Phialemonium curvatum infection after bone marrow transplantation

Heins‐Vaccari, Elisabeth Maria; Machado, Clarisse Martins; Saboya, Rosaura; Silva, Roberto L.; Dulley, Frederico Luiz; Lacaz, Carlos da Silva; Leite, Roseli S. de Freitas; Arriagada, Giovana L. Hernández

doi:10.1590/s0036-46652001000300009

Cited by 18 publications

(14 citation statements)

References 11 publications

(7 reference statements)

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“…In this case, the only theoretical factor that might raise doubts about the patient's complete immunological integrity was his occupation, bringing him in frequent contact with chickens, and the head trauma at the age of 19. In reported Phialemonium infection cases, the filamentous fungus is isolated mainly from blood samples obtained from patients with primary fungemia (3)(4)(5). In the current case, the diagnosis of meningitis caused by P. curvatum was confirmed by CSF culturing, but the blood cultures were negative.…”

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confidence: 62%

“…The majority of Phialemonium infections are invasive, and the most frequent infections include peritonitis endocarditis, osteomyelitis, and cutaneous infections of wounds that may occur after a burn (2)(3)(4)(5)(6). In this case, the only theoretical factor that might raise doubts about the patient's complete immunological integrity was his occupation, bringing him in frequent contact with chickens, and the head trauma at the age of 19.…”

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confidence: 99%

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Infective Meningitis Caused by Phialemonium curvatum

Zou

et al. 2014

J Clin Microbiol

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bInfections caused by rarely encountered fungal pathogens have increased in recent decades. Phialemonium species are widely distributed in the environment and are also involved in human infections, affecting both immunocompromised and immunocompetent patients. The present study describes a case of meningitis caused by Phialemonium curvatum. CASE REPORTA 42-year-old male patient was admitted to the hospital for continuous headache without nausea and fever, with a maximum temperature of 39°C during the past 30 days. He was a poultry farmer and had experienced head trauma at the age of 19. The patient was conscious and claimed acroanesthesia. He denied any systemic disease, history of immunosuppression, or recent travel. When the patient was first admitted to the hospital, his physical examination showed that he had stable vitals, the neurological assessments were unremarkable, and no neck stiffness was noted. A routine blood test revealed a white blood cell (WBC) count of 11.6 ϫ 10 9 /liter (53.7% neutrophils and 36.3% lymphocytes). The first lumbar puncture was performed under local anesthesia, revealing 110 ϫ 10 6 /liter WBCs, 0.3 g/liter protein, 3.1 mmol/liter glucose, and 117 mmol/liter chloride. The pressure of the cerebrospinal fluid (CSF) was 250 mmH 2 O. CSF cytology demonstrated the presence of approximately 70% lymphocytes and 30% neutrophilic granulocytes. A computed tomography scan of the head and a chest radiograph showed no alterations. Cranial magnetic resonance imaging was normal. An echocardiogram revealed that the left ventricle had a normal size and function, and no vegetation was detected. In addition, a serum test for human immunodeficiency virus (HIV) was negative. Aricine staining and India ink staining of the CSF were also negative. He was initially diagnosed with viral encephalitis and tuberculous meningitis and received antiviral therapy (ganciclovir, 0.25 g twice a day) for 10 days, as well as a standard 15-day course of antituberculosis therapy (isoniazid, 0.9 g/24 h, rifampin, 0.6 g once a day [q.d.], and pyrazinamide, 0.25 g three times a day [t.i.d.]). However, the treatment had little effect, and the patient still complained of a heavy headache. Measurements of CSF and blood (1-3)-␤-D-glucan were 151 pg/ml and 466 pg/ml, respectively (with a cutoff value of Ͻ100 pg/ml). The later culture test showed that the four blood cultures were negative. Two of the CSF cultures became positive after 4 days of incubation in blood culture bottles (BacT/Alert, aerobic bottle; bioMérieux) without antibiotics. Subculturing of the positive CSF cultures revealed mold growth after 72 h of incubation. On traditional Sabouraud agar, the colonies were white, reaching 10 to 15 mm in diameter after 10 days at 25°C. Colonies were cream colored, and small areas of the colonies became light yellow after 30 days (Fig. 1). Microscopically, vegetative hyphae and conidia were hyaline. Accumulation of hyaline conidia was observed at the apex, and most of them were allantoid (Fig. 2). Scanning electron microscopy (...

