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BMC Oral Health
Published in: BMC Oral Health 1/2015

Open Access 01-12-2015 | Case report

Antifungal susceptibility and phenotypic characterization of oral isolates of a black fungus from a nasopharyngeal carcinoma patient under radiotherapy

Authors: Chaminda Jayampath Seneviratne, Phoenix HL Fong, Sarah SW Wong, Victor HF Lee

Published in: BMC Oral Health | Issue 1/2015

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Abstract

Background

During a research project on fungal Candida species in patients wearing obturator treated with radiotherapy for their recurrent nasopharyngeal carcinoma, we serendipitously observed the presence of black fungus in two consecutive samples from a patient.

Case presentation

The samples were collected from a 57 year-old Hong Kong gentleman who diagnosed to have undifferentiated type of nasopharyngeal carcinoma. He was treated with definitive concurrent chemoradiotherapy followed by adjuvant chemotherapy and then received a second-course radiotherapy with IMRT. 18S rDNA sequencing revealed that the isolates belong to Exophiala dermatitidis which was susceptible to fluconazole, itraconazole, ketoconazole and voriconazole. Interestingly, E. dermatitidis isolates were resistant to caspofungin and one isolate was resistant to amphotericin B. Both isolates formed biofilms comparable to that of Candida albicans. Single isolate of E. dermatitidis showed hemolysin and proteinase ability comparable to C. albicans whilst the other isolate was not.

