Abstract
Introduction:Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes. Cladophialophora bantiana is one of the most common and dangerous neurotropic fungi, able to cause brain abscess and disseminated infection.Case Presentation:We report a new case of phaeohyphomycosis brain abscesses caused by C. bantiana in Slovakia. The patient was a 63-year-old man having undergone heart transplantation, with dyspnoea, left-sided bronchopneumonia and fevers. CT (computed tomography) and MRI (magnetic resonance imaging) of the brain revealed numerous abscesses. Bacterial infection was proven by neither the growth of bacteria in culture nor the presence of bacterial antigens. Direct microscopy of the pus from the brain abscess showed Gram-positive hyphae. The isolate was finally identified as C. bantiana based on morphological and physiological features, and on DNA sequence analysis.Conclusion:In spite of appropriate therapy, neurological complications and accelerated respiratory insufficiency resulted in the patient’s death. Concerning clinical manifestation of the brain phaeohyphomycosis that can sometimes be a problem to distinguish from malignancy, physicians should also assume infection caused by this serious pathogen.
Highlights
Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes
Phaeohyphomycosis refers to infections caused by darkly pigmented fungi
The spectrum of phaeohyphomycosis symptoms ranges from solitary subcutaneous nodules associated with local trauma, to mycetoma, to life-threatening infections, such as brain
Summary
Phaeohyphomycosis refers to infections caused by darkly pigmented fungi. These fungi contain melanin pigments in their cell walls and spores. We report the first case of disseminated disease caused by C. bantiana in Slovakia. The one-celled oval conidia (7.5–11 mm62.5–4 mm) were smooth-walled and pale brown without pigmented hila They formed long, coherent, sessile, lateral or terminal chains on undifferentiated hyphae (Fig. 1). The mould was urease positive, growth on 10 % NaCl agar was negative and colonies could grow on media containing cycloheximide. Based on these results, the isolate was identified in our laboratory as C. bantiana. The isolate was identified in our laboratory as C. bantiana To confirm this observation, we performed DNA sequencing-based identification. C. bantiana was isolated from autopsy material taken from the lung, brain (Fig. 2) and skin
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