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(left) A (upper), B (lower). Necrosis within the abscess due to C. trichoides var. chlamydosporum (XI30). FIG. 3 (right). Hyphae of C. trichoides var. chlamydosporum in the center of necrosis. A (upper). PAS stained (X450); B (lower, center). Hematoxylin and eosin stained (X1,200); C (lower, right). PAS-stained (x 1,200).
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A brain abscess caused by a new variety of Cladosporium trichoides occurred in a previously healthy man. A reversed T-suppressor/helper cell ratio was noted as the only immunologic abnormality. He required three surgical procedures, the last an occipital lobectomy, and antifungal chemotherapy to control his disease. He received 2,068 mg of amphoter...
Citations
... Different fungal species have been the causative agents of cerebral PHM with poor prognosis [5,7,11,12,17]. Conversely, reports of successful management of PHM species could be found [13,16]. Santosh et al reported successful recovery of a 15-year-old patient suffering from F. pedrosoi cerebral abscess with surgery and amphotericin B plus 5-flucytosine [14]; however, drug resistance could be a matter of concern. ...
Cerebral phaeohyphomycosis caused by Fonsecaea pedrosoi is a rarity. However, about four cases have been reported in the literature. The disease remains mostly fatal despite employment of new treatment modalities.
An 18-year-old boy presented seizures of recent onset. Two years back, he developed cutaneous phaeohyphomycosis after a splinter scratch on his chest wall. Imaging revealed a contrast enhancing parafalcian solid mass. Right frontal parasagittal craniotomy was performed and the lesion resected as much as possible, followed by IV amphotericin B and oral itraconazole treatment. The patient has been doing well during a 15-month follow-up period.
Cerebral phaeohyphomycosis is an extremely rare lesion, which could masquerade as a parafalcian mass. Radical surgical removal together with antimicrobials remains the cornerstone treatment of cerebral phaeohyphomycosis.
... 36,1998 CEREBRAL PHAEOHYPHOMYCOSIS CAUSED BY R. OBOVOIDEUM though culturally proven cases do have a male-to female ratio of about 3:1 (12,24). One exception appears to be the relationship between preexisting Nocardia asteroides and phaeohyphomycotic brain abscesses due to C. bantiana (24,30,32,43). ...
We report a case of cerebral phaeohyphomycosis in a 36-year-old male caused by the neurotropic fungus Ramichloridium obovoideum (Matushima) de Hoog 1977 (Ramichloridium mackenziei Campbell et Al-Hedaithy 1993). This man resided in the Middle East, where the fungus appears to be endemic and, possibly, geographically restricted, since all previous reports of brain abscesses due to this organism have been for patients indigenous to this area. As a servant of the Saudi Arabian royal family, he appeared in the United States seeking treatment for chronic weight loss, fatigue, decreased memory, and a more recent 2-week history of right-hand weakness which worsened to involve the entire right upper extremity. On the day prior to his admission, he had a focal motor seizure with rotation of the head and eyes to the right, followed by secondary generalization. A computerized tomogram showed a ring-enhancing hypodense lesion in the left parietal subcortical region with associated edema and mass effect. Diagnosis of a fungal etiology was made following a parietal craniotomy and excisional biopsy by observation of septate, dematiaceous hyphal elements 2 to 3 microm in width on hematoxylin-and-eosin-stained sections from within areas of inflammation and necrosis. Culture of the excised material grew out a dematiaceous mould which was subsequently identified as R. obovoideum. At two months postsurgery and with a regimen of 200 mg of itraconazole twice a day, the patient was doing well and returned to Saudi Arabia. His condition subsequently deteriorated, however, and following a 7-month course of itraconzole, he expired. We use this case to alert clinicians and personnel in clinical mycology laboratories of the pathogenicity of this organism and its potential occurrence in patients with central nervous system signs and symptoms who have resided in the Middle East and to review and/or compare R. obovoideum with other neurotropic, dematiaceous taxa and similar nonneurotropic, dematiaceous species.
... In 10 of the 32 previous culture proven cases of CNS infection caused by C. bantiana, factors suggested impairment of immunological function [2,4,5,8]. One patient had cellular immunity depression due to an altered T supressor/helper cell ratio [21]. Our patient was apparently healthy, but the drug abuse could predispose the patient to infections and the dexamethasone treatment could have contributed to the disease progression [22]. ...
... There are three reports in which C. bantiana was isolated from the CSF [5,21,23]. In the present case, the fungus was detected in the CSF and cultured from lumbar CSF previously reported as negative. ...
We present a case of cerebral phaeohyphomycosis caused by Cladophialophora bantiana in an apparently immunocompetent patient with a history of intravenous drug use. The diagnosis was achieved in specimens obtained at necropsy by histological and mycological examination, with subsequent identification of the isolate in culture.
... The multiplicity of abscesses in many cases argues for a hematogenous spread; a portal of entry, presumably pulmonary, is rarely documented. One case involving a 61-year-old man with lymphopenia and an absence of T-helper cells has been reported [32]. This history is clearly suggestive of AIDS, but this and other reports were published well before the clinical occurrence of AIDS became common, and no HIV status is reported for most of the patients. ...
