Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei (formerly Ramichloridium mackenziei): A taxonomic update and review of the literature

Saad J. Taj-Aldeen, Muna Almaslamani, Abdullatif Alkhalf, Issam Al Bozom, Anna M Romanelli, Brian L. Wickes, Annette W. Fothergill, Deanna A. Sutton

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Cerebral phaeohyphomycosis caused by Rhinocladiella mackenziei (formerly Ramichlo-ridium mackenziei) is extremely rare, and geographically limited to the Middle East. The fungus exclusively targets the brain and infections have a grave prognosis. Eighteen cases have been reported in the literature from 1983 to 2004 with almost 100% mortality. Our patient presented in February 2008 with a brain abscess while receiving chemotherapy for carcinoma of the breast. Diagnosis was by craniotomy and aspiration of the brain abscess. Direct microscopy showed dematiaceous fungal hyphae. R. mackenziei was recovered in culture and this identification was confirmed by molecular analysis. Examination of histopathological sections of tissue from the brain biopsy revealed moniliform hyphae characteristic for phaeohyphomycosis. The patient failed to respond to antifungal therapy with amphotericin B and voriconazole or amphotericin B and posaconazole and finally expired 64 days after diagnosis. In vitro antifungal susceptibility testing showed this isolate to be resistant to amphotericin B while susceptible to itraconazole, voriconazole, and posaconazole. Previously published antifungal susceptibility data indicate that although strains show variable susceptibility to amphotericin B, the organism is generally refractory to treatment with this agent. Similar outcomes are seen with the azole agents used alone or in combination with other drugs. Although no specific risk factors have been identified, the majority of cases have occurred in immunocompromised individuals. R. mackenziei is a highly virulent agent of serious cerebral phaeohyphomycosis, and should be considered in the differential diagnosis of central nervous system disease in the Middle East.

Original languageEnglish (US)
Pages (from-to)546-556
Number of pages11
JournalMedical Mycology
Volume48
Issue number3
DOIs
StatePublished - 2010
Externally publishedYes

Fingerprint

Cerebral Phaeohyphomycosis
Ramichloridium
amphotericin B
Amphotericin B
brain
Brain Abscess
Middle East
Hyphae
abscess
hyphae
Phaeohyphomycosis
immunocompromised population
azoles
central nervous system diseases
Azoles
Itraconazole
itraconazole
Craniotomy
Central Nervous System Diseases
Brain

Keywords

  • Cerebral phaeohyphomycosis
  • Rhinocladiella mackenziei

ASJC Scopus subject areas

  • veterinary(all)
  • Infectious Diseases

Cite this

Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei (formerly Ramichloridium mackenziei) : A taxonomic update and review of the literature. / Taj-Aldeen, Saad J.; Almaslamani, Muna; Alkhalf, Abdullatif; Al Bozom, Issam; Romanelli, Anna M; Wickes, Brian L.; Fothergill, Annette W.; Sutton, Deanna A.

In: Medical Mycology, Vol. 48, No. 3, 2010, p. 546-556.

Research output: Contribution to journalArticle

Taj-Aldeen, Saad J. ; Almaslamani, Muna ; Alkhalf, Abdullatif ; Al Bozom, Issam ; Romanelli, Anna M ; Wickes, Brian L. ; Fothergill, Annette W. ; Sutton, Deanna A. / Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei (formerly Ramichloridium mackenziei) : A taxonomic update and review of the literature. In: Medical Mycology. 2010 ; Vol. 48, No. 3. pp. 546-556.
@article{45ecca7a49924d6d9cb6c8955c7b8f05,
title = "Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei (formerly Ramichloridium mackenziei): A taxonomic update and review of the literature",
abstract = "Cerebral phaeohyphomycosis caused by Rhinocladiella mackenziei (formerly Ramichlo-ridium mackenziei) is extremely rare, and geographically limited to the Middle East. The fungus exclusively targets the brain and infections have a grave prognosis. Eighteen cases have been reported in the literature from 1983 to 2004 with almost 100{\%} mortality. Our patient presented in February 2008 with a brain abscess while receiving chemotherapy for carcinoma of the breast. Diagnosis was by craniotomy and aspiration of the brain abscess. Direct microscopy showed dematiaceous fungal hyphae. R. mackenziei was recovered in culture and this identification was confirmed by molecular analysis. Examination of histopathological sections of tissue from the brain biopsy revealed moniliform hyphae characteristic for phaeohyphomycosis. The patient failed to respond to antifungal therapy with amphotericin B and voriconazole or amphotericin B and posaconazole and finally expired 64 days after diagnosis. In vitro antifungal susceptibility testing showed this isolate to be resistant to amphotericin B while susceptible to itraconazole, voriconazole, and posaconazole. Previously published antifungal susceptibility data indicate that although strains show variable susceptibility to amphotericin B, the organism is generally refractory to treatment with this agent. Similar outcomes are seen with the azole agents used alone or in combination with other drugs. Although no specific risk factors have been identified, the majority of cases have occurred in immunocompromised individuals. R. mackenziei is a highly virulent agent of serious cerebral phaeohyphomycosis, and should be considered in the differential diagnosis of central nervous system disease in the Middle East.",
keywords = "Cerebral phaeohyphomycosis, Rhinocladiella mackenziei",
author = "Taj-Aldeen, {Saad J.} and Muna Almaslamani and Abdullatif Alkhalf and {Al Bozom}, Issam and Romanelli, {Anna M} and Wickes, {Brian L.} and Fothergill, {Annette W.} and Sutton, {Deanna A.}",
year = "2010",
doi = "10.3109/13693780903383914",
language = "English (US)",
volume = "48",
pages = "546--556",
journal = "Medical Mycology",
issn = "1369-3786",
publisher = "Informa Healthcare",
number = "3",

