Epidemiology, clinical manifestations, and therapy of XXXX caused by dematiaceous fungi.

@entity1 @entity1244 @entity15669 @entity625 @entity2379 @entity8711 @entity13443 @entity3102 @entity884 @entity7189 @entity281 @entity288 @entity56 @entity28537 @entity3558 @entity2059 @entity18227
The dematiaceous (brown-pigmented) fungi are a large and heterogenous group of moulds that cause a wide range of diseases including @entity18227 , @entity8711 , and @entity13443 . Among the more important @entity1 pathogens are Alternaria species, @entity15669 , Cladophialophora bantiana, Curvularia species, Exophiala species, Fonsecaea pedrosoi, Madurella species, Phialophora species, Scedosporium prolificans, Scytalidium dimidiatum, and Wangiella dermatitidis. These organisms are widespread in the environment, being found in soil, wood, and decomposing @entity7189 . Cutaneous, subcutaneous, and @entity281 with dematiaceous fungi occur worldwide, but are more common in tropical and subtropical climates. Infection results from traumatic implantation. Most cases occur in immunocompetent individuals. Dematiaceous moulds are also important causes of invasive @entity1244 and @entity56 . Infection is thought to follow inhalation. Although @entity281 is the commonest form of systemic @entity18227 , other localized deep forms of the disease, such as @entity625 , and @entity884 , have been reported. @entity281 is uncommon, but its incidence is increasing, particularly among immunocompromised individuals. Scedosporium prolificans is the most frequent cause. A number of dematiaceous fungi are neurotropic, including Cladophialophora bantiana, Ramichloridium mackenziei, and Wangiella dermatitidis. Although cases have occurred in immunocompromised @entity1 , @entity28537 is most common in immunocompetent individuals with no obvious risk factors. Most forms of disease caused by dematiaceous fungi require both surgical and medical treatment. @entity2059 is currently the most effective antifungal agent for @entity8711 and @entity18227 , while @entity3102 remains useful for @entity13443 . Extensive surgical debridement combined with @entity2379 treatment is recommended for chronic invasive @entity1244 . Long-term treatment with @entity2059 has led to improvement or remission in some @entity1 that had failed to respond to @entity2379 . @entity56 requires surgical removal of impacted @entity3558 combined with postoperative oral @entity288 . Antifungal treatment is not usually of benefit, but post-operative @entity2059 may reduce the need for reoperation. The clinical outcome of cerebral and other deep-seated forms of @entity18227 is dismal, with long-term survival being reported only when complete surgical resection of discrete lesions is possible. The development of new antifungal agents and combination treatment may help to improve the management of these @entity281 .
