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Cerebral phaeohyphomycosis at a tertiary healthcare center in Saudi Arabia

Mayyadah H Alabdely1, Abdullah S Alolayan1, Reem S Almaghrabi1

  • 1From the Department of Critical Care (Alolayan), Department of Medicine (Almaghrabi, Al-Abdely), King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.

Neurosciences (Riyadh, Saudi Arabia)
|April 12, 2023
PubMed
Abstract

Insights

Cerebral phaeohyphomycosis is a rare fungal brain infection, often affecting immunocompromised individuals. Rhinocladiella mackenziei is a common cause with a poor prognosis, though some treatments show success.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Neurology

Background:

  • Phaeohyphomycetes are fungi with 1,8 dihydroxynaphthalene-melanin in their cell walls.
  • Cerebral infections by these fungi are rare and often linked to neurotrophic species.
  • Understanding the epidemiology and clinical characteristics of cerebral phaeohyphomycosis is crucial.

Purpose of the Study:

  • To document cases of cerebral phaeohyphomycosis at a tertiary hospital in Riyadh, Saudi Arabia.
  • To analyze the demographics, risk factors, clinical presentation, treatment, and outcomes of these infections.
  • To identify the most common causative agents and their associated prognoses.

Main Methods:

  • A retrospective review of medical records was conducted in January 2020.
  • Culture-positive cases of cerebral phaeohyphomycosis were identified at King Faisal Specialist Hospital and Research Center.
  • Data collected included patient demographics, risk factors, clinical details, treatments, and outcomes.

Main Results:

  • Twelve cases of cerebral phaeohyphomycosis were identified.
  • Rhinocladiella mackenziei caused 4 cases, and other phaeohyphomycetes caused 8 cases, including Neoscytalidium dimidiatum.
  • Ten of 12 patients were immunocompromised; R. mackenziei infections manifested as brain abscesses.
  • Four patients survived over a year with successful treatment involving surgical evacuation and triazole antifungals.

Conclusions:

  • Cerebral phaeohyphomycosis is an uncommon, serious fungal infection, predominantly in immunocompromised patients.
  • Rhinocladiella mackenziei is the most frequent pathogen in this series and is associated with high mortality.
  • Combination therapy including surgery and azoles may improve outcomes.

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