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Infective Meningitis Caused by Phialemonium curvatum

Zou

et al. 2014

J Clin Microbiol

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“…To our knowledge, 13 cases of human Phialemonium infection have been reported to date, including our cases [2][3][4][5][6][7][8]. Two cases of Phialemonium osteomyelitis in German shepherd dogs have also been reported [20,21].…”

Section: Discussionmentioning

confidence: 97%

“…Distributed widely in the environment, Phialemonium species have been isolated from air, soil, industrial water, and sewage [1]. Although these species rarely cause human disease, infection is often fatal [2][3][4][5][6][7][8]. We present 4 patients undergoing chronic hemodialysis who developed intravascular infection with an atypical variant of P. curvatum.…”

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Phialemonium: An Emerging Mold Pathogen That Caused 4 Cases of Hemodialysis-Associated Endovascular Infection

Proia

Hayden

Kammeyer

et al. 2004

Clinical Infectious Diseases

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Phialemonium species are emerging as fungal opportunistic pathogens of humans; infections caused by these fungi often have a fatal outcome. We report a series of 4 patients undergoing chronic hemodialysis who developed intravascular infection with Phialemonium curvatum. All isolates were of a distinct morphological type but were shown by partial ribosomal sequencing to be closely related to reference isolates of P. curvatum. Two patients in our case series died; both developed overwhelming infection associated with fungemia and endocarditis. Recent literature corroborates our experience that Phialemonium infection presents unique diagnostic challenges and that optimal management, particularly with regard to antifungal therapy, is not known.

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“…Although Phialemoniopsis species grow as pale colonies, melanin has been detected in their hyphae, and therefore, infections due to these dematiaceous molds are considered to be phaeohyphomycosis (6). Phialemoniopsis species have been reported to cause endocarditis and endovascular infections (9,17,20,22), endophthalmitis and keratitis (2,15,16,18,19), fungemia (7,12,24), meningitis (21), septic arthritis and spondylodiscitis (10,23), and skin and soft tissue infections (1,6,8,25) in humans, with some cases being fatal infections. In addition, they have been isolated from various clinical specimens, including those from cerebrospinal fluid, corneal and vitreous fluid, peritoneal dialysis catheter, sinus, skin lesions and nails, and synovial fluid, although the clinical details of the patients were not presented (1,2,13).…”

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Subcutaneous Phaeohyphomycotic Nodule Due to Phialemoniopsis hongkongensis sp. nov

Tsang

Chan

et al. 2014

J Clin Microbiol

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Phialemoniopsis species are ubiquitous dematiaceous molds associated with a wide variety of superficial and systemic infections in human. In this study, we isolated a mold from the forearm nodule biopsy specimen from a patient with underlying liver cirrhosis, ankylosing spondylosis, and tuberculosis. He was treated with itraconazole, but unfortunately, he succumbed as a result of disseminated tuberculosis with multiorgan failure. The histology results of the skin biopsy showed necrotizing granulomas in which numerous fungal elements were found. On Sabouraud dextrose agar, the fungal isolate grew as white-to-cream and smooth-to-velvety colonies. Microscopically, oval-to-cylindrical conidia were observed from abundant adelophialides, which possessed barely visible parallel collarettes but no basal septa. The azole drugs voriconazole, itraconazole, and posaconazole, as well as amphotericin B, showed high activities against this fungus. Internal transcribed spacer, 28S nuclear ribosomal DNA (nrDNA), and ␤-actin and ␤-tubulin gene sequencing showed that this fungus is most closely related to but distinct from Phialemonium curvata. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and hierarchical cluster analysis showed that the MALDI-TOF MS spectrum of this fungus is most closely related to that of Phialemonium pluriloculosa. We propose a new species, Phialemoniopsis hongkongensis sp. nov., to describe this fungus.

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Phialemonium curvatum infection after bone marrow transplantation

Cited by 18 publications

References 11 publications

Infective Meningitis Caused by Phialemonium curvatum

Infective Meningitis Caused by Phialemonium curvatum

Phialemonium: An Emerging Mold Pathogen That Caused 4 Cases of Hemodialysis-Associated Endovascular Infection

Subcutaneous Phaeohyphomycotic Nodule Due to Phialemoniopsis hongkongensis sp. nov

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