Clinical characteristics of central nervous system phaeohyphomycosis: A brief report of 20 years' experience.

Central nervous system (CNS) phaeohyphomycosis is a rare and often fatal fungal infection. Our study reported a case series of eight CNS phaeohyphomycosis cases at our institution over the past 20 years. We did not observe the common pattern of risk factors, abscess location, or number of abscesses among them. Most patients were immunocompetent without classic risk factors for fungal infection. Early diagnosis and aggressive management with surgical intervention and prolonged antifungal therapy can lead to a favorable outcome. The study highlights the need for further research to better understand the pathogenesis and optimal management of this challenging rare infection.

Phaeohyphomycosis caused by Phialophora americana in a dog.

Phaeohyphomycosis was diagnosed in a 6-year-old, male castrated Dachshund on immunosuppressive treatment. The fungus was identified by culture and PCR as Phialophora americana. This is the first reported case of infection with this pathogen in a dog. The infection was successfully managed medically, without surgical intervention.

Une phaéohyphomycose a été diagnostiquée chez un teckel mâle castré de 6 ans sous traitement immunosuppresseur. Le champignon a été identifié par culture et PCR comme Phialophora americana. Il s'agit du premier cas rapporté d'infection par cet agent pathogène chez un chien. L'infection a été prise en charge médicalement avec succès, sans intervention chirurgicale.

Se diagnosticó feohifomicosis en un macho de Teckel castrado de 6 años en tratamiento inmunosupresor. El hongo fue identificado por cultivo y PCR como Phialophora americana. Este es el primer caso reportado de infección por este patógeno en un perro. La infección se manejó con éxito médicamente, sin intervención quirúrgica.

Feohifomicose foi diagnosticada em um cão da raça Dachshund, macho castrado, de seis anos de idade, em tratamento imunossupressivo. O fungo identificado por cultura e PCR foi Phialophora americana. Este é o primeiro relato de caso de infecção por este patógeno em um cão. A infecção foi bem conduzida com tratamento medicamentoso, sem intervenção cirúrgica.

Medical and Surgical Management of Phaeohyphomycosis in a Kea (Nestor notabilis).

A 2.5-year-old female kea (Nestor notabilis) weighing 711 g was presented for acute lethargy, pelvic limb paraparesis, and decreased appetite. Results from a complete blood count revealed a leukocytosis (67540 cells/µL [reference interval 4200 - 37880 cells/µL]). Radiographic images revealed a mass effect within the mid coelom. The patient was provided supportive care that included antifungal medication (voriconazole 15 mg/kg PO q12h x 6 months and 10 days) and antibiotic therapy (enrofloxacin 20 mg/kg PO q12h x 27 days). A discrete 2.3 × 2.7 × 2.6 cm soft tissue mass adjacent to multiple organs was identified on contrast computed tomographic images (IsoVue 370 at 4 mL/kg IV over 2 minutes). The mass was medial and dorsal to the proventriculus, cranial to the ventriculus, caudal to the liver, and ventral to the cranial renal divisions. The mass had an irregular vascularized wall with a poorly vascularized center. Ten days after initial presentation, exploratory coeliotomy and mass removal via left lateral coeliotomy were performed. Bacterial (aerobic and anaerobic) and fungal cultures were negative. Fourteen days postsurgery, the leukocytosis was resolved. Microscopic review of the submitted tissue mass found multinucleated giant cells, macrophages, and brown fungal hyphae with irregular internal septations and some branching, leading to a diagnosis of phaeohyphomycosis. Panfungal polymerase chain reaction testing and sequencing were unsuccessful at speciation. Treatment with voriconazole was continued until behavioral, hematologic, and computed tomographic assessments indicated resolution of the problem 6 months postsurgery. No recurrence of disease has been reported 20 months following mass removal.

Quantitative PCR for detection and quantification of Veronaea botryosa in fish and environmental samples.

