1
|
Montreuil N, Martinez A, Budrie L, Goyal S, Quiroz T, Vu C, Ayoade F, Sternberg CA. Aspergillus fumigatus Epidural Abscess and Postsurgical Wound Infection in an Immunocompetent Host. Case Rep Infect Dis 2024; 2024:8104167. [PMID: 38455724 PMCID: PMC10919981 DOI: 10.1155/2024/8104167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/09/2024] Open
Abstract
In this case, we present an immunocompetent patient who had a wound infection secondary to Aspergillus fumigatus after undergoing a neurosurgical procedure that was complicated by an epidural abscess. The patient was treated with voriconazole and responded favorably. We highlight the need for awareness of the possibility of an Aspergillus infection in people without any obvious immunocompromise and advocate for the inclusion of this opportunistic fungus in the workup of postneurosurgical infections and dura-based collections. A brief review of relevant literature is also included.
Collapse
Affiliation(s)
| | | | - Leon Budrie
- Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | | | |
Collapse
|
2
|
Thompson GR, Jenks JD, Baddley JW, Lewis JS, Egger M, Schwartz IS, Boyer J, Patterson TF, Chen SCA, Pappas PG, Hoenigl M. Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management. Clin Microbiol Rev 2023; 36:e0001923. [PMID: 37439685 PMCID: PMC10512793 DOI: 10.1128/cmr.00019-23] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Fungal endocarditis accounts for 1% to 3% of all infective endocarditis cases, is associated with high morbidity and mortality (>70%), and presents numerous challenges during clinical care. Candida spp. are the most common causes of fungal endocarditis, implicated in over 50% of cases, followed by Aspergillus and Histoplasma spp. Important risk factors for fungal endocarditis include prosthetic valves, prior heart surgery, and injection drug use. The signs and symptoms of fungal endocarditis are nonspecific, and a high degree of clinical suspicion coupled with the judicious use of diagnostic tests is required for diagnosis. In addition to microbiological diagnostics (e.g., blood culture for Candida spp. or galactomannan testing and PCR for Aspergillus spp.), echocardiography remains critical for evaluation of potential infective endocarditis, although radionuclide imaging modalities such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography are increasingly being used. A multimodal treatment approach is necessary: surgery is usually required and should be accompanied by long-term systemic antifungal therapy, such as echinocandin therapy for Candida endocarditis or voriconazole therapy for Aspergillus endocarditis.
Collapse
Affiliation(s)
- George R. Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis Medical Center, Sacramento, California, USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA
| | - Jeffrey D. Jenks
- Durham County Department of Public Health, Durham, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - John W. Baddley
- Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James S. Lewis
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
| | - Matthias Egger
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Johannes Boyer
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Thomas F. Patterson
- Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center, San Antonio, Texas, USA
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter G. Pappas
- Department of Medicine Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| |
Collapse
|
3
|
Ichikawa H, Doi R, Matsumoto K, Tomoshige K, Hirabaru M, Machino R, Obata T, Mizoguchi S, Irie J, Tsuchiya T, Nagayasu T. Spontaneous pleural aspergillosis in an immunocompetent young adult treated with minimally invasive surgery. Respir Med Case Rep 2023; 44:101869. [PMID: 37229483 PMCID: PMC10203767 DOI: 10.1016/j.rmcr.2023.101869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
Spontaneous cases of pleural aspergillosis in healthy adults are rare, and the optimal therapeutic approach has not been established. Here we report a rare case of spontaneous pleural aspergillosis in an otherwise healthy young adult. Two-stage surgery with decortication and cavernostomy, followed by systemic antifungal therapy, finally resulted in a successful resolution of his empyema without any serious complications. In young patients with good pulmonary compliance, less invasive procedures, such as thoracoscopic decortication and/or carvernotomy, is a potential treatment option.
Collapse
Affiliation(s)
- Hiromi Ichikawa
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Ryoichiro Doi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Koichi Tomoshige
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Masataka Hirabaru
- Department of Respiratory Surgery, Nagasaki Harbor Medical Center, Shinchi-machi 6-39, Nagasaki, 850-0842, Japan
| | - Ryusuke Machino
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Tomohiro Obata
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Satoshi Mizoguchi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| | - Junji Irie
- Department of Pathology, Nagasaki Harbor Medical Center, Shinchi-machi 6-39, Nagasaki, 850-0842, Japan
| | - Tomoshi Tsuchiya
- Department of Thoracic General Surgery, Toyama University Hospital, Sugitani 2630, Toyama, 930-0194, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 852-8102, Japan
| |
Collapse
|
4
|
Stemler J, Többen C, Lass-Flörl C, Steinmann J, Ackermann K, Rath PM, Simon M, Cornely OA, Koehler P. Diagnosis and Treatment of Invasive Aspergillosis Caused by Non- fumigatus Aspergillus spp. J Fungi (Basel) 2023; 9:jof9040500. [PMID: 37108955 PMCID: PMC10141595 DOI: 10.3390/jof9040500] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
With increasing frequency, clinical and laboratory-based mycologists are consulted on invasive fungal diseases caused by rare fungal species. This review aims to give an overview of the management of invasive aspergillosis (IA) caused by non-fumigatus Aspergillus spp.-namely A. flavus, A. terreus, A. niger and A. nidulans-including diagnostic and therapeutic differences and similarities to A. fumigatus. A. flavus is the second most common Aspergillus spp. isolated in patients with IA and the predominant species in subtropical regions. Treatment is complicated by its intrinsic resistance against amphotericin B (AmB) and high minimum inhibitory concentrations (MIC) for voriconazole. A. nidulans has been frequently isolated in patients with long-term immunosuppression, mostly in patients with primary immunodeficiencies such as chronic granulomatous disease. It has been reported to disseminate more often than other Aspergillus spp. Innate resistance against AmB has been suggested but not yet proven, while MICs seem to be elevated. A. niger is more frequently reported in less severe infections such as otomycosis. Triazoles exhibit varying MICs and are therefore not strictly recommended as first-line treatment for IA caused by A. niger, while patient outcome seems to be more favorable when compared to IA due to other Aspergillus species. A. terreus-related infections have been reported increasingly as the cause of acute and chronic aspergillosis. A recent prospective international multicenter surveillance study showed Spain, Austria, and Israel to be the countries with the highest density of A. terreus species complex isolates collected. This species complex seems to cause dissemination more often and is intrinsically resistant to AmB. Non-fumigatus aspergillosis is difficult to manage due to complex patient histories, varying infection sites and potential intrinsic resistances to antifungals. Future investigational efforts should aim at amplifying the knowledge on specific diagnostic measures and their on-site availability, as well as defining optimal treatment strategies and outcomes of non-fumigatus aspergillosis.
Collapse
Affiliation(s)
- Jannik Stemler
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50923 Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, 50923 Cologne, Germany
| | - Christina Többen
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50923 Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, 50923 Cologne, Germany
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, European Diamond Excellence Center for Medical Mycology (ECMM), Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Jörg Steinmann
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Klinikum Nürnberg, 90419 Nuremberg, Germany
- Institute of Medical Microbiology, University Hospital Essen, European Diamond Excellence Center for Medical Mycology (ECMM), 45147 Essen, Germany
| | - Katharina Ackermann
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Klinikum Nürnberg, 90419 Nuremberg, Germany
| | - Peter-Michael Rath
- Institute of Medical Microbiology, University Hospital Essen, European Diamond Excellence Center for Medical Mycology (ECMM), 45147 Essen, Germany
| | - Michaela Simon
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
| | - Oliver Andreas Cornely
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50923 Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, 50923 Cologne, Germany
- Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, 50935 Cologne, Germany
| | - Philipp Koehler
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50923 Cologne, Germany
| |
Collapse
|
5
|
Alquraish FA, AlQattan AS, Al-Shammari T. Surgical site invasive aspergillosis in immunocompetent patient secondary to Kramericeae herb: Case report. Int J Surg Case Rep 2023; 105:108026. [PMID: 36996711 PMCID: PMC10070630 DOI: 10.1016/j.ijscr.2023.108026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/12/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Surgical site infection results in an increased morbidity and length of stay. This poses a great economic burden to society and remains a challenge in the surgical field surgery. In the recent years, there has been great attention in modalities to avert such complications. Primary cutaneous infection with aspergillosis is rare entity in immune competent patient. CASE PRESENTATION We report a rare cause of surgical site infection with invasive aspergillosis in immunocompetent patient secondary to Kramericeae herb. We describe the wound which was noted to be offensive with production of a tar like and golden green slough material, which lack clinical improvement despite aggressive surgical debridement and the use multiple broad-spectrum antibiotics. CLINICAL DISCUSSION Post-operative wound infection with aspergillosis has been reported in literature related to patient and environmental factors; immunocompromised patient and contamination of ventilation system. Poor response to conventional measures in treating wound complication should alert surgeons to anticipate unusual fungal wound infection. Mortality due to aspergillus infection wound is highest in patient with solid organ transplant. However, it is uncommon that it can lead to septic shock and death in immunocompetent patients. CONCLUSION Post-operative wound infection with fungi seems to be less anticipated cause in immunocompetent patient. To improve outcome better awareness of the wound characteristics and clinical course. Furthermore, a better control by local authorities of non-controlled "herbal medicines" sellers in terms of routines checks of their products to ensure their health safety.
