osaka University Hospital, Osaka, Japan
| | | | - Keisuke Kawasaki
- Department of Pathology, Osaka University Hospital, Osaka, Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Hospital, Osaka, Japan
| | - Keigo Kimura
- Laboratory for Clinical Investigation, Osaka University Hospital, Osaka, Japan
| | - Akiko Ueda
- Laboratory for Clinical Investigation, Osaka University Hospital, Osaka, Japan
| | - Nori Yoshioka
- Division of Infection Control and Prevention, Osaka University Hospital, Osaka, Japan; Laboratory for Clinical Investigation, Osaka University Hospital, Osaka, Japan
| | - Atsuko Sunada
- Laboratory for Clinical Investigation, Osaka University Hospital, Osaka, Japan
| | - Isao Nishi
- Laboratory for Clinical Investigation, Osaka University Hospital, Osaka, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Hospital, Osaka, Japan
| | - Yuzuru Kanakura
- Department of Hematology, Osaka University Hospital, Osaka, Japan
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, Osaka, Japan
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11
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Metin B, Döğen A, Yıldırım E, de Hoog GS, Heitman J, Ilkit M. Mating type (MAT) locus and possible sexuality of the opportunistic pathogen Exophiala dermatitidis. Fungal Genet Biol 2019; 124:29-38. [PMID: 30611834 DOI: 10.1016/j.fgb.2018.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 12/27/2018] [Accepted: 12/30/2018] [Indexed: 11/27/2022]
Abstract
Sexual reproduction among the black yeasts is generally limited to environmental saprobic species and is rarely observed among opportunists in humans. To date, a complete sexual cycle has not been observed in Exophiala dermatitidis. In this study, we aimed to gain insight into the reproductive mode of E. dermatitidis by characterizing its mating type (MAT) locus, conducting MAT screening of environmental and clinical isolates, examining the expression of the MAT genes and analyzing the virulence of the isolates of different mating types. Similar to other members of the Pezizomycotina, the E. dermatitidis genome harbors a high mobility group (HMG) domain gene (MAT1-2-1) in the vicinity of the SLA2 and APN2 genes. The MAT loci of 74 E. dermatitidis isolates (11 clinical and 63 environmental) were screened by PCR, and the surrounding region was amplified using long-range PCR. Sequencing of the ∼ 12-kb PCR product of a MAT1-1 isolate revealed an α-box gene (MAT1-1-1). The MAT1-1 idiomorph was 3544-bp long and harbored the MAT1-1-1 and MAT1-1-4 genes. The MAT1-2 idiomorph was longer, 3771-bp, and harbored only the MAT1-2-1 gene. This structure suggests a heterothallic reproduction mode. The distribution of MAT among 74 isolates was ∼ 1:1 with a MAT1-1:MAT1-2 ratio of 35:39. RT-PCR analysis indicated that the MAT genes are transcribed. No significant difference was detected in the virulence of isolates representing different mating types using a Galleria mellonella model (P > 0.05). Collectively, E. dermatitidis is the first opportunistic black yeast in which both MAT idiomorphs have been characterized. The occurrence of isolates bearing both idiomorphs, their approximately equal distribution, and the expression of the MAT genes suggest that E. dermatitidis might reproduce sexually.
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Affiliation(s)
- Banu Metin
- Department of Food Engineering, Faculty of Engineering and Natural Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey.
| | - Aylin Döğen
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Mersin University, Mersin, Turkey.
| | - Esra Yıldırım
- Department of Food Engineering, Faculty of Engineering and Natural Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey.
| | - G Sybren de Hoog
- Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands; Center of Expertise in Mycology of Radboudumc/CWZ, Nijmegen, the Netherlands.
| | - Joseph Heitman
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, USA.
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, Çukurova University, Adana, Turkey.
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12
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de Brito AC, Bittencourt MDJS. Chromoblastomycosis: an etiological, epidemiological, clinical, diagnostic, and treatment update. An Bras Dermatol 2018; 93:495-506. [PMID: 30066754 PMCID: PMC6063100 DOI: 10.1590/abd1806-4841.20187321] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/24/2017] [Indexed: 01/19/2023] Open
Abstract
Chromoblastomycosis is a chronic, granulomatous, suppurative mycosis of the skin and subcutaneous tissue caused by traumatic inoculation of dematiaceous fungi of the family Herpotrichiellaceae. The species Fonsecaea pedrosoi and Cladophialophora carrionii are prevalent in regions where the disease is endemic. Chromoblastomycosis lesions are polymorphous: verrucous, nodular, tumoral, plaque-like, and atrophic. It is an occupational disease that predominates in tropical and subtropical regions, but there have been several reports of cases in temperate regions. The disease mainly affects current or former farm workers, mostly males, and often leaving disabling sequelae. This mycosis is still a therapeutic challenge due to frequent recurrence of lesions. Patients with extensive lesions require a combination of pharmacological and physical therapies. The article provides an update of epidemiological, clinical, diagnostic, and therapeutic features.
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Affiliation(s)
- Arival Cardoso de Brito
- Dermatology Course, Universidade Federal do Pará,
Belém (PA), Brazil
- Medical Residency in Dermatology, Universidade Federal do
Pará, Belém (PA), Brazil
- Dermatopathology Laboratory, Universidade Federal do Pará,
Belém (PA), Brazil
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13
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Invasive Fungal Infection Caused by Exophiala dermatitidis in a Patient After Lung Transplantation: Case Report and Literature Review. Mycopathologia 2018; 184:107-113. [DOI: 10.1007/s11046-018-0275-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/27/2018] [Indexed: 12/20/2022]
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14
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Lang R, Minion J, Skinner S, Wong A. Disseminated Exophiala dermatitidis causing septic arthritis and osteomyelitis. BMC Infect Dis 2018; 18:255. [PMID: 29866071 PMCID: PMC5987487 DOI: 10.1186/s12879-018-3171-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/28/2018] [Indexed: 01/25/2023] Open
Abstract
Background Exophiala dermatitidis is a melanized fungus isolated from many environmental sources. Infections caused by Exophiala species are typically seen in immunocompromised hosts and manifest most commonly as cutaneous or subcutaneous disease. Systemic infections are exceedingly rare and associated with significant morbidity and mortality Case presentation A 28-year-old female originally from India presented with fevers, chills, weight loss and increasing back pain. She had a recent diffuse maculopapular rash that resulted in skin biopsy and a tentative diagnosis of sarcoidosis, leading to administration of azathioprine and prednisone. An MRI of her spine revealed a large paraspinal abscess requiring surgical intervention and hardware placement. Cultures from the paraspinal abscess grew a colony of dark pigmented mold. Microscopy of the culture revealed a melanized fungus, identified as Exophiala dermatitidis. Voriconazole was initially utilized, but due to relapse of infection involving the right iliac crest and left proximal humerus, she received a prolonged course of amphotericin B and posaconazole in combination and required 7 separate surgical interventions. Prolonged disease stability following discontinuation of therapy was achieved. Conclusions Described is the first identified case of disseminated Exophiala dermatitidis causing osteomyelitis and septic arthritis in a patient on immunosuppressive therapy. A positive outcome was achieved through aggressive surgical intervention and prolonged treatment with broad-spectrum antifungal agents.
