Fungi have become increasingly important causes of nosocomial bloodstream infections. The major cause of nosocomial fungemia has been Candida spp, but increasingly molds and other yeasts have caused disease. Exophiala jeanselmei and members of the genus Rhinocladiella are dematiaceous moulds, which have been infrequently associated with systemic infection and have not been described as causes of fungemia. In this paper, the occurrence of 23 cases of fungemia due to these organisms over a 10-month period is reported and the clinical characteristics of patients and outcomes are described. The majority of patients were immunosuppressed; 21 of 23 (91%) had received blood products and 78% had a central venous catheter. All patients had at least one manifestation of fever, but only one patient had signs or symptoms suggesting deep-seated infection. Antifungal therapy was given to 19 of the 23 patients; of those who did not receive therapy, 3 died prior to the culture result and 1 had been discharged without therapy. Antifungal susceptibility of the organisms showed activity of amphotericin B, itraconazole, and the new triazole antifungals voriconazole and posaconazole. E. jeanselmei and Rhinocladiella species are potential causes of nosocomial fungemia and may be associated with systemic infection.Systemic fungal infections are increasingly frequent in hospitalized patients (4). Whereas Candida species account for the majority of fungal infections, the spectrum of fungi that may cause infection is growing (2). Exophiala jeanselmei and Rhinocladiella species are dematiaceous fungi widely distributed in the environment, especially in soil, wood, polluted water, and sewage (7, 17). The clinical spectrum of infection caused by these organisms include mycetomas, chromoblastomycosis, and pheohyphomycosis, either superficial, cutaneous, subcutaneous, or systemic (10, 25). Deep-seated or systemic infections due to E. jeanselmei or Rhinocladiella are rare, with case reports of infection in the lungs (14, 26), brain (9, 30), peritoneum (1,12,22), and esophagus (6, 27). In addition, there is a single case of possible hematogenous dissemination of E. jeanselmei in a patient who developed endocarditis and arthritis (24). However, there have been no reports of fungemia due to these fungi. In this paper we report 23 cases of fungemia due to E. jeanselmei alone, E jeanselmei in combination with a Rhinocladiella species, or a Rhinocladiella species alone.
MATERIALS AND METHODSThe University Hospital of the Universidade Federal do Rio de Janeiro is a tertiary-care hospital with 540 beds, including a 6-bed bone marrow transplant unit, a 20-bed intensive care unit, and a 6-bed semi-intensive postoperative unit. Laboratory records were reviewed to identify patients with positive blood cultures from December 1996 through October 1997. In December 1996, E. jeanselmei was isolated from blood cultures of two patients. During 1997, 21 other patients had positive blood cultures for either E. jeanselmei or a Rhinocladiella species.We reviewed th...