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Infections due to Phialemonium species: case report and review

María Rivero1, Angel Hidalgo, Ana Alastruey-Izquierdo

  • 1Sección de Medicina Interna, Clínica Ubarmin, Elcano, Navarra, Spain.

Medical Mycology
|November 6, 2009
PubMed

Insights

Rare fungal infections are increasing. Phialemonium curvatum can cause disseminated disease, often endocarditis, with high mortality. New triazole antifungals like voriconazole show promise for treating Phialemonium infections.

Area of Science:

  • Medical Mycology
  • Infectious Diseases

Background:

  • Infections by rare fungal pathogens, such as Phialemonium curvatum, are increasingly reported.
  • This study details a disseminated Phialemonium curvatum infection and reviews existing literature.

Observation:

  • A review of 20 cases (1 new, 19 literature) of Phialemonium infections revealed compromised skin barriers (75%) and immunosuppression (70%) as common factors.
  • Dissemination occurred in 83% of immunocompetent and 57% of immunocompromised patients.
  • Endocarditis was the most frequent presentation (40%), with positive blood cultures in 92% of disseminated cases.

Findings:

  • Disseminated Phialemonium infections have a high mortality rate (54%).
  • No fatal outcomes were observed in patients treated with newer triazoles (itraconazole, voriconazole, posaconazole).
  • In vitro studies showed consistent activity of voriconazole and posaconazole against Phialemonium.

Implications:

  • Phialemonium infections, primarily endovascular, pose a significant threat, especially endocarditis.
  • Newer triazole antifungals are associated with improved survival rates.
  • This pathogen can cause infections even in individuals without typical risk factors like compromised skin barriers or weakened host defenses.

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