Collapse
|
6
|
Tebbi CK. Mycoviruses in Fungi: Carcinogenesis of Fungal Agents May Not Always Be Mycotoxin Related. J Fungi (Basel) 2023; 9:jof9030368. [PMID: 36983536 PMCID: PMC10052198 DOI: 10.3390/jof9030368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
Certain viruses have been found to induce diverse biological pathways to carcinogenesis, evidenced by the presence of viral gene products in some tumors. Despite the fact that many fungal agents contain mycoviruses, until recently, their possible direct effects on human health, including carcinogenesis and leukemogenesis, had not been explored. In this regard, most studies of fungal agents have rightly concentrated on their mycotoxin formation and effects. Recently, the direct role of yeasts and fungi in the etiology of cancers, including leukemia, have been investigated. While greater attention has been placed on the carcinogenic effects of Candida, the role of filamentous fungi in carcinogenesis has also been explored. Recent findings from studies using the enzyme-linked immunosorbent assay (ELISA) technique indicate that the plasma of patients with acute lymphoblastic leukemia (ALL) uniformly contains antibodies for a certain mycovirus-containing Aspergillus flavus, while controls are negative. The exposure of mononuclear leukocytes from patients with ALL in full remission, and long-term survivors, to the product of this organism was reported to result in the re-development of typical genetics and cell surface phenotypes characteristic of active ALL. Mycoviruses are known to be able to significantly alter the biological characteristics and functions of their host. The possible carcinogenic and leukemogenic role of mycoviruses, with and without their host, needs to be further investigated.
Collapse
Affiliation(s)
- Cameron K Tebbi
- Children's Cancer Research Group Laboratory, 13719 North Nebraska Avenue, Suite #108, Tampa, FL 33613-3305, USA
| |
Collapse
|
7
|
Gamaletsou MN, Rammaert B, Brause B, Bueno MA, Dadwal SS, Henry MW, Katragkou A, Kontoyiannis DP, McCarthy MW, Miller AO, Moriyama B, Pana ZD, Petraitiene R, Petraitis V, Roilides E, Sarkis JP, Simitsopoulou M, Sipsas NV, Taj-Aldeen SJ, Zeller V, Lortholary O, Walsh TJ. Osteoarticular Mycoses. Clin Microbiol Rev 2022; 35:e0008619. [PMID: 36448782 PMCID: PMC9769674 DOI: 10.1128/cmr.00086-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. Candida osteomyelitis and Candida arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of Candida and Aspergillus arthritis. Relapsed infection, particularly in Candida arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.
Collapse
Affiliation(s)
- Maria N. Gamaletsou
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Blandine Rammaert
- Université de Poitiers, Faculté de médecine, CHU de Poitiers, INSERM U1070, Poitiers, France
| | - Barry Brause
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Marimelle A. Bueno
- Far Eastern University-Dr. Nicanor Reyes Medical Foundation, Manilla, Philippines
| | | | - Michael W. Henry
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aspasia Katragkou
- Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University School of Medicine, Columbus, Ohio, USA
| | | | - Matthew W. McCarthy
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Andy O. Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Zoi Dorothea Pana
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Ruta Petraitiene
- Weill Cornell Medicine of Cornell University, New York, New York, USA
| | | | - Emmanuel Roilides
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | | | - Maria Simitsopoulou
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Nikolaos V. Sipsas
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Valérie Zeller
- Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Olivier Lortholary
- Université de Paris, Faculté de Médecine, APHP, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, CNRS UMR 2000, Paris, France
| | - Thomas J. Walsh
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
| |
Collapse
|
8
|
Kouijzer JJP, Noordermeer DJ, van Leeuwen WJ, Verkaik NJ, Lattwein KR. Native valve, prosthetic valve, and cardiac device-related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies. Front Cell Dev Biol 2022; 10:995508. [PMID: 36263017 PMCID: PMC9574252 DOI: 10.3389/fcell.2022.995508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening microbial infection of native and prosthetic heart valves, endocardial surface, and/or indwelling cardiac device. Prevalence of IE is increasing and mortality has not significantly improved despite technological advances. This review provides an updated overview using recent literature on the clinical presentation, diagnosis, imaging, causative pathogens, treatment, and outcomes in native valve, prosthetic valve, and cardiac device-related IE. In addition, the experimental approaches used in IE research to improve the understanding of disease mechanisms and the current diagnostic pipelines are discussed, as well as potential innovative diagnostic and therapeutic strategies. This will ultimately help towards deriving better diagnostic tools and treatments to improve IE patient outcomes.
Collapse
Affiliation(s)
- Joop J. P. Kouijzer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
- *Correspondence: Joop J. P. Kouijzer,
| | - Daniëlle J. Noordermeer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Wouter J. van Leeuwen
- Department of Cardiothoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Nelianne J. Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Kirby R. Lattwein
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
| |
Collapse
|
9
|
K-L Lo C, Wilson EW. Aspergillus fumigatus sternal osteomyelitis following cardiac surgery: Case report and literature review. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:269-278. [PMID: 36337597 PMCID: PMC9629732 DOI: 10.3138/jammi-2021-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Sternal osteomyelitis caused by Aspergillus spp is uncommon in cardiac surgery patients requiring sternotomy. CASE PRESENTATION We report a 77-year-old male with a history of poorly controlled diabetes who was diagnosed with Aspergillus sternal osteomyelitis, three months following an uneventful coronary artery bypass surgery. He underwent multiple debridement surgeries and was treated with voriconazole. Despite a complicated post-operative course, the patient responded well to voriconazole with clinical and biochemical evidence of remission. Unfortunately, he died of an unrelated cause due to decompensated heart failure. DISCUSSION Though uncommon, Aspergillus sternal osteomyelitis should be considered in the differential diagnosis of immunocompetent patients with post-operative sternal wound infections and negative bacterial tissue cultures. Management should include a combination of medical and surgical therapy.
Collapse
Affiliation(s)
- Carson K-L Lo
- Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Evan W Wilson
- Division of Infectious Diseases, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
10
|
Quint E, Kukeev I, Glinter H, Osyntsov A, Barsky G, Vakhrushev A, Brotfain E, Grupel D. Aspergillus wound infection in an immune-competent patient - A case report. CLINICAL INFECTION IN PRACTICE 2022. [DOI: 10.1016/j.clinpr.2022.100146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
11
|
R. L, Ninan MM, Kurien R, N. A F, Sahni RD, Michael JS. Cryptic aspergillosis: a rare entity and a diagnostic challenge. Access Microbiol 2022; 4:000344. [PMID: 35812705 PMCID: PMC9260091 DOI: 10.1099/acmi.0.000344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/09/2022] [Indexed: 12/16/2022] Open
Abstract
Introduction. Cryptic aspergillosis, caused by cryptic species of Aspergillus, is increasingly reported in humans and causes significant morbidity and mortality in immunocompromised individuals. The main aim of this study was to describe the occurrence of this entity at a large tertiary care centre and analyse the challenges in identifying them in a routine diagnostic laboratory.
Methods. This was a retrospective case review of all patients diagnosed with cryptic Aspergillus species from April 2019 to February 2020. The isolates were identified using conventional microbiological techniques, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI- TOF MS), 28S rRNA and internal transcribed spacer (ITS) sequencing.
Results. The species identified were Aspergillus tamarii, Aspergillus lentulus and Aspergillus sydowii. Identification by MALDI- TOF MS and sequencing was concordant for all except A. sydowii, with MALDI- TOF MS misidentifying it as Aspergillus thermomutans. All isolates showed low minimum inhibitory concentrations (MICs) for the panel of antifungal drugs.
Conclusion. Aspergillosis caused by cryptic Aspergillus species presents a diagnostic challenge. This study confirms the importance of molecular methods for accurate identification.
Collapse
Affiliation(s)
- Lavanya R.