Conclusion

We, for the first time, reported the discovery of a black fungus–E. dermatitidis isolates derived from a patient with nasopharyngeal carcinoma treated with radiotherapy. These isolates were shown to be resistant to caspofungin, a major antifungal agent for systemic candidiasis. As little is known about the black fungus in the clinical setting, it is important that clinicians must keep abreast of the new discovery in this field.
Literature
1.
Sullivan DJ, Moran GP, and Coleman DC. 2011. Fungal Infections of Humans. P. 257-278. Fungi: Biology and Applications. 2nd ed. Edited by Kavanagh K. John Wilet & Sons, Ltd.
2.
Lalla RV, Latortue MC, Hong CH, Ariyawardana A, D’Amato-Palumbo S, Fischer DJ, et al. A systematic review of oral fungal infections in patients receiving cancer therapy. Support Care Cancer. 2010;18 Suppl 8:985–92.CrossRefPubMedPubMedCentral
3.
4.
Lee N, Harris J, Garden AS, Straube W, Glisson B, Xia P, et al. Intensity-modulated radiation therapy with or without chemotherapy for nasopharyngeal carcinoma: radiation therapy oncology group phase II trial 0225. J Clin Oncol. 2009;27:3684–90.CrossRefPubMedPubMedCentral
5.
Pow EHN, Kwong DLW, McMillan AS, Wong MCM, Sham JST, Leung LHT, et al. Xerostomia and quality of life after intensity-modulated radiotherapy vs conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys. 2006;66 Suppl 4:981–91.CrossRefPubMed
6.
Panghal M, Kaushal V, Kadayan S, Yadav JP. Incidence and risk factors for infection in oral cancer patients undergoing different treatments protocols. BMC Oral Health. 2012;12:12.CrossRef
7.
Epstein JB, Tsang AH, Warkentin D, Ship JA. The role of salivary function in modulating chemotherapy-induced oropharyngeal mucositis: a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94 Suppl 1:39–44.CrossRefPubMed
8.
De Hoog GS, Queiroz-Telles F, Haase G, Fernandez-Zeppenfeldt G, Attili Angelis D, Gerrits Van Den Ende AH, et al. Black fungi: clinical and pathogenic approaches. Med Mycol. 2000;38 Suppl 1:243–50.CrossRefPubMed
9.
Li RY, Wang DL. Studies on phaeohyphomycosis and its causative agents in China. Japan J Med Mycol. 1996;37 Suppl 3:135–41.CrossRef
10.
Sudhadham M, de Hoog GS, Menken SBJ, van den Ende AHG, Sihanonth P. Rapid screening for genotypes as possible markers of virulence in the neurotropic black yeast Exophiala dermatitidis using PCR-RFLP. J Microbiol Methods. 2010;80 Suppl 2:138–42.CrossRefPubMed
11.
Matos T, de Hoog GS, de Boer AG, de Crom I, Haase G. High prevalence of the neurotrope Exophiala dermatitidis and related oligotrophic black yeasts in sauna facilities. Mycoses. 2002;45:373–7.CrossRefPubMed
12.
Li DM, Li RY, de Hoog GS, Sudhadham M, Wang DL. Fatal Exophiala infections in China, with a report of seven cases. Mycoses. 2011;54 Suppl 4:e136–42.CrossRefPubMed
13.
Clinical and Laboratory Standards Institute/National Committee for Clinical Laboratory Standards. Method for antifungal disk diffusion susceptibility testing of yeasts: approved guideline. Document M44-A. Wayne, PA: Clinical and Laboratory Standards Institute; 2004.
14.
Espinel-Ingroff A, Canton E, Gibbs D, Wang A. Correlation of Neo-Sensitabs tablet diffusion assay results on three different agar media with CLSI broth microdilution M27-A2 and disk diffusion M44-A results for testing susceptibilities of Candida spp. and Cryptococcus neoformans to amphotericin B, caspofungin, fluconazole, itraconazole, and voriconazole. J Clin Microbiol. 2007;45:858–64.CrossRefPubMedPubMedCentral
15.
Seneviratne CJ, Jin LJ, Samaranayake YH, Samaranayake LP. Cell density and cell aging as factors modulating antifungal resistance of Candida albicans biofilms. Antimicrob Agents Chemother. 2008;52:3259–66.CrossRefPubMedPubMedCentral
16.
Jin Y, Yip HK, Samaranayake YH, Yau JY, Samaranayake LP. Biofilm-forming ability of Candida albicans is unlikely to contribute to high levels of oral yeast carriage in cases of human immunodeficiency virus infection. J Clin Microbiol. 2003;41:2961–7.CrossRefPubMedPubMedCentral
17.
Jin Y, Samaranayake LP, Samaranayake Y, Yip HK. Biofilm formation of Candida albicans is variably affected by saliva and dietary sugars. Arch Oral Biol. 2004;49:789–98.CrossRefPubMed
18.
19.
Wu T, Samaranayake LP, Cao BY, Wang J. In vitro proteinase production by oral Candida albicans isolates from individuals with and without HIV infection and its attenuation by antimycotic agents. J Med Microbiol. 1996;44:311–6.CrossRefPubMed
20.
Woo PC, Ngan AH, Tsang CC, Ling IW, Chan JF, Leung SY, et al. Clinical spectrum of Exophiala infections and a novel Exophiala species, Exophiala hongkongensis. J Clin Microbiol. 2013;51:260–7.CrossRefPubMedPubMedCentral
21.
22.
Kantarcioglu AS, de Hoog GS. Infections of the central nervous system by melanized fungi: a review of cases presented between 1999 and 2004. Mycoses. 2004;47:4–13.CrossRefPubMed
23.
Patel AK, Patel KK, Darji P, Singh R, Shivaprakash MR, Chakrabarti A. Exophiala dermatitidis endocarditis on native aortic valve in a postrenal transplant patient and review of literature on E. dermatitidis infections. Mycoses. 2013;56 Suppl 3:365–72.CrossRefPubMed
24.
Duarte AP, Pagnocca FC, Baron NC, Melhem Mde S, Palmeira GA, de Angelis DF, et al. In vitro susceptibility of environmental isolates of Exophiala dermatitidis to five antifungal drugs. Mycopathologia. 2013;175:455–61.CrossRefPubMed
Metadata
Title
Antifungal susceptibility and phenotypic characterization of oral isolates of a black fungus from a nasopharyngeal carcinoma patient under radiotherapy
Authors
Chaminda Jayampath Seneviratne
Phoenix HL Fong
Sarah SW Wong
Victor HF Lee
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2015
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-015-0023-9

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