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Cladophialophora bantiana

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Cladophialophora bantiana
Cladophialophora bantiana UAMH10767.jpg
Scientific classification OOjs UI icon edit-ltr.svg
Kingdom: Fungi
Division: Ascomycota
Class: Eurotiomycetes
Order: Chaetothyriales
Family: Herpotrichiellaceae
Genus: Cladophialophora
Species:
C. bantiana
Binomial name
Cladophialophora bantiana
de Hoog, Kwon-Chung & McGinnis, (1995)
Synonyms

Torula bantianaSacc., in Saccardo, (1912)
Cladosporium bantianum(Sacc.) Borelli, (1960)
Xylohypha bantiana(Sacc.) McGinnis, Borelli, Padhye & Ajello, (1986)
Cladosporium trichoides C.W. EmmonsBinford, Thompson & Gorham, (1952)
Cladosporium trichoides C.W. Emmons var. trichoidesBinford, Thompson & Gorham, (1952)
Cladosporium trichoides var. chlamydosporumKwon-Chung, (1978)

Contents

Cladophialophora bantiana (C. bantiana) is a melanin producing mold known to cause brain abscesses in humans. [1] It is one of the most common causes of systemic phaeohyphomycosis in mammals. [2] Cladophialophora bantiana is a member of the ascomycota and has been isolated from soil samples from around the world. [3]

Etymology

Cladophialophora bantiana was first isolated from a brain abscess in 1911 by Guido Banti and was described by Pier Andrea Saccardo in 1912 as Torula bantiana. In 1960, the fungus was reclassified by Borelli as Cladosporium bantianum. [2] A morphologically similar species, Cladosporium trichodes was described by Emmons et al. in 1952. Cladosporium trichodes was widely believed to be a different species until 1995 when de Hoog et al. showed it to be conspecific with C. bantiana based on phylogenetic analysis. [4]

Morphology

Cladophialophora bantiana exhibits predominantly hyphal growth both in vivo and in vitro. [5] The normal morphology consists of dark coloured largely unbranched, wavy chains of conidia, individually 5–10 μm in length. [5] The dark colour is due to the presence of the dark pigment melanin. [6] Hyphae are septate, as is the case for species belonging to the phylum ascomycota. [1]

In culture, the colony is black with a velvety texture or dark grey in color, depending on the type of agar medium it is grown on. [2] It grows on routine fungal culture media, including potato dextrose agar, oatmeal agar, and malt agar. [7] Cladophialophora bantiana has been reported to grow in culture under temperatures ranging from 14-42 °C with optimal growth around 30 °C. [2] Cladophialophora bantiana grows slowly in vitro, taking ~15 days to mature when grown at 25–30 °C. [1] Cladophialophora bantiana can be distinguished from other species of the genus Cladophialophora by the presence of the enzyme urease. [8]

In samples isolated from cerebral tissue compared to cultured samples, a predominance of unbranched conidial chains and absence of conidiophores has been reported. [5] [6] For visualization of hyphal elements in brain abscesses, Fontana-Masson or lactophenol cotton blue staining can be used. [9]

Infection

Non-human

Cladophialophora bantiana can cause infection in several species of animals including cats, [10] dogs, [11] and humans. [12] However, it is very rare to find it in non-mammalian species. [12] In one case in a dog, C. bantiana was identified as the causative agent of eumycetoma. [11] It has been known to cause systemic phaeohyphomycosis in both cats and dogs. [10]

Human

Cladophialophora bantiana is known to cause a cerebral phaeohyphomycosis affecting the central nervous system in humans. [13] It is unique in that it causes primary cerebral infection where the first symptoms of disease are of neurological nature, rather than disseminated. [9] It is hypothesized that predilection of this species for the central nervous system is due to the presence of melanin, which may be able to cross the blood–brain barrier. [3] However, this is unlikely since fungal melanin is structurally and biochemically different from human melanin and other species of highly pigmented fungi do not show neurotropism. [3] It has also been suggested that the presence of introns in the 18S rDNA subunit of Cladophialophora may be related to the preference of C. bantiana for the CNS, however more research is required to determine the mechanism of this. [14]

