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Gupta S, Srivastava A, Vyas N, Kaur H, Sharma BS, Rudramurthy SM. Fungal thalamic abscess caused by Rhinocladiella mackenziei in an immunocompetent patient. Indian J Med Microbiol 2024; 49:100605. [PMID: 38734140 DOI: 10.1016/j.ijmmb.2024.100605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/06/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
Cerebral phaeohyphomycosis (CP) stands as an exceedingly uncommon yet severe type of fungal infection affecting the central nervous system, attributable to dematiaceous fungi. Despite the patient's immune status, CP is associated with grave prognosis. In the present study, authors describe the first case of left thalamic fungal abscess due to Rhinocladiella mackenziei in an immunocompetent 39-year-old male patient in Jaipur, Rajasthan. Early diagnosis by direct microscopy of aspirated pus and extensive management with surgical excision and prolonged antifungal coverage showed favourable outcome. The present case is one of the few cases documented globally who has survived.
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Affiliation(s)
- Shilpi Gupta
- Microbiology, Mahatma Gandhi Medical College and Hospital, Jaipur, India.
| | - Anurag Srivastava
- Neurosurgery, Mahatma Gandhi Medical College and Hospital, Jaipur, India.
| | - Nitya Vyas
- Microbiology, Mahatma Gandhi Medical College and Hospital, Jaipur, India.
| | - Harsimran Kaur
- Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - B S Sharma
- Neurosurgery, Mahatma Gandhi Medical College and Hospital, Jaipur, India.
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Khandhar AV, Warade A, Agrawal U, Shetty A, Sunavala A, Desai K. Post covid cerebral phaeohyphomycosis by Rhinocladiella mackenziei: An unusual association. Indian J Med Microbiol 2023; 46:100430. [PMID: 37945123 DOI: 10.1016/j.ijmmb.2023.100430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/04/2023] [Accepted: 07/15/2023] [Indexed: 11/12/2023]
Abstract
Cerebral phaeohyphomycosis (CP) is a rare but a highly morbid fungal infection of the central nervous system caused by the fungi belonging to the order Chaetothyriales, which includes Cladophialophora bantiana, Exophiala dermatitidis, Rhinocladiella mackenziei (RM) etc. This disease is associated with poor clinical outcomes, with reported mortality of over 80%. We present the case of a 65-year gentleman who developed CP secondary to RM infection following COVID-19 and the associated challenges in his medical and surgical management.
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Affiliation(s)
- Alay V Khandhar
- P.D. Hinduja National Hospital and Research Center, Mumbai, India; Department of Neurosurgery and Gamma Knife Radiosurgery, P.D. Hinduja National Hospital and Research Center, Mumbai, 400016, India.
| | - Abhijit Warade
- P.D. Hinduja National Hospital and Research Center, Mumbai, India; Department of Neurosurgery and Gamma Knife Radiosurgery, P.D. Hinduja National Hospital and Research Center, Mumbai, 400016, India.
| | - Umang Agrawal
- P.D. Hinduja National Hospital and Research Center, Mumbai, India; Department of Infectious Diseases, P.D. Hinduja National Hospital and Research Center, Mumbai, 400016, India.
| | - Anjali Shetty
- P.D. Hinduja National Hospital and Research Center, Mumbai, India; Department of Laboratory Medicine, P.D. Hinduja National Hospital and Research Center, Mumbai, 400016, India.
| | - Ayesha Sunavala
- P.D. Hinduja National Hospital and Research Center, Mumbai, India; Department of Infectious Diseases, P.D. Hinduja National Hospital and Research Center, Mumbai, 400016, India.
| | - Ketan Desai
- P.D. Hinduja National Hospital and Research Center, Mumbai, India; Department of Neurosurgery and Gamma Knife Radiosurgery, P.D. Hinduja National Hospital and Research Center, Mumbai, 400016, India.
