Chaminda Jayampath Seneviratne, Phoenix HL Fong and Victor HF Lee contributed equally to this work.
The authors declare that they have no competing interests.
CJS and VHFL conceived and designed the study. VHFL performed the sample collection. PHLF performed the experiments. CJS, PHLF, SSWW analysed the data. CJS, PHLF, SSWW and VHFL wrote the manuscript. All authors read and approved the final manuscript.
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.
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.
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.
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.
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
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
Li RY, Wang DL. Studies on phaeohyphomycosis and its causative agents in China. Japan J Med Mycol. 1996;37 Suppl 3:135–41. CrossRef
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.
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
- Antifungal susceptibility and phenotypic characterization of oral isolates of a black fungus from a nasopharyngeal carcinoma patient under radiotherapy
Chaminda Jayampath Seneviratne
Phoenix HL Fong
Sarah SW Wong
Victor HF Lee
- BioMed Central
Neu im Fachgebiet Zahnmedizin
Mail Icon II