Exophiala infection: A systematic review

Background: Given the limited understanding of this rare fungal disease, this study aimed to conduct a systematic review of patients with Exophiala infections. Methods: A systematic retrospective analysis was performed, including 248 articles involving 298 patients, retrieved from PubMed and China National Knowledge Infrastructure. Statistical analyses were conducted using the Chi-square test and binary logistic regression by SPSS 27.0. Results: A total of 19 Exophiala species were identified, with E dermatitidis , E jeanselmei , and E spinifera being the most prevalent. Common infection sites included subcutaneous tissue, lung, and skin, with distinct site predilections among different species. Central nervous system (CNS) infection was the only independent risk factor for mortality ( P < .001, OR = 35.432). For E dermatitidis , the risk of infecting the skin ( P < .001, OR = 0.075, 95% CI = 0.017–0.335) and subcutaneous tissue ( P < .001, OR = 0.035) was significantly lower, while the risk of infecting the lungs ( P < .001, OR = 44.850), CNS ( P = .002, OR = 4.523), and blood ( P < .001, OR = 12.498) was significantly higher. E jeanselmei showed a higher risk of subcutaneous tissue infection ( P < .001, OR = 4.221) but lower risks of lung ( P = .003, OR = 0.045) and CNS ( P = .039, OR = 0.118) infections. E spinifera had a higher risk of infecting both subcutaneous tissue ( P < .001, OR = 6.598) and skin ( P = .006, OR = 3.778). Conclusions: Exophiala species exhibit distinct predilections for infection sites, and CNS infection is a critical risk factor for mortality. These findings may inform clinical diagnosis and management of Exophiala infections.