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Management of phaeohyphomycosis
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
The treatment of phaeohyphomycosis is primarily based on isolated human cases and several small case series [33]. There has been an attempt by the Euopean Society of Microbiology and European Confederation of Medical Mycology to provide some general guidelines for this group of fungi [50]. However, there are no robust randomized, blind studies to provide guidance for the use of any antifungal agents for this group of infections. This deficiency in guidance is a combination of the variety of clinical syndromes produced by this group of fungi, the heterogenous risk groups with underlying diseases, and the number of genus strains that might have varying drug susceptibility. Despite the paucity of robust guidelines with accurate measured outcomes, there are actually several principles that can be followed that will generally provide a positive outcome for phaeohyphomycosis in most patients.
Amphotericin B Deoxycholate
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Neil R. H. Stone, Tihana Bicanic
There are four forms of phaeohyphomycosis—superficial infection, cutaneous or corneal disease, subcutaneous infection, and systemic disease. It can be caused by many of the dematiaceous fungi. Infections caused by Bipolaris and Exserohilum include disseminated disease in the immunocompromised host characterized by vascular invasion and tissue necrosis, osteomyelitis, meningoencephalitis, sinusitis, peritonitis in association with continuous ambulatory peritoneal dialysis, keratitis, and allergic bronchopulmonary disease (Adam et al., 1986). For these infections, AMB is probably the treatment of choice, and treatment should include surgical debridement of locally invasive disease. Cutaneous and subcutaneous disease due to Exophiala species should be managed with surgical excision, but the most effective treatment for deep-seated infection is uncertain. Most of these species are susceptible to AMB (Fothergill et al., 2009). Case reports of successful treatment with AMB, 5FC, and ketoconazole have been reported (Sudduth et al., 1992). Itraconazole, posaconazole, and voriconazole have also been used with some success; however, optimal therapy is not known.
Invasive Mold Infections
Published in Johan A. Maertens, Kieren A. Marr, Diagnosis of Fungal Infections, 2007
Fernanda P. Silveira, Flavio Queiroz-Telles, Marcio Nucci
Dematiaceous fungi comprise a group of darkly pigmented fungi. The pigment results from the production of melanin by the fungus. Dematiaceous fungi are widely distributed in the environment, and occasionally cause infection in humans. These fungi are considered to have a relatively low virulence, and the spectrum of disease is influenced mainly by host factors. The clinical spectrum of infection includes black grain mycetomas, chromoblastomycosis, sinusitis, and superficial, cutaneous, subcutaneous, and systemic phaeohyphomycosis (145). Recently, other conditions such as fungemia have been added to the spectrum of diseases caused by dematiaceous fungi (146). The clinical presentationof mycetoma was described in the previous session. The most frequent dematiaceous fungi causing mycetoma is Madurella mycetomatis. Chromoblastomycosis is an infection that involves the skin and subcutaneous tissues, and is a consequence of penetrating trauma to the skin, especially in the lower extremities. The infection has a chronic course, and different types of skin lesions may occur, including papules and nodules that increase over time to produce extensive lesions with different aspects, such as plaques and verrucous, cicatricial, and tumorous lesions (147). The diagnosis characteristic of chromoblastomycosis in tissue is the presence of sclerotic or muriform bodies, round fungal elements with horizontal and vertical septa. Phaeohyphomycosis is designated when there is invasive infection with darkly pigmented hyphae in tissue or abscesses. Several pigmented fungal structures, including septate hyphae, yeast cells, and vesicular bodies may be observed (Fig. 18). The hallmark of its diagnosis is the demonstration of tissue invasion by these pigmented elements. However, hyphal pigmentation may be difficult to detect by the most frequently used stains, unless the Masson-Fontana stain is used. Although it is not specific for these fungi (148), a positive staining with Masson-Fontana is virtually diagnostic of a phaeohyphomycosis.
Breaking the mold: a case of recalcitrant eyelid subconjunctival infection by Exophilia Phaeomuriformis
Published in Orbit, 2023
Colin P. Froines, Nathe Connor, Emily Li, Rebecca A. Yoda, Luis F. Gonzalez-Cuyar, G. Nina Lu, Roxana Fu, Matthew Zhang
Phaeohyphomycosis describes chronic infection by a wide diversity of melanin-producing fungi including genus Bipolaris, Cladophialophora, Cladosporium, Exophiala, Fonsecaea, Phialophora, Ochronosis, Rhinocladiella, and Wangiella. Phaeohyphomycosis has an estimated prevalence of one case per million people per year.1Exophilia spp. are a genus of rare ophthalmic fungal pathogens with few cases of confirmed speciation.2 The most commonly identified Exophiala infections in the United States are E. dermatitidis (29.3%), E. xenobiotica (29.7%), and E. oligosperma (18.6%), with E. phaeomuriformis isolated in only 6.4% of cases.3 While rarer still, E. phaeomuriformis represents an ophthalmologic pathogen of increasing significance with three case reports of cornea-involving infections published since 2017.4–6 Herein, the authors describe the first reported case of lower eyelid E. phaeomuriformis infection.