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Mody P, Wada P, Bloch KC, Lionakis MS, White KD, Maris AS, Snyder T, Steinhauer J, Humphries R. Gram stain to the rescue: a case report of cerebral phaeohyphomycosis by Cladophialophora bantiana in an immunocompetent 24-year-old. BMC Infect Dis 2022; 22:13. [PMID: 34983414 PMCID: PMC8725554 DOI: 10.1186/s12879-021-07008-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/22/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Fungal brain abscesses in immunocompetent patients are exceedingly rare. Cladophialophora bantiana is the most common cause of cerebral phaeohyphomycosis, a dematiaceous mold. Radiological presentation can mimic other disease states, with diagnosis through surgical aspiration and growth of melanized fungi in culture. Exposure is often unknown, with delayed presentation and diagnosis. CASE PRESENTATION We present a case of cerebral phaeohyphomycosis in a 24-year-old with no underlying conditions or risk factors for disease. He developed upper respiratory symptoms, fevers, and headaches over the course of 2 months. On admission, he underwent brain MRI which demonstrated three parietotemporal rim-enhancing lesions. Stereotactic aspiration revealed a dematiaceous mold on staining and the patient was treated with liposomal amphotericin B, 5-flucytosine, and posaconazole prior to culture confirmation. He ultimately required surgical excision of the brain abscesses and prolonged course of antifungal therapy, with clinical improvement. CONCLUSIONS Culture remains the gold standard for diagnosis of infection. Distinct microbiologic findings can aid in identification and guide antimicrobial therapy. While little guidance exists on treatment, patients have had favorable outcomes with surgery and combination antifungal therapy. In improving awareness, clinicians may accurately diagnose disease and initiate appropriate therapy in a more timely manner.
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Affiliation(s)
- Perceus Mody
- Department of Pathology, Immunology and Microbiology, Vanderbilt University Medical Center, 1301 Medical Center Dr., TVC 4524, Nashville, TN, 37232, USA.
| | - Paul Wada
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karen C Bloch
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michail S Lionakis
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Annapolis, MD, USA.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Annapolis, MD, USA
| | - Katie D White
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander S Maris
- Department of Pathology, Immunology and Microbiology, Vanderbilt University Medical Center, 1301 Medical Center Dr., TVC 4524, Nashville, TN, 37232, USA
| | - Tonya Snyder
- Department of Pathology, Immunology and Microbiology, Vanderbilt University Medical Center, 1301 Medical Center Dr., TVC 4524, Nashville, TN, 37232, USA
| | - Jennifer Steinhauer
- Department of Pathology, Immunology and Microbiology, Vanderbilt University Medical Center, 1301 Medical Center Dr., TVC 4524, Nashville, TN, 37232, USA
| | - Romney Humphries
- Department of Pathology, Immunology and Microbiology, Vanderbilt University Medical Center, 1301 Medical Center Dr., TVC 4524, Nashville, TN, 37232, USA
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Lai SHY, Duque JSR, Chung BHY, Chung TWH, Leung D, Ho RSL, Lee R, Poon RWS, Chua GT, Cheong KN, Chui MMC, Lee M, Tam S, Him AHC, Cheng KF, Ho WWS, Yuen KY, Lee P, Lau YL. Invasive cerebral phaeohyphomycosis in a Chinese boy with CARD9 deficiency and showing unique radiological features, managed with surgical excision and antifungal treatment. Int J Infect Dis 2021; 107:59-61. [PMID: 33872781 DOI: 10.1016/j.ijid.2021.04.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022] Open
Abstract
We report this rare case of cerebral phaeohyphomycosis in a previously healthy Chinese boy, who was found to have caspase recruitment domain family member 9 (CARD9) deficiency. Initial radiological features suggested a neoplastic cerebral lesion, while histopathological examination supplemented by internal transcribed sequencing (ITS) of cerebral tissue confirmed the diagnosis of phaeohyphomycosis. He was treated with intravenous (IV) liposomal amphotericin B and voriconazole, guided by plasma and cerebrospinal fluid (CSF) level monitoring at drug initiation. At the 1 year follow-up, the patient demonstrated near complete neurological and radiological recovery.
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Affiliation(s)
- Sophie H Y Lai
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong
| | - Jaime S Rosa Duque
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong; Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | - Tom Wai-Hin Chung
- Department of Microbiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Daniel Leung
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Ronnie Siu-Lun Ho
- Department of Pathology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Raymand Lee
- Department of Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Rosana W S Poon
- Department of Microbiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Gilbert T Chua
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong; Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kai-Ning Cheong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong; Hong Kong Children's Hospital, Hong Kong
| | | | - Mianne Lee
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Sidney Tam
- Department of Pathology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Andrew Ho Cheuk Him
- Department of Neurosurgery, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - King-Fai Cheng
- Department of Neurosurgery, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wilson Wai-Shing Ho
- Department of Neurosurgery, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kwok-Yung Yuen
- Department of Microbiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Pamela Lee
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong; Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Hong Kong Children's Hospital, Hong Kong
| | - Yu-Lung Lau
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong; Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Hong Kong Children's Hospital, Hong Kong.
