Cladophialophora: Difference between revisions
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Cladophialophora
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* Includes ''[[Cladophialophora bantiana]]'' and ''[[Cladophialophora modesta]]'', which are neurotropic and cause CNS disease |
* Includes ''[[Cladophialophora bantiana]]'' and ''[[Cladophialophora modesta]]'', which are neurotropic and cause CNS disease |
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* Other ''Cladophialophora'' species may cause mild cutaneous lesions to disseminated disease. |
* Other ''Cladophialophora'' species may cause mild cutaneous lesions to disseminated disease. |
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=== Microbiology === |
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* ''[[Cladophialophora bantiana]]'' and ''[[Cladophialophora modesta]]'', which cause [[fungal brain abscesses]] |
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* ''[[Cladophialophora arxii]]'', ''[[Cladophialophora emmonsii]]'', and ''[[Cladophialophora modesta]]'' can cause brain abscess as well as non-CNS disease |
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* ''[[Cladophialophora carionii]]'' causes [[chromoblastomycosis]] |
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* Many non-pathogenic species, which can be laboratory contaminants |
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=== Epidemiology === |
=== Epidemiology === |
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* More common in India |
* More common in India |
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* Associated with soil, bark, or carbon-rich environments, like coal mining or sawdust |
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* More common in gardeners and farmers, but not exclusive |
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* Unclear if acquired by inhalation or implantation |
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== Clinical Presentation == |
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* Certain species may present as [[fungal brain abscess]] |
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== Diagnosis == |
== Diagnosis == |
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* [[Is treated by::Amphotericin B]], [[Is treated by::flucytosine]], [[Is treated by::caspofungin]] and [[Is treated by::terbinafine]], or an extended spectrum triazole may be tried when surgical resection is not possible |
* [[Is treated by::Amphotericin B]], [[Is treated by::flucytosine]], [[Is treated by::caspofungin]] and [[Is treated by::terbinafine]], or an extended spectrum triazole may be tried when surgical resection is not possible |
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** For ''[[Cladophialophora bantiana]]'' infections, the combination of the three drugs ([[Is treated by::flucytosine]], [[Is treated by::micafungin]] and [[Is treated by::posaconazole]]) is recommended based on a mouse model[[CiteRef::mariné2009co]] |
** For ''[[Cladophialophora bantiana]]'' infections, the combination of the three drugs ([[Is treated by::flucytosine]], [[Is treated by::micafungin]] and [[Is treated by::posaconazole]]) is recommended based on a mouse model[[CiteRef::mariné2009co]] |
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** [[Is treated by::Isavuconazole]] has very promising responses in CNS infections, though limited data[[CiteRef::schwartz2019is]] |
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{{DISPLAYTITLE:''Cladophialophora'' species}} |
{{DISPLAYTITLE:''Cladophialophora'' species}} |
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Revision as of 19:43, 3 November 2019
- Includes Cladophialophora bantiana and Cladophialophora modesta, which are neurotropic and cause CNS disease
- Other Cladophialophora species may cause mild cutaneous lesions to disseminated disease.
Background
Microbiology
- Cladophialophora bantiana and Cladophialophora modesta, which cause fungal brain abscesses
- Cladophialophora arxii, Cladophialophora emmonsii, and Cladophialophora modesta can cause brain abscess as well as non-CNS disease
- Cladophialophora carionii causes chromoblastomycosis
- Many non-pathogenic species, which can be laboratory contaminants
Epidemiology
- More common in India
- Associated with soil, bark, or carbon-rich environments, like coal mining or sawdust
- More common in gardeners and farmers, but not exclusive
- Unclear if acquired by inhalation or implantation
Clinical Presentation
- Certain species may present as fungal brain abscess
Diagnosis
- Culture
- Microscopy
- Long, delicate, branching chains of hydrophobic brown conidia and lacking yeast cells, with brown septate hyphae
- The species (and Cladosporium) are differentiated by physiologic tests include temperature tolerance, gelatin liquefaction, cycloheximide growth, urease test, and the nitrate test
- Microscopy
- Histopathology is necessary for subcutaneous infections
Management
- Surgical resection is recommended when possible
- CNS disease may not respond to antifungal therapy
- Amphotericin B, flucytosine, caspofungin and terbinafine, or an extended spectrum triazole may be tried when surgical resection is not possible
- For Cladophialophora bantiana infections, the combination of the three drugs (flucytosine, micafungin and posaconazole) is recommended based on a mouse model1
- Isavuconazole has very promising responses in CNS infections, though limited data2
References
- ^ Marçal Mariné, F. Javier Pastor, Josep Guarro. Combined antifungal therapy in a murine model of disseminated infection byCladophialophora bantiana. Medical Mycology. 2009;47(1):45-49. doi:10.1080/13693780802526840.
- ^ Stefan Schwartz, Oliver A Cornely, Kamal Hamed, Francisco M Marty, Johan Maertens, Galia Rahav, Raoul Herbrecht, Werner J Heinz. Isavuconazole for the treatment of patients with invasive fungal diseases involving the central nervous system. Medical Mycology. 2019. doi:10.1093/mmy/myz103.
