Management of an Outbreak of Exophiala dermatitidis Bloodstream Infections at an Outpatient Oncology Clinic

Vasquez, Amber; Zavasky, Dani Margot; Chow, Nancy A.; Gade, Lalitha; Zlatanic, E; Elkind, Sandra; Litvintseva, Anastasia P.; Pappas, Peter G.; Perfect, John R.; Revankar, Sanjay G.; Lockhart, Shawn R.; Chiller, Tom; Ackelsberg, Joel; Vallabhaneni, Snigdha

doi:10.1093/cid/cix948

Cited by 20 publications

(21 citation statements)

References 9 publications

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“…Exophiala is a fungi genus of the Herpotrichiellaceae family that has been involved in infections known as phaeohyphomycosis, particularly in immunocompromised hosts. Most of these infections affect the skin,44 but Exophiala can also cause systemic infections that involve the lungs or the central nervous system 44. Of particular interest, Oztas et al reported the case of a systemic infection by Exophiala dermatitidis mimicking PSC in a 24-year-old woman without immunodeficiency 45.…”

Section: Discussionmentioning

confidence: 99%

Fungi participate in the dysbiosis of gut microbiota in patients with primary sclerosing cholangitis

Lemoinne¹,

Kemgang²,

Belkacem³

et al. 2019

Gut

152

134

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ObjectivePatients with primary sclerosing cholangitis (PSC) were previously shown to display a bacterial gut dysbiosis but fungal microbiota has never been examined in these patients. The aim of this study was to assess the fungal gut microbiota in patients with PSC.DesignWe analysed the faecal microbiota of patients with PSC and concomitant IBD (n=27), patients with PSC and no IBD (n=22), patients with IBD and no PSC (n=33) and healthy subjects (n=30). Bacterial and fungal composition of the faecal microbiota was determined using 16S and ITS2 sequencing, respectively.ResultsWe found that patients with PSC harboured bacterial dysbiosis characterised by a decreased biodiversity, an altered composition and a decreased correlation network density. These alterations of the microbiota were associated with PSC, independently of IBD status. For the first time, we showed that patients with PSC displayed a fungal gut dysbiosis, characterised by a relative increase in biodiversity and an altered composition. Notably, we observed an increased proportion of Exophiala and a decreased proportion of Saccharomyces cerevisiae. Compared with patients with IBD and healthy subjects, the gut microbiota of patients with PSC exhibited a strong disruption in bacteria-fungi correlation network, suggesting an alteration in the interkingdom crosstalk.ConclusionThis study demonstrates that bacteria and fungi contribute to gut dysbiosis in PSC.

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Section: Discussionmentioning

confidence: 99%

Fungi participate in the dysbiosis of gut microbiota in patients with primary sclerosing cholangitis

Lemoinne¹,

Kemgang²,

Belkacem³

et al. 2019

Gut

152

134

View full text Add to dashboard Cite

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“…Occasionally, it can cause mildly invasive systemic infections that are associated with significant morbidity and mortality. Typical infections are seen in immunocompromised hosts such as transplant recipients, oncology, and pediatric patients, where it manifests itself as a subcutaneous disease and rarely as deep mycoses [9,[22][23][24][25][26]. Particularly in East Asia, E. dermatitidis was detected in disseminated and neurotropic infections with high mortality [11,27].…”

Section: Introductionmentioning

confidence: 99%

The Neurotropic Black Yeast Exophiala dermatitidis Induces Neurocytotoxicity in Neuroblastoma Cells and Progressive Cell Death

Lavrin

Konte

Kostanjšek

et al. 2020

Cells

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The neurotropic and extremophilic black yeast Exophiala dermatitidis (Herpotrichellaceae) inhabits diverse indoor environments, in particular bathrooms, steam baths, and dishwashers. Here, we show that the selected strain, EXF-10123, is polymorphic, can grow at 37 °C, is able to assimilate aromatic hydrocarbons (toluene, mineral oil, n-hexadecane), and shows abundant growth with selected neurotransmitters (acetylcholine, gamma-aminobutyric acid, glycine, glutamate, and dopamine) as sole carbon sources. We have for the first time demonstrated the effect of E. dermatitidis on neuroblastoma cell model SH-SY5Y. Aqueous and organic extracts of E. dermatitidis biomass reduced SH-SY5Y viability by 51% and 37%, respectively. Melanized extracellular vesicles (EVs) prepared from this strain reduced viability of the SH-SY5Y to 21%, while non-melanized EVs were considerably less neurotoxic (79% viability). We also demonstrated direct interactions of E. dermatitidis with SH-SY5Y by scanning electron and confocal fluorescence microscopy. The observed invasion and penetration of neuroblastoma cells by E. dermatitidis hyphae presumably causes the degradation of most neuroblastoma cells in only three days. This may represent a so far unknown indirect or direct cause for the development of some neurodegenerative diseases such as Alzheimer’s.

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“…Previous cases concerning the clinical manifestation and diagnostic procedure have underscored the importance of considering the patient's immune status and culture test findings (10). The beta-D-glucan test has also shown some utility for detecting fungal infection (11), as 9 out of 12 cases with E. dermatitidis infection showed an increase in its level, although our case did not. Identification can also be achieved using MALDI-TOF MS, which has been shown to be a reliable way of distinguishing bacteria in community-based analyses.…”

Section: Discussionmentioning

confidence: 55%

“…Clinically, E. dermatitidis is the cause of skin chromomycosis (7). In addition, pulmonary infection with the pathogen has been reported in bronchiectasis (9) and hematological malignancy (10); outbreaks due to fungal contamination also happen (11). Fungemia caused by E. dermatitidis is known to be associated with catheter-related infection (12).…”

Section: Discussionmentioning

confidence: 99%

<i>Exophiala dermatitidis</i> Fungemia Diagnosed Using Time-of-flight Mass Spectrometry during Chemotherapy for Malignant Lymphoma and Successful Treatment with Voriconazole

et al. 2019

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Infectious diseases, including those caused by fungi, remain important issues in patients receiving malignant lymphoma chemotherapy. We herein report a rare case of Exophiala dermatitidis fungemia during chemotherapy in a 67-year-old woman admitted to our hospital. She had a fever that could not be resolved despite antifungal therapy. Yeast-like fungi were detected in blood culture samples, but biochemical identification was difficult. E. dermatitidis , a black mold, was identified using time-of-flight mass spectrometry. The patient finally improved after her treatment was switched to voriconazole. Fungal infection is difficult to diagnose and treat, but this novel approach can improve patients' outcomes.

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Management of an Outbreak of Exophiala dermatitidis Bloodstream Infections at an Outpatient Oncology Clinic

Cited by 20 publications

References 9 publications

Fungi participate in the dysbiosis of gut microbiota in patients with primary sclerosing cholangitis

Fungi participate in the dysbiosis of gut microbiota in patients with primary sclerosing cholangitis

The Neurotropic Black Yeast Exophiala dermatitidis Induces Neurocytotoxicity in Neuroblastoma Cells and Progressive Cell Death

<i>Exophiala dermatitidis</i> Fungemia Diagnosed Using Time-of-flight Mass Spectrometry during Chemotherapy for Malignant Lymphoma and Successful Treatment with Voriconazole

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