Dixon D M, Walsh T J, Merz W G, McGinnis M R
Department of Biology, Loyola College, Baltimore, Maryland.
Rev Infect Dis. 1989 Jul-Aug;11(4):515-25. doi: 10.1093/clinids/11.4.515.
Thirty culture-documented cases of infection caused by Xylohypha bantiana (synonyms, Cladosporium bantianum, Cladosporium trichoides) were identified in the world literature; 26 cases involved the central nervous system (CNS) and most frequently presented as chronic headache followed by fever and hemiparesis. Phaeohyphomycosis due to X. bantiana occurs worldwide, predominantly in young males. Pharmacologic immunosuppression was not an important predisposing factor. However, four patients had a history of systemic nocardiosis or facial phaeohyphomycosis caused by Alternaria species. Chest radiography revealed no pulmonary infiltrates. Computed tomography of the brain demonstrated a mass defect, the frontal lobes being the most common sites of infection. Lumbar puncture usually demonstrated an elevated opening pressure, elevated cerebrospinal fluid protein level, hypoglycorrhachia, and cultures were negative. No preoperative clinical or laboratory features indicated CNS fungal infection. Complete neurosurgical resection of the lesion was the most important therapeutic intervention determining survival; systemic antifungal chemotherapy apparently did not influence outcome. The survival rate of 35% for all patients and of 45% for all neurosurgically treated patients was higher than had previously been reported, probably because patients dying from infections confirmed only histopathologically were excluded.
在世界文献中，共确认了30例由班替木霉（同义词：班替枝孢霉、毛状枝孢霉）引起的有培养记录的感染病例；其中26例累及中枢神经系统（CNS），最常见的表现为慢性头痛，其次是发热和偏瘫。由班替木霉引起的暗色丝孢霉病在全球范围内均有发生，主要见于年轻男性。药物性免疫抑制并非重要的易感因素。然而，有4例患者有系统性诺卡菌病或由链格孢属引起的面部暗色丝孢霉病病史。胸部X线检查未显示肺部浸润。脑部计算机断层扫描显示有占位性病变，额叶是最常见的感染部位。腰椎穿刺通常显示初压升高、脑脊液蛋白水平升高、脑脊液低糖，培养结果为阴性。术前没有临床或实验室特征提示中枢神经系统真菌感染。病变的完整神经外科切除是决定生存的最重要治疗干预措施；全身抗真菌化疗显然不影响预后。所有患者的生存率为35%，所有接受神经外科治疗的患者生存率为45%，高于此前报道，这可能是因为排除了仅经组织病理学确诊为感染而死亡的患者。
