Exserohilum infections in Australian Queensland children

Abstract

Summary Background Exserohilum species are environmental moulds that can cause skin infection and sinusitis in both normal and immunosuppressed children. This study reviews paediatric cases of Exserohilum infection in Queensland, Australia, to identify the spectrum of disease and its clinical course. Methods All culture‐positive samples of Exserohilum species in children <18 years of age were identified from the Queensland Health Laboratory database (April 2003‐April 2018). Clinical information was recorded from medical records. Results Eleven children were identified, and all had isolated Exserohilum rostratum. The mean age was 7.4 years (range 2.3‐17.8) and 64% female. Four immunocompetent children (36%) had a skin infection (2/4), chronic sinusitis (1/4) or otitis externa (1/4). Seven children (64%) had an underlying oncological diagnosis with E. rostratum causing local skin infection (2/7), invasive rhinosinus disease (3/7) or disseminated infection (2/7). All oncological patients were empirically started on liposomal amphotericin B with addition, or switch, to posaconazole or voriconazole. Conclusion Exserohilum rostratum infection of the skin has a favourable course, whereas rhinosinus infection can be rapidly invasive in the immunocompromised child requiring prompt surgical intervention and antifungal therapy. Susceptibility data support empiric use of liposomal amphotericin and/or posaconazole.

Exserohilum rostratum, a rare cause of opportunistic skin infection in children: Case report and review of the literature

“…E. rostratum was the species identified in all pediatric cases. Five cases were reported in Australia, two in the United States and one each in Canada, Bolivia, and Israel 1 . We did not find previous reports in Europe.…”

“…The treatment resulted in resolution of the lesion in most of the patients with cutaneous localized fungal infection, although two died from their underlying neoplastic disease or bacterial sepsis. Disseminated fungal infection was only confirmed in three cases 1,7,8 …”

“…While infection with Exserohilum and other dematiaceous molds are unusual, a trend toward a growing incidence of phaeohyphomycosis has been noted, likely related to the increasing number of at‐risk children 1 …”

“…Exserohilum species are environmental molds that may rarely cause skin and nasal infections, especially in immunocompromised children 1 . In this report, we present the case of a girl with a skin ulcer in which E rostratum was isolated.…”

Infección rino-sinusal por Exserohilum rostratum en un niño con leucemia mieloide aguda

“…Esta presentación clínica ha sido descrita previamente. En Australia, en una serie de 11 casos pediátricos con cultivo positivo para E. rostratum entre 2003 y 2018, 50% de ellos tuvieron compromiso rino-sinusal, destacando que esta afección puede ser rápidamente invasora en niños inmunocomprometidos 9 .…”