array:24 [
  "pii" => "S1579212918304440"
  "issn" => "15792129"
  "doi" => "10.1016/j.arbr.2018.12.013"
  "estado" => "S300"
  "fechaPublicacion" => "2019-03-01"
  "aid" => "1927"
  "copyright" => "SEPAR"
  "copyrightAnyo" => "2018"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Arch Bronconeumol. 2019;55:162-3"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 372
    "formatos" => array:3 [
      "EPUB" => 44
      "HTML" => 225
      "PDF" => 103
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0300289618302047"
      "issn" => "03002896"
      "doi" => "10.1016/j.arbres.2018.05.014"
      "estado" => "S300"
      "fechaPublicacion" => "2019-03-01"
      "aid" => "1927"
      "copyright" => "SEPAR"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Arch Bronconeumol. 2019;55:162-3"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 903
        "formatos" => array:3 [
          "EPUB" => 59
          "HTML" => 691
          "PDF" => 153
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta Cient&#237;fica</span>"
        "titulo" => "Deterioro cl&#237;nico por <span class="elsevierStyleItalic">Exophiala dermatitidis</span> en un paciente con fibrosis qu&#237;stica"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "162"
            "paginaFinal" => "163"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Clinical Deterioration Due to <span class="elsevierStyleItalic">Exophiala Dermatitidis</span> in a Patient with Cystic Fibrosis"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 748
                "Ancho" => 1000
                "Tamanyo" => 89373
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Colonias de <span class="elsevierStyleItalic">Exophiala dermatitidis</span> en placa de agar Sabouraud con cloranfenicol&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Alexandra Mart&#237;n Ram&#237;rez, Marta Erro Iribarren, Buenaventura Buend&#237;a Moreno, Rosa Mar&#237;a Gir&#243;n"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Alexandra"
                "apellidos" => "Mart&#237;n Ram&#237;rez"
              ]
              1 => array:2 [
                "nombre" => "Marta"
                "apellidos" => "Erro Iribarren"
              ]
              2 => array:2 [
                "nombre" => "Buenaventura"
                "apellidos" => "Buend&#237;a Moreno"
              ]
              3 => array:2 [
                "nombre" => "Rosa"
                "apellidos" => "Mar&#237;a Gir&#243;n"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1579212918304440"
          "doi" => "10.1016/j.arbr.2018.12.013"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212918304440?idApp=UINPBA00003Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289618302047?idApp=UINPBA00003Z"
      "url" => "/03002896/0000005500000003/v1_201903020650/S0300289618302047/v1_201903020650/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1579212918304452"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2018.12.014"
    "estado" => "S300"
    "fechaPublicacion" => "2019-03-01"
    "aid" => "1932"
    "copyright" => "SEPAR"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Arch Bronconeumol. 2019;55:163-4"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 310
      "formatos" => array:3 [
        "EPUB" => 40
        "HTML" => 192
        "PDF" => 78
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>"
      "titulo" => "Adult Cystic Fibrosis&#58; A Possible Cause of Bronchiectasis in COPD Patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "163"
          "paginaFinal" => "164"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Fibrosis qu&#237;stica del adulto&#44; una causa de bronquiectasias a considerar en el paciente con EPOC"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 470
              "Ancho" => 1350
              "Tamanyo" => 71339
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT slices showing numerous areas of bronchiectasis in the pulmonary parenchyma&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Cristina Benito Bern&#225;ldez, Virginia Almadana Pacheco, Agust&#237;n S&#46; Valido Morales, Pedro Juan Rodr&#237;guez Mart&#237;n"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Benito Bern&#225;ldez"
            ]
            1 => array:2 [
              "nombre" => "Virginia"
              "apellidos" => "Almadana Pacheco"
            ]
            2 => array:2 [
              "nombre" => "Agust&#237;n S&#46;"
              "apellidos" => "Valido Morales"
            ]
            3 => array:2 [
              "nombre" => "Pedro Juan"
              "apellidos" => "Rodr&#237;guez Mart&#237;n"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289618302096"
        "doi" => "10.1016/j.arbres.2018.05.019"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289618302096?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212918304452?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005500000003/v1_201903020641/S1579212918304452/v1_201903020641/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1579212918304439"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2018.12.012"
    "estado" => "S300"
    "fechaPublicacion" => "2019-03-01"
    "aid" => "1926"
    "copyright" => "SEPAR"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Arch Bronconeumol. 2019;55:160-2"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 278
      "formatos" => array:3 [
        "EPUB" => 40
        "HTML" => 151
        "PDF" => 87
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>"
      "titulo" => "An Atypical Radiological Presentation of Lung Adenocarcinoma"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "160"
          "paginaFinal" => "162"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Presentaci&#243;n radiol&#243;gica at&#237;pica de un adenocarcinoma de pulm&#243;n"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1876