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Affiliation(s)
- Raynell Lang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Minion
- Regina Qu'Appelle Health Region, Department of Laboratory Medicine, University of Saskatchewan, College of Medicine, Regina, Saskatchewan, Canada
| | - Stuart Skinner
- Division of Infectious Diseases, Department of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada.,4E - ID Clinic, Regina General Hospital, 1440 14th Avenue Regina, Regina, Saskatchewan, Canada
| | - Alexander Wong
- Division of Infectious Diseases, Department of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada. .,4E - ID Clinic, Regina General Hospital, 1440 14th Avenue Regina, Regina, Saskatchewan, Canada.
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15
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Combination of Amphotericin B and Terbinafine against Melanized Fungi Associated with Chromoblastomycosis. Antimicrob Agents Chemother 2018; 62:AAC.00270-18. [PMID: 29581111 DOI: 10.1128/aac.00270-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/15/2018] [Indexed: 11/20/2022] Open
Abstract
Our in vitro studies showed that a combination of amphotericin B and terbinafine had synergistic effects against the majority of melanized fungi associated with chromoblastomycosis (CBM) and similar infections, including those with Cladophialophora carrionii, Cladophialophora arxii, Exophialadermatitidis, Exophialaspinifera, Fonsecaea monophora, Fonsecaea nubica, Fonsecaea pedrosoi, and Phialophora verrucosa. This drug combination could provide an option for the treatment of severe or unresponsive cases of CBM, particularly in cases due to species of Fonsecaea and Cladophialophora.
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16
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Watanabe N, Gotoh A, Shirane S, Hamano Y, Hirai Y, Shimizu M, Nakamura A, Matsumoto K, Morita K, Mori T, Ohsaka A, Komatsu N. BreakthroughExophiala dermatitidisinfection during prophylactic administration of micafungin during second umbilical cord blood transplantation after graft failure. Transpl Infect Dis 2018; 20:e12833. [DOI: 10.1111/tid.12833] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/27/2017] [Accepted: 10/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Naoki Watanabe
- Division of Hematology; Department of Medicine; Juntendo University School of Medicine; Tokyo Japan
| | - Akihiko Gotoh
- Division of Hematology; Department of Medicine; Juntendo University School of Medicine; Tokyo Japan
| | - Shuichi Shirane
- Division of Hematology; Department of Medicine; Juntendo University School of Medicine; Tokyo Japan
| | - Yasuharu Hamano
- Division of Hematology; Department of Medicine; Juntendo University School of Medicine; Tokyo Japan
| | - Yuji Hirai
- Department of General Medicine; Faculty of Medicine; Juntendo University; Tokyo Japan
| | - Maika Shimizu
- Clinical Laboratory; Juntendo University Hospital; Tokyo Japan
| | - Ayako Nakamura
- Clinical Laboratory; Juntendo University Hospital; Tokyo Japan
| | - Kana Matsumoto
- Department of Clinical Pharmaceutics; Faculty of Pharmaceutical Sciences; Doshisha Women's College of Liberal Arts; Kyoto Japan
| | - Kunihiko Morita
- Department of Clinical Pharmaceutics; Faculty of Pharmaceutical Sciences; Doshisha Women's College of Liberal Arts; Kyoto Japan
| | - Takeshi Mori
- Division of Hematology; Department of Medicine; Juntendo University School of Medicine; Tokyo Japan
| | - Akimichi Ohsaka
- Department of Transfusion Medicine and Stem Cell Regulation; Juntendo University Graduate School of Medicine; Tokyo Japan
| | - Norio Komatsu
- Division of Hematology; Department of Medicine; Juntendo University School of Medicine; Tokyo Japan
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17
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Song Y, Laureijssen-van de Sande WWJ, Moreno LF, Gerrits van den Ende B, Li R, de Hoog S. Comparative Ecology of Capsular Exophiala Species Causing Disseminated Infection in Humans. Front Microbiol 2017; 8:2514. [PMID: 29312215 PMCID: PMC5742258 DOI: 10.3389/fmicb.2017.02514] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/04/2017] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Yinggai Song
- Department of Dermatology, Peking University First Hospital, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China.,Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | | | | | | | - Ruoyu Li
- Department of Dermatology, Peking University First Hospital, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China
| | - Sybren de Hoog
- Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands.,Center of Expertise in Mycology Radboudumc/CWZ, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
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18
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Abstract
Chromoblastomycosis (CBM), also known as chromomycosis, is one of the most prevalent implantation fungal infections, being the most common of the gamut of mycoses caused by melanized or brown-pigmented fungi. CBM is mainly a tropical or subtropical disease that may affect individuals with certain risk factors around the world. The following characteristics are associated with this disease: (i) traumatic inoculation by implantation from an environmental source, leading to an initial cutaneous lesion at the inoculation site; (ii) chronic and progressive cutaneous and subcutaneous tissular involvement associated with fibrotic and granulomatous reactions associated with microabscesses and often with tissue proliferation; (iii) a nonprotective T helper type 2 (Th2) immune response with ineffective humoral involvement; and (iv) the presence of muriform (sclerotic) cells embedded in the affected tissue. CBM lesions are clinically polymorphic and are commonly misdiagnosed as various other infectious and noninfectious diseases. In its more severe clinical forms, CBM may cause an incapacity for labor due to fibrotic sequelae and also due to a series of clinical complications, and if not recognized at an early stage, this disease can be refractory to antifungal therapy.
