Infections due to Xylohypha bantiana (Cladosporium trichoides)

Thirty culture-documented cases of infection caused by Xylohypha bantiana (synonyms, Cladosporium bantianum, Cladosporium trichoides) were identified in the world literature; 26 cases involved the central nervous system (CNS) and most frequently presented as chronic headache followed by fever and hemiparesis. Phaeohyphomycosis due to X. bantiana occurs worldwide, predominantly in young males. Pharmacologic immunosuppression was not an important predisposing factor. However, four patients had a history of systemic nocardiosis or facial phaeohyphomycosis caused by Alternaria species. Chest radiography revealed no pulmonary infiltrates. Computed tomography of the brain demonstrated a mass defect, the frontal lobes being the most common sites of infection. Lumbar puncture usually demonstrated an elevated opening pressure, elevated cerebrospinal fluid protein level, hypoglycorrhachia, and cultures were negative. No preoperative clinical or laboratory features indicated CNS fungal infection. Complete neurosurgical resection of the lesion was the most important therapeutic intervention determining survival; systemic antifungal chemotherapy apparently did not influence outcome. The survival rate of 35% for all patients and of 45% for all neurosurgically treated patients was higher than had previously been reported, probably because patients dying from infections confirmed only histopathologically were excluded.