Nosocomial fungemia due to Exophiala jeanselmei var. jeanselmei and a Rhinocladiella species: Newly described causes of bloodstream infection

Fungi have become increasingly important causes of nosocomial bloodstream i nfections. The major cause of nosocomial fungemia has been Candida spp, but increasingly molds and other yeasts have caused disease. Exophiala jeansel mei and members of the genus Rhinocladiella are dematiaceous moulds, which have been infrequently associated with systemic infection and have not been described as causes of fungemia. In this paper, the occurrence of 23, case s of fungemia due to these organisms over a 10-month period is reported and the clinical characteristics of patients and outcomes are described. The m ajority of patients were immunosuppressed; 21 of 23 (91%) had received bloo d products and 78% had a central venous catheter, All patients had at least one manifestation of fever, but only one patient had signs or symptoms sug gesting deep-seated infection. Antifungal therapy was given to 19 of the 23 patients; of those who did not receive therapy, 3 died prior to the cultur e result and 1 had been discharged without therapy. Antifungal susceptibili ty of the organisms showed activity of amphotericin B, itraconazole, and th e new triazole antifungals voriconazole and posaconazole. E. jeanselmei and Rhinocladiella species are potential causes of nosocomial fungemia and may be associated with systemic infection.