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19
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Queiroz-Telles F, Fahal AH, Falci DR, Caceres DH, Chiller T, Pasqualotto AC. Neglected endemic mycoses. THE LANCET. INFECTIOUS DISEASES 2017; 17:e367-e377. [PMID: 28774696 DOI: 10.1016/s1473-3099(17)30306-7] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/19/2016] [Accepted: 03/23/2017] [Indexed: 01/18/2023]
Abstract
Fungi often infect mammalian hosts via the respiratory route, but traumatic transcutaneous implantation is also an important source of infections. Environmental exposure to spores of pathogenic fungi can result in subclinical and unrecognised syndromes, allergic manifestations, and even overt disease. After traumatic cutaneous inoculation, several fungi can cause neglected mycoses such as sporotrichosis, chromoblastomycosis, mycetoma, entomophthoramycosis, and lacaziosis. Most of these diseases have a subacute to chronic course and they can become recalcitrant to therapy and lead to physical disabilities, including inability to work, physical deformities, and amputations. For many years, paracoccidioidomycosis was considered the most prevalent endemic systemic mycosis in the Americas, but this situation might be changing with recognition of the worldwide presence of Histoplasma capsulatum. Both paracoccidioidomycosis and histoplasmosis can mimic several infectious and non-infectious medical conditions and lead to death if not recognised early and treated. Cutaneous implantation and systemic mycoses are neglected diseases that affect millions of individuals worldwide, especially in low-income countries where their management is suboptimum because challenges in diagnosis and therapeutic options are substantial issues.
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Affiliation(s)
| | | | - Diego R Falci
- Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Centro Universitário La Salle, Canoas, Brazil
| | - Diego H Caceres
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alessandro C Pasqualotto
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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20
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Tanuskova D, Horakova J, Buzassyova D, Poczova M, Bodova I, Svec P, Chocholova A, Adamcakova J, Sykora T, Pozdechova M, Geczova L, Kolenova A. A case of Exophiala dermatitidis infection in a child after allogeneic stem cell transplantation: case report and literature review of paediatric cases. JMM Case Rep 2017; 4:e005102. [PMID: 29026629 PMCID: PMC5630971 DOI: 10.1099/jmmcr.0.005102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/31/2017] [Indexed: 01/20/2023] Open
Abstract
Introduction.Exophiala dermatitidisis a relatively common environmental black yeast with worldwide distribution and is a rare cause of fungal infection, mostly in patients with certain predisposing factors. Due to the rarity of the infection, little is known about the specific predisposing factors, way of infection or treatment. Case presentation. Here, we report what is to our knowledge the first case of E. dermatitidis infection in a child after allogeneic stem cell transplantation. We also review all paediatric cases reported in the literature since 1993. Conclusion. This is, to our knowledge, the first reported case of E. dermatitidis infection in a child after allogeneic stem cell transplantation. This report should increase the awareness of E. dermatitidis in immunocompromised paediatric patients, particularly after stem cell transplantation.
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Affiliation(s)
- Dominika Tanuskova
- Department of Paediatric Haematology and Oncology, Haematopoietic Stem Cell Transplantation Unit, Comenius University Children's Hospital, Bratislava, Slovakia
| | - Julia Horakova
- Department of Paediatric Haematology and Oncology, Haematopoietic Stem Cell Transplantation Unit, Comenius University Children's Hospital, Bratislava, Slovakia
| | - Darina Buzassyova
- Department of Paediatric Anaesthesiology and Intensive Medicine, Comenius University Children's Hospital, Bratislava, Slovakia
| | - Miroslava Poczova
- Department of Mycology, HPL Ltd, The Medirex Group, Bratislava, Slovakia
| | - Ivana Bodova
- Department of Paediatric Haematology and Oncology, Haematopoietic Stem Cell Transplantation Unit, Comenius University Children's Hospital, Bratislava, Slovakia
| | - Peter Svec
- Department of Paediatric Haematology and Oncology, Haematopoietic Stem Cell Transplantation Unit, Comenius University Children's Hospital, Bratislava, Slovakia
| | - Alica Chocholova
- Department of Paediatric Haematology and Oncology, Haematopoietic Stem Cell Transplantation Unit, Comenius University Children's Hospital, Bratislava, Slovakia
| | - Jaroslava Adamcakova
- Department of Paediatric Haematology and Oncology, Haematopoietic Stem Cell Transplantation Unit, Comenius University Children's Hospital, Bratislava, Slovakia
| | - Tomas Sykora
- Department of Paediatric Haematology and Oncology, Haematopoietic Stem Cell Transplantation Unit, Comenius University Children's Hospital, Bratislava, Slovakia
| | - Miroslava Pozdechova
- Department of Paediatric Haematology and Oncology, Haematopoietic Stem Cell Transplantation Unit, Comenius University Children's Hospital, Bratislava, Slovakia
| | - Lucia Geczova
- Department of Paediatric Haematology and Oncology, Haematopoietic Stem Cell Transplantation Unit, Comenius University Children's Hospital, Bratislava, Slovakia
| | - Alexandra Kolenova
- Department of Paediatric Haematology and Oncology, Haematopoietic Stem Cell Transplantation Unit, Comenius University Children's Hospital, Bratislava, Slovakia
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21
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Ecology of the Human Opportunistic Black Yeast Exophiala dermatitidis Indicates Preference for Human-Made Habitats. Mycopathologia 2017; 183:201-212. [PMID: 28447292 DOI: 10.1007/s11046-017-0134-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/13/2017] [Indexed: 01/01/2023]
Abstract
Exophiala dermatitidis is an ascomycetous black yeast from the order Chaetothyriales. Its growth characteristics include the polymorphic life cycle, ability to grow at high and low temperatures, at a wide pH range, survival at high concentrations of NaCl, and survival at high UV and radioactive radiation. Exophiala dermatitidis causes deep or localized phaeohyphomycosis in immuno-compromised people worldwide and is regularly encountered in the lungs of cystic fibrosis patients. Regardless of numerous ecological studies worldwide, little is known about its natural habitat or the possible infection routes. The present review summarizes the published data on its frequency of occurrence in nature and in man-made habitats. We additionally confirmed its presence with culture-depending methods from a variety of habitats, such as glacial meltwater, mineral water, mineral-rich salt-pan mud, dishwashers, kitchens and different environments polluted with aromatic hydrocarbons. In conclusion, the frequency of its recovery was the highest in man-made indoor habitats, connected to water sources, and exposed to occasional high temperatures and oxidative stress.