              "Ancho" => 2500
              "Tamanyo" => 334651
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Computed axial tomography slices before &#40;A and C&#41; and 4 months after starting treatment &#40;B and D&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Mar&#237;a Montes Ruiz-Cabello, Emilio Guirao Arrabal, Manuel Gallardo Medina, David Vinuesa Garc&#237;a"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Mar&#237;a"
              "apellidos" => "Montes Ruiz-Cabello"
            ]
            1 => array:2 [
              "nombre" => "Emilio"
              "apellidos" => "Guirao Arrabal"
            ]
            2 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Gallardo Medina"
            ]
            3 => array:2 [
              "nombre" => "David"
              "apellidos" => "Vinuesa Garc&#237;a"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289618302035"
        "doi" => "10.1016/j.arbres.2018.05.013"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289618302035?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212918304439?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005500000003/v1_201903020641/S1579212918304439/v1_201903020641/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>"
    "titulo" => "Clinical Deterioration Due to <span class="elsevierStyleItalic">Exophiala dermatitidis</span> in a Patient With Cystic Fibrosis"
    "tieneTextoCompleto" => true
    "saludo" => "To the Editor&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "162"
        "paginaFinal" => "163"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Alexandra Mart&#237;n Ram&#237;rez, Marta Erro Iribarren, Buenaventura Buend&#237;a Moreno, Rosa Mar&#237;a Gir&#243;n"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Alexandra"
            "apellidos" => "Mart&#237;n Ram&#237;rez"
            "email" => array:1 [
              0 => "sandra&#46;martin&#46;ramirez&#64;gmail&#46;com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Marta"
            "apellidos" => "Erro Iribarren"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Buenaventura"
            "apellidos" => "Buend&#237;a Moreno"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Rosa"
            "apellidos" => "Mar&#237;a Gir&#243;n"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Microbiolog&#237;a y Parasitolog&#237;a&#44; Hospital Universitario de la Princesa&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Instituto de Investigaci&#243;n Sanitaria de la Princesa&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Neumolog&#237;a&#44; Hospital Universitario de la Princesa&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Deterioro cl&#237;nico por <span class="elsevierStyleItalic">Exophiala dermatitidis</span> en un paciente con fibrosis qu&#237;stica"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 748
            "Ancho" => 1000
            "Tamanyo" => 89707
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Exophiala dermatitidis</span> colonies in Sabouraud agar with chloramphenicol&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An increase in respiratory isolates of <span class="elsevierStyleItalic">Exophiala dermatitidis</span> has been described in recent years in patients with cystic fibrosis &#40;CF&#41;&#46; We report the case of a CF patient with chronic <span class="elsevierStyleItalic">E&#46; dermatitidis</span> bronchial infection&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">This was a 21-year-old woman who had been diagnosed with genotype F508del&#47;3849&#43;1G&#62;A CF at the age of 3 months&#46; Chest computed tomography &#40;CT&#41; revealed multiple cylindrical&#44; cystic&#44; and string-of-pearls bronchiectasis in both lungs&#46; Spirometry showed moderate-severe pulmonary obstruction with a forced expiratory volume in 1 second &#40;FEV<span class="elsevierStyleInf">1</span>&#41; of 1680<span class="elsevierStyleHsp" style=""></span>ml &#40;53&#37; predicted&#41;&#46; Pancreatic insufficiency and intermittent bronchial infection caused by methicillin-sensitive <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#44; <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; and <span class="elsevierStyleItalic">Achromobacter xylosoxidans</span> were detected&#46; The patient had shown declining lung function&#44; and in recent years only <span class="elsevierStyleItalic">E&#46; dermatitidis</span> was isolated from sputum microbiology studies&#46; Given her clinical deterioration and the absence of bacterial growth&#44; we performed a bronchoscopy&#44; obtaining bronchial aspirate &#40;BAS&#41; and bronchoalveolar lavage &#40;BAL&#41; samples&#46; Selective media&#44; Sabouraud agar and blood agar&#44; were seeded quantitatively and incubated for 5 days&#46; MALDI-TOF mass spectrometry was used for the identification of the different pathogens&#46; <span class="elsevierStyleItalic">E&#46; dermatitidis</span> grew from both BAL and BAS&#44; and antibiotic sensitivity testing was performed with amphotericin B and voriconazole using the Etest<span class="elsevierStyleSup">&#174;</span> method&#44; obtaining MICs of 0&#46;1 and 0&#46;023&#44; respectively&#46; Treatment with oral voriconazole 300<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h began&#44; but adverse effects &#40;hallucinations and altered liver profile&#41; led the dose to be reduced to the maximum tolerable level of 100<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#46; During follow-up&#44; the patient has shown important clinical improvement and reduced exacerbations&#44; despite persistent isolation of the fungus&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The prevalence