1
|
Glampedakis E, Cassaing S, Fekkar A, Dannaoui E, Bougnoux ME, Bretagne S, Neofytos D, Schreiber PW, Hennequin C, Morio F, Shadrivova O, Bongomin F, Fernández-Ruiz M, Bellanger AP, Arikan-Akdagli S, Erard V, Aigner M, Paolucci M, Khanna N, Charpentier E, Bonnal C, Brun S, Gabriel F, Riat A, Zbinden R, Le Pape P, Klimko N, Lewis RE, Richardson M, İnkaya AC, Coste AT, Bochud PY, Lamoth F. Invasive Aspergillosis Due to Aspergillus Section Usti: A Multicenter Retrospective Study. Clin Infect Dis 2021; 72:1379-1385. [PMID: 32155262 DOI: 10.1093/cid/ciaa230] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/04/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Aspergillus spp. of section Usti (A. ustus) represent a rare cause of invasive aspergillosis (IA). This multicenter study describes the epidemiology and outcome of A. ustus infections. METHODS Patients with A. ustus isolated from any clinical specimen were retrospectively identified in 22 hospitals from 8 countries. When available, isolates were sent for species identification (BenA/CaM sequencing) and antifungal susceptibility testing. Additional cases were identified by review of the literature. Cases were classified as proven/probable IA or no infection, according to standard international criteria. RESULTS Clinical report forms were obtained for 90 patients, of whom 27 had proven/probable IA. An additional 45 cases were identified from literature review for a total of 72 cases of proven/probable IA. Hematopoietic cell and solid-organ transplant recipients accounted for 47% and 33% cases, respectively. Only 8% patients were neutropenic at time of diagnosis. Ongoing antimold prophylaxis was present in 47% of cases. Pulmonary IA represented 67% of cases. Primary or secondary extrapulmonary sites of infection were observed in 46% of cases, with skin being affected in 28% of cases. Multiple antifungal drugs were used (consecutively or in combination) in 67% of cases. The 24-week mortality rate was 58%. A. calidoustus was the most frequent causal agent. Minimal inhibitory concentrations encompassing 90% isolates (MIC90) were 1, 8, >16, and 4 µg/mL for amphotericin B, voriconazole, posaconazole, and isavuconazole, respectively. CONCLUSIONS Aspergillus ustus IA mainly occurred in nonneutropenic transplant patients and was frequently associated with extrapulmonary sites of infection. Mortality rate was high and optimal antifungal therapy remains to be defined.
Collapse
Affiliation(s)
- Emmanouil Glampedakis
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sophie Cassaing
- Department of Parasitology and Mycology, Toulouse University Hospital, Paul Sabatier University, Toulouse, France
| | - Arnaud Fekkar
- Groupe Hospitalier Pitié-Salpêtrière, Service de Parasitologie-Mycologie, Paris, France
| | - Eric Dannaoui
- Paris-Descartes University, Faculty of Medicine, AP-HP, European Georges Pompidou Hospital, Parasitology-Mycology Unit, Paris, France
| | - Marie-Elisabeth Bougnoux
- Department of Microbiology, Necker-Enfants malades Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Stéphane Bretagne
- Université de Paris, Parasitology-Mycology Laboratory, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
| | - Dionysios Neofytos
- Infectious Disease Service, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Peter W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Christophe Hennequin
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Florent Morio
- Parasitology and Medical Mycology Laboratory, Nantes University Hospital, Nantes, France
| | - Olga Shadrivova
- Mechnikov North-Western State Medical University, St Petersburg, Russian Federation, St Petersburg, Russia
| | - Felix Bongomin
- Mycology Reference Centre-Manchester, ECMM Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | | | - Sevtap Arikan-Akdagli
- Mycology Laboratory, Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey
| | - Veronique Erard
- Clinique de Médecine et Spécialités, Infectiologie, HFR-Fribourg, Fribourg, Switzerland
| | - Maria Aigner
- Institute for Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michela Paolucci
- Unit of Clinical Microbiology, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Basel, Basel, Switzerland
| | - Eléna Charpentier
