Metarrhizium anisopliae as a cause of sinusitis in immunocompetent hosts

Revisiting Metarhizium and the description of new species from Thailand

Over the last two decades the molecular phylogeny and classification of Metarhizium has been widely studied. Despite these efforts to understand this enigmatic genus, the basal lineages in Metarhizium are still poorly resolved. In this study, a phylogenetic framework is reconstructed for the Clavicipitaceae focusing on Metarhizium through increased taxon-sampling using five genomic loci (SSU, LSU, tef, rpb1, rpb2) and the barcode marker ITS rDNA. Multi-gene phylogenetic analyses and morphological characterisation of green-spored entomopathogenic Metarhizium isolates from Thailand and soil isolates of M. carneum and M. marquandii reveal their ecological, genetic and species diversity. Nineteen new species are recognised in the Metarhizium clade with narrow host ranges: two new species are found in the M. anisopliae complex - M. clavatum on Coleoptera larvae and M. sulphureum on Lepidoptera larvae; four new species are found in the M. flavoviride complex - M. biotecense and M. fusoideum on brown plant hoppers (Hemiptera), M. culicidarum on mosquitoes, M. nornnoi on Lepidoptera larvae; three new species M. megapomponiae, M. cicadae, M. niveum occur on cicadas; five new species M. candelabrum, M. cercopidarum, M. ellipsoideum, M. huainamdangense M. ovoidosporum occur on planthoppers, leafhoppers and froghoppers (Hemiptera); one new species M. eburneum on Lepidoptera pupae; and four new species M. phuwiangense, M. purpureum, M. purpureonigrum, M. flavum on Coleoptera . Of these 19 new species, seven produce a sexual morph (M. clavatum, M. eburneum, M. flavum, M. phuwiangense, M. purpureonigrum, M. purpureum, and M. sulphureum) and asexual morphs are found in the remaining new species and also in M. sulphureum, M. purpureonigrum and M. purpureum. Metarhizium blattodeae, M. koreanum and M. viridulum are new records for Thailand. An alternative neotype for Metarhizium anisopliae is proposed based on multi-gene and 5'tef analyses showing that CBS 130.71 from Ukraine is more suitable, being from a much closer geographical location to Metchnikoff's Metarhizium anisopliae. This isolate is distinct from the neotype of Metarhizium anisopliae var. anisopliae proposed by M. Tulloch from Ethiopia (ARSEF 7487). Six new genera are established for monophyletic clades subtending the core Metarhizium clade, including Keithomyces, Marquandomyces, Papiliomyces, Purpureomyces, Sungia, and Yosiokobayasia. Metarhizium carneum, M. aciculare, and M. neogunnii are combined in Keithomyces and one new combination for M. marquandii in Marquandomyces is proposed. Purpureomyces is introduced for species producing purple stromata including a new combination for M. khaoyaiense and two new species P. maesotensis and P. pyriformis. Papiliomyces contains two new combinations for M. liangshanense and Metacordyceps shibinensis. The genus Sungia is proposed for the Korean species M. yongmunense on Lepidoptera pupa and Yosiokobayasia for the Japanese species M. kusanagiense also on Lepidoptera pupa. A synoptic and dichotomous key to the accepted taxa is provided together with tables listing distinguishing morphological characters between species, host preferences, and geography.

Two cases of fungal keratitis caused by Metarhizium anisopliae

We present two cases of keratitis due to Metarhizium anisopliae in geographically separated areas of the United States. The isolates were microscopically similar but morphologically different and were identified by ribosomal DNA sequencing. Both isolates had low minimum inhibitory concentration (MIC) values to caspofungin and micafungin, but high MIC values to amphotericin B. The morphologic and antifungal susceptibility differences between the two isolates indicate possible polyphylogeny of the group.