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22
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Exophiala (Wangiella) dermatitidis Prosthetic Aortic Valve Endocarditis and Prosthetic Graft Infection in an Immune Competent Patient. Case Rep Infect Dis 2017; 2017:4839314. [PMID: 28484654 PMCID: PMC5412134 DOI: 10.1155/2017/4839314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/02/2017] [Accepted: 03/21/2017] [Indexed: 01/14/2023] Open
Abstract
Exophiala (Wangiella) dermatitidis is an emerging dematiaceous fungus associated with high mortality rates and is a rare cause of endocarditis. We describe the first case of E. dermatitidis endocarditis of a prosthetic aortic valve and aortic graft in an immune competent patient with no clear risk factors of hematological acquisition.
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23
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Poyntner C, Blasi B, Arcalis E, Mirastschijski U, Sterflinger K, Tafer H. The Transcriptome of Exophiala dermatitidis during Ex-vivo Skin Model Infection. Front Cell Infect Microbiol 2016; 6:136. [PMID: 27822460 PMCID: PMC5075926 DOI: 10.3389/fcimb.2016.00136] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/06/2016] [Indexed: 12/12/2022] Open
Abstract
The black yeast Exophiala dermatitidis is a widespread polyextremophile and human pathogen, that is found in extreme natural habitats and man-made environments such as dishwashers. It can cause various diseases ranging from phaeohyphomycosis and systemic infections, with fatality rates reaching 40%. While the number of cases in immunocompromised patients are increasing, knowledge of the infections, virulence factors and host response is still scarce. In this study, for the first time, an artificial infection of an ex-vivo skin model with Exophiala dermatitidis was monitored microscopically and transcriptomically. Results show that Exophiala dermatitidis is able to actively grow and penetrate the skin. The analysis of the genomic and RNA-sequencing data delivers a rich and complex transcriptome where circular RNAs, fusion transcripts, long non-coding RNAs and antisense transcripts are found. Changes in transcription strongly affect pathways related to nutrients acquisition, energy metabolism, cell wall, morphological switch, and known virulence factors. The L-Tyrosine melanin pathway is specifically upregulated during infection. Moreover the production of secondary metabolites, especially alkaloids, is increased. Our study is the first that gives an insight into the complexity of the transcriptome of Exophiala dermatitidis during artificial skin infections and reveals new virulence factors.
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Affiliation(s)
- Caroline Poyntner
- Department of Biotechnology, VIBT EQ Extremophile Center, University of Natural Resources and Life Sciences Vienna, Austria
| | - Barbara Blasi
- Department of Biotechnology, VIBT EQ Extremophile Center, University of Natural Resources and Life Sciences Vienna, Austria
| | - Elsa Arcalis
- Department for Applied Genetics and Cell Biology, Molecular Plant Physiology and Crop Biotechnology, University of Natural Resources and Life Sciences Vienna, Austria
| | - Ursula Mirastschijski
- Klinikum Bremen-Mitte, Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Biology and Chemistry, Center for Biomolecular Interactions Bremen, University Bremen Bremen, Germany
| | - Katja Sterflinger
- Department of Biotechnology, VIBT EQ Extremophile Center, University of Natural Resources and Life Sciences Vienna, Austria
| | - Hakim Tafer
- Department of Biotechnology, VIBT EQ Extremophile Center, University of Natural Resources and Life Sciences Vienna, Austria
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Abstract
ABSTRACT
Filamentous mycoses are often associated with significant morbidity and mortality. Prompt diagnosis and aggressive treatment are essential for good clinical outcomes in immunocompromised patients. The host immune response plays an essential role in determining the course of exposure to potential fungal pathogens. Depending on the effectiveness of immune response and the burden of organism exposure, fungi can either be cleared or infection can occur and progress to a potentially fatal invasive disease. Nonspecific cellular immunity (i.e., neutrophils, natural killer [NK] cells, and macrophages) combined with T-cell responses are the main immunologic mechanisms of protection. The most common potential mold pathogens include certain hyaline hyphomycetes, endemic fungi, the
Mucorales
, and some dematiaceous fungi. Laboratory diagnostics aimed at detecting and differentiating these organisms are crucial to helping clinicians make informed decisions about treatment. The purpose of this chapter is to provide an overview of the medically important fungal pathogens, as well as to discuss the patient characteristics, antifungal-therapy considerations, and laboratory tests used in current clinical practice for the immunocompromised host.
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Abstract
Chromoblastomycosis (CMB) is a chronic fungal infection of the skin and the
subcutaneous tissue caused by a transcutaneous traumatic inoculation of a specific
group of dematiaceous fungi occurring mainly in tropical and subtropical zones
worldwide. If not diagnosed at early stages, patients with CBM require long term
therapy with systemic antifungals, sometimes associated with physical methods. Unlike
other neglected endemic mycoses, comparative clinical trials have not been performed
for this disease. Nowadays, therapy is based on a few open trials and on expert
opinion. Itraconazole either as monotherapy or associated with other drugs, or with
physical methods, is widely used. Recently, photodynamic therapy has been
successfully employed in combination with antifungals in patients presenting with
CBM. In the present revision the most used therapeutic options against CBM are
reviewed as well as the several factors that may have impact on the patient's
outcome.