of <span class="elsevierStyleItalic">E&#46; dermatitidis</span> in CF patients varies between 2&#37; and 15&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> This may be due to the lack of standardized procedures for the detection of this organism in sputum samples&#46; <span class="elsevierStyleItalic">E&#46; dermatitidis</span> is a slow-growing opportunistic fungus that is not ubiquitous&#44; and as such is generally an uncommon contaminant in microbiology laboratories&#46; It is mostly detected in patients with CF&#44; so isolation in a non-CF patient should prompt suspicion&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It was first described in 1990&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> and some cases have been published since then&#46; In 2010&#44; the first case of pigmented sputum was described&#44; with the black flecks being attributed to fungal hyphae&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> In 2017&#44; Grenouillet et al&#46; published 2 cases of patients with bronchiectasis and chronic persistent <span class="elsevierStyleItalic">E&#46; dermatitidis</span> colonization which led to the diagnosis of CF&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">For the definitive diagnosis of this fungus&#44; the sample must be cultured in Sabouraud agar&#44; incubated at room temperature or 30<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; and repeated isolates must be obtained&#46; Cultures must be observed for 3&#8211;4 weeks&#44; although colonies are usually detected in less than 7 days&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> The colonies are small at first&#44; and over time increase in size and acquire a characteristic intense olive black or dark brown color &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; However&#44; <span class="elsevierStyleItalic">E&#46; dermatitidis</span> isolation is sometimes complicated&#44; and the use of appropriate media&#44; such as erythritol-chloramphenicol agar &#40;ECA&#41; can increase the recovery rate&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Molecular techniques &#40;LAMP or reverse hybridization&#41; can be powerful alternatives to culture media&#44; increasing the rate of detection in sputum samples&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In patients with CF&#44; chronic or intermittent <span class="elsevierStyleItalic">E&#46; dermatitidis</span> isolation usually has no clinical repercussions&#44; although some cases have been reported&#44; such as that of a child with CF who presented symptoms of dyspnea due to <span class="elsevierStyleItalic">E&#46; dermatitidis</span> pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> Two prospective studies in a Swedish cohort of 98 CF patients over 12 years of age found <span class="elsevierStyleItalic">E&#46; dermatitidis</span> or elevated serum levels of IgG antibodies to <span class="elsevierStyleItalic">E&#46; dermatitidis</span> to be associated with pancreatic insufficiency&#44; more frequent colonization by non-tuberculous mycobacteria&#44; increased inflammatory markers&#44; requirements for more frequent intravenous antibiotic treatment&#44; and lower FEV<span class="elsevierStyleInf">1</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> Although the clinical impact of this pathogen is still pending investigation&#44; its presence in the respiratory tract must be monitored as it is currently considered to be an emerging opportunistic pathogen in CF&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mart&#237;n Ram&#237;rez A&#44; Erro Iribarren M&#44; Buend&#237;a Moreno B&#44; Mar&#237;a Gir&#243;n R&#46; Deterioro cl&#237;nico por <span class="elsevierStyleItalic">Exophiala dermatitidis</span> en un paciente con fibrosis qu&#237;stica&#46; Arch Bronconeumol&#46; 2019&#59;55&#58;162&#8211;163&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 748
            "Ancho" => 1000
            "Tamanyo" => 89707
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Exophiala dermatitidis</span> colonies in Sabouraud agar with chloramphenicol&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:9 [
            0 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagn&#243;stico microbiol&#243;gico de la colonizaci&#243;n-infecci&#243;n broncopulmonar en el paciente con fibrosis qu&#237;stica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Oliver"
                            1 => "T&#46; Alarc&#243;n"
                            2 => "E&#46; Caballero"
                            3 => "R&#46; Cant&#243;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eimc.2008.05.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Enferm Infecc Microbiol Clin"
                        "fecha" => "2009"
                        "volumen" => "27"
                        "paginaInicial" => "89"
                        "paginaFinal" => "104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19232782"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Exophiala dermatitidis</span> revealing cystic fibrosis in adult patients with chronic pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Grenouillet"
                            1 => "B&#46; Cimon"
                            2 => "H&#46; Pana-Katatali"
                            3 => "C&#46; Person"
                            4 => "M&#46; Gainet-Brun"
                            5 => "M&#46;C&#46; Malinge"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11046-017-0218-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mycopathologia"
                        "fecha" => "2018"
                        "volumen" => "183"
                        "paginaInicial" => "71"
