Fungemia due to Exophiala janselmei. Report of 15 cases.

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Fungemia due to Exophiala janselmei. Report of 15 cases.

Int Symp Infect Immunocompromised Host. 1998 Jun 21-24;10:(abstract no. 106). Unique Identifier : AIDSLINE AIDS/20710033
Nucci M; Akiti T; Silveira F; Barreiros G; Rinaldi M; University Hospital, Universidade Federal do Rio de Janeiro,; Brazil.

Abstract: Objective: To report cases of fungemia due to Exophiala janselmei occurring in an University Hospital in Rio de Janeiro, Brazil. Methods: Between December 1996 and September 1997 we identified an outbreak of fungemias due to black yeasts, further identified as Exophiala janselmei. We reviewed the charts of all patients in order to provide an insight into this emerging condition. Results: Exophiala janselmei fungemia occurred in 15 patients with the following underlying diseases: hematological malignancies (6), systemic lupus erythematosus (1), AIDS (1), unstable angina (1), breast cancer (1), agranulocytosis (1), osteomyelitis (1) and in the post-operative period (3). Patients were admitted to 7 different wards and the majority (6) was at the bone marrow transplantation unit. Thirteen patients had a central venous catheter (CVC) in place and 7 patients were neutropenic (<500/mm3). Fever occurred in 14 patients. Ten patients received antifungal treatment: amphotericin B (5), itraconazole (2) and amphotericin B followed by itraconazole (3). In addition, among the 13 patients with a CVC, the device was removed in 11. Four patients died (26.7%). The death was probably due to the fungemia in one case. Conclusions: Exophiala janselmei fungemia is a condition not previously described in the literature. In order to identify the source of this unusual outbreak, a survey of possible environmental sources of this fungus (including the hospital water supply), as well as a case-control study are underway.

Keywords: ABSTRACT Amphotericin B/ADMINISTRATION & DOSAGE/THERAPEUTIC USE Drug Therapy, Combination Exophiala/*ISOLATION & PURIF Fungemia/COMPLICATIONS/DRUG THERAPY/*MICROBIOLOGY Human *Immunocompromised Host Itraconazole/ADMINISTRATION & DOSAGE/THERAPEUTIC USE

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A0040252

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