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Sousa C, Pasini RA, Pasqualotto A, Marchiori E, Altmayer S, Irion K, Mançano A, Hochhegger B. Imaging Findings in Aspergillosis: From Head to Toe. Mycopathologia 2023; 188:623-641. [PMID: 37380874 DOI: 10.1007/s11046-023-00766-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/16/2023] [Indexed: 06/30/2023]
Abstract
Aspergillosis is a mycotic infection induced by airborne fungi that are ubiquitous. Inhalation of Aspergillus conidia results in transmission through the respiratory tract. The clinical presentation is dependent on organism and host specifics, with immunodeficiency, allergies, and preexisting pulmonary disease constituting the most important risk factors. In recent decades, the incidence of fungal infections has increased dramatically, due in part to the increased number of transplants and the pervasive use of chemotherapy and immunosuppressive drugs. The spectrum of clinical manifestations can range from an asymptomatic or mild infection to a swiftly progressive, life-threatening illness. Additionally, invasive infections can migrate to extrapulmonary sites, causing infections in distant organs. Recognition and familiarity with the various radiological findings in the appropriate clinical context are essential for patient management and the prompt initiation of life-saving treatment. We discuss the radiological characteristics of chronic and invasive pulmonary aspergillosis, as well as some of the typically unexpected extrapulmonary manifestations of disseminated disease.
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Affiliation(s)
- Célia Sousa
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | | | - Alessandro Pasqualotto
- Radiology Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Edson Marchiori
- Radiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Klaus Irion
- Radiology Department, University of Florida, Gainesville, FL, USA
| | | | - Bruno Hochhegger
- Radiology Department, University of Florida, Gainesville, FL, USA.
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2
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Jung KU, Yoon KW, Do IG, Lee D. Aspergillus appendicitis complicating chemotherapy of leukemia: A case report and review of the literature. Int J Surg Case Rep 2022; 100:107738. [PMID: 36274295 PMCID: PMC9589183 DOI: 10.1016/j.ijscr.2022.107738] [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] [Received: 08/01/2022] [Revised: 10/01/2022] [Accepted: 10/08/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction The diagnosis of primary Aspergillus appendicitis can be missed or delayed because of its rarity. We report our experience of a case of Aspergillus appendicitis complicating chemotherapy of leukemia. Presentation of case A 48-year-old man who was diagnosed with acute myeloid leukemia developed high fever and epigastric pain two weeks after administration of his fourth consolidation chemotherapy. Right lower quadrant tenderness and rebound tenderness were noticed on physical examination, and the abdomen and pelvis computed tomography suggested acute perforated appendicitis with localized peritonitis. Emergency laparoscopy showed an inflamed appendix, which was resected. Pathology reports revealed invasive aspergillosis in the appendix. The patient recovered after high-dose antifungal therapy, although he required prolonged hospitalization. Discussion Acute appendicitis is very rarely caused by fungi infection with an overall incidence of up to 1.15 %. Differential diagnosis of fungal appendicitis without pathology report is challenging due to low incidence. Conclusion Isolated Aspergillus appendicitis is a rare disease that can progress without appropriate antifungal therapy even after surgical resection of the appendix. Surgeons should pay attention to pathology reports after appendectomy to avoid missing unusual cases, especially in immunocompromised patients. Fungal infections principally occur in the immunocompromised. Misdiagnosis and incorrect treatment are frequent in this rare disease entity. Early diagnosis and prompt surgery with antifungal treatment is best
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Affiliation(s)
- Kyung Uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyoung Won Yoon
- Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
| | - In-Gu Do
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Donghyoun Lee
- Department of Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea.
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3
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Puing AG, Ross J, Parekh V, Nanayakkara DD. Oesophageal and pulmonary invasive aspergillosis in a patient with multiple myeloma. BMJ Case Rep 2022; 15:e246403. [PMID: 35318199 PMCID: PMC8943765 DOI: 10.1136/bcr-2021-246403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/03/2022] Open
Abstract
Invasive aspergillosis (IA) is a serious fungal infection that primarily affects patients with prolonged and profound neutropenia, and compromised cell-mediated immunity. Aspergillosis of the oesophagus and gastrointestinal tract is uncommon but seen in advanced cases of disseminated IA. However, it is difficult to diagnose antemortem due to the poor specificity of the symptoms and the absence of characteristic imaging findings. Therefore, the reported cases of gastrointestinal aspergillosis have been associated with high morbidity and mortality, and frequently diagnosed postmortem. Here we present a successful outcome in a patient with relapsed and refractory multiple myeloma who had presented with febrile neutropenia, cough and dysphagia, and was diagnosed with disseminated IA comprising of pulmonary and oesophageal involvement. This case highlights the need for a high index of suspicion and the importance of invasive procedures for histopathology and molecular diagnostics to ensure an early diagnosis and therapeutic intervention.
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Affiliation(s)
- Alfredo G Puing
- Division of Infectious Diseases, Department of Medicine, City of Hope National Medical Center, Duarte, California, USA
| | - Justine Ross
- Department of Pharmacy Services, City of Hope National Medical Center, Duarte, California, USA
| | - Vishwas Parekh
- Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Deepa D Nanayakkara
- Division of Infectious Diseases, Department of Medicine, City of Hope National Medical Center, Duarte, California, USA
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4
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Quintero O, Allard L, Ho D. Invasive mold infection of the gastrointestinal tract - A case series of 22 immunocompromised patients from a single academic center. Med Mycol 2022; 60:6517313. [PMID: 35092429 PMCID: PMC8896981 DOI: 10.1093/mmy/myac007] [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] [Received: 10/19/2021] [Revised: 12/24/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Invasive mold infection (IMI) of the gastrointestinal (GI) tract is a rare complication in immunocompromised patients that carries a high mortality rate. It is most often described in the setting of disseminated disease. Early diagnosis and treatment are critical in its management, but this is rarely obtained, leading to delayed therapy. To describe the clinical characteristics, treatment and outcomes of this infection, we reviewed all the cases of adult patients with histopathological findings from autopsy or surgical specimens that demonstrated fungal invasion into the GI tract at Stanford Hospital & Clinics from January 1997 to August 2020. Twenty-two patients that met criteria were identified and they were all immunocompromised, either due to their underlying medical conditions or the treatments that they received. The most common underlying disease was hematological malignancies (63.6%) and the most common symptoms were abdominal pain, GI bleeding and diarrhea. A majority of patients (72.7%) had disseminated invasive mold infection, while the rest had isolated GI tract involvement. In 2/3 of our cases, the fungal genus or species was confirmed based on culture or PCR results. Given the very high mortality associated with GI mold infection, this diagnosis should be considered when evaluating immunocompromised patients with concerning GI signs and symptoms. A timely recognition of the infection, prompt initiation of appropriate antifungal therapy as well as surgical intervention if feasible, are key to improve survival from this devastating infection.
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Affiliation(s)
- Orlando Quintero
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine 300 Pasteur Drive, Lane Building L-135, Stanford, CA 94305- 5107, USA
| | - Libby Allard
- Department of Pathology, Stanford University School of Medicine 300 Pasteur Drive, Stanford, CA 94305- 5107, USA
| | - Dora Ho
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine 300 Pasteur Drive, Lane Building L-135, Stanford, CA 94305- 5107, USA
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5
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Panarelli NC. Infectious diseases of the upper gastrointestinal tract. Histopathology 2020; 78:70-87. [PMID: 33382485 DOI: 10.1111/his.14243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022]
Abstract
A broad spectrum of pathogens produce gastrointestinal disease. The ongoing spread of human immunodeficiency virus/acquired immune deficiency syndrome, the increased use of immunosuppressive therapy and the persistence of overcrowding and suboptimal sanitation in underdeveloped areas facilitate both disease transmission from environmental and foodborne sources and person-to-person transmission. Clinicians increasingly rely on endoscopic biopsy sample interpretation to diagnose gastrointestinal infections. Thus, pathologists must be aware of diagnostic features of a variety of microbial pathogens. Detection with molecular techniques also allows for correlation between infectious agents and their histopathological features, which has expanded our knowledge of the inflammatory changes produced by infectious agents. This review covers infectious disorders of the upper gastrointestinal tract encountered in surgical pathology. Clinical, endoscopic and pathological features are presented. The review emphasises morphological features of viruses, bacteria, fungi and parasites that may be found in tissue samples, and the inflammatory patterns that they produce. Differential diagnoses and useful ancillary techniques are discussed.
