0836 Cladophialophora bantiana as a cause of cerebral abscess

When single clinical units around the world are able to put unusual case series together that cover 75-100 patients between 2000 and 2005 one should probably take note of the responsible organism. Recent reviews of cerebral abscess have indicated that Cladophialophora bantiana, while not as common aetiologically as pyogenic bacteria or Mycobacterium tuberculosis, is nevertheless an important contributor. Previously known as Torula bantiana or Cladosporium bantianum, this organism is one of the so-called melanised fungi. Found in soil and rotting plant material, it is generally acquired by inhalation and is highly neurotropic. In an Indian review of 75 paediatric cases of cerebral abscess, chronic suppurative otitis media was the most common predisposing factor for abscesses in the temporal lobe, and Cladophialophora bantiana was found in a couple of cases. Not confined to the developing world, this organism has also been described in the US, with Texas reviewing the records of 101 cases. The infection has been lethal in most cases, with authors recommending surgical intervention plus antifungal agents (Amphotericin B, flucytosine, itraconazole or voriconazole). The infection affects both the immune competent and immune compromised, with several cases described in transplant recipients.

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