1432. Phaeohyphomycosis in Immunocompromised and Immunocompetent Host: A Comparison of Characteristics and Treatment Outcome
Session: Poster Abstract Session: Fungal Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • phaeohyphomycosis-IDSA2013-4.pdf (481.6 kB)
  • Background: Phaeohyphomycosis is an infection caused by dematiaceous fungi. From the previous knowledge, the infection is commonly described in tropical and subtropical regions but the data of the infection in Thailand is limited. We aimed to describe and compare clinical characteristics and outcome of phaeohyphomycosis among immuncompetent (IP) and immunocompromised (IC) patients in Thailand.

    Methods: We retrospectively reviewed the medical record of patients who were diagnosed with phaeohyphomycosis at the Faculty of Medicine, Ramathibodi hospital, Bangkok, Thailand from January 1994 to December 2009.

    Results: During the study period, 42 patients had pathologically confirmed diagnosis of phaeohyphomycosis and available medical records. Patients’ mean age (+SD) was 59.8 +14.5 years and 19 (45%) were male. Fourteen (32%) had agricultural related work. Major underlying diseases were diabetes mellitus (23.8%), malignancy (23.8%) and IC  host (23.8%). The major clinical presentations were subcutaneous infection (88.1%) and sinusitis (9.5%). The main infected body area was lower limbs (54.8%) and upper limbs (31%). The median time (range) to presentation was 4 (1-48) months. There was no significant difference in the clinical and histopathological charactersitics between IP and IC patients. All patients underwent surgical removal and 88% had free surgical margin. Seventeen (40.5%) recieved antifungal therapy with the median treatment duration (range) of 3 (0.2-10) months. The 3-and 6-month disease free survival rate was 91.4% [95% Confidence interval (CI) 75.6- 97.2%] and 88.1% [95% CI: 71.3-95.4], respectively. The outcome between patients who had surgery alone and those recieved surgery plus medical treatment was not different. Higher chance of relapse was noted among IC patients and those with eye infection [hazard ratio (HR) 10.14, 95% CI: 1.99-51.67, P=0.005 and HR 37.72, 95% CI: 2.76-515.46, P=0.007, respectively]. Progression to systemic infection occurred in 11.1% of the relapse cases. Two (4.8%) patients died.

    Conclusion: Majority of phaeohyphomycosis cases in Thailand occurred without history of agricultural work. Relapse of the infection was not uncommon and was strongly associated with IC status and eye infection. Antifungal therapy did not improve the outcome after surgical resection.

    Siriorn Watcharananan, MD1, Alissara Anannub, M.D.2, Yingluck Visessiri, M.D.3 and Ploysyne Rattanakaemakorn, M.D.2, (1)Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, (2)Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, (3)Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Disclosures:

    S. Watcharananan, None

    A. Anannub, None

    Y. Visessiri, None

    P. Rattanakaemakorn, None

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