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Pajer HB, Asher AM, Gelinne A, Northam W, van Duin D, Quinsey CS. Impact of Surgical and Medical Treatment on Survival of Patients with Cerebral Aspergillosis: Systematic Review of the Literature. World Neurosurg 2021; 149:244-248.e13. [PMID: 33482411 DOI: 10.1016/j.wneu.2021.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Cerebral aspergillosis carries a high mortality. Rapid diagnosis and treatment can increase survival, but symptoms and imaging findings are nonspecific. The literature on cerebral aspergillosis consists mostly of case reports and case series and lacks large-scale review of data. METHODS We performed a review of the literature using PubMed in March 2019. We recorded the year of publication, age and sex of patients, neurosurgical involvement, the antifungals administered, use of intrathecal antifungals, and the outcome of patients. The relationships among variables were tested using bivariant statics and linear regression. RESULTS A total of 324 studies met the eligibility criteria, and 198 studies including 248 patients were included. Surgical resection (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.25-0.80; P < 0.01) and administration of voriconazole (OR, 0.32; 95% CI, 0.18-0.55; P < 0.001) or itraconazole (OR, 0.36; 95% CI, 0.16-0.72; P < 0.001) were shown to be significantly associated with survival. CONCLUSIONS Given the significant survival benefits for patients who received voriconazole and surgical intervention, we suggest early antifungal medical treatment and resection.
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Affiliation(s)
- Hengameh B Pajer
- Campbell University School of Osteopathic Medicine, Buis Creek, North Carolina, USA
| | - Anthony M Asher
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Aaron Gelinne
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Weston Northam
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David van Duin
- Department of Infectious Disease, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Carolyn S Quinsey
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA.
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2
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Burton L, Baumgart K, Novakovic D, Beattie J, Joffe D, Falk G, Van der Wall H. Fungal Pneumonia in The Immunocompetent Host: A Possible Statistical Connection Between Allergic Fungal Sinusitis with Polyposis and Recurrent Pulmonary Infection Detected by Gastroesophageal Reflux Disease Scintigraphy. Mol Imaging Radionucl Ther 2020; 29:72-78. [PMID: 32368878 PMCID: PMC7201431 DOI: 10.4274/mirt.galenos.2020.32154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: Fungal pneumonia in the immune competent host is a rarity with few reported cases in the literature. We present a series of 7 cases of recurrent fungal pneumonia in association with allergic fungal rhinosinusitis and gastroesophageal reflux disease (GERD). We hypothesised that recurrent infection may have been transported from the infected paranasal sinuses into the lung by GERD as the process was terminated by surgical fundoplication in 2 of these patients. Methods: Patients were recruited into the study if they were immune competent and had recurrent fungal pneumonia and GERD. Allergic fungal rhinosinusitis was proven by biopsy. GERD was investigated by a scintigraphic test that assessed local oesophageal disease, lung aspiration and head and neck involvement with a hybrid gamma camera and X-ray computed tomography. Results: All patients were shown to have GERD with 5/7 showing paranasal sinus contamination and 7/7 showing laryngopharyngeal involvement and 6/7 lung aspiration. One patient had characteristics strongly predictive of aspiration. Fundoplication led to cessation of fungal lung infection in two patients. Conclusion: Recurrent fungal pneumonia in the immune competent host should raise the possibility of re-infection from the paranasal sinuses, especially in patients with GERD.
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Affiliation(s)
- Leticia Burton
- University of Notre Dame, CNI Molecular Imaging, Sydney, Australia
| | | | | | | | - David Joffe
- Royal North Shore Hospital, Sydney, Australia
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3
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El Hasbani G, Chirayil J, Nithisoontorn S, Antezana AA, El Husseini I, Landaeta M, Saeed Y, Assaker R. Cerebral aspergillosis presenting as a space occupying lesion in an immunocompetent individual. Med Mycol Case Rep 2019; 25:45-48. [PMID: 31453078 PMCID: PMC6700407 DOI: 10.1016/j.mmcr.2019.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/06/2019] [Accepted: 07/31/2019] [Indexed: 11/11/2022] Open
Abstract
Cerebral aspergillosis has the tendency to occur in immunocompromised patients. Less commonly, immunocompetent individuals can be affected, with neuroimaging findings being difficult to interpret. The diagnosis necessitates imaging of the brain as well as the sinuses with biopsy and pathological confirmation. A surgical excision with aggressive antifungal agents are required for a proper management. This case report describes an immunocompetent patient with cerebral aspergillosis that presented radiologically as a suspicious mass to be diagnosed pathologically and excised surgically.
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Affiliation(s)
| | - Joseph Chirayil
- Lincoln Medical and Mental Health Center, Bronx, New York, USA
| | | | | | | | - Maria Landaeta
- Lincoln Medical and Mental Health Center, Bronx, New York, USA
| | - Yasir Saeed
- Lincoln Medical and Mental Health Center, Bronx, New York, USA
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4
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Kumar D, Nepal P, Singh S, Ramanathan S, Khanna M, Sheoran R, Bansal SK, Patil S. CNS aspergilloma mimicking tumors: Review of CNS aspergillus infection imaging characteristics in the immunocompetent population. J Neuroradiol 2018; 45:169-176. [DOI: 10.1016/j.neurad.2017.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 09/24/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
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5
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Dufour X, Kauffmann-Lacroix C, Roblot F, Goujon JM, Breux JP, Ferrie JC, Michel Klossek J. Chronic Invasive Fungal Rhinosinusitis: Two New Cases and Review of the Literature. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240401800406] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Chronic invasive fungal rhinosinusitis is rare in the immunocompetent patient. Few cases have been published except for in a specific geographic area (Sudan, India). Methods and Results We reported two new cases of chronic invasive fungal rhinosinusitis due to Aspergillus, which was successfully treated, to analyze the different clinical, radiological, and mycological criteria. Conclusion Through these two new clinical cases and the analysis of the literature, we suggested, in the absence of general agreement on the surgical and medical management, the current strategies available for this rare pathology. New antifungal drugs seem to be an efficient alternative to classic antifungal agents, especially those that require an extended course of oral therapy for the chronic invasive form.