- Department of Clinical Microbiology, Christian Medical College, Vellore 632004, India
| | - Marilyn M. Ninan
- Department of Clinical Microbiology, Christian Medical College, Vellore 632004, India
| | - Regi Kurien
- Department of ENT 3 and Anterior Skull Base Surgery, Christian Medical College, Vellore 632004, India
| | - Fouzia N. A
- Department of Hematology, Christian Medical College, Vellore 632004, India
| | - Rani D. Sahni
- Department of Clinical Microbiology, Christian Medical College, Vellore 632004, India
| | - Joy S. Michael
- Department of Clinical Microbiology, Christian Medical College, Vellore 632004, India
| |
Collapse
|
12
|
Archana H, Geetha Bose V. Evaluation of phytoconstituents from selected medicinal plants and its synergistic antimicrobial activity. CHEMOSPHERE 2022; 287:132276. [PMID: 34601372 DOI: 10.1016/j.chemosphere.2021.132276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/26/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
Phytoconstituents of plants had enormous therapeutic potential against the wounds on skin. Plants like Tecoma stans, Manilkara zapota and Cassia fistula were some which had the ability to heal the wounds. However, there was limited research in Cassia fistula flowers and its synergism with plants on wound healing and its mechanism. Qualitative analysis was performed to confirm the presence of phytoconstituents like flavonoids, saponins and tannins in solvents:aqueous ethanol and methanol. All three components showed their attributes towards wound healing. Results of antimicrobial activity clearly stated that, methanol extract of the Cassia fistula flowers at increasing concentration, showed the maximum zone of inhibition of 27 mm at 100 μl (antibacterial assay) and 18 mm at 100 μl (anti-fungal assay). They had higher potential against the selective microbes Staphylococcus aureus and Aspergillus niger. The combination of C. fistula flowers and C. fistula leaves; C. fistula flowers and M. zapota leaves showed maximum zone of inhibition of 23 mm and 21 mm for anti-bacterial; 22 mm and 23 mm for antifungal at 100 μl respectively. The C. fistula flowers along with the Manilkara zapota leaves and C. fistula leaves enhanced the antimicrobial nature than the individual plants. The antimicrobial properties present in the plants would engage them in future for developing an improved medicine for wound healing. Thus a polyherbal plant solution containing equal proportions of plants, tested for the antibacterial activity, succeeded by showing its higher inhibition of 25 mm at 100 μl.This concluded that the synergism of plants had higher efficiency in microbial activity than the individual samples hence proving the plants attributes towards the wound healing.
Collapse
Affiliation(s)
- H Archana
- Department of Biotechnology, Rajalakshmi Engineering College (Autonomous), Affiliated to Anna University, Thandalam, Chennai, 602105, Tamil Nadu, India.
| | - Vijaya Geetha Bose
- Department of Biotechnology, Rajalakshmi Engineering College (Autonomous), Affiliated to Anna University, Thandalam, Chennai, 602105, Tamil Nadu, India.
| |
Collapse
|
13
|
Kamali Sarvestani H, Ahmadi B, Gerami Shoar M, Getso M, Rafat Z, Mahmoudi S, Khansari M, Salahshour F, Fatahi L, Salehi M, Ansari S. Mycetoma due to Aspergillus flavus in a diabetic patient: Case report and literature review. IDCases 2022; 29:e01585. [PMID: 35928000 PMCID: PMC9344346 DOI: 10.1016/j.idcr.2022.e01585] [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: 05/23/2022] [Accepted: 07/25/2022] [Indexed: 12/03/2022] Open
Abstract
Diabetes mellitus patients are prone to cutaneous and subcutaneous fungal infections due to pathogenic fungi, including dermatophytes, Mucorales, Candida, Aspergillus, and Fusarium species. Here, we report a case of A. flavus mycetoma confirmed by isolation and molecular identification. The case was a 38-year-old male farmer with a seven-year history of type 2 diabetes mellitus, living in Khuzestan, southwest of Iran. The patient presented with a right foot swelling associated with a nodule and multiple discharging sinuses following trauma sustained on the foot while working barefoot on the rice farm, a year ago. The nodule appeared at the site of the trauma two months after the injury. The initial diagnosis was based on direct microscopic examination of lesions scraping using 20% potassium hydroxide and radiology. Molecular analysis confirmed the isolates to be A. flavus. In vitro susceptibility of the isolate to voriconazole, posaconazole, caspofungin, itraconazole, and amphotericin B was determined. Treatment with voriconazole (200 mg twice daily) stopped the purulent discharge, reduced the swelling, and improved the clinical condition within two months. The study emphasizes the importance of wearing footwear to prevent skin trauma as the main risk factor of patient involvement.
Collapse
|
14
|
Onyiriuka L, Tambirajoo K, Watkins S, Walsh DC. Occam or Hickham? The diagnostic dilemma of an inflammatory brain lesion in the setting of pulmonary aspergillosis and previous neurosurgery. Br J Neurosurg 2021; 37:1-4. [PMID: 34251947 DOI: 10.1080/02688697.2021.1947979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Occam's Razor is a precept which invites one to consider the simplest and most unifying diagnosis as correct. In the modern era, clinical diagnosis remains critical in selecting appropriate therapies yet grows ever more complex with increased information from diagnostic technologies, but not always with sufficient granularity to answer the clinical question with certainty. We present an example of this dilemma in a patient with complex partial seizures on a background of pulmonary aspergillosis and historic clipping of a middle cerebral artery (MCA) aneurysm. CASE DESCRIPTION A 69-year-old female presented with progressive headaches, temporal lobe seizures, poor short-term memory and weight loss. She had suffered a subarachnoid haemorrhage 22 years earlier requiring surgical repair of a right MCA aneurysm. She was treated for breast cancer in 2006 followed by pulmonary aspergilloma in 2014 for which systemic antifungals were discontinued due to toxicity. Imaging revealed a right temporal inflammatory lesion adjacent to the aneurysm clip. Gastrointestinal toxicity and haemoptysis complicated the clinical and radiological response to systemic steroids. Cerebral aspergillosis was considered given her medical history despite an equivocal fungal screen, but intolerable side effects negated the continued use of systemic antifungals. Surgical exploration to establish a definitive diagnosis and potentially treat the underlying cause was recommended despite the high surgical risk involved and subsequently revealed a foreign body type granuloma, and excluded aspergillosis. Tuberculosis and other granulomatous disease processes were excluded. CONCLUSION This case illustrates the importance of pathological diagnosis to guide therapy and reminds us that the occasional patient will encounter multiple, rare and unrelated diseases during their lifetime. A high index of suspicion is necessary in patients who have undergone surgical aneurysm repair involving muslin as it may be subject to secondary infection and or granuloma formation many years later.
Collapse
Affiliation(s)
- Louis Onyiriuka
- Department of Neurosurgery, Kings College Hospital NHS Foundation Trust, London, UK
| | | | - Susanne Watkins
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Daniel C Walsh
- Department of Neurosurgery, Kings College Hospital NHS Foundation Trust, London, UK
- Department of Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, UK
| |
Collapse
|
15
|
Dai T, Hu Q, Xie Z, Li C. Case Report: Infective Endocarditis Caused by Aspergillus flavus in a Hemodialysis Patient. Front Med (Lausanne) 2021; 8:655640. [PMID: 34026787 PMCID: PMC8131528 DOI: 10.3389/fmed.2021.655640] [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: 01/19/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022] Open
Abstract
Fungal endocarditis (FE) is a rare but fatal disease. The incidence of infective endocarditis (IE) in hemodialysis patients with catheters is thought to be obviously higher than that in the general population. We reported a case of IE caused by Aspergillus flavus (A. flavus) in a 36-year-old woman on hemodialysis. Because the blood cultures were persistently negative, so we used mNGS (Metagenomic next generation sequencing) for early clinical diagnosis. After treatment with voriconazole, the patient's condition improved rapidly. She continued oral voriconazole treatment 1 year after discharge and is in good condition. The diagnosis and treatment strategies of FE in hemodialysis patients were discussed.
