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Jirawat N, Leelayuwatanakul N. Unusual manifestation of pulmonary Verruconis gallopava infection with synchronous reactive pericardial effusion in a non-transplanted patient. BMJ Case Rep 2023; 16:e251835. [PMID: 37474138 PMCID: PMC10360439 DOI: 10.1136/bcr-2022-251835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Verruconis gallopava is an emerging causative agent in solid organ transplant patients, increasing in prevalence both in non-transplanted patients and also in immunocompetent ones, albeit rarely. In this case report, we describe an unusual V. gallopava infection in a patient with steroid-dependent autoimmune haemolytic anaemia. The chest CT scan revealed a mass-like consolidation in the superior segment of the right lower lobe, and bronchoscopic examination confirmed V. gallopava from bronchoalveolar lavage. The histopathology showed non-necrotising granulomatous inflammation concurrent with septate-pigmented hyphae, which is compatible with dematiaceous fungi. After 3 weeks of posaconazole treatment, the patient developed a new pericardial effusion. Further investigations, including culture, cytology and histopathology, yielded negative results, leading to suspicion of reactive pericardial effusion associated with V. gallopava pulmonary infection. The patient received antifungal therapy for 9 months, after which a follow-up chest CT scan showed complete resolution of consolidation and pericardial effusion.
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Affiliation(s)
- Napat Jirawat
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nophol Leelayuwatanakul
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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2
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Moran C, Delafield NL, Kenny G, Asbury KL, Larsen BT, Lambert KL, Patron RL. A case ofVerruconis gallopavainfection in a heart transplant recipient successfully treated with posaconazole. Transpl Infect Dis 2019; 21:e13044. [DOI: 10.1111/tid.13044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/06/2018] [Accepted: 12/16/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Conor Moran
- Department of Medicine Mater Misericordiae University Hospital Dublin Ireland
| | | | - Grace Kenny
- Department of Medicine Mater Misericordiae University Hospital Dublin Ireland
| | - Kara L. Asbury
- Division of Infectious Diseases Mayo Clinic Hospital Phoenix Arizona
| | - Brandon T. Larsen
- Department of Laboratory Medicine and Pathology Mayo Clinic Scottsdale Arizona
| | - Karen L. Lambert
- Department of Laboratory Medicine and Pathology Mayo Clinic Hospital Phoenix Arizona
| | - Roberto L. Patron
- Division of Infectious Diseases Mayo Clinic Hospital Phoenix Arizona
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3
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Ochroconis gallopava bronchitis mimicking haemoptysis in a patient with bronchiectasis. Respir Med Case Rep 2017; 22:215-217. [PMID: 28884072 PMCID: PMC5581866 DOI: 10.1016/j.rmcr.2017.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/21/2022] Open
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4
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Douglas AP, Chen SCA, Slavin MA. Emerging infections caused by non-Aspergillus filamentous fungi. Clin Microbiol Infect 2016; 22:670-80. [PMID: 26812445 DOI: 10.1016/j.cmi.2016.01.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/02/2016] [Accepted: 01/09/2016] [Indexed: 12/25/2022]
Abstract
There are three broad groups of non-Aspergillus moulds: the mucormycetes, the hyalohyphomycetes and the phaeohyphomycetes. Infections with these pathogens are increasingly reported, particularly in the context of increasing use of immunosuppressant agents and improved diagnostics. The epidemiology of non-Aspergillus mould infections varies with geography, climate and level of immunosuppression. Skin and soft-tissue infections are the predominant presentation in the immunocompetent host and pulmonary and other invasive infections in the immunocompromised host. The more common non-Aspergillus moulds include Rhizopus, Mucor, Fusarium and Scedosporium species; however, other emerging pathogens are Rasamsonia and Verruconis species, which are discussed in this article. Outbreaks of non-Aspergillus mould infections have been increasingly reported, with contaminated medical supplies and natural disasters as common sources. Currently culture and other conventional diagnostic methods are the cornerstone of diagnosis. Molecular methods to directly detect and identify mould pathogens in tissue and body fluids are increasingly used.
