Brain abscess caused by Cladosporium trichoides

Area of Science:

• Mycology
• Infectious Diseases
• Clinical Pharmacology

Background:

• Cladosporiosis is a rare fungal infection with a historically poor prognosis.
• No consistently effective therapeutic strategies have been established for cladosporiosis.
• Previous reports indicate a high mortality rate, typically within one year of diagnosis.

Observation:

• Two patients with cladosporiosis were treated with flucytosine.
• Pre-treatment fungal isolates exhibited susceptibility to flucytosine at concentrations of 6.2 µg/ml and 3.1 µg/ml.
• Both patients ultimately succumbed to the infection.

Findings:

• Post-mortem examination revealed complete eradication of the fungus in one patient.
• In the second patient, the causative agent, Cladophialophora trichoides, demonstrated acquired resistance to flucytosine post-treatment.
• Flucytosine exhibited fungistatic or fungicidal activity in vitro, but clinical outcomes were poor.

Implications:

• Flucytosine may have a role in managing cladosporiosis, potentially leading to fungal clearance in some cases.
• The development of flucytosine resistance in Cladophialophora trichoides is a significant clinical concern.
• Further research is needed to develop more robust and reliable therapeutic regimens for cladosporiosis.