Collapse
Affiliation(s)
- Tingting Dai
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Qinghua Hu
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhongshang Xie
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Chunhui Li
- Hospital Infection Control Center, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
16
|
Meena DS, Kumar D, Bohra GK, Kumar G. Clinical manifestations, diagnosis, and treatment outcome of CNS aspergillosis: A systematic review of 235 cases. Infect Dis Now 2021; 51:654-660. [PMID: 33964485 DOI: 10.1016/j.idnow.2021.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
Aspergillus is a ubiquitous ascomycete that can cause a variety of clinical presentations depending on immune status. Central nervous system aspergillosis is a fatal disease with non-specific clinical features. The aim of this systematic review was to evaluate the epidemiology, clinical features, diagnosis and therapeutic interventions in CNS aspergillosis patients. We also aimed to examine the possible predictors of mortality in neuroaspergillosis. Literature search was performed in Medline, PubMed, and Google scholar and all patients≥18 years with proven CNS aspergillosis were included. A total of 175 articles (235 patients) were included in the final analysis. Their mean age was 51 years and the majority were male (57.4%). Overall case-fatality was 45.1%. Aspergillus fumigatus was the most common species (70.8%) followed by A. flavus (18.6%). Corticosteroids (22.6%), malignancy (19.1%) and diabetes mellitus (14%) were the most common risk factors. Neuroimaging findings included cerebral abscess (70.2%), meningitis (14%), infarction (13.2%) and mycotic aneurysm (8.9%). Disseminated disease (29.2% vs 17.8%, p 0.03), CSF hypoglycorrhachia (48.1% vs 22.2%, P: 0.001) and heightened CSF galactomannan (3.62 vs 2.0ng/ml, p 0.05), were the factors associated with poor outcome in neuroaspergillosis. Persons infected with Aspergillus flavus (13.1% vs 3.1%, P: 0.01), and having been treated with Voriconazole (51.9% vs 29.2%, P: 0.004) were more likely to survive. Our review will provide insight into the different spectrums of CNS aspergillosis. Notwithstanding the promising role of Voriconazole, future work is required to ascertain the role of combination antifungal therapy.
Collapse
Affiliation(s)
- Durga Shankar Meena
- Department of Internal Medicine, All India Institute of Medical Sciences, 342005 Jodhpur, Rajasthan, India.
| | - Deepak Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences, 342005 Jodhpur, Rajasthan, India.
| | - Gopal Krishana Bohra
- Department of Internal Medicine, All India Institute of Medical Sciences, 342005 Jodhpur, Rajasthan, India.
| | - Gaurav Kumar
- Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| |
Collapse
|
17
|
Affiliation(s)
- A K Mishra
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA, 01608, USA
| | - A Lahiri
- Department of Cardiology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| |
Collapse
|
18
|
Microbial Monitoring as a Tool for Preventing Infectious Risk in the Operating Room: Results of 10 Years of Activity. ATMOSPHERE 2020. [DOI: 10.3390/atmos12010019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Environmental microbial contamination in the operating room (OR) can favour contamination of the surgical wound, posing the risk of infection of the surgical site. Thus, environmental monitoring is a useful tool for assessing environmental health and the effectiveness and efficiency of the measures adopted to control the risk of infection in the OR. This work aimed to analyse the long term environmental quality of 18 ORs throughout Sardinia, Italy, through the quantitative and qualitative characterisation of the microbial flora present in the air and on surfaces, in order to evaluate the trend over time, including in relation to any control measures adopted. The results of the sampling carried out in the period from January 2010 to December 2019 have been extrapolated from the archive-database of the Laboratory of the Hygiene and Control of Hospital Infections Unit of the University Hospital in Sassari. During the period in question, 188 air evaluations were carried out, both in empty rooms and during surgery, and 872 surface samples were taken. When the air was monitored, it emerged that significant contamination was detectable in a reduced number of examinations and a limited number of rooms. Microbial load values higher than the reference values may have been mainly determined by sub-optimal operation/maintenance of the air conditioning system. Surface testing showed a good level of sanitisation, given the low percentage of non-compliant values detected. The possibility of having data available on environmental quality is a useful educational and training tool both for those responsible for sanitisation procedures and the surgical team, in order to increase awareness of the effects of a lack of compliance with behavioural standards.
Collapse
|
19
|
Song C, Cai Q, Huang Y, Lu Q. Multilayer bare stent technique in treating intact mycotic suprarenal aortic aneurysm: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 33442625 PMCID: PMC7793158 DOI: 10.1093/ehjcr/ytaa361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/14/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
Background Invasive aspergillosis (IA) related mycotic aortic aneurysm is rare in immunocompetent patient. The endovascular therapy remains controversial due to potential risk of graft infection, while the suprarenal cases might face catastrophic complications during open surgery. Case summary We presented an IA case with suprarenal abdominal aortic aneurysm confirmed by joint effusion. Multilayer bare stent technique was performed to preserve visceral blood flow and promote aneurysmal thrombus formation, along with antifungal treatment. Two years of follow-up revealed complete aneurysm thrombosis without evidence of infection. Discussion Fungal infection that affects the aorta is difficult to recognize due to often negative blood cultures. Close observation is recommended in case of suspicion of mycotic aneurysms. Multilayer bare stent technique can restore luminal laminar blood flow and reduce the risk of infection in intact mycotic suprarenal aortic aneurysm.
Collapse
Affiliation(s)
- Chao Song
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University, Shanghai 200082, People's Republic of China
| | - Qing Cai
- Department of Department of Rheumatology and Immunology, Shanghai Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Yi Huang
- Department of Respiratory Medicine, Shanghai Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Qingsheng Lu
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University, Shanghai 200082, People's Republic of China
| |
Collapse
|
20
|
Jalalian R, Shokohi T, Mirzakhani R, Ghasemian R, Hedayati MT, Ardalani S, Azizi S, Kalhori S, Kermani F, Mayahi S. Fatal Prosthetic Valve Endocarditis Due to Aspergillus flavus in a Diabetic Patient. Infect Drug Resist 2020; 13:2245-2250. [PMID: 32765000 PMCID: PMC7360421 DOI: 10.2147/idr.s258637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/26/2020] [Indexed: 12/25/2022] Open
Abstract
Aspergillus endocarditis (AE) accounts for a-quarter of all fungal endocarditis, mainly in immunocompromised hosts prior to heart-valve surgery with high mortality, even with treatment. Herein, we report a rare case of AE in a diabetic 60-year-old woman with a history of redo mitral valve prosthesis suspecious of acute endocarditis. She underwent second redo surgical mitral valve replacement in combination with mechanical aortic valve replacement. Blood cultures were negative. The explanted valve and vegetation were subjected to identification. Grown colonies were identified as Aspergillus flavus, based on conventional and molecular methods. Despite the administration of liposomal amphotericin B and improvement in her general condition shortly after initiation of therapy, the patient passed away. As AE is a late consequence of redo prosthetic valve replacement, extended follow-up, early diagnosis, repeating valve-replacement surgeries, and timely selective antifungal treatments are warranted.
Collapse
Affiliation(s)
- Rozita Jalalian
- Department of Cardiology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Centre (IFRC), Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roghayeh Mirzakhani
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roya Ghasemian
- Antimicrobial Resistance Research Center, and Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Centre (IFRC), Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sirus Ardalani
- Department of Cardiac Surgery, Cardiovascular Research Center of Mazandaran Heart Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Soheil Azizi
- Department of Pathology, Mazandaran Heart Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shamsi Kalhori
- Department of Pathology, Mazandaran Heart Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Firoozeh Kermani
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sabah Mayahi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| |
Collapse
|
21
|
Mishra AK, Bansal V, Roy G, Halder V, Gupta P, Chakrabarti A. Aspergillus mediastinitis in a post-operative immunocompetent child. Indian J Med Microbiol 2020; 38:492-495. [PMID: 33154273 DOI: 10.4103/ijmm.ijmm_20_267] [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: 11/04/2022]
Abstract
Post-operative Aspergillus mediastinitis is regarded to be a devastating infection, usually affecting patients undergoing cardiothoracic surgery with specific predisposing factors characterised by a high mortality and chronic morbidity. Patient outcome after such a complication is extremely poor despite antifungal therapy and surgery. We describe the case of an immunocompetent 2-month-old child with obstructed supracardiac total anomalous pulmonary venous circulation (TAPVC) and severe pulmonary artery hypertension, who underwent TAPVC repair through median sternotomy and developed post-operative mediastinitis due to Aspergillus flavus.
Collapse
Affiliation(s)
- Anand Kumar Mishra
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vidur Bansal
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gradlin Roy
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikram Halder
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parakritii Gupta
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
22
|
Ji SH, Yoo SJ, Park EA, Song SG. Invasive Pulmonary Aspergillosis in a Immunocompetent Patient after Congenital Heart Disease Surgery: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:1529-1536. [PMID: 36237705 PMCID: PMC9431841 DOI: 10.3348/jksr.2020.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 12/04/2022]
Abstract
침습성 폐 아스페르길루스증은 주로 면역저하 환자에서 발생하는 것으로 알려져 있지만 드물게 면역저하가 없는 환자에서도 발생한다. 면역저하가 없는 환자에서 발병하는 경우, 초기에 진균에 의한 폐 감염을 의심하기가 어렵기 때문에 진단 및 치료가 늦어지고 나쁜 예후를 보일 수 있다. 저자들은 면역저하가 없는 29세 남성 환자에서 선천성 심장질환 수술 후 발생한 침습성 폐 아스페르길루스증의 사례가 있어 시간 경과에 따른 CT 소견과 함께 보고하고자 한다.