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Affiliation(s)
- A P Douglas
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - S C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, University of Sydney, New South Wales, Australia
| | - M A Slavin
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
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5
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Chowdhary A, Perfect J, de Hoog GS. Black Molds and Melanized Yeasts Pathogenic to Humans. Cold Spring Harb Perspect Med 2014; 5:a019570. [PMID: 25384772 DOI: 10.1101/cshperspect.a019570] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A review is given of melanized fungi involved in human infection, including species forming budding cells and strictly filamentous representatives. Classically, they are known as "phaeoid" or "dematiaceous" fungi, and, today, agents are recognized to belong to seven orders of fungi, of which the Chaetothyriales and Pleosporales are the most important. Infections range from cutaneous or pulmonary colonization to systemic or disseminated invasion. Subcutaneous involvement, either primary or after dissemination, may lead to host tissue proliferation of dermis or epidermis. Particularly in the Chaetothyriales, subcutaneous and systemic infections may occur in otherwise apparently healthy individuals. Infections are mostly chronic and require extended antifungal therapy and/or surgery.
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Affiliation(s)
- Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India
| | - John Perfect
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center Durham, North Carolina 27710
| | - G Sybren de Hoog
- CBS-KNAW Fungal Biodiversity Centre, 3508 AD Utrecht, The Netherlands
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6
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Kaur H, Rudramurthy SM, Mohindra S, Gupta S, Chakrabarti A. Ochroconis humicola coexisting with esthesioneuroblastoma: an incidental coloniser or allergen? Mycopathologia 2014; 178:79-83. [PMID: 24952014 DOI: 10.1007/s11046-014-9759-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
Abstract
Ochroconis humicola, a fish pathogen, is rarely reported to cause disease in human. We report its first isolation from nasal tissue of a human immunodeficiency virus-positive young female patient. Histopathologically, the nasal mass was diagnosed as esthesioneuroblastoma. She presented with right-sided nasal obstruction and bleeding for two and half months. Computed tomography scan showed the nasal mass filling the whole right nasal cavity, maxillary, ethmoid and sphenoid sinuses. The direct microscopy of the nasal tissue and mucin demonstrated the presence of septate hyphae. On culture, O. humicola was isolated from the same tissue and the fungus was identified by morphologic, physiologic and molecular data including sequencing of ITS and 28S rDNA regions. No antifungal was prescribed, and the whole mass was resected out by endoscopic surgery. The patient was treated further by radical radiotherapy. After 1 year of follow-up, patient is stable with no recurrence of tumour. The role of this fungus was not clear, as it may be bystander or producing allergic fungal rhinosinusitis.
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Affiliation(s)
- Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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7
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Chowdhary A, Meis J, Guarro J, de Hoog G, Kathuria S, Arendrup M, Arikan-Akdagli S, Akova M, Boekhout T, Caira M, Guinea J, Chakrabarti A, Dannaoui E, van Diepeningen A, Freiberger T, Groll A, Hope W, Johnson E, Lackner M, Lagrou K, Lanternier F, Lass-Flörl C, Lortholary O, Meletiadis J, Muñoz P, Pagano L, Petrikkos G, Richardson M, Roilides E, Skiada A, Tortorano A, Ullmann A, Verweij P, Cornely O, Cuenca-Estrella M. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi. Clin Microbiol Infect 2014; 20 Suppl 3:47-75. [DOI: 10.1111/1469-0691.12515] [Citation(s) in RCA: 216] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 12/13/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022]
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8
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Antifungal susceptibility patterns of opportunistic fungi in the genera Verruconis and Ochroconis. Antimicrob Agents Chemother 2014; 58:3285-92. [PMID: 24687495 DOI: 10.1128/aac.00002-14] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Species of Verruconis and species of Ochroconis are dematiaceous fungi generally found in the environment but having the ability to infect humans, dogs, cats, poultry, and fish. This study presents the antifungal susceptibility patterns of these fungi at the species level. Forty strains originating from clinical and environmental sources were phylogenetically identified at the species level by using sequences of the ribosomal DNA internal transcribed spacer (rDNA ITS). In vitro antifungal susceptibility testing was performed against eight antifungals, using the Clinical and Laboratory Standards Institute (CLSI) broth microdilution method. The geometric mean MICs for amphotericin B (AMB), flucytosine (5FC), fluconazole (FLC), itraconazole (ITC), voriconazole (VRC), and posaconazole (POS) and minimum effective concentrations (MECs) for caspofungin (CAS) and anidulafungin (AFG) across the Ochroconis and Verruconis species were as follows, in increasing order. For Verruconis species, the values (μg/ml) were as follows: AFG, 0.04; POS, 0.25; ITC, 0.37; AMB, 0.50; CAS, 0.65; VRC, 0.96; 5FC, 10.45; and FLC, 47.25. For Ochroconis species, the values (μg/ml) were as follows: AFG, 0.06; POS, 0.11; CAS, 0.67; VRC, 2.76; ITC, 3.94; AMB, 5.68; 5FC, 34.48; and FLC, 61.33. Antifungal susceptibility of Ochroconis and Verruconis was linked with phylogenetic distance and thermotolerance. Echinocandins and POS showed the greatest in vitro activity, providing possible treatment options for Ochroconis and Verruconis infections.