Radiologically, the intrafungal cerebral abscesses of C. bantiana are known as “the great mimickers” and may be difficult to distinguish from high grade gliomas, lymphoma, or metastatic cancer. Contrast-enhanced images show irregular heterogeneous lesions with significant surrounding edema. [7]

In a review of 101 cases of phaeohyphomycosis by Revankar et al., C. bantiana was the causal agent responsible for 48% of cases. It most often manifests as brain abscesses in immunocompetent people, however meningitis and myelitis were observed in a limited number of cases. [3] Although the majority of the patients were immunocompetent (73%), infection is also commonly seen in immunocompromised patients. [13] Clinical symptoms of infection are varied and can include headache, seizure, arm pain, and ataxia. [1] The mortality rate is about 70%, with better outcomes observed in patients who underwent complete excision of the abscess. [13] Since the majority of patients infected were immunocompetent, the means of exposure to the fungi is still unclear. However, inhalation is the likely route of entrance. [8]

Cases of infection are most commonly found in subtropical regions with high average humidity although cases have also been identified in the US, Canada and the UK. [12] Cases from regions with hot, arid climate are rare. [12] It has also been suggested to occupations with high exposure to dust and dirt such as farming and gardening are associated with higher risk of infection. [12]

Treatment

Since infection is very rare, there is no standard therapy for treatment of C. bantiana phaeohyphomycosis.

In 2021, the European Confederation of Medical Mycology, the International Society for Human and Animal Mycology, and the American Society for Microbiology created guidelines for rare mold infections, which includes C. bantiana. Current recommendations conclude that liposomal amphotericin B alone or in combination with an azole and/or echinocandin or voriconazole monotherapy is supported as first-line therapy. 5-Fluorocytosine can be used in combination with the other recommend antifungals, however, it has little supportive data. [15] In addition, surgical resection of the fungal abscess is often necessary. Treatments utilizing only one of these approaches have had higher fatality rates, and the best outcomes are reported in cases utilizing both surgical and antifungal therapy; however, even with this approach, mortality remains high. [16]