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Affiliation(s)
- Flavio Queiroz-Telles
- Departamento de Saúde Pública, Universidade Federal do Paraná, Curitiba, PR, Brasil,
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26
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Combination of Amphotericin B and Flucytosine against Neurotropic Species of Melanized Fungi Causing Primary Cerebral Phaeohyphomycosis. Antimicrob Agents Chemother 2016; 60:2346-51. [PMID: 26833164 DOI: 10.1128/aac.02526-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/28/2016] [Indexed: 01/13/2023] Open
Abstract
Primary central nervous system phaeohyphomycosis is a fatal fungal infection due mainly to the neurotropic melanized fungiCladophialophora bantiana,Rhinocladiella mackenziei, andExophiala dermatitidis.Despite the combination of surgery with antifungal treatment, the prognosis continues to be poor, with mortality rates ranging from 50 to 70%. Therefore, a search for a more-appropriate therapeutic approach is urgently needed. Ourin vitrostudies showed that with the combination of amphotericin B and flucytosine against these species, the median fractional inhibitory concentration (FIC) indices for strains ranged from 0.25 to 0.38, indicating synergy. By use of Bliss independence analysis, a significant degree of synergy was confirmed for all strains, with the sum ΔE ranging from 90.2 to 698.61%. No antagonism was observed. These results indicate that amphotericin B, in combination with flucytosine, may have a role in the treatment of primary cerebral infections caused by melanized fungi belonging to the orderChaetothyriales Furtherin vivostudies and clinical investigations to elucidate and confirm these observations are warranted.
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Zupančič J, Novak Babič M, Zalar P, Gunde-Cimerman N. The Black Yeast Exophiala dermatitidis and Other Selected Opportunistic Human Fungal Pathogens Spread from Dishwashers to Kitchens. PLoS One 2016; 11:e0148166. [PMID: 26867131 PMCID: PMC4750988 DOI: 10.1371/journal.pone.0148166] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 01/13/2016] [Indexed: 12/19/2022] Open
Abstract
We investigated the diversity and distribution of fungi in nine different sites inside 30 residential dishwashers. In total, 503 fungal strains were isolated, which belong to 10 genera and 84 species. Irrespective of the sampled site, 83% of the dishwashers were positive for fungi. The most frequent opportunistic pathogenic species were Exophiala dermatitidis, Candida parapsilosis sensu stricto, Exophiala phaeomuriformis, Fusarium dimerum, and the Saprochaete/Magnusiomyces clade. The black yeast E. dermatitidis was detected in 47% of the dishwashers, primarily at the dishwasher rubber seals, at up to 106 CFU/cm2; the other fungi detected were in the range of 102 to 105 CFU/cm2. The other most heavily contaminated dishwasher sites were side nozzles, doors and drains. Only F. dimerum was isolated from washed dishes, while dishwasher waste water contained E. dermatitidis, Exophiala oligosperma and Sarocladium killiense. Plumbing systems supplying water to household appliances represent the most probable route for contamination of dishwashers, as the fungi that represented the core dishwasher mycobiota were also detected in the tap water. Hot aerosols from dishwashers contained the human opportunistic yeast C. parapsilosis, Rhodotorula mucilaginosa and E. dermatitidis (as well as common air-borne genera such as Aspergillus, Penicillium, Trichoderma and Cladosporium). Comparison of fungal contamination of kitchens without and with dishwashers revealed that virtually all were contaminated with fungi. In both cases, the most contaminated sites were the kitchen drain and the dish drying rack. The most important difference was higher prevalence of black yeasts (E. dermatitidis in particular) in kitchens with dishwashers. In kitchens without dishwashers, C. parapsilosis strongly prevailed with negligible occurrence of E. dermatitidis. F. dimerum was isolated only from kitchens with dishwashers, while Saprochaete/Magnusiomyces isolates were only found within dishwashers. We conclude that dishwashers represent a reservoir of enriched opportunistic pathogenic species that can spread from the dishwasher into the indoor biome.
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Affiliation(s)
- Jerneja Zupančič
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Monika Novak Babič
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Polona Zalar
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Nina Gunde-Cimerman
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Centre of Excellence for Integrated Approaches in Chemistry and Biology of Proteins (CIPKeBiP), Ljubljana, Slovenia
- * E-mail:
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Vijayakumar R, Saleh Al-Aboody M, Sandle T. A review of melanized (black) fungal contamination in pharmaceutical products-incidence, drug recall and control measures. J Appl Microbiol 2016; 120:831-41. [DOI: 10.1111/jam.12888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 12/17/2022]
Affiliation(s)
- R. Vijayakumar
- Department of Medical Laboratory; College of Science AlZulfi; Majmaah University; AlZulfi Saudi Arabia
| | - M. Saleh Al-Aboody
- Department of Medical Laboratory; College of Science AlZulfi; Majmaah University; AlZulfi Saudi Arabia
| | - T. Sandle
- Microbiology; Bio Products Laboratory; Elstree Hertfordshire UK
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29
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Deng S, Tsui CKM, Gerrits van den Ende AHG, Yang L, Najafzadeh MJ, Badali H, Li R, Hagen F, Meis JF, Sun J, Dolatabadi S, Papierok B, Pan W, de Hoog GS, Liao W. Global Spread of Human Chromoblastomycosis Is Driven by Recombinant Cladophialophora carrionii and Predominantly Clonal Fonsecaea Species. PLoS Negl Trop Dis 2015; 9:e0004004. [PMID: 26496430 PMCID: PMC4619687 DOI: 10.1371/journal.pntd.0004004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/22/2015] [Indexed: 12/20/2022] Open
Abstract
Global distribution patterns of Cladophialophora carrionii, agent of human chromoblastomycosis in arid climates of Africa, Asia, Australia, Central-and South-America, were compared with similar data of the vicarious Fonsecaea spp., agents of the disease in tropical rain forests. Population diversities among 73 C. carrionii strains and 60 strains of three Fonsecaea species were analyzed for rDNA ITS, partial β-tubulin, and amplified fragment-length polymorphism (AFLP) fingerprints. Populations differed significantly between continents. Lowest haplotype diversity was found in South American populations, while African strains were the most diverse. Gene flow was noted between the African population and all other continents. The general pattern of Fonsecaea agents of chromoblastomycosis differed significantly from that of C. carrionii and revealed deeper divergence among three differentiated species with smaller numbers of haplotypes, indicating a longer evolutionary history.
