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Dumic I, Caetano EM, Domingues SM, Pantic I, Radovanovic M, Prada LR, Nordstrom CW, Antic M, Milovanovic T, Kotseva M, Singh A, Fnu S. Clinical characteristics, diagnosis, treatment, and outcome of patients with liver abscess due to Aspergillus spp: a systematic review of published cases. BMC Infect Dis 2024; 24:345. [PMID: 38519916 PMCID: PMC10960385 DOI: 10.1186/s12879-024-09226-y] [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] [Received: 12/12/2023] [Accepted: 03/14/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Aspergillus spp liver abscess is a relatively rare entity and thus far no systematic review has been performed examining patients' demographics, clinical manifestations, diagnosis, management, and outcome. METHODS We performed a systematic review of the literature using MEDLINE and LILACS databases. We searched for articles published in the period from January 1990 to December 24, 2022, to identify patients who developed liver abscesses due to Aspergillus spp. RESULTS Our search yielded 21 patients all of whom had invasive aspergillosis confirmed on liver biopsy. Of these patients 81% were adults, and 60% were males. The majority (86%) of patients were immunocompromised and 95% had symptomatic disease at the time of diagnosis. The most common symptoms were fever (79%), abdominal pain (47%), and constitutional symptoms (weight loss, chills, night sweats, fatigue) (38%). Liver enzymes were elevated in 50%, serum galactomannan was positive in 57%, and fungal blood cultures were positive in only 11%. Co-infection with other pathogens preceded development of apsergillosis in one-third of patients, and the majority of the abscesses (43%) were cryptogenic. In the remaining patients with known source, 28% of patients developed liver abscess through dissemination from the lungs, 19% through the portal vein system, and in 10% liver abscess developed through contiguous spread. The most common imaging modality was abdominal computerized tomography done in 86% of patients. Solitary abscess was present in 52% of patients while 48% had multiple abscesses. Inadequate initial empiric therapy was prescribed in 60% of patients and in 44% of patients definite treatment included combination therapy with two or more antifungal agents. Percutaneous drainage of the abscesses was done in 40% of patients, while 20% required liver resection for the treatment of the abscess. Overall mortality was very high at 38%. CONCLUSION Further studies are urgently needed for a better understanding of pathophysiology of liver aspergillosis and for developement of newer blood markers in order to expedite diagnosis and decrease mortality.
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Affiliation(s)
- Igor Dumic
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.
| | | | | | - Ivana Pantic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Radovanovic
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Libardo Rueda Prada
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Jacksonville, Florida, USA
| | - Charles W Nordstrom
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Marina Antic
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Tamara Milovanovic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Magdalena Kotseva
- Internal Medicine Residency Program, Franciscan Health, Olympia Fields, IL, USA
| | - Amteshwar Singh
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Shweta Fnu
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Infectious Diseases, Mayo Clinic Health System, Eau Claire, WI, USA
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2
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Ahamefule CS, Ezeuduji BC, Ogbonna JC, Moneke AN, Ike AC, Wang B, Jin C, Fang W. Marine Bioactive Compounds against Aspergillus fumigatus: Challenges and Future Prospects. Antibiotics (Basel) 2020; 9:E813. [PMID: 33207554 PMCID: PMC7698247 DOI: 10.3390/antibiotics9110813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022] Open
Abstract
With the mortality rate of invasive aspergillosis caused by Aspergillus fumigatus reaching almost 100% among some groups of patients, and with the rapidly increasing resistance of A. fumigatus to available antifungal drugs, new antifungal agents have never been more desirable than now. Numerous bioactive compounds were isolated and characterized from marine resources. However, only a few exhibited a potent activity against A. fumigatus when compared to the multitude that did against some other pathogens. Here, we review the marine bioactive compounds that display a bioactivity against A. fumigatus. The challenges hampering the discovery of antifungal agents from this rich habitat are also critically analyzed. Further, we propose strategies that could speed up an efficient discovery and broaden the dimensions of screening in order to obtain promising in vivo antifungal agents with new modes of action.
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Affiliation(s)
- Chukwuemeka Samson Ahamefule
- National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China; (C.S.A.); (B.W.)
- College of Life Science and Technology, Guangxi University, Nanning 530005, Guangxi, China
- Department of Microbiology, University of Nigeria, Nsukka 410001, Enugu State, Nigeria; (J.C.O.); (A.N.M.); (A.C.I.)
| | | | - James C. Ogbonna
- Department of Microbiology, University of Nigeria, Nsukka 410001, Enugu State, Nigeria; (J.C.O.); (A.N.M.); (A.C.I.)
| | - Anene N. Moneke
- Department of Microbiology, University of Nigeria, Nsukka 410001, Enugu State, Nigeria; (J.C.O.); (A.N.M.); (A.C.I.)
| | - Anthony C. Ike
- Department of Microbiology, University of Nigeria, Nsukka 410001, Enugu State, Nigeria; (J.C.O.); (A.N.M.); (A.C.I.)
| | - Bin Wang
- National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China; (C.S.A.); (B.W.)