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6
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Nywening AV, Rybak JM, Rogers PD, Fortwendel JR. Mechanisms of triazole resistance in Aspergillus fumigatus. Environ Microbiol 2020; 22:4934-4952. [PMID: 33047482 PMCID: PMC7828461 DOI: 10.1111/1462-2920.15274] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022]
Abstract
The ubiquitous fungal pathogen Aspergillus fumigatus is the primary cause of opportunistic mould infections in humans. Aspergilli disseminate via asexual conidia passively travelling through air currents to germinate within a broad range of environs, wherever suitable nutrients are found. Though the average human inhales hundreds of conidia daily, A. fumigatus invasive infections primarily affect the immunocompromised. At-risk individuals can develop often fatal invasive disease for which therapeutic options are limited. Regrettably, the global insurgence of isolates resistant to the triazoles, the frontline antifungal class used in medicine and agriculture to control A. fumigatus, is complicating the treatment of patients. Triazole antifungal resistance in A. fumigatus has become recognized as a global, yet poorly comprehended, problem. Due to a multitude of factors, the magnitude of resistant infections and their contribution to treatment outcomes are likely underestimated. Current studies suggest that human drug-resistant infections can be either environmentally acquired or de novo host selected during patient therapy. While much concerning development of resistance is yet unknown, recent investigations have revealed assorted underlying mechanisms enabling triazole resistance within individual clinical and environmental isolates. This review will provide an overview of triazole resistance as it is currently understood, as well as highlight some of the prominent biological mechanisms associated with clinical and environmental resistance to triazoles in A. fumigatus.
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Affiliation(s)
- Ashley V Nywening
- Department of Clinical Pharmacy and Translational Sciences, The University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN, USA
- College of Graduate Health Sciences, Integrated Biomedical Sciences Program, The University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Jeffrey M Rybak
- Department of Clinical Pharmacy and Translational Sciences, The University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN, USA
| | - Phillip David Rogers
- Department of Clinical Pharmacy and Translational Sciences, The University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN, USA
| | - Jarrod R Fortwendel
- Department of Clinical Pharmacy and Translational Sciences, The University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN, USA
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7
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Qiu X, Zhao X, Cui X, Mao X, Tang N, Jiao C, Wang D, Zhang Y, Ye Z, Zhang H. Characterization of fungal and bacterial dysbiosis in young adult Chinese patients with Crohn's disease. Therap Adv Gastroenterol 2020; 13:1756284820971202. [PMID: 33240394 PMCID: PMC7672770 DOI: 10.1177/1756284820971202] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/14/2020] [Indexed: 02/04/2023] Open
Abstract
Intestinal microbiota dysbiosis has been described in inflammatory bowel disease (IBD), but data from China are limited. In this study, we performed molecular analysis of the fecal microbial community from 20 healthy Chinese subjects and 25 patients with Crohn's disease (CD), and evaluated associations with bacterial and fungal compositions. Decreased richness and diversity of bacterial composition was observed in the CD group compared with healthy (H) subjects. Significant structural differences in bacterial (but not fungal) composition among healthy controls and CD patients were found. A reduction in Firmicutes and Actinobacteria abundance, and overrepresentation of Proteobacteria were observed in the CD patients compared with the H group. The Escherichia-Shigella genus was overrepresented in the CD group, whereas Faecalibacterium, Gemmiger, Bifidobacterium, Romboutsia, Ruminococcus, Roseburia, and Fusicatenibacter abundance were decreased in the CD group compared with H subjects. Differences in fungal microbiota between the H and CD groups were observed at the genus rather than at the phylum level. The Candida genus was overrepresented in the CD (active disease) group compared with the H group, whereas no difference between CD (remission) and H groups was observed. Aspergillus, unclassified_Sordariomycetes, and Penicillium genera had greater representation in the H subjects compared with the CD group. Bacterial and fungal intra- and inter-kingdom correlations were observed between the H and CD groups. Therefore, fecal bacterial and fungal microbiome communities differed considerably between H and CD patients, and between Chinese and Western populations. The role of gut microbiota in homeostasis and in gastrointestinal disorders should be investigated further.
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Affiliation(s)
| | | | - Xiufang Cui
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaqiong Mao
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Nana Tang
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chunhua Jiao
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Di Wang
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yue Zhang
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ziping Ye
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongjie Zhang
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300#, Nanjing, 210029, China
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8
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Pourbaix A, Guery R, Bruneau J, Blanc E, Jouvion G, Weinandt M, Rouzaud C, Lourenço J, Boutboul D, Mira JP, Rouquette A, Molina TJ, Lecuit M, Lortholary O. "Chronic Disseminated Aspergillosis," a Novel Fungal Immune Reconstitution Inflammatory Syndrome. Open Forum Infect Dis 2020; 7:ofaa175. [PMID: 33204743 PMCID: PMC7651489 DOI: 10.1093/ofid/ofaa175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 10/22/2020] [Indexed: 01/11/2023] Open
Abstract
We report a case of chronic hepatosplenic aspergillosis following immune reconstitution complicating colic aspergillosis in an AIDS patient with multicentric Castleman disease. Symptoms mimicked the clinical presentation of chronic disseminated candidiasis and responded to corticosteroid. This emerging entity enlarges the spectrum of fungal immune reconstitution inflammatory syndrome in the HIV setting.
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Affiliation(s)
- Annabelle Pourbaix
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Romain Guery
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Julie Bruneau
- Pathology Department, Necker-Enfants Malades Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Estelle Blanc
- Nuclear Medicine Department, Marie Lannelongue Hospital, Le Plessis-Robinson, France
| | - Gregory Jouvion
- Pathophysiology of Pediatric Genetic Diseases, Sorbonne Université, INSERM, Assistance Publique Hôpitaux de Paris, Hôpital Armand-Trousseau, UF Génétique Moléculaire, Paris, France.,Experimental Neuropathology Unit, Institut Pasteur, Paris, France
| | - Marthe Weinandt
- Visceral Surgery Department, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Claire Rouzaud
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Jérémy Lourenço
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - David Boutboul
- Clinical Immunopathology Department, St Louis Hospital, AP-HP, University of Paris, INSERM U967 HIPI, Paris, France
| | - Jean-Paul Mira
- Medical Intensive Care Department, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Alexandre Rouquette
- Pathology Department, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Thierry Jo Molina
- Pathology Department, Necker-Enfants Malades Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Marc Lecuit
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,Biology of Infection Unit, Institut Pasteur, INSERM U1117, Paris, France
| | - Olivier Lortholary
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,Molecular Mycology Unit, Institut Pasteur, CNRS UMR2000, Paris, France
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9
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Xiao J, Zhang R, Chen W, Niu B. An unusual case of acute lower gastrointestinal bleeding due to fungal infection. J Int Med Res 2020; 48:300060520967820. [PMID: 33143513 PMCID: PMC7645517 DOI: 10.1177/0300060520967820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A 63-year-old woman was admitted to our hospital with herpes zoster viral infection and intermittent disorder of consciousness. On day 13 of hospitalization for glucocorticoid treatment, the patient experienced seven episodes of hematochezia. She had a 2-year history of systemic lupus erythematosus and had undergone splenectomy at 40 years of age. Computed tomography and electronic endoscopy revealed bleeding and contrast agent leakage into the splenic flexure of the colon. The patient underwent an emergency exploratory laparotomy and left hemicolectomy for suspected active hemorrhaging into the digestive tract. Pathological examination revealed that the bleeding had been caused by a fungal infection. No further hemorrhaging occurred after the surgery, suggesting that intestinal fungal infection might be a potential differential diagnosis for gastrointestinal bleeding in compromised hosts.