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Affiliation(s)
- Xavier Dufour
- Departments of Ear, Nose, and Throat and Maxillofacial Surgery France
| | | | - France Roblot
- Departments of Infectious Diseases Poitiers Cedex, France
| | | | | | - Jean Claude Ferrie
- Departments of Radiology, C. H. University Poitiers, Poitiers Cedex, France
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6
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Serious fungal infections in Pakistan. Eur J Clin Microbiol Infect Dis 2017; 36:949-956. [PMID: 28161741 DOI: 10.1007/s10096-017-2919-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 11/25/2022]
Abstract
The true burden of fungal infection in Pakistan is unknown. High-risk populations for fungal infections [tuberculosis (TB), diabetes, chronic respiratory diseases, asthma, cancer, transplant and human immunodeficiency virus (HIV) infection] are numerous. Here, we estimate the burden of fungal infections to highlight their public health significance. Whole and at-risk population estimates were obtained from the WHO (TB), BREATHE study (COPD), UNAIDS (HIV), GLOBOCAN (cancer) and Heartfile (diabetes). Published data from Pakistan reporting fungal infections rates in general and specific populations were reviewed and used when applicable. Estimates were made for the whole population or specific populations at risk, as previously described in the LIFE methodology. Of the 184,500,000 people in Pakistan, an estimated 3,280,549 (1.78%) are affected by a serious fungal infection, omitting all cutaneous infection, oral candidiasis and allergic fungal sinusitis, which we could not estimate. Compared with other countries, the rates of candidaemia (21/100,000) and mucormycosis (14/100,000) are estimated to be very high, and are based on data from India. Chronic pulmonary aspergillosis rates are estimated to be high (39/100,000) because of the high TB burden. Invasive aspergillosis was estimated to be around 5.9/100,000. Fungal keratitis is also problematic in Pakistan, with an estimated rate of 44/100,000. Pakistan probably has a high rate of certain life- or sight-threatening fungal infections.
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7
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Ghanaat F, Tayek JA. Weight loss and diabetes are new risk factors for the development of invasive aspergillosis infection in non-immunocompromized humans. CLINICAL PRACTICE (LONDON, ENGLAND) 2017; 14:296-301. [PMID: 29670744 PMCID: PMC5901980 DOI: 10.4172/clinical-practice.1000125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Well-established risk factors for aspergillosis include HIV, cancer, recent corticosteroid (prednisone) therapy, chemotherapy, or thoracic surgery. Non-established risk factors may include weight loss and a history of diabetes. Twenty-three patients without the classical risk factors for IA were identified retrospectively at Harbor UCLA Medical Center by discharge diagnosis over a 20 year period (1992-2012). None of the well-known risk factors are for Invasive Apergillious (IA). A history of weight loss was seen in 66% of the patients with IA (15 of 23). The weight loss ranged from 3.3 lbs to 43 lbs. In patients with weight loss the average loss was 22±3 lbs (mean±SEM). In this small group of patients with IA, diabetes was seen in 8 of the 23 (34%), which is significantly higher than the 19% incidence of diabetes seen in 100 patients with severe sepsis (p<0.05). Likewise, the 34% incidence of diabetes was higher than the 21% incidence reported in immunocompromised patients with invasive aspergillus (IA) infection (p<0.05). A reduced serum albumin concentration was seen in 33% of the study patients, which was less common than the 87% incidence seen in patients with severe sepsis or candidaemia (54%). Seventeen of the 23 patients had pulmonary involvement. While no one had a well-established risk factor for aspergillious, four patients had alcoholism as a potential risk factor. Eleven of the 23 (48%) died during the hospital stay despite antifungal therapy. Immunocompromised patients are known to have a mortality rate of approximately 45% for pulmonary or disseminated disease. CONCLUSION The incidence of diabetes was greater than seen in immunocompromised patients and may be considered an additional risk factor for the development of aspergillois infection. In addition, a history of weight loss should increase the suspicion for the diagnosis of IA in otherwise a non-immunocompromised patient. Early recognition and treatment of aspergillosis in the non-immunocompromised patient may improve outcome. Weight loss and diabetes should be added to the list of well-known risk factors for invasive aspergillosis and its high mortality rate.