Collapse
Affiliation(s)
- So-Hyun Ji
- Department of Radiology, Korea Cancer Center Hospital, Seoul, Korea
| | - Seung-Jin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Seung-Geun Song
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
23
|
Spadea L, Giannico MI. Diagnostic and Management Strategies of Aspergillus Endophthalmitis: Current Insights. Clin Ophthalmol 2019; 13:2573-2582. [PMID: 31920280 PMCID: PMC6939405 DOI: 10.2147/opth.s219264] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022] Open
Abstract
Fungal endophthalmitis is subsequent to endogenous or exogenous infection and represents an important complication of ocular surgery which may lead to significant visual loss and blindness. The prognosis is poor because of delayed diagnosis and limited availability of effective antifungal drugs with good ocular penetration. Furthermore, the critical issue in diagnosing fungal infection of the eye is microbiological identification of the etiologic agent in clinical samples. Aspergillus is among the most frequent isolated organisms in fungal endophthalmitis. Early diagnosis is essential to prevent severe complications and blindness. Treatments include local, systemic and surgical therapeutic strategies. The purpose of the present review is the analysis of the current procedures adopted to promptly diagnose and treat Aspergillus endophthalmitis.
Collapse
Affiliation(s)
- Leopoldo Spadea
- University “La Sapienza”, Department of Sense Organs, Eye Clinic, Rome, Italy
| | | |
Collapse
|
24
|
Central Nervous System Infections Due to Aspergillus and Other Hyaline Molds. J Fungi (Basel) 2019; 5:jof5030079. [PMID: 31480311 PMCID: PMC6787746 DOI: 10.3390/jof5030079] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023] Open
Abstract
Central nervous system infections due to Aspergillus spp and other hyaline molds such as Fusarium and Scedosporium spp are rare but fatal conditions. Invasion of the central nervous system (CNS) tends to occur as a result of hematogenous dissemination among immunocompromised patients, and by local extension or direct inoculation secondary to trauma in immunocompetent hosts. Efforts should be directed to confirm the diagnosis by image-guided stereotactic brain biopsy when feasible. Non-culture methods could be useful to support the diagnosis, but they have not been validated to be performed in cerebral spinal fluid. Treatment of these infections is challenging given the variable susceptibility profile of these pathogens and the penetration of antifungal agents into the brain.
Collapse
|
25
|
Tavakoli M, Yazdani Charati J, Hedayati MT, Moosazadeh M, Badiee P, Seyedmousavi S, Denning DW. National trends in incidence, prevalence and disability-adjusted life years of invasive aspergillosis in Iran: a systematic review and meta-analysis. Expert Rev Respir Med 2019; 13:1121-1134. [PMID: 31426666 DOI: 10.1080/17476348.2019.1657835] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: We aimed to study the epidemiology, prevalence, incidence, clinical manifestations, underlying diseases, treatments, outcomes, and societal impact through disability-adjusted life years (DALYs) of IA in Iran. Methods: A random-effect meta-analytic model was fitted to estimate the prevalence and incidence of IA in Iran. We also calculated DALYs. Results: Out of 79 published studies during the past 25 years from Iran, 23 met the inclusion criteria. A total of 2947 patients were included, of whom 396 (13.4%) patients were diagnosed with IA according to EORTC/MSG and ICU criteria. The main underlying condition for IA was hematologic disorders (39.4%). A. flavus 86 (43%) was the most common isolate. The pooled prevalence and incidence rates were 20.5 (95% CI 12.5 to 29.9) and 4.8 (95% CI 2.3-8.2) per 100,000 population, respectively. Total DALYs was estimated 164.13 per 100,000 population. YLLs constitute the majority of IA burden compared to YLDs (162.80 YLLs/100,000 population vs 1.33 YLDs per 100,000 population). The highest YLL rates were found in people aged 45-49 (62.9 YLLs/100,000 population) and 30-34 years (45.2 YLLs/100,000 population), respectively. Conclusion: This study indicates an increasing burden of IA in Iran, despite the extensive use of prophylaxis, challenging the public health, especially immunocompromised patients.
Collapse
Affiliation(s)
- Mahin Tavakoli
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences , Sari , Iran
| | - Jamshid Yazdani Charati
- Department of statistic, Faculty of Health, Mazandaran University of Medical Sciences , Sari , Iran
| | - Mohammad T Hedayati
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences , Sari , Iran.,Department of Medical mycology, Mazandaran University of Medical Sciences , Sari , Iran
| | - Mahmood Moosazadeh
- Health Sciences Research center, Addiction Institute, Mazandaran University of Medical Sciences , Sari , Iran
| | - Parisa Badiee
- Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Seyedmojtaba Seyedmousavi
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences , Sari , Iran.,Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health , Bethesda , MD , USA
| | | |
Collapse
|
26
|
Rudramurthy SM, Paul RA, Chakrabarti A, Mouton JW, Meis JF. Invasive Aspergillosis by Aspergillus flavus: Epidemiology, Diagnosis, Antifungal Resistance, and Management. J Fungi (Basel) 2019; 5:jof5030055. [PMID: 31266196 PMCID: PMC6787648 DOI: 10.3390/jof5030055] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 12/12/2022] Open
Abstract
Aspergillus flavus is the second most common etiological agent of invasive aspergillosis (IA) after A. fumigatus. However, most literature describes IA in relation to A. fumigatus or together with other Aspergillus species. Certain differences exist in IA caused by A. flavus and A. fumigatus and studies on A. flavus infections are increasing. Hence, we performed a comprehensive updated review on IA due to A. flavus. A. flavus is the cause of a broad spectrum of human diseases predominantly in Asia, the Middle East, and Africa possibly due to its ability to survive better in hot and arid climatic conditions compared to other Aspergillus spp. Worldwide, ~10% of cases of bronchopulmonary aspergillosis are caused by A. flavus. Outbreaks have usually been associated with construction activities as invasive pulmonary aspergillosis in immunocompromised patients and cutaneous, subcutaneous, and mucosal forms in immunocompetent individuals. Multilocus microsatellite typing is well standardized to differentiate A. flavus isolates into different clades. A. flavus is intrinsically resistant to polyenes. In contrast to A. fumigatus, triazole resistance infrequently occurs in A. flavus and is associated with mutations in the cyp51C gene. Overexpression of efflux pumps in non-wildtype strains lacking mutations in the cyp51 gene can also lead to high voriconazole minimum inhibitory concentrations. Voriconazole remains the drug of choice for treatment, and amphotericin B should be avoided. Primary therapy with echinocandins is not the first choice but the combination with voriconazole or as monotherapy may be used when the azoles and amphotericin B are contraindicated.
Collapse
Affiliation(s)
- Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Research, Chandigarh 160012, India.
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, 3015GD Rotterdam, The Netherlands.
| | - Raees A Paul
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Research, Chandigarh 160012, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Research, Chandigarh 160012, India
| | - Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, 3015GD Rotterdam, The Netherlands
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ) and Center of Expertise, 6532SZ Nijmegen, The Netherlands
- Center of Expertise in Mycology Radboudumc/CWZ, 6532SZ Nijmegen, The Netherlands
| |
Collapse
|
27
|
Clarke NS, Sengupta A, Miller A, Jessen ME, Murthy RA. Aspergillus aortitis & aortic valve endocarditis after coronary surgery. J Card Surg 2019; 34:871-874. [PMID: 31233241 DOI: 10.1111/jocs.14125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/12/2019] [Accepted: 05/28/2019] [Indexed: 11/30/2022]
Abstract
The authors report a case of Aspergillus aortitis and aortic valve endocarditis that developed after coronary artery bypass surgery resulting in recurrent, embolic, bilateral lower extremity ischemia. This necessitated multiple lower extremity embolectomies followed by redo-sternotomy, extensive annular debridement, root reconstruction with a modified Bentall technique, and hemiarch replacement. This case highlights the challenges in diagnosis and management of this rare disease entity and some of its devastating complications.