}

TY - JOUR

T1 - Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei (formerly Ramichloridium mackenziei)

T2 - A taxonomic update and review of the literature

AU - Taj-Aldeen, Saad J.

AU - Almaslamani, Muna

AU - Alkhalf, Abdullatif

AU - Al Bozom, Issam

AU - Romanelli, Anna M

AU - Wickes, Brian L.

AU - Fothergill, Annette W.

AU - Sutton, Deanna A.

PY - 2010

Y1 - 2010

N2 - Cerebral phaeohyphomycosis caused by Rhinocladiella mackenziei (formerly Ramichlo-ridium mackenziei) is extremely rare, and geographically limited to the Middle East. The fungus exclusively targets the brain and infections have a grave prognosis. Eighteen cases have been reported in the literature from 1983 to 2004 with almost 100% mortality. Our patient presented in February 2008 with a brain abscess while receiving chemotherapy for carcinoma of the breast. Diagnosis was by craniotomy and aspiration of the brain abscess. Direct microscopy showed dematiaceous fungal hyphae. R. mackenziei was recovered in culture and this identification was confirmed by molecular analysis. Examination of histopathological sections of tissue from the brain biopsy revealed moniliform hyphae characteristic for phaeohyphomycosis. The patient failed to respond to antifungal therapy with amphotericin B and voriconazole or amphotericin B and posaconazole and finally expired 64 days after diagnosis. In vitro antifungal susceptibility testing showed this isolate to be resistant to amphotericin B while susceptible to itraconazole, voriconazole, and posaconazole. Previously published antifungal susceptibility data indicate that although strains show variable susceptibility to amphotericin B, the organism is generally refractory to treatment with this agent. Similar outcomes are seen with the azole agents used alone or in combination with other drugs. Although no specific risk factors have been identified, the majority of cases have occurred in immunocompromised individuals. R. mackenziei is a highly virulent agent of serious cerebral phaeohyphomycosis, and should be considered in the differential diagnosis of central nervous system disease in the Middle East.

AB - Cerebral phaeohyphomycosis caused by Rhinocladiella mackenziei (formerly Ramichlo-ridium mackenziei) is extremely rare, and geographically limited to the Middle East. The fungus exclusively targets the brain and infections have a grave prognosis. Eighteen cases have been reported in the literature from 1983 to 2004 with almost 100% mortality. Our patient presented in February 2008 with a brain abscess while receiving chemotherapy for carcinoma of the breast. Diagnosis was by craniotomy and aspiration of the brain abscess. Direct microscopy showed dematiaceous fungal hyphae. R. mackenziei was recovered in culture and this identification was confirmed by molecular analysis. Examination of histopathological sections of tissue from the brain biopsy revealed moniliform hyphae characteristic for phaeohyphomycosis. The patient failed to respond to antifungal therapy with amphotericin B and voriconazole or amphotericin B and posaconazole and finally expired 64 days after diagnosis. In vitro antifungal susceptibility testing showed this isolate to be resistant to amphotericin B while susceptible to itraconazole, voriconazole, and posaconazole. Previously published antifungal susceptibility data indicate that although strains show variable susceptibility to amphotericin B, the organism is generally refractory to treatment with this agent. Similar outcomes are seen with the azole agents used alone or in combination with other drugs. Although no specific risk factors have been identified, the majority of cases have occurred in immunocompromised individuals. R. mackenziei is a highly virulent agent of serious cerebral phaeohyphomycosis, and should be considered in the differential diagnosis of central nervous system disease in the Middle East.

KW - Cerebral phaeohyphomycosis

KW - Rhinocladiella mackenziei

UR - http://www.scopus.com/inward/record.url?scp=77950574970&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77950574970&partnerID=8YFLogxK

U2 - 10.3109/13693780903383914

DO - 10.3109/13693780903383914

M3 - Article

C2 - 19886775

AN - SCOPUS:77950574970

VL - 48

SP - 546

EP - 556

JO - Medical Mycology

JF - Medical Mycology

SN - 1369-3786

IS - 3

ER -