AUTHOR=Singh Shreya , Rudramurthy Shivaprakash M. , Padhye Arvind A. , Hemashetter Basavaraj M. , Iyer Ranganathan , Hallur Vinaykumar , Sharma Anuradha , Agnihotri Sourav , Gupta Sunita , Ghosh Anup , Kaur Harsimran 

TITLE=Clinical Spectrum, Molecular Characterization, Antifungal Susceptibility Testing of Exophiala spp. From India and Description of a Novel Exophiala Species, E. arunalokei sp. nov

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=11

YEAR=2021

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2021.686120

DOI=10.3389/fcimb.2021.686120

ISSN=2235-2988

ABSTRACT=<sec><title>Introduction</title><p><italic>Exophiala</italic> spp. are important opportunist pathogens causing subcutaneous or even fatal disseminated infections in otherwise both immunosuppressed and healthy individuals but there are no systematic studies on the isolates of <italic>Exophiala</italic> species from India.</p></sec><sec><title>Methods</title><p>Twenty-four isolates of <italic>Exophiala</italic> species were retrieved from the National Culture Collection of Pathogenic Fungi (NCCPF) and identified phenotypically and by molecular methods (ITS region sequencing) followed by antifungal susceptibility testing (AFST) as per CLSI-M38A3 guidelines. A review of the literature of cases from India was performed up to 1<sup>st</sup> January 2021 using the Medline and Cochrane database.</p></sec><sec><title>Results</title><p><italic>E. dermatitidis</italic> (n = 8), <italic>E. jeanselmei</italic> (n = 6), <italic>E. spinifera</italic> (n = 6), <italic>E. mesophila</italic> (n = 1), <italic>E. oligosperma</italic> (n = 1), <italic>E. xenobiotica</italic> (n = 1) were identified and the sequencing of <italic>ITS, β-tubulin</italic> and <italic>β-actin</italic> revealed a novel species, <italic>E. arunalokei</italic> sp. nov. (n = 1). The ITS sequence phylogram of <italic>E. jeanselmei</italic> revealed that the majority (83%) formed a separate cluster close to type A while majority (75%) of <italic>E. dermatitidis</italic> were type B. The MIC50 (mg/L) of amphotericin, itraconazole, voriconazole, micafungin, caspofungin, anidulafungin, and posaconazole, was 1, 0.25, 0.125, 0.12, 0.125, 0.062, and 0.062, respectively. Sixteen more cases were identified on the literature review and a significant association of <italic>E. dermatitidis</italic> with history of surgical procedures (p = 0.013), invasive disease (p = 0.032) and of <italic>E. mesophila</italic> with tuberculosis (p = 0.026) was seen.</p></sec><sec><title>Conclusion</title><p>This, to the best of our knowledge is the first study from India elucidating the molecular and clinical characteristics of <italic>Exophiala</italic> species and the first Indian report of human infection due to <italic>E. xenobiotica</italic> and <italic>E. arunalokei.</italic></p></sec>