Cerebral phaeohyphomycosis due to Cladophialophora bantiana in an immunocompetent individual: A case report and brief review of literature

Document Type: Case report

Authors

1 Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India

2 Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.

Abstract

 Background and Purpose: Fungal infections of the central nervous system (CNS) are life-threatening conditions that are frequently misdiagnosed with bacterial and viral CNS infections. Cerebral phaeohyphomycosis is a cerebral infection caused by dematiaceous fungi, especially Cladophialophora bantiana. Very few cases of fungal CNS infection have been reported across the world. High clinical suspicion should be cast for the patients with brain abscess that do not respond to conventional antibiotic therapy.
Case report: We report a case of a 21-year-old male presenting with headache, seizures and weakness in the limbs. Radiological examination revealed multiple brain abscesses. After surgical excision and laboratory evaluation, it was found to be caused by C. bantiana. The patient’s outcome was good with surgical excision and voriconazole therapy.
Conclusion: Brain abscess caused by C. bantiana is on rise, especially in immunocompromised groups. Thus, high clinical suspicion, accurate diagnosis and management are the fundamentals for good prognosis.

Keywords


1. Revankar SG. Cladophialophora bantiana brain abscess in an immunocompetent patient. Can J Infect Dis Med Microbiol. 2011; 22(4):149-50. 
2. Revankar SG, Sutton DA. Melanized fungi in human disease. Clin Microbiol Rev. 2010; 23(4):884-928.
3. Ajantha GS, Kulkarni RD. Cladophialophora bantiana, the neurotropic fungus-a mini review. J Clin Diagn Res. 2011; 5:1301-6.
4. Richard J. Hamill. In: Dismukes WE, Pappas PG, Sobel JD, editors. Clinical mycology. 2nd ed. Oxford: Oxford University Press; 2009. P. 591-607. 
5. Jennings Z, Kathy K, Halliday CL, Nankivell BJ, Kok J, Wong G, et al. Verruconis gallopava cardiac and endovascular infection with dissemination after renal transplantation: case report and lessons learned. Med Myco Case Rep. 2017; 15:5-8.
6. Nóbrega JP, Rosemberg S, Adami AM, Heins-Vaccari EM, Lacaz CD, Brito TD. Fonsecaea pedrosoi cerebral phaeohyphomycosis (" chromoblastomycosis"): first human culture-proven case reported in Brazil. Rev Instit Med Trop Sao Paulo. 2003; 45(4):217-20. 
7. Aribandi M, Iii CB, Rinaldi MG. Magnetic resonance imaging findings in fatal primary cerebral infection due to Chaetomium strumarium. Australas Radiol. 2005; 49(2):166-9. 
8. Jung NY, Kim E. Cerebral phaeohyphomycosis: a rare cause of brain abscess. J Korean Neurosurg Soc. 2014; 56(5):444-7. 
9. Al-Mohsen IZ, Sutton DA, Sigler L, Almodovar E, Mahgoub N, Frayha H, et al. Acrophialophora fusispora brain abscess in a child with acute lymphoblastic leukemia: review of cases and taxonomy. J Clin Microbiol. 2000; 38(12):4569-76.
10. Agrawal A, Shanthi V, Mohan KV, Hegde KV, Reddy UV. Cladophialophora bantiana brain abscess masquerading cerebral tuberculoma in an immunocompetent host. Roman Neurosurg. 2014; 21:(1):73-7.
11. Khaliq MF, Ihle RE, Schirtzinger CP. Cladophialophora bantiana cerebral phaeohyphomycosis complicated by pulmonary nocardiosis: a tale of two infections. Case Rep Infect Dis. 2019; 2019:4352040.