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Affiliation(s)
- Shuwen Deng
- Shanghai Institute of Medical Mycology, Changzheng Hospital, Shanghai, China
- First Hospital of Xinjiang Medical University, Xinjiang, China
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Clement K. M. Tsui
- British Columbia Public Health Microbiology & Reference Laboratory at BCCDC site, Provincial Health Services Authority, Vancouver, Canada
| | | | - Liyue Yang
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Mohammad Javad Najafzadeh
- Department of Parasitology and Mycology & Cancer Molecular Pathology Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Badali
- Department of Medical Mycology and Parasitology / Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ruoyu Li
- Research Center for Medical Mycology, Beijing Medical University, Beijing, China
| | - Ferry Hagen
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jacques F. Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jiufeng Sun
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Somayeh Dolatabadi
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Weihua Pan
- Shanghai Institute of Medical Mycology, Changzheng Hospital, Shanghai, China
| | - G. S. de Hoog
- Shanghai Institute of Medical Mycology, Changzheng Hospital, Shanghai, China
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Research Center for Medical Mycology, Beijing Medical University, Beijing, China
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
- King Abdulaziz University, Jeddah, Saudi Arabia
- * E-mail: (GSdH); (WL)
| | - Wanqing Liao
- Shanghai Institute of Medical Mycology, Changzheng Hospital, Shanghai, China
- * E-mail: (GSdH); (WL)
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30
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Black yeasts and their filamentous relatives: principles of pathogenesis and host defense. Clin Microbiol Rev 2015; 27:527-42. [PMID: 24982320 DOI: 10.1128/cmr.00093-13] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Among the melanized fungi, the so-called "black yeasts" and their filamentous relatives are particularly significant as agents of severe phaeohyphomycosis, chromoblastomycosis, and mycetoma in humans and animals. The pathogenicity and virulence of these fungi may differ significantly between closely related species. The factors which probably are of significance for pathogenicity include the presence of melanin and carotene, formation of thick cell walls and meristematic growth, presence of yeast-like phases, thermo- and perhaps also osmotolerance, adhesion, hydrophobicity, assimilation of aromatic hydrocarbons, and production of siderophores. Host defense has been shown to rely mainly on the ingestion and elimination of fungal cells by cells of the innate immune system, especially neutrophils and macrophages. However, there is increasing evidence supporting a role of T-cell-mediated immune responses, with increased interleukin-10 (IL-10) and low levels of gamma interferon (IFN-γ) being deleterious during the infection. There are no standardized therapies for treatment. It is therefore important to obtain in vitro susceptibilities of individual patients' fungal isolates in order to provide useful information for selection of appropriate treatment protocols. This article discusses the pathogenesis and host defense factors for these fungi and their severity, chronicity, and subsequent impact on treatment and prevention of diseases in human or animal hosts.
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31
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Castro LGM, de Andrade TS. Chromoblastomycosis: still a therapeutic challenge. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.10.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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32
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Challenges in the therapy of chromoblastomycosis. Mycopathologia 2013; 175:477-88. [PMID: 23636730 DOI: 10.1007/s11046-013-9648-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
Abstract
Chromoblastomycosis (CBM) is an implantation mycosis mainly occurring in tropical and subtropical zones worldwide. If not diagnosed at early stages, patients with CBM require long-term therapy with systemic antifungals flanked by various physical treatment regimens. As in other neglected endemic mycoses, comparative clinical trials have not been performed for this disease; nowadays, therapy is mainly based on a few open trials and on expert opinions. Itraconazole, either as monotherapy or associated with other drugs, or with physical methods, is widely used. Recently, photodynamic therapy has been employed successfully in combination with antifungals in patients presenting with CBM. In the present paper, the most used therapeutic options against CBM are reviewed as well as the several factors that may have impact on the patient's outcome.
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Döğen A, Kaplan E, Oksüz Z, Serin MS, Ilkit M, de Hoog GS. Dishwashers are a major source of human opportunistic yeast-like fungi in indoor environments in Mersin, Turkey. Med Mycol 2012; 51:493-8. [PMID: 23167707 DOI: 10.3109/13693786.2012.738313] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The natural habitat of opportunistic fungal pathogens is outside of the host; therefore, it is crucial to understand their ecology and routes of transmission. In this study, we investigated the presence of black and filamentous fungi in moist indoor environments in the city of Mersin in subtropical Turkey. In total, 177 private dwellings were screened and 893 samples obtained using cotton swabs and moistened with physiological saline from dishwashers, washing machines, refrigerators, bath-tubs, bathroom walls, and shower heads. These were then inoculated onto malt extract agar supplemented with chloramphenicol, followed by incubation at 37°C. Thirty samples (3.4%) were positive for fungi, which were then identified by sequencing the rDNA internal transcribed spacer region. Exophiala dermatitidis was the most common species (23), followed by E. phaeomuriformis (three), Magnusiomyces capitatus (two), and Candida parapsilosis (two). Genotype A of E. dermatitidis (14) was more prevalent than genotypes B (eight) and C (one) and E. phaeomuriformis was also represented by two genotypes. Our findings suggest that dishwashers are a major indoor niche for thermophilic black yeasts. The occurrence of the opportunistic filamentous fungus M. capitatus in dishwashers is consistent with a recent report.
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Affiliation(s)
- Aylin Döğen
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Mersin University, Mersin, Turkey
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34
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Suzuki K, Nakamura A, Fujieda A, Nakase K, Katayama N. Pulmonary infection caused by Exophiala dermatitidis in a patient with multiple myeloma: A case report and a review of the literature. Med Mycol Case Rep 2012; 1:95-8. [PMID: 24371750 DOI: 10.1016/j.mmcr.2012.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 10/09/2012] [Accepted: 10/09/2012] [Indexed: 10/27/2022] Open
Abstract
Exophiala dermatitidis is a dematiaceous fungus that is increasingly being identified as a cause of fungal infection especially in patients with immunodeficiency. To date, however, the factors predisposing E. dermatitidis and its optimal treatments have not been fully addressed. Here, we report the first patient with untreated multiple myeloma who developed E. dermatitidis pulmonary infection. We also review recent clinical reports describing the features of E. dermatitidis infection.
