Lung abscess caused by Paecilomyces lilacinus

Consensus guidelines for the diagnosis and management of invasive fungal disease due to moulds other than Aspergillus in the haematology/oncology setting, 2021

Invasive fungal disease (IFD) due to moulds other than Aspergillus is a significant cause of mortality in patients with malignancies or post haemopoietic stem cell transplantation. The current guidelines focus on the diagnosis and management of the common non-Aspergillus moulds (NAM), such as Mucorales, Scedosporium species (spp.), Lomentospora prolificans and Fusarium spp. Rare but emerging NAM including Paecilomyces variotii, Purpureocillium lilacinum and Scopulariopsis spp. are also reviewed. Culture and histological examination of tissue biopsy specimens remain the mainstay of diagnosis, but molecular methods are increasingly being used. As NAM frequently disseminate, blood cultures and skin examination with biopsy of any suspicious lesions are critically important. Treatment requires a multidisciplinary approach with surgical debridement as a central component. Other management strategies include control of the underlying disease/predisposing factors, augmentation of the host response and the reduction of immunosuppression. Carefully selected antifungal therapy, guided by susceptibility testing, is critical to cure. We also outline novel antifungal agents still in clinical trial which offer substantial potential for improved outcomes in the future. Paediatric recommendations follow those of adults. Ongoing epidemiological research, improvement in diagnostics and the development of new antifungal agents will continue to improve the poor outcomes that have been traditionally associated with IFD due to NAM.

Occurrence of fruiting structures allows determination of Purpureocillium lilacinum as an inciting agent of pleuritis and pneumonia in a loggerhead sea turtle (Caretta caretta) by histopathologic correlation to culture

Purpureocillium lilacinum and Beauveria bassiana were isolated from lung sampled at necropsy of a 12 year-old female loggerhead sea turtle (Caretta caretta) that had displayed abnormal buoyancy. Histopathologic evaluation revealed pleuritis and pneumonia with non-melanized, septate hyphae and fruiting structures identical to those of P. lilacinum. This case emphasizes the importance of a histological correlate to fungal culture when environmental fungi are isolated and demonstrates the infrequent phenomenon of fruiting or conidial production in tissue.

Human Hyalohyphomycoses: A Review of Human Infections Due toAcremoniumspp.,Paecilomycesspp.,Penicilliumspp., andScopulariopsisspp

Human infections due to opportunistic molds are on the rise. This is due to recent advances in medical technology that have led to increased numbers of patients who are immunosuppressed, receiving broad-spectrum antibiotics, or have indwelling medical devices. In this article, human infections caused by four hyalohyphomycoses, Acremonium spp., Paecilomyces spp., Penicillium spp., and Scopulariopsis spp., will be reviewed. Specific areas of focus will include the epidemiology, mycology, clinical presentations, and treatment options for each of these four hyaline molds.

Paecilomyces variotii as an Emergent Pathogenic Agent of Pneumonia

Paecilomyces variotii is a commonly occurring species in air and food, and it is also associated with many types of human infections. Pneumonia due to Paecilomyces variotii has been rarely reported in the medical literature. The authors report a 48-year-old patient with refractory lymphoma who underwent allogenic hematopoietic cell transplantation and developed pneumonia due to Paecilomyces variotii. They also review the published case reports of pneumonia caused by this fungus.

Purpureocillium lilacinum as a cause of cavitary pulmonary disease: a new clinical presentation and observations on atypical morphologic characteristics of the isolate

The first case of cavitary pulmonary disease caused by Purpureocillium lilacinum is described. The isolate showed atypical microscopic characteristics similar to Acremonium and Fusarium spp., which necessitated molecular identification by sequencing of multiple conserved loci. The patient responded to voriconazole, reinforcing its therapeutic efficacy for P. lilacinum infections.

Pulmonary Paecilomyces lilacinus Infection in a Cat

A 6-year-old, spayed female domestic shorthair cat was referred for an intermittent cough and wheezing of 3 to 4 months' duration. Thoracic radiography revealed atelectasis of the right middle and caudal lung lobes with hyperinflation of the accessory lobe, consistent with bronchial obstruction. Bronchoscopy confirmed a narrowing of the right mainstem bronchial lumen; however, positive-pressure ventilation resulted in a severe pneumothorax. A lateral thoracotomy and right caudal lung lobectomy resulted in complete resolution of the pneumothorax and respiratory signs. Histopathology and culture of the lung revealed Paecilomyces lilacinus. The cat was placed on itraconazole therapy for 6 months. Since dismissal from the hospital, the cat has not exhibited clinical evidence of wheezing, coughing, or dyspnea and is neurologically normal.

Emerging fungal pathogens in pulmonary disease

PURPOSE OF REVIEW

Invasive fungal infections of the lung have been increasing due to the increase of the population most at risk. This review aims to describe some of the emerging fungal pathogens and their complex management.

RECENT FINDINGS

With the increase in immunosuppressed populations, physicians are increasingly encountering uncommon fungal pathogens that historically have been difficult to identify and treat. Many of these fungal infections present with similar clinical features and often show similar histopathological changes. Treatment options are more complex because of an increasing number of antifungals that have become available for clinical use. The correct usage of these antifungals in addressing emerging fungal infections is unclear, however. Drawing from in-vitro and in-vivo susceptibility testing and case reports, some deductions may be made for the best empirical treatment of these deadly diseases. In general, the newer triazoles (voriconazole and posiconazole) and the use of combination therapy have shown promise.

