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Cerebral phaeohyphomycosis due to Cladophialophora bantiana: case report and systematic review of cases

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Abstract

Purpose

Cladophialophora bantiana is a wonted melanized fungus causing brain abscess. In past many cases were reported from Asia, particularly from India. Of late, there is a rise in cases in places besides Asia and hence a review of the cases is warranted.

Methods

We present a case of fatal cerebral phaeohyphomycosis caused by C. bantiana and conduct a systematic review of culture confirmed brain abscess due to C. bantiana reported between 2015 and 2022.

Results

Of the 39 cases found, majority (68%) were immunocompromised. The various clinical presentations were headache (53%), hemiparesis (34%), visual disturbance (25%), altered sensorium (18%), aphasia/dysarthria (12%) and seizures (9%). Isolated lesion was observed in 18 (60%) patients. In the sequence of occurrence, the lesions were in frontal (30%), temporal (27%) and parietal (20%) region. There were five cases with coinfections such as concurrent detection of Nocardia pneumonia in two cases, toxoplasma DNA in brain abscess, coexisting pulmonary Cryptococcus neoformans infection and coexisting Candida in a case of brain abscess in one case each. Surgical intervention was performed in 84% cases. Antifungal therapy included voriconazole (80%), liposomal amphotericin B (76%), 5-fluorocytosine (30%), posaconazole (10%), and amphotericin B deoxycholate (6%). The overall mortality was 50% with lower mortality (42%) in regions outside Asia compared to Asia (63.6%) though not statistically significant.

Conclusions

C. bantiana brain abscess is an emerging infection worldwide. Next generation sequencing is an upcoming promising diagnostic test. Early complete excision of the lesion with effective antifungals may improve the outcome.

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Data availability

All relevant data have been published in the manuscript. Further details can be obtained by writing to the corresponding author.

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Acknowledgements

We acknowledge the support from Indian Council of Medical Research for their support to identify the mold (Myco/9/3/2021-ECD-II). The agency had no role in the study design, in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.

Funding

This research received no external funding.

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Authors and Affiliations

  1. Velammal Medical College Hospital and Research Institute, Madurai, India

    Vithiya Ganesan, S. Velvizhi & T. Rajendran

  2. All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India

    Vinaykumar Hallur

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  1. Vithiya Ganesan
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  3. S. Velvizhi
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  4. T. Rajendran
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Contributions

Conceptualisation: VG, RT, VS; validation: VG, RT; investigation and article search: VG, VH independently screened and extracted data from the studies: VG, VS; original draft preparation: VG, VH; writing—review and editing: VG, VH. All authors have read and endorsed the final version of the manuscript.

Corresponding author

Correspondence to Vithiya Ganesan.

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The authors declare that they have no conflicts of interest.

Ethical approval

Ethical approval was waived by the local Ethics Committee (VMCIEC-Velammal Medical College Institute Ethics Committee) in view of the retrospective chart review of patient records and all the procedures being performed were part of the routine care.

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Informed consent obtained from the patient’s relative.

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Informed consent was obtained from the patient’s relative for publication purposes.

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Ganesan, V., Hallur, V., Velvizhi, S. et al. Cerebral phaeohyphomycosis due to Cladophialophora bantiana: case report and systematic review of cases. Infection (2023). https://doi.org/10.1007/s15010-023-02126-4

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