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Ramichloridium mackenziei conidia attached to sympodially proliferated axis in vitro. (Polyvinyl alcohol-cotton blue preparation, magnication £ 240).
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We report two cases of brain abscesses caused by Ramichloridium mackenziei, a neurotropic dematiaceous fungus that seems to be geographically restricted to the Middle East. One of the patients had chronic myelomonocytic leukemia but did not receive any chemotherapeutic agents. The other patient was a normal host. Both cases had a fatal outcome desp...
Context in source publication
Context 1
... were subcultured onto Sabouraud peptone- glucose agar. Colonies were black on both obverse and reverse. Microscopically, septate melanized hyphae and poorly differentiated conidiophores were present. Pale brown oval conidia were produced sympodially with an obvious dark hilum which protruded slightly. Conidia were attached to a sympodially proliferated axis (rha- chis); several were produced on each conidiophore (Fig. 5). Cultures grew at 42, 37 and 25 o C but there was better growth at 37 o C than at 25 and 42 o ...
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Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue. It usually occurs following trauma with vegetative matter and mainly affects middle-aged male agricultural workers. Only a few cases have been reported in children. The lesions commonly involve the lower limbs, while the upper limbs and face are only rarely affec...
We report a 53-year-old male who presented with headache, tremor and memory disturbance. Radiological evaluation was suggestive of brain abscess. He underwent gross total excision of the cerebral abscess. The histopathological examination and pus culture was suggestive of brain abscess caused by Cladophialophora bantiana. Authors report a rare case...
Chromoblastomycosis (CBM) is a chronic, progressive, cutaneous and subcutaneous fungal infection following the traumatic implantation of certain dematiaceous fungi. The disease has worldwide prevalence with predominant cases reported from humid tropical and subtropical regions of America, Asia, and Africa. Diagnosis is often delayed or misdirected...
Citations
... [3][4][5][6] To the best of our knowledge, as of July 10, 2022, 37 cases of R. mackenziei have been reported, 15,16 12 of which originated in Saudi Arabia (Table 2). [17][18][19][20][21][22][23][24][25][26] R. mackenziei affects immunocompromised and immunocompetent individuals. Nine of the 12 reported cases in Saudi Arabia were immunocompetent. ...
... nature, and its Middle Eastern distribution suggests a preference for the saprophytic phase in arid climates. 21 In addition, diagnosis of phaeohyphomycosis is challenging because it depends on the histopathology and culture. Phaeohyphomycosis is characterized by darkly pigmented hyphae, which can be observed more clearly with Masson-Fontana melanin staining. ...
Objectives:
To report cases of cerebral phaeohyphomycosis at a tertiary hospital in Riyadh, Saudi Arabia. Phaeohyphomycetes are a widely distributed group of fungi whose cell walls contain 1,8 dihydroxynaphthalene-melanin. Cerebral infections caused by these fungi are uncommon and primarily associated with neurotrophic phaeohyphomycetes.
Methods:
In January of 2020 we looked back to identify cases of culture-positive cerebral phaeohyphomycosis from our medical records at King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia. Data on demographics, potential risk factors, clinical presentation, treatment, and outcomes were analyzed.
Results:
Twelve cases of cerebral phaeohyphomycosis were identified, of which 4 were caused by Rhinocladiella mackenziei and the other 8 were caused by various phaeohyphomycetes. There were 2 cases caused by Neoscytalidium dimidiatum, and one case each caused by the following: Acrophialophora fusispora, Chaetomium atrobrunneum, Exophiala dermatitidis, Exerohilum rostratum, Fonsecaea pedrosoi, and Cladophialophora bantiana. Most patients (10 of 12) had underlying immunosuppression. R. mackenziei caused a brain-only infection manifesting as abscess formation. Four patients survived for more than a year after therapy. Surgical evacuation and triazole therapy with posaconazole or itraconazole, alone or in combination with other antifungal agents, were associated with success.
Conclusion:
Cerebral phaeohyphomycosis is an uncommon fungal infection that primarily affects immunocompromised patients and is associated with poor prognosis. R. mackenziei is the most prevalent fungus in our facility and has been linked to a universal mortality.