Systemic phaeohyphomycosis, aka 'fluid belly', is one of the most important emergent diseases in sturgeon Acipenser spp. aquaculture. The etiologic agent is the saprobic, dematiaceous fungus Veronaea botryosa. Effective vaccines and chemotherapeutic treatments are currently unavailable. Additionally, the fungus is a slow-growing organism, taking from 10-15 d for colonies to be observed in agar media. To this end, a specific quantitative PCR (qPCR) targeting the V. botryosa ß-tubulin gene was developed and validated. The specificity of the assay to V. botryosa was initially confirmed in silico and in vivo against common fungal fish pathogens, including closely related members of the order Chaetothyriales (Exophiala spp.) and other black pigmented fungi (Alternaria spp. and Cladosporium spp.), as well as tissues from uninfected sturgeon. The assay possessed high clinical specificity (100%) and clinical sensitivity (74%) in detecting V. botryosa DNA in splenic tissues from laboratory-infected sturgeon. Using V. botryosa genomic DNA as a template, the limit of detection was equivalent to 10 conidia, and the method was found suitable for the detection of fungal DNA in fresh and formalin-fixed tissues. In addition, the presence of non-target DNA from white sturgeon did not influence assay sensitivity. The developed qPCR assay is a sensitive, specific, and rapid diagnostic method for the detection and quantification of V. botryosa DNA from white sturgeon tissues.

Phaeohyphomycosis due to Veronaea botryosa in cultured white sturgeon (Acipenser transmontanus Richardson) from California USA during 2006 to 2015.

Infection with Veronaea botryosa can result in rare cutaneous or disseminated, granulomatous to pyogranulomatous phaeohyphomycosis in humans, although disease due to the fungus has also been reported in non-mammalian vertebrates. This report documents disease due to V. botryosa in captive, juvenile to subadult or young adult white sturgeon (Acipenser transmontanus Richardson) from California USA and complements a previous report of the disease in captive Siberian sturgeon (Acipenser baerii) from Florida USA. Pathological examinations revealed granulomatous to pyogranulomatous inflammation of multiple organs. Isolates of the fungal agent were phenotypically consistent with V. botryosa, and molecular analyses of the D1/D2 region of the fungal 28S rRNA gene and the internal transcribed spacer (ITS) region located between the fungal 18S and 28S rRNA genes confirmed the aetiologic agent as V. botryosa. The disease in captive sturgeon results in a considerable economic encumbrance to the producer due to the loss of the cumulative financial resources invested in the production of older subadult to young adult sturgeon.

Systemic phaeohyphomycosis in splitnose rockfish (Sebastes diploproa) caused by Devriesia sp.

A novel pathogen was documented after two wild-caught, juvenile, splitnose rockfish presented with buphthalmia, grey corneal endothelial plaques and evidence of uveitis. Cytologic evaluation of ocular contents revealed fungal hyphae. Histologic evaluation identified multiple fungal granulomas and granulomatous inflammation in the globes, periocular tissue and heart. Fungi were slender, hyphenated and branched at angles, had parallel cell walls and had brown pigmentation in haematoxylin- and eosin-stained sections. Both fish were diagnosed with phaeohyphomycosis. Culture with nuclear ribosomal RNA internal transcribed spacer (ITS) segment identification further classified the fungus as Devriesia sp., which has not been previously documented as a cause of disease in animals.

Retrospective study of phaeohyphomycosis in aquarium-housed fish, with first descriptions of Exophiala lecanii-corni and Neodevriesia cladophorae in fish.

