文献简介

出版社:Medical Mycology

作  者:SAAD J. TAJ-ALDEEN, MUNA ALMASLAMANI, ABDULLATIF ALKHAL, ISSAM AL BOZOM, ANNA M. ROMANELLI, BRIAN L. WICKES, ANNETTE W. FOTHERGILL & DEANNA A. SUTTON

编  号:10.3109/13693780903383914

关键字:Rhinocladiella mackenziei, cerebral phaeohyphomycosis

年  份:2010   点击量:1090

文献摘要

Cerebral phaeohyphomycosis caused by Rhinocladiella mackenziei (formerly Ramichloridium 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 his to pathological 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.

Rhinocladiella mackenziei(原名Ramichloridium mackenziei引起的脑暗色丝孢霉病十分罕见,并且从地理学上来看,仅限于中东地区。这种真菌专门攻击脑,且感染有严重的预后。从1983年到2004年已有18个病历记录在案,几乎100%的死亡率。一名患者在20082月因乳腺癌而接受化疗时出现脑脓肿。通过脑脓肿的开颅手术和抽吸术进行的诊断。直接镜检显示培养皿中存在暗色真菌菌丝R. mackenziei的复苏,且此结论通过分子分析进行了证实。对他的脑活检组织的病理学切片检查显示为念珠菌感染特征的暗色丝孢霉病。患者用两性霉素B和福利康唑或两性霉素B泊沙康唑进行抗菌治疗最终在治疗64天后药物对疾病失去治疗效果,宣告治疗失败。在体外进行抗真菌药物敏感性实验表明这种分离菌可耐受两性霉素B,但是对伊曲康唑、福利康唑和泊沙康唑敏感。先前发表的有关抗菌敏感性的资料表明,尽管不同的菌株对两性霉素B的敏感性不同,但是菌株通常对该药物的治疗有耐性。类似的结论在唑类药物单独使用或和其他药物联合使用时也得到体现。尽管未鉴定到特殊的危险因素,但大部分病例都是在免疫功能不全的患者。R. mackenziei是一种引起脑暗色丝孢霉病的非常严重的恶性真菌,并且关于中东地区的中枢神经系统疾病的鉴别诊断,应当考虑该菌。