Exophiala species invades the human body, mainly causing phaeohyphomycosis which shows brown hyphae or yeast-like spores in involved tissue. The species rarely causes either chromoblastomycosis in which round-shaped sclerotic cells or muriform cells with a thick wall are observed or eumycotic mycetoma which is characterized by the development of abscesses, draining sinuses, and the formation of fistulae discharging granules
1,20,21. Phaeohyphomycosis usually occurs in the skin or subcutaneous tissue. The skin lesion appears as pustules or verrucous plaques. It is rarely disseminated to the internal organs
22-24. In Korea, three strains of
E. jeanselmei species and three strains of
E. dermatitidis were isolated from patients with phaeohyphomycosis
25-30. Most of these strains caused subcutaneous infections, but only one strain of
E. dermatitidis species involved the brain
30. More strains of
Exophiala species were isolated in many countries: 188 strains in United States
6, 76 strains in Japan
9 and 20 strains in China
3. It is expected that more strains will appear in Korea. In this study, we used two strains of
E. jeanselmei and two strains of
E. dermatitidis which were isolated and preserved in our hospital as well as one strain of
E. dermatitidis CBS 109154 obtained from GenBank. One strain of
E. jeanselmei isolated by Kim et al.
27 was excluded from the study because no molecular biological information was available. Of these five strains, one was identified as
E. jeanselmei by Suh et al.
25 through morphological analysis. However, this strain was regarded as a new strain because it had no identical ITS sequences with
Exophiala species. Therefore, molecular biological analysis is recommended as a supplementary method if morphological analysis is inadequate.
The classification and identification of
Exophiala species have been performed by morphological examination, including colony morphology and light microscopy, as well as a physiological examination, including sugar assimilation tests and heat tolerance
1. Molecular biological analysis has recently been used as a supplementary method
3-15.
E. jeanselmei species is morphologically and molecular biologically heterogeneous
4-10,13,14, whereas
E. dermatitidis species is homogeneous
6,8,9,14.
In the past,
E. jeanselmei species were re-identified as
E. jeanselmei var. jeanselmei,
E. jeanselmei var.
heteromorpha and
E. jeanselmei var.
lecanii-corni by morphological and cultural features
31. After then, this species were further classified as
E. jeanselmei var.
jeanselmei,
E. jeanselmei var.
heteromorpha and
E. jeanselmei var.
lecanii-corni and
E. lecanii-corni by mitochondrial DNA analysis
14. Furthermore,
E. jeanselmei was newly subclassified
E. jeanselmei as
E. jeanselmei,
E. xenobiotica,
E. oligosperma,
E. lecanii-corni and
E. heteromorpha by sequence analysis of the ITS regions, elongation factor 1-α (EF1-α) and β-tubulin (β-TUB)
7. Currently,
E. jeanselmei is much more subdivided into seven species, including
E. jeanselmei,
E. xenobiotica,
E. oligosperma,
E. exophialae,
E. nishimurae,
E. bergeri and
E. nigra by sequence analysis of the ITS regions
5. The above-mentioned species was confirmed as fifteen subtypes by ITS-RFLP analysis
8.
In this study, we classified
E. jeanselmei as types A, B and C by ITS-RFLP analysis, and matched with fifteen subtypes suggested by Kawasaki et al.
8; types A and B are considered to be subtype E5, whereas type C is considered to be subtype E2 or E3. In addition, since
E. jeanselmei DUMC 9901 corresponds to type B, and subtype E5 is the most commonly isolated subtype in Japan, there is a possibility that more type B strains will be identified in Korea.
Although the DUMC O501 strain isolated in Korea was identified as E. jeanselmei by morphological and physiological analyses, it had a 84% (432/512) homology to E. jeanselmei by ITS sequences analysis. While this strain was close to Pseudocladosporium species and E. salmonis, this is regarded as a new strain because no identical ITS sequences were detected from GenBank. Since most of the strains with similar ITS sequences originate from soil, this strain is also thought to originate from soil. Because morphological and physiological analyses have some limitations in the identification of strains, molecular biological analysis is recommended as supplementary method. Since one of the five Korean isolates is a new species, further new species will be identified in Korea.
Since
E. dermatitidis species is very homogeneous
6,8,9,14, it had not been subclassified by morphological or molecular biological analysis before the studies by Uijthof et al.
15 which reported that of the five subgroups, group I is most common and the number of nucleotides in groups II to V is different by 1 to 4 from that in group I. In 2003, Matos et al.
11 further classified
E. dermatitidis species as groups A, B, C and D by ITS sequence analysis and M-13 fingerprinting. They also stated that most strains belong to groups A and B, and that group A strains are clinical isolates, whereas group B strains are environmental isolates. In this study, it was found that the 3 strains isolated in Korea were classified as A0, A1 and A2, although there were no significant differences in locations and clinical features between A0, A1 and A2.
In conclusion, the five Korean isolates did not show more diversity than western isolates and only three species, including one strain of E. jeanselmei, three strains of E. dermatitidis and one strain of other Exophiala species were identified. All these strains were isolated from patients with phaeohyphomycosis. Despite the low number of the strains included in this study, E. dermatitidis is the most commonly isolated strains from phaeohyphomycosis patients in Korea. In the Western world, however, E. jeanselmei is the main causative agent of phaeohyphomycosis.
Taken together, ITS sequence analysis and phylogenetic analysis can supplement traditional morphological and physiological analyses in the identification of Exophiala species as well as the evaluation of its distribution, determination of subtypes and detection of new species.