SUMMARY

Invasive fungal infections are on the increase and contribute significantly to overall mortality, particularly among transplant recipients. With the lack of well designed controlled clinical studies, physicians will need to draw from previously described cases and in-vitro susceptibility testing to optimize therapy.

Clinical manifestations, treatment and outcome of Paecilomyces lilacinus infections

The fungus Paecilomyces lilacinus is an emerging pathogen that causes severe human infections, including devastating oculomycosis. Usually, it shows low susceptibility to conventional antifungal drugs in vitro, and variable susceptibility to novel triazoles. A review of the published literature identified 119 reported cases of human infection by P. lilacinus between 1964 and 2004. Most were cases of oculomycosis (51.3%), followed by cutaneous and sub-cutaneous infections (35.3%), and a smaller group of miscellaneous infections (13.4%). Lens implantation is the most frequent predisposing factor for oculomycosis. Cutaneous and sub-cutaneous infections occur mainly in solid organ and bone marrow transplant recipients, although surgery and primary or acquired immunodeficiency are also relevant predisposing factors. Infections in apparently immunocompetent patients have also been reported. Surgical debridement combined with antifungal drug therapy, or the correction of predisposing factors, such as neutropenia, are usually required to obtain improvement. Treatment with traditional antifungal drugs often fails. Voriconazole has demonstrated good activity in both cutaneous and ocular infections in the few cases in which this drug has been used. The new triazoles ravuconazole and posaconazole show good in-vitro activity against P. lilacinus and could be promising therapeutic alternatives.

Pulmonary mycetoma caused by an atypical isolate of Paecilomyces species in an immunocompetent individual: case report and literature review of Paecilomyces lung infections

The first case of pulmonary fungus ball caused by Paecilomyces species is reported. The diagnosis was established by isolation of the fungus in culture from specimens obtained by percutaneous transthoracic needle aspiration in an immunocompetent individual. The isolate was atypical, as it failed to produce fruiting structures on routine mycological media. Identification was achieved by sequencing polymorphisms of the internal transcriber spacer regions of the ribosomal DNA. The antifungal susceptibility profile was also determined. This report underscores the increasing importance of Paecilomyces species in human infections. Paecilomyces should be included among the etiological agents of pulmonary mycetoma.

Paecilomyces lilacinus vaginitis in an immuno-competent patient

Paecilomyces lilacinus, an environmental mold found in soil and vegetation, rarely causes human infection. We report the first case of P. lilacinus isolated from a vaginal culture in a patient with vaginitis.

Testing the nematophagous biological control strainPaecilomyces lilacinus251 for paecilotoxin production

Paecilomyces lilacinus is a nematophagous fungus currently developed as a biological control agent. In order to evaluate potential toxin production, culture extract and concentrated culture supernatant of P. lilacinus strain 251 were tested against Gram-negative and Gram-positive bacteria. High-performance liquid chromatography analysis was carried out to compare the chromatograms of P. lilacinus strain 251 with the chromatogram of known paecilotoxin. It was found that the 251 strain of P. lilacinus did not produce detectable levels of paecilotoxin or other toxins with antimicrobial activity.

Voriconazole treatment of disseminated paecilomyces infection in a patient with acquired immunodeficiency syndrome

We describe a patient with poorly controlled, multidrug-resistant human immunodeficiency virus disease who developed >20 skin lesions caused by Paecilomyces lilacinus. The lesions failed to improve during treatment with oral itraconazole, amphotericin B, and amphotericin B lipid complex but improved during treatment with voriconazole.

Phylogeny of mitosporic entomopathogenic fungi: is the genus Paecilomyces polyphyletic?

We analyzed sequences of the divergent domain at the 5' end of the large subunit rRNA gene from the mitosporic entomopathogenic fungi Paecilomyces sp., Paecilomyces fumosoroseus, Paecilomyces farinosus, Paecilomyces lilacinus, Verticillium lecanii, Verticillium psalliotae, Beauveria bassiana, Aschersonia sp., Aschersonia placenta, ascomycetous Cordyceps sp., and Cordyceps militaris. Phylogenetic analysis showed P. fumosorseus as the best characterized out of the analyzed species with the B. bassiana clade as its sister group. Two of the P. farinosus isolates were invariably placed within the Verticillium cluster, which also contained C. militaris. The only analyzed P. lilacinus isolate appeared on the root of the hyphomycetous fungi and was characterized as the most distinct from all the hyphomycetous fungi tested. Polyphyly of the genus Paecilomyces was well supported by the Kishino-Hasegawa test. In all trees based on the small subunit rRNA gene sequences obtained from the GenBank, V. lecanii, V. psalliotae, P. fumosoroseus, P. tenuipes and B. bassiana form, together with that of C. militaris, the best supported cluster in the tree. The rest of Cordyceps spp. constitute a distinct clade. Phylogenetic relationships derived from both tested DNA regions show polyphyly of the genus Paecilomyces and close relationships among entomopathogenic species of the genera Verticillium, Paecilomyces, and Beauveria.