... R. mackenziei is one of the most well-known causes of cerebral phaeohyphomycosis, with cases frequently appearing in healthy individuals. R. aquaspersa is also frequently linked to chromoblastomycosis lesions, and R. basitona and R. similis are two of the most common skin pathogens [11,17,47,48]. ...
Two fungal strains belonging to Ascomycota were discovered in Gyeonggi-do, Korea, during this investigation of soil microfungi and microbiota of insects. The strain KNUF-20-047 produced milky white on the back and a milky creamy center to white toward the margin on the front side of colonies. Conversely, the closest Xenoacremonium falcatus displayed a pale luteous to luteous center, white toward margins on the front side, and pale luteous or luteous pigment on the back side, whereas X. recifei produced white colonies. The conidiophores of KNUF-20-047 were slightly larger than those of X. falcatus, and the conidia were distinct from X. recifei. Strain KNUF-20-NI-005 produced light brown to subhyaline conidiophores up to 56.0 μm tall, whereas Rhinocladiella anceps displayed golden to dark brown conidiophores up to 350 μm. Strain KNUF-20-NI-005 also produced larger conidia than R. anceps but smaller than R. coryli and R. fasciculata. Moreover, the molecular phylogeny strongly supports the detailed description and illustration of each proposed species to be designated as Xenoacremonium minutisporum sp. nov. and Rhinocladiella terrigenum sp. nov. in Korea.
... Another rare fungal organism that has been described in the region to cause invasive infection is Rhinocladiella mackenziei (formerly Ramichloridium mackenziei) [60,61]. Cases of brain abscesses have been described mostly from KSA, but also from Kuwait, Qatar, and Oman among the countries of Arab League [60][61][62]. ...
... Another rare fungal organism that has been described in the region to cause invasive infection is Rhinocladiella mackenziei (formerly Ramichloridium mackenziei) [60,61]. Cases of brain abscesses have been described mostly from KSA, but also from Kuwait, Qatar, and Oman among the countries of Arab League [60][61][62]. This is a devastating infection affecting immunocompetent patients with poor prognosis and a mortality rate of more than 80% [62]. ...
The burden of invasive fungal infections is alarming worldwide. The aim of this paper is to review the published literature and evaluate the knowledge gap pertaining to studies on invasive fungal infections in the countries of the Arab League. Few countries from this region have published reports. The most commonly studied invasive fungal infections is invasive candidiasis. Candida albicans remains overall the most common causative pathogen (33.8–60%), however, non-albicans Candida species are increasing. Antifungal susceptibility testing is non-standardized across the published studies. Data on aspergillosis and other fungal infections is scarce. This sheds light on the need for standardized surveillance in the region encompassing more countries of the Arab League to guide diagnostic approach and empiric therapy.
... Campbell and Al Hedaithy in a review of fi ve cases of brain abscesses due to R. mackenziei reported two cases to be in kidney transplant patients from Qatar and Oman (Campbell and Al-Hedaithy 1993). A report of two cases from Saudi Arabia and review of additional ten cases with various underlying co-morbid conditions showed the high mortality rate of this invasive fungal infection with majority of patients dying of disease, some despite aggressive antifungal chemotherapy with or without neurosurgical drainage or resection (Kanj et al. 2001). ...
Chapter 6 in Medical Mycology. Current Trends and Future Prospects. 2015
... Campbell and Al Hedaithy in a review of fi ve cases of brain abscesses due to R. mackenziei reported two cases to be in kidney transplant patients from Qatar and Oman (Campbell and Al-Hedaithy 1993). A report of two cases from Saudi Arabia and review of additional ten cases with various underlying co-morbid conditions showed the high mortality rate of this invasive fungal infection with majority of patients dying of disease, some despite aggressive antifungal chemotherapy with or without neurosurgical drainage or resection (Kanj et al. 2001). ...
