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CC BY 4.0 · Surg J (N Y) 2017; 03(02): e62-e68
DOI: 10.1055/s-0037-1598248
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cladophialophora Bantiana: A Rare Intracerebral Fungal Abscess—Case Series and Review of Literature

Maleeha Ahmad
1   Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania
,
Darren Jacobs
1   Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania
,
Hueizhi Hope Wu
2   Department of Pathology, Geisinger Health System, Danville, Pennsylvania
,
Donna M. Wolk
3   Department of Laboratory Medicine, Geisinger Health System, Danville, Pennsylvania
,
Syed A. Jaffar Kazmi
2   Department of Pathology, Geisinger Health System, Danville, Pennsylvania
3   Department of Laboratory Medicine, Geisinger Health System, Danville, Pennsylvania
,
Carlos Jaramillo
4   Department of Infectious Disease, Geisinger Health System, Danville, Pennsylvania
,
Steven A. Toms
5   Department of Neurosurgery, Lifespan Health System, Rhode Island
› Author Affiliations
Further Information

Publication History

17 September 2015

29 December 2016

Publication Date:
30 March 2017 (online)

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Abstract

Background Intracerebral Cladophialophora bantiana may carry up to a 70% mortality rate despite advances in surgical resection capabilities and the use of both systemic and intrathecal antifungal treatments.

Objectives The authors examined a retrospective case series of two patients with intracerebral infection from the rare, neurotropic fungus Cladophialophora bantiana and conducted a literature review to evaluate optimal therapies.

Patients/Methods At our institution, the patients' cases presented with raised intracranial features of headache, visual field cut, and/or memory loss, with a correspondingly wide variety of radiological differential diagnoses. It was the microbiological, histopathological, and genomic identification of C. bantiana that ensured targeted, individualized patient therapies.

Results and Conclusions Successful treatment depends on obtaining a complete surgical resection, an accurate microbiological diagnoses for mold identification, and an effective long-term, personalized antifungal treatment. Close radiographic surveillance is necessary to ensure complete eradication of pheoid fungi.

