Seneviratne Chaminda Jayampath, Fong Phoenix H L, Wong Sarah S W, Lee Victor H F
Oral Sciences, Faculty of Dentistry, National University of Singapore, 11 Lower Kent Ridge Road, Singapore, 119083, Singapore.
Oral Biosciences, Faculty of Dentistry, The University of Hong Kong, Pok Fu Lam, Hong Kong.
BMC Oral Health. 2015 Mar 20;15:39. doi: 10.1186/s12903-015-0023-9.
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.
在一项针对佩戴闭孔器的复发性鼻咽癌患者进行放疗治疗时真菌念珠菌属的研究项目中，我们意外地在一名患者的连续两份样本中发现了黑真菌。
样本取自一名57岁的香港男性，他被诊断患有未分化型鼻咽癌。他接受了根治性同步放化疗，随后进行辅助化疗，然后接受了调强放疗的第二疗程。18S rDNA测序显示分离株属于皮炎外瓶霉，对氟康唑、伊曲康唑、酮康唑和伏立康唑敏感。有趣的是，皮炎外瓶霉分离株对卡泊芬净耐药，其中一株对两性霉素B耐药。两种分离株形成的生物膜与白色念珠菌相当。单株皮炎外瓶霉显示出与白色念珠菌相当的溶血素和蛋白酶能力，而另一株则没有。
我们首次报告了从一名接受放疗的鼻咽癌患者中发现黑真菌——皮炎外瓶霉分离株。这些分离株显示对卡泊芬净耐药，卡泊芬净是治疗系统性念珠菌病的主要抗真菌药物。由于在临床环境中对黑真菌了解甚少，临床医生必须及时了解该领域的新发现，这一点很重要。
