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Brain abscess caused by Cladosporium trichoides (Bantianum): a case with paranasal sinus involvement
Abstract:
Dematiacious fungi (ie, fungi with dark hyphae) are a rare and usually fatal cause of central nervous system infection. Cladosporium trichoides has been implicated most frequently. Documentation of extra-CNS involvement has been rare. Our patient had a brain abscess and paranasal sinus infection due to C trichoides. The organism was sensitive to less than or equal 2mug/ml of flucytosine. Although our patient did not receive flucytosine, it is possible that this drug, because of its excellent penetration into the cerebrospinal fluid, may be a useful therapeutic agent in cerebral cladosporiosis.
Insights
Dematiacious fungi, like Cladosporium trichoides, rarely cause fatal central nervous system infections. This case highlights potential flucytosine efficacy for brain infections, even with extra-CNS involvement.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Dematiacious fungi, characterized by dark hyphae, are infrequent but severe causes of central nervous system (CNS) infections.
- Cladosporium trichoides is the most commonly identified dematiacious fungus implicated in CNS disease.
- Instances of Cladosporium trichoides causing infections outside the CNS are seldom reported.
Observation:
- A patient presented with a brain abscess and a concurrent paranasal sinus infection.
- The causative agent identified for both infections was Cladosporium trichoides.
- Laboratory testing revealed that the Cladosporium trichoides isolate was susceptible to low concentrations of flucytosine (≤ 2 μg/ml).
Findings:
- This case documents simultaneous central nervous system and paranasal sinus infection by Cladosporium trichoides.
- The susceptibility of the organism to flucytosine suggests a potential therapeutic avenue.
Implications:
- Flucytosine, known for its good penetration into cerebrospinal fluid, may represent a viable treatment option for cerebral cladosporiosis.
- Further investigation into flucytosine's role in treating CNS dematiacious fungal infections is warranted.
- This case underscores the importance of considering extra-CNS sites in diagnosing and managing fungal brain infections.