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Invasive pulmonary aspergillosis associated with COVID-19 in a kidney transplant recipient.
Trujillo, H, Fernández-Ruiz, M, Gutiérrez, E, Sevillano, Á, Caravaca-Fontán, F, Morales, E, López-Medrano, F, Aguado, JM, Praga, M, Andrés, A
Transplant infectious disease : an official journal of the Transplantation Society. 2021;(2):e13501
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might increase the risk of invasive pulmonary aspergillosis (IPA). Although several case reports and small series have been reported in the general population, scarce information is available regarding coronavirus disease 2019 (COVID-19)-associated IPA in the setting of solid organ transplantation. We describe a case of a kidney transplant recipient with severe COVID-19 that was subsequently diagnosed with probable IPA on the basis of the repeated isolation of Aspergillus fumigatus in sputum cultures, repeatedly increased serum (1 → 3)-β-d-glucan levels, and enlarging cavitary nodules in the CT scan. The evolution was favorable after initiation of isavuconazole and nebulized liposomal amphotericin B combination therapy and the withdrawal of immunosuppression.
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Hormographiella aspergillata: an emerging basidiomycete in the clinical setting? A case report and literature review.
Moniot, M, Lavergne, RA, Morel, T, Guieze, R, Morio, F, Poirier, P, Nourrisson, C
BMC infectious diseases. 2020;(1):945
Abstract
BACKGROUND Filamentous basidiomycetes are mainly considered to be respiratory tract colonizers but the clinical significance of their isolation in a specimen is debatable. Hormographiella aspergillata was first reported as a human pathogen in 1971. We discuss the role of this mold as a pathogen or colonizer and give an update on diagnostic tools and in vitro antifungal susceptibility. CASE PRESENTATION We identified three cases of H. aspergillata with respiratory symptoms in a short period of time. One invasive infection and two colonizations were diagnosed. Culture supernatants showed that H. aspergillata can produce galactomannan and β-D-glucan but not glucuronoxylomannan. For the first time, isavuconazole susceptibility was determined and high minimum inhibitory concentrations (MICs) were found. Liposomal amphotericin B and voriconazole have the lowest MICs. CONCLUSION To date, 22 invasive infections involving H. aspergillata have been reported. On isolation of H. aspergillata, its pathogenic potential in clinical settings can be tricky. Molecular identification and antifungal susceptibility testing are essential considering high resistance against several antifungal therapies.
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Tinea Capitis by Microsporum audouinii: Case Reports and Review of Published Global Literature 2000-2016.
Brito-Santos, F, Figueiredo-Carvalho, MHG, Coelho, RA, Sales, A, Almeida-Paes, R
Mycopathologia. 2017;(11-12):1053-1060
Abstract
Tinea capitis caused by Microsporum audouinii is reported herein from two Brazilian schoolchildren, which are brothers. Arthroconidia were evidenced on direct examination of scalp hair, and a fungus of the genus Microsporum was isolated from cultures of each patient. The isolated fungi were classified as M. audouinii by visualization of species-specific structures, including: pectinate hyphae, chlamydospores, and fusiform macroconidia, sterile growth with characteristic brown pigment in rice grains, and through DNA sequencing of the internal transcriber spacer region. Patients were refractory to ketoconazole, but the two cases had a satisfactory response to oral terbinafine. All M. audouinii infections described in this century were reviewed, and to our knowledge, this is the first literature description of this species from South America. Misidentification of M. audouinii with Microsporum canis can occur in this area, leading to erroneous data about the occurrence of this species.
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Successful treatment of Aspergillus ventriculitis through voriconazole adaptive pharmacotherapy, immunomodulation, and therapeutic monitoring of cerebrospinal fluid (1→3)-β-D-glucan.
Chen, TK, Groncy, PK, Javahery, R, Chai, RY, Nagpala, P, Finkelman, M, Petraitiene, R, Walsh, TJ
Medical mycology. 2017;(1):109-117
Abstract
Aspergillus ventriculitis is an uncommon but often fatal form of invasive aspergillosis of the central nervous system (CNS). As little is known about the diagnosis, treatment, and outcome of this potentially lethal infection, we report the strategies used to successfully treat Aspergillus ventriculitis complicating a pineal and pituitary germinoma with emphasis on the critical role of adaptive pharmacotherapy of voriconazole and serial monitoring of (1→3)-β-D-glucan in cerebrospinal fluid. We describe several rationally based therapeutic modalities, including adaptive pharmacotherapy, combination therapy, sargramostim-based immunomodulation, and biomarker-based therapeutic monitoring of the CNS compartment. Through these strategies, our patient remains in remission from both his germinoma and Aspergillus ventriculitis making him one of the few survivors of Aspergillus ventriculitis.
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[Thalamo-mesencephalic aspergillus abscess in a heart transplant subject: a case report and literature review].