                        "paginaFinal" => "79"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29094263"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Exophiala dermatitidis</span> infection in cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Haase"
                            1 => "H&#46; Skopnik"
                            2 => "G&#46; Kusenbach"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1990"
                        "volumen" => "336"
                        "paginaInicial" => "188"
                        "paginaFinal" => "189"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1973514"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Isolation of <span class="elsevierStyleItalic">Exophiala</span> dermatitidis from pigmented sputum in a cystic fibrosis patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;A&#46; Griffard"
                            1 => "J&#46;R&#46; Guajardo"
                            2 => "M&#46;S&#46; Cooperstock"
                            3 => "C&#46;L&#46; Scoville"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatr Pulmonol"
                        "fecha" => "2010"
                        "volumen" => "45"
                        "paginaInicial" => "508"
                        "paginaFinal" => "510"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infecciones humanas por levaduras negras del g&#233;nero <span class="elsevierStyleItalic">Exophiala</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Garc&#237;a-Martos"
                            1 => "A&#46; M&#225;rquez"
                            2 => "J&#46; Gen&#233;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Iberoam Micol"
                        "fecha" => "2002"
                        "volumen" => "19"
                        "paginaInicial" => "72"
                        "paginaFinal" => "79"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12828507"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Direct detection of <span class="elsevierStyleItalic">Exophiala</span> and <span class="elsevierStyleItalic">Scedosporium</span> species in sputa of patients with cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Chen"
                            1 => "N&#46; Kondori"
                            2 => "D&#46; Shuwen"
                            3 => "A&#46;H&#46;G&#46; Gerrits van den Ende"
                            4 => "M&#46; Lackner"
                            5 => "W&#46; Liao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/mmy/myx108"
                      "Revista" => array:2 [
                        "tituloSerie" => "Med Mycol"
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exophiala dermatitidis pneumonia in cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Kusenbach"
                            1 => "H&#46; Skopnik"
                            2 => "G&#46; Haase"
                            3 => "F&#46; Friedrichs"
                            4 => "H&#46; D&#246;hmen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Pediatr"
                        "fecha" => "1992"
                        "volumen" => "151"
                        "paginaInicial" => "344"
                        "paginaFinal" => "346"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1396889"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development of IgG antibodies to <span class="elsevierStyleItalic">Exophiala dermatitidis</span> is associated with inflammatory responses in patients with cystic fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46; Kondori"
                            1 => "A&#46; Lindblad"
                            2 => "C&#46; Welinder-Olsson"
                            3 => "C&#46; Wenner&#229;s"
                            4 => "M&#46; Gilljam"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcf.2013.12.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cyst Fibros"
                        "fecha" => "2014"
                        "volumen" => "13"
                        "paginaInicial" => "391"
                        "paginaFinal" => "399"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24439251"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Exophiala &#40;Wangiella&#41;</span> dermatitidis and cystic fibrosis&#46; Prevalence and risk factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Lebecque"
                            1 => "A&#46; Leonard"
                            2 => "D&#46; Huang"
                            3 => "G&#46; Reychler"
                            4 => "A&#46; Boeras"
                            5 => "T&#46; Leal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/13693786.2010.495731"
                      "Revista" => array:7 [
                        "tituloSerie" => "Med Mycol"
                        "fecha" => "2010"
                        "volumen" => "48"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "S4"
                        "paginaFinal" => "S9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21067329"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000005500000003/v1_201903020641/S1579212918304440/v1_201903020641/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "49861"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Scientific letters"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005500000003/v1_201903020641/S1579212918304440/v1_201903020641/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212918304440?idApp=UINPBA00003Z"
]
Share
Journal Information
Vol. 55. Issue 3.
Pages 162-163 (March 2019)
Vol. 55. Issue 3.
Pages 162-163 (March 2019)
Scientific Letter
Full text access
Clinical Deterioration Due to Exophiala dermatitidis in a Patient With Cystic Fibrosis
Deterioro clínico por Exophiala dermatitidis en un paciente con fibrosis quística
Visits
3619
Alexandra Martín Ramíreza,b,
Corresponding author
sandra.martin.ramirez@gmail.com