A broadening fish host range is affected by novel and known pigmented fungal pathogens. A review of 2,250 piscine submissions received by the Aquatic Pathology Service, University of Georgia, revealed 47 phaeohyphomycosis cases (2.1%), representing 34 bony and cartilaginous fish species. The majority involved bony fish (45/47, 95.7%) and were predominantly marine (41/47, 87.2%), with only a few freshwater species (4/47, 8.5%). Cartilaginous fish cases included two zebra sharks (Stegostoma fasciatum) (2/47, 4.3%). Northern seahorses (Hippocampus erectus) had the highest incidence overall (7/47, 14.9%). Culture and sequencing of the internal-transcribed spacer region of the rDNA (ITS), large ribosomal subunit gene D1/D2 domains (LSU) and the DNA polymerase II gene (RPB2) were performed for fungal identification when fresh tissue was obtainable. Exophiala, Ochroconis and Neodevriesia spp. were identified, with Exophiala as the most common fungal genus (8/11, 72.7%). Exophiala lecanii-corni and Neodevriesia cladophorae were described for the first time from fish. Microscopically, lesions were characterized by necrosis, granulomatous inflammation and angioinvasion most frequently affecting the skin/fin, skeletal muscle and kidneys. In this study of diverse aquarium-housed fish species, phaeohyphomycosis cases occurred sporadically and in rare outbreaks with variable pathologic presentations, tissue distributions and severities.

Cladophialophora encephalitis in an alpaca.

A 4-year-old Huacaya hembra was evaluated for acute neurologic signs including recumbency and a left head tilt. Cranial nerve examination revealed a left ear droop, muzzle deviation to the right, mydriasis of the left eye, an absent menace response, bilateral absent pupillary light reflex when light was directed into the left eye, and bilateral horizontal nystagmus with fast phase to the right. Multifocal intracranial lesions were suspected. Computed tomography revealed an intracranial mass. Postmortem examination, histopathology, and sequencing of a polymerase chain reaction product confirmed a diagnosis of phaeohyphomycotic meningoencephalitis caused by Cladophialophora bantiana. Key clinical message: Advanced diagnostic imaging (computed tomography) was useful in achieving a diagnosis of an intracranial mass in an alpaca with acute neurological signs, later confirmed to be central nervous system (CNS) phaeohyphomycosis. Although uncommon, intracranial fungal infection should be considered as a differential diagnosis in camelid patients exhibiting CNS signs, particularly if they do not respond to initial antimicrobial and anthelmintic therapy.

Encéphalite à Cladophialophora chez un alpaga. Une femelle alpaga de race Huacaya âgée de 4 ans fut évaluée pour des signes neurologiques aigus incluant un décubitus et une inclinaison de la tête à gauche. L'examen des nerfs crâniens a révélé un affaissement de l'oreille gauche, une déviation vers la droite du museau, une mydriase de l'oeil gauche, une absence de réponse à la menace, l'absence bilatérale de réflexe pupillaire lorsqu'une lumière était pointée dans l'oeil gauche, et un nystagmus horizontal bilatéral avec phase rapide vers la droite. Des lésions intra-crâniales multifocales étaient suspectées. Un examen par tomodensitométrie révéla une masse intra-crâniale. L'examen post-mortem, l'histopathologie et le séquençage d'un produit de réaction d'amplification en chaîne par la polymérase confirmèrent un diagnostic de méningo-encéphalite phaeohyphomycotique causée par Cladophialophora bantiana.Message clinique clé :L'examen par imagerie diagnostique de pointe (tomodensitométrie) fut utile afin d'arriver à un diagnostic de masse intra-crâniale chez un alpaga avec des signes neurologiques aigus, plus tard confirmé par une phaeohyphomycose du système nerveux central (CNS). Bien que peu fréquente, une infection fongique intra-crâniale devrait être considérée comme un diagnostic différentiel chez des camélidés présentant des signes du CNS, particulièrement s'ils ne répondent pas à un traitement initial avec des antimicrobiens et des anthelmintiques.(Traduit par Dr Serge Messier).

Mycotic Rhinitis and Sinusitis in Florida Horses.