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G Rathod P, Mishra B, Thakur A, S Loomba P, Sharma A, Bajaj A, Das M, Bhasin A. Cerebral phaeohyphomycosis due to Cladophialophora bantiana in an immunocompetent individual: A case report and brief review of literature. Curr Med Mycol 2021; 6:52-57. [PMID: 33628983 PMCID: PMC7888520 DOI: 10.18502/cmm.6.2.2693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose Fungal infections of the central nervous system (CNS) are life-threatening conditions that are frequently misdiagnosed with bacterial and viral CNS infections. Cerebral phaeohyphomycosis is a cerebral infection caused by dematiaceous fungi, especially Cladophialophora bantiana. Very few cases of fungal CNS infection have been reported across the world. High clinical suspicion should be cast for the patients with brain abscess that do not respond to conventional antibiotic therapy. Case report We report a case of a 21-year-old male presenting with headache, seizures and weakness in the limbs. Radiological examination revealed multiple brain abscesses. After surgical excision and laboratory evaluation, it was found to be caused by C. bantiana. The patient's outcome was good with surgical excision and voriconazole therapy. Conclusion Brain abscess caused by C. bantiana is on rise, especially in immunocompromised groups. Thus, high clinical suspicion, accurate diagnosis and management are the fundamentals for good prognosis.
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Affiliation(s)
- Prachala G Rathod
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Bibhabati Mishra
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Archana Thakur
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Poonam S Loomba
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Abha Sharma
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Ashish Bajaj
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Madhusmita Das
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Ashna Bhasin
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Mohanty S, Mohanty P, Priyadarshini L. Solitary Intracerebral Phaeoid Fungal Granuloma: A Case Report. Neurol India 2019; 67:1107-1109. [PMID: 31512646 DOI: 10.4103/0028-3886.266263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Fungal granuloma in the brain parenchyma caused by pheohyphomycosis is extremely rare. Antifungal drugs are not very effective. The present report is a case of solitary pheohyphomycosis granuloma, which underwent surgical excision followed by antifungal drug treatment with excellent result.
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Affiliation(s)
- Sureswar Mohanty
- Department of Neurosurgery, IMS and Sum Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Pranita Mohanty
- Department of Pathology, IMS and Sum Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
| | - Lipsa Priyadarshini
- Department of Neurosurgery, IMS and Sum Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
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Goel RS, Gupta S, Dua V, Kumar R. Cerebral Phaeohyphomycosis with Onychomycosis: Case Report and Review of Literature. Asian J Neurosurg 2019; 14:575-577. [PMID: 31143287 PMCID: PMC6516010 DOI: 10.4103/ajns.ajns_259_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The term phaeohyphomycosis (PHM) means dark-pigmented fungal hyphae. Cerebral PHM (CPHM) with onychomycosis is extremely rare; very few have been reported so far. The authors report a case of CPHM with onychomycosis in a 37-year-old male from a rural background in Haryana, India, with involvement of the left frontal lobe. The mass was resected and biopsy was sent for histopathological examination. He was given antifungal drugs in the postoperative period. The patient responded very well to the treatment, and there were no signs of recurrence at the 6-month follow-up visit. The clinical features, imaging and histopathological investigations, and management of this rare entity are discussed, and the available literature is also reviewed.
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Affiliation(s)
- Ravishankar S Goel
- Department of Neurosurgery, QRG Central Hospital and Research Centre, Faridabad, Haryana, India
| | - Sachin Gupta
- Department of Neurosurgery, QRG Central Hospital and Research Centre, Faridabad, Haryana, India
| | - Vikram Dua
- Department of Neurosurgery, QRG Central Hospital and Research Centre, Faridabad, Haryana, India
| | - Ranjan Kumar
- Department of Pathology, QRG Central Hospital and Research Centre, Faridabad, Haryana, India
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