References

  1. 1 2 3 4 Levin, T. P.; Baty, D. E.; Fekete, T.; Truant, A. L.; Suh, B. (2004). "Cladophialophora bantiana Brain Abscess in a Solid-Organ Transplant Recipient: Case Report and Review of the Literature". Journal of Clinical Microbiology. 42 (9): 4374–4378. doi:10.1128/JCM.42.9.4374-4378.2004. PMC   516289 . PMID   15365048.
  2. 1 2 3 4 Kwon-Chung, K.J.; Bennett, John E. (1992). Medical mycology. Philadelphia: Lea & Febiger. ISBN   0-8121-1463-9.
  3. 1 2 3 4 Revankar, S. G.; Sutton, D. A.; Rinaldi, M. G. (2004). "Primary Central Nervous System Phaeohyphomycosis: A Review of 101 Cases". Clinical Infectious Diseases. 38 (2): 206–216. doi: 10.1086/380635 . PMID   14699452.
  4. ↑ De Hoog, G. S.; Guého, E.; Masclaux, F.; Gerrits Van Den Ende, A. H. G.; Kwon-Chung, K. J.; McGinnis, M. R. (1995). "Nutritional physiology and taxonomy of human-pathogenic Cladosporium-Xylohypha species". Medical Mycology. 33 (5): 339. doi:10.1080/02681219580000661.
  5. 1 2 3 Emmons, Chester W. (1977). Medical mycology (3. ed.). Philadelphia: Lea & Febiger. ISBN   0-8121-0566-4.
  6. 1 2 Butler, M. J.; Day, A. W. (1998). "Fungal melanins: A review". Canadian Journal of Microbiology. 44 (12): 1115. doi:10.1139/cjm-44-12-1115.
  7. 1 2 Ahmad, Maleeha; Jacobs, Darren; Wu, Hueizhi; Wolk, Donna; Kazmi, Syed; Jaramillo, Carlos; Toms, Steven (2017). "Cladophialophora Bantiana: A Rare Intracerebral Fungal Abscess—Case Series and Review of Literature". The Surgery Journal. 03 (2): e62–e68. doi:10.1055/s-0037-1598248. ISSN   2378-5128. PMC   5553499 . PMID   28825023.
  8. 1 2 "Doctor Fungus: Cladophialophora spp". Archived from the original on 2013-12-03. Retrieved 2013-12-03.
  9. 1 2 Versalovic, James; American Society for Microbiology, eds. (2011). Manual of clinical microbiology (10th ed.). Washington, DC: ASM Press. ISBN   978-1-55581-463-2.
  10. 1 2 Elies, L.; Balandraud, V.; Boulouha, L.; Crespeau, F.; Guillot, J. (February 2003). "Fatal Systemic Phaeohyphomycosis in a Cat due to Cladophialophora bantiana". Journal of Veterinary Medicine, Series A. 50 (1): 50–53. doi:10.1046/j.1439-0442.2003.00501.x. PMID   12650510.
  11. 1 2 Guillot, J.; Garcia-Hermoso, D.; Degorce, F.; Deville, M.; Calvie, C.; Dickele, G.; Delisle, F.; Chermette, R. (7 October 2004). "Eumycetoma Caused by Cladophialophora bantiana in a Dog". Journal of Clinical Microbiology. 42 (10): 4901–4903. doi:10.1128/JCM.42.10.4901-4903.2004. PMC   522343 . PMID   15472377.
  12. 1 2 3 4 5 Kantarcioglu, A. S.; Hoog, G. S. (February 2004). "Infections of the central nervous system by melanized fungi: a review of cases presented between 1999 and 2004. Infektionen des Zentralnervensystems durch melanisierte Pilze: Eine Ubersicht von Fallen prasentiert zwischen 1999 und 2004". Mycoses. 47 (1–2): 4–13. doi:10.1046/j.1439-0507.2003.00956.x. PMID   14998393. S2CID   1878026.
  13. 1 2 3 Garzoni, C.; Markham, L.; Bijlenga, P.; Garbino, J. (2008). "Cladophialophora bantiana: A rare cause of fungal brain abscess. Clinical aspects and new therapeutic options" (PDF). Medical Mycology. 46 (5): 481–486. doi: 10.1080/13693780801914906 . PMID   18608882.
  14. ↑ De Hoog, G. S.; Queiroz-Telles, F.; Haase, G.; Fernandez-Zeppenfeldt, G.; Angelis, D. Attili; Van Den Ende, A. H. Gerrits; Matos, T.; Peltroche-Llacsahuanga, H.; Pizzirani-Kleiner, A. A.; Rainer, J.; Richard-Yegres, N.; Vicente, V.; Yegres, F. (2000). "Black fungi: clinical and pathogenic approaches". Medical Mycology. 38 (Suppl 1): 243–50. doi: 10.1080/mmy.38.s1.243.250 . PMID   11204152.
  15. ↑ Hoenigl, Martin; Salmanton-García, Jon; Walsh, Thomas J.; Nucci, Marcio; Neoh, Chin Fen; Jenks, Jeffrey D.; Lackner, Michaela; Sprute, Rosanne; Al-Hatmi, Abdullah M. S.; Bassetti, Matteo; Carlesse, Fabianne; Freiberger, Tomas; Koehler, Philipp; Lehrnbecher, Thomas; Kumar, Anil (2021-08-01). "Global guideline for the diagnosis and management of rare mould infections: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology and the American Society for Microbiology". The Lancet Infectious Diseases. 21 (8): e246–e257. doi:10.1016/S1473-3099(20)30784-2. ISSN   1473-3099. PMID   33606997.
  16. ↑ Walkenhorst, Molly S.; Savage, Elizabeth; Wark, Kellie; Kimball, Joanna; Weihe, Rachel; Lamberton, Kathryn; Hamilton-Seth, Robert; Hankins, Julia D.; Lakis, Nelli S. (2026-01-15). "Remarkable recovery from a Cladophialophora bantiana fungal brain abscess in an immunocompromised patient: a case report". ASM Case Reports. 0 e00150-25: e00150–25. doi: 10.1128/asmcr.00150-25 .
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