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Affiliation(s)
- Jianchun Xiao
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Ruopeng Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Wanqi Chen
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Beizhan Niu
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
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10
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Rothe K, Rasch S, Wantia N, Poszler A, Ulrich J, Schlag C, Huber W, Schmid RM, Busch DH, Lahmer T. Aspergillus fumigatus cholangitis in a patient with cholangiocarcinoma: case report and review of the literature. Infection 2020; 49:159-164. [PMID: 32860594 PMCID: PMC7851102 DOI: 10.1007/s15010-020-01487-4] [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] [Received: 12/19/2019] [Accepted: 07/21/2020] [Indexed: 11/30/2022]
Abstract
Aspergillus spp. cholangitis is an uncommon presentation of invasive aspergillosis. Only few cases are described in the literature affecting severely immunocompromised patients or patients following biliary surgery. Especially, invasive aspergillosis in non-haematological patients is associated with high mortality rates, caused by atypical presentations, which is associated with a delay in diagnosis and therapy. We report a 72-year-old man with primary diagnosis of cholangiocarcinoma and stent implantation by endoscopic retrograde cholangiopancreatography (ERCP) for biliary decompression who developed severe cholangitis with invasive aspergillosis. The patient had no history of prior hospitalisation, no immunosuppressive therapy and no preceding biliary surgery. Furthermore, in this exceptional case of extrapulmonary aspergillosis, there were no signs of pulmonary involvement. From the literature review, only three cases of Aspergillus cholangitis could be identified. Clinical manifestations of invasive aspergillosis can be variable and classical risk factors such as immunosuppression are not mandatorily present. Clinical awareness of these rare cases is of vital importance for initiation of correct therapy.
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Affiliation(s)
- Kathrin Rothe
- School of Medicine, Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
| | - Sebastian Rasch
- School of Medicine, Department of Medicine II, Technical University of Munich, University Hospital Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Nina Wantia
- School of Medicine, Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
| | - Alexander Poszler
- School of Medicine, Department of Medicine II, Technical University of Munich, University Hospital Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Joerg Ulrich
- School of Medicine, Department of Medicine II, Technical University of Munich, University Hospital Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christoph Schlag
- School of Medicine, Department of Medicine II, Technical University of Munich, University Hospital Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Wolfgang Huber
- School of Medicine, Department of Medicine II, Technical University of Munich, University Hospital Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Roland M Schmid
- School of Medicine, Department of Medicine II, Technical University of Munich, University Hospital Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Dirk H Busch
- School of Medicine, Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany.,German Centre for Infection Research (DZIF), Partner site Munich, Munich, Germany
| | - Tobias Lahmer
- School of Medicine, Department of Medicine II, Technical University of Munich, University Hospital Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.
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11
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Acute isolated Aspergillus appendicitis in pediatric leukemia. J Infect Chemother 2020; 26:1229-1231. [PMID: 32839111 DOI: 10.1016/j.jiac.2020.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 11/22/2022]
Abstract
Aspergillus is a widespread fungus in the environment, usually invades through the respiratory tract. Invasive aspergillosis is a fatal disseminated infection in immunocompromised hosts. Appendicitis occurs scarcely in patients with leukemia. We report a case of Aspergillus appendicitis that underwent an urgent appendectomy. An 11-year-old boy received the diagnosis of acute myeloid leukemia, because of the bone pain and results of the bone marrow study. He obtained a complete remission after cancer chemotherapy and received peripheral blood stem cell transplantation from a histocompatible sibling. Leukemia relapsed 5 months post-transplant. Induction therapy with etoposide, cytarabine and mitoxantrone was started on Candida prophylaxis. Fifteen days after the end of chemotherapy, he presented with febrile neutropenia and abdominal pain, that did not respond to broad-spectrum antibiotics. Serum levels of C-reactive protein, β-D-glucan and procalcitonin were unremarkable. Computed tomography scan revealed a swollen appendix and the adjacent tissue inflammation. An urgent appendectomy led to a tentative diagnosis of Aspergillus appendicitis based on the histopathological findings of many fungal hyphal forms. Panfungal polymerase chain reaction using DNA extracted from the lesion determined the pathogen of Aspergillus niger. There was no evidence of invasive aspergillosis. During the prolonged anti-fungal therapy, he achieved a remission of leukemia and underwent the second hematopoietic cell transplantation. To our knowledge, Aspergillus appendicitis was reported to occur in 5 leukemia patients. Four of them survived after appendectomy and one died from intestinal perforation. Early surgical intervention is mandatory for a cure of Aspergillus appendicitis in neutropenic patients on Candida prophylaxis.
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12
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Yelika SB, Tumati A, Denoya P. Intestinal Aspergillosis: Systematic Review on Patterns of Clinical Presentation and Management. Surg Infect (Larchmt) 2020; 22:326-333. [PMID: 32758013 DOI: 10.1089/sur.2020.157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Intestinal aspergillosis (IA) is a rare entity primarily discovered in immunocompromised patients. Because of its low incidence, IA is not considered routinely in the differential of abdominal pain, distension, and diarrhea. A systematic characterization of demographics, comorbidities, clinical presentations, and outcomes can help surgeons recognize and manage IA in critically ill patients. Methods: Two independent authors carried out the literature search using PubMed, MEDLINE, and Scopus databases. The Mesh terms utilized were: 'intestinal' and 'aspergillosis' combined with the Boolean operator 'AND' (synonyms were combined with the Boolean operator 'OR'). Intestinal aspergillosis was defined as inflammation of the gastrointestinal tract (duodenum to rectum) caused by Aspergillus spp. All articles reporting IA were included. Articles describing aspergillosis of the esophagus or stomach were excluded. Statistical analysis was performed using SPSS software (version 18; SPSS Inc., Chicago, IL). Results: Forty-two articles reporting 56 cases were included in the study. Mean age was 44.9 ± 20.5 years. Male to female ratio was 29:27. The most common condition in patients who developed IA was transplantation (19 patients; 34%). The most common clinical presentations of IA were abdominal pain (21 patients; 38%) and diarrhea 12 patients; 21%). Sixty-six percent of patients had primary IA whereas 34% developed IA secondarily to systemic infection. Diagnostic modalities included exploratory laparotomy (35 patients; 63%) and endoscopy (7 patients; 13%). Mean time to diagnosis was 8.6 ± 11.3 days. Intestinal aspergillosis was limited to the small bowel in 61% of patients. In 43 (77%) patients, bowel resection is the definitive treatment, whereas 13 (23%) patients underwent antifungal therapy alone. Mortality rate was 39%. Sixty-three percent of patients treated with surgery survived, compared with 46% treated with antifungal therapy alone (p = 0.34). Conclusion: Intestinal aspergillosis is a life-threatening condition with a mortality rate of 39%. Extrapulmonary IA is seen in patients with neutropenia, sepsis, inflammatory conditions, and immunosuppression. Patients who undergo surgery are more likely to survive this infection.
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Affiliation(s)
- Suresh Baba Yelika
- Division of Colon and Rectal Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Abhinay Tumati
- Division of Colon and Rectal Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Paula Denoya
- Division of Colon and Rectal Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, New York, USA
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13
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Delayed Diagnosis of a Diffuse Invasive Gastrointestinal Aspergillosis in an Immunocompetent Patient. Case Rep Crit Care 2020; 2020:3601423. [PMID: 32547793 PMCID: PMC7271229 DOI: 10.1155/2020/3601423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022] Open
Abstract
Invasive aspergillosis represents a clinical picture frequently associated with host's immunosuppression which usually involves a high morbidity and mortality. In general, the most frequent fungal entry is the lungs with secondary hematogenous dissemination, but there are other hypotheses like a gastrointestinal portal of entry. There are some rare publications of cases with invasive aspergillosis in immunocompetent patients. We present the case of an immunocompetent patient without any risk factors except for age, ICU stay, and surgical intervention, who developed a septic shock by invasive gastrointestinal aspergillosis as primary infection. Due to the unusualness of the case, despite all the measures taken, the results were obtained postmortem. We want to emphasize the need not to underestimate the possibility for an invasive aspergillosis in an immunocompetent patient. Not only pulmonary but also gastrointestinal aspergillosis should be taken into account in the differential diagnosis to avoid a delay of treatment.
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Long Y, Liu L, Tang X. Acute isolated appendicitis caused by aspergillus in a patient suffering from severe aplastic anemia. Med Clin (Barc) 2020; 156:144-146. [PMID: 32089339 DOI: 10.1016/j.medcli.2019.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/08/2019] [Accepted: 10/24/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Yaoying Long
- Department of Hematopathology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Lin Liu
- Department of Hematopathology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Xiaoqiong Tang
- Department of Hematopathology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China.
