Exophiala: Difference between revisions
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Exophiala
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== Clinical Manifestations == |
== Clinical Manifestations == |
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* Primarily in immunosuppressed or eldery patients |
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** Most commonly, cutaneous and subcutaneous infection, including [[phaeohyphomycosis]], [[chromoblastomycosis]], [[Fungal keratitis|keratitis]], and nail infections |
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* Also pneumonia, brain abscess, disseminated disease |
** Also pneumonia, brain abscess, disseminated disease |
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* [[Exophiala dermatitidis]] is neurotropic, with high mortality |
* [[Exophiala dermatitidis]] is neurotropic, with high mortality, and this can occur in immunocompetent (often Asian) patients |
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* Known to colonize [[cystic fibrosis]] patients (3-20%) |
* Known to colonize [[cystic fibrosis]] patients (3-20%) |
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== Management == |
== Management == |
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* No validated clinical breakpoints to guide therapy |
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* [[Is treated by::Itraconazole]] or oral [[Is treated by::terbinafine]], alone or in combination |
* [[Is treated by::Itraconazole]] or oral [[Is treated by::terbinafine]], alone or in combination |
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* [[Is treated by::Amphotericin B]] is also commonly used, and [[Is treated by::voriconazole]] also likely works |
* [[Is treated by::Amphotericin B]] is also commonly used, and [[Is treated by::voriconazole]] also likely works |
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* Echinocandins are likely ineffective |
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{{DISPLAYTITLE:''Exophiala''}} |
{{DISPLAYTITLE:''Exophiala''}} |
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Latest revision as of 15:00, 22 April 2026
Background
- Genus of dematiaceous filamentous fungi
- Exophiala dermatitidis is the most clinically relevant "black yeast"
Clinical Manifestations
- Primarily in immunosuppressed or eldery patients
- Most commonly, cutaneous and subcutaneous infection, including phaeohyphomycosis, chromoblastomycosis, keratitis, and nail infections
- Also pneumonia, brain abscess, disseminated disease
- Exophiala dermatitidis is neurotropic, with high mortality, and this can occur in immunocompetent (often Asian) patients
- Known to colonize cystic fibrosis patients (3-20%)
Diagnosis
- On histology of cutaneous infection, shows epidermal hyperkeratosis, hyperplasia, acanthosis, pseudoepitheliomatous and intraepidermal pustules
- Culture
- Colony: yeast-like, black, and mucoid
- Microscopy
- Can have pigmented fungal elements within or adjoining multinucleate giant cells
- Yeast form is budding and black, while filamentous form is septate and pigmented.
Management
- No validated clinical breakpoints to guide therapy
- Itraconazole or oral terbinafine, alone or in combination
- Amphotericin B is also commonly used, and voriconazole also likely works
- Echinocandins are likely ineffective