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Affiliation(s)
- Kei Suzuki
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Akiko Nakamura
- Central Clinical Laboratories, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Atsushi Fujieda
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Kazunori Nakase
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Naoyuki Katayama
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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35
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Queiroz-Telles F, Santos DWCL. Chromoblastomycosis in the Clinical Practice. CURRENT FUNGAL INFECTION REPORTS 2012. [DOI: 10.1007/s12281-012-0116-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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36
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Patel AK, Patel KK, Darji P, Singh R, Shivaprakash MR, Chakrabarti A. Exophiala dermatitidisendocarditis on native aortic valve in a postrenal transplant patient and review of literature onE. dermatitidisinfections. Mycoses 2012; 56:365-72. [DOI: 10.1111/myc.12009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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37
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38
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39
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Packeu A, Lebecque P, Rodriguez-Villalobos H, Boeras A, Hendrickx M, Bouchara JP, Symoens F. Molecular typing and antifungal susceptibility of Exophiala isolates from patients with cystic fibrosis. J Med Microbiol 2012; 61:1226-1233. [PMID: 22580912 DOI: 10.1099/jmm.0.042317-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The black yeast Exophiala dermatitidis is a frequent agent of colonization of the lungs of patients with cystic fibrosis (CF). A total of 71 clinical isolates of Exophiala from 13 patients were identified at the species level by sequencing the internal transcribed spacer (ITS) regions 1 and 2 of the rDNA genes and typed by random amplification of polymorphic DNA (RAPD), using two different primers, BG-2 and ERIC-1. In vitro susceptibility of these isolates to some systemic antifungal drugs was investigated using the CLSI method. Almost all the isolates were identified as E. dermatitidis, but long-term colonization with the closely related species E. phaeomuriformis was observed in one patient. No clustering was found according to the geographical origin of the isolates, the isolation date or the antifungal susceptibility. Variations were seen in the susceptibility of studied isolates to antifungals but most of them exhibited low susceptibility to amphotericin B and although some patients were successively colonized by two distinct genotypes, most of the isolates were distributed in patient-specific clusters. This phenomenon may be due to genomic variations of E. dermatitidis in the lung environment of CF patients. These results are typical of colonization of the airways of patients by a poorly distributed environmental fungus, which occupies particular reservoirs that need to be defined.
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Affiliation(s)
- Ann Packeu
- Scientific Institute of Public Health, Service of Mycology and Aerobiology, Brussels, Belgium
| | - Patrick Lebecque
- Department of Pediatrics, Cliniques Universitaires St Luc, Brussels, Belgium
| | | | - Anca Boeras
- Department of Microbiology, Cliniques Universitaires St Luc, Brussels, Belgium
| | - Marijke Hendrickx
- Scientific Institute of Public Health, Service of Mycology and Aerobiology, Brussels, Belgium
| | - Jean-Philippe Bouchara
- Groupe d'Etude des Interactions Hôte-Pathogène, UPRES-EA 3142, Angers University, Angers, France.,Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Françoise Symoens
- Scientific Institute of Public Health, Service of Mycology and Aerobiology, Brussels, Belgium
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40
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Use of ribosomal introns as new markers of genetic diversity in Exophiala dermatitidis. Fungal Biol 2011; 115:1038-50. [DOI: 10.1016/j.funbio.2011.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 05/06/2011] [Accepted: 05/09/2011] [Indexed: 11/21/2022]
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41
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Deng S, van den Ende AHGG, Ram AFJ, Arentshorst M, Gräser Y, Hu H, de Hoog GS. Evolution of CDC42, a putative virulence factor triggering meristematic growth in black yeasts. Stud Mycol 2011; 61:121-9. [PMID: 19287534 PMCID: PMC2610298 DOI: 10.3114/sim.2008.61.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The cell division cycle gene (CDC42) controlling cellular
polarization was studied in members of Chaetothyriales. Based on
ribosomal genes, ancestral members of the order exhibit meristematic growth in
view of their colonization of inert surfaces such as rock, whereas in derived
members of the order the gene is a putative virulence factor involved in
expression of the muriform cell, the invasive phase in human
chromoblastomycosis. Specific primers were developed to amplify a portion of
the gene of 32 members of the order with known position according to ribosomal
phylogeny. Phylogeny of CDC42 proved to be very different. In all
members of Chaetohyriales the protein sequence is highly conserved.
In most species, distributed all over the phylogenetic tree, introns and
3rd codon positions are also invariant. However, a number of
species had paralogues with considerable deviation in non-coding exon
positions, and synchronous variation in introns, although non-synonomous
variation had remained very limited. In some strains both orthologues and
paralogues were present. It is concluded that CDC42 does not show any
orthologous evolution, and that its paralogues haves the same function but are
structurally relaxed. The variation or absence thereof could not be linked to
ecological changes, from rock-inhabiting to pathogenic life style. It is
concluded that eventual pathogenicity in Chaetothyriales is not
expressed at the DNA level in CDC42 evolution.
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Affiliation(s)
- S Deng
- Department of Dermatology, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang, China
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42
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Selbmann L, de Hoog GS, Zucconi L, Isola D, Ruisi S, van den Ende AHGG, Ruibal C, De Leo F, Urzì C, Onofri S. Drought meets acid: three new genera in a dothidealean clade of extremotolerant fungi. Stud Mycol 2011; 61:1-20. [PMID: 19287523 PMCID: PMC2610311 DOI: 10.3114/sim.2008.61.01] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Fungal strains isolated from rocks and lichens collected in the Antarctic ice-free area of the Victoria Land, one of the coldest and driest habitats on earth, were found in two phylogenetically isolated positions within the subclass Dothideomycetidae. They are here reported as new genera and species, Recurvomyces mirabilisgen. nov., sp. nov. and Elasticomyces elasticusgen. nov., sp. nov. The nearest neighbours within the clades were other rock-inhabiting fungi from dry environments, either cold or hot. Plant-associated Mycosphaerella-like species, known as invaders of leathery leaves in semi-arid climates, are also phylogenetically related with the new taxa. The clusters are also related to the halophilic species Hortaea werneckii, as well as to acidophilic fungi. One of the latter, able to grow at pH 0, is Scytalidium acidophilum, which is ascribed here to the newly validated genus Acidomyces. The ecological implications of this finding are discussed.