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Affiliation(s)
- Farhad Ghanaat
- Department of Internal Medicine, Los Angeles BioMedical Research
Institute (LaBioMed), Harbor-UCLA Medical Center, David Geffen School of
Medicine at UCLA, USA
| | - John A Tayek
- Department of Internal Medicine, Los Angeles BioMedical Research
Institute (LaBioMed), Harbor-UCLA Medical Center, David Geffen School of
Medicine at UCLA, USA
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8
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Shah SR, Keshri A, Patadia S, Marak RSK, Behari S. Invasive Aspergillosis of Anterior Skull Base in the Immunocompetent Host: Outcomes with a Combined Treatment Modality-An Institutional Experience. J Neurol Surg B Skull Base 2016; 78:89-95. [PMID: 28180049 DOI: 10.1055/s-0036-1585089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022] Open
Abstract
Objectives To study outcomes with voriconazole therapy in immunocompetent individuals following maximal safe endoscopic resection in invasive aspergillosis of the anterior skull base. Design Retrospective study of patients with chronic invasive aspergillosis including symptomatology, extent of disease, and response to voriconazole following maximal safe resection in immunocompetent individuals. Setting Tertiary care superspeciality referral center. Participants Ten consecutive patients of invasive aspergillosis of anterior skull base managed over a period of 2 years. Main Outcome Measures Symptom resolution with systemic voriconazole and radiologic evaluation following systemic antifungals as per predefined protocol. Conclusions Maximal safe resection via transnasal endoscopic route followed by systemic antifungals provides excellent outcomes in invasive skull base aspergillosis. Although liver and renal functions, besides visual acuity, need serial monitoring, voriconazole is well tolerated by our patients.
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Affiliation(s)
- Saurin R Shah
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amit Keshri
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Simple Patadia
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rungmei S K Marak
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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9
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Abstract
Invasive aspergillosis, an infection most frequently induced by Aspergillus fumigatus and Aspergillus flavus, typically occurs in immunocompromised patients and is usually transmitted through inhalation of Aspergillus spores. As the lungs are by far the most common site involved in invasive aspergillosis and invasive aspergillosis in immunocompetent hosts is very rare, there have been a few case reports of extra-pulmonary, disseminated invasive aspergillosis in immunocompetent persons. Herein, we report a case of an adult, male, immunocompetent patient with disseminated invasive aspergillosis that successively spread from the right adrenal gland to the left hepatic lobe. The patient was successfully treated through surgical excisions of his adrenal and hepatic masses followed by voriconazole therapy. To our knowledge, this is the first case report of invasive aspergillosis affecting the adrenal glands.
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Affiliation(s)
- Liyu Chen
- From the Center for Infectious Diseases, West China Hospital, Sichuan University , Chengdu , China
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10
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Chen L, Liu Y, Wang W, Liu K. WITHDRAWN: Adrenal and hepatic aspergillosis in an immunocompetent patient: A case report. IDCases 2014. [DOI: 10.1016/j.idcr.2014.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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11
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Gabrielli E, Fothergill AW, Brescini L, Sutton DA, Marchionni E, Orsetti E, Staffolani S, Castelli P, Gesuita R, Barchiesi F. Osteomyelitis caused by Aspergillus species: a review of 310 reported cases. Clin Microbiol Infect 2013; 20:559-65. [PMID: 24303995 DOI: 10.1111/1469-0691.12389] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 08/31/2013] [Accepted: 08/31/2013] [Indexed: 11/30/2022]
Abstract
Aspergillus osteomyelitis is a rare infection. We reviewed 310 individual cases reported in the literature from 1936 to 2013. The median age of patients was 43 years (range, 0-86 years), and 59% were males. Comorbidities associated with this infection included chronic granulomatous disease (19%), haematological malignancies (11%), transplantation (11%), diabetes (6%), pulmonary disease (4%), steroid therapy (4%), and human immunodeficiency virus infection (4%). Sites of infection included the spine (49%), base of the skull, paranasal sinuses and jaw (18%), ribs (9%), long bones (9%), sternum (5%), and chest wall (4%). The most common infecting species were Aspergillus fumigatus (55%), Aspergillus flavus (12%), and Aspergillus nidulans (7%). Sixty-two per cent of the individual cases were treated with a combination of an antifungal regimen and surgery. Amphotericin B was the antifungal drug most commonly used, followed by itraconazole and voriconazole. Several combination or sequential therapies were also used experimentally. The overall crude mortality rate was 25%.
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Affiliation(s)
- E Gabrielli
- Clinica Malattie Infettive, Università Politecnica delle Marche, Ancona, Italy
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12
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Vohra S, Taylor R, Aronowitz P. The tell-tale heart: Aspergillus fumigatus endocarditis in an immunocompetent patient. Hosp Pract (1995) 2013; 41:117-121. [PMID: 23466974 DOI: 10.3810/hp.2013.02.1017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Aspergillus is a saprophytic, spore-forming fungus that is ubiquitous in our daily environment. Inhalation of the airborne conidia leads to a variety of diseases, from asymptomatic colonization to disseminated disease. Immunocompromised patients are usually viewed as the population most susceptible to aspergillosis because of their lack of host immune defenses. However, a healthy immune system does not preclude an individual from susceptibility to aspergillosis. Our case illustrates an immunocompetent patient with disseminated aspergillosis involving the tricuspid valve. A high degree of suspicion is imperative in patients who present without the classic risk factors. Recognition of disseminated aspergillosis in such patients is necessary to promote early diagnosis, treatment, and improved outcomes in an otherwise fulminant, life-threatening infection.
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Affiliation(s)
- Sheba Vohra
- Department of Hospital-Based Specialists, Kaiser Permanente, Santa Rosa, CA, USA.
