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Peer-reviewedCC BY-NC-NDMycoses

Between Skin and Brain: A Systematic Review of 712 Cases 1976-2025 Reveals a Highly Diverse Disease Spectrum in Chaetothyriales.

  • Jiayi Li1,2,3
  • Huaxuan Wu1,2,3
  • Yalong Li1,2,3
  • Ruoyu Li1,2,3
  • Dallas J Smith4
  • Sybren de Hoog2,5,6
  • Yinggai Song1,2,3
6 affiliations
  1. 1Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China.
  2. 2Research Center for Medical Mycology, Peking University, Beijing, China.
  3. 3National Clinical Research Center for Skin and Sexually Transmitted Diseases, Beijing, China.
  4. 4Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  5. 5Department of Medical Microbiology and Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, the Netherlands.
  6. 6Foundation Atlas of Clinical Fungi, Hilversum, the Netherlands.
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Abstract

Background

Black yeast-like species of the order Chaetothyriales cause superficial to life-threatening systemic infections. Comprehensive global epidemiology data remain limited.Objectives

This study aimed to analyze the global epidemiology, spectrum of pathogens, clinical manifestations and outcomes of Chaetothyriales infections.Methods

We systematically reviewed 712 cases reported between 1976 and 2025.Results

The analysis revealed a steady increase in diagnosed cases, with Cladophialophora bantiana (21%), Exophiala dermatitidis (19%), and E. jeanselmei (15%) being the predominant causative agents; notably, the proportion of E. jeanselmei declined from 18%-28% in 1976-2015 to 7% in 2016-2025. Published cases were more frequent in tropical/subtropical regions; however, cases were reported from Africa. Although 42% of infections occurred in immunocompetent individuals, transplant recipients, diabetics, and those with CARD9 deficiency showed higher risk. Deep infections exhibited substantially greater mortality than cutaneous forms (47% vs. 7%; p < 0.001); particularly, central nervous system infections (58%) and disseminated disease (53%) were involved.Conclusions

This study highlights a seemingly growing burden of Chaetothyriales infections, possibly partly due to better recognition, emphasizing the need for improved surveillance, diagnostics, and targeted prevention in high-risk populations.

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Cite

BibTeXRIS
BibTeX
@article{li2026between,
  title = {{Between Skin and Brain: A Systematic Review of 712 Cases 1976-2025 Reveals a Highly Diverse Disease Spectrum in Chaetothyriales.}},
  author = {Jiayi Li and Huaxuan Wu and Yalong Li and Ruoyu Li and Dallas J Smith and Sybren de Hoog and Yinggai Song},
  journal = {Mycoses},
  year = {2026},
  month = oct,
  doi = {10.1111/myc.70234},
  url = {https://europepmc.org/article/MED/42952339},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Between Skin and Brain: A Systematic Review of 712 Cases 1976-2025 Reveals a Highly Diverse Disease Spectrum in Chaetothyriales.
AU  - Jiayi Li
AU  - Huaxuan Wu
AU  - Yalong Li
AU  - Ruoyu Li
AU  - Dallas J Smith
AU  - Sybren de Hoog
AU  - Yinggai Song
PY  - 2026
DA  - 2026/10/29
JO  - Mycoses
DO  - 10.1111/myc.70234
UR  - https://europepmc.org/article/MED/42952339
AB  - Background  Black yeast-like species of the order Chaetothyriales cause superficial to life-threatening systemic infections. Comprehensive global epidemiology data remain limited.Objectives  This study aimed to analyze the global epidemiology, spectrum of pathogens, clinical manifestations and outcomes of Chaetothyriales infections.Methods  We systematically reviewed 712 cases reported between 1976 and 2025.Results  The analysis revealed a steady increase in diagnosed cases, with Cladophialophora bantiana (21%), Exophiala dermatitidis (19%), and E. jeanselmei (15%) being the predominant causative agents; notably, the proportion of E. jeanselmei declined from 18%-28% in 1976-2015 to 7% in 2016-2025. Published cases were more frequent in tropical/subtropical regions; however, cases were reported from Africa. Although 42% of infections occurred in immunocompetent individuals, transplant recipients, diabetics, and those with CARD9 deficiency showed higher risk. Deep infections exhibited substantially greater mortality than cutaneous forms (47% vs. 7%; p < 0.001); particularly, central nervous system infections (58%) and disseminated disease (53%) were involved.Conclusions  This study highlights a seemingly growing burden of Chaetothyriales infections, possibly partly due to better recognition, emphasizing the need for improved surveillance, diagnostics, and targeted prevention in high-risk populations.
SN  - 0933-7407
SN  - 1439-0507
ER  -