Abstract：
Rhinocladiella mackenziei is a highly neurotropic fungus, mainly reported from the Middle East. However, in recent years, there have been some cases from outside this region. We described an additional fatal case of R. mackenziei cerebral infection for the first time from Turkey and made a literature review of all previously reported cases. During 34 years (1988-2022), there have been 42 R. mackenziei brain abscess cases. Most patients have been reported from Saudi Arabia (n = 14, 33.3%). It is noteworthy that 40.5% of patients, including our case, were immunocompetent at initial diagnosis and mostly presented with a single lesion (n = 10, 23.8%). The most frequent comorbidities were solid organ transplant (n = 9, 21.4%), diabetes mellitus (n = 6, 14.3%), malignancy (n = 6, 14.3%) and prior surgery (n = 3, 7.1%). The most commonly used initial antifungal regimen were amphotericin B together with itraconazole (n = 9, 21.4%), combinations of lipid preparations of amphotericin B, voriconazole and/or posaconazole (n = 9, 21.4%) and amphotericin B alone (n = 8, 19%). Although both surgical procedures and antifungal medication in the majority of patients were performed, mortality rates remained high (90.4%). The area at risk of R. mackenziei cerebral abscess cases extends to other countries. Clinicians should be aware of this emerging disease and take a detailed travel history in patients with atypical and undocumented brain abscesses. Our case confirms the hypothesis that this fungus might spread more widely than previously predicted regions.
摘要：
Mackenzenziei是一种高度嗜神经的真菌，主要来自中东。然而,近年来,有一些来自该地区以外的案件。我们首次描述了来自土耳其的另一例致命的R.mackenziei脑感染病例，并对以前报道的所有病例进行了文献综述。34年（1988-2022）有42例R.mackenziei脑脓肿病例。大多数患者来自沙特阿拉伯（n=14，33.3％）。值得注意的是，40.5%的患者，包括我们的案子,在最初诊断时具有免疫能力，并且大部分表现为单个病变（n=10，23.8％）。最常见的合并症是实体器官移植（n=9，21.4％），糖尿病（n=6，14.3%），恶性肿瘤（n=6，14.3%）和既往手术（n=3，7.1%）。最常用的初始抗真菌治疗方案是两性霉素B和伊曲康唑（n=9，21.4%），两性霉素B的脂质制剂的组合，伏立康唑和/或泊沙康唑（n=9，21.4％）和单独的两性霉素B（n=8，19％）。尽管大多数患者都进行了外科手术和抗真菌药物治疗，死亡率仍然很高(90.4%).R.mackenziei脑脓肿病例的风险区域扩展到其他国家。临床医生应该意识到这种新出现的疾病，并对患有非典型和无证脑脓肿的患者进行详细的旅行史。我们的案例证实了这种真菌可能比以前预测的区域传播更广泛的假设。
