title: An updated comprehensive systematic review of Cladophialophora bantiana and analysis of epidemiology, clinical characteristics, and outcome of cerebral cases.
abstract: Cladophialophora bantiana is a phaeoid fungus that only rarely has been isolated from sources other than the human brain. It has a particular tropism for the central nervous system (CNS). We have integrated and updated large-scale data related to several aspects of C. Bantiana and reviewed all the available reports on its cerebral infections, focusing on their geographical distribution, infection routes, immune status of infected individuals, type and location of infections, clinical manifestations and treatment and outcome, briefly looking over the spectrum of other disease entities associated with C. bantiana, that is, extra-cerebral and animal infections and on the environmental sources of this fungus. Among the agents of phaeohyphomycosis, a term used to describe an infection caused by a dark pigmented fungus, C. bantiana has some significant specific features. A total of 120 case reports were identified with a significantly higher percentage of healthy subjects than immune-debilitated patients (58.3% vs. 41.7%). Infections due to C. bantiana occur worldwide. The main clinical manifestations are brain abscess (97.5%), coinfection of brain tissue and meninges (14.2%) and meningitis alone (2.5%). Among immunocompetent patients, cerebral infection occurred in the absence of pulmonary lesions. The mortality rate is 65.0% regardless of the patient's immune status. The therapeutic options used include surgery or antifungals alone, and the combination of both, in most cases the fatal outcome being rapid after admission. Since the fungus is a true pathogen, laboratory workers should be made aware that BioSafety Level-3 precautions might be necessary.
authors.affiliation: Mycology Unit, Department of Medical Microbiology, Cerrahpasa Medical Faculty, 343098 Cerrahpasa, Istanbul, Turkey.
authors.forename: A Serda
authors.initials: AS
authors.lastname: Kantarcioglu
authors.affiliation: Unitat de Microbiologia, Facultat de Medicina i Ciencies de la Salut, IISPV, Universitat Rovira i Virgili, E-43201 Reus, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Guarro
authors.affiliation: Centraalbureau voor Schimmelcultures, Utrecht, and Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Sybren
authors.initials: S
authors.lastname: De Hoog
authors.affiliation: Department of Neurology, Cerrahpasa Medical Faculty, 34098 Cerrahpasa, Istanbul, Turkey.
authors.forename: Hulya
authors.initials: H
authors.lastname: Apaydin
authors.affiliation: Mycology Unit, Department of Medical Microbiology, Cerrahpasa Medical Faculty, 343098 Cerrahpasa, Istanbul, Turkey.
authors.forename: Nuri
authors.initials: N
authors.lastname: Kiraz
mesh_terms: D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use*; D001203:Ascomycota / Q000502:physiology*; D020314:Central Nervous System Fungal Infections / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D006801:Humans; D060446:Phaeohyphomycosis / Q000382:microbiology*; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents
keywords: Cladophialophora bantiana, central nervous system
                      infections; brain abscess; cerebral phaeohyphomycosis; fungal meningitis