Abstract
Exophiala is the main genus of black fungi comprising numerous opportunistic species. Data on antifungal susceptibility of Exophiala isolates are limited, while infections are potentially fatal. In vitro activities of eight antifungal drugs (AMB, five azoles, two echinocandins) against 126 clinical (n=76) and environmental (n=47) isolates from around the world were investigated. E.oligosperma (n=58), E.spinifera (n=33), E.jeanselmei (n=14) and E.xenobiotica (n=21) were included in our dataset. The resulting MIC90 s of all strains were as follows, in increasing order: posaconazole 0.063μg/ml, itraconazole 0.125μg/ml, voriconazole and amphotericin B 1μg/ml, isavuconazole 2μg/ml, micafungin and caspofungin 4μg/ml, and fluconazole 64μg/ml. Posaconazole, itraconazole and micafungin were the drugs with the best overall activity against Exophiala species. Fluconazole could not be considered as a treatment choice. No significant difference could be found among antifungal drug activities between these four species, neither in clinical nor in environmental isolates. Antifungal susceptibility data for Exophiala spp. are crucial to improve the management of this occasionally fatal infection and the outcome of its treatment.
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