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Cladophialophora Bantiana, the Neurotropic Fungus – a Mini Review

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Cladophialophora Bantiana, the Neurotropic Fungus – a Mini Review Review Article Cladophialophora bantiana, the Microbiology Neurotropic Fungus – A Mini Review GANAVALLI S. AJANTHA, RAGHAVENDRA D. KULKARNI ABSTRACT laboratory personnel who handle it. Only few clinicians are Cladophialophora bantiana is the most common and dangerous aware of this fungus. Complete awareness among the clinicians neurotropic fungus which causes brain abscess. The infection and other health care personnel is essential for the successful which is caused due to this fungus is risky, not only to the management of these infections. On this basis, we have reviewed patient due to the poor prognosis, but also to the clinician the microbiological, clinical and the therapeutic aspects of the because of the difficulty in its management as well as to the C. bantiana infections. Key Words: Cladophialophora - Cladophialophora bantiana - Brain abscess - Neurotropic fungi – Dematiaceous fungi – Phaeoid fungi - Cerebral phaeohyphomycosis KEY MESSAGE n C. bantiana is the commonest cause of non-traumatic CNS infections. INTRODUCTION debate about using different terms to describe the same character CNS infections which are caused by fungi except Cryptococcus continues, all these terms are in common use. Dematiaceous neoformans are always a surprise, as the incidence is very fungi, though they are mainly saprophytic, are important agents of less, especially in immunocompetent individuals [1]. Apart human and animal diseases. At present, over 150 species and 70 from Cryptococcus neoformans, a few fungal species like genera of dematiaceous fungi are known to cause various diseases Cladophialophora bantiana, Exophiala dermatitidis, Rhinocladiella and the list of potential pathogens is expanding rapidly [7]. This mackenzie and Ochroconis gallopava are the recognized group includes hyphomycetes, coelomycetes and ascomycetes. neurotropes. C. bantiana, a phaeoid fungus, is the commonest The clinical conditions which are associated with dematiaceous fungi are broadly classified into chromoblastomycosis, eumycotic cause of cerebral phaeohyphomycosis [2-4]. The purpose of mycetoma, and phaeohyphomycosis [Table/Fig-1] [6, 8-10]. this review was to provide adequate and clinico-microbiologically meaningful information to the health care personnel who were The second nomenclature committee of the International Society for involved in the management of neurological infections. We Human and Animal Mycology (ISHAM) recommends that the term searched the English language manuscripts which were published “phaeohyphomycosis” should be a generic term for any mycosis on ‘any date’, through PubMed, Google Scholar, ScienceDirect, which involves a dematiaceous fungus [5]. Clinical laboratories MDConsult, Ovid and Medknow. The search terms which were have to maintain high vigil and diligence in the task of identifying used were ‘Brain abscess’, ‘Cerebral Phaeohyphomycosis’, the dark moulds and in assessing their clinical significance. ‘Phaeohyphomycosis’, ‘Cladophialophora’, ‘Cladophialophora bantiana’, ‘Cladophialophora bantianum’, ‘Xylohypha bantiana’, TAXONOMY OF C. BANTIANA ‘Xylohypha emmonsii’, and ‘Cladosporium trichoides’. C. bantiana is a melanized hyphomycetous (hyphomycetous - conidia not enclosed within any special structure) fungus which DEMatiacEOUS FUNGI belongs to the order, Chaetothyriales [4]. This fungus has been Dematiaceous, melanized or phaeoid fungi are a heterogeneous christened several times by taxonomists; hence, different names collection of generally unrelated fungi which share the common like Cladosporium bantianum, Cladosporium trichoides, Xylohypha phenotypic feature of being darkly coloured. Their dark pigmentation bantiana and Xylohypha emmonsii have been found to be used for results from the presence of dihydroxynaphthalene melanin in the the same organism in the literature. [2-5, 11] cell walls. There is an argument that the term, ‘dematiaceous’ is The genus, Cladophialophora represents the anamorph members epistemologically incorrect. Therefore, the term ‘phaeoid’ (which of ascomycetes in the order, Chaetothyriales, in the family, is derived from the Greek word “phaeo,” meaning “dark”) came to Herpotrichiellaceae. [9] These members are encountered in human be used as a replacement. Both the terms, ‘dematiaceous fungi’ infections which range from mild cutaneous lesions to fatal CNS or ‘phaeoid fungi’ have no real taxonomic significance [5, 6]. Now- infections. [12] C. bantiana was earlier under the genus, Cladosporium a-days, the term “melanized” is more frequently used. Though the and it was later transferred to the genus, Xylohypha. [13] C. carrionii PB Journal of Clinical and Diagnostic Research. 