Phaeohyphomycosis caused by the fungal genera Bipolaris and Exserohilum. A report of 9 cases and review of the literature

R. D. Adam, M. L. Paquin, E. A. Petersen, M. A. Saubolle, M. G. Rinaldi, J. G. Corcoran, John N Galgiani, Richard E Sobonya

Research output: Contribution to journalArticle

137 Citations (Scopus)

Abstract

We have reported 7 new cases of Bipolaris infection and 2 of Exserohilum infection, which demonstrate the capability of these 2 genera to cause invasive as well as 'allergic' disease. As noted previously, it is likely that all of the cases of 'Helminthosporium' and Drechslera infections reported in the literature were caused by Bipolaris or Exserohilum. Infections due to these 2 genera are probably more common than previously recognized. They should be included in the differential diagnosis of central nervous system and disseminated fungal disease, sinusitis, keratitis, peritonitis associated with continuous ambulatory peritoneal dialysis, and allergic bronchopulmonary disease. These various entities have distinct histopathologic characteristics. With disseminated disease in the immunocompromised patient, the most frequent findings are acute inflammation with prominent vascular invasion, thrombosis, and infarction. In contrast, granulomatous inflammation and leukocytoclastic vasculitis are seen in meningoencephalitis caused by these fungi. The histologic features of allergic bronchopulmonary disease and sinusitis are similar. A chronic inflammatory infiltrate of lymphocytes, plasma cells and eosinophils within edematous granulation tissue is found in addition to squamous metaplasia and thickening of the basement membrane. Infections caused by Bipolaris/Exserohilum and Aspergillus show many clinical and pathologic similarities despite the lack of taxonomic relationship between these fungi. Both cause disseminated disease in immunocompromised patients that is characterized by tissue necrosis and vascular invasion. Both cause central nervous system disease, osteomyelitis, and sinusitis and are associated with allergic bronchopulmonary disease. Sinusitis, the most common form of disease caused by Bipolaris and Exserohilum, occurs in otherwise healthy patients with nasal polyposis and allergic rhinitis. Although pathologic evidence of bone invasion may not be found, there frequently is radiographic evidence of invasive disease. Most patients who are treated initially with surgical debridement and amphotericin B have apparently been cured. However, longer follow-up will be necessary in these patients. Amphotericin B appears to be the treatment of choice for invasive infections caused by Bipolaris/Exserohilum species. Ketoconazole and other imidazole derivatives may also be effective in certain of the disease entities caused by these black moulds; however, their role has yet to be defined. Further research is needed to prospectively correlate in vitro values with the outcome of treatment of experimental mycotic infections and, when possible and appropriate, with human mycoses. Clinicians and microbiologists must be aware of phaeohyphomycoses caused by species of Bipolaris and Exserohilum, as well as related organisms, since they are being seen with increasing frequency.

Original languageEnglish (US)
Pages (from-to)203-217
Number of pages15
JournalMedicine
Volume65
Issue number4
StatePublished - 1986

Fingerprint

Phaeohyphomycosis
Sinusitis
Infection
Fungi
Mycoses
Immunocompromised Host
Amphotericin B
Blood Vessels
Helminthosporium
Inflammation
Meningoencephalitis
Ketoconazole
Continuous Ambulatory Peritoneal Dialysis
Granulation Tissue
Keratitis
Central Nervous System Diseases
Metaplasia
Debridement
Osteomyelitis
Aspergillus

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Adam, R. D., Paquin, M. L., Petersen, E. A., Saubolle, M. A., Rinaldi, M. G., Corcoran, J. G., ... Sobonya, R. E. (1986). Phaeohyphomycosis caused by the fungal genera Bipolaris and Exserohilum. A report of 9 cases and review of the literature. Medicine, 65(4), 203-217.

Phaeohyphomycosis caused by the fungal genera Bipolaris and Exserohilum. A report of 9 cases and review of the literature. / Adam, R. D.; Paquin, M. L.; Petersen, E. A.; Saubolle, M. A.; Rinaldi, M. G.; Corcoran, J. G.; Galgiani, John N; Sobonya, Richard E.

In: Medicine, Vol. 65, No. 4, 1986, p. 203-217.