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Samerpitak K, Van der Linde E, Choi HJ, Gerrits van den Ende AHG, Machouart M, Gueidan C, de Hoog GS. Taxonomy of Ochroconis, genus including opportunistic pathogens on humans and animals. FUNGAL DIVERS 2013. [DOI: 10.1007/s13225-013-0253-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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10
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Kumaran MS, Bhagwan S, Savio J, Rudramurthy SM, Chakrabarti A, Tirumalae R, Abraham A. Disseminated cutaneousOchroconis gallopavainfection in an immunocompetent host: an unusual concurrence - a case report and review of cases reported. Int J Dermatol 2013; 54:327-31. [DOI: 10.1111/j.1365-4632.2012.05841.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Shuba Bhagwan
- Department of Dermatology; St Johns Medical College Hospital; Bangalore India
| | - Jayanthi Savio
- Department of Microbiology; St Johns Medical College Hospital; Bangalore India
| | | | | | | | - Anil Abraham
- Department of Dermatology; St Johns Medical College Hospital; Bangalore India
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11
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Meriden Z, Marr KA, Lederman HM, Illei PB, Villa K, Riedel S, Carroll KC, Zhang SX. Ochroconis gallopavainfection in a patient with chronic granulomatous disease: case report and review of the literature. Med Mycol 2012; 50:883-9. [DOI: 10.3109/13693786.2012.681075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Qureshi ZA, Kwak EJ, Nguyen MH, Silveira FP. Ochroconis gallopava: a dematiaceous mold causing infections in transplant recipients. Clin Transplant 2011; 26:E17-23. [DOI: 10.1111/j.1399-0012.2011.01528.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Hollingsworth JW, Shofer S, Zaas A. Successful treatment of Ochroconis gallopavum infection in an immunocompetent host. Infection 2007; 35:367-9. [PMID: 17710372 DOI: 10.1007/s15010-007-6054-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Accepted: 12/21/2006] [Indexed: 10/22/2022]
Abstract
Ochroconis gallopavum, a dematiaceous fungus, is a rare cause disease in immunocompromised patients and epidemic encephalitis in poultry. We report the first case of active O. gallopavum pulmonary infection in an immunocompetent host with rapid and complete response to oral antifungal therapy.
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Affiliation(s)
- J W Hollingsworth
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Box 3136, Durham, NC 27710, USA.
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14
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Yarita K, Sano A, Murata Y, Takayama A, Takahashi Y, Takahashi H, Yaguchi T, Ohori A, Kamei K, Miyaji M, Nishimura K. Pathogenicity of Ochroconis gallopava isolated from hot springs in Japan and a review of published reports. Mycopathologia 2007; 164:135-47. [PMID: 17594533 DOI: 10.1007/s11046-007-9034-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 06/05/2007] [Indexed: 11/25/2022]
Abstract
Four strains of Ochroconis gallopava from 3 out of 15 Japanese hot springs were isolated. Colonies of the hot spring isolates were uniformly floccose and dark olive green on the surface and dark brown on their reverse side on potato dextrose agar (PDA) plates, however, they became felty, flat, and brownish-black, and produced a reddish-brown pigment after several times of subculture at room temperature. Shapes and sizes of conidia of the four strains were individual, while the D1/D2 domain of the large subunit ribosomal RNA gene sequences showed 99.7% identity in the GenBank database. The DNA pattern of the hot spring isolates amplified by species specific loop mediated isothermal amplification method were as the same pattern as that of a clinical isolate. The minimum inhibitory concentrations of antifungal agents to O. gallopava isolated from the hot springs were ranged from 0.5 to 1 microg/ml in amphotericin B, 1 to 16 microg/ml in flucytosine, 0.125 to 0.25 microg/ml in itraconazole, 1 to 4 microg/ml in miconazole, 16 to 64 microg/ml in flconazole and 0.03 to 0.5 microg/ml in micafungin. The isolates had fatal outcome in experimentally infected mice intravenously with severe invasiveness to brains and kidneys. These findings suggested that O. gallopava habitats in hot springs could be one of sources for infection.
