Rhinocladiella mackenziei as an Emerging Cause of Cerebral Phaeohyphomycosis in Pakistan: A Case Series

Department of Pathology/Microbiology, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan.
Clinical Infectious Diseases (Impact Factor: 8.89). 01/2011; 52(2):213-7. DOI: 10.1093/cid/ciq114
Source: PubMed


Six cases of Rhinocladiella mackenziei cerebral phaeohyphomycosis are being reported for the first time in Pakistan. Identification was confirmed by DNA sequencing
(isolates and fixed tissue). Diabetes, head trauma, immunosuppressive treatment, and postpartum state were present in 4 cases.
Two survivals and 3 fatalities occurred, with 1 patient lost to follow-up.

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    • "Rhinocladiella mackenziei is a neurotropic black yeast fungus and an agent of cerebral phaeohyphomycosis restricted to patients living or coming from Middle East (Saudi Arabia, Kuwait, Qatar, United Arab Emirate, Israel, Pakistan and Afghanistan) with nearly 100% mortality in both immunocompetent and immunocompromised individuals [12] [14] [15], although in 2010, Badali et al. reported the first case of cerebral phaeohyphomycosis in India, which should now be added to the list of areas where cerebral phaeohyphomycosis is endemic [5]. Until now, this fungus has not yet been previously isolated from nature of the Middle East [4]. "
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    ABSTRACT: Black yeast-like fungi and relatives as agents of cerebral phaeohyphomycosis are often encountered in human fatal brain abscesses and lead to almost 100% mortality despite the application of antifungal and surgical therapy. We report to our knowledge the first case of brain infection due to Rhinocladiella mackenziei in a 54-year-old immunocompetent male in Iran where R. mackenziei has not been reported previously. The initial diagnosis was brain fungal infection because of pigmented, irregular, branched, septated hyphae based on histopathological staining. The patient was treated with intravenous amphotericin B deoxycholate (0.5mg/kg/day) combined with oral itraconazole (200mg twice daily), nevertheless, his neurological function deteriorated rapidly and ultimately the patient died due to respiratory failure later two weeks. R. mackenziei was identified based on the sequencing of internal transcribed spacer (ITS rDNA region) (KJ140287). Therefore, considerable attention for this life-threatening infection is highly recommended. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    Full-text · Article · Jan 2015 · Journal de Mycologie Médicale/Journal of Medical Mycology
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    • "R. mackenziei is characterized by its stout conidiophores and brown, thick-walled conidia. Definitive identification of the species requires sequencing of ITS and/or D1/D2 regions of the LSU rDNA gene (Jabeen et al. 2011). "
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    ABSTRACT: A review is given of melanized fungi involved in human infection, including species forming budding cells and strictly filamentous representatives. Classically, they are known as "phaeoid" or "dematiaceous" fungi, and, today, agents are recognized to belong to seven orders of fungi, of which the Chaetothyriales and Pleosporales are the most important. Infections range from cutaneous or pulmonary colonization to systemic or disseminated invasion. Subcutaneous involvement, either primary or after dissemination, may lead to host tissue proliferation of dermis or epidermis. Particularly in the Chaetothyriales, subcutaneous and systemic infections may occur in otherwise apparently healthy individuals. Infections are mostly chronic and require extended antifungal therapy and/or surgery.
    Full-text · Article · Nov 2014 · Cold Spring Harbor Perspectives in Medicine
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    ABSTRACT: Rhinocladiella mackenziei (formerly Ramichloridium mackenziei), a causative agent of cerebral phaeohyphomycosis, is extremely rare and it is geographically limited to the Middle East. The organism has a predilection to cause brain infections and results in a grave prognosis with a high mortality rate. The current patient was admitted to a long term care facility with chronic respiratory failure and dependence on a mechanical ventilator. She later developed left sided weakness and a CT-scan of the brain revealed multiple variable sized hypodense, well-defined lesions with ring enhancement. A stereotactic needle aspiration of the largest lesion showed fungal hyphae. The final culture grew R. mackenzie. The patient was initially started on liposomal amphotericin B, then voriconazole and caspofungin intravenously as posaconazole was not available. The patient failed to respond to antifungal therapy and finally she died 34 days after the start of the treatment. R. mackenziei is a highly virulent agent, and should be considered in the differential diagnosis of central nervous system disease in patients from the Middle East.
    No preview · Article · Jun 2011
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