Research output: Contribution to journalArticle

Adam, RD, Paquin, ML, Petersen, EA, Saubolle, MA, Rinaldi, MG, Corcoran, JG, Galgiani, JN & Sobonya, RE 1986, 'Phaeohyphomycosis caused by the fungal genera Bipolaris and Exserohilum. A report of 9 cases and review of the literature', Medicine, vol. 65, no. 4, pp. 203-217.
Adam RD, Paquin ML, Petersen EA, Saubolle MA, Rinaldi MG, Corcoran JG et al. Phaeohyphomycosis caused by the fungal genera Bipolaris and Exserohilum. A report of 9 cases and review of the literature. Medicine. 1986;65(4):203-217.
Adam, R. D. ; Paquin, M. L. ; Petersen, E. A. ; Saubolle, M. A. ; Rinaldi, M. G. ; Corcoran, J. G. ; Galgiani, John N ; Sobonya, Richard E. / Phaeohyphomycosis caused by the fungal genera Bipolaris and Exserohilum. A report of 9 cases and review of the literature. In: Medicine. 1986 ; Vol. 65, No. 4. pp. 203-217.
@article{1c580f9c7d834e5ab16b256f33000ff4,
title = "Phaeohyphomycosis caused by the fungal genera Bipolaris and Exserohilum. A report of 9 cases and review of the literature",
abstract = "We have reported 7 new cases of Bipolaris infection and 2 of Exserohilum infection, which demonstrate the capability of these 2 genera to cause invasive as well as 'allergic' disease. As noted previously, it is likely that all of the cases of 'Helminthosporium' and Drechslera infections reported in the literature were caused by Bipolaris or Exserohilum. Infections due to these 2 genera are probably more common than previously recognized. They should be included in the differential diagnosis of central nervous system and disseminated fungal disease, sinusitis, keratitis, peritonitis associated with continuous ambulatory peritoneal dialysis, and allergic bronchopulmonary disease. These various entities have distinct histopathologic characteristics. With disseminated disease in the immunocompromised patient, the most frequent findings are acute inflammation with prominent vascular invasion, thrombosis, and infarction. In contrast, granulomatous inflammation and leukocytoclastic vasculitis are seen in meningoencephalitis caused by these fungi. The histologic features of allergic bronchopulmonary disease and sinusitis are similar. A chronic inflammatory infiltrate of lymphocytes, plasma cells and eosinophils within edematous granulation tissue is found in addition to squamous metaplasia and thickening of the basement membrane. Infections caused by Bipolaris/Exserohilum and Aspergillus show many clinical and pathologic similarities despite the lack of taxonomic relationship between these fungi. Both cause disseminated disease in immunocompromised patients that is characterized by tissue necrosis and vascular invasion. Both cause central nervous system disease, osteomyelitis, and sinusitis and are associated with allergic bronchopulmonary disease. Sinusitis, the most common form of disease caused by Bipolaris and Exserohilum, occurs in otherwise healthy patients with nasal polyposis and allergic rhinitis. Although pathologic evidence of bone invasion may not be found, there frequently is radiographic evidence of invasive disease. Most patients who are treated initially with surgical debridement and amphotericin B have apparently been cured. However, longer follow-up will be necessary in these patients. Amphotericin B appears to be the treatment of choice for invasive infections caused by Bipolaris/Exserohilum species. Ketoconazole and other imidazole derivatives may also be effective in certain of the disease entities caused by these black moulds; however, their role has yet to be defined. Further research is needed to prospectively correlate in vitro values with the outcome of treatment of experimental mycotic infections and, when possible and appropriate, with human mycoses. Clinicians and microbiologists must be aware of phaeohyphomycoses caused by species of Bipolaris and Exserohilum, as well as related organisms, since they are being seen with increasing frequency.",
author = "Adam, {R. D.} and Paquin, {M. L.} and Petersen, {E. A.} and Saubolle, {M. A.} and Rinaldi, {M. G.} and Corcoran, {J. G.} and Galgiani, {John N} and Sobonya, {Richard E}",
year = "1986",
language = "English (US)",
volume = "65",
pages = "203--217",
journal = "Medicine (United States)",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Phaeohyphomycosis caused by the fungal genera Bipolaris and Exserohilum. A report of 9 cases and review of the literature

AU - Adam, R. D.

AU - Paquin, M. L.

AU - Petersen, E. A.

AU - Saubolle, M. A.

AU - Rinaldi, M. G.

AU - Corcoran, J. G.