Mazzaferri, F, Adami, I, Tocco, P, Cazzadori, A, Merighi, M, Forni, A, Storato, S, Ferrari, S, Concia, E
Le infezioni in medicina. 2015;(1):51-5
Abstract
Cerebral aspergillosis is a rare and highly fatal infection that mainly affects immunocompromised patients. We report on a case of a heart transplanted Caucasian man, who arrived at our hospital because of the onset of diplopy. We performed a broad diagnostic work-up: the brain MRI showed a single ring-enhancing thalamo-mesencephalic area suggestive of abscess lesion; cerebrospinal fluid (CSF) analysis disclosed galactomannan and beta-D-glucan antigens. Thus the antifungal therapy was immediately started. We decided to discontinue the therapy 16 months later because of severe hepatic toxicity, given that the patient was persistently asymptomatic, brain imaging showed a progressive resolution of the abscess area and CSF antigen analysis was persistently negative. The follow-up at three months was unchanged.
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Treatment of neonatal fungal infective endocarditis with recombinant tissue plasminogen: activator in a low birth weight infant case report and review of the literature.
Babayigit, A, Cebeci, B, Buyukkale, G, Semerci, SY, Bornaun, H, Oztarhan, K, Gokce, M, Cetinkaya, M
Mycoses. 2015;(10):578-81
Abstract
With advances in medical sciences, an increase in survival rates of low birth weight; increased incidence in use of catheter and antibiotics, and total parenteral nutrition are reported, therefore, the rate of fungal infections in late and very late onset neonatal sepsis have increased. Although fungal endocarditis rarely occur in newborns, it has a high morbidity and mortality. Antifungal therapy is often insufficient in cases who develop fungal endocarditis and surgical treatment is not preferred due to its difficulty and high mortality. Herein, fungal endocarditis in a preterm newborn treated with single-dose recombinant tissue plasminogen activator in addition to antifungal therapy is presented and relevant literature has been reviewed. The vegetation completely disappeared following treatment and no complication was observed.
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An unusual inflammatory rash.
Gathings, RM, Abide, JM, Brodell, RT
JAMA pediatrics. 2014;(2):185-6
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Pseudozyma spp catheter-associated blood stream infection, an emerging pathogen and brief literature review.
Siddiqui, W, Ahmed, Y, Albrecht, H, Weissman, S
BMJ case reports. 2014
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Abstract
Pseudozyma spp are amorphic yeasts. They are commonly plant pathogens, but rarely cause invasive fungal disease in humans. Only three cases of central venous catheter (CVC)-associated blood stream infections due to this organism have been reported in the literature. Main underlying risk factors for Pseudozyma spp infection are bowel surgery, CVC and total parenteral nutrition. We present a rare case of Pseudozyma spp catheter-associated blood stream infection that was successfully treated with antifungal therapy and removal of CVC. It is important to recognise and differentiate this species from other yeasts as it may require the use of amphotericin B or voriconazole instead of fluconazole, to which the organism is variably resistant.
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Rapid induction of multiple resistance mechanisms in Aspergillus fumigatus during azole therapy: a case study and review of the literature.
Camps, SM, van der Linden, JW, Li, Y, Kuijper, EJ, van Dissel, JT, Verweij, PE, Melchers, WJ
Antimicrobial agents and chemotherapy. 2012;(1):10-6
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Abstract
Nine consecutive isogenic Aspergillus fumigatus isolates cultured from a patient with aspergilloma were investigated for azole resistance. The first cultured isolate showed a wild-type phenotype, but four azole-resistant phenotypes were observed in the subsequent eight isolates. Four mutations were found in the cyp51A gene of these isolates, leading to the substitutions A9T, G54E, P216L, and F219I. Only G54 substitutions were previously proved to be associated with azole resistance. Using a Cyp51A homology model and recombination experiments in which the mutations were introduced into a susceptible isolate, we show that the substitutions at codons P216 and F219 were both associated with resistance to itraconazole and posaconazole. A9T was also present in the wild-type isolate and thus considered a Cyp51A polymorphism. Isolates harboring F219I evolved further into a pan-azole-resistant phenotype, indicating an additional acquisition of a non-Cyp51A-mediated resistance mechanism. Review of the literature showed that in patients who develop azole resistance during therapy, multiple resistance mechanisms commonly emerge. Furthermore, the median time between the last cultured wild-type isolate and the first azole-resistant isolate was 4 months (range, 3 weeks to 23 months), indicating a rapid induction of resistance.
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[A tinea incognito case caused by Trichophyton rubrum with clinical and mycological cure and review of the literature].
Ilkit, M, Karakaş, M, Yüksel, T
Mikrobiyoloji bulteni. 2010;(1):149-53
Abstract
Tinea incognito is the result of lack of diagnosis of dermatophyte infection of the glabrous skin and the misuse of steroids or calcineurin inhibitors. In this case report a 20-years-old female patient diagnosed as tinea incognito and Trichophyton rubrum isolated from her skin lesions, was presented. The patient suffered from an itchy skin lesion on her neck and right breast. Physical examination revealed and plaques with erythema and papules on neck and breast area. The patient had used several corticostero- ids suggested by dermatologists for 10 months. Direct microscopic examination of the skin scrapings with 10% potassium hydroxide preparation revealed fungal elements and Trichophyton rubrum was isolated in culture. Use of corticosteroids was ceased and terbinafine (250 mg tb and cream) therapy was initiated to continue for four weeks. Following treatment, total clinical and mycological cure was established. It was concluded that tinea incognito which was not a rare clinical entity, could be presented in various clinical forms and usually resulted from the wrong treatment modalities. Thus atypical erythematous plaques should be investigated in terms of presence of fungi and treated accordingly to establish total clinical and mycological cure.