Nosocomial Fungemia Due to Exophiala jeanselmei var. jeanselmei and a Rhinocladiella Species: Newly Described Causes of Bloodstream Infection

Abstract

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...

Spectrum of Clinically RelevantExophialaSpecies in the United States

“…Epidemics caused by these species have not been observed, but repeated reports of pseudoepidemics due to contaminated fluids have been published (2,33,34). In the large set of strains analyzed for the present study, 12 of the 17 known invasive species were encountered, with the exception of E. castellanii, E. moniliae, E. nishimurae, E. salmonis, and E. pisciphila.…”

“…Most of these species have been reported from proven clinical cases, whereby slight, species-specific differences in preferred sites of infection were noted (15). Unfortunately, case reports continue to be published under obsolete concepts (33,34) and thus create confusion. The present study utilizes species circumscriptions pub- lished after the latest overview of clinically relevant Exophiala species, which dates back to the year 2000 (9).…”

Species Diversity and Polymorphism in theExophiala spiniferaClade Containing Opportunistic Black Yeast-Like Fungi

“…The environmental strains clustering in this group mostly originated from low-nutrient or sugary substrates, such as honey or silicone, or were found on damp surfaces on inert material in saunas and swimming pools (Table 1). Nucci et al (30,31) reported a nosocomial outbreak of 19 cases of fungemia caused by E. jeanselmei and originating from contaminated hospital water. All of the strains were shown to be strictly identical.…”

Feo-hifomicose subcutânea por Exophiala jeanselmei localizada na bolsa escrotal: relato de caso

“…An additional benefit is the minimal tissue loss with surgical removal of the lesions. 12 Complete surgical resection of localized lesions results in cure with no recurrence in the major- 3,8,11,13,14 Although the study conducted by Silveira and Nucci (2001) showed high minimum inhibitory concentration (MIC) values for dematiaceous fungi in general with fluconazole 15 , in the present case report the use of fluconazole preceding surgery led to a reduction in the size of the lesion and principally in the inflammatory process, improving local conditions during surgery and facilitating surgical removal of the entire lesion.…”