Organizing pneumonia secondary to Exophiala dermatitidis in cystic fibrosis: A case report

Radonjic, Aleksandar; Pakhalé, Smita; Aaron, Shawn D.; Earlam, Karen; Gaudet, Ena; Gomes, Marcio M.; Gupta, Ashish; Mulpuru, Sunita; Chin, Melanie

doi:10.1016/j.jcf.2019.12.010

Cited by 1 publication

(2 citation statements)

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“…Although our findings suggest that E. dermatitidis does not cause clinically significant lung disease in a majority of patients, other investigators have described individual cases where E. dermatitidis has caused an apparent pneumonic illness in CF [7,8]. Kondori et al identified 4 of 17 patients with E. dermatitidis in their sputum, who had received treatment with broadspectrum antifungals.…”

Section: Discussioncontrasting

confidence: 60%

“…However, the clinical consequences of E. dermatitidis in CF remain unclear. Cases of pneumonia with this organism have been reported [7,8], but a large cohort study of 1312 patients with CF in the Netherlands found that although isolation of E. dermatitidis was associated with older age, female sex and presence of Aspergillus spp., the detection of E. dermatitidis was not associated with significant differences in clinical measures, such as body mass index (BMI) and lung function [9].…”

Section: Introductionmentioning

confidence: 99%

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Isolation of Exophiala dermatitidis is not associated with worse clinical outcomes during acute pulmonary exacerbations in cystic fibrosis

Tewkesbury

Looi

Barry

et al. 2022

Journal of Medical Microbiology

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Introduction. The black yeast Exophiala dermatitidis has been isolated in respiratory samples from people with cystic fibrosis (CF). However, adequate detection may require longer incubation periods than the current UK national standard for CF respiratory samples. Furthermore, it is unclear whether isolation of E. dermatitidis is associated with poorer clinical outcomes in CF. Hypothesis/gap statement. E. dermatitidis does not cause clinically significant lung disease in CF adults. Aim. To evaluate differences in clinical outcomes over a 12 month period and during acute pulmonary exacerbations between CF adults with and without untreated E. dermatitidis. Methodology. Incubation times for respiratory samples on Sabouraud dextrose agar with chloramphenicol (SABC) plates at a large regional adult CF centre were extended from 2 to 7 days over a 1 month period. The number of patients from whom E. dermatitidis was isolated, and the length of incubation time prior to isolation, were recorded. Outcomes of treatment of exacerbations with intravenous antibiotics but in the absence of concomitant antifungal therapy were compared between those with and without E. dermatitidis, as were changes in lung function and body mass index (BMI) over a 12 month period. Results. Extended incubation unmasked the presence of E. dermatitidis in 22 of 132 patients; all isolations occurred after >48 h of incubation. Patients who isolated E. dermatitidis had lower rates of Pseudomonas aeruginosa isolation (P=0.02) and higher rates of non-tuberculous mycobacteria isolation (P=0.03), and were more likely to be prescribed a long-term antifungal medication (P=0.03), but had no differences in age, sex, baseline lung function or body mass index (BMI). There were no differences in response to treatment of acute exacerbations between patients with and without E. dermatitidis, or in change in forced expiratory volume in 1 s (FEV1), BMI and number of exacerbations over 12 months of follow-up. Conclusion. E. dermatitidis is not associated with worse clinical outcomes in CF. Given potential side effects and drug interactions, routine targeting of E. dermatitidis with antifungals during acute exacerbations is not advised.

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Section: Discussioncontrasting

confidence: 60%