Skip to main content

Advertisement

SpringerLink
Log in

Black Mold Infections: What We Know and What We Need to Know

  • Mycology (J Perfect, Section Editor)
  • Published:
Current Clinical Microbiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Dematiaceous, or black fungi, are distinguished from other fungal species by the presence of melanin. They are ubiquitous and commonly found in soil, though rarely cause infection in humans. As a result, randomized clinical trials are impractical and reliable data regarding management is not available. Our aim is to summarize what is known and what needs to be studied in the future.

Recent Findings

These fungi can cause superficial and disseminated infection in both immunocompromised and immunocompetent individuals and are often difficult to treat, requiring both surgical intervention and prolonged medical therapy. No specific diagnostic tests are available. Combination antifungal therapy may provide better outcomes than traditional approaches to treatment.

Summary

Black fungi are increasingly recognized as causing disease, though high clinical suspicion is needed to establish the diagnosis. Standard therapies are lacking; management is based on in vitro data, animal studies, and clinical experience with expert opinions derived primarily from descriptive case studies. Further studies focused on diagnostic and management strategies are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. McGinnis MR. Chromoblastomycosis and phaeohyphomycosis: new concepts, diagnosis, and mycology. J Am Acad Dermatol. 1983;8:1–16.

    Article  CAS  PubMed  Google Scholar 

  2. Rinaldi MG. Phaeohyphomycosis. Dermatol Clin. 1996;14:147–53.

    Article  CAS  PubMed  Google Scholar 

  3. Revankar SG, Sutton DA. Melanized fungi in human disease. Clin Microbiol Rev. 2010;23:884–928.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wang L, Wang C, Shen Y, et al. Phaeohyphomycosis caused by Exophiala sinifera: an increasing disease in young females in mainland China? Two case reports and review of five cases reported from mainland China. Mycoses. 2015;58:193–6.

    Article  PubMed  Google Scholar 

  5. Bonifaz A, Davoudi MM, de Hoog GS, et al. Severe disseminated phaeohyphomycosis in an immunocompetent patient caused by Veronaea botryosa. Mycopathologia. 2013;175:497–503.

    Article  PubMed  Google Scholar 

  6. Mazzurco JD, Ramirez J, Fivenson DP. Phaeohyphomycosis caused by Phaeoacremonium species in a patient taking infliximab. J Am Acad Dermatol. 2012;66:333–5.

    Article  PubMed  Google Scholar 

  7. Vallabhaneni S, Purfield AE, Benedict K, Luvsansharav U, Lockhart SR, Pham CD, et al. Cardiothoracic surgical site phaeohyphomycosis caused by Bipolaris mould, multiple US states, 2008–2013: a clinical description. Med Mycol. 2016;54:318–21.

    Article  PubMed  Google Scholar 

  8. Chiller TM, Roy M, Nguyen D, Guh A, Malani AN, Latham R, et al. Clinical findings for fungal infections caused by methylprednisolone injections. N Engl J Med. 2013;369:1610–9.

    Article  CAS  PubMed  Google Scholar 

  9. Jacobson ES. Pathogenic roles for fungal melanins. Clin Microbiol Rev. 2000;13:708–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Butler MJ, Day AW. Fungal melanins: a review. Can J Microbiol. 1998;44:1115–36.

    Article  CAS  Google Scholar 

  11. Hamilton AJ, Gomez BL. Melanins in fungal pathogens. J Med Microbiol. 2002;51:189–91.

    Article  CAS  PubMed  Google Scholar 

  12. Dixon DM, Polak A, Szaniszlo PJ. Pathogenicity and virulence of wild-type and melanin-deficient Wangiella dermatitidis. J Med Vet Mycol. 1987;25:97–106.

    Article  CAS  PubMed  Google Scholar 

  13. van Duin D, Casadevall A, Nosanchuk JD. Melanization of Cryptococcus neoformans and Histoplasma capsulatum reduces their susceptibilities to amphotericin B and caspofungin. Antimicrob Agents Chemother. 2002;46:3394–400.

    Article  PubMed  PubMed Central  Google Scholar 

  14. • Lanternier F, Barbati E, Meinzer U, Liu L, Pedergnana V, Migaud M, et al. Inherited CARD9 deficiency in 2 unrelated patients with invasive Exophiala infection. J Infect Dis. 2015;211:1241–50. This is the first report of genetic susceptibility to Exophiala infection.

