First fatal cerebral phaeohyphomycosis due to Rhinocladiella mackenziei in Iran, based on ITS rDNA

M Didehdar; A Gokanian; M Sofian; S Mohammadi; R Mohammadi; N Aslani; I Haghani; H Badali

doi:10.1016/j.mycmed.2014.11.003

First fatal cerebral phaeohyphomycosis due to Rhinocladiella mackenziei in Iran, based on ITS rDNA

J Mycol Med. 2015 Mar;25(1):81-6. doi: 10.1016/j.mycmed.2014.11.003. Epub 2015 Jan 27.

Authors

M Didehdar¹, A Gokanian², M Sofian³, S Mohammadi⁴, R Mohammadi⁵, N Aslani⁶, I Haghani⁶, H Badali⁷

Affiliations

¹ Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran; Department of Medical Mycology and Parasitology, Arak University of Medical Sciences, Arak, Iran.
² Department of Surgery and cerebral, Arak University of Medical Sciences, Arak, Iran.
³ Tuberculosis and pediatric infectious Research Center, Arak University of Medical Sciences, Arak, Iran.
⁴ Laboratory of Valiaasr Hospital, Arak University of Medical Sciences, Arak, Iran.
⁵ Department of Medical Parasitology and Mycology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
⁶ Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran.
⁷ Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran. Electronic address: badalii@yahoo.com.

PMID: 25637429
DOI: 10.1016/j.mycmed.2014.11.003

Abstract

Black yeast-like fungi and relatives as agents of cerebral phaeohyphomycosis are often encountered in human fatal brain abscesses and lead to almost 100% mortality despite the application of antifungal and surgical therapy. We report to our knowledge the first case of brain infection due to Rhinocladiella mackenziei in a 54-year-old immunocompetent male in Iran where R. mackenziei has not been reported previously. The initial diagnosis was brain fungal infection because of pigmented, irregular, branched, septated hyphae based on histopathological staining. The patient was treated with intravenous amphotericin B deoxycholate (0.5mg/kg/day) combined with oral itraconazole (200mg twice daily), nevertheless, his neurological function deteriorated rapidly and ultimately the patient died due to respiratory failure later two weeks. R. mackenziei was identified based on the sequencing of internal transcribed spacer (ITS rDNA region) (KJ140287). Therefore, considerable attention for this life-threatening infection is highly recommended.

Keywords: Abcès cérébral; Brain abscess; ITS rADN; ITS rDNA; Iran; R. mackenziei.

Publication types

Case Reports
Research Support, Non-U.S. Gov't

MeSH terms

Ascomycota / classification
Ascomycota / genetics
Ascomycota / isolation & purification*
Central Nervous System Fungal Infections / diagnostic imaging
Central Nervous System Fungal Infections / microbiology
Cerebral Phaeohyphomycosis / diagnostic imaging
Cerebral Phaeohyphomycosis / microbiology*
Cerebral Phaeohyphomycosis / pathology
DNA, Fungal / analysis*
DNA, Ribosomal / analysis*
DNA, Ribosomal Spacer / analysis
DNA, Ribosomal Spacer / genetics
Fatal Outcome
Humans
Iran
Male
Middle Aged
Mycological Typing Techniques / methods
Radiography

Substances

DNA, Fungal
DNA, Ribosomal
DNA, Ribosomal Spacer