- Department of Parasitology and Mycology, Toulouse University Hospital, Paul Sabatier University, Toulouse, France
| | - Christine Bonnal
- Parasitology Mycology Laboratory, Bichat Claude Bernard Universitary Hospital, Paris, France
| | - Sophie Brun
- Parasitology-Mycology Department, Avicenne University Hospital, AP-HP, Bobigny, France
| | - Frederic Gabriel
- CHU Bordeaux, Department of Parasitology and Mycology, Bordeaux, France
| | - Arnaud Riat
- Service of Laboratory Medicine, Department of Diagnostic, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - Reinhard Zbinden
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Patrice Le Pape
- Parasitology and Medical Mycology Laboratory, Nantes University Hospital, Nantes, France
| | - Nikolai Klimko
- Mechnikov North-Western State Medical University, St Petersburg, Russian Federation, St Petersburg, Russia
| | - Russel E Lewis
- Infectious Diseases Unit, S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Malcolm Richardson
- Mycology Reference Centre-Manchester, ECMM Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Ahmet Cagkan İnkaya
- Department of Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alix T Coste
- Institute of Microbiology, Department of Laboratories, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre-Yves Bochud
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frederic Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Microbiology, Department of Laboratories, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
2
|
Seroy J, Antiporta P, Grim SA, Proia LA, Singh K, Clark NM. Aspergillus calidoustuscase series and review of the literature. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12755] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/17/2017] [Accepted: 05/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Justin Seroy
- Division of Infectious Diseases; Department of Internal Medicine; Loyola University Medical Center; Maywood IL USA
| | - Philip Antiporta
- Division of Infectious Diseases; Department of Internal Medicine; Loyola University Medical Center; Maywood IL USA
| | - Shellee A. Grim
- Division of Infectious Diseases; Department of Internal Medicine; Loyola University Medical Center; Maywood IL USA
- Department of Pharmacy Practice; University of Illinois at Chicago; Chicago IL USA
| | - Laurie A. Proia
- Division of Infectious Diseases; Department of Internal Medicine; Rush University Medical Center; Chicago IL USA
| | - Kamaljit Singh
- Department of Pathology; Rush University Medical Center; Chicago IL USA
| | - Nina M. Clark
- Division of Infectious Diseases; Department of Internal Medicine; Loyola University Medical Center; Maywood IL USA
| |
Collapse
|
3
|
Abstract
Primary cutaneous aspergillosis (PCA) is an uncommon infection of the skin. There is a paucity of organized literature regarding this entity in regard to patient characteristics, associated Aspergillus species, and treatment modalities on outcome (disease recurrence, disease dissemination, and mortality).We reviewed all published reports of PCA from 1967 to 2015. Cases were deemed eligible if they included the following: patient baseline characteristics (age, sex, underlying condition), evidence of proven or probable PCA, primary treatment strategy, and outcome.We identified 130 eligible cases reported from 1967 to 2015. The patients were predominantly male (63.8%) with a mean age of 30.4 ± 22.1 years. Rates of PCA recurrence, dissemination, and mortality were 10.8%, 18.5%, and 31.5%, respectively. In half of the cases, there was an association with a foreign body. Seven different Aspergillus species were reported to cause PCA. Systemic antifungal therapy without surgery was the most common form of therapy (60% of cases). Disease dissemination was more common in patients with underlying systemic conditions and occurred on average 41.4 days after PCA diagnosis (range of 3-120 days). In a multivariate linear regression model of mortality including only patients with immunosuppressive conditions, dissemination and human immunodeficiency virus/acquired immune deficiency syndrome were statistically significantly associated with increased mortality.Nearly one-third of patients with PCA die with the disease. Dissemination and host status are critical in patient outcome.