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Affiliation(s)
- L Selbmann
- DECOS, Università degli Studi della Tuscia, Largo dell'Università, Viterbo, Italy
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43
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Al-Tawfiq JA, Boukhamseen A. Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei (formerly Ramichloridium mackenziei): Case presentation and literature review. J Infect Public Health 2011; 4:96-102. [DOI: 10.1016/j.jiph.2011.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 01/10/2011] [Accepted: 01/16/2011] [Indexed: 10/18/2022] Open
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Dairi T, Kuzuyama T, Nishiyama M, Fujii I. Convergent strategies in biosynthesis. Nat Prod Rep 2011; 28:1054-86. [PMID: 21547300 DOI: 10.1039/c0np00047g] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This review article focuses on how nature sometimes solves the same problem in the biosynthesis of small molecules but using very different approaches. Four examples, involving isopentenyl diphosphate, menaquinone, lysine, and aromatic polyketides, are highlighted that represent different strategies in convergent metabolism.
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Affiliation(s)
- Tohru Dairi
- Faculty of Engineering and Graduate School of Engineering, Hokkaido University, Sapporo 060-8628, Japan.
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45
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Calvo E, Rodríguez MM, Mariné M, Mayayo E, Pastor FJ, Guarro J. Comparative virulence of three species of Exophiala in mice. Med Mycol 2010; 48:853-7. [PMID: 20144129 DOI: 10.3109/13693780903582481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The virulence of Exophiala dermatitidis, E. oligosperma and E. xenobiotica, three of the most common members of the genus that cause human infections, was evaluated using experimental models of disseminated infection in immunocompromised mice. Exophiala dermatitidis, and to a lesser extent E. oligosperma, were the two species causing the highest mortality, while mice infected with E. xenobiotica had the lowest mortality. Tissue burden and histopathology studies demonstrated the neurotropism of E. dermatitidis, while E. oligosperma and E. xenobiotica had a limited capacity for invading brain tissue. These models could be useful for testing new therapies against Exophiala infections.
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Affiliation(s)
- Enrique Calvo
- Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, IISPV, Universitat Rovira i Virgili, Carrer Sant Llorenç 21, Reus, Spain
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46
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Griffard EA, Guajardo JR, Cooperstock MS, Scoville CL. Isolation of Exophiala dermatitidis from pigmented sputum in a cystic fibrosis patient. Pediatr Pulmonol 2010; 45:508-10. [PMID: 20425860 DOI: 10.1002/ppul.21187] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 16-year-old female with cystic fibrosis (CF) presented with an acute respiratory exacerbation during which black flecks were observed in the spontaneously expectorated sputum. The production of this pigmented sputum was subsequently attributed to Exophiala dermatitidis hyphae. Treatment with antibiotics, corticosteroids, and antifungal medications led to an initial resolution of symptoms and clearance of the black pigment from her sputum. However, the patient again presented nine months later with reappearance of the pigmented flecks and concomitant clinical deterioration and was subsequently treated with an extended course of voriconazole. To the authors' knowledge, this is the first case report of fungal colonization by E. dermatitidis presenting as black flecks spontaneously expectorated in CF sputum.
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47
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Li DM, Li RY, de Hoog GS, Sudhadham M, Wang DL. Fatal Exophiala infections in China, with a report of seven cases. Mycoses 2010; 54:e136-42. [DOI: 10.1111/j.1439-0507.2010.01859.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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48
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Alabaz D, Kibar F, Arikan S, Sancak B, Celik U, Aksaray N, Turgut M. Systemic phaeohyphomycosis due to Exophiala (Wangiella) in an immunocompetent child. Med Mycol 2010; 47:653-7. [PMID: 19184769 DOI: 10.1080/13693780802715815] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
We report a rare case of systemic lymphadenitis and hepatic involvement due to Exophiala (Wangiella) dermatitidis in a pediatric patient. An 8-year-old immunocompetent boy with chronic fever was examined through the use of sonography and CT scan which demonstrated cervical and mesenteric lymph node enlargement and numerous small hepatic lesions. The etiologic agent was isolated by means of lymph node aspiration. The fungus was identified by its morphological characteristics and through DNA sequencing of the internal transcribed spacer region of rDNA. Despite initial amphotericin B and voriconazole therapy, the child's jaundice subsided and he died 7 months later. In addition to pathogenic aspects of Exophiala dermatitidis, the diagnostic approaches and relevant therapeutic strategies are discussed.
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Affiliation(s)
- Derya Alabaz
- Pediatric Infectious Diseases Department, Cukurova University, Adana, Turkey.
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Sudhadham M, de Hoog GS, Menken SBJ, Gerrits van den Ende AHG, Sihanonth P. Rapid screening for genotypes as possible markers of virulence in the neurotropic black yeast Exophiala dermatitidis using PCR-RFLP. J Microbiol Methods 2009; 80:138-42. [PMID: 19961882 DOI: 10.1016/j.mimet.2009.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 11/04/2009] [Accepted: 11/24/2009] [Indexed: 11/18/2022]
Abstract
A simple method for fungal genotype screening was developed for the black yeast Exophiala dermatitidis based on RFLP of ribosomal ITS regions currently used as potential virulence markers. In a study set of 502 strains of the species, two main genotypes were recognized. Only 0.97% of lanes were difficult to interpret as they did not clearly present one of the expected genotypes. Twenty strains were deviating and proved to be E. spinifera after sequencing. Eight common, related species (based on SSU data) with clinical significance yielded different patterns with TaqI digestion, and thus the method is also usable for routine diagnostics.
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Affiliation(s)
- M Sudhadham
- Centraalbureau voor Schimmelcultures Fungal Biodiversity Centre, Utrecht, The Netherlands
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Isolation and Antifungal Susceptibility of Exophiala dermatitidis Isolates from Human Stool Samples in Nigeria. Mycopathologia 2009; 169:201-6. [DOI: 10.1007/s11046-009-9244-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 08/11/2009] [Indexed: 10/20/2022]
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