title: Antifungal susceptibility and phenotypic characterization of oral isolates of a black fungus from a nasopharyngeal carcinoma patient under radiotherapy.
abstract: BACKGROUND
  During a research project on fungal Candida species in patients wearing obturator treated with radiotherapy for their recurrent nasopharyngeal carcinoma, we serendipitously observed the presence of black fungus in two consecutive samples from a patient.
  
  
  METHODS
  The samples were collected from a 57 year-old Hong Kong gentleman who diagnosed to have undifferentiated type of nasopharyngeal carcinoma. He was treated with definitive concurrent chemoradiotherapy followed by adjuvant chemotherapy and then received a second-course radiotherapy with IMRT. 18S rDNA sequencing revealed that the isolates belong to Exophiala dermatitidis which was susceptible to fluconazole, itraconazole, ketoconazole and voriconazole. Interestingly, E. dermatitidis isolates were resistant to caspofungin and one isolate was resistant to amphotericin B. Both isolates formed biofilms comparable to that of Candida albicans. Single isolate of E. dermatitidis showed hemolysin and proteinase ability comparable to C. albicans whilst the other isolate was not.
  
  
  CONCLUSIONS
  We, for the first time, reported the discovery of a black fungus-E. dermatitidis isolates derived from a patient with nasopharyngeal carcinoma treated with radiotherapy. These isolates were shown to be resistant to caspofungin, a major antifungal agent for systemic candidiasis. As little is known about the black fungus in the clinical setting, it is important that clinicians must keep abreast of the new discovery in this field.
authors.affiliation: Oral Sciences, Faculty of Dentistry, National University of Singapore, 11 Lower Kent Ridge Road, Singapore, 119083, Singapore. jaya@hku.hk.|Oral Biosciences, Faculty of Dentistry, The University of Hong Kong, Pok Fu Lam, Hong Kong. jaya@hku.hk.
authors.forename: Chaminda Jayampath
authors.initials: CJ
authors.lastname: Seneviratne
authors.affiliation: Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, 1/F, Professorial Block, Queen Mary Hospital, Pok Fu lam, Hong Kong. phoenix77@connect.hku.hk.
authors.forename: Phoenix H L
authors.initials: PH
authors.lastname: Fong
authors.affiliation: Oral Biosciences, Faculty of Dentistry, The University of Hong Kong, Pok Fu Lam, Hong Kong. sarahsww@connect.hku.hk.
authors.forename: Sarah S W
authors.initials: SS
authors.lastname: Wong
authors.affiliation: Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, 1/F, Professorial Block, Queen Mary Hospital, Pok Fu lam, Hong Kong. vhflee@hku.hk.
authors.forename: Victor H F
authors.initials: VH
authors.lastname: Lee
mesh_terms: D000666:Amphotericin B / Q000494:pharmacology; D000935:Antifungal Agents / Q000627:therapeutic use*; D018441:Biofilms / Q000187:drug effects; D002277:Carcinoma / Q000532:radiotherapy*; D000077336:Caspofungin; D059248:Chemoradiotherapy / Q000379:methods; D017024:Chemotherapy, Adjuvant; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000494:pharmacology; D005093:Exophiala / Q000187:drug effects* / Q000302:isolation & purification; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000627:therapeutic use; D007654:Ketoconazole / Q000627:therapeutic use; D055666:Lipopeptides / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000382:microbiology*; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009894:Opportunistic Infections / Q000188:drug therapy*; D060446:Phaeohyphomycosis / Q000188:drug therapy*; D050397:Radiotherapy, Intensity-Modulated; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole; D000077336:Caspofungin; D065819:Voriconazole; D007654:Ketoconazole