Review Article

Central Nervous System Infections in Transplant Recipients by Cladophialophora bantiana

Authors: D Keith Harrison, MD, Stephen Moser, PhD, Cheryl Ann Palmer, MD

Abstract

Cladophialophora bantiana, a dematiaceous fungus, is an uncommon pathogenic organism originally thought to more commonly affect immunocompetent patients. Increasing numbers of reports, however, describe the organism affecting immunocompromised patients. Like all dematiaceous fungi, Cladophialophora can be recognized in histopathologic sections by the golden-brown coloration in the walls of the hyphae. Of all the dematiaceous fungi, Cladophialophora bantiana demonstrates the most neurotropism, which is responsible for increasing recognition of this fungus as the causative agent in brain abscesses in transplant patients. We describe one patient with a liver transplant and another with a double lung transplant, both of whom developed cerebral abscesses caused by this organism, and review the reported literature.


Key Points


* Cladophialophora bantiana is the most common neurotropic dematiaceous fungus.


* Originally thought to be more common in immunocompetent patients, Cladophialophora bantiana is increasingly recognized in patients with immunosuppression.


* This pigmented fungus should be suspected in solid organ transplant patients with brain abscesses.

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References

1.Rossman SN, Cernoch PL, Davis JR. Dematiaceous fungi are an increasing cause of human disease. Clin Infect Dis 1996;22:73–80.
 
2.Fader RC, McGinnis MR. Infections caused by dematiaceous fungi: chromoblastomycosis and phaeohyphomycosis. Infect Dis Clin North Am 1988;2:925–938.
 
3.Dixon DM, Polak-Wyss A. The medically important dematiaceous fungi and their identification. Mycoses 1991;34:1–18.
 
4.Singh H, Chang FY, Gayowski T, et al. Infections due to dematiaceous fungi in organ transplant recipients: case report and review. Clin Infect Dis 1997;24:369–374.
 
5.Baddley JW, Salzman D, Pappas PG. Fungal brain abscess in transplant recipients: epidemiologic, microbiologic and clinical features. Clin Transplant 2002;16:419–424.
 
6.Duque O. Meningoencephalitis and brain abscess caused by Cladosporium and Fonsecaea. Am J Clin Pathol 1961;36:505–517.
 
7.Binford CH, Thompson RK, Gorham ME, et al. Mycotic brain abscess due to Cladosporium trichoides, a new species. Am J Clin Pathol 1952;22:535–542.
 
8.Aldape KD, Fox HS, Robert JP, et al. Cladosporium trichoides cerebral phaeohyphomycosis in a liver transplant recipient. Report of a case. Am J Clin Pathol 1991;95:499–502.
 
9.Middleton FG, Jurgenson PF, Utz JP, et al. Brain abscess caused by Cladosporium trichoides. Arch Intern Med 1976;136:444–448.
 
10.Kim RC, Hodge CJ, Lamberson HV, et al. Traumatic intracerebral implantation of Cladosporium trichoides. Neurology 1981;31:1145–1148.
 
11.Crichlow DK, Enrile FT, Memon MY. Cerebellar abscess due to Cladosporium trichoides (bantianum): case report. Am J Clin Pathol 1973;60:416–421.
 
12.Emmens RK, Richardson D, Thomas W, et al. Necrotizing cerebritis in an allogeneic bone marrow transplant recipient due to Cladophialophora bantiana. J Clin Microbiol 1996;34:1330–1332.
 
13.Gupta SK, Manjunath-Prasad KS, Sharma BS, et al. Brain abscess in renal transplant recipients: report of three cases. Surg Neurol 1997;48:284–287.
 
14.Salama AD, Rogers T, Lord GM, et al. Multiple Cladosporium brain abscesses in a renal transplant patient. Transplantation 1997;63:160–162.
15.Arunkumar MJ, Rajshekhar V, Chandy MJ, et al. Management and outcome of brain abscess in renal transplant patients. Postgrad Med J 2000;76:207–211.
16.Osiyeme OO, Dowdy LM, Mallon SM, et al. Cerebral phaeohyphomycosis due to a novel species: report of a case and review of the literature. Transplantation 2001;71:1343–1346.
17.Keyser A, Schmid F-X, Linde H-J, et al. Disseminated Cladophialophora bantiana infection in a heart transplant recipient. J Heart Lung Transplant 2002;21:503–505.
18.Lee YM, Tambyah PA, Lee KH, et al. Successful treatment of Xylohypha bantiana brain abscess mimicking invasive cerebral aspergillosis in a liver transplant recipient. J Infect 2003;47:348–351.
19.Silveira ER, Resende MA, Mariano VS, et al. Brain abscess caused by Cladophialophora (Xylohypha) bantiana in a renal transplant patient. Transpl Infect Dis 2003;5:104–107.
20.Levin TP, Baty DE, Fekete T, et al. Cladophialophora bantiana brain abscess in a solid-organ transplant recipient: case report and review of the literature. J Clin Microbiol 2004;42:4374–4378.
21.Revankar SG, Sutton DA, Rinaldi MG. Primary central nervous system Phaeohyphomycosis: a review of 101 cases. Clin Infect Dis 2004;38:208–216.
22.Lyons MK, Blair JE, Leslie KO. Successful treatment with voriconazole of fungal cerebral abscess due to Cladophialophora bantiana. Clin Neurol Neurosurg 2005;107:532–534.
23.Fica A, Diaz M-C, Luppi M, et al. Unsuccessful treatment with voriconazole of a brain abscess due to Cladophialophora bantiana. Scand J Infect Dis 2003;35:892–893.