Disseminated Dactylaria gallopava Infection in a Diabetic Patient with Chronic Lymphocytic Leukemia of the T-Cell Type

Terreni, Anne A.; DiSalvo, Arthur F.; Baker, A S; Crymes, William B.; Morris, Phillip R.; Dowda, H

doi:10.1093/ajcp/94.1.104

Cited by 31 publications

(21 citation statements)

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“…Disseminated infection is the most uncommon manifestation of infection caused by melanized fungi. In a review of 72 cases (627), most patients were immunocompromised, though occasional patients without known immunodeficiency or risk factors developed disseminated disease as well (3,24,73,76,95,105,119,171,208,238,242,246,288,291,308,321,345,386,389,397,400,402,403,409,423,424,435,471,485,516,538,543,550,557,578,593,595,596,612,621,627,640,647,672,688,712,713,740,…”

Section: Phaeohyphomycosismentioning

confidence: 99%

Melanized Fungi in Human Disease

2010

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SUMMARY Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes. Many are soil organisms and are generally distributed worldwide, though certain species appear to have restricted geographic ranges. Though they are uncommon causes of disease, melanized fungi have been increasingly recognized as important pathogens, with most reports occurring in the past 20 years. The spectrum of diseases with which they are associated has also broadened and includes allergic disease, superficial and deep local infections, pneumonia, brain abscess, and disseminated infection. For some infections in immunocompetent individuals, such as allergic fungal sinusitis and brain abscess, they are among the most common etiologic fungi. Melanin is a likely virulence factor for these fungi. Diagnosis relies on careful microscopic and pathological examination, as well as clinical assessment of the patient, as these fungi are often considered contaminants. Therapy varies depending upon the clinical syndrome. Local infection may be cured with excision alone, while systemic disease is often refractory to therapy. Triazoles such as voriconazole, posaconazole, and itraconazole have the most consistent in vitro activity. Further studies are needed to better understand the pathogenesis and optimal treatment of these uncommon infections.

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Section: Phaeohyphomycosismentioning

confidence: 99%

Melanized Fungi in Human Disease

2010

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“…The lesions manifested as subcutaneous nodules and abscesses caused by O. gallopavum. The second disseminated fatal infection, the first in the United States, caused by O. gallopavum was described recently by Terreni et al [ 15] in a 62-year-old man with chronic lymphocytic leukaemia of T-cell type and diabetes mellitus. The present report describes a third human infection caused by this emerging pathogen in a patient from North Carolina with malignant lymphoma.…”

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confidence: 90%

Phaeohyphomycotic brain abscess due toOchroconis gallopavumin a patient with malignant lymphoma of a large cell type

1991

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A 60-year-old man with a 9-year history of malignant lymphoma developed an initial pulmonary infection with Nocardia asteroides which later disseminated to the central nervous system with multiple brain abscesses. He was treated successfully with intravenous trimethoprim-sulfamethoxazole for 6 weeks. A follow-up computed tomography (CT) scan showed complete resolution of the abscesses. Two years later, he returned to the hospital with a 2-week history of confusion, loss of concentration, ataxia, and leaning to the left. ACT scan revealed an enhancing multiloculated complex fight frontal lesion. Craniotomy revealed a large fight frontal lobe abscess, which was totally resected. Histopathologic examination of the resected tissue revealed multiple, lightly pigmented, septate, branched hyphal elements typical of phaeohyphomycosis. The fungal isolate cultured from the tissue was a dematiaceous, thermotolerant fungus that was identified as Ochroconis gallopavum. Despite treatment with amphotericin B, flucytosine and fluconazole, the patient gradually deteriorated and died. This case represents the third fatal infection, the second from the southeastern United States, due to O. gallopavum.

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“…There have been about 30 reported cases of O. gallopavum human infection, since the first report by Fukushiro et al on an AML patient in 1986 (11). Patients with hematological malignancies frequently suffer from fungal infections, such as Aspergillus, Candida or Cryptococcus, but among such patients, O. gallopavum infection is a very rare event, with only four cases of the infection reported (11)(12)(13)(14). Table 1 presents a summary of the clinical features of the cases, which now number five, including the present case: Four cases were lymphoid malignancies and one was acute myeloblastic leukemia (AML).…”

Section: Case Reportmentioning

confidence: 93%