Between Skin and Brain: A Systematic Review of 712 Cases 1976-2025 Reveals a Highly Diverse Disease Spectrum in Chaetothyriales.
Jiayi Li, Huaxuan Wu, Yalong Li et al.
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In 30 seconds
This systematic review examined the global epidemiology, causative species, clinical presentations, and outcomes of 712 reported Chaetothyriales infections from 1976 to 2025. Cases were increasingly reported, although the authors note that improved recognition may partly explain this trend. Cladophialophora bantiana (21%), Exophiala dermatitidis (19%), and E. jeanselmei (15%) were the leading pathogens. Deep infections had higher mortality than cutaneous infections (47% vs. 7%; p < 0.001), with the highest reported mortality in central nervous system infection (58%) and disseminated disease (53%).
Key findings
- The leading reported pathogens were Cladophialophora bantiana (21%), Exophiala dermatitidis (19%), and E. jeanselmei (15%).
- The proportion of E. jeanselmei declined from 18%-28% in 1976-2015 to 7% in 2016-2025.
- Mortality was higher for deep than cutaneous infections (47% vs. 7%; p < 0.001); central nervous system and disseminated infections had mortality of 58% and 53%, respectively.
- Although 42% of infections occurred in immunocompetent individuals, transplant recipients, people with diabetes, and those with CARD9 deficiency were identified as higher-risk groups.
Why it matters
The review brings together a broad range of reported infections, from cutaneous disease to life-threatening systemic involvement. The marked mortality difference by infection depth underscores the clinical importance of recognizing invasive presentations. Its findings also show that infection is not confined to immunocompromised people, while identifying groups in whom risk may be higher.
What to keep in mind
The review is based on published case reports and cases, so reported patterns may not represent population incidence; the authors also note that increasing diagnoses may partly reflect better recognition.