Collapse
Affiliation(s)
- Nicholas S Clarke
- Division of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aditya Sengupta
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amanda Miller
- Perioperative Services, Lucile Packard Children's Hospital at Stanford, Palo Alto, California
| | - Michael E Jessen
- Division of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Raghav A Murthy
- Division of Pediatric Cardiac Surgery, Department of Cardiovascular Surgery, The Mount Sinai Hospital, New York, New York
| |
Collapse
|
28
|
Landaburu MF, López Daneri G, Ploszaj F, Kruss M, Vinante A, Veciño CH, Mujica MT. Osteomyelitis of the rib cage by Aspergillus flavus. Rev Iberoam Micol 2019; 36:86-89. [PMID: 31128846 DOI: 10.1016/j.riam.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/27/2018] [Accepted: 02/18/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Aspergillus osteomyelitis of the ribs is relatively uncommon. It is a debilitating and severe form of invasive aspergillosis. CASE REPORT A 61year-old female presented with spontaneous chest pain on the right side of the rib cage and a palpable soft-tissue mass. FDG-PET/CT scan identified activity in the infected site. The lesion was punctured, and purulent material was sent to the laboratory. Aspergillus complex Flavi was isolated. An antifungal treatment with voriconazole was started. The lesion healed, and no recurrence was observed at 8-month follow-up. Molecular identification of the isolate was based on PCR amplification and sequencing of β-tubulin gene. Aspergillus flavus was identified. CONCLUSIONS Our case highlights the relevance of microbiological studies in patients with osteomyelitis and the involvement of soft tissue. The FDG-PET/CT scan was found to be a useful tool for revealing the extent of the disease and evaluating the response to the antifungal therapy.
Collapse
Affiliation(s)
- María Fernanda Landaburu
- Centro de Micología, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina; Sanatorio Municipal Dr. Julio Méndez, Buenos Aires, Argentina
| | - Gabriela López Daneri
- Centro de Micología, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Federico Ploszaj
- Centro de Micología, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Mariana Kruss
- Sanatorio Municipal Dr. Julio Méndez, Buenos Aires, Argentina
| | | | - Cecilia H Veciño
- Centro de Micología, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - María Teresa Mujica
- Centro de Micología, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.
| |
Collapse
|
29
|
Bukhary GA, Arabi M, Khan AL. Intra-Arterial Aspergillosis Resulting in Recurrent Subclavian Artery Thrombosis: A Late Complication of Coronary Bypass Surgery. J Vasc Interv Radiol 2019; 30:621-622. [PMID: 30910189 DOI: 10.1016/j.jvir.2018.01.762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/05/2018] [Accepted: 01/05/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ghazy A Bukhary
- Section of Vascular Interventional Radiology, Medical Imaging Department, King Abdulaziz Medical City, National Guards Health Affairs, P.O. Box 22490, Riyadh 11462, Saudi Arabia
| | - Mohammad Arabi
- Section of Vascular Interventional Radiology, Medical Imaging Department, King Abdulaziz Medical City, National Guards Health Affairs, P.O. Box 22490, Riyadh 11462, Saudi Arabia
| | - Abdul Latif Khan
- Histopathology Department, King Abdulaziz Medical City, National Guards Health Affairs, P.O. Box 22490, Riyadh 11462, Saudi Arabia
| |
Collapse
|
30
|
Sharifulin R, Bogachev-Prokophiev A, Varnek Y, Klimko N, Malakhova O, Volkov A, Murashev I, Pivkin A, Karaskov A. Successful Treatment of an Aortotomy Site Aspergillus Infection. Ann Thorac Surg 2019; 108:e253-e255. [PMID: 30910659 DOI: 10.1016/j.athoracsur.2019.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/06/2019] [Accepted: 02/10/2019] [Indexed: 12/21/2022]
Abstract
Aspergillus aortitis is a rare, often fatal infection. Here, we report successful treatment of an aortotomy site that became infected by Aspergillus spp. after valve replacement. Surgical debridement, combined with antifungal therapy, allowed a favorable outcome.
Collapse
Affiliation(s)
- Ravil Sharifulin
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation.
| | | | - Yuliya Varnek
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Nikolay Klimko
- Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University, Saint Petersburg, Russian Federation
| | - Oksana Malakhova
- Department of Ultrasound Diagnostics, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexander Volkov
- Department of Pathology, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Ivan Murashev
- Department of Pathology, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexey Pivkin
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexander Karaskov
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| |
Collapse
|
31
|
Aspergillus endocarditis diagnosed by fungemia plus serum antigen testing. Med Mycol Case Rep 2018; 23:1-3. [PMID: 30416954 PMCID: PMC6216080 DOI: 10.1016/j.mmcr.2018.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 10/22/2018] [Indexed: 01/04/2023] Open
Abstract
Fungal endocarditis remains an uncommon clinical diagnosis, though is likely to become more frequent due to the global increase in transplantations and cardiac valvular surgery. A case of prosthetic valve endocarditis due to Aspergillus fumigatus is described that was diagnosed with serologic fungal markers and confirmed with positive blood cultures, an uncommon finding.
Collapse
|
32
|
Rocco JM, Benson MK. Aspergillus aortitis in an immunocompetent patient presenting with acute endophthalmitis. Infect Dis Rep 2018; 10:7750. [PMID: 30344969 PMCID: PMC6176472 DOI: 10.4081/idr.2018.7750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/23/2022] Open
Abstract
Aspergillus is a common environmental mold most often recognized as an infectious agent in patients with severe immune compromise. We present a case of an immunocompetent patient presenting with endogenous endophthalmitis in the absence of other infectious symptoms. The search for a systemic source revealed an ascending aortic pseudoaneurysm. Surgical resection and pathology revealed angioinvasive aspergillus aortitis. Recent cardiac surgery has been noted to be a risk factor for angioinvasive aspergillosis. Diagnosis is difficult as symptoms are mild and laboratory studies are often normal. To our knowledge this is the first case of aspergillus aortitis presenting as endogenous endophthalmitis without systemic signs of inflammation. These patients have a high mortality rate therefore early recognition is essential. It is important to consider angioinvasive aspergillus infections in patients with prior cardiac surgery presenting with occult embolic phenomena. Only with early diagnosis and prompt treatment can we improve outcomes of this disease process.
Collapse
Affiliation(s)
- Joseph M. Rocco
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | |
Collapse
|
33
|
Gonzales Zamora JA, Henry Z, Gultekin SH. Central Nervous System Aspergillosis: An Unexpected Complication following Neurosurgery. Diseases 2018; 6:diseases6020046. [PMID: 29857501 PMCID: PMC6023335 DOI: 10.3390/diseases6020046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/18/2022] Open
Abstract
Post-surgical aspergillosis is an uncommon complication that carries a high mortality rate in affected patients. The diagnosis is challenging given the lack of highly sensitive methods to isolate Aspergillus from surgical sites. Here, we present a case of post-surgical aspergillosis that occurred after the resection of acoustic neuroma in an immunocompetent patient. Imaging revealed leptomeningeal enhancement and a cerebellar extra-axial fluid collection adjacent to the right retrosigmoid craniotomy. The patient was taken to the operating room for debridement, where purulent fluid was obtained from subdural space. The diagnosis was achieved by histopathology and polymerase chain reaction (PCR) in brain tissue. Appropriate investigations failed to detect contamination in the operating room. The patient was successfully treated with 3 months of voriconazole. We highlight the importance of recognizing this uncommon complication and advocate for the use of molecular techniques to improve the diagnostic yield in central nervous system aspergillosis.
Collapse
Affiliation(s)
- Jose Armando Gonzales Zamora
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 863B, Miami, FL 33136, USA.
| | - Zachary Henry
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 863B, Miami, FL 33136, USA.
| | - Sakir Humayun Gultekin
- Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
| |
Collapse
|
34
|
Cardiac Aspergilloma: A Rare Case of a Cardiac Mass Involving the Native Tricuspid Valve, Right Atrium, and Right Ventricle in an Immunocompromised Patient. Case Rep Cardiol 2018; 2018:6927436. [PMID: 29619256 PMCID: PMC5829353 DOI: 10.1155/2018/6927436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/31/2017] [Indexed: 01/23/2023] Open
Abstract
Aspergillus can cause devastating opportunistic infections in immunocompromised patients. Rarely does this fungus invade the heart, and when it does, survival is especially poor despite optimal medical and surgical treatment. We report a case of cardiac aspergilloma with involvement of the tricuspid valve and both the right atrium and ventricle found on a transthoracic echocardiogram in an immunocompromised patient after developing atrial fibrillation with rapid ventricular rate. The findings from this case suggest that early clinical suspicion is critical in early diagnosis and thus early treatment.