Keywords

Cladophialophora bantiana - pheohyphomycosis - voriconazole
 

  • References

  • 1 Ellison D, Love S, Chimelli L. , et al. Fungal infections. In: Neuropathology: A Reference Text of CNS Pathology. 3rd ed. Edinburgh: Mosby-Elsevier; 2013: 385-401
    Google Scholar
  • 2 Ajantha GS, Raghavendra D, Kulkarni R. Cladophialophora bantiana, the neurotropic fungus – a mini review. J Clin Diagn Res 2011; 5: 1301-1306
    PubMedGoogle Scholar
  • 3 Garzoni C, Markham L, Bijlenga P, Garbino J. Cladophialophora bantiana: a rare cause of fungal brain abscess. Clinical aspects and new therapeutic options. Med Mycol 2008; 46 (05) 481-486
    CrossrefPubMedGoogle Scholar
  • 4 Revankar SG, Sutton DA, Rinaldi MG. Primary central nervous system phaeohyphomycosis: a review of 101 cases. Clin Infect Dis 2004; 38 (02) 206-216
    CrossrefPubMedGoogle Scholar
  • 5 Perfect J, Schell W, Cox G. Phaeohyphomycosis. In: Dismukes W, Pappas P, Sobel J. , eds. Clinical Mycology. New York: Oxford University Press; 2003: 271-282
    Google Scholar
  • 6 Emmens RK, Richardson D, Thomas W. , et al. Necrotizing cerebritis in an allogeneic bone marrow transplant recipient due to Cladophialophora bantiana . J Clin Microbiol 1996; 34 (05) 1330-1332
    PubMedGoogle Scholar
  • 7 Sutton DA, Rinaldi MG, Sanche SE. Dematiaceous fungi. In: Anaissie EJ, McGinnis MR, Pfaller MA. , eds. Clinical Mycology. 2nd ed. Philadelphia, PA: Churchill Livingstone/Elsevier; 2009: 329-354
    CrossrefGoogle Scholar
  • 8 Naggie S, Perfect JR. Molds: hyalohyphomycosis, phaeohyphomycosis, and zygomycosis. Clin Chest Med 2009; 30 (02) 337-353 , vii–viii vii–viii
    CrossrefPubMedGoogle Scholar
  • 9 Masini T, Riviera L, Cappricci E, Arienta C. Cerebral phaeohyphomycosis. Clin Neuropathol 1985; 4 (06) 246-249
    PubMedGoogle Scholar
  • 10 Rakeman JL, Bui U, Lafe K, Chen YC, Honeycutt RJ, Cookson BT. Multilocus DNA sequence comparisons rapidly identify pathogenic molds. J Clin Microbiol 2005; 43 (07) 3324-3333
    CrossrefPubMedGoogle Scholar
  • 11 Sayers EW, Barrett T, Benson DA. , et al. Database resources of the National Center for Biotechnology Information. Nucleic Acids Res 2009; 37 (Database issue) D5-D15
    CrossrefPubMedGoogle Scholar
  • 12 Benson DA, Karsch-Mizrachi I, Lipman DJ, Ostell J, Sayers EW. GenBank. Nucleic Acids Res 2009; 37 (Database issue) D26-D31
    CrossrefPubMedGoogle Scholar
  • 13 Jayakeerthi SR, Dias M, Nagarathna S, Anandh B, Mahadevan A, Chandramuki A. Brain abscess due to Cladophialophora bantiana . Indian J Med Microbiol 2004; 22 (03) 193-195
    PubMedGoogle Scholar
  • 14 Lakshmi V, Padmasri C, Umabala P, Sundaram C, Panigrahi M. Cerebral phaeohyphomycosis due to Cladophialophora bantiana . Indian J Med Microbiol 2008; 26 (04) 392-395
    CrossrefPubMedGoogle Scholar
  • 15 Borges Jr MC, Warren S, White W, Pellettiere EV. Pulmonary phaeohyphomycosis due to Xylohypha bantiana. Arch Pathol Lab Med 1991; 115 (06) 627-629
    PubMedGoogle Scholar
  • 16 Padhye AA, Bennett JE, McGinnis MR, Sigler L, Fliss A, Salkin IF. Biosafety considerations in handling medically important fungi. Med Mycol 1998; 36 (Suppl. 01) 258-265
    PubMedGoogle Scholar
  • 17 Badali H, Gueidan C, Najafzadeh MJ, Bonifaz A, van den Ende AH, de Hoog GS. Biodiversity of the genus Cladophialophora. Stud Mycol 2008; 61: 175-191
    CrossrefPubMedGoogle Scholar
  • 18 Badali H, de Hoog GS, Curfs-Breuker I, Klaassen CH, Meis JF. Use of amplified fragment length polymorphism to identify 42 Cladophialophora strains related to cerebral phaeohyphomycosis with in vitro antifungal susceptibility. J Clin Microbiol 2010; 48 (07) 2350-2356
    CrossrefPubMedGoogle Scholar
  • 19 Chakrabarti A. Epidemiology of central nervous system mycoses. Neurol India 2007; 55 (03) 191-197
    CrossrefPubMedGoogle Scholar
  • 20 Al-Abdely HM, Najvar LK, Bocanegra R, Graybill JR. Antifungal therapy of experimental cerebral phaeohyphomycosis due to Cladophialophora bantiana . Antimicrob Agents Chemother 2005; 49 (05) 1701-1707
    CrossrefPubMedGoogle Scholar
  • 21 Levin TP, Baty DE, Fekete T, Truant AL, Suh B. Cladophialophora bantiana brain abscess in a solid-organ transplant recipient: case report and review of the literature. J Clin Microbiol 2004; 42 (09) 4374-4378
    CrossrefPubMedGoogle Scholar
  • 22 Perfect JR. Treatment of fungal infections. Infect Dis Special Ed 2002; 5: 55-60
    PubMedGoogle Scholar
  • 23 Johnson EM, Szekely A, Warnock DW. In-vitro activity of voriconazole, itraconazole and amphotericin B against filamentous fungi. J Antimicrob Chemother 1998; 42 (06) 741-745
    CrossrefPubMedGoogle Scholar
  • 24 Johnson EM, Szekely A, Warnock DW. In vitro activity of Syn-2869, a novel triazole agent, against emerging and less common mold pathogens. Antimicrob Agents Chemother 1999; 43 (05) 1260-1263
    PubMedGoogle Scholar
  • 25 Salama AD, Rogers T, Lord GM, Lechler RI, Mason PD. Multiple Cladosporium brain abscesses in a renal transplant patient: aggressive management improves outcome. Transplantation 1997; 63 (01) 160-162
    CrossrefPubMedGoogle Scholar
  • 26 Trinh JV, Steinbach WJ, Schell WA, Kurtzberg J, Giles SS, Perfect JR. Cerebral phaeohyphomycosis in an immunodeficient child treated medically with combination antifungal therapy. Med Mycol 2003; 41 (04) 339-345
    CrossrefPubMedGoogle Scholar