Rhinitis and sinusitis caused by fungal pathogens were studied in biopsy samples submitted from 52 horses distributed throughout subtropical and tropical regions of Florida. Methods included routine histopathology as well as polymerase chain reaction (PCR) with panfungal/panoomycete primers and DNA sequencing on extracted DNA (DNA barcoding). Granulomatous, pyogranulomatous, and fibrinopurulent lesions in nasal and sinus mucosa were associated with signs of upper airway obstruction and noise as well as nasal discharge. Morphologic and histochemical assessment of cases identified 31 cases of zygomycosis/pythiosis plus 1 mixed infection case, 16 cases of phaeohyphomycosis with 2 additional mixed infection cases, and 3 cases caused by other fungi. Morphologic evidence of Aspergillus sp. infection as a superficial copathogen was found in 2 of the mixed fungal infection cases. PCR and DNA sequencing facilitated identification of fungal pathogens in 11 of 52 cases (21%). No evidence of oomycete infection was found. Histomorphologic features of previously unrecognized forms of equine rhinitis/sinusitis were described, including those caused by Flavodon flavus, Curvularia lunata, Exserohilum rostrata, Alternaria alternata, Alternaria sp., Cladophialophora bantiana, Fusarium solani, and Toxicocladosporium irritans. PCR and DNA sequencing using panfungal and oomycete primers with DNA from formalin-fixed and paraffin-embedded specimens successfully identified the pathogen in phaeohyphomycosis (7/18 cases, 39%), zygomycosis/pythiosis (1/32 cases, 3%), and other nonpigmented fungal infections (3/3 cases, 100%). Zygomycosis and phaeohyphomycosis were the most common forms of fungal rhinitis found in Florida horses.

Fatal phaeohyphomycosis due to Exophiala sp. infection in a free-living common toad Bufo bufo.

A wild adult female common toad Bufo bufo found dead in Scotland in September 2016 was observed to have hepatomegaly, a large soft tissue mass in the coelomic cavity (2.7 g, 3.5 × 2.3 × 1.8 cm) and numerous dark-red papules (1-2 mm diameter) in the skin and subjacent tissue over the back and dorsal aspects of the limbs. Histopathological examination identified marked hepatitis and coelomitis associated with pigmented fungal hyphae, which are results consistent with a diagnosis of phaeohyphomycosis. Sequencing of the internal transcribed spacer region and the D1-D2 region of the large subunit of the ribosomal RNA gene from affected liver tissue identified the presence of Exophiala (Chaetothyriales) sp., a black yeast previously identified as a cause of amphibian phaeohyphomycosis. To our knowledge, this is the first published report of Exophiala sp. in a wild or captive amphibian in Europe and the first description of phaeohyphomycosis affecting a free-living amphibian in Great Britain. Exophiala spp. are saprobes and opportunistic pathogens. It has been postulated that phaeohyphomycosis is a disease of immunocompromised amphibians; however, we found no evidence of significant concurrent infection or generalised debility in this common toad. Phaeohyphomycosis appears to be a sporadic cause of mortality in amphibians, and this report adds to the growing list of pathogens known to affect wild amphibians in Europe.

Exophiala angulospora infection in hatchery-reared lumpfish (Cyclopterus lumpus) broodstock.

Samples from moribund lumpfish were collected in a marine hatchery in Scotland in 2015. Black nodules were noted on the skin, and gills and fungal hyphae were extensively distributed in musculature and internal organs. Multifocal chronic inflammatory lesions displaced structures in all affected organs. Mortalities commenced on completion of spawning in May and were evenly distributed over the second year in the temperature range 11-15°C. The main systemic infection causing agent was initially identified based on morphological characteristics as an Exophiala species. Ribosomal DNA (rDNA) ITS regions of the isolates were subsequently sequenced confirming the isolates belonged to Exophiala genus. All isolates fell in a single phylogenetic cluster, which is represented by Exophiala angulospora. Fish were treated with either formalin or Bronopol or a combination of both, but there was no effect on the pattern or numbers of mortalities. Isolates were also tested against three different concentrations of Latrunculin A, Amphotericin B and Itraconazole with no success. It is of utmost importance to increase the knowledge on pathogen-host interactions to successfully develop sustainable control methods.