Since the first successful human kidney transplant performed in 1954, solid organ transplantation (SOT) has increased worldwide. With time, as immunosuppressive therapy and graft survival improved, the risk of infectious complications and malignancies also increased. In particular invasive fungal infection (IFI) is a major complication and an important cause of morbidity and mortality among SOT patients. The most common causes of IFIs in SOT are Candidiasis followed by Aspergillosis, and Cryptococcosis except in lung transplant recipients where Aspergillus is the most common cause of IFI. Fungal infections in renal transplant recipients had been reported since the early days of the introduction of kidney transplantation as a mode of therapy for renal failure. The estimated risk of developing IFI in renal transplant recipients varies from 1.4-9.4%, commonly between 3-5%, depending on different reports from various transplant centers (Peterson et al. 1982; Nampoory et al. 1996; Patel and Paya 1997; Stitt 2003; Badiee et al. 2005; Einollahi et al. 2008; Low and Rotstein 2011). The risk of opportunistic infections in kidney transplant patients is determined by the interaction between epidemiologic exposures to offending organisms, whether it is within the hospital or in the community, or recipient’s net-state of immunosuppression. These patients may acquire fungal infection via one of the two main routes.
... Two of these, R. basitona and R. similis, are rare agents of skin infections. R. aquaspersa is one of the agents of chromoblastomycosis. R. mackenziei is one of the most notorious causative agents of cerebral phaeohyphomycosis, often occurring in otherwise healthy individuals (del Palacio-Hernanz et al. 1989;Kanj et al. 2001;de Gruyter et al. 2009;González et al. 2013); it is strictly endemic to the Middle East, and its natural habitat is presently unknown. Rhinocladiella species have dark olivaceous-brown colonies producing conidiophores, which are pale to dark brown, somewhat or clearly differentiated from the mycelium, suberect, and mostly unbranched. ...
A review is given of melanized fungi involved in human infection, including species forming budding cells and strictly filamentous representatives. Classically, they are known as "phaeoid" or "dematiaceous" fungi, and, today, agents are recognized to belong to seven orders of fungi, of which the Chaetothyriales and Pleosporales are the most important. Infections range from cutaneous or pulmonary colonization to systemic or disseminated invasion. Subcutaneous involvement, either primary or after dissemination, may lead to host tissue proliferation of dermis or epidermis. Particularly in the Chaetothyriales, subcutaneous and systemic infections may occur in otherwise apparently healthy individuals. Infections are mostly chronic and require extended antifungal therapy and/or surgery.
... The genus Rhinocladiella is a small, polyphyletic genus comprising a few clinically significant species, R. aquaspersa, R. similis, R. basitona, R. mackenziei, and R. obovoideum [164,478]. R. mackenziei and R. obovoideum are the neurotropic fungi affecting only the CNS [122,[478][479][480]. R. mackenziei has never been isolated from the environment and thus the natural niche of this organism remains unknown [481]. ...
The etiologic agents of many invasive fungal infections are saprobes and opportunistic pathogens. Some of these fungi are darkly pigmented due to melanin production and traditionally have been named 'dematiaceous'. The melanised fungi cause a wide array of clinical syndromes ranging from superficial to deep-seated infections. Diagnosis relies on histopathological examination of clinical specimens and of examination of cultures. Sequencing is recommended for accurate species identification, especially for unusual or newly described pathogens. In cases of mycetoma and chromoblastomycosis, pathognomonic histological findings are very useful and the Fontana-Masson stain, specific for melanin, usually confirms the diagnosis. There are no standardized therapies but voriconazole, posaconazole and itraconazole demonstrate the most consistent in vitro activity against this group of fungi. Oral itraconazole has been considered the drug of choice, given the extensive clinical experience with this drug. However, voriconazole may presumably be superior for central nervous system infections due to its ability to achieve good cerebrospinal fluid levels. Posaconazole is a well-tolerated alternative drug, backed by less clinical experience but with excellent salvage treatment results after failure of other antifungals. Amphotericin B has been useful as alternative therapy in some cases. Combination antifungal therapy is recommended for cerebral abscesses when surgery is not possible and for disseminated infections in immunocompromised patients. This article is protected by copyright. All rights reserved.
... The genus Rhinocladiella is a small, polyphyletic genus comprising a few clinically significant species, Rhinocladiella aquaspersa, Rhinocladiella similis, Rhinocladiella basitona, Rhinocladiella mackenziei and Rhinocladiella obovoideum [164,474]. Rhinocladiella mackenziei and Rhinocladiella obovoideum are the neurotropic fungi affecting only the central nervous system [122,[474][475][476]. Rhinocladiella mackenziei has never been isolated from the environment so the natural niche of this organism remains unknown [477]. ...