Species of the Metarhizium anisopliae complex with diverse ecological niches display different susceptibilities to antifungal agents

Species of the Metarhizium anisopliae complex are globally ubiquitous soil-inhabiting and predominantly insect-pathogenic fungi. The Metarhizium genus contains species ranging from specialists, such as Metarhizium acridum that only infects acridids, to generalists, such as M. anisopliae, Metarhizium brunneum, and Metarhizium robertsii that infect a broad range of insects and can also colonize plant roots. There is little information available about the susceptibility of Metarhizium species to clinical and non-clinical antifungal agents. We determined the susceptibility of 16 isolates comprising four Metarhizium species with different ecological niches to seven clinical (amphotericin B, ciclopirox olamine, fluconazole, griseofulvin, itraconazole, tebinafine, and voriconazole) and one non-clinical (benomyl) antifungal agents. All isolates of the specialist M. acridum were clearly more susceptible to most antifungals than the isolates of the generalists M. anisopliae sensu lato, M. brunneum, and M. robertsii. All isolates of M. anisopliae, M. brunneum, and M. robertsii were resistant to fluconazole and some were also resistant to amphotericin B. The marked differences in susceptibility between the specialist M. acridum and the generalist Metarhizium species suggest that this characteristic is associated with their different ecological niches, and may assist in devising rational antifungal treatments for the rare cases of mycoses caused by Metarhizium species.

Species of Metarhizium anisopliae complex implicated in human infections: retrospective sequencing study

OBJECTIVES

Fungi belonging to the Metarhizium anisopliae complex comprise ubiquitous arthropod pathogenic moulds used as mycopesticides. Rare cases of human infections due to M. anisopliae have been reported. We hypothesize misidentifications of fungal strains implicated in these cases or used in mycopesticides.

METHODS

A review of the literature was conducted to identify previously published cases. We collected some of these previous described strains and reported new cases, and a French mycopesticide containing M. anisopliae. All identifications were performed based on elongation factor-1α gene sequencing.

RESULTS

We report eight new cases of Metarhizium infection in humans (three from France and five from Australia). The strains isolated from these cases, and three others from already published cases and reported as M. anisopliae, were molecularly identified based on elongation factor-1α (Ef1-α) gene sequencing as follows: Metarhizium robertsii (six), Metarhizium guizhouense (three), Metarhizium brunneum (one) and Metarhizium pingshaense (one).

CONCLUSIONS

In this study, we report new human cases of Metarhizium infections, and, based on Ef-1α gene sequencing, we demonstrate the misidentification of species in case reports. We also correct the species identification of a strain reported as M. anisopliae used in a commercially available mycopesticide. According to our results, none of the strains from the human infection reports reviewed belongs to the species M. anisopliae.

First unusual case of keratitis in Europe due to the rare fungus Metarhizium anisopliae

Metarhizium anisopliae is a fungus utilized worldwide for insect-pest biocontrol. Few M. anisopliae infections have been reported previously. Here, M. anisopliae was isolated from a corneal ulcer in a healthy man. It is the first ocular case in France and Europe of this extremely rare fungus in humans.

Computed tomography of granulomatous pneumonia with oxalosis in an American alligator (Alligator mississippiensis) associated with Metarhizium anisopliae var anisopliae

An 18-yr-old, male, albino, American alligator (Alligator mississippiensis) was evaluated for decreased appetite and abnormal buoyancy. Computed tomography (CT) of the coelomic cavity showed multifocal mineral and soft tissue attenuating pulmonary masses consistent with pulmonary fungal granulomas. Additionally, multifocal areas of generalized, severe emphysema and pulmonary and pleural thickening were identified. The alligator was euthanized and necropsy revealed severe fungal pneumonia associated with oxalosis. Metarhizium anisopliae var. anisopliae was cultured from lung tissue and exhibited oxalate crystal formation in vitro. Crystals were identified as calcium oxalate monohydrate by X-ray powder defractometry. Fungal identification was based on morphology, including tissue sporulation, and DNA sequence analysis. This organism is typically thought of as an entomopathogen. Clinical signs of fungal pneumonia in nonavian reptiles are often inapparent until the disease is at an advanced stage, making antemortem diagnosis challenging. This case demonstrates the value of CT for pulmonary assessment and diagnosis of fungal pneumonia in the American alligator. Fungal infection with associated oxalosis should not be presumed to be aspergillosis.