Collapse
|
35
|
|
36
|
Tresson P, Roussel A, Mordant P, Cerceau P, Castier Y, Pellenc Q. Endovascular Repair as a Bridge to Open Repair of a Ruptured Descending Thoracic Aspergillus Aortitis. Ann Thorac Surg 2017; 104:e425-e428. [DOI: 10.1016/j.athoracsur.2017.04.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 04/06/2017] [Accepted: 04/22/2017] [Indexed: 12/15/2022]
|
37
|
Invasive intravascular aspergillosis leading to myocardial infarction. HUMAN PATHOLOGY: CASE REPORTS 2017. [DOI: 10.1016/j.ehpc.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
38
|
Moya-Sánchez E, Ruiz-Carazo E. Aspergillus flavus infection in an aortic graft: Imaging findings. RADIOLOGIA 2017; 60:175-176. [PMID: 29029758 DOI: 10.1016/j.rx.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/19/2017] [Accepted: 09/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- E Moya-Sánchez
- Complejo Hospitalario Universitario Granada, Granada, España.
| | - E Ruiz-Carazo
- Complejo Hospitalario Universitario Granada, Granada, España
| |
Collapse
|
39
|
Harada T, Isomura ET, Uchihashi T, Kogo M. Aspergillosis associated with migration of a dental implant into the maxillary sinus: A case report. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2017. [DOI: 10.1016/j.ajoms.2017.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
40
|
Abstract
Although sinusitis affects about 20 % of the population, fungal sinusitis is rare. Aspergillus sp. are most frequently implicated. Fungal sinusitis represents a wide spectrum of disorders, including acute or chronic and invasive or non-invasive forms. Invasive fungal sinusitis may develop in an immunocompromised or diabetic patient, whereas non-invasive fungal sinusitis should be considered in a chronic situation, resistant to antibiotics in immunocompetent patients. Allergic fungal sinusitis is related to hypersensitivity of the host to the fungus. The diagnosis of these infections requires radiological examination and endoscopy with mucosal biopsies examined histologically and mycologically in order to distinguish the different types of sinusitis. In the non-invasive forms, surgical treatment is essential, sometimes combined with antifungal and anti-inflammatory treatment. The invasive forms require antifungal treatment, combined with surgery in some forms, particularly mucormycosis.
Collapse
|
41
|
Vidal-García M, Sánchez-Chueca P, Domingo MP, Ballester C, Roc L, Ferrer I, Revillo MJ, Pardo J, Gálvez EM, Rezusta A. Disseminated aspergillosis in an immunocompetent patient with detectable bis(methylthio)gliotoxin and negative galactomannan. Rev Iberoam Micol 2016; 34:49-52. [PMID: 27939578 DOI: 10.1016/j.riam.2016.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 04/07/2016] [Accepted: 05/19/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Disseminated invasive aspergillosis is an exceptional finding in immunocompetent hosts. As in immunocompromised patients, it has high mortality rates. Early diagnostic methods are required in order to properly manage the patient. Bis(methylthio)gliotoxin (bmGT) is a novel biomarker, useful in onco-hematological patients. CASE REPORT A 70-year-old male, with non-insulin dependent type II diabetes mellitus and a past surgery history of aortic valve replacement with coronary by-pass five years ago, was seen in the emergency department with blurred vision. Three days later, endogen endophthalmitis was diagnosed in the ophthalmology clinic. During admission for the vitrectomy, he suffered an ischemia of the right lower limb. A thoracic computed tomography revealed a mycotic aneurysm of the ascending thoracic aorta and parietal thrombus. The ascending aorta was replaced and abundant brittle material of infectious appearance, found between the aortic valve graft and the aneurysm, was removed. Aspergillus fumigatus sensu stricto grew in both vitreous and aorta cultures. BmGT was detected in two serum samples obtained prior to intravenous antifungal treatment, which was then reduced after voriconazole treatment was started. CONCLUSIONS Disseminated invasive aspergillosis is a severe disease regardless of the immune status of the patient. This case report suggests that bmGT could be a suitable early diagnostic biomarker, not only in neutropenic patients, but also in immunocompetent hosts.
Collapse
Affiliation(s)
- Matxalen Vidal-García
- Universidad de Zaragoza, Microbiology, Preventive Medicine and Public Health, Zaragoza, Spain.
| | - Pilar Sánchez-Chueca
- Unidad de Cuidados Intensivos - Hospìtal Universitario Miguel Servet, Universidad de Zaragoza, Zaragoza, Spain
| | | | - Carlos Ballester
- Servicio de Cardiología - Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Lourdes Roc
- Servicio de Microbiología - Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Isabel Ferrer
- Servicio de Microbiología - Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - María José Revillo
- Servicio de Microbiología - Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Julián Pardo
- Fundación Instituto de Investigación Sanitaria Aragón, Centro de Investigación Biomédica de Aragón, Fundación ARAID, Universidad de Zaragoza, Spain
| | | | - Antonio Rezusta
- Universidad de Zaragoza, Microbiology, Preventive Medicine and Public Health, Zaragoza, Spain; Servicio de Microbiología - Hospital Universitario Miguel Servet, Zaragoza, Spain
| |
Collapse
|
42
|
Pasha AK, Lee JZ, Low SW, Desai H, Lee KS, Al Mohajer M. Fungal Endocarditis: Update on Diagnosis and Management. Am J Med 2016; 129:1037-43. [PMID: 27267285 DOI: 10.1016/j.amjmed.2016.05.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 12/25/2022]
Abstract
Fungal endocarditis is an extremely debilitating disease associated with high morbidity and mortality. Candida spp. are the most common isolated organisms in fungal endocarditis. It is most prevalent in patients who are immunosuppressed and intravenous drug users. Most patients present with constitutional symptoms, which are indistinguishable from bacterial endocarditis, hence a high index of suspicion is required for pursuing diagnosis. Diagnosis of fungal endocarditis can be very challenging: most of the time, blood cultures are negative or take a long time to yield growth. Fungal endocarditis mandates an aggressive treatment strategy. A medical and surgical combined approach is the cornerstone of therapy.
Collapse
Affiliation(s)
| | - Justin Z Lee
- Department of Medicine, University of Arizona, Tucson
| | - See-Wei Low
- Department of Medicine, University of Arizona, Tucson
| | - Hem Desai
- Department of Medicine, University of Arizona, Tucson
| | - Kwan S Lee
- Division of Cardiovascular Disease, Department of Medicine, University of Arizona, Tucson
| | - Mayar Al Mohajer
- Division of Infectious Disease, Department of Medicine, University of Arizona, Tucson.
| |
Collapse
|
43
|
Taj-Aldeen SJ, Chandra P, Denning DW. Burden of fungal infections in Qatar. Mycoses 2016; 58 Suppl 5:51-7. [PMID: 26449507 DOI: 10.1111/myc.12386] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/15/2015] [Accepted: 05/20/2015] [Indexed: 12/31/2022]
Abstract
Few estimates of fungal disease frequency have been attempted in the Middle East. We have estimated the burden of fungal infections in Qatar. The aim of the study was to compute and determine the burden of serious fungal infections, in an attempt to estimate fungal disease frequency, which has not previously been attempted in this country. Disease statistics were collected from the Microbiology laboratory database and from 2011 WHO statistics. The data are expressed per 100,000 populations. The reported cases of candidaemia rose to 288 with an estimated rate of 15.4/100,000. A real increase in the burden of candidaemia was found over that previously reported (12.9/100,000) for the years 2004-2009. Candida peritonitis was estimated in 8.02 cases/100,000 population. Recurrent (≥4 year(-1) ) vaginal infections affect at least 32,782 women with a rate of 3506/100,000 inhabitants. Severe asthma with fungal sensitisation affected 1486 people, allergic bronchopulmonary aspergillosis 1126 people and chronic pulmonary aspergillosis 176 people. Rhinosinusitis, mucormycosis and Fusarium infection occurred at rates of 2.31, 1.23, 1.86 cases/100,000 respectively. The estimated rate of invasive aspergillosis was very low (0.6/100,000). Low rates of Cryptococcus meningitis and Pneumocystis pneumonia are attributable to low HIV infection rates. In conclusion, fungal infections are increasingly reported, especially candidaemia. Surveillance and guidelines are needed to optimise care and management of common fungal infections. In addition, a fungal registry system needs development for surveillance.
Collapse
Affiliation(s)
- Saad J Taj-Aldeen
- Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Doha, Qatar
| | - Prem Chandra
- Medical Research Department, Hamad Medical Corporation, Doha, Qatar
| | - David W Denning
- Manchester Academic Health Science Centre, The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester, UK
| |
Collapse
|
44
|
Dichtl K, Wagener J, Tschöp J, Ney L. Analysis of peritoneal galactomannan for the diagnosis of Aspergillus peritonitis. Infection 2016; 44:683-6. [PMID: 27160571 DOI: 10.1007/s15010-016-0902-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/21/2016] [Indexed: 11/29/2022]
Abstract
Here, we report a patient developing a postoperative peritoneal infection by Aspergillus fumigatus. While galactomannan serum levels were negative throughout the time course, galactomannan levels in peritoneal fluids yielded high results. Serological testing of peritoneal fluids for fungal antigens might be a useful and easily applicable tool to support diagnosis of intraabdominal aspergillosis, which represents a rare type of invasive fungal infection.
