Hendersonula toruloidea infection in man. Index cases in the non-endemic North American host, and a review of the literature.

Hendersonula toruloidea (HT) is a dematiaceous fungus that is an endemic human pathogen in tropical and subtropical countries. Infection with this fungus is often clinically indistinguishable from Trichophyton rubrum or other dermatophytoses. However, because HT will not grow on standard cycloheximide containing fungal media, and because HT is usually resistant to standard anti-fungal therapies, we believe that HT is a more common cause of 'recalcitrant dermatophytosis' in the United States than is currently recognized. HT may be especially prevalent among immigrant patients from endemic countries. We report the first cases of HT to occur in a non-endemic region of the United States. This suggests that HT may become a significant pathogen in the native American host as well. Moreover, we report the first case of a tinea capitis-like infection due to HT.