Corresponding author.
, Marta Erro Iribarrenb,c, Buenaventura Buendía Morenoa,b, Rosa María Girónb,c
a Servicio de Microbiología y Parasitología, Hospital Universitario de la Princesa, Madrid, Spain
b Instituto de Investigación Sanitaria de la Princesa, Madrid, Spain
c Servicio de Neumología, Hospital Universitario de la Princesa, Madrid, Spain
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Full Text
To the Editor,

An increase in respiratory isolates of Exophiala dermatitidis has been described in recent years in patients with cystic fibrosis (CF). We report the case of a CF patient with chronic E. dermatitidis bronchial infection.

This was a 21-year-old woman who had been diagnosed with genotype F508del/3849+1G>A CF at the age of 3 months. Chest computed tomography (CT) revealed multiple cylindrical, cystic, and string-of-pearls bronchiectasis in both lungs. Spirometry showed moderate-severe pulmonary obstruction with a forced expiratory volume in 1 second (FEV1) of 1680ml (53% predicted). Pancreatic insufficiency and intermittent bronchial infection caused by methicillin-sensitive Staphylococcus aureus, Pseudomonas aeruginosa, and Achromobacter xylosoxidans were detected. The patient had shown declining lung function, and in recent years only E. dermatitidis was isolated from sputum microbiology studies. Given her clinical deterioration and the absence of bacterial growth, we performed a bronchoscopy, obtaining bronchial aspirate (BAS) and bronchoalveolar lavage (BAL) samples. Selective media, Sabouraud agar and blood agar, were seeded quantitatively and incubated for 5 days. MALDI-TOF mass spectrometry was used for the identification of the different pathogens. E. dermatitidis grew from both BAL and BAS, and antibiotic sensitivity testing was performed with amphotericin B and voriconazole using the Etest® method, obtaining MICs of 0.1 and 0.023, respectively. Treatment with oral voriconazole 300mg/12h began, but adverse effects (hallucinations and altered liver profile) led the dose to be reduced to the maximum tolerable level of 100mg/12h. During follow-up, the patient has shown important clinical improvement and reduced exacerbations, despite persistent isolation of the fungus.

