Gram stain to the rescue: a case report of cerebral phaeohyphomycosis by Cladophialophora bantiana in an immunocompetent 24-year-old

Abstract

Background Fungal brain abscesses in immunocompetent patients are exceedingly rare. Cladophialophora bantiana is the most common cause of cerebral phaeohyphomycosis, a dematiaceous mold. Radiological presentation can mimic other disease states, with diagnosis through surgical aspiration and growth of melanized fungi in culture. Exposure is often unknown, with delayed presentation and diagnosis. Case presentation We present a case of cerebral phaeohyphomycosis in a 24-year-old with no underlying conditions or risk factors for disease. He developed upper respiratory symptoms, fevers, and headaches over the course of 2 months. On admission, he underwent brain MRI which demonstrated three parietotemporal rim-enhancing lesions. Stereotactic aspiration revealed a dematiaceous mold on staining and the patient was treated with liposomal amphotericin B, 5-flucytosine, and posaconazole prior to culture confirmation. He ultimately required surgical excision of the brain abscesses and prolonged course of antifungal therapy, with clinical improvement. Conclusions Culture remains the gold standard for diagnosis of infection. Distinct microbiologic findings can aid in identification and guide antimicrobial therapy. While little guidance exists on treatment, patients have had favorable outcomes with surgery and combination antifungal therapy. In improving awareness, clinicians may accurately diagnose disease and initiate appropriate therapy in a more timely manner.

Phaeohyphomycosis: A Review

“…A. infectoria is an emerging species of this disease [21,22]. C. bantiana is a highly neurotropic dematiaceous fungus in the order Chaetothyriales and the most common cause of human cerebral phaeohyphomycosis [12,23].…”

Cladophialophora bantiana metabolites are efficient in the larvicidal and ovicidal control of Aedes aegypti, and Culex quinquefasciatus and have low toxicity in zebrafish embryo

“…(Wang et al, 2010) that are used in agriculture, medicine, and trades (Porras-Alfaro & Bayman, 2011). A species of endophytic fungi refers to Cladophialophora bantiana, which, although considered an emerging pathogen in animals, including humans (Prenafeta-Boldú et al, 2015;Mody et al, 2022), the secondary metabolite connected to central nervous system dysfunction may help control mosquitoes that act as important epidemiological disease vectors. As Velayutham et al (2022) highlight, D. rerio is a species used worldwide in drug toxicity tests, secondary metabolites, and pollutants, among others.…”

Molecular Characterisation of Cladophialophora species Isolated from Brain Abscess in a Renal Transplant Recipient

“…Primary cerebral phaeohyphomycosis is a rare infection caused by darkly pigmented fungi, called as dematiaceous moulds with melanized cell wall, which carry a high mortality rate up to 70% [1][2][3]. In a review of cases of primary central nervous system phaeohyphomycosis, the most frequently isolated species was Cladophialophora bantiana (48%) and the next most frequent isolate was Ramichloridium mackenziei (13%) [2,4].…”

“…In a review of cases of primary central nervous system phaeohyphomycosis, the most frequently isolated species was Cladophialophora bantiana (48%) and the next most frequent isolate was Ramichloridium mackenziei (13%) [2,4]. Cladophialophora bantiana is strikingly neurotropic, ubiquitously present in soil, prefers warmer climate with high humidity and distributed widely (Asia, North and South America, Europe, Africa) [1,5,6]. Though its propensity for nervous tissue is not fully understood, a possible mechanism involves melanin production which interferes with microbial recognition, scavenges free radicals and prevents eradication of fungi from brain parenchymal tissue [7,8].…”