TABLE 4.

Clinical syndromes, associated dematiaceous fungi, and suggested therapya

Clinical syndromeCommonly associated fungal genera or speciesTherapyb
Eumycetoma Madurella, Pyrenochaetae, LeptosphaeriaAzole ± Terb
Chromoblastomycosis Fonsecaea(F. pedrosoi), Phialophora, RhinocladiellaAzole ± Terb
Phaeohyphomycosis
    Allergic fungal sinusitis Bipolaris, CurvulariaSurgery + steroids ± Itra
    Allergic bronchopulmonary mycosis Bipolaris, CurvulariaSteroids ± Itra
    Onychomycosis Alternaria, ScopulariopsisItra or Terb ± topical agents
    Tinea nigra Hortaea werneckii, Stenella araguataTopical agents
    Subcutaneous nodules Alternaria, Exophiala, PhialophoraSurgery ± azole
    Keratitis Curvularia, Bipolaris, ExserohilumTopical natamycin ± topical azole
    Bone and joint infection Scedosporium prolificans, AlternariaVori ± Terb
    Peritonitis Curvularia, Exophiala, AlternariaCatheter removal ± AmB or azole
    Pneumonia Ochroconis, Exophiala, ChaetomiumVori (L-AmB if severe)
    Brain abscess Cladophialophora bantiana, Rhinocladiella mackenziei, OchroconisAzole + L-AmB or echinocandin ± 5-FC (see text)
    Disseminated disease Scedosporium prolificans, Bipolaris, ExophialaVori + 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.