    Article  PubMed  Google Scholar 

  15. Cuétara MS, Alhambra A, Moragues MD, González-Elorza E, Pontón J, del Palacio A. Detection of (1-->3)-beta-D-glucan as an adjunct to diagnosis in a mixed population with uncommon proven invasive fungal diseases or with an unusual clinical presentation. Clin Vaccine Immunol. 2009;16:423–6.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Schoch C, Seifert K, Huhndorf S, et al. Nuclear ribosomal internal transcribed spacer (ITS) region as a universal DNA barcode marker for fungi. Proc Natl Acad Sci U S A. 2012;109(16):6241–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. McGinnis MR, Pasarell L. In vitro testing of susceptibilities of filamentous ascomycetes to voriconazole, itraconazole, and amphotericin B, with consideration of phylogenetic implications. J Clin Microbiol. 1998;36:2353–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Espinel-Ingroff A, Boyle K, Sheehan DJ. In vitro antifungal activities of voriconazole and reference agents as determined by NCCLS methods: review of the literature. Mycopathologia. 2001;150:101–15.

    Article  CAS  PubMed  Google Scholar 

  19. Wong EH, Revankar SG. Dematiaceous molds. Infect Dis Clin N Am. 2016;30:165–78.

    Article  Google Scholar 

  20. Espinel-Ingroff A. In vitro fungicidal activities of voriconazole, itraconazole, and amphotericin B against opportunistic moniliaceous and dematiaceous fungi. J Clin Microbiol. 2001;39:954–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. McGinnis MR, Pasarell L. In vitro evaluation of terbinafine and itraconazole against dematiaceous fungi. Med Mycol. 1998;36:243–6.

    Article  CAS  PubMed  Google Scholar 

  22. Hosseini-Yeganeh M, McLachlan AJ. Physiologically based pharmacokinetic model for terbinafine in rats and humans. Antimicrob Agents Chemother. 2002;46:2219–28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Ryder NS, Frank I. Interaction of terbinafine with human serum and serum proteins. J Med Vet Mycol. 1992;30:451–60.

    Article  CAS  PubMed  Google Scholar 

  24. Revankar SG. Therapy of infections caused by dematiaceous fungi. Expert Rev Anti-Infect Ther. 2005;3:601–12.

    Article  CAS  PubMed  Google Scholar 

  25. Vermes A, Guchelaar HJ, Dankert J. Flucytosine: a review of its pharmacology, clinical indications, pharmacokinetics, toxicity and drug interactions. J Antimicrob Chemother. 2000;46:171–9.

    Article  CAS  PubMed  Google Scholar 

  26. •• Chowdhary A, Meis JF, Guarro J, et al. European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and European Confederation of Medical Mycology (ECMM) joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi. Clin Microbiol Infect. 2014;20(Suppl 3):47–75. These are the first published guidelines for phaeohyphomycosis. While based on limited data, they are a framework for future studies.

    Article  CAS  PubMed  Google Scholar 

  27. Gupta AK, Ryder JE, Baran R, et al. Non-dermatophyte onychomycosis. Dermatol Clin. 2003;21:257–68.

    Article  PubMed  Google Scholar 

  28. Tosti A, Piraccini BM, Lorenzi S, et al. Treatment of nondermatophyte mold and Candida onychomycosis. Dermatol Clin. 2003;21:491–7.

    Article  PubMed  Google Scholar 

  29. Kimura M, Goto A, Furuta T, et al. Multifocal subcutaneous phaeohyphomycosis caused by Phialophora verrucosa. Arch Pathol Lab Med. 2003;127:91–3.

    PubMed  Google Scholar 

  30. Chuan MT, Wu MC. Subcutaneous phaeohyphomycosis caused by Exophiala jeanselmei: successful treatment with itraconazole. Int J Dermatol. 1995;34:563–6.

    Article  CAS  PubMed  Google Scholar 

  31. Koga T, Matsuda T, Matsumoto T, et al. Therapeutic approaches to subcutaneous mycoses. Am J Clin Dermatol. 2003;4:537–43.

    Article  PubMed  Google Scholar 

  32. Summerbell RC, Krajden S, Levine R, et al. Subcutaneous phaeohyphomycosis caused by Lasiodiplodia theobromae and successfully treated surgically. Med Mycol. 2004;42:543–7.

    Article  PubMed  Google Scholar 

  33. Garg P, Gopinathan U, Choudhary K, et al. Keratomycosis: clinical and microbiologic experience with dematiaceous fungi. Ophthalmology. 2000;107:574–80.

    Article  CAS  PubMed  Google Scholar 

  34. Wilhelmus KR, Jones DB. Curvularia keratitis. Trans Am Ophthalmol Soc. 2001;99:111–30.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Schubert MS. Allergic fungal sinusitis: pathogenesis and management strategies. Drugs. 2004;64:363–74.

    Article  PubMed  Google Scholar 

  36. Houser SM, Corey JP. Allergic fungal rhinosinusitis: pathophysiology, epidemiology, and diagnosis. Otolaryngol Clin N Am. 2000;33:399–409.

    Article  CAS  Google Scholar 

  37. Kuhn FA, Javer AR. Allergic fungal rhinosinusitis: perioperative management, prevention of recurrence, and role of steroids and antifungal agents. Otolaryngol Clin N Am. 2000;33:419–33.

