A case of Exophiala dermatitidis infection in a child after allogeneic stem cell transplantation: case report and literature review of paediatric cases
Abstract:Introduction.
Exophiala dermatitidisis a relatively common environmental black yeast with worldwide distribution and is a rare cause of fungal infection, mostly in patients with certain predisposing factors. Due to the rarity of the infection, little is known about the specific predisposing factors, way of infection or treatment.
Case presentation. Here, we report what is to our knowledge the first case of E. dermatitidis infection in a child after allogeneic stem cell transplantation. We also review all paedi… Show more
“…Immunosuppressed and elderly patients suffer from infections with E. dermatitidis most commonly in the form of phaeohyphomycosis, keratitis or chromoblastomycosis; 54 cases of phaeohyphomycosis have been described between 1934 and 2006 (Figure 2) [12,13]. Literature research on recent published case reports involving E. dermatitidis-caused infections revealed 20 new cases since 2007 in both, immunocompetent and -suppressed patients (Table 1) [21,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]. E. dermatitidis may also be a severe agent of pneumonia [12].…”
Section: E Dermatitidis Causing Phaeohyphomycosis In Immunosuppressed Patients and Fatal Infections In Immunocompetent Individualsmentioning
confidence: 99%
“…Currently there are no available standardized broth microdilution methodologies or validated MIC breakpoints for in vitro resistance testing for E. dermatitidis. However, numerous studies dealing with susceptibility patterns of the black yeast-like fungus exist [21,29,41,45,123,130,[132][133][134][135][136][137][138][139][140].…”
The black yeast Exophiala dermatitidis is an opportunistic pathogen, causing phaeohyphomycosis in immunosuppressed patients, chromoblastomycosis and fatal infections of the central nervous system in otherwise healthy Asian patients. In addition, it is also regularly isolated from respiratory samples from cystic fibrosis patients, with rates varying between 1% and 19%.Melanin, as part of the cell wall of black yeasts, is one major factor known contributing to the pathogenicity of E. dermatitidis and increased resistance against host defense and anti-infective therapeutics. Further virulence factors, e.g. the capability to adhere to surfaces and to form biofilm were reported. A better understanding of the pathogenicity of E. dermatitidis is essential for the development of novel preventive and therapeutic strategies. In this review, the current knowledge of E. dermatitidis prevalence, clinical importance, diagnosis, microbiological characteristics, virulence attributes, susceptibility, and resistances as well as therapeutically strategies are discussed.
“…Immunosuppressed and elderly patients suffer from infections with E. dermatitidis most commonly in the form of phaeohyphomycosis, keratitis or chromoblastomycosis; 54 cases of phaeohyphomycosis have been described between 1934 and 2006 (Figure 2) [12,13]. Literature research on recent published case reports involving E. dermatitidis-caused infections revealed 20 new cases since 2007 in both, immunocompetent and -suppressed patients (Table 1) [21,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]. E. dermatitidis may also be a severe agent of pneumonia [12].…”
Section: E Dermatitidis Causing Phaeohyphomycosis In Immunosuppressed Patients and Fatal Infections In Immunocompetent Individualsmentioning
confidence: 99%
“…Currently there are no available standardized broth microdilution methodologies or validated MIC breakpoints for in vitro resistance testing for E. dermatitidis. However, numerous studies dealing with susceptibility patterns of the black yeast-like fungus exist [21,29,41,45,123,130,[132][133][134][135][136][137][138][139][140].…”
The black yeast Exophiala dermatitidis is an opportunistic pathogen, causing phaeohyphomycosis in immunosuppressed patients, chromoblastomycosis and fatal infections of the central nervous system in otherwise healthy Asian patients. In addition, it is also regularly isolated from respiratory samples from cystic fibrosis patients, with rates varying between 1% and 19%.Melanin, as part of the cell wall of black yeasts, is one major factor known contributing to the pathogenicity of E. dermatitidis and increased resistance against host defense and anti-infective therapeutics. Further virulence factors, e.g. the capability to adhere to surfaces and to form biofilm were reported. A better understanding of the pathogenicity of E. dermatitidis is essential for the development of novel preventive and therapeutic strategies. In this review, the current knowledge of E. dermatitidis prevalence, clinical importance, diagnosis, microbiological characteristics, virulence attributes, susceptibility, and resistances as well as therapeutically strategies are discussed.
“…Disseminated infections are extremely rare and probably all associated with inherited immunological diseases such as CARD9 innate immune deficiency [2]. Other predisposing factors for invasive disease include peritoneal dialysis, steroid use, human immunodeficiency virus infection, cancer, bronchiectasis, and diabetes mellitus, demonstrating that numerous changes in patient's condition have been correlated with disease progression [13]. Fig.…”
Section: Discussionmentioning
confidence: 99%
“…Exophiala dermatitidis infections are very rare in pediatric (14%) and adolescent patients (7%). Hong et al [14] reported a case of liver cirrhosis caused by E. dermatitidis in a previously healthy child, while a pulmonary infection in a child after allogenic stem cell transplantation was reported by Tanuskova et al [13]. Recently, a case of phaeohyphomycosis breast infection in a teenage girl was reported [15].…”
Fungal peritonitis is frequent on peritoneal dialysis, with rare cases by
Exophiala dermatitidis
. A 25-month-old female admitted to the pediatric ICU with acute renal failure was submitted to peritoneal dialysis. After 10 days patient presented fever. Peritoneal fluid culture showed yeast colonies molecularly identified as
E. dermatitidis
. Patient was treated with voriconazole and hemodialysis. The literature was reviewed. Disseminated infections are frequently fatal, but appropriate diagnose and therapeutic led to cure in this case.
“…This dematiaceous (brown-pigmented) fungus is a large, heterogenous group of molds that can cause a wide range of diseases, including phaeohyphomycosis, chromoblastomycosis, and eumycotic mycetoma; however, it is rarely the cause of fungal infection, primarily in patients who already have certain predisposing factors[ 3 , 8 , 14 - 17 ]. It is known to generate a biofilm in a strain-specific manner, with invasive E. dermatitidis isolates forming biofilms with the greatest biomass[ 16 , 18 ].…”
Exophiala
is a genus comprising several species of opportunistic black yeasts, which belongs to Ascomycotina. It is a rare cause of fungal infections. However, infections are often chronic and recalcitrant, and while the number of cases is steadily increasing in both immunocompromised and immunocompetent people, detailed knowledge remains scarce regarding infection mechanisms, virulence factors, specific predisposing factors, risk factors, and host response. The most common manifestations of
Exophiala
infection are skin infections, and the most frequent type of deep infection is pulmonary infection due to inhalation. The invasive disease ranges from cutaneous or subcutaneous infection to systemic dissemination to internal organs. The final identification of the causative organism should be achieved through a combination of several methods, including the newly introduced diagnostic analysis, matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry, together with sequencing of the ribosomal ribonucleic acid internal transcribed spacer region of the fungi, and histological and culture findings. Regarding treatment, because anti-infective agents and natural compounds exhibited poor antibiofilm activity, few treatments have ultimately been found to be effective for specific antifungal therapy, so the optimal antifungal therapy and duration of therapy for these infections remain unknown. Therefore, most forms of disease caused by
Exophiala dermatitidis
require aggressive combination therapies: Both surgical intervention and aggressive antifungal therapy with novel compounds and azoles are necessary for effective treatment.
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