Collapse
Affiliation(s)
- Karl Dichtl
- Max Von Pettenkofer-Institut, Ludwig-Maximilians-Universität München, 80336, Munich, Germany.
| | - Johannes Wagener
- Max Von Pettenkofer-Institut, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Johannes Tschöp
- Department of Anaesthesiology, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| | - Ludwig Ney
- Department of Anaesthesiology, Ludwig-Maximilians-Universität München, 80336, Munich, Germany
| |
Collapse
|
45
|
Caballero MJ, Mongardon N, Haouache H, Vodovar D, Ben Ayed I, Auvergne L, Hillion ML, Botterel F, Dhonneur G. Aspergillus mediastinitis after cardiac surgery. Int J Infect Dis 2016; 44:16-9. [PMID: 26845443 DOI: 10.1016/j.ijid.2016.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Mediastinitis is a serious complication after cardiac surgery. While bacteria are the more common pathogens, fungal infections are rare. In particular, several cases of postoperative Aspergillus mediastinitis have been reported, the majority of which had an extremely poor outcome. METHODS A case of mediastinitis in a 42-year-old patient due to Aspergillus fumigatus after cardiac surgery is described. Two main risk factors were found: cardiogenic shock requiring veno-arterial extracorporeal life support and failure of primary closure of the sternum. A full recovery was attained after surgical drainage and antifungal therapy with liposomal amphotericin B, followed by a combination of voriconazole and caspofungin. The patient was followed for 18 months without relapse. RESULTS This is an extremely rare case of postoperative Aspergillus mediastinitis exhibiting a favourable outcome. Based on a systematic review of the literature, previous cases were examined with a focus on risk factors, antifungal therapies, and outcomes. CONCLUSION The clinical features of postoperative Aspergillus mediastinitis may be paucisymptomatic, emphasizing the need for a low index of suspicion in cases of culture-negative mediastinitis or in indolent wound infections. In addition to surgical debridement, the central component of antifungal therapy should include amphotericin B or voriconazole.
Collapse
Affiliation(s)
- Marie-Josée Caballero
- Université Paris Est, Faculté de Médecine, Créteil, France; Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Nicolas Mongardon
- Université Paris Est, Faculté de Médecine, Créteil, France; Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
| | - Hakim Haouache
- Université Paris Est, Faculté de Médecine, Créteil, France; Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Dominique Vodovar
- Université Paris Est, Faculté de Médecine, Créteil, France; Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Issam Ben Ayed
- Université Paris Est, Faculté de Médecine, Créteil, France; Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Lauriane Auvergne
- Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Marie-Line Hillion
- Université Paris Est, Faculté de Médecine, Créteil, France; Service de Chirurgie Cardiaque, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Françoise Botterel
- Université Paris Est, Faculté de Médecine, Créteil, France; Unité de Mycologie, Département de Microbiologie, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Gilles Dhonneur
- Université Paris Est, Faculté de Médecine, Créteil, France; Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| |
Collapse
|
46
|
El-Sayed Ahmed MM, Almanfi A, Aftab M, Singh SK, Mallidi HR, Frazier OH. Aspergillus Mediastinitis after Orthotopic Heart Transplantation: A Case Report. Tex Heart Inst J 2015; 42:468-70. [PMID: 26504444 DOI: 10.14503/thij-14-4732] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A 55-year-old woman was admitted for orthotopic heart transplantation. Her medical history was notable for multiple cardiovascular problems, including ischemic cardiomyopathy that necessitated circulatory support with a left ventricular assist device. Five weeks after undergoing orthotopic heart transplantation, she developed Aspergillus calidoustus mediastinitis, for which she underwent a prolonged course of antifungal treatment that comprised (in sequence) posaconazole for 11 days, voriconazole for 10 days, and amphotericin B for 42 days. During this period, she also underwent repeated mediastinal drainage and sternal débridement, followed by sternal wiring and coverage with bilateral pectoralis advancement flaps. Four months postoperatively, she was discharged from the hospital with a successfully controlled infection and a healed sternum. To our knowledge, only 3 previous cases of Aspergillus mediastinitis after orthotopic heart transplantation have been reported in the literature, none of which was Aspergillus calidoustus.
Collapse
|
47
|
Kornberger A, Walter V, Jaeger F, Lehnert T, Soriano M, Moritz A, Stock UA, Beiras-Fernandez A. Necrotizing pulmonary aspergillosis and ventricular assist device infection: case report and review of literature. Transpl Infect Dis 2015. [PMID: 26224318 DOI: 10.1111/tid.12427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Necrotizing pulmonary aspergillosis and Aspergillus device infection are rare and have potentially fatal complications after left ventricular assist device (LVAD) implantation. To date, few cases of patients surviving Aspergillus device infection have been published, with survival reported only after device removal. We present a patient implanted with an LVAD in whom necrotizing pulmonary aspergillosis with device involvement was successfully treated by segmentectomy and prolonged antifungal treatment without device exchange or removal. Similar cases in the literature were searched for and are discussed in view of the severity of this complication.
Collapse
Affiliation(s)
- A Kornberger
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - V Walter
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - F Jaeger
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - T Lehnert
- Department of Radiology, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - M Soriano
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - A Moritz
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - U A Stock
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - A Beiras-Fernandez
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| |
Collapse
|
48
|
Matthaiou DK, Christodoulopoulou T, Dimopoulos G. How to treat fungal infections in ICU patients. BMC Infect Dis 2015; 15:205. [PMID: 25930035 PMCID: PMC4419464 DOI: 10.1186/s12879-015-0934-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/21/2015] [Indexed: 12/22/2022] Open
Abstract
Fungal infections represent a major burden in the critical care setting with increasing morbidity and mortality. Candidiasis is the leading cause of such infections, with C. albicans being the most common causative agent, followed by Aspergillosis and Mucormycosis. The diagnosis of such infections is cumbersome requiring increased clinical vigilance and extensive laboratory testing, including radiology, cultures, biopsies and other indirect methods. However, it is not uncommon for definitive evidence to be unavailable. Risk and host factors indicating the probability of infections may greatly help in the diagnostic approach. Timely and adequate intervention is important for their successful treatment. The available therapeutic armamentarium, although not very extensive, is effective with low resistance rates for the newer antifungal agents. However, timely and prudent use is necessary to maximize favorable outcomes.
Collapse
Affiliation(s)
- Dimitrios K Matthaiou
- Department of Critical Care, University Hospital ATTIKON, Medical School, University of Athens, 1 Rimini str, Haidari-Athens, 12462, Greece.
| | - Theodora Christodoulopoulou
- Department of Critical Care, University Hospital ATTIKON, Medical School, University of Athens, 1 Rimini str, Haidari-Athens, 12462, Greece.
| | - George Dimopoulos
- Department of Critical Care, University Hospital ATTIKON, Medical School, University of Athens, 1 Rimini str, Haidari-Athens, 12462, Greece.
| |
Collapse
|
49
|
Skibba AA, West MR, Evans JR, Hopkins SP, Maltais S, Rush DS. Aspergillus thromboembolism from a mycotic ascending aortic pseudoaneurysm. J Vasc Surg Cases 2015; 1:94-96. [PMID: 31724580 PMCID: PMC6849891 DOI: 10.1016/j.jvsc.2015.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/01/2015] [Indexed: 11/29/2022] Open
Abstract
This case report describes an immune-competent patient with acute upper extremity ischemia caused by thromboembolism from an Aspergillus-infected ascending aortic pseudoaneurysm. Efforts to identify the source of an acute arterial thromboembolic occlusion should be made, and a high index of suspicion for mycotic infection should be maintained in patients with an atypical presentation, such as fevers of unknown origin. Additional measures, such as pathologic examination of thromboembolic debris, blood cultures, and positron emission tomography, should be performed to identify the etiology in these unexplained situations.
Collapse
Affiliation(s)
- Afshin A Skibba
- Division of Vascular Surgery, East Tennessee State University, Johnson City, Tenn
| | - Michael R West
- Division of Vascular Surgery, East Tennessee State University, Johnson City, Tenn
| | - James R Evans
- Division of Vascular Surgery, East Tennessee State University, Johnson City, Tenn
| | - Steven P Hopkins
- Division of Vascular Surgery, East Tennessee State University, Johnson City, Tenn
| | - Simon Maltais
- Department of Cardiac Surgery, Vanderbilt Heart and Vascular Institute, Nashville, Tenn
| | - Daniel S Rush
- Division of Vascular Surgery, East Tennessee State University, Johnson City, Tenn
| |
Collapse
|
50
|
Abstract
We report a case of mediastinal mass caused by a fungal infection in an immunocompetent child. The patient presented with superior mediastinal syndrome along with a swelling in the chest wall. Cytology and culture demonstrated Aspergillus flavus. The child was treated with voriconazole, which resulted in clinical response.
Collapse
|