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Kennes S, Van de Putte D, Van Dorpe J, Van Hende V, Kerre T, Vlummens P. Primary intestinal aspergillosis resulting in acute intestinal volvulus after autologous stem cell transplantation in a patient with relapsed non-Hodgkin lymphoma: report on a rare infectious complication and a review of the literature. Acta Clin Belg 2019; 74:359-363. [PMID: 30238855 DOI: 10.1080/17843286.2018.1522018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: Since primary intestinal aspergillosis is a severe infectious complication with a high morbidity and mortality in immunocompromised patients, we want to draw attention to this rare entity and the importance of early recognition. Methods: We report a case of documented primary intestinal aspergillosis in a patient receiving an autologous stem cell transplantation (SCT). Furthermore, this article gives a short reflection on the occurrence of invasive aspergillosis in autologous SCT and the value of serum galactomannan levels based on literature search and linked with the case. Results: In this case the patient presented on day +8 after autologous SCT for a relapsed diffuse large B-cell lymphoma with an acute abdomen with urgent need for surgical intervention. Biopsy revealed the presence of fungal colonies due to aspergillosis and voriconazole was started. Until that day the systematically taken serum galactomannan tests were all negative or pending. Initially there was some resistance to perform surgery in the presence of neutropenia and thrombocytopenia but in the end it provided the definitive diagnosis and should not be delayed. Until now this patient is in good health and retains a complete remission. Conclusion: With this case, we would like to emphasize that early recognition of primary intestinal aspergillosis is of the utmost importance as it is a rare but serious infectious complication. It should be included in the differential diagnosis of neutropenic patients with sudden onset abdominal pain and ongoing fever, even in the absence of a positive serum galactomannan.
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Affiliation(s)
- Soetkin Kennes
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - Dirk Van de Putte
- Department of Gastro-Intestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | | | - Tessa Kerre
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - Philip Vlummens
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
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16
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Food pollution: a comprehensive review of chemical and biological sources of food contamination and impact on human health. ACTA ACUST UNITED AC 2019. [DOI: 10.1186/s41110-019-0096-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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Kulkarni AA, Aruni A, Rastogi P, Rana S, Gupta R. Invasive aspergillosis causing gastric necrosis and perforation: A case report. JGH OPEN 2019; 4:90-93. [PMID: 32055703 PMCID: PMC7008170 DOI: 10.1002/jgh3.12157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 11/29/2022]
Abstract
Aspergillosis is an opportunistic infection commonly seen in immunocompromised patients. Patients with hematological malignancies, postorgan transplantation, or those with comorbid conditions are susceptible to the development of invasive aspergillosis. Lungs are the main portal of entry and are thus most commonly involved. Aspergillosis can involve the gut, causing vascular thrombosis leading to ischemia and necrosis of the gut wall, resulting in perforation. Primary gastric involvement has been rarely seen, with few case reports in the literature. We report a rare case of primary invasive gastric aspergillosis in a 60‐year‐old diabetic and cirrhotic woman, who presented with clinical features of perforation peritonitis. Exploratory laparotomy was performed, and a 6 cm × 6 cm perforation with necrotizing inflammation was found in the distal stomach, pylorus, and duodenum. Distal gastrectomy with Billroth II reconstruction was performed. Pathology demonstrated septate fungal hyphae invading the gastric wall transmurally. The morphology was compatible with those of Aspergillus spp. Liposomal amphotericin B was started immediately after surgery based on the presence of unusually large areas of necrosis and perforation with blackish exudate covering the ulcer base. Unfortunately, the patient succumbed to rapidly progressive fungal septicemia despite early surgical intervention and critical care management. We recommend that any large confluent areas of gastric ulceration and necrosis with blackish exudates in an appropriate setting should evoke suspicion of invasive fungal infection. These patients should be started on prophylactic broadspectrum antifungal therapy immediately, which may be switched over to specific therapy once the diagnosis is confirmed.
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Affiliation(s)
- Aditya Atul Kulkarni
- Division of Surgical Gastroenterology, Department of General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Amaresh Aruni
- Division of Surgical Gastroenterology, Department of General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Pulkit Rastogi
- Department of Histopathology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Surinder Rana
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Rajesh Gupta
- Division of Surgical Gastroenterology, Department of General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
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Guirao-Arrabal E, García-López C, Anguita-Santos F, de la Cruz-Sabido J, Chueca N, Ruíz-Escolano E, Aliaga-Martínez L, Giner-Escobar P, Ceballos-Torres Á. Disseminated aspergillosis in an immunocompetent patient treated with corticosteroids: value of PCR for diagnosis. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2019; 32:273-275. [PMID: 31037931 PMCID: PMC6609944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Affiliation(s)
- Emilio Guirao-Arrabal
- Infectious Diseases Unit. Hospital Universitario San Cecilio. Granada. Spain,Correspondence: Emilio Guirao-Arrabal. Infectious Diseases Unit. Hospital Universitario San Cecilio. Avenida de la Investigación, s/n. 18016 Granada. Spain. E-mail:
| | | | | | | | - Natalia Chueca
- Microbiology Unit. Hospital Universitario San Cecilio. Granada. Spain
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19
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Yedla R, Bala S, Uppin M, Gundeti S. Unusual cause of intestinal perforation during induction chemotherapy in acute myeloid leukemia. JOURNAL OF DR. NTR UNIVERSITY OF HEALTH SCIENCES 2019. [DOI: 10.4103/jdrntruhs.jdrntruhs_82_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Pastrone L, Corsetti MT, Depaoli L, Sampò S, Colonna M, Rocchetti A. An atypical occurrence of Aspergillosis in leukemic patient: Brief description of a clinical case. J Mycol Med 2018; 28:655-658. [DOI: 10.1016/j.mycmed.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/13/2018] [Accepted: 10/05/2018] [Indexed: 11/27/2022]
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21
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Ekowati Y, Ferrero G, Kennedy MD, de Roda Husman AM, Schets FM. Potential transmission pathways of clinically relevant fungi in indoor swimming pool facilities. Int J Hyg Environ Health 2018; 221:1107-1115. [PMID: 30145117 DOI: 10.1016/j.ijheh.2018.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 11/30/2022]
Abstract
Possible transmission pathways of fungi in indoor swimming pool facilities were assessed through fungal counting in different areas of the facilities and typing of the collected fungal isolates. Air, water and surface samples were collected from seven different indoor swimming pool facilities. Fungal species were identified based on their internal transcribed spacer (ITS) sequences. Maximum fungal concentrations of 6.2 CFU/cm2, 1.39 CFU/100 mL, and 202 CFU/m³ were found on surfaces, in water and air, respectively. In total, 458 isolates were obtained, belonging to 111 fungal species, of which 50 species were clinically relevant. Phialophora oxyspora (13.3%) and Trichosporon dohaense (5.0%) were the most frequently isolated species and were merely detected on floors, as were the dermatophytes, Trichophyton interdigitale and T. rubrum. Penicillium spp. and Aspergillus spp. were the dominant fungi in water and air. No typical patterns of fungal concentrations along the preferential pathways of pool visitors were observed, however, sites where pool visitors converge while moving from one room (e.g. dressing room) to another (e.g. shower room) and walking barefoot displayed the highest fungal concentrations thus posing the highest risk of contamination. The dispersal of fungi on floors is most likely facilitated by the pool visitors and cleaning tools. Clinically relevant fungi, including the ones rarely identified in nature, were widely detected on floors, in water and in air, as well as on cleaning tools and flexibeams. Preventive measures such as cleaning should minimize the prevalence of clinically relevant fungi in swimming pool facilities since these potentially pose health risks to those vulnerable for infections.
