The taxonomy of the synnematous genera Cephalotrichum, Doratomyces and Trichurus, and other related genera Gamsia, Wardomyces and Wardomycopsis, has been controversial and relies mainly on morphological criteria. These are microascaceous saprobic fungi mostly found in air and soil and with a worldwide distribution. In order to clarify their taxonomy and to delineate generic boundaries within the Microascaceae, we studied 57 isolates that include clinical, environmental and all the available ex-type strains of a large set of species by means of morphological, physiological and molecular phylogenetic analyses using DNA sequence data of four loci (the ITS region, and fragments of rDNA LSU, translation elongation factor 1α and β-tubulin). The results demonstrate that Cephalotrichum, Doratomyces and Trichurus are congeneric and the genus Cephalotrichum is accepted here with Echinobotryum as a further synonym. The genera Acaulium and Fairmania, typified by A. albonigrescens and F. singularis, respectively, are distinct from Microascus and Scopulariopsis, Gamsia is distinct from Wardomyces, and Wardomycopsis is confirmed as a separate genus in the Microascaceae. Two new species of Cephalotrichum are described as C. brevistipitatum and C. hinnuleum. Nine new combinations are proposed, i.e. Acaulium acremonium, A. caviariforme, Cephalotrichum asperulum, C. columnare, C. cylindricum, C. dendrocephalum, C. gorgonifer, Gamsia columbina and Wardomyces giganteus. A neotype is designed for C. stemonitis. Lectotypes and epitypes are designated for A. acremonium, A. albonigrescens, C. gorgonifer, C. nanum and W. anomalus. Cephalotrichum cylindricum, C. microsporum, F. singularis and Gamsia columbina are also epitypified with new specimens. Descriptions of the phenotypic features and dichotomous keys for identification are provided for accepted species in the different genera.

Three cases of fatal cerebral mycosis in males with prior histories of intravenous drug use from the United States and Australia are reported. Infection in each case was limited to brain abscess; no other sites of infection were observed. The fungus seen by histopathology and isolated from the brain tissue in each case was identified as Chaetomium strumarium. This is the first report of human infection by this species, and C. strumarium is the second species of Chaetomium known to cause primary brain infection. Chaetomium strumarium is unusual among members of the genus Chaetomium in forming ascocarps covered with pale, thin-walled, flexuous hairs, a feature leading to its original placement in the genus Achaetomium. Presence of pinkish exudate droplets and/or crystals associated with hyphae or ascocarps, sometimes accompanied by a pinkish diffusible pigment; good growth at 42؇C; and production of small conidia further distinguish this species. The brain abscess isolates were compared with isolates from prior cases of cerebral infection which had been identified as either Chaetomium atrobrunneum or Chaetomium globosum. With reidentification of one isolate originally identified as C. globosum to C. atrobrunneum, only C. strumarium and C. atrobrunneum have been confirmed to cause infection involving the brain.

A 44-year-old diabetic female presented to a hospital in Jamaica with thermal burns. Trichosporon asahii was isolated from facial wounds, sputum, and a meningeal swab. Dissemination of the fungus was demonstrated in stained histological sections of the meninges and a brain abscess at autopsy. Pure growth of the fungus from patient samples submitted and an environmental isolate obtained from a wash basin in the hospital supported the diagnosis. CASE REPORTA 44-year-old hypertensive, diabetic woman presented with partial and full-thickness thermal burns involving 50% of her total body surface area, including the face and neck, torso, upper limbs, and proximal portion of the lower limbs. She was admitted to the intensive care unit (ICU) for ventilatory support for suspected inhalational injury. Her initial hemoglobin level was 5.2 g/dl, her white blood cell count was 6.4 ϫ 10 9 /liter, her platelet count was 239 ϫ 10 9 /liter, and her blood urea nitrogen (BUN) and creatinine levels were 2 mmol/liter and 54 mol/liter, respectively. Management included fluid resuscitation, topical and systemic antibiotic therapy, surgical intervention for control of wound sepsis, and limb perfusion. She also received ceftriaxone for empirical antibiotic coverage, tetracycline ointment for facial burn wounds, and twice daily application of dressings using flumazine to the wounds on the body. Nursing and dietary supportive measures were also instituted.The patient was clinically stable on admission when a primary culture of sputum yielded a light growth of a yeast reported as "yeast not Candida albicans." However, despite broad-spectrum antibiotic coverage, signs of sepsis appeared within 5 days of admission. She developed multiorganism infection of the burn wounds, which were culture positive for Pseudomonas aeruginosa, Streptococcus group D, Bacteroides, Alcaligenes sp., and Stenotrophomonas maltophilia. Blood culture and culture of a femoral central venous catheter tip were also positive for Streptococcus group D and Acinetobacter sp. Sputum and urine cultures were negative at that time. Appropriate antibiotic intervention following antibiotic susceptibility testing of isolates was commenced, and 0.25% acetic acid was included in the dressings applied to wounds that were positive for Pseudomonas. Despite the continued use of antibiotics, she persistently showed clinical, biochemical, and hematological signs of sepsis. The patient's clinical status continued to deteriorate, and she developed multiorgan dysfunction.Over the period of hospitalization, gradually increasing BUN levels (mean, 20.9 mmol/liter; range, 9.1 to 32.1 mmol/ liter) and creatinine levels (mean, 287.2 mol/liter; range, 54 to 353 mol/liter) were recorded. Levels remained relatively high throughout the remainder of the patient's hospital stay and were consistent with renal failure.

No abstract

No abstract