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Exophiala  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  Exophiala  species from India.    Methods  Twenty-four isolates of  Exophiala  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 st  January 2021 using the Medline and Cochrane database.    Results    E. dermatitidis  (n = 8),  E. jeanselmei  (n = 6),  E. spinifera  (n = 6),  E. mesophila  (n = 1),  E. oligosperma  (n = 1),  E. xenobiotica  (n = 1) were identified and the sequencing of  ITS, β-tubulin  and  β-actin  revealed a novel species,  E. arunalokei  sp. nov. (n = 1). The ITS sequence phylogram of  E. jeanselmei  revealed that the majority (83%) formed a separate cluster close to type A while majority (75%) of  E. dermatitidis  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  E. dermatitidis  with history of surgical procedures (p = 0.013), invasive disease (p = 0.032) and of  E. mesophila  with tuberculosis (p = 0.026) was seen.    Conclusion  This, to the best of our knowledge is the first study from India elucidating the molecular and clinical characteristics of  Exophiala  species and the first Indian report of human infection due to  E. xenobiotica  and  E. arunalokei.

frontiers in cellular and infection microbiology

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