The aetiological agents of many invasive fungal infections are saprobes and opportunistic pathogens. Some of these fungi are darkly pigmented due to melanin production and traditionally have been named 'dematiaceous'. The melanized fungi cause a wide array of clinical syndromes ranging from superficial to deep-seated infections. Diagnosis relies on histopathological examination of clinical specimens and on examination of cultures. Sequencing is recommended for accurate species identification, especially for unusual or newly described pathogens. In cases of mycetoma and chromoblastomycosis, pathognomonic histological findings are useful and the Fontana–Masson stain, specific for melanin, usually confirms the diagnosis. There are no standardized therapies but voriconazole, posaconazole and itraconazole demonstrate the most consistent in vitro activity against this group of fungi. Oral itraconazole has been considered the drug of choice, given the extensive clinical experience with this drug. However, voriconazole may presumably be superior for central nervous system infections ª2014 The Authors Clinical Microbiology and Infection because of its ability to achieve good levels in the cerebrospinal fluid. Posaconazole is a well-tolerated alternative drug, backed by less clinical experience but with excellent salvage treatment results after failure of other antifungals. Amphotericin B has been useful as alternative therapy in some cases. Combination antifungal therapy is recommended for cerebral abscesses when surgery is not possible and for disseminated infections in immunocompromised patients.
... de reciente incorporación en el reino de los hongos. 9, [21][22][23][24] Por otra parte, cada día se hace más evidente la necesidad de incorporar técnicas moleculares que confirmen la preservación de la identidad de las cepas conservadas como uno de los principios básicos de las colecciones microbianas. 1,19,25 En aspectos legales y de bioseguridad relacionados con la adquisición, utilización y traslado de cepas entre colecciones o entre diferentes instituciones, en un mismo país o en diferentes países también se ha avanzado recién, aunque aún quedan muchos aspectos sobre los cuales no existe aceptación unánime y resulta necesario consolidar y unificar criterios. ...
culture collections are responsible for providing the microbial resources for development of biological sciences. Storage in distilled water is one of the easiest and least expensive method for long-term fungal preservation.
to evaluate the usefulness of this preservation method in fungal culture of Histoplasma and Cryptococcus.
the preservation condition of the highest biological risk species from Histoplasma y Cryptococcus genera, included in the fungal culture collection of "Pedro Kouri" Institute of Tropical Medicine in Havana, was evaluated in this study. One hundred and two strains stored in distilled water, 92% of which had been preserved for more than 10 years, were analyzed.
the percentages of recovered strains from H. capsulatum, C. neoformans and C. gattii were 64.3%; 79.1% and 100% respectively. This method of preservation proved to be satisfactory for fungal culture in labs with limited financial resources. A web-based database with interesting information about the collection was made. The importance of strict compliance with the biosafety measures in these collections, particularly with high risk pathogens.
preservation of fungal cultures in distilled water is a very useful method for laboratories with limited resources. Culture collections should be assumed as an essential activity in order to solve increasing challenges in the development of biomedical sciences.
... This infection has affected apparently immunocompetent and immunocompromised patients, with similarly dismal outcomes. Of the total reported cases, seven (25%) had no reported underlying conditions [9][10][11]14,18], five (18%) patients had diabetes mellitus [1,8,15,18] and four patients had solid organ transplant [3,10,18] (Table 1). The current patient had diabetes mellitus, a condition that is found in 18% of the reported cases. ...
Rhinocladiella mackenziei (formerly Ramichloridium mackenziei), a causative agent of cerebral phaeohyphomycosis, is extremely rare and it is geographically limited to the Middle East. The organism has a predilection to cause brain infections and results in a grave prognosis with a high mortality rate. The current patient was admitted to a long term care facility with chronic respiratory failure and dependence on a mechanical ventilator. She later developed left sided weakness and a CT-scan of the brain revealed multiple variable sized hypodense, well-defined lesions with ring enhancement. A stereotactic needle aspiration of the largest lesion showed fungal hyphae. The final culture grew R. mackenzie. The patient was initially started on liposomal amphotericin B, then voriconazole and caspofungin intravenously as posaconazole was not available. The patient failed to respond to antifungal therapy and finally she died 34 days after the start of the treatment. R. mackenziei is a highly virulent agent, and should be considered in the differential diagnosis of central nervous system disease in patients from the Middle East.