Allergic Responses Induced by a Fungal Biopesticide Metarhizium anisopliae and House Dust Mite Are Compared in a Mouse Model

Biopesticides can be effective in controlling their target pest. However, research regarding allergenicity and asthma development is limited. We compared the ability of fungal biopesticide Metarhizium anisopliae (MACA) and house dust mite (HDM) extracts to induce allergic responses in BALB/c mice. The extracts were administered by intratracheal aspiration at doubling doses (2.5-80 μg protein) 4X over a four-week period. Three days after the last exposure, serum and bronchoalveolar lavage fluid (BALF) were collected. The extracts' relative allergenicity was evaluated based on response robustness (lowest significant dose response compared to control (0 μg)). MACA induced a more robust serum total IgE response than HDM. However, in the antigen-specific IgE assay, a similar dose of both MACA and HDM was required to achieve the same response level. Our data suggest a threshold dose of MACA for allergy induction and that M. anisopliae may be similar to HDM in allergy induction potential.

Pediatric Metarrhizium anisopliae keratitis

Metarrhizium anisopliae (M. anisopliae) is an entomopathogenic fungus used as an agricultural pesticide in many countries, including the United States. M. anisopliae grows optimally at 25°C and is therefore considered safe to humans. We report a case of a 12-year-old girl who is a soft contact lens wearer with M. anisopliae corneal ulcer who was treated effectively with topical natamycin after identification of the organism by corneal culture. Topical amphotericin B was not effective.

The effects of the fungus Metarhizium anisopliae var. acridum on different stages of Lutzomyia longipalpis (Diptera: Psychodidae)

The control of Visceral Leishmaniasis (VL) vector is often based on the application of chemical residual insecticide. However, this strategy has not been effective. The continuing search for an appropriate vector control may include the use of biological control. This study evaluates the effects of the fungus Metarhizium anisopliae var. acridum on Lutzomyia longipalpis. Five concentrations of the fungus were utilized, 1 x 10(4) to 1 x 10(8) conidia/ml, accompanied by controls. The unhatched eggs, larvae and dead adults previously exposed to fungi were sown to reisolate the fungi and analysis of parameters of growth. The fungus was subsequently identified by PCR and DNA sequencing. M. anisopliae var. acridum reduced egg hatching by 40%. The mortality of infected larvae was significant. The longevity of infected adults was lower than that of negative controls. The effects of fungal infection on the hatching of eggs laid by infected females were also significant. With respect to fungal growth parameters post-infection, only vegetative growth was not significantly higher than that of the fungi before infection. The revalidation of the identification of the reisolated fungus was confirmed post-passage only from adult insects. In terms of larvae mortality and the fecundity of infected females, the results were significant, proving that the main vector species of VL is susceptible to infection by this entomopathogenic fungus in the adult stage.

Topically applied myco-acaricides for the control of cattle ticks: overcoming the challenges

In the absence of commercially viable and environmentally friendly options, the management of cattle ticks is heavily dependent on the use of chemical acaricides. Due to recent advances in production, formulation and application technology, commercial fungus-based biological pesticides (myco-insecticides, myco-acaricides) are becoming increasingly popular for the control of plant pests; however, they have not been used against animal ectoparasites. The literature clearly demonstrates that entomopathogenic fungi are pathogenic to ticks under laboratory conditions. Pasture applications have also shown promise while experiments on topical application have had variable results. These results suggest that major research hurdles still exist especially for the latter. Although literature on ticks and their interactions with entomopathogenic fungi exists, there is not a clear understanding on how this can be influenced by the microenvironment of the cattle skin surface. This paper critically reviews pathogen, tick target and host skin microenvironmental factors that potentially affect pathogenicity of the applied entomopathogen. Factors influencing the route of infection for topically applied myco-acaricides are also reviewed. Major researchable constraints and recommendations are identified and prioritized. In particular, there is the need for basic studies to understand the interaction of entomopathogenic fungi with the components of the skin microenvironment, to identify suitable strains, and to develop improved formulations to overcome the various challenges.

