No abstract available.
Exophiala* ; Korea* ; Phaeohyphomycosis* ; Wrist*

Exophiala species are dark pigmented fungi associated with phaeohyphomycosis that exhibit yeast-like or hyphal forms of the fungus in superficial subcutaneous locations or systemic disease. The incidence of subcutaneous tissue infection of Exophiala species has recently increased, particularly in immunocompromised hosts. In Korea, E. jeanselmei, E. dermatitidis, and E. salmonis were isolated from patients with phaeohyphomycosis. However, there have been no case reports of phaeohyphomycosis caused by E. oligosperma. Here we report the first case of phaeohyphomycosis caused by E. oligosperma in Korea. An 82-year-old female with competent immune function presented with multiple subcutaneous masses on the dorsum of the left hand and wrist. A histopathological examination of the skin specimen revealed granulomatous inflammation with fungal hyphae and yeast. Molecular identification was performed using internal transcribed spacer sequences analysis. The sequence showed 100% identity with the E. oligosperma strains. She was treated with oral itraconazole and showed improvement.
Aged, 80 and over ; Exophiala* ; Female ; Fungi ; Hand ; Humans ; Hyphae ; Immunocompromised Host ; Incidence ; Inflammation ; Itraconazole ; Korea ; Phaeohyphomycosis* ; Skin ; Subcutaneous Tissue ; Wrist ; Yeasts

No abstract available.
Exophiala* ; Phaeohyphomycosis*

Phaeohyphomycosis is an infection of humans and other animals caused by a number of phaeoid fungi. It is characterized by the development of dark-colored hyphae and other types of fungal elements in invaded tissues. Phaeohyphomycosis caused by Exophiala species is an unusual infection, but it has been reported with increasing frequency as laboratory methods for diagnosis have improved. A 68-year-old woman presented with yellowish round crusted plaque which is similar to actinic keratosis or keratoacanthoma on her right cheek. Histopathologic examination showed mononuclear cell infiltrate and dark-brown hyphae. The nucleotide sequence of internal transcribed spacer-2 was identical to that of Exophiala species. We report a case of phaeohyphomycosis mimicking skin cancer.
Aged ; Animals ; Base Sequence ; Cheek ; Diagnosis ; Exophiala* ; Female ; Fungi ; Humans ; Hyphae ; Keratoacanthoma ; Keratosis, Actinic ; Phaeohyphomycosis* ; Skin Neoplasms

OBJECTIVETo summarize the clinical features, imaging characteristics, diagnosis and treatment of a case with central nervous system infection caused by Exophiala dermatitidis, as well as to review the related literature.

METHODAssociated literature and clinical data of an 8-year-old boy who was diagnosed as central nervous system infection caused by Exophiala dermatitidis in Beijing Children's Hospital Affiliated to Capital Medical University and hospitalized twice from 2012 to 2014 were analyzed retrospectively.

RESULTThe boy was 8 years old with the chief complaint of dizziness for 2 months, intermittent fever for 1 month accompanied with spasm twice. He was diagnosed as bile ducts space-occupying lesions 2 years ago, when the pathological diagnosis was fungal infection. The boy was treated with irregular anti-fungal therapy. Then the boy developed nervous symptoms, impaired consciousness and abnormal physical activity that developed gradually. After hospitalization the cerebral MRI of the boy showed space-occupying lesions accompanied with edema of surrounding area. Filamentous fungi was found by brain biopsy, which was culture positive for Exophiala dermatitidis. After diagnosis the boy was treated with amphotericin B (AMB), voriconazole and 5-Fu, as well as symptomatic treatment. The state of the boy was improved gradually. Two months later, the boy could communicate with others normally and move personally. The lesions and edema seen on the MRI was decreased moderately. Accordingly, the boy was treated with oral voriconazole maintenance treatment for about 1 year and 4 months after discharge. During this period, the state of him was stable without symptoms. The lesions shown by MRI did not disappear but decreased on regular examination. However, recently the disease of the boy progressed again, with dizziness, neck pain, headache and progressive nervous symptoms (intermittent spasm, inability to cough, and impaired consciousness). The boy died at last, even with the active treatment at the second hospitalization. Exophiala dermatitidis was culture-positive again in his CSF, and was confirmed by PCR successfully.

