Phaeohyphomycosis: A 10-Year Review (2006–2016)

BACKGROUND: Phaeohyphomycosis is a rare infection caused by dematiaceous (pigmented) fungi, frequently reported in tropical and sub-tropical countries. Data regarding this infection is sparse and comprises mainly of case reports. This study was carried out to review epidemiology, causative spectrum, clinical features, and treatment outcomes in patients with Phaeohyphomycosis. METHODS: We reviewed 20 cases of culture proven Phaeohyphomycosis over a 10-year period at Christian Medical College, Vellore, South India. RESULTS: In our cohort, 16 of the 20 patients were male (80%) with an average age of 42 (range 17–66 years). Most of them (35%) were from Tamil Nadu, India and some from Bhutan and Nepal. Eighty-five percent presented with cutaneous lesions, 5% with involvement of the paranasal sinuses, and 5% each had organ involvement in brain and liver. Possible predisposing factors included type II diabetes mellitus (35%), renal transplantation (30%), long-term use of steroids (15%), and human immunodeficiency virus (5%). For all the patients, the direct microscopy and the culture positivity was 100%. The common species isolated were Cladophialophora bantiana, Cladosporium cladosporoides, Cladosporium sphaerospermum, Phialophora oxyspora, and Exophiala spinifera. Most patients (60%) received monotherapy with itraconazole. Five patients were cured, four had recurrence, one patient died (due to leukemia), and 10 were lost to follow-up. CONCLUSION: Phaeohyphomycosis, though an uncommon infection, causes life-threatening disease in both the immunocompetent and immunocompromised hosts. To our knowledge, this is the largest single-centre retrospective study on Phaeohyphomycosis. Though our follow-up was sub-optimal and possible in only 50%, it was noteworthy that disease recurrence was common. Better understanding of pathogenesis and newer antifungals are needed for optimal cure of this disease. DISCLOSURES: All authors: No reported disclosures.