EFEITO DO FUNGO METARHIZIUM ANISOPLIAE (METSCH.) SOROK. (DEUTEROMYCETES) PARA ASTYANAX SCABRIPINNIS (JENYNS, 1842) (PISCES: CHARACIDAE)

RESUMO Avaliou-se o efeito de Metarhizium anisopliae (Metsch.) para Astyanax scabripinnis (Jenyns, 1842) (Pisces, Characidae), em condições de laboratório. Suspensões aquosas de conídios recémproduzidos, viáveis (viabilidade mínima 90%) e inviabilizados por meio de autoclavagem (121º C, 20 minutos, a 1 atm), na concentração de 6,5 x 1010 conídios/aquário (equivalente a 5 x 1015 conídios/ ha, que representa 1.000 vezes a concentração recomendada para o controle de cigarrinhas de pastagens, principal praga-alvo deste entomopatógeno no Brasil), foram aplicadas em aquários contendo A. scabripinnis . Foram analisadas amostras de água e dos peixes, dos quais foram dissecados as brânquias e o estômago, em diferentes intervalos de tempo, a fim de se avaliar a presença dos conídios. Observaram-se diariamente o comportamento e a mortalidade de peixes em ambos os tratamentos. Avaliou-se nos peixes sobreviventes a morfologia das células das brânquias e do fígado. Verificou-se que nas brânquias não houve alteração no número de conídios ao longo de 16 dias de contato, sendo que no estômago houve um ligeiro acréscimo inicial seguido de redução constante. A viabilidade dos conídios em todos os locais avaliados decresceu após 24 horas da aplicação. Constatou-se que não houve morte ou quaisquer alterações comportamentais após 30 dias de contato, indicando a ausência de efeitos adversos associados à capacidade do fungo em provocar infecção ou exercer efeitos tóxicos em ambos os organismos-teste.

Atypical fungal sclerokeratitis

PURPOSE

To report a case of fungal sclerokeratitis caused by Metarrhizium anisopliae, which to our knowledge is the first reported case worldwide.

METHODS

A 52-year-old woman presented from rural Australia with a 1-week history of ocular injection involving the right eye without associated pain. Her best-corrected visual acuity was 6/9 in the right eye and 6/6 in the left eye. Intraocular pressure was 40 and 15 mm Hg in the right eye and left eye, respectively. On examination, a 7.0 x 4.5-mm area of corneal infiltrate and adjacent scleral necrosis involving the nasal limbus was evident. Cultures of corneal scrapings grew a filamentous fungus, identified as Metarrhizium anisopliae. The patient was started on multiple antifungal agents including topical natamycin, systemic and topical voriconazole, and eventually systemic and topical posaconazole.

RESULTS

No significant response to antifungal agents over the course of a 25-day hospital admission was seen. A limbus-to-limbus therapeutic corneal graft was performed on eventual perforation. The patient developed multiple postoperative complications including cataract, hypotony, and a flat anterior chamber. Six months after initial presentation, her resulting visual acuity was hand motion, with evidence of early graft failure and hypotony; however, she was free of infection.

CONCLUSIONS

Metarrhizium anisopliae is an extremely rare cause of ocular infection, and this report represents the first case of sclerokeratitis caused by this pathogen worldwide. Although found to be clinically sensitive to antifungal agents in previously reported cases of keratomycosis alone, it was found to be resistant to multiple antifungal agents with devastating consequences with the presence of scleral involvement.

Recurrent disseminated skin lesions due to Metarrhizium anisopliae in an adult patient with acute myelogenous leukemia

Metarrhizium anisopliae is a common insect pathogen that rarely causes infection in animals and humans. We report the first case of a disseminated skin infection in an immunocompromised adult patient. To date, only five cases of the disease in humans have been reported. There is no standard treatment for this infection.

