Primary central nervous system phaeohyphomycosis: a review of 101 cases.
Phaeohyphomycosis refers to infections caused by darkly pigmented fungi. These fungi rarely cause life-threatening disease. We reviewed 101 cases of culture-proven primary central nervous system phaeohyphomycosis reported in the English-language literature from 1966 to 2002. The most frequently isolated species was Cladophialophora bantiana. The next most frequent isolate was Ramichloridium mackenziei, seen exclusively in patients from the Middle East. More than one-half of the cases occurred in patients with no known underlying immunodeficiency. Mortality rates were high regardless of immune status. Therapy is not standardized, although the combination of amphotericin B, flucytosine, and itraconazole may improve survival rates. Newer azoles, such as voriconazole, also have a broad spectrum of activity against these fungi, although clinical experience is limited. Complete excision of brain lesions may provide better results than simple aspiration. An aggressive medical and surgical approach is warranted in treating these infections to optimize outcomes.
Revankar
Sanjay G
SG
Dallas Veterans Affairs Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas 75216, USA. sanjay.revankar@med.va.gov
Sutton
Deanna A
DA
Rinaldi
Michael G
MG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D020314:Central Nervous System Fungal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D016896:Treatment Outcome
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B