Collapse
Affiliation(s)
- Alexander M. Tatara
- Department of Bioengineering, Rice University
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Dimitrios P. Kontoyiannis
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX
- Correspondence: Dimitrios P. Kontoyiannis, Department of Infectious Diseases, Infection Control and Employee Health, Unit 1416, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 (e-mail: )
| |
Collapse
|
4
|
Venugopal TV, Venugopal PV. Primary cutaneous aspergillosis from Tamilnadu diagnosed by fine needle aspiration cytology. Med Mycol Case Rep 2012; 1:103-6. [PMID: 24371752 DOI: 10.1016/j.mmcr.2012.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 09/20/2012] [Accepted: 09/21/2012] [Indexed: 11/26/2022] Open
Abstract
Aspergillus are ubiquitous and more than 30 species have been reported to be involved in human infection. Most of the cases occur in immunocompromised patients and are disseminated in the blood. Primary cutaneous aspergillosis in immunocompetent hosts is rare. We report a unique case of primary cutaneous aspergillosis in an immunocompetent patient diagnosed by fine needle aspiration cytology. The characteristic ascocarp and ascospores of Aspergillus species were found in the aspirate and Aspergillus glaucus was isolated in pure culture. The case is presented to increase the awareness of the usefulness of fine needle aspiration cytology for diagnosing fungal infections.
Collapse
Affiliation(s)
- Taralakshmi V Venugopal
- Department of Pathology, Shri Sathya Sai Medical College and Research Institute, Tiruporur, Kanchipuram 603 110, India
| | | |
Collapse
|
5
|
Sato Y, Suzino K, Suzuki A, Fukasawa N, Ouchi Y, Yaguchi T, Sato T. [Case of primary cutaneous Aspergillus caldioustus infection caused by nerve block therapy]. Med Mycol J 2011; 52:239-44. [PMID: 21891986 DOI: 10.3314/mmj.52.239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a case of primary cutaneous Aspergillus caldioustus infection caused by nerve block therapy. A 67-year-old Japanese woman had been treated with oral predonisolon and tacrolimus for adult-onset Still disease and interstitial pneumonia. She presented with a 2-month-history of the lesions on the left back. A biopsy specimen from the skin lesion revealed granulomatous inflammation with hyphae. Culture of the pus and the skin specimen confirmed the diagnosis of cutaneous Aspergillus infection. The sequence of β- tubulin gene was analyzed to confirm the mycological diagnosis and the causative agent was identified as A. caldioustus. The patient was treated with surgical removal of the lesions and oral 200 mg/day itraconazole but she died of infectious interstitial pneumonia due to Pneumocystis jiroveci and Cytomegalovirus infection Percutaneous infection may have been responsible for the incidence of localized infection. There was no evidence of systemic aspergillosis. A. caldioustus is an emerging opportunistic fungal pathogen in immunocompromised patients. Immunocompromised patients who have persistent traumatic atypical skin lesion need to be ruled out of such rare fungus infection. An opportunistic infection in Immunocompromised patients can be life-threatening and prompt treatment based on accurate diagnosis is important.
Collapse
Affiliation(s)
- Yukie Sato
- Department of Dermatology, National Hospital Organization Tokyo Medical Center Meguro Tokyo, Japan
| | | | | | | | | | | | | |
Collapse
|
6
|
Abstract
Invasive fungal infections (IFIs) are associated with high morbidity and mortality in immunocompromised patients. Although Aspergillus spp. remain an important cause of IFI, other moulds such as Fusarium spp., dematiaceous fungi and Mucorales have become increasingly prevalent among this patient population. Diagnosis and treatment of invasive mould infections remain a challenge. Because of the poor prognosis associated with IFIs, understanding the activity, efficacy and limitations of the available drugs is critical to select the appropriate antifungal agent on an individualised basis.