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Affiliation(s)
- Kyoko Yarita
- Research Center for Pathogenic Fungi and Microbial Toxicoses, Chiba University, 1-8-1, Inohana, Chuo-ku, Japan
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15
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Boggild AK, Poutanen SM, Mohan S, Ostrowski MA. Disseminated phaeohyphomycosis due toOchroconis gallopavumin the setting of advanced HIV infection. Med Mycol 2006; 44:777-82. [PMID: 17127636 DOI: 10.1080/13693780600900098] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Disseminated phaeohyphomycosis is a rare and typically fatal infection caused by members of the dematiaceous fungi, and occurs almost universally in the setting of immunocompromise. We herein report a case of systemic phaeohyphomycosis caused by Ochroconis gallopavum in a patient with advanced HIV disease. A possible risk factor for this infection in our patient was heavy marijuana use. This case highlights both the diagnostic and management challenges posed by these infections. To our knowledge, this is the first reported case of disseminated phaeohyphomycosis due to Ochroconis gallopavum in a patient with HIV.
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Affiliation(s)
- Andrea K Boggild
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada.
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16
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Abstract
Although species of Aspergillus and Candida account for most deeply invasive and life-threatening fungal infections, the past decades have seen a rise in the immunocompromised population. With this increase, additional fungi have emerged as important agents of morbidity and mortality. These opportunistic fungi are characterized by their ubiquitous presence in the environment, their ability to cause disease in immunosuppressed patients, and their diminished susceptibility to the currently available antifungal agents. Pneumonia, one aspect of a myriad of clinical manifestations caused by these fungal pathogens, is discussed in this article.
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Affiliation(s)
- Sylvia F Costa
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
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17
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Fukushima N, Mannen K, Okamoto S, Shinogi T, Nishimoto K, Sueoka E. Disseminated Ochroconis gallopavum infection in a chronic lymphocytic leukemia: a case report and review of the literature on hematological malignancies. Intern Med 2005; 44:879-82. [PMID: 16157992 DOI: 10.2169/internalmedicine.44.879] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Disseminated fungal infection is an important cause of morbidity and mortality among patients with hematological malignancies. Ochroconis gallopavum is a dematiaceous and thermotolerant fungus that causes opportunistic infections in immunocompromised hosts. About only 30 cases of this organism infection have been reported worldwide. We report a disseminated Ochroconis gallopavum infection in a B-cell chronic lymphocytic leukemia patient. In spite of intensive anti-fungal treatment, no improvement in the clinical condition was observed and the patient died 4 months after diagnosis of the infection. Ochroconis gallopavum infection is a potentially fatal disease in hematological malignancies.
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Affiliation(s)
- Noriyasu Fukushima
- Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
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18
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Malani PN, Bleicher JJ, Kauffman CA, Davenport DS. Disseminated Dactylaria constricta infection in a renal transplant recipient. Transpl Infect Dis 2001; 3:40-3. [PMID: 11429039 DOI: 10.1034/j.1399-3062.2001.003001040.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report the case of a 32-year-old renal transplant recipient who developed disseminated Dactylaria constricta infection. The patient died despite treatment with amphotericin B, itraconazole, and fluconazole.
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Affiliation(s)
- P N Malani
- Division of Infectious Diseases, Department of Internal Medicine, Veterans Affairs Healthcare System, University of Michigan Medical School, Ann Arbor, Michigan 48105, USA
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19
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Gilleece AC, Fenelon L. Unusual infections and novel therapy in the immunocompromised host. Curr Opin Infect Dis 1999; 12:379-83. [PMID: 17035803 DOI: 10.1097/00001432-199908000-00012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many of the reports of infection in immunocompromised patients over the past year have been caused by unusual bacterial pathogens or fungi, which are often multiresistant and difficult to treat. Although many difficulties still remain some progress has been made over the past year in the development of new antimicrobial agents and alternative therapies.
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Affiliation(s)
- A C Gilleece
- Department of Microbiology, St Vincents Hospital, Dublin, Ireland.
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