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, Ruoyu Li, Dallas J. Smith, Sybren de Hoog, Yinggai SongABSTRACT
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.