Cerebral phaeohyphomycosis—a cure at what lengths.pdf

376 /infection Vol 9 June 2009 Review Cerebral phaeohyphomycosis—a cure at what lengths? Dong Ming Li, G Sybren de Hoog Cerebral phaeohyphomycosis is a fungal infection of the brain typically caused by Cladophialophora bantiana, Exophiala dermatitidis, and Rhinocladiella mackenziei, all of which belong to the order Chaetothyriales. The disease results in black, necrotic brain tissue, black pus, and black cerebrospinal fl uid. Pathogens usually reach the brain through the bloodstream or lymphatic fl uid and occasionally through direct spreading or accidental inoculation. Patients can present with hemiparesis, tonic spasm, headache, fever, sensory variation, cerebral irritation, and even psychotic behavioural changes. Radiological images are characterised by ring-enhanced signs and hyperdense and hypodense lesions. Pathological features frequently include black-to-brown necrotic tissue or dark-coloured pus, granulomatous infl ammation, giant cell vasculitis, and pigmented fungal elements, which are easily seen on a direct potassium hydroxide smear, a rapid method for diagnosis. Black fungi can be cultured from a biopsy specimen. Combined antifungal chemotherapy, surgical debridement, and careful immunological interventions are strongly recommended to eradicate these intractable infections. Introduction Cerebral phaeohyphomycosis is the collective name for a group of cerebral fungal infections that are characterised by black necrotic tissue, black pus, and black cerebro spinal fl uid (CSF).1–3 If untreated, the infection leads to death within weeks, months, or, occasionally, years.1–6 This infection is caused by a group of black fungi, and emerging pathogens from this group are still being encountered.5–12 Most of the pathogens belong to a single order of environmental fungi, Chaetothyriales, according to new genetic studies.1 The sporadic and non-random distribution of these infections often leads them to be thought of as isolated events. Thu