RESUMO
Pleurostomophora richardsiae is a dematiaceous mold that causes subcutaneous cystic phaeohyphomycosis. Few cases of invasive P richardsiae infection have been reported. Hepatic artery thrombosis following organ transplantation caused by a fungal organism is also very rare. We present here a 57-year-old man with refractory ascites and liver failure following liver transplantation for treatment of hepatocellular carcinoma. Abdominal computed tomography demonstrated total occlusion of hepatic artery and blood clot in the portal vein and inferior vena cava. P richardsiae was isolated from blood culture and the blood clot in his liver. The patient was treated successfully with a 4-week course of amphotericin B deoxycholate and liver retransplantation.
Assuntos
Ascomicetos/patogenicidade , Artéria Hepática/microbiologia , Transplante de Fígado/efeitos adversos , Feoifomicose/sangue , Veia Porta/microbiologia , Trombose/microbiologia , Abdome/diagnóstico por imagem , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Ácido Desoxicólico/uso terapêutico , Combinação de Medicamentos , Humanos , Fígado/microbiologia , Fígado/patologia , Neoplasias Hepáticas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Feoifomicose/tratamento farmacológico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
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Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Feoifomicose/diagnóstico , Transplante de Rim/métodos , Transplante de Pulmão/métodos , Transplantados , Feoifomicose/sangue , Feoifomicose/tratamento farmacológico , Alternaria/patogenicidade , Itraconazol/administração & dosagem , Radiografia Torácica/métodosRESUMO
The Exophiala genus is responsible for many superficial and invasive infections resulting from black fungi. Identification of Exophiala at the species level is based on morphological observations complemented by molecular tests. The aim of this study was to identify 23 clinical isolates of Exophiala spp. and evaluate the antifungal susceptibility to seven different agents. Molecular identification was based on an analysis of ITS region of rDNA using genomic databases. The micromorphology was evaluated by microculture and scanning electron microscopy. The susceptibility tests were performed using the antifungal agents 5-fluorocytosine (5-FC), amphotericin B (AMB), itraconazole (ITC), voriconazole (VRC), posaconazole (PSC), caspofungin (CFG) and terbinafine (TRB). The ITS analysis identified 100% of the following isolates as: E. dermatitidis (8), E. xenobiotica (6), E. bergeri (4), E. oligosperma (3), E. spinifera (1) and E. mesophila (1). The antifungal susceptibility tests showed that the triazoles compounds were in vitro the most active agents against Exophiala. ITS sequencing enabled the accurate identification of the 23 tested isolates. The triazoles, particularly itraconazole and posaconazole, exhibited MIC values lower than AMB, CAS and 5-FC. Although the guidelines do not indicate AMB for treatment against Exophiala spp., this study showed activity for all of the tested species, except E. mesophila.
