Background

Exophiala dermatitidis is a dematiaceous fungus known to cause superficial, subcutaneous, cutaneous and deep seated infections, and rarely central line associated bloodstream infection (CLABSI). A case of CLABSI due to E. dermatitidis in an infant is described.

Case report

Clinical and laboratory data were extracted from patient's chart and laboratory records. The isolate was identified as E. dermatitidis by phenotypic characterization and sequencing of the ITS and LSU regions of the ribosomal DNA. Medline search was done to review all cases of CLABSI due to E. dermatitidis. Among the azoles tested, posaconazole (0.06 mg/l), voriconazole (0.03 mg/l) and itraconazole (0.03 mg/l) showed very low MICs when compared to fluconazole (4 mg/l)

Conclusions

As we did not found in the literature any case of CLABSI due to E. dermatitidis in an infant, we report the first one. Sequencing is a mandatory method for accurately identifying this species. Prompt removal of the central line, followed by a treatment with amphotericin B or an azole, seems to be the most effective treatment.

中文翻译：

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Exophiala dermatitidis 作为婴儿中心线相关血流感染的原因：病例报告和文献回顾

背景

Exophiala dermatitidis是一种已知会引起浅表、皮下、皮肤和深部感染的暗色真菌，很少引起中心线相关血流感染 (CLABSI)。描述了因婴儿皮炎大肠杆菌引起的 CLABSI 病例。

案例报告

从患者的病历和实验室记录中提取临床和实验室数据。通过核糖体 DNA 的 ITS 和 LSU 区域的表型表征和测序，该分离物被鉴定为皮炎大肠杆菌。进行了 Medline 搜索以审查所有由皮炎大肠杆菌引起的 CLABSI 病例。在测试的唑类中，泊沙康唑 (0.06  mg/l)、伏立康唑 (0.03  mg/l) 和伊曲康唑 (0.03  mg/l) 与氟康唑 (4  mg/l)相比显示出非常低的 MIC

结论

由于我们在文献中没有发现任何婴儿感染E. dermatitidis引起的 CLABSI 病例，因此我们报告了第一个病例。测序是准确识别该物种的强制性方法。迅速切除中心线，然后用两性霉素 B 或唑类进行治疗，似乎是最有效的治疗方法。