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13
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Abstract
Invasive aspergillosis has been classically associated with certain risk factors: cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation, AIDS. However, the literature is growing that this mycosis, particularly pulmonary aspergillosis, can be seen in patients lacking these factors. Many of the latter patients are in the intensive care unit. Other associated conditions include influenza, nonfungal pneumonia, chronic obstructive lung disease, immaturity, sepsis, liver failure, alcoholism, chronic granulomatous disease and surgery. Certain focal sites, such as sinusitis or cerebral aspergillosis, have additional risk factors. This emphasizes the potential importance of a positive culture for Aspergillus in the critically ill, the need for awareness about possible aspergillosis in patients lacking the classical risk factors, and readiness to proceed with appropriate diagnostic maneuvers.
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Affiliation(s)
- David A Stevens
- Department of Medicine, Santa Clara Valley Medical Center, 751 So. Bascom Ave., San Jose, CA 95128-2699, USA.
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14
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Pelaez T, Munoz P, Guinea J, Valerio M, Giannella M, Klaassen CHW, Bouza E. Outbreak of Invasive Aspergillosis After Major Heart Surgery Caused by Spores in the Air of the Intensive Care Unit. Clin Infect Dis 2012; 54:e24-31. [DOI: 10.1093/cid/cir771] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Abstract
SummaryWe present a case of disseminated invasive aspergillosis in a young male adult with progressive complex gastrointestinal, non-specific peripheral neural and respiratory symptoms and subsequent acute haemorrhagic conjunctivitis and generalized dermatitis.The case emphasizes the difficulty in diagnosing systemic mycosis and a high index of suspicion is recommended particularly in patients on prolonged antibiotics and systemic steroids.
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Affiliation(s)
- A Aleksenko
- Department of Pathology, University of Ghana Medical School, P. O. Box 4236, Accra, Ghana
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16
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Studemeister A, Stevens DA. Aspergillus Vertebral Osteomyelitis in Immunocompetent Hosts: Role of Triazole Antifungal Therapy. Clin Infect Dis 2011; 52:e1-6. [DOI: 10.1093/cid/ciq039] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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17
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Rüchel R. Chronisch nekrotisierende pulmonale Aspergillose (CNPA). Mycoses 2010; 53 Suppl 1:3-4. [DOI: 10.1111/j.1439-0507.2009.01842.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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A case of invasive paranasal aspergillosis that developed from a non-invasive form during 5-year follow-up. Auris Nasus Larynx 2010; 37:250-4. [DOI: 10.1016/j.anl.2009.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 05/19/2009] [Accepted: 06/08/2009] [Indexed: 11/21/2022]
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Vanhee LME, Symoens F, Jacobsen MD, Nelis HJ, Coenye T. Comparison of multiple typing methods for Aspergillus fumigatus. Clin Microbiol Infect 2009; 15:643-50. [PMID: 19548925 DOI: 10.1111/j.1469-0691.2009.02844.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
As part of studies on the spread of infections, risk factors and prevention, several typing methods were developed to investigate the epidemiology of Aspergillus fumigatus. In the present study, 52 clinical isolates of A. fumigatus from 12 airway specimens from patients with invasive aspergillosis (hospitalized in three different centres) were characterized by short tandem repeat (STR) typing and multilocus sequence typing (MLST). These isolates were previously typed by random amplified polymorphic DNA (RAPD), sequence-specific DNA polymorphism (SSDP), microsatellite polymorphism (MSP) and multilocus enzyme electrophoresis (MLEE). STR typing identified 30 genotypes and, for most patients, all isolates were grouped in one cluster of the unweighted pair group method with arithmetic mean dendrogram. Using MLST, 16 genotypes were identified among 50 isolates, while two isolates appeared untypeable. RAPD, MSP, SSDP and MLEE allowed identification of eight, 14, nine and eight genotypes, respectively. Combining the results of these methods led to the delineation of 25 genotypes and a similar clustering pattern as with STR typing. In general, STR typing led to similar results to the previous combination of RAPD, SSDP, MSP and MLEE, but had a higher resolution, whereas MLST was less discriminatory and resulted in a totally different clustering pattern. Therefore, this study suggests the use of STR typing for research concerning the local epidemiology of A. fumigatus, which requires a high discriminatory power.
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Affiliation(s)
- L M E Vanhee
- Laboratory of Pharmaceutical Microbiology, Ghent University, Harelbekestraat, Ghent, Belgium
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20
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Karapinar B, Yilmaz D, Asar G, Vardar F. Disseminated invasive vertebral aspergillosis in an immunocompetent girl with a 7 year latent period. Pediatr Int 2007; 49:516-8. [PMID: 17587279 DOI: 10.1111/j.1442-200x.2007.02412.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bülent Karapinar
- Department of Pediatrics, Ege University Faculty of Medicine, Izmir, Turkey
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21
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Mylona S, Tzavara V, Ntai S, Pomoni M, Thanos L. Chronic invasive sinus aspergillosis in an immunocompetent patient: a case report. Dentomaxillofac Radiol 2007; 36:102-4. [PMID: 17403888 DOI: 10.1259/dmfr/75735786] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report the case of an immunocompetent, 39 year old male who presented with diplopia and diffuse headache. The CT scan demonstrated the presence of a sizeable mass that took over the nasal cavity, the right maxillary sinus, the sphenoid and ethmoid sinus, extending to the sellar and suprasellar region, and eroding the adjacent bones. The patient also underwent MRI and endoscopic sinus surgery. Biopsy of the suspected tissue for pathology and culture demonstrated Aspergillus fumigatus.
