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Phaeohyphomycosis
Cerebral chromomycosis, chromoblastomycosis (in part), chromomycosis (in part), cladosporiosis, phaeomycotic cyst, phaeosporotrichosis, subcutaneous mycotic cyst.
Phaeohyphomycosis consists of a group of mycotic infections characterized by the presence of dematiaceous (dark-walled) septate hyphae and sometimes yeast or a combination of both in tissue. The hyphae may be short to elongate, distorted or swollen (toruloid hyphae), regularly shaped, or any combination of the above. The yeast when present will be variable in size and most of the time will show budding. The yeast should not be confused with the sclerotic Medler cells seen with the agents of chromoblastomycosis in subcutaneous tissue, although there are case reports of Wangiella (Exophiala) dermatitidis and Exophiala jeanselmei producing a combination of hyphae, yeast, and sclerotic cells from deep infections that otherwise could not be classified as chromoblastomycosis. Infections of the eyes and skin by the black fungi could also be classified as phaeohyphomycosis [9, 449, 700, 726, 1927, 2075, 2184].
| CATEGORIES |
VARIETIES |
COMMENTS |
REFERENCES |
| Superficial |
Black piedrae
Skin infections |
Infection only involves the stratum corneum.
Minimal if any tissue response.
In hairy areas, the fungi grow around the hair shaft |
[700] |
| Cutaneous |
Dermatomycosis
Onychomycosis |
Infection affects keratinized tissue and produces extensive destruction |
[726] |
| Corneal |
Mycotic keratitis |
Lesions are classically produced by traumatic inoculation of the etiologic agent |
[9, 73, 74, 1847] |
| Subcutaneous |
|
Infection is produced by traumatic inoculation of the etiologic agent
Abscess formation is frequent |
[342, 449, 478, 1701, 2184] |
| Respiratory tract |
Nasal
Sinus
Pneumoniae |
Dark lesion on the septum is a common presentation; sinusitis is associated with allergic rhinitis, polyps and/or some form of immunosuppression |
[1239, 1487, 1873, 1927, 2127, 2482] |
| Others |
Brain
Peritoneal cavity
Bone |
Carries a poor prognosis
Associated with peritoneal dialysis
Usually follows a traumatic injury |
[9, 416, 1411, 1608, 1706, 1847, 2075] |
Most cases of phaeohyphomycosis can be controlled by surgical excision and chemotherapy. Amphotericin B and 5-fluorocytosine or Itraconazole are the drugs of choice. Invasion of the brain or bone has a grave prognosis [9, 449, 700, 2344].
The histopathology is extremely varied, ranging from tissue reactions associated with walled abscesses to active tissue invasion by hyphae. Most of the time the hyphae will stain positive for the Fontana-Masson or other melanin stains.
Direct examination
Clinical materials such as pus and tissue are mounted in 10% KOH for examination. The dematiaceous nature of the hyphal elements is a key characteristic for the diagnosis of phaehyphomycosis. The hyphae may be regular in shape or variable. In some cases special stains such as Fontana may help in the diagnosis of the disease.
Isolation
The specimens are inoculated onto Inhibitory Mould Agar and/or Saboraud Dextrose Agar and a medium containing cycloheximide and then incubated at 30°C. Many of the etiologic agents of phaeohyphomycosis are sensitive to cycloheximide. The cultures are discarded as negative in 4 weeks. The isolated fungus must be compatible with the clinical disease and tissue morphology (that is, dematiaceous) before it can be concluded that it is the etiologic agent involved.
Ubiquitous
Standardized testing procedures are not available. Microbiological resistance has not been demonstrated.
|
H and E stain of tissue with Exophiala spinifera |
H and E with GMS stain tissue with Exophiala spinifera |
Phaeohyphomycosis of arm caused by Exserohilum rostratum |
Phaeohyphomycosis of arm caused by Exserohilum rostratum. |
Phaeohyphomycosis caused by Exophiala spinifera in a compromised patient.
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References
9. Adam, R. D., M. L. Paquin, E. A. Petersen, M. A. Saubolle, M. G. Rinaldi, J. G. Corcoran, J. N. Galgiani, and R. E. Sobonya. 1986. Phaeohyphomycosis caused by the fungal genera Bipolaris and Exserohilum. A report of 9 cases and review of the literature. Medicine. 65:203-17.
73. Anandi, V., J. A. George, R. Thomas, K. N. Brahmadathan, and T. J. John. 1991. Phaeohyphomycosis of the eye caused by Exserohilum rostratum in India. Mycoses. 34:489-91.
74. Anandi, V., N. B. Suryawanshi, G. Koshi, A. A. Padhye, and L. Ajello. 1988. Corneal ulcer caused by Bipolaris hawaiiensis. J. Med. Vet. Mycol. 26:301-6.
342. Burges, G. E., C. T. Walls, and J. C. Maize. 1987. Subcutaneous phaeohyphomycosis caused by Exserohilum rostratum in an immunocompetent host. Arch. Dermatol. 123:1346-50.