Chaetomiaceae Fungi, Novel Pathogens of Equine Neurotropic Phaeohyphomycosis.

Many previously unrecognized fungi are emerging as potential pathogens. One such group is dematiaceous fungi of the Chaetomiaceae family (phylum Ascomycota, class Sordariomycetes). These fungi are rare causes of opportunistic, neurotropic phaeohyphomycosis in humans but are not known to cause similar infections in animals. The aims of this study were to investigate equine hyphal mycotic encephalitis, characterize key histopathologic features, and classify causative organisms with molecular diagnostic techniques. Seven cases were evaluated by histopathology. Panfungal PCR targeting the ribosomal RNA large subunit coding region and the noncoding internal transcribed spacer-2 region was performed on DNA extracted from formalin-fixed, paraffin-embedded sections of affected brain, and the resulting sequences were queried against published fungal genomes. Affected animals ranged from 8 to 22 years of age and presented with neurologic signs. Macroscopic lesions within affected brains included multifocal hemorrhage, focal swelling of the thalamus with red and yellow discoloration, and focal cerebral malacia. Major histologic findings included multifocal discrete foci of necrosis, neutrophilic to granulomatous inflammation, vasculitis, and intralesional fungal hyphae variably affecting the cerebrum, thalamus, and brainstem. DNA sequences in 4 cases showed > 98% homology with species within the Chaetomiaceae family, including Acrophialophora fusispora, Acrophialophora levis, and Chaetomium strumarium. Histomorphologically, Chaetomiaceae fungi were 7 to 10 µm wide, septate, parallel walled, and nonpigmented, with dichotomous branching in affected horses. This case series is the first report of equine mycotic encephalitis caused by members of the Chaetomiaceae family, previously reported as rare emerging pathogens in humans.

Diversity of Veronaea botryosa from different hosts and evaluation of laboratory challenge models for phaeohyphomycosis in Acipenser transmontanus.

Veronaea botryosa has been identified as a pathogen of cultured white sturgeon Acipenser transmontanus. In 2015, samples from 19 white sturgeon were received for diagnosis, of which 14 cultured positive for V. botryosa. Intraspecific variability among V. botryosa isolates from different clinically affected hosts and geographic regions was investigated using repetitive extragenic palindromic PCR fingerprinting (rep-PCR). The rep-PCR profiles of 16 V. botryosa isolates from a human, sea turtles, and cultured fish were distinct from those of other phaeoid fungi belonging to the genera Cladophialophora and Exophiala. To gain a better understanding of the pathogenesis of V. botryosa mycosis, 5 laboratory challenge methods were evaluated in white sturgeon fingerlings. Intramuscular (IM) and intracoelomic (IC) injection challenges produced cumulative mortalities of 13.3% (8/60) and 3.3% (2/60), respectively, and V. botryosa was recovered from 100% (10/10) of dead fingerlings. Affected fish exhibited abnormal orientation and/or failure to maintain neutral buoyancy, emaciation, coelomic distension, exophthalmos, cutaneous erythema, and ulcerated skin. After 6 wk, surviving fish were euthanized, and samples of liver were taken for mycological evaluation. Viable fungus was detected in 90% and 100% of fish surviving IM and IC challenge, respectively. No V. botryosa-associated mortality was detected in other groups challenged by immersion, immersion with abrasion, or orally. Both IM and IC challenge routes appear suitable for the induction of V. botryosa infection in white sturgeon and can serve as models for the study of disease pathogenesis associated with this emergent pathogen.

Disseminated infection due to Exophiala pisciphila in Cardinal tetra, Paracheirodon axelrodi.