CONCLUSIONThe central nervous system infection caused by Exophiala dermatitidis is rare. Clinical features of this disease were similar to those of other fungal CNS infection, cerebral MRI of which could show the similar lumpy lesions. Diagnosis of the disease should be based on pathology and culture.

Amphotericin B ; administration & dosage ; Antifungal Agents ; administration & dosage ; Brain ; diagnostic imaging ; microbiology ; pathology ; Central Nervous System Infections ; diagnosis ; drug therapy ; microbiology ; Cerebrospinal Fluid ; microbiology ; Child ; Drug Therapy, Combination ; Exophiala ; isolation & purification ; Fatal Outcome ; Fluorouracil ; administration & dosage ; Humans ; Magnetic Resonance Imaging ; Male ; Mycoses ; diagnosis ; drug therapy ; microbiology ; Radiography ; Voriconazole ; administration & dosage

BACKGROUND: Recently, identification of fungi have been supplemented by molecular tools, such as ribosomal internal transcribed spacer (ITS) sequence analysis. According to these tools, morphological Exophiala species was newly introduced or redefined. OBJECTIVE: This study was designed to investigate the phylogenetics based on ribosomal ITS sequence analysis from clinical Exophiala species isolated in Korea. METHODS: The strains of Exophiala species were 4 clinical isolates of phaeohyphomycosis agents kept in the department of dermatology, Dongguk University Medical Center(DUMC), Gyeongju, Korea. The DNAs of total 5 strains of Exophiala species were extracted by bead-beating method. Polymerase chain reaction of ITS region using the primer pairs ITS1-ITS4, was done and phylogenetic tree contributed from sequences of ITS region from 5 Korean isolates including E. dermatitidis CBS 109154 and comparative related strains deposited in GenBank. RESULTS: The strains of Exophiala species were 3 strains of E. dermatitidis, 1 strain of E. jeanselmei and 1 strain of Exophiala new species. Among the 3 subtypes (type A, B, C) of E. jeanselmei, E. jeanselmei DUMC 9901 belonged to type B. Of the 2 main types of E. dermatitidis (type A, B) and 3 subtypes of E. dermatitidis type A (A0, A1 and A2), two strains (E. dermatitidis CBS 709.95, E. dermatitidis CBS 109154) belonged to A0 subtypes, 1 strain (E. dermatitidis DUMC 9902) A1 subtype, respectively. CONCLUSION: Phylogenetic analysis of ITS region sequence provided useful information not only for new species identification but for the subtyping and origin of Exophiala species.
Dermatology ; DNA ; Exophiala ; Fungi ; Korea ; Phaeohyphomycosis ; Phylogeny ; Polymerase Chain Reaction ; Sequence Analysis ; Sprains and Strains

We report a case of cutaneous and subcutaneous phaeohyphomycosis caused by Exophiala jeanselmei after renal transplantation in Guangdong. A 66-year-old man who had a renal transplantation 6 years ago was admitted in October 2011 for the presence of 16 nodules (0.5-1.5 cm) found on his right middle finger, wrist and forearm for 5 months. Microscopic examination of the purulent exudate showed segmented and branched brown mycelium, and tissue biopsy and PAS staining showed fungal hyphae. The isolate was processed for morphological identification and molecular sequence analysis. A black colony was found after culture of the isolate on SDA at 26 degrees Celsius;, and small culture identified the isolate as Exophiala jeanselmei. ITS sequence analysis of the isolate showed a 100% homology with Exophiala jeanselmei. E-test strip was used in drug sensitivity test, and the isolate was sensitive to amphotericin B, voriconazole, itraconazole and fluconazole, but resistant to 5-flucytosine and caspofungin. Good response was obtained with surgical intervention, local injection and systemic antifungal treatment.
Aged ; Exophiala ; pathogenicity ; Humans ; Kidney Transplantation ; adverse effects ; Male ; Phaeohyphomycosis ; etiology ; Postoperative Complications