Collapse
Affiliation(s)
- Marisa H Miceli
- Department of Internal Medicine, Oakwood Hospital and Medical Center, Dearborn, MI, USA
| | | |
Collapse
|
7
|
[Primary cutaneous aspergillosis in an immunocompetent farmworker]. Ann Dermatol Venereol 2010; 137:373-6. [PMID: 20470919 DOI: 10.1016/j.annder.2010.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 01/08/2010] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Aspergillosis is an uncommon fungal infection in which primary cutaneous sites are very rare. Most cases occur in immunodepressed patients and are disseminated in the blood. We report a case of primary cutaneous aspergillosis in a 37-year-old immunocompetent farmworker presenting as a kerion-like lesion. CASE REPORT A 37-year-old farmworker presented erythematous and nodular lesions of the face. These lesions were not associated with any general symptoms and failed to respond to antibiotic treatment. Histological examination of a skin biopsy sample showed a granulomatous reaction in the dermis associated with an extensive neutrophilic infiltrate. PAS staining revealed the presence of right-angled branched hyphae with conidia. Aspergillus fumigatus was isolated and identified in cultures. Clinical and biological examinations did not reveal any systemic localisation of aspergillosis, ruling out the hypothesis of blood dissemination. This primary cutaneous infection occurred in an immunocompetent patient, in whom laboratory tests ruled out any underlying immunosuppression. Systemic antifungal treatment with voriconazole led to complete resolution. DISCUSSION Reports in the literature of primary cutaneous aspergillosis in immunocompetent patients are extremely rare. Clinical lesions may comprise often painful weeping or necrotic macules or papules or subcutaneous nodules that can progress towards abscess or necrosis. The semiological similarity between these lesions and kerions can lead to misdiagnosed cases and delayed treatment.
Collapse
|
8
|
Kim CW, Seo JS, Kim MK, Jun EJ, Choi JC, Choi BW. Secondary cutaneous aspergillosis disseminated from the lungs of a patient with asthma on 1 month steroid treatment. Diagn Microbiol Infect Dis 2009; 66:104-7. [PMID: 19709841 DOI: 10.1016/j.diagmicrobio.2009.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 04/27/2009] [Accepted: 05/08/2009] [Indexed: 10/20/2022]
Abstract
Cutaneous aspergillosis is very rare and occurs predominantly in transplant patients. Here, we report a 55-year-old female who underwent steroid treatment for 1 month and developed secondary cutaneous aspergillosis from pulmonary aspergillosis due to Aspergillus fumigatus.
Collapse
Affiliation(s)
- Chan Woong Kim
- Department of Emergency Medicine, Chung-Ang University Yong-San Hospital, Seoul 140-757, South Korea
| | | | | | | | | | | |
Collapse
|
9
|
Cheung CY, Wu TC, Chan YH, Lee KC, Chan HW, Chau KF, Li CS. Coexisting Cutaneous Aspergillosis and Pulmonary Tuberculosis in a Renal Transplant Recipient. Int J Organ Transplant Med 2008. [DOI: 10.1016/s1561-5413(08)60025-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
10
|
Ozcan D, Güleç AT, Haberal M. Multiple subcutaneous nodules leading to the diagnosis of pulmonary aspergillosis in a renal transplant recipient. Clin Transplant 2008; 22:120-3. [PMID: 18217913 DOI: 10.1111/j.1399-0012.2007.00740.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aspergillosis is the second most frequent opportunistic fungal infection in solid organ transplant recipients; however, cutaneous aspergillosis occurs very rarely. Herein, we report a 34-yr-old male renal transplant recipient with secondary cutaneous aspergillosis due to Aspergillus fumigatus in whom cutaneous lesions led to the correct diagnosis. To the best of our knowledge, this is the first case of secondary cutaneous aspergillosis reported in the setting of a solid organ transplantation.
