TABLE 4.
Clinical syndromes, associated dematiaceous fungi, and suggested therapya
| Clinical syndrome | Commonly associated fungal genera or species | Therapyb |
|---|---|---|
| Eumycetoma | Madurella, Pyrenochaetae, Leptosphaeria | Azole ± Terb |
| Chromoblastomycosis | Fonsecaea(F. pedrosoi), Phialophora, Rhinocladiella | Azole ± Terb |
| Phaeohyphomycosis | ||
| Allergic fungal sinusitis | Bipolaris, Curvularia | Surgery + steroids ± Itra |
| Allergic bronchopulmonary mycosis | Bipolaris, Curvularia | Steroids ± Itra |
| Onychomycosis | Alternaria, Scopulariopsis | Itra or Terb ± topical agents |
| Tinea nigra | Hortaea werneckii, Stenella araguata | Topical agents |
| Subcutaneous nodules | Alternaria, Exophiala, Phialophora | Surgery ± azole |
| Keratitis | Curvularia, Bipolaris, Exserohilum | Topical natamycin ± topical azole |
| Bone and joint infection | Scedosporium prolificans, Alternaria | Vori ± Terb |
| Peritonitis | Curvularia, Exophiala, Alternaria | Catheter removal ± AmB or azole |
| Pneumonia | Ochroconis, Exophiala, Chaetomium | Vori (L-AmB if severe) |
| Brain abscess | Cladophialophora bantiana, Rhinocladiella mackenziei, Ochroconis | Azole + L-AmB or echinocandin ± 5-FC (see text) |
| Disseminated disease | Scedosporium prolificans, Bipolaris, Exophiala | Vori + Terb ± echinocandin, Vori ± echinocandin or L-AmB (see text) |
a
Adapted from reference 625 with permission of Expert Reviews Ltd.
b
Abbreviations: Vori, voriconazole; Itra, itraconazole; Terb, terbinafine; L-AmB, lipid amphotericin B; 5-FC, flucytosine; azole, voriconazole, posaconazole, or itraconazole; +, with; ±, with or without.