title: Species diversity, antifungal susceptibility and phenotypic and genotypic characterisation of Exophiala spp. infecting patients in different medical centres in Brazil.
abstract: The Exophiala genus is responsible for many superficial and invasive infections resulting from black fungi. Identification of Exophiala at the species level is based on morphological observations complemented by molecular tests. The aim of this study was to identify 23 clinical isolates of Exophiala spp. and evaluate the antifungal susceptibility to seven different agents. Molecular identification was based on an analysis of ITS region of rDNA using genomic databases. The micromorphology was evaluated by microculture and scanning electron microscopy. The susceptibility tests were performed using the antifungal agents 5-fluorocytosine (5-FC), amphotericin B (AMB), itraconazole (ITC), voriconazole (VRC), posaconazole (PSC), caspofungin (CFG) and terbinafine (TRB). The ITS analysis identified 100% of the following isolates as: E. dermatitidis (8), E. xenobiotica (6), E. bergeri (4), E. oligosperma (3), E. spinifera (1) and E. mesophila (1). The antifungal susceptibility tests showed that the triazoles compounds were in vitro the most active agents against Exophiala. ITS sequencing enabled the accurate identification of the 23 tested isolates. The triazoles, particularly itraconazole and posaconazole, exhibited MIC values lower than AMB, CAS and 5-FC. Although the guidelines do not indicate AMB for treatment against Exophiala spp., this study showed activity for all of the tested species, except E. mesophila.
authors.affiliation: Laboratório Especial de Micologia, Disciplina de Infectologia, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Wendy C
authors.initials: WC
authors.lastname: Silva
authors.affiliation: Centro de Investigações em Micologia Médica (CIMM), Departamento de Patologia, Universidade Federal do Espírito Santo, Vitória, Brazil.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Gonçalves
authors.affiliation: Laboratório Especial de Micologia, Disciplina de Infectologia, Universidade Federal de São Paulo, São Paulo, Brazil.|Hospital do Rim - Fundação Oswaldo Ramos, São Paulo, Brazil.
authors.forename: Daniel W C L
authors.initials: DW
authors.lastname: Santos
authors.affiliation: Laboratório Especial de Micologia, Disciplina de Infectologia, Universidade Federal de São Paulo, São Paulo, Brazil.|Departamento de Microbiologia e Imunologia, Instituto de Ciências Biomédicas, Universidade Federal de Alfenas, Alfenas, Brazil.
authors.forename: Ana Carolina B
authors.initials: AC
authors.lastname: Padovan
authors.affiliation: Laboratório Especial de Micologia, Disciplina de Infectologia, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Fernando C
authors.initials: FC
authors.lastname: Bizerra
authors.affiliation: Laboratório Especial de Micologia, Disciplina de Infectologia, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Analy S A
authors.identifier: http://orcid.org/0000-0001-6900-6468
authors.initials: AS
authors.lastname: Melo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000494:pharmacology; D000935:Antifungal Agents / Q000494:pharmacology*; D001938:Brazil / Q000453:epidemiology; D000077336:Caspofungin; D002648:Child; D002675:Child, Preschool; D021903:DNA, Ribosomal Spacer / Q000235:genetics; D054714:Echinocandins / Q000494:pharmacology; D005093:Exophiala / Q000145:classification / Q000187:drug effects* / Q000235:genetics* / Q000648:ultrastructure; D005260:Female; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D017964:Itraconazole / Q000494:pharmacology; D055666:Lipopeptides / Q000494:pharmacology; D008297:Male; D008826:Microbial Sensitivity Tests; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D060446:Phaeohyphomycosis / Q000097:blood / Q000453:epidemiology / Q000382:microbiology*; D010641:Phenotype
chemical_list: D000935:Antifungal Agents; D021903:DNA, Ribosomal Spacer; D054714:Echinocandins; D055666:Lipopeptides; D017964:Itraconazole; D000666:Amphotericin B; D000077336:Caspofungin
keywords: Exophiala spp.; antifungal susceptibility; species identification