Collapse
Affiliation(s)
- Deren Ozcan
- Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey.
| | | | | |
Collapse
|
11
|
Saracli MA, Mutlu FM, Yildiran ST, Kurekci AE, Gonlum A, Uysal Y, Erdem U, Basustaoglu AC, Sutton DA. Clustering of invasiveAspergillus ustuseye infections in a tertiary care hospital: A molecular epidemiologic study of an uncommon species. Med Mycol 2007; 45:377-84. [PMID: 17510862 DOI: 10.1080/13693780701313803] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Aspergillus infections are being increasingly recognized as an important cause of morbidity and blindness. We report here the first cluster of Aspergillus ustus endophthalmitis cases which occurred in a large tertiary care hospital during the period October 2003 to June 2004. In three of the cases, the patients required enucleation following cataract surgery, while the fourth involved a fatal infection in a pediatric patient hospitalized for osteopetrosis. Patient charts from the four cases were reviewed retrospectively and indicated that postoperative signs of fungal endophthalmitis developed in the patients 1-11 weeks after surgery. The molecular characterization of the isolates and their epidemiological relatedness were evaluated by Random Amplification of Polymorphic DNA (RAPD). A source investigation of this mini outbreak was performed by environmental sampling, but no isolates of A. ustus were recovered from these studies. All A. ustus strains isolated from three patients with fungal endophthalmitis had the same RAPD pattern suggesting a common source. The strain from the pediatric patient differed from the ophthalmic isolates in five electrophoretic loci. The latter was included solely as an outbreak, unrelated control to evaluate the discriminatory power of the molecular typing method employed in the analysis of the ophthalmic strains. These cases illustrate the potential for uncommon species like A. ustus to cause high morbidity and mortality in some clinical settings. Aspergillus ustus endophthalmitis is a serious and devastating complication of ocular surgery. It is unknown whether ongoing hospital construction may have contributed to this cluster of cases. Random amplification of polymorphic DNA may give valuable clues about the clonality of A. ustus strains.
Collapse
Affiliation(s)
- M A Saracli
- Department of Microbiology, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
This is the first report of clustered Aspergillus ustus causing systemic disease in transplant patients. Aspergillus ustus is a mold that rarely infects humans; only 15 systemic cases have been reported. We report the first outbreak of invasive infection caused by A. ustus among hematopoietic stem cell transplant (HSCT) recipients. Six patients with infections were identified; 3 infections each occurred in both 2001 and 2003. Molecular typing by using randomly amplified polymorphic DNA (RAPD) and antifungal drug susceptibility testing were performed on clinical and environmental isolates recovered from our hospital from 1999 to 2003. The highest overall attack rate in HSCT patients was 1.6%. The overall death rate was 50%, and death occurred within 8 days after diagnostic culture collection. Clinical isolates exhibited decreased susceptibility to antifungal drugs, especially azoles. RAPD and phylogenetic analysis showed genetic similarity between isolates from different patients. Based on the clustering of cases in space and time and molecular data, common-source acquisition of this unusual drug-resistant species is possible.
Collapse
Affiliation(s)
- Anil A. Panackal
- Fred Hutchinson Cancer Research Center; Seattle, Washington, USA
- University of Washington Medical Center, Seattle, Washington, USA
| | - Alexander Imhof
- Fred Hutchinson Cancer Research Center; Seattle, Washington, USA
- University Hospital, Zürich, Zürich, Switzerland
| | - Edward W. Hanley
- Fred Hutchinson Cancer Research Center; Seattle, Washington, USA
| | - Kieren A. Marr
- Fred Hutchinson Cancer Research Center; Seattle, Washington, USA
- University of Washington Medical Center, Seattle, Washington, USA
| |
Collapse
|
13
|
Ajith C, Dogra S, Radotra BD, Chakrabarti A, Kumar B. Primary cutaneous aspergillosis in an immunocompetent individual. J Eur Acad Dermatol Venereol 2006; 20:738-9. [PMID: 16836509 DOI: 10.1111/j.1468-3083.2006.01465.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
14
|
Paterson DL. New clinical presentations of invasive aspergillosis in non-conventional hosts. Clin Microbiol Infect 2004; 10 Suppl 1:24-30. [PMID: 14748800 DOI: 10.1111/j.1470-9465.2004.00840.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Infections by Aspergillus spp. are most typically associated with invasive pulmonary aspergillosis. However, an increasing number of reports deal with unusual manifestations of invasive aspergillosis. In the lung this may take the form of chronic invasive pulmonary aspergillosis, bronchocentric granulomatosis or tracehobronchitis. A number of extrapulmonary infections have been noted, sometimes in immunocompetent individuals. Examples include vertebral osteomyelitis, primary cutaneous aspergillosis (such as in premature neonates), prosthetic vascular graft infection and infective endocarditis. Early recognition of these entities, prompt initiation of new, highly active antifungal therapies and adjunctive surgical management may improve the prognosis of these conditions.