Cardinal tetra, Paracheirodon axelrodi (Schultz, 1956), kept in an ornamental tank, was found to be affected by severe invasive mycosis. Externally, the disease manifested as abdominal swelling, and internally, the anterior part of the intestine was extremely bloated with abundant dematiaceous septate hyphae and an accumulation of fluid. Histopathologically, a granulomatous inflammatory response was observed in the intestine wall, kidney and spleen. We assume that the mycotic agent was primarily deposited in the intestine and was then gradually disseminated to the other organs. DNA sequencing of ITS and LSU rDNA regions and phenotypic characterization were used for identification of the isolated fungus. The obtained data confirmed that the infection was caused by Exophiala pisciphila. The disease was subsequently reproduced in the carp fingerling using intramuscular and intraperitoneal injection of a spore suspension. The 13th day after intramuscular infection, a marked elevation of neutrophils was recorded in the peripheral blood; this involved a proliferation of band forms and segmented forms. As far as we know, this is the first report of infection due to E. pisciphila in Cardinal tetra.

Is Marine Dispersion of the Lethargic Crab Disease Possible? Assessing the Tolerance of Exophiala cancerae to a Broad Combination of Salinities, Temperatures, and Exposure Times.

Since 1997, an emergent fungal disease named lethargic crab disease (LCD) has decimated stocks of the edible mangrove land crab Ucides cordatus (Linnaeus, 1763) (Brachyura: Ocypodidae) along the Brazilian coast, threatening the mangrove ecosystem and causing socioeconomic impacts. Evidence from a variety of sources suggests that the black yeast Exophiala cancerae (Herpotrichiellaceae, Chaetothyriales) has been responsible for such epizootic events. Based on the spatiotemporal patterns of the LCD outbreaks, the well-established surface ocean currents, and the range of ecological traits of Exophiala spp., a marine dispersal hypothesis may be proposed. Using in vitro experiments, we tested the survival and growth of E. cancerae CBS 120420 in a broad combination of salinities, temperatures, and exposure times. While variation in salinity did not significantly affect the growth of colony-forming units (CFUs) (P > 0.05), long exposure times visibly influenced an increase in CFUs growth (P < 0.05). However, higher temperature (30 °C) caused a reduction of about 1.2-fold in CFUs growth (P < 0.05). This result suggests that sea surface temperatures either above or below the optimum growth range of E. cancerae could play a key role in the apparent north-south limits in the geographical distribution of LCD outbreaks. In light of our results, we conclude that a fundamental step toward the understanding of LCD epidemiological dynamics should comprise a systematic screening of E. cancerae in estuarine and coastal waters.

Phaeohyphomycosis due to Pyrenophora phaeocomes and Drechslera nobleae in an Appaloosa mare.

A 21-year-old Appaloosa mare was presented with a pigmented cutaneous mass at the base of the right side of the neck. The diagnosis of phaeohyphomycosis due to pigmented fungi, known as Pyrenophora phaeocomes and Drechslera nobleae, was made based on a histopathology report followed by polymerase chain reaction (PCR) and 18S rRNA gene sequencing. The mass was surgically excised with clean margins, which is usually curative.

Phæohyphomycose attribuable àPyrenophora phaeocomeset àDrechslera nobleaechez une jument Appaloosa. Une jument Appaloosa âgée de 21 ans a été présentée avec une masse cutanée pigmentée à la base du côté droit du cou. Le diagnostic de phæohyphomycose causée par des champignons pigmentés, connus sous le nom de Pyrenophora phaeocomes et de Drechslera nobleae, a été posé en se fondant sur un rapport d'histopathologie suivi d'une amplification en chaîne par la polymérase et d'un séquençage du gène 18S rRNA. La masse a été excisée chirurgicalement avec des bords nets, ce qui se traduit habituellement par la guérison.(Traduit par Isabelle Vallières).

PHAEOHYPHOMYCOSIS ASSOCIATED WITH OSSIFICATION OF THE SKULL AND CERVICAL VERTEBRAE IN A SWELL SHARK (CEPHALOSCYLLIUM VENTRIOSUM).