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Affiliation(s)
- S Mylona
- Korgialenio Benakio Red Cross Hospital of Athens, Department of Radiology, Athanasaki 1 St., 11526 Athens, Greece
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23
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Song MJ, Lee DG, Seo SM, Kim WC, Bin HG, Woo HY, Jun YJ, Cho SG, Son BC, Lee HK. A Case of Fatal Multiple Cerebral Aspergillosis in a Patient with Acute Promyelocytic Leukemia during Complete Remission. THE KOREAN JOURNAL OF HEMATOLOGY 2005. [DOI: 10.5045/kjh.2005.40.3.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Myoung Joon Song
- Division of Infection, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Division of Infection, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suk Min Seo
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Chul Kim
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hong Gern Bin
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Young Woo
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon Joo Jun
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Goo Cho
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung Cheol Son
- Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae Kyung Lee
- Department of Clinical Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Mousavi SAA, Robson GD. Oxidative and amphotericin B-mediated cell death in the opportunistic pathogen Aspergillus fumigatus is associated with an apoptotic-like phenotype. MICROBIOLOGY-SGM 2004; 150:1937-1945. [PMID: 15184579 DOI: 10.1099/mic.0.26830-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
When protoplasts of the opportunistic fungal pathogen Aspergillus fumigatus were treated with low but toxic levels of hydrogen peroxide (0.1 mM) or amphotericin B (0.5 microg ml(-1)), loss of cell viability and death were associated with a number of phenotypic changes characteristic of apoptosis. The percentage of protoplasts staining positive with annexin V-FITC, an indicator of the externalization of phosphatidylserine and an early marker of apoptosis, rose to approximately 55 % within 1 h. This was followed by a similar increase in apoptotic DNA fragmentation detected by the TUNEL assay, and led to a loss of cell permeability and death in approximately 90 % of protoplasts, as indicated by the uptake of propidium iodide. The development of an apoptotic phenotype was blocked when protoplasts were pre-treated with the protein synthesis inhibitor cycloheximide, indicating active participation of the cell in the process. However, no significant activity against synthetic caspase substrates was detected, and the inclusion of the cell-permeant broad-spectrum caspase inhibitor Z-VAD-fmk did not block the development of the apoptotic-like phenotype. Higher concentrations of H(2)O(2) (1.8 mM) and amphotericin B (1 microg ml(-1)) caused protoplasts to die without inducing an apoptotic phenotype. As predicted, the fungistatic antifungal agent itraconazole, which inhibits growth without causing immediate cell death, did not induce an apoptotic-like phenotype.
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Affiliation(s)
- S Amin A Mousavi
- School of Biological Sciences, 1.800 Stopford Building, University of Manchester, Manchester M13 9PT, UK
| | - Geoffrey D Robson
- School of Biological Sciences, 1.800 Stopford Building, University of Manchester, Manchester M13 9PT, UK
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Lutz BD, Jin J, Rinaldi MG, Wickes BL, Huycke MM. Outbreak of invasive Aspergillus infection in surgical patients, associated with a contaminated air-handling system. Clin Infect Dis 2003; 37:786-93. [PMID: 12955639 DOI: 10.1086/377537] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2003] [Accepted: 05/14/2003] [Indexed: 11/03/2022] Open
Abstract
An outbreak of Aspergillus infection at a tertiary care hospital was identified among inpatients who had amputation wounds, peritonitis, allograft nephritis, or mediastinitis. During a 2-year period, 6 patients were identified, all of whom had Aspergillus species recovered from samples from normally sterile sites. All cases clustered in the operating theater during a single 12-day period. To assess operating theater air quality, particle counts were measured as surrogate markers for Aspergillus conidia. A substantial increase in the proportion of airborne particles > or =3 microm in size (range, 3-fold to 1000-fold) was observed in many operating rooms. A confined space video camera identified moisture and contamination of insulating material in ductwork and variable airflow volume units downstream of final filters. No additional invasive Aspergillus wound infections were identified after the operating theater air-handling systems were remediated, suggesting that this unusual outbreak was due to the deterioration of insulating material in variable airflow volume units.
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Affiliation(s)
- Brock D Lutz
- The Muchmore Laboratories for Infectious Diseases Research, Department of Veterans Affairs Medical Center, San Antonio, Texas, USA
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26
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Watanabe A, Kamei K, Sekine T, Waku M, Nishimura K, Miyaji M, Kuriyama T. Immunosuppressive substances in Aspergillus fumigatus culture filtrate. J Infect Chemother 2003; 9:114-21. [PMID: 12825108 DOI: 10.1007/s10156-002-0227-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Invasive aspergillosis has become a serious problem in clinical practice, but the actual factor that confers virulence on the fungus has not been thoroughly elucidated. To identify and isolate the immunosuppressive substances produced by the fungus, the bioactivity of culture filtrates was assessed, and analyses of the culture filtrates were carried out. Culture filtrates from different strains of Aspergillus fumigatus were assessed for their effect on human polymorphonuclear leukocytes and murine macrophages. To assess their activities in vivo, their effect on the survival of mice infected by the fungus was also studied. Subsequently, the composition of the culture filtrates was analyzed by gas chromatography-mass spectrometry. The analyses revealed that the culture filtrates contained gliotoxin at concentrations of 3 to 4 microgram/ml, and some other unidentified compounds. The bioactivities of the culture filtrates were similar to those of gliotoxin. The fungal culture filtrate reduced the survival of infected mice, but the filtrate itself did not cause the death of mice. However, all the bioactivities could not be accounted for by gliotoxin itself. These results indicate that gliotoxin in the culture filtrates may be responsible for part of the immunosuppressive activity, but some other components produced by A. fumigatus contribute, in an additive or synergistic manner, to the virulence of the fungus.