12. Badali H, Gueidan C, Najafzadeh MJ, Bonifaz A, van den Ende AH, de Hoog GS. Biodiversity of the genus Cladophialophora. Stud Mycol. 2008; 61:175-91.
13. Borkar SA, Sharma MS, Rajpal G, Jain M, Xess I, Sharma BS. Brain abscess caused by cladophialophora bantiana in an immunocompetent host: need for a novel cost-effective antifungal agent. Ind J Med Microbiol. 2018; 26(3):271-4.
14. Gandham P. Cladophialophora bantiana. Int J Res Med Sci. 2014; 2(1):38-41. 
15. Chakrabarti A, Kaur H, Rudramurthy SM, Appannanavar SB, Patel A, Mukherjee KK, et al. Brain abscess due to Cladophialophora bantiana: a review of 124 cases. Med Mycol. 2016; 54(2):111-9.
16. Garg N, Devi IB, Vajramani GV, Nagarathna S, Sampath S, Chandramouli BA, et al. Central nervous system cladosporiosis: An account of ten culture-proven cases. Neurol India. 2007; 55(3):282-8.
17. Sood P, Dogra V, Thakur A, Mishra B, Mandal A, Sinha S. Brain abscess due to Xylohypha bantiana. Scand J Infect Dis. 2000; 32(6):708-9.
18. Rantala M, Attia S, Koukila-Kähkölä P, de Hoog S, Anttila M, Katila T. Cladophialophora bantiana as an Emerging Pathogen in Animals: case report of equine endometritis and review of the literature. J Clin Microbiol. 2015; 53(9):3047-53.
19. Schweizer LA, Bärlocher L, Graber A, Boggian K. Brain abscess caused by Cladophialophora bantiana: total remission after full resection and short-course Voriconazole treatment. Med Mycol Case Rep. 2018; 23:43-5. 
20. Singh A, Singh PK, Kumar A, Chander J, Khanna G, Roy P, et al. Molecular and matrix-assisted laser desorption ionization-time of flight mass spectrometry-based characterization of clinically significant melanized fungi in India. J Clin Microbiol. 2017; 55(4):1090-103. 
21. Velasco J, Revankar S. CNS infections caused by brown-black fungi. J Fungi (Basel). 2019; 5(3):E60.
22. Jayakeerthi SR, Dias M, Nagarathna S, Anandh B, Mahadevan A, Chandramuki A. Brain abscess due to cladophialophora bantiana. Indian J Med Microbiol. 2004; 22(3):193-5. 
23. Suri P, Chhina DK, Kaushal V, Kaushal RK, Singh J. Cerebral phaeohyphomycosis due to Cladophialophora bantiana - a case report and review of literature from India. J Clin Diagn Res. 2014; 8(4):DD01-5.
24. Gopalakrishnan R, Sethuraman N, Madhumitha R, Sukhwani K, Bansal N, Poojaray I, et al. Cadophialophora bantiana brain abscess: a report of two cases treated with Voriconazole. Indian J Med Microbiol. 2017; 35(4):620-2.
25. Aher A, Rastogi V. A case of cerebral abscess due to Cladophialophora bantiana. J Microbiol Infect Dis. 2012; 2(4):171-3.
26. Kumar D, Thaha F, Gilvaz P. A rare case of brain abscess. J Evolution Med Dent Sci. 2016; 5(63):4491-3.
27. Jangla SM, Vishwanathan I. Brain abscess caused by cladophialophora species. J Krishna Instit Med Sci. 2017; 6(4):120-2.
28. Huang WM, Fan YM, Wen Li, Yang WW. Brain abscess caused by Cladophialophora bantiana in China. J Med Microbiol. 2011; 60:1872-4.
29. Liutkus D, Silkūnas D, Staskevicius A. Fungal brain abscess mimicking high grade glioma. Clinical case. Health Sci East Eur. 2016; 26(5):97-100. 
30. Kuan CS, Cham CY, Singh G, Yew SM, Tan YC, Chong PS, et al. Genomic analyses of Cladophialophora bantiana, a major cause of cerebral phaeohyphomycosis provides insight into its lifestyle, virulence and adaption in host. PLoS One. 11(8):e0161008.