Journal List > Korean J Clin Microbiol > v.13(3) > 1038194

Korean J Clin Microbiol. 2010 Sep;13(3):135-139. Korean.
Published online September 30, 2010.
Copyright © 2010 The Korean Society of Clinical Microbiology
Fungemia due to Exophiala dermatitidis
Eun Sun Jeong, Jong Hee Shin, Myung Geun Shin, Soon Pal Suh and Dong Wook Ryang
Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea.

Correspondence: Jong Hee Shin, Department of Laboratory Medicine, Chonnam National University Medical School, 671 Jebong-ro, Dong-gu, Gwangju 501-757, Korea. (Tel) 82-62-220-5342, (Fax) 82-62-224-2518, Email:
Received January 12, 2010; Revised July 13, 2010; Accepted August 20, 2010.


We report a rare case of fungemia due to Exophiala (Wangiella) dermatitidis in a 4-month-old female infant who was admitted to an intensive care unit with sudden infant death syndrome (SIDS). E. dermatitidiswas repeatedly isolated from blood cultures (on the 28th and 32nd day of hospitalization) of the patient, who died on the 44th day of hospitalization. The fungus was identified by its morphological characteristics and DNA sequencing of both the D1/D2 domain and the ITS region of rDNA. To our knowledge, this is the first reported case of E. dermatitidis fungemia in Korea.

Keywords: Exophiala (Wangiella) dermatitidis; Fungemia; ITS; Sequencing


Fig. 1
Two weeks after incubation at 30℃ on the potato dextrose agar, the colonies appeared as black, reverse black, wet, and mucoid.
Click for larger image

Fig. 2
Microscopically, septate, and pale olivaceous hyphae and black yeast synanarmorphs were found. Conidiogenous cells were cylindrical, with rounded apeces producing one-celled conidia. Round to ovoid, pale brown conidia accumulated in balls or slipped down the side of conidiophores (Lactophenol cotton blue stain, ×400).
Click for larger image

Fig. 3
A pyelogenetic tree of Exophiala and neighboring species, constructed by using neighbor-joining algorithm.
Click for larger image

1. Nachman S, Alpan O, Malowitz R, Spitzer ED. Catheter-associated fungemia due to Wangiella (Exophiala) dermatitidis. J Clin Microbiol 1996;34:1011–1013.
2. Hohl PE, Holley HP Jr, Prevost E, Ajello L, Padhye AA. Infections due to Wangiella dermatitidis in humans: report of the first documented case from the United States and a review of the literature. Rev Infect Dis 1983;5:854–864.
3. Vlassopoulos D, Kouppari G, Arvanitis D, Papaefstathiou K, Dounavis A, Velegraki A, et al. Wangiella dermatitidis peritonitis in a CAPD patient. Perit Dial Int 2001;21:96–97.
4. Chang CL, Kim DS, Park DJ, Kim HJ, Lee CH, Shin JH. Acute cerebral phaeohyphomycosis due to Wangiella dermatitidis accompanied by cerebrospinal fluid eosinophilia. J Clin Microbiol 2000;38:1965–1966.
5. Kim DS, Yoon YM, Kim SW. Phaeohyphomycosis due to Exophiala dermatitidis successfully treated with itraconazole. Korean J Med Mycol 1999;4:79–83.
6. Hong KH, Kim JW, Jang SJ, Yu E, Kim EC. Liver cirrhosis caused by Exophiala dermatitidis. J Med Microbiol 2009;58:674–677.
7. Sugita T, Nishikawa A, Ikeda R, Shinoda T. Identification of medically relevant Trichosporon species based on sequences of internal transcribed spacer regions and construction of a database for Trichosporon identification. J Clin Microbiol 1999;37:1985–1993.
8. Kurtzman CP, Robnett CJ. Identification of clinically important ascomycetous yeasts based on nucleotide divergence in the 5' end of the large-subunit (26S) ribosomal DNA gene. J Clin Microbiol 1997;35:1216–1223.
9. Untereiner WA. Fruiting studies in species of Capronia (Herpotrichiellaceae). Antonie Van Leeuwenhoek 1995;68:3–17.
10. Al-Obaid I, Ahmad S, Khan ZU, Dinesh B, Hejab HM. Catheter-associated fungemia due to Exophiala oligosperma in a leukemic child and review of fungemia cases caused by Exophiala species. Eur J Clin Microbiol Infect Dis 2006;25:729–732.
11. Lim WH, Shin JH, Suh SP, Ryang DW. Diagnosis of central venous catheter-related sepsis using differential quantitative blood cultures. Korean J Clin Pathol 1998;18:208–214.
12. de Hoog GS, Matos T, Sudhadham M, Luijsterburg KF, Haase G. Intestinal prevalence of the neurotropic black yeast Exophiala (Wangiella) dermatitidis in healthy and impaired individuals. Mycoses 2005;48:142–145.
13. Woollons A, Darley CR, Pandian S, Arnstein P, Blackee J, Paul J. Phaeohyphomycosis caused by Exophiala dermatitidis following intra-articular steroid injection. Br J Dermatol 1996;135:475–477.
14. de Hoog GS, Vitale RG. Bipolaris, Exophiala, Scedosporium, Sporothriz, and Other Dematiaceous Fungi. In: Murray PR, Baron EJ, Jeorgensen JH, Landry ML, Pfaller MA, editors. Manual of Clinical Microbiology. 9th ed. Washington D.C.: ASM Press; 2007. pp. 1898-1917.
15. Petti CA. Detection and identification of microorganisms by gene amplification and sequencing. Clin Infect Dis 2007;44:1108–1114.
16. Vitale RG, De Hoog GS, Verweij PE. In vitro activity of amphotericin B, itraconazole, terbinafine and 5-fluocytosine against Exophiala spinifera and evaluation of post-antifungal effects. Med Mycol 2003;41:301–307.