Exophiala species
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Exophiala /
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- Exophiala dermatitidis is the most clinically relevant "black yeast"
Clinical Manifestations
- Causes cutaneous and subcutaneous infection most commonly, including chromoblastomycosis, eye infections, and nail infections
- Also pneumonia, brain abscess, disseminated disease (in elderly and immunosuppressed patients including AIDS and chemotherapy)
- E. dermatitidis is neurotropic, with high mortality, and is 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
- Itraconazole or oral terbinafine, alone or in combination
- Amphotericin B is also commonly used, and voriconazole also likely works
