Exophiala dermatitidis infection in non-cystic fibrosis bronchiectasis

Abstract

A 54-year-old female presented with an exacerbation of right middle lobe bronchiectasis. A bronchoscopic bronchial washing and repeated trials of sputum culture consistently recovered no other infectious agent except Exophiala dermatitidis. Her illness was improved by administrations of intravenous miconazole and nebulized amphotericin B when sputum cultures yielded no fungi, demonstrating a pathogenic role of the fungi. The present case illustrates E. dermatitidis as a pathogenic agent in non-cystic fibrosis bronchiectasis.

WdStuAp, an APSES Transcription Factor, Is a Regulator of Yeast-Hyphal Transitions in Wangiella ( Exophiala ) dermatitidis

“…First identified as an agent of subcutaneous chromoblastomycosis, it is today considered a paradigm for the emerging mycosis known as phaeohyphomycosis, because this polymorphic fungus also causes systemic and sometimes fatal disease, as well as chronic superficial, cutaneous, and subcutaneous infections (13,24). Systemic phaeohyphomycosis caused by W. dermatitidis includes respiratory, intestinal, cardiac, and cerebral diseases (6,27,47). In the manner of most dematiaceous pathogens of humans, W. dermatitidis is a saprophyte, although isolations from nature are infrequent and most strains are from patients (22,23).…”

The treatment of pulmonaryWangiella dermatitidisinfection with oral voriconazole

“…Human infection from W. dermatitidis was first reported in 1934 and limited reports in subsequent years suggest it can affect any organ, with the skin, lungs and central nervous system (CNS) being the most common sites of infection (1–4). The majority of these cases occurred in East Asia and the United States (2, 3, 7–12). Due to the rarity of human infections, definite risk factors have yet to be established.…”

“…Patients with pulmonary infections typically present with a history of an unresolved respiratory illness despite antibiotic therapy and radiographic evidence of infiltrates, nodules or abscesses (4, 5, 18). Invasive W. dermatitis infections generally have a high mortality rate and there are only three reports of non‐cystic fibrosis patients surviving pulmonary infections caused by this organism (2, 3, 5, 8–12).…”

“…Exactly which antifungal(s) should be utilized for W. dermatitidis remains perplexing. Amphotericin B, flucytosine, ketoconazole, itraconazole, miconazole and fluconazole have all been used; however, no single agent is associated with improved outcomes (2, 3, 5, 8–11). Each of the three survivors of pulmonary infection was treated with amphotericin B at varying doses (3, 9, 10).…”

“…Amphotericin B, flucytosine, ketoconazole, itraconazole, miconazole and fluconazole have all been used; however, no single agent is associated with improved outcomes (2, 3, 5, 8–11). Each of the three survivors of pulmonary infection was treated with amphotericin B at varying doses (3, 9, 10). Adjunct therapy with flucytosine was reported in two of these patients, one of whom required substitution with ketoconazole due to elevations in hepatic transaminase levels (3, 9).…”