416. Chang, C. L., D. S. Kim, D. J. Park, H. J. Kim, C. H. Lee, and J. H. Shin. 2000. Acute cerebral phaeohyphomycosis due to Wangiella dermatitidis accompanied by cerebrospinal fluid eosinophilia. J Clin Microbiol. 38:1965-1966.
449. Clancy, C. J., J. R. Wingard, and M. H. Nguyen. 2000. Subcutaneous phaeohyphomycosis in transplant recipients: review of the literature and demonstration of in vitro synergy between antifungal agents. Med Mycol. 38:169-175.
478. Costa, A. R., E. Porto, A. H. Tabuti, C. d. S. Lacaz, N. Y. Sakai-Valente, W. M. Maranhao, and M. C. Rodrigues. 1991. Subcutaneous phaeohyphomycosis caused by Bipolaris hawaiiensis. A case report. Revista do Instituto de Medicina Tropical de Sao Paulo. 33:74-9.
700. Fader, R. C., and M. R. McGinnis. 1988. Infections caused by dematiaceous fungi: chromoblastomycosis and phaeohyphomycosis. Infect Dis Clin North Am. 2:925-38.
726. Fernandez, M., D. E. Noyola, S. N. Rossmann, and M. S. Edwards. 1999. Cutaneous phaeohyphomycosis caused by Curvularia lunata and a review of Curvularia infections in pediatrics. Pediat Inf Dis J. 18:727-731.
1239. Koshi, G., V. Anandi, M. Kurien, M. G. Kirubakaran, A. A. Padhye, and L. Ajello. 1987. Nasal phaeohyphomycosis caused by Bipolaris hawaiiensis. J. Med. Vet. Mycol. 25:397-402.
1411. Magnon, K. C., M. Jalbert, and A. A. Padhye. 1993. Osteolytic phaeohyphomycosis caused by Phialemonium obovatum. Arch Pathol Lab Med. 117:841-3.
1487. McGinnis, M. R., G. Campbell, W. K. Gourley, and H. L. Lucia. 1992. Phaeohyphomycosis caused by Bipolaris spicifera: an informative case. Eur. J. Epidemiol. 8:383-6.
1608. Naim Ur, R., M. el Sheikh, H. Abu Aisha, M. Laajam, B. Yaqoub, and A. H. Chagla. 1987. Cerebral phaeohyphomycosis. Bulletin de la Societe de Pathologie Exotique et de Ses Filiales. 80:320-8.
1701. Padhye, A. A., M. S. Davis, D. Baer, A. Reddick, K. K. Sinha, and J. Ott. 1998. Phaeohyphomycosis caused by Phaeoacremonium inflatipes. J Clin Microbiol. 36:2763-5.
1706. Palaoglu, S., A. Sav, T. Basak, Y. Yalcinlar, and B. W. Scheithauer. 1993. Cerebral phaeohyphomycosis. Neurosurgery. 33:894-897.
1847. Pritchard, R. C., and D. B. Muir. 1987. Black fungi: a survey of dematiaceous hyphomycetes from clinical specimens identified over a five year period in a reference laboratory. Pathology. 19:281-4.
1873. Rao, A., R. Forgan-Smith, S. Miller, and H. Haswell. 1989. Phaeohyphomycosis of the nasal sinuses caused by Bipolaris species. Pathology. 21:280-1.
1927. Rinaldi, M. G., P. Phillips, J. G. Schwartz, R. E. Winn, G. R. Holt, F. W. Shagets, J. Elrod, G. Nishioka, and T. B. Aufdemorte. 1987. Human Curvularia infections. Report of five cases and review of the literature. Diagn. Microbiol. Infect. Dis. 6:27-39.
2075. Sekhon, A. S., J. Galbraith, B. W. Mielke, A. K. Garg, and G. Sheehan. 1992. Cerebral phaeohyphomycosis caused by Xylohypha bantiana, with a review of the literature. Eur. J. Epidemiol. 8:387-90.
2127. Sobol, S. M., R. G. Love, S. H. R, and T. J. Pysher. 1984. Phaeohyphomycosis of the maxilloethmoid sinus cause by Drechslera spicifera: A new fungal pathogen. Laryngoscope. 94:620-626.
2184. Sudduth, E. J., A. J. d. Crumbley, and W. E. Farrar. 1992. Phaeohyphomycosis due to Exophiala species: clinical spectrum of disease in humans [see comments]. Clin Infect Dis. 15:639-44.
2344. Vukmir, R. B., S. Kusne, P. Linden, W. Pasculle, A. W. Fothergill, J. Sheaffer, J. Nieto, R. Segal, H. Merhav, A. J. Martinez, and et al. 1994. Successful therapy for cerebral phaeohyphomycosis due to Dactylaria gallopava in a liver transplant recipient. Clin. Infect. Dis. 19:714-9.
2482. Zaharopoulos, P., V. J. Schnadig, K. D. Davie, R. E. Boudreau, and V. W. Weedn. 1988. Multiseptate bodies in systemic phaeohyphomycosis diagnosed by fine needle aspiration cytology. Acta Cytol. 32:885-91.
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