The prevalence of E. dermatitidis in CF patients varies between 2% and 15%.1 This may be due to the lack of standardized procedures for the detection of this organism in sputum samples. E. dermatitidis is a slow-growing opportunistic fungus that is not ubiquitous, and as such is generally an uncommon contaminant in microbiology laboratories. It is mostly detected in patients with CF, so isolation in a non-CF patient should prompt suspicion.2

It was first described in 1990,3 and some cases have been published since then. In 2010, the first case of pigmented sputum was described, with the black flecks being attributed to fungal hyphae.4 In 2017, Grenouillet et al. published 2 cases of patients with bronchiectasis and chronic persistent E. dermatitidis colonization which led to the diagnosis of CF.2

For the definitive diagnosis of this fungus, the sample must be cultured in Sabouraud agar, incubated at room temperature or 30°C, and repeated isolates must be obtained. Cultures must be observed for 3–4 weeks, although colonies are usually detected in less than 7 days.5 The colonies are small at first, and over time increase in size and acquire a characteristic intense olive black or dark brown color (Fig. 1). However, E. dermatitidis isolation is sometimes complicated, and the use of appropriate media, such as erythritol-chloramphenicol agar (ECA) can increase the recovery rate.6 Molecular techniques (LAMP or reverse hybridization) can be powerful alternatives to culture media, increasing the rate of detection in sputum samples.6

Fig. 1.

Exophiala dermatitidis colonies in Sabouraud agar with chloramphenicol.

(0.09MB).

In patients with CF, chronic or intermittent E. dermatitidis isolation usually has no clinical repercussions, although some cases have been reported, such as that of a child with CF who presented symptoms of dyspnea due to E. dermatitidis pneumonia.7 Two prospective studies in a Swedish cohort of 98 CF patients over 12 years of age found E. dermatitidis or elevated serum levels of IgG antibodies to E. dermatitidis to be associated with pancreatic insufficiency, more frequent colonization by non-tuberculous mycobacteria, increased inflammatory markers, requirements for more frequent intravenous antibiotic treatment, and lower FEV1.8 Although the clinical impact of this pathogen is still pending investigation, its presence in the respiratory tract must be monitored as it is currently considered to be an emerging opportunistic pathogen in CF.9

References
[1]
A. Oliver, T. Alarcón, E. Caballero, R. Cantón.
Diagnóstico microbiológico de la colonización-infección broncopulmonar en el paciente con fibrosis quística.
Enferm Infecc Microbiol Clin, 27 (2009), pp. 89-104
[2]
F. Grenouillet, B. Cimon, H. Pana-Katatali, C. Person, M. Gainet-Brun, M.C. Malinge.
Exophiala dermatitidis revealing cystic fibrosis in adult patients with chronic pulmonary disease.
Mycopathologia, 183 (2018), pp. 71-79
[3]
G. Haase, H. Skopnik, G. Kusenbach.
Exophiala dermatitidis infection in cystic fibrosis.
Lancet, 336 (1990), pp. 188-189
[4]
E.A. Griffard, J.R. Guajardo, M.S. Cooperstock, C.L. Scoville.
Isolation of Exophiala dermatitidis from pigmented sputum in a cystic fibrosis patient.
Pediatr Pulmonol, 45 (2010), pp. 508-510
[5]
P. García-Martos, A. Márquez, J. Gené.
Infecciones humanas por levaduras negras del género Exophiala.
Rev Iberoam Micol, 19 (2002), pp. 72-79
[6]
M. Chen, N. Kondori, D. Shuwen, A.H.G. Gerrits van den Ende, M. Lackner, W. Liao, et al.
Direct detection of Exophiala and Scedosporium species in sputa of patients with cystic fibrosis.
[7]
G. Kusenbach, H. Skopnik, G. Haase, F. Friedrichs, H. Döhmen.
Exophiala dermatitidis pneumonia in cystic fibrosis.
Eur J Pediatr, 151 (1992), pp. 344-346
[8]
N. Kondori, A. Lindblad, C. Welinder-Olsson, C. Wennerås, M. Gilljam.
Development of IgG antibodies to Exophiala dermatitidis is associated with inflammatory responses in patients with cystic fibrosis.
J Cyst Fibros, 13 (2014), pp. 391-399
[9]
P. Lebecque, A. Leonard, D. Huang, G. Reychler, A. Boeras, T. Leal, et al.
Exophiala (Wangiella) dermatitidis and cystic fibrosis. Prevalence and risk factors.

Please cite this article as: Martín Ramírez A, Erro Iribarren M, Buendía Moreno B, María Girón R. Deterioro clínico por Exophiala dermatitidis en un paciente con fibrosis quística. Arch Bronconeumol. 2019;55:162–163.

Copyright © 2018. SEPAR
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?