Disseminated Phaeohyphomycosis: Review of an Emerging Mycosis

Revankar, Sanjay G.; Patterson, Jan E.; Sutton, Deanna A.; Pullen, Renee; Rinaldi, Michael G.

doi:10.1086/338636

Cited by 365 publications

(382 citation statements)

References 84 publications

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“…These findings suggest a lack of systemic dissemination of Exserohilum, which was surprising given the extensive meningeal vascular invasion, high fungal burdens, and the occurrence of systemic involvement with other angioinvasive fungal infections, especially in immunocompromised patients. 42,43 Fungal inoculation directly into the epidural space with rapid development of meningitis and death may account for the lack of systemic dissemination observed in these cases.…”

Section: Pathology Of Exserohilum Infectionsmentioning

confidence: 99%

Exserohilum Infections Associated with Contaminated Steroid Injections

Ritter

Muehlenbachs

Blau

et al. 2013

The American Journal of Pathology

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The ASCP designates this journal-based CME activity ("ASIP 2013 AJP CME Program in Pathogenesis") for a maximum of 48 AMA PRA Category 1 Credit(s)ä. Physicians should only claim credit commensurate with the extent of their participation in the activity. CME Disclosures: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose. September 2012 marked the beginning of the largest reported outbreak of infections associated with epidural and intra-articular injections. Contamination of methylprednisolone acetate with the black mold, Exserohilum rostratum, was the primary cause of the outbreak, with >13,000 persons exposed to the potentially contaminated drug, 741 confirmed drug-related infections, and 55 deaths. Fatal meningitis and localized epidural, paraspinal, and peripheral joint infections occurred. Tissues from 40 laboratoryconfirmed cases representing these various clinical entities were evaluated by histopathological analysis, special stains, and IHC to characterize the pathological features and investigate the pathogenesis of infection, and to evaluate methods for detection of Exserohilum in formalin-fixed, paraffin-embedded (FFPE) tissues. Fatal cases had necrosuppurative to granulomatous meningitis and vasculitis, with thrombi and abundant angioinvasive fungi, with extensive involvement of the basilar arterial circulation of the brain. IHC was a highly sensitive method for detection of fungus in FFPE tissues, demonstrating both hyphal forms and granular fungal antigens, and PCR identified Exserohilum in FFPE and fresh tissues. Our findings suggest a pathogenesis for meningitis involving fungal penetration into the cerebrospinal fluid at the injection site, with transport through cerebrospinal fluid to the basal cisterns and subsequent invasion of the basilar arteries. Further studies are needed to characterize Exserohilum and investigate the potential effects of underlying host factors and steroid administration on the pathogenesis of infection. Accepted for publication

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Section: Pathology Of Exserohilum Infectionsmentioning

confidence: 99%

Exserohilum Infections Associated with Contaminated Steroid Injections

Ritter

Muehlenbachs

Blau

et al. 2013

The American Journal of Pathology

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“…Melanin, an extremely stable resistant molecule, is involved in the pathogenicity [6] . Infections caused by these black fungi are termed phaeohyphomycosis and comprise mainly of ulcerative skin lesions of traumatic origin, black grain eumycotic mycetoma, fungal keratitis, paranasal sinusitis and rarely systemic (respiratory and cerebral) or disseminated disease [6,7] .…”

Section: Discussionmentioning

confidence: 99%

“…With regard to Curvularia, there have been sporadic reports of deep infections such as endophthalmitis, fatal recurrent Curvularia brain abscess in a child and Curvularia endocarditis following cardiac surgery [6,7,8] where none of the patients suffered from known immunologic disorders or underlying debilitating diseases. A fatal case of cerebral Curvularia infection was also reported in a young african american male with no known history of immunocompromise or prior respiratory tract or sinus infection in 2004 [9] .…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Curvularia Hawaiiensis in the Ear Following Trauma

Gunasekaran¹

2017

JMSCR

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Curvularia belongs to the group of phaeoid or black fungi that can cause opportunistic infections in humans and other animals. Curvularia hawaiiensis or Cochliobolus hawaiiensis (previously Case ReportA 38-year-old previously healthy male who worked as a construction site labourer was brought to the casualty ward of our hospital with a history of loss of consciousness and right ear bleed following a road traffic accident. In the casualty, the patient was conscious and oriented, with a Glasgow Coma Score (GCS) within normal limits. Preliminary investigations including a Computerized Tomography (CT) scan were also normal. He was admitted as an inpatient for further monitoring and evaluation. Routine laboratory investigations were done. An ear swab was also sent for bacterial culture and sensitivity. There were no microorganisms seen in the Gram Stain and the culture plates had no growth in 48 www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 71.58

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“…Pese a su rareza, las feohifomicosis tienen mayor crecimiento por la cantidad de especies fúngicas involucradas y las formas clínicas, así como los numerosos reportes en la literatura (7,8).…”

Section: Introductionunclassified

Feohifomicosis, una infección fúngica oportunista emergente

Gómez

Cardona‐Castro

2016

CES Med

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ResumenLas feohifomicosis comprenden un grupo de infecciones causadas por hongos pigmentados, negros o dematiáceos. En las últimas dos décadas se ha incrementado la frecuencia de reportes y la diversidad de los agentes etiológicos implicados, especialmente en los individuos inmunosuprimidos. Los principales géneros involucrados incluyen Alternaria, Bipolaris, Cladophialophora y Exophiala. Estos hongos típicamente se encuentran en el suelo y son introducidos al cuerpo a través de la inhalación o el trauma. El espectro de las enfermedades asociadas también se ha ampliado e incluye infecciones cutáneas superficiales y profundas, enfermedad alérgica, neumonía, abscesos cerebrales e infección diseminada. El diagnóstico de laboratorio está basado en las características morfológicas de los agentes según lo observado en el examen microscópico directo y la histopatología. El tratamiento es a menudo difícil y depende del síndrome clínico. No hay terapias estandarizadas, pero voriconazol, posaconazol e itraconazol han demostrado la actividad in vitro más consistente contra este grupo de hongos. La rareza de estas micosis justifica describir las características clínicas, epidemiológicas y diagnósticas para ayudar a un reconocimiento inmediato y un tratamiento oportuno.Palabras clave: Feohifomicosis, Dematiáceos, Feohifomicosis subcutánea, Infecciones oportunistas, Agentes antifúngicos. AbstractPhaeohyphomycosis comprises a group of infections caused by black pigmented or dematiaceous fungi. In the last two decades the frequency of reporting and diversity of etiologic agents involved have increased, especially in immunosuppressed individuals. The main genera involved include Alternaria, Bipolaris, Cladophialophora and Exophiala. These fungi are typically found in the soil and introduced through inhalation or trauma. The spectrum of associated diseases also has broadened and includes superficial and deep cutaneous infections, allergic disease, pneumonia, brain abscess and disseminated infection. The laboratory diagnosis is based on the morphological characteristics of the agents as observed by direct microscopic examination and histopathology. Treatment is often challenging and depends upon

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Disseminated Phaeohyphomycosis: Review of an Emerging Mycosis

Cited by 365 publications

References 84 publications

Exserohilum Infections Associated with Contaminated Steroid Injections

Exserohilum Infections Associated with Contaminated Steroid Injections

A Rare Case of Curvularia Hawaiiensis in the Ear Following Trauma

Feohifomicosis, una infección fúngica oportunista emergente

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