We report a rare case of fungemia due to Exophiala (Wangiella) dermatitidis in a 4-month-old female infant who was admitted to an intensive care unit with sudden infant death syndrome (SIDS). E. dermatitidiswas repeatedly isolated from blood cultures (on the 28th and 32nd day of hospitalization) of the patient, who died on the 44th day of hospitalization. The fungus was identified by its morphological characteristics and DNA sequencing of both the D1/D2 domain and the ITS region of rDNA. To our knowledge, this is the first reported case of E. dermatitidis fungemia in Korea.
DNA, Ribosomal ; Exophiala ; Female ; Fungemia ; Fungi ; Hospitalization ; Humans ; Infant ; Intensive Care Units ; Korea ; Sequence Analysis, DNA ; Sudden Infant Death

BACKGROUND: Despite the increase of infections caused by dematiaceous fungi, the antifungal susceptibility of these fungi has been the little study. It is necessary to perform antifungal susceptibility testing of dematiaceous fungi. Etest (AB Biodisk, Sweden) is a rapid, easy-to-perform in-vitro antifungal susceptibility test. OBJECTIVE: The purpose of the study was to investigate the minimal inhibitory concentration (MICs) of dematiaous fungi isolated from skin lesion using Etest. METHODS: The dematiaceous fungal strains studied were nine clinical isolates of chromoblastomycosis and phaeohyphomycosis agents (3 strains of Exophiala dermatitidis, 4 strains of Fonsecaea pedrosoi, 2 strains of Exophiala jeanselmei) and two standard strains (Aspergillus flavus KCTC 6905, Aspergillus fumigatus KCTC 6145). MIC endpoints of Etest for amphotericin B (AMB) and itraconazole (ITZ) susceptibility were read after 72, 96, and 120 hours incubation for each isolates on RPMI 1640 agar. RESULTS: MIC of AMB was 0.125~1.0 microgram/mL on E. dermatitidis & F. pedrosoi, and 0.19~0.25 microgram/mL on E. jeanselmei. MIC of ITZ was 0.38~1.5 microgram/mL on E. dermatitidis, 0.016~0.125 microgram/mL on F. pedrosoi, and 0.064~0.25 microgram/mL on E. jeanselmei. Two strains of E. dermatitidis isolated from Korean patients with phaeohyphomycosis showed ITZ-resistant. CONCLUSION: This study showed that Etest represented a simple and efficacious method for antifungal susceptibility testing of dematiaceous fungi.
Agar ; Amphotericin B ; Aspergillus fumigatus ; Chromoblastomycosis ; Exophiala ; Fungi ; Humans ; Itraconazole ; Phaeohyphomycosis ; Skin

We report a case of subcutaneous phaeohyphomycosis caused by Exophiala (E.) jeanselmei in a 75-year-old female, who showed subcutaneous abscesses on the both forearms for 8 months. Histopathologically, suppurative granulomatous inflammation and short hyphae & spores were observed. Fungal culture grew out the typical black-gray velvety colonies of E. jeanselmei after 3 weeks. The isolate grew well at 25degrees C, but very poorly at 37degrees C. No growth could be observed at 40degrees C. We confirmed E. jeanselmei by colony & microscopic morphology and temperature tolerance test. The patient had been treated with fluconazole for 3 months.
Abscess ; Aged ; Exophiala* ; Female ; Fluconazole ; Forearm ; Humans ; Hyphae ; Inflammation ; Phaeohyphomycosis* ; Spores