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Affiliation(s)
- Yuli Ekowati
- IHE Delft Institute for Water Education, Westvest 7, 2611 AX Delft, The Netherlands.
| | - Giuliana Ferrero
- IHE Delft Institute for Water Education, Westvest 7, 2611 AX Delft, The Netherlands
| | - Maria D Kennedy
- IHE Delft Institute for Water Education, Westvest 7, 2611 AX Delft, The Netherlands; Delft University of Technology, Stevinweg 1, 2628 CN Delft, The Netherlands
| | - Ana Maria de Roda Husman
- National Institute for Public Health and the Environment, Centre for Zoonoses and Environmental Microbiology, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; Utrecht University, Faculty of Veterinary Medicine, Institute for Risk Assessment Sciences, Domplein 29, 3512 JE, The Netherlands
| | - Franciska M Schets
- National Institute for Public Health and the Environment, Centre for Zoonoses and Environmental Microbiology, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
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22
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A Rare and Potentially Catastrophic Infection: Primary Intestinal Aspergillosis-Case Report in an HIV Patient. Case Rep Infect Dis 2018; 2018:3269847. [PMID: 30073099 PMCID: PMC6057411 DOI: 10.1155/2018/3269847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/03/2018] [Indexed: 11/18/2022] Open
Abstract
Aspergillus species are ubiquitous in nature; however, infection is uncommon, except in immunocompromised or immunosuppressed hosts. We present the case of a 71-year-old woman with a history of human immunodeficiency virus infection who presented with fever, weight loss, and diarrhea, posteriorly diagnosed with intestinal aspergillosis after examination of a segmental enterectomy piece. The diagnosis was made postmortem once the patient died after fast and progressive deterioration in the postoperative period.
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Review of Appendicitis in Patients With Prolonged Neutropenia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000610] [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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24
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Kamal M, Apewokin S, Anand M, Abu Jawdeh BG, Govil A, Sheikh MM, Shah S. Late-Onset Allograft Aspergillosis in an HIV-Positive Renal Transplant Recipient: A Case Report. Transplant Proc 2018; 49:1570-1573. [PMID: 28838442 DOI: 10.1016/j.transproceed.2017.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/13/2017] [Indexed: 01/11/2023]
Abstract
Aspergillus infection of the allograft in renal transplant patients is rare and associated with a high mortality. We report a case of a 21-year-old, human immunodeficiency virus-positive, deceased-donor kidney recipient who presented 1 year after transplant with oliguric kidney injury. A nuclear medicine renal scan revealed absence of flow to the transplanted kidney, and a urine fungal culture was positive for Aspergillus flavus. The diagnosis was confirmed with the presence of fungal hyphae along with thrombosis in the vascular structures in renal allograft pathology. We found no evidence of disseminated aspergillosis or involvement of any other organ in the patient. To our knowledge, this case is the first reported in the literature of late-onset non-disseminated renal-limited aspergillosis in a human immunodeficiency virus-positive renal transplant patient.
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Affiliation(s)
- M Kamal
- Nephrology and Hypertension, University of Cincinnati, Cincinnati, Ohio.
| | - S Apewokin
- Infectious Disease, University of Cincinnati, Cincinnati, Ohio
| | - M Anand
- Nephrology and Hypertension, University of Cincinnati, Cincinnati, Ohio
| | - B G Abu Jawdeh
- Nephrology and Hypertension, University of Cincinnati, Cincinnati, Ohio
| | - A Govil
- Nephrology and Hypertension, University of Cincinnati, Cincinnati, Ohio
| | - M M Sheikh
- Pulmonary and Critical Care Medicine, University of Cincinnati, Cincinnati, Ohio
| | - S Shah
- Nephrology and Hypertension, University of Cincinnati, Cincinnati, Ohio
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25
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Di Franco G, Tagliaferri E, Pieroni E, Benedetti E, Guadagni S, Palmeri M, Furbetta N, Campani D, Di Candio G, Petrini M, Mosca F, Morelli L. Multiple small bowel perforations due to invasive aspergillosis in a patient with acute myeloid leukemia: case report and a systematic review of the literature. Infection 2018; 46:317-324. [PMID: 29357049 DOI: 10.1007/s15010-018-1115-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 01/16/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Invasive aspergillosis (IA) represents a major cause of morbidity and mortality in immunocompromised patients. Involvement of the gastrointestinal tract by Aspergillus is mostly reported as part of a disseminated infection from a primary pulmonary site and only rarely as an isolated organ infection. METHODS We report a case of small bowel perforation due to IA in a patient with acute leukemia under chemotherapy and pulmonary aspergillosis. We performed a systematic review of the literature as well. RESULTS A 43-year-old man with acute myeloid leukemia under chemotherapy developed severe neutropenia and pulmonary aspergillosis due to Aspergillus flavus. He developed melena and hemodynamic failure and a contrast-enhanced ultrasound scan suggested active intestinal bleeding. During emergency laparotomy we found multiple intestinal abscesses, several perforations of intestinal loop and Aspergillus flavus was isolated from the abscesses. Resection of the jejunum was performed. The patient received voriconazole and finally recovered. The patient is now alive and in complete disease remission. From literature review we found 35 intestinal IA previously published in single case reports or small case series as well. CONCLUSION Clinical manifestations of gastrointestinal aspergillosis are nonspecific, such as abdominal pain, and only occasionally it presents as an acute abdomen. Antemortem detection of bowel involvement is rarely achieved and, only in cases of complicated gastrointestinal aspergillosis, the diagnosis is achieved thanks to the findings during surgery. Gastrointestinal aspergillosis should be suspected in patients with severe and prolonged neutropenia with or without pulmonary involvement in order to consider the right therapy and prompt surgery.
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Affiliation(s)
- Gregorio Di Franco
- General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy
| | - Enrico Tagliaferri
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisa, Pisa, Italy
| | - Erica Pieroni
- General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy
| | | | - Simone Guadagni
- General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy
| | - Matteo Palmeri
- General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy
| | - Niccolò Furbetta
- General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy
| | - Daniela Campani
- Division of Surgical Pathology, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Giulio Di Candio
- General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy
| | | | - Franco Mosca
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy. .,EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy.
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26
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Liver Abscess in Patients With Leukemia and Prolonged Neutropenia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2017. [DOI: 10.1097/ipc.0000000000000478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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27
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Portugal R, Nucci M. Typhlitis (neutropenic enterocolitis) in patients with acute leukemia: a review. Expert Rev Hematol 2017; 10:169-174. [PMID: 28075196 DOI: 10.1080/17474086.2017.1280389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Typhlitis is an abdominal complication of cancer chemotherapy, affecting mostly patients receiving intensive chemotherapeutic regimens with high potential to induce mucosal damage, such as patients with acute leukemia. Despite being relatively frequent, there are no randomized trials or high-quality cohort studies addressing important aspects of the diagnosis and management of the disease. Areas covered: In this review we discuss the gaps in the literature, acknowledging that the evidences for recommendations regarding the management of typhlitis are mostly expert opinion. We performed a computerized search of the MEDLINE database (PubMed version) for appropriate articles published from 1963 through July, 2016 in English language. Thereafter the reference lists of all identified studies were screened, reviewing the abstracts of all potentially pertinent articles for inclusion. Expert commentary: The diagnosis of typhlitis still relies on clinical and radiologic features consisting of fever, abdominal pain and thickness of a segment of the bowel wall, as seen by ultrasonography or CT scan. The treatment consists in antimicrobial therapy with a regimen that covers the most frequent pathogens, taking into consideration the local epidemiology. Other measures include bowel rest, and the use of G-CSF. Surgery is indicated only in selected situations.
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Affiliation(s)
- Rodrigo Portugal
- a Department of Internal Medicine , University Hospital, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Marcio Nucci
- a Department of Internal Medicine , University Hospital, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
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28
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Primary Duodenal Aspergillosis in a Patient With Alcoholic Cirrhosis and Poorly Controlled Diabetes Mellitus. ACG Case Rep J 2016; 3:e147. [PMID: 27847833 PMCID: PMC5104900 DOI: 10.14309/crj.2016.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/11/2016] [Indexed: 11/17/2022] Open
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29
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Cappell MS, Singh D, Sage R, Amin MB. Resolution of Isolated, Aspergillus Colonization in a Deep Esophageal Ulcer in an Immunocompetent Patient with Ulcer Healing Without Specific Antifungal Therapy. Dig Dis Sci 2016; 61:2445-2450. [PMID: 26984119 DOI: 10.1007/s10620-016-4101-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 02/24/2016] [Indexed: 12/09/2022]
Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology and Hepatology, William Beaumont Hospital, MOB #602, 3535 West Thirteen Mile Road, Royal Oak, MI, 48073, USA. .,Division of Gastroenterology and Hepatology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, 48073, USA.