A female, captive bred, juvenile swell shark ( Cephaloscyllium ventriosum ) was observed swimming in tight circles and rolling. Radiographs and computed tomography of this individual revealed extensive cartilage mineralization of the skull and cranial cervical vertebrae compared with diagnostic images of clinically healthy conspecifics. Gross necropsy and histopathologic examination revealed ossification and fibrosis of the cartilaginous matrix of the skull and cervical vertebrae with deep invasion by a pigmented hyphal fungus. There was no growth on fungal culture, but fungal polymerase chain reaction identified a DNA sequence compatible with Exophiala sp. (99%). Radiographs and computed tomography were helpful to determine a prognosis and course of action for this individual. This case emphasizes the need to include fungal infections as a differential diagnosis when evaluating elasmobranchs with abnormal swimming behaviors and mineralization of the skeletal structures.

Phaeohyphomycosis resulting in obstructive tracheitis in three green sea turtles Chelonia mydas stranded along the Florida coast.

Three wild immature green sea turtles Chelonia mydas were found alive but lethargic on the shores of the Indian River Lagoon and Gulf of Mexico in Florida, USA, and subsequently died. Necropsy findings in all 3 turtles included partial occlusion of the trachea by a mass comprised of granulomatous inflammation. Pigmented fungal hyphae were observed within the lesion by histology and were characterized by culture and sequencing of the internal transcribed spacer 2 domain of the rRNA gene and D1/D2 region of the fungal 28s gene. The dematiaceous fungus species Veronaea botryosa was isolated from the tracheal mass in 2 cases, and genetic sequence of V. botryosa was detected by polymerase chain reaction in all 3 cases. Genetic sequencing and fungal cultures also detected other dematiaceous fungi, including a Cladosporium sp., an Ochroconis sp., and a Cochliobolus sp. These cases are the first report of phaeohyphomycosis caused by V. botryosa in wild marine animals.

Bipolaris hawaiiensis as an emerging cause of cutaneous phaeohyphomycosis in an Antillean manatee Trichechus manatus manatus.

Phaeohyphomycoses are emerging and opportunistic diseases caused by dematiaceous fungi that infect many animal species. This paper describes a case of cutaneous phaeohyphomycosis in an Antillean manatee Trichechus manatus manatus caused by Bipolaris hawaiiensis. Blackish skin lesions were observed in an Antillean manatee calf held captive in Brazil. Direct examination of skin scraping from the affected areas revealed the presence of dematious hyphae. Culture of skin fragments led to the isolation and subsequent identification of B. hawaiiensis as the etiologic agent. Treatment with itraconazole for 14 d was effective. Infections by Bipolaris spp. are rare in animals, and this is the first report of B. hawaiiensis in veterinary medicine.

Cutaneous Phaeohyphomycosis Caused by Exophiala attenuata in a Domestic Cat.

A 7-year-old female-spayed, domestic short-haired cat was presented to her veterinarian with a mass on the hind paw. Histopathologic examination of a tissue biopsy revealed nodular pyogranulomatous panniculitis with intralesional pigmented fungal hyphae. A dematiaceous fungal isolate was isolated with a micromorphological phenotype consistent with the anamorphic genus Exophiala: budding cells, torulose mycelium and annellidic conidiogenesis from simple conidiophores consisting of terminal and lateral cells that tapered to a short beak at the apex. Sequence homology of the internal transcribed spacer region of the rDNA gene confirmed the identification of the isolate as Exophiala attenuata. Reported here is the first confirmed case of feline phaeohyphomycosis caused by E. attenuata in North America. Similar to historical cases of feline phaeohyphomycosis caused by Exophiala spp., there was no history or postmortem evidence to suggest the patient was in an immunocompromised state (e.g., suffering from FeLV or FIV). Although aggressive surgical excision of local lesions is recommended prior to drug treatment when dealing with subcutaneous phaeohyphomycosis, surgery followed by itraconazole treatment did not resolve the E. attenuata infection in this cat.