Femoral osteomyelitis due to Cladophialophora arxii in a patient with chronic granulomatous disease

Shigemura, Tomonari; Agematsu, Kazunaga; Yamazaki, Tomoo; Eriko, K.; Yasuda, Gen; Nishimura, Kazuko; Koike, Kenichi

doi:10.1007/s15010-009-8238-9

Cited by 20 publications

(12 citation statements)

References 18 publications

(16 reference statements)

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“…Posaconazole and itraconazole (MIC 90 , 0.125 g/ml) demonstrated the best in vitro activities, followed by isavuconazole (MIC 90 , 0.5 g/ml). Some clinical experience suggests that therapy with itraconazole was successfully used in treating a C. bantiana cerebral infection (25,35), eumycetoma (7), and C. arxii osteomyelitis (53). Treatment with posaconazole is supported by our in vitro results, other in vitro data from small series (n ϭ 5, range 0.06 to 0.5 g/ml) (16), data for a clinical case (18), and data from murine infection models in which posaconazole prolonged the survival of mice and reduced the level of brain fungal burden compared to that achieved with itraconazole and amphotericin B (1, 39).…”

Section: Discussionmentioning

confidence: 99%

“…Within the genus, the majority of brain abscesses with fatal outcomes are associated with Cladophialophora bantiana (formerly Cladosporium bantianum, Cladosporium trichoides, Cladosporium trichoides var. chlamydosporum, Torula bantiana, and Xylohypha bantiana), a neurotropic fungus, although severe phaeohyphomycotic infections are also caused by novel Cladophialophora species like C. modesta (40,44), C. arxii (53,56), C. emmonsii (Xylohypha emmonsii) (45), C. devriesii (22,28,42) C. saturnica (4), and C. boppii (34). Moreover, Exophiala dermatitidis and Rhinocladiella mackenziei, other members of the black yeast group, are also frequently isolated from cerebral infections (8,27,37).…”

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confidence: 99%

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Use of Amplified Fragment Length Polymorphism To Identify 42 Cladophialophora Strains Related to Cerebral Phaeohyphomycosis with In Vitro Antifungal Susceptibility

et al. 2010

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The amplified fragment length polymorphism technique has been applied to identify neurotropic chaetothyrialean black yeasts and relatives from clinical sources. Cladophialophora bantiana, C. emmonsii, C. arxii, C. devriesii, and C. modesta, previously identified on the basis of sequencing and phenotypic and physiological criteria, were confirmed by cluster analysis, demonstrating the clear separation of C. bantiana as a rather homogeneous group from the other species. C. bantiana is a neurotropic fungus causing cerebral abscesses with a mortality of up to 70%. Successful therapy consists of neurosurgical intervention and optimal antifungal therapy. Since the latter is not clearly defined in a large series, we tested the in vitro activities of eight antifungal drugs against clinical isolates of C. bantiana (n ‫؍‬ 37), C. modesta (n ‫؍‬ 2), C. arxii (n ‫؍‬ 1), C. emmonsii (n ‫؍‬ 1), and C. devriesii (n ‫؍‬ 1), all of which had caused invasive infections. The resulting MIC 90 s for all neurotropic C. bantiana strains were as follows, in increasing order: posaconazole, 0.125 g/ml; itraconazole, 0.125 g/ml; isavuconazole, 0.5 g/ml; amphotericin B, 1 g/ml; voriconazole, 2 g/ml; anidulafungin, 2 g/ml; caspofungin, 4 g/ml; and fluconazole, 64 g/ml. On the basis of these in vitro results and the findings of previous clinical and animal studies, posaconazole seems to be a good alternative to the standard treatment, amphotericin B, for C. bantiana cerebral infections. The new agent isavuconazole, which is also available as an intravenous preparation, has adequate activity against C. bantiana.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Use of Amplified Fragment Length Polymorphism To Identify 42 Cladophialophora Strains Related to Cerebral Phaeohyphomycosis with In Vitro Antifungal Susceptibility

et al. 2010

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“…Other organisms associated with single case reports include P. obovatum, E. oligosperma, C. arxii, M. mycetomatis, P. richardsiae, F. pedrosoi, and P. parasiticum (94,390,398,472,512,689,812). Itraconazole was the most common single agent used with success (398,512,689).…”

Section: Phaeohyphomycosismentioning

confidence: 99%

“…Itraconazole was the most common single agent used with success (398,512,689). Antifungal therapy for all these cases is usually prolonged, i.e., Ͼ6 months and up to 2 years.…”

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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“…Of 203 infections in 23 patients with CGD followed at our center over a 21-year period, the frequency of osteomyelitis was 7%, of lung infections 34%, and of lymphadenitis 15% [5]. Aspergillus spp., Serratia spp., and Staphylococcus aureus were reported as pathogens causing osteomyelitis in patients with CGD [6,7]. This is the first case report of osteomyelitis caused by trimethoprim/sulfamethoxazole-resistant E. tarda infection in a patient with X-linked chronic granulomatous disease (X-CGD).…”

Section: Introductionmentioning

confidence: 93%

Osteomyelitis due to trimethoprim/sulfamethoxazole-resistant Edwardsiella tarda infection in a patient with X-linked chronic granulomatous disease

et al. 2011

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Edwardsiella tarda, a catalase-positive bacillus widely distributed throughout nature, is generally susceptible to trimethoprim/sulfamethoxazole. We describe osteomyelitis due to trimethoprim/sulfamethoxazole-resistant E. tarda in a patient with chronic granulomatous disease (CGD). Once E. tarda acquires antibiotic resistance, infected CGD patients may develop severe infections with unforeseeable consequences.

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Femoral osteomyelitis due to Cladophialophora arxii in a patient with chronic granulomatous disease

Cited by 20 publications

References 18 publications

Use of Amplified Fragment Length Polymorphism To Identify 42 Cladophialophora Strains Related to Cerebral Phaeohyphomycosis with In Vitro Antifungal Susceptibility

Use of Amplified Fragment Length Polymorphism To Identify 42 Cladophialophora Strains Related to Cerebral Phaeohyphomycosis with In Vitro Antifungal Susceptibility

Melanized Fungi in Human Disease

Osteomyelitis due to trimethoprim/sulfamethoxazole-resistant Edwardsiella tarda infection in a patient with X-linked chronic granulomatous disease

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