    Article  CAS  Google Scholar 

  38. Odell JA, Alvarez S, Cvitkovich DG, et al. Multiple lung abscesses due to Ochroconis gallopavum, a dematiaceous fungus, in a nonimmunocompromised wood pulp worker. Chest. 2000;118:1503–5.

    Article  CAS  PubMed  Google Scholar 

  39. Mukai Y, Nureki S, Hata M, Shigenaga T, Tokimatsu I, Miyazaki E, et al. Exophiala dermatitidis pneumonia successfully treated with long-term itraconazole therapy. J Infect Chemother. 2014;20:446–9.

    Article  PubMed  Google Scholar 

  40. Revankar SG, Sutton DA, Rinaldi MG. Primary central nervous system phaeohyphomycosis: a review of 101 cases. Clin Infect Dis. 2004;38:206–16.

    Article  PubMed  Google Scholar 

  41. • Chakrabarti A, Kaur H, Rudramurthy SM, Appannanavar SB, Patel A, Mukherjee KK, et al. Brain abscess due to Cladophialophora bantiana: a review of 124 cases. Med Mycol. 2016;54:111–9. This is the largest case series published to date of this uncommon and refractory infection.

    Article  PubMed  Google Scholar 

  42. Kantarcioglu AS, Guarro J, de Hoog GS, Apaydin H, Kiraz N, Balkan II, et al. A case of central nervous system infection due to Cladophialophora bantiana. Rev Iberoam Micol. 2016;33:237–41.

    Article  PubMed  Google Scholar 

  43. Al Abdely HM, Alkhunaizi AM, Al Tawfiq JA, et al. Successful therapy of cerebral phaeohyphomycosis due to Ramichloridium mackenziei with the new triazole posaconazole. Med Mycol. 2005;43:91–5.

    Article  CAS  PubMed  Google Scholar 

  44. Deng S, Pan W, Liao W, de Hoog GS, Gerrits van den Ende AH, Vitale RG, et al. Combination of amphotericin B and flucytosine against neurotropic species of melanized fungi causing primary cerebral phaeohyphomycosis. Antimicrob Agents Chemother. 2016;60:2346–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Mariné M, Pastor FJ, Guarro J. Combined antifungal therapy in a murine model of disseminated infection by Cladophialophora bantiana. Med Mycol. 2009;47:45–9.

    Article  PubMed  Google Scholar 

  46. McCarty TP, Baddley JW, Walsh TJ, et al. Phaeohyphomycosis in transplant recipients: results from the Transplant Associated Infection Surveillance Network (TRANSNET). Med Mycol. 2015;53(5):440–6.

    Article  PubMed  Google Scholar 

  47. Revankar SG, Patterson JE, Sutton DA, Pullen R, Rinaldi MG. Disseminated phaeohyphomycosis: review of an emerging mycosis. Clin Infect Dis. 2002;34:467–76.

    Article  PubMed  Google Scholar 

  48. Howden BP, Slavin MA, Schwarer AP, et al. Successful control of disseminated Scedosporium prolificans infection with a combination of voriconazole and terbinafine. Eur J Clin Microbiol Infect Dis. 2003;22:111–3.

    CAS  PubMed  Google Scholar 

  49. Sanguinetti M, Posteraro B. Identification of molds by matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol. 2017;55:369–79.

    Article  PubMed  Google Scholar 

  50. Singh A, Singh PK, Kumar A et al. Molecular and matrix-assisted laser desorption ionization-time of flight mass spectrometry-based characterization of clinically significant melanized fungi in India. J Clin Microbiol 2017;55:1090-1103.

  51. • Moudgal V, Singal B, Kauffman CA, Brodkey JA, Malani AN, Olmsted RN, et al. Spinal and paraspinal fungal infections associated with contaminated methylprednisolone injections. Open Forum Infect Dis. 2014;1(1):ofu022. doi:10.1093/ofid/ofu022. This is the largest case series from the fungal outbreak, highlighting the difficulties in managing these patients.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Infectious Diseases, Wayne State University, 3990 John R. St., 5 Hudson, Detroit, MI, 48201, USA

    Noman Hussain & Sanjay G. Revankar

Authors
  1. Noman Hussain
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sanjay G. Revankar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sanjay G. Revankar.

Ethics declarations

Conflict of Interest

Dr. Hussain has nothing to disclose.

Dr. Revankar reports grants from Merck, Gilead, and Astellas, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Mycology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hussain, N., Revankar, S.G. Black Mold Infections: What We Know and What We Need to Know. Curr Clin Micro Rpt 4, 106–111 (2017). https://doi.org/10.1007/s40588-017-0062-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40588-017-0062-x

Keywords

Search

Navigation