| | - Dupinder Singh
- Division of Gastroenterology and Hepatology, William Beaumont Hospital, MOB #602, 3535 West Thirteen Mile Road, Royal Oak, MI, 48073, USA
| | - Ross Sage
- Division of Gastroenterology and Hepatology, William Beaumont Hospital, MOB #602, 3535 West Thirteen Mile Road, Royal Oak, MI, 48073, USA
| | - Mitual B Amin
- Division of Gastroenterology and Hepatology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, 48073, USA.,Anatomic Pathology, William Beaumont Hospital, Royal Oak, MI, 48073, USA
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30
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Patterson TF, Thompson GR, Denning DW, Fishman JA, Hadley S, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Nguyen MH, Segal BH, Steinbach WJ, Stevens DA, Walsh TJ, Wingard JR, Young JAH, Bennett JE. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 63:e1-e60. [PMID: 27365388 DOI: 10.1093/cid/ciw326] [Citation(s) in RCA: 1635] [Impact Index Per Article: 204.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/11/2016] [Indexed: 12/12/2022] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- Thomas F Patterson
- University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System
| | | | - David W Denning
- National Aspergillosis Centre, University Hospital of South Manchester, University of Manchester, United Kingdom
| | - Jay A Fishman
- Massachusetts General Hospital and Harvard Medical School
| | | | | | | | - Kieren A Marr
- Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Vicki A Morrison
- Hennepin County Medical Center and University of Minnesota, Minneapolis
| | | | - Brahm H Segal
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, and Roswell Park Cancer Institute, New York
| | | | | | - Thomas J Walsh
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York
| | | | | | - John E Bennett
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
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31
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Benedict K, Chiller TM, Mody RK. Invasive Fungal Infections Acquired from Contaminated Food or Nutritional Supplements: A Review of the Literature. Foodborne Pathog Dis 2016; 13:343-9. [PMID: 27074753 DOI: 10.1089/fpd.2015.2108] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Fungi are an integral part of the natural environment and, therefore, play many roles in relation to food: some fungi are used in food production, some are food sources themselves, and some are agents of food spoilage. Some fungi that contaminate food can also be harmful to human health. The harmful but noninfectious health consequences of mycotoxins have been well-characterized, but the extent to which fungi in food pose a risk for invasive infections is unknown. We conducted a literature review to identify cases of invasive fungal infections (IFIs) believed to have resulted from ingestion or inhalation of food, beverages, or dietary supplements (excluding Saccharomyces infections). We identified 11 publications describing cases or small outbreaks of IFIs related to foods or beverages and three describing IFIs related to dietary supplements. These food-associated IFIs were predominantly mold infections, and the few yeast infections were associated with dairy products. Suspected foodborne IFIs appear to be rare, but are increasingly described in the electronically searchable literature. They are associated with a variety of foods, are due to a variety of fungal pathogens, and primarily occur in persons with immunosuppressive conditions or other predisposing factors. Various guidelines for high-risk patients recommend avoidance of certain food products that may contain high levels of fungi, but further work is needed to evaluate the effectiveness of these restrictive diets in preventing fungal infections. The relationships between food spoilage, food insecurity, and IFI risk are another area that may warrant further exploration.
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Affiliation(s)
- Kaitlin Benedict
- Mycotic Diseases Branch, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Tom M Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Rajal K Mody
- Mycotic Diseases Branch, Centers for Disease Control and Prevention , Atlanta, Georgia
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32
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McElvanna K, Loughrey MB, Gillespie S, Gardiner KR. Disseminated aspergillosis causing intestinal failure following colectomy for perforated colitis. Frontline Gastroenterol 2016; 7:110-113. [PMID: 28839844 PMCID: PMC5369472 DOI: 10.1136/flgastro-2014-100463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/02/2014] [Accepted: 07/07/2014] [Indexed: 02/04/2023] Open
Abstract
Disseminated aspergillosis is a rare, invasive, opportunistic, fungal infection associated with a high mortality. We report a non-fatal case diagnosed following extensive enterectomy for intestinal infarction in a patient recovering from emergency abdominal colectomy for perforated ulcerative colitis. This resulted in intestinal failure necessitating life-long parenteral nutrition and prolonged antifungal therapy.
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Affiliation(s)
- Kevin McElvanna
- Department of Colorectal Surgery & Intestinal Failure, Royal Victoria Hospital, Belfast, UK
| | - Maurice B Loughrey
- Department of Histopathology, Royal Victoria Hospital, Belfast Trust,Belfast, UK
| | | | - Keith R Gardiner
- Department of Colorectal Surgery & Intestinal Failure, Royal Victoria Hospital, Belfast, UK
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Gil E, Ha TS, Suh GY, Chung CR, Park CM. Primary Invasive Intestinal Aspergillosis in a Non-Severely Immunocompromised Patient. Korean J Crit Care Med 2016. [DOI: 10.4266/kjccm.2016.31.2.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Eunmi Gil
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sun Ha
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi-Min Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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In-hospital transfer is a risk factor for invasive filamentous fungal infection among hospitalized patients with hematological malignancies: a matched case-control study. Infect Control Hosp Epidemiol 2015; 36:320-8. [PMID: 25695174 DOI: 10.1017/ice.2014.69] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Immunocompromised patients now benefit from a longer life expectancy due to advanced medical techniques, but they are also weakened by aggressive treatment approaches and are at high risk for invasive fungal disease. We determined risk factors associated with an outbreak of invasive filamentous fungal infection (IFFI) among hospitalized hemato-oncological patients. METHODS A retrospective, matched, case-control study was conducted between January 1, 2009, and April 31, 2011, including 29 cases (6 proven, 8 probable, and 15 possible) of IFFI and 102 matched control patients hospitalized during the same time period. Control patients were identified from the hospital electronic database. Conditional logistic regression was performed to identify independent risk factors for IFFI. RESULTS Overall mortality associated with IFFI was 20.7% (8.0%-39.7%). Myelodysplastic syndrome was associated with a higher risk for IFFI compared to chronic hematological malignancies. After adjustment for major risk factors and confounders, >5 patient transfers outside the protected environment of the hematology ward increased the IFFI risk by 6.1-fold. The risk increased by 6.7-fold when transfers were performed during neutropenia. CONCLUSION This IFFI outbreak was characterized by a strong association with exposure to the unprotected environment outside the hematology ward during patient transfer. The independent associations of a high number of transfers with the presence of neutropenia suggest that affected patients were probably not sufficiently protected during transport in the corridors. Our study highlights that a heightened awareness of the need for preventive measures during the entire care process of at-risk patients should be promoted among healthcare workers.
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Effective treatment of invasive Aspergillus fumigatus infection using combinations of topical and systemic antifungals in a severely burned patient. J Burn Care Res 2015; 36:e85-9. [PMID: 25127025 DOI: 10.1097/bcr.0000000000000143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors describe an invasive Aspergillus fumigatus deep-burn wound infection in a severely burned patient that was successfully treated with a combination of topical terbinafine and systemic voriconazole antifungal therapy. To our knowledge, this is the first case report describing the effective control of an invasive deep-burn wound infection using this combination.
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Cha SA, Kim MH, Lim TS, Kim HH, Chang KY, Park HS, Kim HW, Wie SH, Jin DC. Invasive Primary Colonic Aspergillosis in the Immunocompetent Host without Classical Risk Factors. Yonsei Med J 2015; 56:1453-6. [PMID: 26256995 PMCID: PMC4541682 DOI: 10.3349/ymj.2015.56.5.1453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/19/2014] [Accepted: 09/22/2014] [Indexed: 11/27/2022] Open
Abstract
Invasive aspergillosis (IA), generally considered an opportunistic infection in immunocompromised hosts, is associated with high morbidity and mortality. IA commonly occurs in the respiratory tract with isolated reports of aspergillosis infection in the nasal sinuses, central nervous system, skin, liver, and urinary tract. Extra-pulmonary aspergillosis is usually observed in disseminated disease. To date, there are a few studies regarding primary and disseminated gastrointestinal (GI) aspergillosis in immunocompromised hosts. Only a few cases of primary GI aspergillosis in non-immunocompromised hosts have been reported; of these, almost all of them involved the upper GI tract. We describe a very rare case of IA involving the lower GI tract in the patient without classical risk factors that presented as multiple colon perforations and was successfully treated by surgery and antifungal treatment. We also review related literature and discuss the characteristics and risk factors of IA in the immunocompetent hosts without classical risk factors. This case that shows IA should be considered in critically ill patients, and that primary lower GI aspergillosis may also occur in the immunocompetent hosts without classical risk factors.
