Unusual mycoses caused by uncommon or rare fungi.
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Bacterial infections of dialysis access fistulae are well known in patients with end-stage renal disease, but fungal infections of these prostheses have not been reported. Two patients who presented with recurrent infections and thromboses of their grafts grew Staphylococcus aureus and Cephalosporium species. This new entity suggests a different approach to the management of clotted grafts in patients with end-stage renal disease. If fungus is isolated from the graft, extirpation of the graft and amphotericin B therapy are suggested. We review here the mycology of Cephalosporium species, in-vitro sensitivity studies, and previous reports of infection with this fungus.
Phaeohyphomycosis caused by Phialophora parasitica is rare and it has never been documented in Thailand. The first two Thai cases of phaeohyphomycosis caused by P. parasitica were recognized in early 1990 at Ramathibodi Hospital, Bangkok, Thailand. Both patients had underlying diseases. The fungus developed in abscesses with pigmented mycelium at the lower extremity. Cultures from pus and tissue biopsies were positive for dematiaceous fungi. Light microscopic features suggested P. parasitica and which was illustrated by both scanning and transmission electron microscope. The first case was treated with itraconazole with a satisfactory initial response. The second case was successfully treated by surgical removal of the entire lesion.
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