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Affiliation(s)
- Akira Watanabe
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan.
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27
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Stratov I, Korman TM, Johnson PDR. Management of Aspergillus osteomyelitis: report of failure of liposomal amphotericin B and response to voriconazole in an immunocompetent host and literature review. Eur J Clin Microbiol Infect Dis 2003; 22:277-83. [PMID: 12734721 DOI: 10.1007/s10096-003-0909-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Presented here is a case of Aspergillus osteomyelitis in an immunocompetent patient that progressed despite surgery and prolonged treatment with liposomal amphotericin B; the report is followed by a review of the literature. The review of this case and 41 similar cases found an overall cure rate of 69%. The importance of surgery when amphotericin B is used as first-line therapy is indicated by a 14% cure rate when amphotericin B is used alone compared to 75% when combined with surgery. When therapy is failing or surgery is contraindicated, dose escalation using a lipid formulation was not effective. On review, the addition of another agent, in particular 5-fluorocytosine, appears to be more beneficial. The patient reported here responded rapidly to voriconazole, a promising new antifungal agent for Aspergillus infections.
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Affiliation(s)
- I Stratov
- Department of Microbiology and Immunology, The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia.
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28
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de Lastours V, Lefort A, Zappa M, Dufour V, Belmatoug N, Fantin B. Two cases of cerebral aspergillosis successfully treated with voriconazole. Eur J Clin Microbiol Infect Dis 2003; 22:297-9. [PMID: 12740666 DOI: 10.1007/s10096-003-0934-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Described here are two cases of cerebral aspergillosis successfully treated with voriconazole after the failure of first-line treatment with amphotericin B deoxycholate. In both cases, clinical and radiological cure was achieved within 6 weeks. Voriconazole should be considered as first-line therapy for cerebral aspergillosis.
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Affiliation(s)
- V de Lastours
- Service de Médecine Interne, Hópital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
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29
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Garcés Jarque JM, Terradas Robledo R, Alvarez-Lerma F, Grau Cerrato S, Salvadó Costa M, Torres-Rodríguez JM. Aspergilosis pulmonar. Papel de los corticoides como factor de riesgo asociado en el bronquítico crónico. Rev Clin Esp 2003; 203:472-4. [PMID: 14563238 DOI: 10.1016/s0014-2565(03)71330-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BASIS Description of a situation of incidence increase of bronchial secretions with positive cultures for Aspergillus fumigatus, and analysis of the related risk factors in the invasive aspergillosis. METHODS Between January 1999 and February 2000, a prospective study of the patients was conducted with culture of bronchial secretions and with positive result for A. fumigatus. VARIABLES STUDIED age, sex, primary diagnosis, type of cultivated sample, clinical interpretation (colonization/infection), probable source (community/nosocomial), situation of the patient after discharge, and risk factors for opportunistic infection. The results were compared among the colonized and infected patients. RESULTS Fifty-two patients showed positive cultures of bronchial secretions to A. fumigatus, 43 (82.6%) colonized and 9 (17.3%) infected. Cultivated sputum sample on 30 occasions (57.6%) and bronchial aspiration in 22 (42.3%). Median age: 70 years (31-84). Sex: 40 men (76.9%). Probable source of infection/colonization: nosocomial in 18 cases (34.6%), community in 3 (5.7%) and unknown in 31 (59.6%). Mortality: 15 patient colonized (34.8%) and 8 infected (88.8%). Risk factors with statistical significance for invasive infection by A. fumigatus: diagnosis of chronic bronchopathy (COPD) (p=0.007) and treatment with prednisone in dose higher than 60 mg/day (p=0.0005). CONCLUSIONS The patients with positive culture of bronchial secretions to A. fumigatus with COPD and treatment with prednisone in dose higher than 60 mg/day should be considered with a greater risk for infection by this pathogen. A more restricted use and adequate of the corticoids in these patients, and an early diagnosis and treatment in light of the suspicion of infection by A. fumigatus in patients with COPD, it could imply a reduction of morbidity and mortality.
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Affiliation(s)
- J M Garcés Jarque
- Comisión de Infecciones, Hospital del Mar, Instituto Municipal de Asistencia Sanitaria, Barcelona.
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30
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Beckers EA, Strack van Schijndel RJ. Aspergillus spondylodiskitis in a patient with chronic obstructive pulmonary disease. Eur J Intern Med 2002; 13:139-142. [PMID: 11893474 DOI: 10.1016/s0953-6205(01)00206-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Invasive aspergillosis is a well-known complication in immunocompromised patients. There are only a few reports of invasive aspergillosis in non-immunocompromised patients. We describe a 72-year-old female patient with clinical signs of spondylodiskitis occurring 4 months after what had appeared to be successful treatment of pulmonary aspergillosis. The patient used inhalation corticosteroids on a daily basis because of chronic obstructive pulmonary disease (COPD). Spondylodiskitis of the intervertebral disc Th11 and Th12 with involvement of both adjacent vertebral bodies was confirmed by magnetic resonance imaging. Histopathological examination revealed the presence of septate hyphae, indicative of Aspergillus species. Subsequently, evidence of Aspergillus spondylodiskitis was obtained by amplification of Aspergillus-DNA with a specific polymerase chain reaction method. Aspergillus spondylodiskitis after pulmonary aspergillosis is only very rarely encountered. Patients with COPD, managed with short-term courses of systemic corticosteroids or with high-dose corticosteroid inhalation therapies, are considered non-immunocompromised but might be at risk of developing invasive aspergillosis.