2011 November (Suppl-1), Vol-5(6): 1301-1306 Journal of Clinical and Diagnostic Research. 2011 November (Suppl-1), Vol-5(6): 1301-1306 13011301 Ganavalli S. Ajantha, Raghavendra D. Kulkarni, C. bantiana www.jcdr.net Disease in humans Common agents mainly because of its typical morphology and the source of the clinical specimen. It can grow on routine fungal culture media. The Fonsecaea pedrosoi (most common) more commonly used media are potato dextrose agar, oatmeal F. compacta agar and malt agar. Sabouraud’s dextrose agar is not generally Cladophialophora carrionii preferred for black mould identification because the colonies may Chromoblastomy- Phialophora verrucosa fail to develop their characteristic colour on this medium and the cosis Rhinocladiella aquapersa conidiation or sporulation may also be delayed or poor. [6] Exophiala jeanselmei There are few important growth requirements and colony Exophiala spinifera characteristics that may help towards the identification of this Fonsecaea monophora fungus. [6, 14, 18, 19] Its growth rate is moderate and it takes Madurella mycetomatis around 7-8 days of incubation to see visible growth. This fungus 0 Madurella grisea grows at both room temperature and at 37 C. The colonies mature Eumycetoma Exophiala jeanselmei within 15 days and they show a velvety texture and olivaceous-gray to brown discolouration with a black reverse [Table/Fig-2]. They do Leptosphaeria senegalensis not produce any diffusible pigment. Pyrenochaeta species Phaeohyphomycosis C. bantiana has few important microscopic features which help in its identification. [6, 14, 18, 19] The fungus shows hyaline-to-brown, Superficial phaeohy- Tinea nigra: Hortae werneckii phomycosis Black piedra: Piedraia hortae septate hyphae. Smooth walled, single-celled, pale olivaceous, Cutaneous phae- Exophiala jeanselmei ellipsoidal to spindle-shaped conidia of approximately 2.5-5 x 6-11 ohyphomycosis Nattrassia mangiferae / Scytalidium dimidiatum µm in size are seen. They are arranged in long, strongly coherent Exophiala spp. (non-fragile) chains and rarely show branching [Table/Fig-3] and Subcutaneous Alternaria spp. [Table/Fig-4]. The chains of the conidia arise directly from the phaeohyphomycosis Phialophora spp. hyphae. Chlamydoconidia are seen occasionally. Bipolaris spp. Curvularia spp. The Cladophialophora species are prone to identification problems Corneal phaeohy- Alternaria spp. because of the high degree of phenotypic similarity between phomycosis Bipolaris spp. (Mycotic keratitis) its different species. Cladophialophora and Cladosporium can Lasiodiplodia theobromae be differentiated, as the former do not display the dark scars of Bipolaris spp. Sinusitis attachment. The type species of the genus Cladophialophora, Curvularia spp. Cladophialophora carrioni, shows densely-branched conidial Disseminated DSP chains. The chains arise from branched or unbranched denticles Scedosporium prolificans Deep-seated (Some experts do not consider it dematiaceous) in C. carrioni. phaeohyphomycosis Bipolaris spp. (DSP) Curvularia spp. There are some conventional biochemical tests and physiological Exophiala spp. tests which are commonly used in the identification ofC. bantiana. Wangiella spp. [6, 20, 21] This fungus grows at 42-430 C, it can grow on media Cerebral phaeohyphomycosis which contain cycloheximide, it is urease positive and the Fontana- Cladophialophora bantiana (Most common) Masson staining stains it black (Table/Figure-3). The Fontana- Ochroconis gallopavum Masson stain is specific for melanin. This species is non-proteolytic on casein agar and it is unable to liquefy 12% gelatin. However, Rhinocladiella mackenziei molecular methods like sequencing are the most dependable tools [Table/Fig-1]: Melanized Fungi and Diseases in Humans [5, 6, 8-10] which can be used for its confirmation. and C. devriesii also were included in the genus, Cladosporium. C. bantiana has rarely been isolated from nonhuman sources and Large subunit rRNA sequencing studies and nutritional physiology only a few reports of its isolation from nature are on record. [20] The tests have led to the taxonomic reclassification of many fungal precise ecological niche of the fungus is unknown, but it is believed pathogens into the genus, Cladophialophora. Other species which to be a soil fungus. [2, 12] The occupational association of the C. are included under the genus, Cladophialophora are C. emmonsii, bantiana infection with farming is suggestive of the presence of this C. modesta, C. arxii, C. saturnica, and C. boppii. [6, 14, 15] fungus in this environment.[22, 23] The type species of the genus, C. carrionii, causes Its primary pulmonary colonization may be important, following chromoblastomycosis. C. bantiana and C. modesta cause brain which it is transferred through the haematogenous route to the infections, C. devriesii and C. arxii cause disseminated
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