... United States has been noted, but this organism has also been isolated from thermal pools in Yellowstone National Park and thermal effluents of nuclear reactors [64, 65]. It is interesting that a number of other cases of cerebral phaeohyphomycosis with various species have been reported in association with N. asteroides [20, 27, 32, 62] . While underlying immunosuppression may be suspected in all these patients , the association seems stronger than might be expected by chance. ...
The dematiaceous fungi appear to be an increasing cause of human disease. At The Methodist Hospital, in Houston, Texas, five
cases of serious disease caused by these fungi occurred between 1987 and 1992. Cerebral abscesses with Xylohypha bantiana followed treatment for lymphoma. An infection of the lower extremity with Exophiala jeanselmei var. castellanii followed cardiac surgery. Peritoneal growth of Alternaria tenuissima was a complication of peritoneal dialysis. Cerebral abscesses with Dactylaria gallopava occurred in a liver transplantation patient. A traumatic ankle wound contaminated with dirt led to an infection with Phialophora repens. All patients except the last were immunocompromised at the time of the infection; diabetics and patients on steroids may
be at particular risk.
... The ma-jority of patients are healthy before the development of infection. Only in occasional cases has immunodeficiency been a predisposing factor (18,22). X. bantiana does not, therefore, appear to be an opportunistic fungus. ...
... Antifungal chemotherapy has been used so infrequently that its efficacy in human infection cannot be established. Based on limited experience, it appears that resection followed by flucytosine therapy is the most successful approach (17,22). Although, in general, the prognosis of patients with cerebral phaeohyphomycosis infection is poor, a few have experienced survivals exceeding 1 year This article by Palaoglu et al. illustrates an intracranial infection by X. bantiana, commonly referred to as Cladosporium. ...
A 14-year-old girl with a rare form of fungal brain abscess involving the dura and brain parenchyma is reported. No portal of entry of the infection was found. Histological findings and fungal culture both indicated that the causative agent was Xylohypha bantiana, an uncommon dematiaceous fungus. A review of the literature suggests that this infection, which affects primarily young male patients, exhibits distinct neurotropism. Despite therapy, the prognosis is generally poor.
Candida spp., Malassezia spp., Cladosporium spp. and Alternaria spp are among the most common fungi detected in the brain of patients with Alzheimer's disease (AD). These fungi are opportunistic organisms, where they often cause infection among immunocompromised patients. Coincidentally, these fungi can reach the brain and cause fungal meningitis. In general, they enter the brain via systemic infection due to disrupted epithelial barrier from skin and gut colonization. Once it reaches the brain, Candida species has been postulated to induce fungal glial granulomas with amyloid precursor protein (APP) accumulated inside. Cleavage of APP can lead to the production of amyloid-beta (Aβ). Malassezia species can lead to neuroinflammation via activating helper T-cell (Th) 1 and Th17 immune response. Besides that, the pathogenesis of Cladosporium species and Alternaria species in AD remains unknown, but it could be related to the neuroinflammation. These two fungal species may have involved in acetylcholinesterase (AChE) inhibitor production in the brain. All these four fungi can be detected at the same time in the brain, which contribute to chronic neuroinflammation and neurodegeneration in the brain. This review is hopes to shed some light in understanding the presence of fungi in the brain and their possible role in AD pathogenesis.
Dematiaceous (melanized or phaeoid) fungi are common in the environment. However, clinical diseases caused by them are uncommon. Despite their rarity, they are being increasingly recognized as causal agents of disease in man and animal. There is growing awareness among medical fraternity about the clinical significance of these melanized fungi in medical practice. In this article, we have reviewed some clinically significant publications reporting some emerging phaeoid genera up to 2017. The genera reviewed are Alternaria, Aureobasidium, Bipolaris, Exserohilum, Curvularia, Ochroconis, Exophiala, Phialophora, Chaetomium, Neoscytalidium, Leptosphaeria, Microascus, Lecythophora, Phaeoacremonium, Scedosporium, Veronaea, Fonsecaea, Wallemia sebi, Verruconis, etc. In addition, laboratory diagnosis and future areas of research have also been dealt along with conclusion.
Cladophialophora bantiana is a phaeoid fungus that only rarely has been isolated from sources other than the human brain. It has a particular tropism for the central nervous system (CNS). We have integrated and updated large-scale data related to several aspects of C. Bantiana and reviewed all the available reports on its cerebral infections, focusing on their geographical distribution, infection routes, immune status of infected individuals, type and location of infections, clinical manifestations and treatment and outcome, briefly looking over the spectrum of other disease entities associated with C. bantiana, that is, extra-cerebral and animal infections and on the environmental sources of this fungus. Among the agents of phaeohyphomycosis, a term used to describe an infection caused by a dark pigmented fungus, C. bantiana has some significant specific features. A total of 120 case reports were identified with a significantly higher percentage of healthy subjects than immune-debilitated patients (58.3% vs. 41.7%). Infections due to C. bantiana occur worldwide. The main clinical manifestations are brain abscess (97.5%), coinfection of brain tissue and meninges (14.2%) and meningitis alone (2.5%). Among immunocompetent patients, cerebral infection occurred in the absence of pulmonary lesions. The mortality rate is 65.0% regardless of the patient's immune status. The therapeutic options used include surgery or antifungals alone, and the combination of both, in most cases the fatal outcome being rapid after admission. Since the fungus is a true pathogen, laboratory workers should be made aware that BioSafety Level-3 precautions might be necessary.