Collapse
Affiliation(s)
- D L Paterson
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Suite 3A, Falk Medical Building, Pittsburgh, PA 15213, USA.
| |
Collapse
|
15
|
Meletiadis J, Mouton JW, Meis JFGM, Bouman BA, Verweij PE. Comparison of the Etest and the sensititre colorimetric methods with the NCCLS proposed standard for antifungal susceptibility testing of Aspergillus species. J Clin Microbiol 2002; 40:2876-85. [PMID: 12149345 PMCID: PMC120664 DOI: 10.1128/jcm.40.8.2876-2885.2002] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The susceptibilities of 25 clinical isolates of Aspergillus fumigatus, A. flavus, A. terreus, A. nidulans, and A. ustus to itraconazole and amphotericin B were determined by an agar diffusion-dilution method (the Etest method) and a colorimetric broth microdilution method (the Sensititre method); and the results were compared with those obtained by the NCCLS proposed standard M-38P method for antifungal susceptibility testing of filamentous fungi. Various MIC endpoints for the three methods were determined visually by four different observers in three blinded experiments, and the reproducibilities among the observers (interobserver agreement) and among the replicates (interexperimental agreement) as well as the levels of agreement between the NCCLS, the Etest, and the Sensititre methods were calculated. High levels of reproducibility (within 1 twofold dilution) were found for the NCCLS method (>95%) with the MIC-0 endpoint (complete inhibition of growth) for both drugs and with the MIC-1 endpoint (slight growth) for itraconazole and for the Sensititre method (>90%) with all MIC endpoints, although for the latter the interexperimental agreement for itraconazole was comparatively lower (83 to 93%). The Etest method was less reproducible (67 to 87%) for both drugs. Using the recommended MIC endpoints, high levels of agreement (within one twofold dilution) between the NCCLS and the Sensititre methods for all species were found for amphotericin B (>77%) but not for itraconazole (<66%), for which the MICs by the Sensititre method were up to 3 twofold dilutions lower than the corresponding MICs by the NCCLS method. The use of the first blue well as an endpoint for the Sensititre method and 48 h of incubation improved the levels of agreement with the NCCLS method. Low levels of agreement between the NCCLS and the Etest methods using the recommended MIC endpoints were found for most species, especially after 48 h of incubation (<50%), when the MICs obtained by the Etest method were up to 9 twofold dilutions higher than the corresponding MICs obtained by the NCCLS method. Relatively better agreement was found after 24 h, although it was species dependent, with the highest levels of agreement (>82%) found for A. terreus and A. ustus for amphotericin B and A. fumigatus for both drugs. Overall, better agreement was found when MIC-0 was used as the MIC endpoint for the NCCLS method for both drugs and when the MICs by the Etest method were determined after 48 h of incubation for itraconazole and after 24 h of incubation for amphotericin B.