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Affiliation(s)
- Erik A.M. Beckers
- Medical Intensive Care Unit, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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Perfect JR, Cox GM, Lee JY, Kauffman CA, de Repentigny L, Chapman SW, Morrison VA, Pappas P, Hiemenz JW, Stevens DA. The impact of culture isolation of Aspergillus species: a hospital-based survey of aspergillosis. Clin Infect Dis 2001; 33:1824-33. [PMID: 11692293 DOI: 10.1086/323900] [Citation(s) in RCA: 306] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2001] [Revised: 06/11/2001] [Indexed: 11/04/2022] Open
Abstract
The term "aspergillosis" comprises several categories of infection: invasive aspergillosis; chronic necrotizing aspergillosis; aspergilloma, or fungus ball; and allergic bronchopulmonary aspergillosis. In 24 medical centers, we examined the impact of a culture positive for Aspergillus species on the diagnosis, risk factors, management, and outcome associated with these diseases. Most Aspergillus culture isolates from nonsterile body sites do not represent disease. However, for high-risk patients, such as allogeneic bone marrow transplant recipients (60%), persons with hematologic cancer (50%), and those with signs of neutropenia (60%) or malnutrition (30%), a positive culture result is associated with invasive disease. When such risk factors as human immunodeficiency virus infection (20%), solid-organ transplantation (20%), corticosteroid use (20%), or an underlying pulmonary disease (10%) are associated with a positive culture result, clinical judgment and better diagnostic tests are necessary. The management of invasive aspergillosis remains suboptimal: only 38% of patients are alive 3 months after diagnosis. Chronic necrotizing aspergillosis, aspergilloma, and allergic bronchopulmonary aspergillosis have variable management strategies and better short-term outcomes.
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Affiliation(s)
- J R Perfect
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Kretschmar M, Buchheidt D, Hof H, Nichterlein T. Galactomannan enzyme immunoassay for monitoring systemic infection with Aspergillus fumigatus in mice. Diagn Microbiol Infect Dis 2001; 41:107-12. [PMID: 11750162 DOI: 10.1016/s0732-8893(01)00282-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Intravenous (i.v.) infection of immunocompetent mice with Aspergillus fumigatus was used to investigate the ability of a commercial galactomannan enzyme-linked immunosorbent assay (ELISA) to monitor the course of organ infection after dissemination. The test detected 100% of the fungemias which occurred for up to 5 days after infection. When blood-cultures became negative but there was a high load of fungi in the parenchymal organs and a positive culture from the brain, the ELISA was again positive in all animals. However, when blood cultures as well as brain cultures were negative and lower amounts of fungi demarcated by immune cells were present in the liver and kidneys which was the case between day 5 and 30 of infection, the test was negative in most of the animals. Therefore, the test was excellent for detection of early i.v. infection with Aspergillus fumigatus but not suited for detection of limited organ infection in immunocompetent mice.
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Affiliation(s)
- M Kretschmar
- Institut für Medizinische Mikrobiologie und Hygiene, Klinikum Mannheim, D-68135, Mannheim, Germany
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Vandenbos F, Hyvernat H, Tamisier R, Bernard E, Gari-Toussaint M, Mattei M. [Community-acquired pulmonary aspergillosis due to Aspergillus fumigatus in a slightly immunocompromised patient]. Rev Med Interne 2001; 22:1130-2. [PMID: 11817128 DOI: 10.1016/s0248-8663(01)00482-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Smith AN, Spencer JA, Stringfellow JS, Vygantas KR, Welch JA. Disseminated infection with Phialemonium obovatum in a German shepherd dog. J Am Vet Med Assoc 2000; 216:708-12, 684-5. [PMID: 10707686 DOI: 10.2460/javma.2000.216.708] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 4-year-old spayed female German Shepherd Dog was evaluated because of left forelimb lameness. A fungal granuloma on the distal portion of the radius was determined to be the cause of the lameness; the infecting organism was identified as Phialemonium obovatum. Despite aggressive treatment with amphotericin B, itraconazole, and ketoconazole and curettage of the local area, the dog developed systemic disease and was euthanatized 5 months after initial evaluation. Immune dysfunction may have played a role in development of disseminated disease, because although serum concentrations of total IgG, IgA, and IgM were within or greater than reference ranges, results of lymphocyte proliferation assays were abnormal, which indicated cellular immune dysfunction. Infection with Phialemonium obovatum should be considered as a differential diagnosis when branching fungal organisms are detected during histologic, cytologic, or microbiologic evaluation of tissue specimens.
