Li Dong Ming, de Hoog G Sybren
Peking University Third Hospital, Beijing, China.
Lancet Infect Dis. 2009 Jun;9(6):376-83. doi: 10.1016/S1473-3099(09)70131-8.
Cerebral phaeohyphomycosis is a fungal infection of the brain typically caused by Cladophialophora bantiana, Exophiala dermatitidis, and Rhinocladiella mackenziei, all of which belong to the order Chaetothyriales. The disease results in black, necrotic brain tissue, black pus, and black cerebrospinal fluid. Pathogens usually reach the brain through the bloodstream or lymphatic fluid and occasionally through direct spreading or accidental inoculation. Patients can present with hemiparesis, tonic spasm, headache, fever, sensory variation, cerebral irritation, and even psychotic behavioural changes. Radiological images are characterised by ring-enhanced signs and hyperdense and hypodense lesions. Pathological features frequently include black-to-brown necrotic tissue or dark-coloured pus, granulomatous inflammation, giant cell vasculitis, and pigmented fungal elements, which are easily seen on a direct potassium hydroxide smear, a rapid method for diagnosis. Black fungi can be cultured from a biopsy specimen. Combined antifungal chemotherapy, surgical debridement, and careful immunological interventions are strongly recommended to eradicate these intractable infections.
脑暗色丝孢霉病是一种脑部真菌感染，通常由班替枝孢瓶霉、皮炎外瓶霉和麦肯齐鼻分支孢引起，它们均属于座囊菌目。该病会导致脑组织出现黑色坏死、黑色脓液和黑色脑脊液。病原体通常通过血液或淋巴液进入脑部，偶尔也会通过直接蔓延或意外接种进入。患者可能出现偏瘫、强直性痉挛、头痛、发热、感觉异常、脑部刺激症状，甚至出现精神行为改变。放射影像学表现为环形强化征以及高密度和低密度病变。病理特征通常包括黑色至棕色的坏死组织或深色脓液、肉芽肿性炎症、巨细胞血管炎以及色素沉着的真菌成分，这些在直接氢氧化钾涂片上很容易看到，这是一种快速诊断方法。黑色真菌可从活检标本中培养出来。强烈建议联合抗真菌化疗、手术清创和仔细的免疫干预措施来根除这些难治性感染。