Lack of acute pathogenicity and toxicity in mice of an isolate of Metarhizium anisopliae var. anisopliae from spittlebugs

A monospore strain of Metarhizium anisopliae var. anisopliae (EH-479/2), isolated in Mexico from Aeneolamia sp., was tested for oral acute intragastric pathogenicity and toxicity in CD-1 mice, including a thorough histological study. Animals were inoculated by gavage with one dose (10(8) conidia/animal) of viable (72 mice) and nonviable (24 mice) conidia and compared to 18 control mice. Clinical observations were done daily; mycological and histological tests were performed during necropsies at days 3, 10, 17, and 21 after the inoculation. At the end of the study, no mice showed clinical symptoms of illness, and the animals' mean weight corresponded to that of healthy adults. No inflammatory reactions were identified in analyzed organs, suggesting the nonimmunogenic status of this fungal strain. Evidence of fungal germination was noted in two lymph nodes and in liver and lung of one dead mouse, out of 72 viable-conidia treated mice. There was no evidence of toxicity symptoms in mice inoculated with nonviable conidia. The results obtained support the nonpathogenic and nontoxic status of this fungal strain when administered in a sole intragastric dose in mice.

Laboratory evaluation of new antifungal agents against rare and refractory mycoses

PURPOSE OF REVIEW

An increase in refractory invasive fungal infections in the setting of marrow/solid organ transplantation and other immune-compromising clinical entities has provided the impetus for the development of new, more efficacious/less toxic antifungal agents. This review (1) examines currently available laboratory methods for the in-vitro evaluation of these new agents against both yeasts and filamentous fungi; (2) provides a summary of the most attractive investigational agents currently undergoing clinical trials/development; and (3) outlines the major refractory mycoses in contemporary medicine.

RECENT FINDINGS

Fluconazole-resistant Candida spp., Trichosporon spp., zygomycetous genera, the endemic mycoses, Scedosporium, Aspergillus, and Fusarium spp., and an ever-expanding list of lesser-known hyaline and phaeoid genera inciting invasive fungal infections comprise the bulk of refractory mycoses in the immune-compromised host. In-vitro data generated from reference-based antifungal susceptibility testing methods indicate an increased armamentarium of potentially efficacious agents against most of these mycoses.

SUMMARY

The newly approved antifungal agents caspofungin and voriconazole, used either as monotherapy or in combination regimens, have a significantly improved spectrum of activity over previously available therapeutic options. Correlation of clinical outcomes with investigational agents demonstrating in-vivo/in-vitro activity will provide critical information needed for the development of clinically significant minimum inhibitory concentration interpretative breakpoints.

An unusual case of fungal keratitis: Metarrhizium anisopliae

PURPOSE

To report a case of fungal keratitis caused by Metarrhizium anisopliae, which to our knowledge is the first reported case in the United States.

METHOD

Case report.

RESULTS

A 36-year-old female librarian who wore extended-wear soft contact lenses was seen by an ophthalmologist on September 11 for an irritated right eye, and a corneal ulcer was diagnosed. Symptoms increased by September 27, and the patient was referred to another ophthalmologist who cultured the ulcer and had scrapings examined, which were Gram-negative for microorganisms. The patient was referred to one of the authors (W.J.R.). Her exam on October 1 showed vision corrected to 20/25 OD, a 5-mm epithelial defect with a 2.5-mm anterior stromal grayish-type infiltrate, and a quiet anterior chamber; the eye did not appear to be inflamed. The patient was reexamined on October 4 and was noted to have worsening vision. Because the initial cultures remained negative, the patient underwent a corneal biopsy, Gram stain, and cultures on October 6. Scrapings at the time of the biopsy revealed septate hyphal elements, as did the biopsy specimen, and on October 7, the patient was started on a treatment of bacitracin ointment once a day and natamycin 5% every hour. The eye gradually quieted down. A mold growing from the biopsy culture, which had been sent to a reference laboratory in San Antonio, Texas, was identified as M. anisopliae var. anisopliae. The patient was subsequently fitted with a rigid gas permeable lens, which resulted in a best-corrected visual acuity of 20/20, although glare remained a major problem.

CONCLUSION

Although not previously reported in the United States, M. anisopliae can cause a keratomycosis, and one must consider this common insect pathogen in the differential diagnosis of fungal keratitis.