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Affiliation(s)
- A N Smith
- Department of Small Animal Surgery, College of Veterinary Medicine, Auburn University, AL 36849, USA
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36
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Yano S, Shishido S, Kobayashi K, Nakano H, Kawasaki Y. Bronchocentric granulomatosis due to Aspergillus terreus in an immunocompetent and non-asthmatic woman. Respir Med 1999; 93:672-4. [PMID: 10542983 DOI: 10.1016/s0954-6111(99)90109-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This is the first report of bronchocentric granulomatosis due to Aspergillus terreus in a healthy and non-asthmatic 74-year-old Japanese woman. Following identification of the fungus, oral itraconazole therapy was begun after intrabronchial infusion of amphotericin B. No recurrence has occurred after treatment for 24 months. We should consider the possibility of bronchocentric granulomatosis including Aspergillus terreus, when an intrabronchial lesion is found even in a healthy and non-asthmatic person. Oral itraconazole after intrabronchial infusion of amphotericin B seems to be effective in such cases.
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Affiliation(s)
- S Yano
- Department of Pulmonary Medicine, National Sanatorium Matsue Hospital, Japan
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37
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Martinez M, Lee AS, Hellinger WC, Kaplan J. Vertebral Aspergillus osteomyelitis and acute diskitis in patients with chronic obstructive pulmonary disease. Mayo Clin Proc 1999; 74:579-83. [PMID: 10377933 DOI: 10.4065/74.6.579] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aspergillus osteomyelitis of the spine with acute diskitis has been well documented in immunocompromised hosts but is rare in immunocompetent patients. Predisposing factors to infection are prolonged neutropenia, hematologic malignancies, chemotherapy, history of prior spinal trauma or surgery, allograft transplantation, or any condition requiring the use of long-term immunosuppressive agents or systemic corticosteroids. Patients with chronic obstructive pulmonary disease (COPD) treated with systemic corticosteroids for either long-term management or frequent exacerbations are at potential risk for such infections. Patients with severe COPD treated primarily with inhaled corticosteroids are considered immunocompetent. This report describes 2 cases of Aspergillus osteomyelitis with acute diskitis in apparently immunocompetent patients with COPD who, aside from brief courses of systemic corticosteroids, were using inhaled corticosteroid therapy. One patient was treated with intravenous amphotericin B alone, whereas the other received amphotericin B and underwent surgical debridement. Both have done well and were symptom free at 6-month follow-up.
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Affiliation(s)
- M Martinez
- Department of Internal Medicine, Mayo Clinic Jacksonville, FL 32224, USA
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Mariushi WM, Arruda WO, Tsubouchi MH, Ramina R. Chronic Aspergillus sp. meningitis successfully treated with fluconazole. Case report. ARQUIVOS DE NEURO-PSIQUIATRIA 1999; 57:288-91. [PMID: 10412532 DOI: 10.1590/s0004-282x1999000200020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We a case of chronic Aspergillus sp. meningitis in a healthy 43-year-old woman successfully treated with fluconazole given orally (300 ms/day). The diagnosis was made by detection of anti-aspergillus antibodies and positive culture to Aspergillus sp. in the cerebrospinal fluid.
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Affiliation(s)
- W M Mariushi
- Unidade de Ciências Neurológicas, Hospital das Nações, Brasil
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Abstract
Aspergillus fumigatus is one of the most ubiquitous of the airborne saprophytic fungi. Humans and animals constantly inhale numerous conidia of this fungus. The conidia are normally eliminated in the immunocompetent host by innate immune mechanisms, and aspergilloma and allergic bronchopulmonary aspergillosis, uncommon clinical syndromes, are the only infections observed in such hosts. Thus, A. fumigatus was considered for years to be a weak pathogen. With increases in the number of immunosuppressed patients, however, there has been a dramatic increase in severe and usually fatal invasive aspergillosis, now the most common mold infection worldwide. In this review, the focus is on the biology of A. fumigatus and the diseases it causes. Included are discussions of (i) genomic and molecular characterization of the organism, (ii) clinical and laboratory methods available for the diagnosis of aspergillosis in immunocompetent and immunocompromised hosts, (iii) identification of host and fungal factors that play a role in the establishment of the fungus in vivo, and (iv) problems associated with antifungal therapy.
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Affiliation(s)
- J P Latgé
- Laboratoire des Aspergillus, Institut Pasteur, 75015 Paris, France.
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Abstract
OBJECTIVES to describe the clinical, microbiological and pathological features of invasive sinus aspergillosis affecting immunocompetent hosts, and to identify the risk factors for mortality. METHODS we report three apparently immunocompetent patients with invasive sinus aspergillosis, and review all cases reported in the English literature since 1987, the year in which the triazole antifungal agents were introduced. RESULTS twenty-nine patients (including three of our own) were identified. The presenting symptoms were non-specific and indistinguishable from viral, bacterial or allergic causes of sinusitis. The findings on computed tomography scan were also non-specific, and histopathology and culture of sinus tissue biopsy had low yield. These factors, along with the mistaken impression that Aspergillus can only affect immunocompromised hosts, frequently delayed the diagnosis. Fifty-nine percent of patients either failed therapy or died. The following factors were associated with a poor prognosis: delayed diagnosis, intracranial extension of infection, and histopathology demonstrating hyphal invasion of blood vessel or tissue. Complete surgical extirpation was the key element of successful therapy; antifungal agents played an adjunctive role. CONCLUSIONS invasive sinus aspergillosis carries high morbidity and mortality, even in immunocompetent hosts. To improve outcome, the diagnosis must be recognized early, before the organism can invade the central nervous system or vascular structures. Aggressive surgical resection of the infected areas is of utmost importance in the management of this infection.
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Affiliation(s)
- C J Clancy
- University of Florida College of Medicine and the VA Medical Center, Gainesville 32610, USA
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