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Affiliation(s)
- Seon Ah Cha
- Department of Internal Medicine, School of Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
| | - Mi Hee Kim
- Department of Internal Medicine, School of Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
| | - Tae Seok Lim
- Department of Internal Medicine, School of Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
| | - Hyun Ho Kim
- Department of Internal Medicine, School of Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
| | - Kyung Yoon Chang
- Department of Internal Medicine, School of Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
| | - Hoon Suk Park
- Department of Internal Medicine, School of Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea.
| | - Hyung Wook Kim
- Department of Internal Medicine, School of Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
| | - Seong Heon Wie
- Department of Internal Medicine, School of Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
| | - Dong Chan Jin
- Department of Internal Medicine, School of Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
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Seyedmousavi S, Guillot J, Arné P, de Hoog GS, Mouton JW, Melchers WJG, Verweij PE. Aspergillus and aspergilloses in wild and domestic animals: a global health concern with parallels to human disease. Med Mycol 2015; 53:765-97. [PMID: 26316211 DOI: 10.1093/mmy/myv067] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/30/2015] [Indexed: 12/22/2022] Open
Abstract
The importance of aspergillosis in humans and various animal species has increased over the last decades. Aspergillus species are found worldwide in humans and in almost all domestic animals and birds as well as in many wild species, causing a wide range of diseases from localized infections to fatal disseminated diseases, as well as allergic responses to inhaled conidia. Some prevalent forms of animal aspergillosis are invasive fatal infections in sea fan corals, stonebrood mummification in honey bees, pulmonary and air sac infection in birds, mycotic abortion and mammary gland infections in cattle, guttural pouch mycoses in horses, sinonasal infections in dogs and cats, and invasive pulmonary and cerebral infections in marine mammals and nonhuman primates. This article represents a comprehensive overview of the most common infections reported by Aspergillus species and the corresponding diseases in various types of animals.
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Affiliation(s)
- Seyedmojtaba Seyedmousavi
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC, the Netherlands Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, the Netherlands Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jacques Guillot
- Department of Parasitology-Mycology, Dynamyc Research Group, EnvA, UPEC, UPE, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Pascal Arné
- Department of Animal Production, Dynamyc Research Group, EnvA, UPEC, UPE, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - G Sybren de Hoog
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, the Netherlands, Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, the Netherlands, Peking University Health Science Center, Research Center for Medical Mycology, Beijing, China, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China, and King Abdullaziz University, Jeddah, Saudi Arabia
| | - Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC, the Netherlands Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, the Netherlands
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Hadchiti MT, Abdalkader M, Rached L, Mahfoud D, Khoury G, Ghanem H. Disseminated Intra-Abdominal Aspergilloma With Abdominal Wall Invasion in a Patient With Acute Myeloid Leukemia: A Case Report. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15 Suppl:S94-7. [PMID: 26297288 DOI: 10.1016/j.clml.2014.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 12/31/2014] [Accepted: 12/31/2014] [Indexed: 01/03/2023]
Affiliation(s)
| | | | - Linda Rached
- Division of General Surgery, Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), Beirut, Lebanon
| | - Daniel Mahfoud
- Division of Radiology, Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), Beirut, Lebanon
| | - Georges Khoury
- Division of General Surgery, Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), Beirut, Lebanon
| | - Hady Ghanem
- Division of Hematology-Oncology, Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), Beirut, Lebanon.
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Lemmer A, Kia L, Cohen G. A rare esophageal complication after autologous stem cell transplantation. Gastroenterology 2015; 148:717-8. [PMID: 25721449 DOI: 10.1053/j.gastro.2014.12.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/05/2014] [Accepted: 12/29/2014] [Indexed: 12/02/2022]
Affiliation(s)
- Alexander Lemmer
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Leila Kia
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Greg Cohen
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Bizet J, Cooper CJ, Zuckerman MJ, Torabi A, Mendoza-Ladd A. A bleeding colonic ulcer from invasive Aspergillus infection in an immunocompromised patient: a case report. J Med Case Rep 2014; 8:407. [PMID: 25476874 PMCID: PMC4289056 DOI: 10.1186/1752-1947-8-407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 10/26/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Invasive Aspergillus commonly involves the lungs, but can also affect other organs such as the skin, adrenal glands, central nervous system, liver, spleen and the gastrointestinal tract. Gastrointestinal aspergillosis is rare and is most often discovered in immunocompromised patients. There is only one other case report to our knowledge that describes the diagnosis being discovered on histopathological analysis of endoscopic biopsies of necrotic ulcers. CASE PRESENTATION A 36-year-old Hispanic woman presented with septic shock secondary to extensive Fournier gangrene that required multiple surgical debridement of the perineal and retroperitoneal area. Her vital signs on admission were a temperature of 39.4°C and blood pressure of 85/56 mmHg, pulse rate of 108/min and respiratory rate of 25. An examination of the perineum/genital area revealed bilateral gluteal and perilabial edema, erythema and focal areas of necrotic tissue with purulent discharge. Other surgeries included small bowel resections with ileoileal anastomosis that later developed an anastomotic leak that required and diverting end ileostomy. Eleven weeks after admission, our patient developed hematochezia from the colostomy associated with a decrease in hemoglobin and hematocrit to 6.4 g/dL and 20.2% respectively. Colonoscopy through the ostomy revealed blood throughout the colon and a 3 cm necrotic ulcer with an adherent clot in the transverse colon. Biopsies were taken from the edge of the ulcer. Histopathological analysis of the specimen with Grocott's methenamine silver stain revealed septated hyphae with the 45-degree-angle branching that is morphologically consistent with Aspergillus species. Our patient was treated with intravenous voriconazole for 30 days with a prolonged hospitalization but no recurrent bleeding. CONCLUSIONS Gastrointestinal aspergillosis is an unusual presentation of invasive Aspergillus associated with a high mortality rate. Characteristic features of gastrointestinal aspergillosis include invasion of the mesenteric arteries, intravascular thrombosis and subsequent tissue ischemia. Clinical manifestations of invasive Aspergillus of the gastrointestinal tract can include fever, abdominal pain, ileus, peritonitis, bloody diarrhea or hematochezia. In an autopsy series of patients with invasive Aspergillus, 37 of 107 patients had Aspergillus involvement of the gastrointestinal system; the most common pathological findings included ulcers and abscesses. Although rare, invasive aspergillosis may present with gastrointestinal bleeding associated with necrotic ulcers on endoscopic examination.
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Affiliation(s)
| | - Chad J Cooper
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Ave, El Paso, TX 79905, USA.
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Jouvion G, Brock M, Droin-Bergere S, Ibrahim-Granet O. Duality of liver and kidney lesions after systemic infection of immunosuppressed and immunocompetent mice withAspergillus fumigatus. Virulence 2014; 3:43-50. [DOI: 10.4161/viru.3.1.18654] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Reischies F, Hoenigl M. The role of surgical debridement in different clinical manifestations of invasive aspergillosis. Mycoses 2014; 57 Suppl 2:1-14. [PMID: 25186615 DOI: 10.1111/myc.12224] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/30/2014] [Accepted: 07/09/2014] [Indexed: 11/30/2022]
Abstract
Invasive aspergillosis (IA) has a wide spectrum of clinical presentations and is associated with high mortality rates. Early initiation of systemic antimould therapy remains the most important measure to reduce mortality. Surgical debridement is an important additional therapeutic option mainly in cases of extrapulmonary IA. The main intention for surgical intervention in IA is to obtain material for diagnosis and antifungal susceptibility testing. There are, however, also therapeutic implications for surgical interventions in rare manifestation of IA such as endocarditis or mycotic aneurysm. Here, we will review the role of surgical interventions in the treatment of different clinical manifestations of IA.
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Affiliation(s)
- Frederike Reischies
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
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43
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Li E, Hussein H, Todiwala A, Kirby R. Primary gut aspergillosis in a patient with acute myeloid leukaemia: the importance of early suspicion and definitive treatment. BMJ Case Rep 2014; 2014:bcr-2013-202316. [PMID: 24642177 DOI: 10.1136/bcr-2013-202316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aspergillus infection is a known complication in immunocompromised patients, particularly in those with impaired neutrophil function. The pathophysiology of respiratory tract infection and disseminated disease are well understood, and guidelines exist for early detection and treatment. The gut has been speculated to be the potential portal of entry for Aspergillus, though previous case series outline that this is often discovered late and results in high morbidity and mortality. Early clinical suspicion, with definitive surgical intervention and antifungal treatment with voriconazole, can significantly increase the chances of survival. In this article, the authors discuss a case of primary gut aspergillosis with secondary dissemination in a patient with acute myeloid leukaemia who developed serious sequelae.