AU - Galgiani, John N

AU - Sobonya, Richard E

PY - 1986

Y1 - 1986

N2 - We have reported 7 new cases of Bipolaris infection and 2 of Exserohilum infection, which demonstrate the capability of these 2 genera to cause invasive as well as 'allergic' disease. As noted previously, it is likely that all of the cases of 'Helminthosporium' and Drechslera infections reported in the literature were caused by Bipolaris or Exserohilum. Infections due to these 2 genera are probably more common than previously recognized. They should be included in the differential diagnosis of central nervous system and disseminated fungal disease, sinusitis, keratitis, peritonitis associated with continuous ambulatory peritoneal dialysis, and allergic bronchopulmonary disease. These various entities have distinct histopathologic characteristics. With disseminated disease in the immunocompromised patient, the most frequent findings are acute inflammation with prominent vascular invasion, thrombosis, and infarction. In contrast, granulomatous inflammation and leukocytoclastic vasculitis are seen in meningoencephalitis caused by these fungi. The histologic features of allergic bronchopulmonary disease and sinusitis are similar. A chronic inflammatory infiltrate of lymphocytes, plasma cells and eosinophils within edematous granulation tissue is found in addition to squamous metaplasia and thickening of the basement membrane. Infections caused by Bipolaris/Exserohilum and Aspergillus show many clinical and pathologic similarities despite the lack of taxonomic relationship between these fungi. Both cause disseminated disease in immunocompromised patients that is characterized by tissue necrosis and vascular invasion. Both cause central nervous system disease, osteomyelitis, and sinusitis and are associated with allergic bronchopulmonary disease. Sinusitis, the most common form of disease caused by Bipolaris and Exserohilum, occurs in otherwise healthy patients with nasal polyposis and allergic rhinitis. Although pathologic evidence of bone invasion may not be found, there frequently is radiographic evidence of invasive disease. Most patients who are treated initially with surgical debridement and amphotericin B have apparently been cured. However, longer follow-up will be necessary in these patients. Amphotericin B appears to be the treatment of choice for invasive infections caused by Bipolaris/Exserohilum species. Ketoconazole and other imidazole derivatives may also be effective in certain of the disease entities caused by these black moulds; however, their role has yet to be defined. Further research is needed to prospectively correlate in vitro values with the outcome of treatment of experimental mycotic infections and, when possible and appropriate, with human mycoses. Clinicians and microbiologists must be aware of phaeohyphomycoses caused by species of Bipolaris and Exserohilum, as well as related organisms, since they are being seen with increasing frequency.

AB - We have reported 7 new cases of Bipolaris infection and 2 of Exserohilum infection, which demonstrate the capability of these 2 genera to cause invasive as well as 'allergic' disease. As noted previously, it is likely that all of the cases of 'Helminthosporium' and Drechslera infections reported in the literature were caused by Bipolaris or Exserohilum. Infections due to these 2 genera are probably more common than previously recognized. They should be included in the differential diagnosis of central nervous system and disseminated fungal disease, sinusitis, keratitis, peritonitis associated with continuous ambulatory peritoneal dialysis, and allergic bronchopulmonary disease. These various entities have distinct histopathologic characteristics. With disseminated disease in the immunocompromised patient, the most frequent findings are acute inflammation with prominent vascular invasion, thrombosis, and infarction. In contrast, granulomatous inflammation and leukocytoclastic vasculitis are seen in meningoencephalitis caused by these fungi. The histologic features of allergic bronchopulmonary disease and sinusitis are similar. A chronic inflammatory infiltrate of lymphocytes, plasma cells and eosinophils within edematous granulation tissue is found in addition to squamous metaplasia and thickening of the basement membrane. Infections caused by Bipolaris/Exserohilum and Aspergillus show many clinical and pathologic similarities despite the lack of taxonomic relationship between these fungi. Both cause disseminated disease in immunocompromised patients that is characterized by tissue necrosis and vascular invasion. Both cause central nervous system disease, osteomyelitis, and sinusitis and are associated with allergic bronchopulmonary disease. Sinusitis, the most common form of disease caused by Bipolaris and Exserohilum, occurs in otherwise healthy patients with nasal polyposis and allergic rhinitis. Although pathologic evidence of bone invasion may not be found, there frequently is radiographic evidence of invasive disease. Most patients who are treated initially with surgical debridement and amphotericin B have apparently been cured. However, longer follow-up will be necessary in these patients. Amphotericin B appears to be the treatment of choice for invasive infections caused by Bipolaris/Exserohilum species. Ketoconazole and other imidazole derivatives may also be effective in certain of the disease entities caused by these black moulds; however, their role has yet to be defined. Further research is needed to prospectively correlate in vitro values with the outcome of treatment of experimental mycotic infections and, when possible and appropriate, with human mycoses. Clinicians and microbiologists must be aware of phaeohyphomycoses caused by species of Bipolaris and Exserohilum, as well as related organisms, since they are being seen with increasing frequency.

UR - http://www.scopus.com/inward/record.url?scp=0022466798&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0022466798&partnerID=8YFLogxK

M3 - Article

C2 - 3523112

AN - SCOPUS:0022466798

VL - 65

SP - 203

EP - 217

JO - Medicine (United States)

JF - Medicine (United States)

SN - 0025-7974

IS - 4

ER -