Collapse
Affiliation(s)
- Joseph Meletiadis
- Department of Medical Microbiology, University Medical Center Nijmegen, The Netherlands
| | | | | | | | | |
Collapse
|
16
|
Khatri ML, Stefanato CM, Benghazeil M, Shafi M, Kubba A, Bhawan J. Cutaneous and paranasal aspergillosis in an immunocompetent patient. Int J Dermatol 2000; 39:853-6. [PMID: 11123449 DOI: 10.1046/j.1365-4362.2000.00095-3.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 26-year-old Libyan woman presented with asymptomatic nodulo-ulcerative skin lesions present for 1 year. Three years prior to presentation, she had experienced a nasal discharge followed by the development of a nodule in the nasal cavity and a plaque on the hard palate. These lesions had gradually increased in size and ulcerated, resulting in perforation of the nasal septum and palate. Two years later, the patient noticed the appearance of skin lesions: a nodule on the right thumb and numerous nodulo-ulcerative lesions on the extremities. General physical examination was normal with no significant lymphadenopathy. Examination of the oral cavity revealed perforation of the distal nasal septum, with a perforated nodular plaque involving the entire palate, associated with subluxation of the upper incisors (Fig. 1a). On skin examination, multiple firm nodules and nodulo-ulcerative lesions with a central eschar and raised margins were observed. The lesions ranged in size from 0.5 to 5 cm and were distributed on the right hand and fingers, left upper arm (Fig. 1b), left calf, and right thigh. Routine laboratory investigations (liver function tests, serum calcium, electrolytes, lipid profile, urine and stool culture studies) were normal. Immunoelectrophoresis disclosed normal levels of immunoglobulins IgG, IgA, and IgM. Serologic studies for human immunodeficiency virus (HIV) and syphilis, and a tuberculin test, were all negative. A Giemsa-stained tissue smear was negative for Leishmania tropica organisms. Radiological studies disclosed a slight haziness of the maxillary sinuses with perforation of the nasal septum. A chest X-ray was normal. Histopathologic examination of biopsies taken from both the palate and from ulcerated and nonulcerated skin lesions was performed, and all showed similar findings. The biopsy of a nonulcerated skin lesion showed pseudoepitheliomatous epidermal hyperplasia with neutrophilic microabscesses (Fig. 2a). A dermal diffuse and nodular granulomatous mixed infiltrate of lymphocytes, histiocytes, giant cells, numerous eosinophils, and neutrophilic microabscesses was seen in all tissues examined. Septate hyphae were present both within giant cells and free in the dermis (Fig. 2b). The hyphae were branching at a 45 degrees angle and were positive on periodic acid-Schiff and Grocott methenamine silver stains (Fig. 2c). Fungal culture studies of material taken from an ulcerated skin lesion grew Aspergillus flavus. Blood cultures were negative for Aspergillus sp. or other microorganisms. The patient was treated with intravenous amphotericin B, but the medication was discontinued due to her intolerance to the drug. She was subsequently lost to follow-up.
Collapse
Affiliation(s)
- M L Khatri
- Department of Dermatology, Faculty of Medicine, Al-Fateh University of Medical Sciences, Tripoli, Libya
| | | | | | | | | | | |
Collapse
|
17
|
Verweij PE, van den Bergh MF, Rath PM, de Pauw BE, Voss A, Meis JF. Invasive aspergillosis caused by Aspergillus ustus: case report and review. J Clin Microbiol 1999; 37:1606-9. [PMID: 10203536 PMCID: PMC84848 DOI: 10.1128/jcm.37.5.1606-1609.1999] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A case of invasive pulmonary aspergillosis in an allogeneic bone marrow transplant recipient caused by Aspergillus ustus is presented. A. ustus was also recovered from the hospital environment, which may indicate that the infection was nosocomially acquired. A literature review revealed seven cases of invasive infections caused by A. ustus, and three of these were primarily cutaneous infections. In vitro susceptibility testing of 12 A. ustus isolates showed that amphotericin B and terbinafine had fungicidal activity and that itraconazole and voriconazole had fungistatic activity.
Collapse
Affiliation(s)
- P E Verweij
- Departments of Medical Microbiology, University Hospital Nijmegen, Nijmegen, The Netherlands.
| | | | | | | | | | | |
Collapse
|