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Affiliation(s)
- Elizabeth Li
- Department of General Surgery, University Hospital of North Staffordshire, Stoke-on-Trent, UK
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Abstract
PURPOSE OF REVIEW The clinical spectrum of intra-abdominal fungal infections has not been systematically analyzed in the literature. RECENT FINDINGS Even though intra-abdominal fungal infections have been recognized with increasing frequency in the recent years, most clinical experience is limited to case reports or uncontrolled case series. These infections are more common than clinically recognized disease. The clinical presentation varies broadly depending on the organism and host's immune status, but it is frequently severe, difficult to treat, and associated with significant morbimortality. Predisposing factors, clinical characteristics, and advances in the management are discussed. SUMMARY Intra-abdominal fungal infections are increasingly important in clinical practice. Early recognition and a combined treatment approach, usually consisting of surgical intervention and systemic antifungal therapy, are required for improved outcomes.
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Gisi U. Assessment of selection and resistance risk for demethylation inhibitor fungicides in Aspergillus fumigatus in agriculture and medicine: a critical review. PEST MANAGEMENT SCIENCE 2014; 70:352-364. [PMID: 24123539 DOI: 10.1002/ps.3664] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND An increasing number of publications have claimed that demethylation inhibitor (DMI) fungicides are confronted with resistance development in the fungus Aspergillus fumigatus and that the origin of resistant isolates may also be outside the medical area. For resistance risk assessment and sourcing the origin of DMI resistance, the primary exposure events ofA. fumigatus with DMI treatments have been analysed case by case, resulting in the pathogen exposure risk (PER). RESULTS The calculated maximum exposure concentrations (MEC) are highest during medical treatments (human and veterinary), certain fruit and seed treatments and wood preservation, and are much lower for crop protection applications. Most agricultural DMIs are intrinsically ∼10-100 times less active than medical DMIs for A. fumigatus control and potential resistance selection. However, imazalil is used in agriculture and veterinary medicine (as enilconazole) expressing strong intrinsic activity against A. fumigatus. The majority of mutations in the target gene, cyp51, of DMI-resistant isolates are different in A. fumigatus(e.g. TR34/L98H) in comparison with plant pathogens (e.g. A379G, I381V). CONCLUSIONS The assumed selection risk, ASR (MEC × PER) for resistance evolution to DMIs in A. fumigatus is estimated to be highest for human and veterinary applications. However, environmental origin of DMI-resistant spores from certain sites cannot be ruled out.
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Fieber JH, Atladóttir J, Solomon DG, Maerz LL, Reddy V, Mitchell-Richards K, Longo WE. Disseminated enteroinvasive aspergillosis in a critically ill patient without severe immunocompromise. J Surg Case Rep 2013; 2013:rjt091. [PMID: 24968426 PMCID: PMC3853028 DOI: 10.1093/jscr/rjt091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Invasive aspergillosis (IA) is a rapidly progressive and often fatal infectious disease described classically in patients who are highly immunocompromised. However, there has been increasing evidence that IA may affect critically ill patients without traditional risk factors. We present a case of a 47-year-old man without conventional risk factors for IA who presented with impending sepsis and proceeded to have a complicated hospital course with a postmortem diagnosis of invasive gastrointestinal aspergillosis of the small bowel.
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Chasan R, Patel G, Malone A, Finn M, Huprikar S. Primary hepatic aspergillosis following induction chemotherapy for acute leukemia. Transpl Infect Dis 2013; 15:E201-5. [PMID: 24034232 DOI: 10.1111/tid.12127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/17/2013] [Accepted: 06/26/2013] [Indexed: 12/18/2022]
Abstract
Invasive aspergillosis (IA) contributes significantly to the burden of infectious complications in heavily immunosuppressed patients with acute leukemia. The infection is typically acquired via inhalation into the respiratory tract, and the lungs are most commonly involved. However, disseminated disease may occur and reports of isolated extrapulmonary infection suggest the gastrointestinal tract is likely an additional portal of entry for this organism. We describe a case of primary hepatic aspergillosis in a patient with acute myelogenous leukemia. The patient did not respond to medical therapy with antifungals and ultimately required surgical exploration and drainage. IA should be considered in an immunosuppressed patient with hepatic abscesses and may require a combined surgical and medical approach to therapy.
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Affiliation(s)
- R Chasan
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Mora D, Barba P, Ruiz I, Castillo N, Aizpurua M, Roselló E, Bosch F, Valcárcel D. Primary gastrointestinal aspergillosis 6 months after allogeneic hematopoietic cell transplantation: a case report. Transpl Infect Dis 2013; 15:E107-10. [DOI: 10.1111/tid.12082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 12/30/2012] [Accepted: 01/16/2013] [Indexed: 12/01/2022]
Affiliation(s)
- D. Mora
- Department of Hematology; Vall d'Hebron Hospital; Barcelona; Spain
| | - P. Barba
- Department of Hematology; Vall d'Hebron Hospital; Barcelona; Spain
| | - I. Ruiz
- Department of Infectious Diseases; Vall d'Hebron Hospital; Barcelona; Spain
| | - N. Castillo
- Department of Hematology; Vall d'Hebron Hospital; Barcelona; Spain
| | - M. Aizpurua
- Department of Pathology; Vall d'Hebron Hospital; Barcelona; Spain
| | - E. Roselló
- Department of Microbiology; Vall d'Hebron Hospital; Barcelona; Spain
| | - F. Bosch
- Department of Hematology; Vall d'Hebron Hospital; Barcelona; Spain
| | - D. Valcárcel
- Department of Hematology; Vall d'Hebron Hospital; Barcelona; Spain
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Lunde LE, Chuang C, Linden MA, Williams SA, Sachs Z, Cayci Z, Young JAH, Ustun C. Lethal small bowel necrosis due to aspergillosis during acute promyelocytic leukemia induction. Am J Hematol 2013; 88:329-32. [PMID: 22791390 DOI: 10.1002/ajh.23290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 06/04/2012] [Accepted: 06/05/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Laura E. Lunde
- Division of Hematology-Oncology and Transplantation; University of Minnesota; Minneapolis Minnesota
- Department of Medicine; University of Minnesota; Minneapolis Minnesota
| | - Charles Chuang
- Department of Medicine; University of Minnesota; Minneapolis Minnesota
| | - Michael A. Linden
- Divison of Hematopathology; Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis Minnesota
| | - Sarah A. Williams
- Divison of Hematopathology; Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis Minnesota
| | - Zohar Sachs
- Division of Hematology-Oncology and Transplantation; University of Minnesota; Minneapolis Minnesota
- Department of Medicine; University of Minnesota; Minneapolis Minnesota
| | - Zuzan Cayci
- Department of Radiology; University of Minnesota; Minneapolis Minnesota
| | - Jo-Anne H. Young
- Department of Medicine; University of Minnesota; Minneapolis Minnesota
- Division of Infectious Disease; Department of Medicine; University of Minnesota; Minneapolis Minnesota
| | - Celalettin Ustun
- Division of Hematology-Oncology and Transplantation; University of Minnesota; Minneapolis Minnesota
- Department of Medicine; University of Minnesota; Minneapolis Minnesota
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50
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Disseminated Aspergillosis due to Aspergillus niger in Immunocompetent Patient: A Case Report. Case Rep Infect Dis 2013; 2013:385190. [PMID: 23533852 PMCID: PMC3600237 DOI: 10.1155/2013/385190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/31/2013] [Indexed: 11/18/2022] Open
Abstract
Invasive aspergillosis is a major cause of morbidity and mortality in immunocompromised patients. Many cases of pulmonary, cutaneous, cerebral, and paranasal sinus aspergillosis in immunocompetent patient were defined in literature but disseminated aspergillosis is very rare. Here we present an immunocompetent case with extrapulmonary disseminated aspergillosis due to Aspergillus niger, totally recovered after effective antifungal treatment with voriconazole.
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