- State Key Laboratory of Non-food Biomass and Enzyme Technology, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China
| | - Cheng Jin
- National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China; (C.S.A.); (B.W.)
- College of Life Science and Technology, Guangxi University, Nanning 530005, Guangxi, China
| | - Wenxia Fang
- National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China; (C.S.A.); (B.W.)
- State Key Laboratory of Non-food Biomass and Enzyme Technology, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China
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Pourbaix A, Guery R, Bruneau J, Blanc E, Jouvion G, Weinandt M, Rouzaud C, Lourenço J, Boutboul D, Mira JP, Rouquette A, Molina TJ, Lecuit M, Lortholary O. "Chronic Disseminated Aspergillosis," a Novel Fungal Immune Reconstitution Inflammatory Syndrome. Open Forum Infect Dis 2020; 7:ofaa175. [PMID: 33204743 PMCID: PMC7651489 DOI: 10.1093/ofid/ofaa175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 10/22/2020] [Indexed: 01/11/2023] Open
Abstract
We report a case of chronic hepatosplenic aspergillosis following immune reconstitution complicating colic aspergillosis in an AIDS patient with multicentric Castleman disease. Symptoms mimicked the clinical presentation of chronic disseminated candidiasis and responded to corticosteroid. This emerging entity enlarges the spectrum of fungal immune reconstitution inflammatory syndrome in the HIV setting.
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Affiliation(s)
- Annabelle Pourbaix
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Romain Guery
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Julie Bruneau
- Pathology Department, Necker-Enfants Malades Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Estelle Blanc
- Nuclear Medicine Department, Marie Lannelongue Hospital, Le Plessis-Robinson, France
| | - Gregory Jouvion
- Pathophysiology of Pediatric Genetic Diseases, Sorbonne Université, INSERM, Assistance Publique Hôpitaux de Paris, Hôpital Armand-Trousseau, UF Génétique Moléculaire, Paris, France.,Experimental Neuropathology Unit, Institut Pasteur, Paris, France
| | - Marthe Weinandt
- Visceral Surgery Department, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Claire Rouzaud
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Jérémy Lourenço
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - David Boutboul
- Clinical Immunopathology Department, St Louis Hospital, AP-HP, University of Paris, INSERM U967 HIPI, Paris, France
| | - Jean-Paul Mira
- Medical Intensive Care Department, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Alexandre Rouquette
- Pathology Department, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Thierry Jo Molina
- Pathology Department, Necker-Enfants Malades Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Marc Lecuit
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,Biology of Infection Unit, Institut Pasteur, INSERM U1117, Paris, France
| | - Olivier Lortholary
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,Molecular Mycology Unit, Institut Pasteur, CNRS UMR2000, Paris, France
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Invasive Aspergillosis of the Liver in an Immunocompetent Patient. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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de Oliveira FM, Fragoso MCBV, Meneses AF, Vilela LAP, Almeida MQ, Palhares RB, de Arruda Mattos TV, Scalissi NM, Viana Lima J. ADRENAL INSUFFICIENCY CAUSED BY PARACOCCIDIOIDOMYCOSIS: THREE CASE REPORTS AND REVIEW. AACE Clin Case Rep 2019; 5:e238-e243. [PMID: 31967043 DOI: 10.4158/accr-2018-0632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 02/03/2019] [Indexed: 11/15/2022] Open
Abstract
Objective Fungal infections can affect the adrenal glands, causing primary adrenal insufficiency (PAI). Although endemic to South America, paracoccidioidomycosis (PCM), which can lead to PAI, has gained global relevance with the increase in international travel and migration. Methods The present report describes 3 patients with PAI caused by PCM. Results Patients in cases 1 and 2 both reported indisposition, asthenia, nausea, hyperpigmentation of the skin, hypotension, and weight loss. Complementary exams confirmed PAI due to PCM. Case 1 was serologically diagnosed. In contrast, the definitive diagnosis of case 2 was only reached by computed tomography (CT)-guided adrenal biopsy after negative serologies for PCM. Case 3, with diabetes mellitus, had a history of asthenia, nausea and weight loss after persistent sinusitis. Initially, serologic results were negative for PCM and the patient's CT-guided biopsy resulted in insufficient tissue to obtain a definitive diagnosis. Contrary to the initial hypothesis of invasive aspergillosis, since the only etiological evidence for the patient's clinical condition were positive serologies for Aspergillus fumigatus, histopathologic examination of the specimen provided by a left adrenalectomy finally confirmed PCM as the etiology for PAI in this case as well. Conclusion The 3 cases illustrate the necessity to investigate PAI whenever there are suspicious clinical findings. They also show that fungal infections should be considered among the diagnostic hypotheses during the etiological investigation of PAI. Finally, they teach us that definitive diagnosis of PCM may require direct visualization of the pathogen.
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Grover S, Selhi PK, Sood N, Sood R, Kaur H. "Polka Dot Macrophages" on cytology of bilateral adrenal masses-Nailing disseminated histoplasmosis. Diagn Cytopathol 2017; 45:943-946. [PMID: 28548709 DOI: 10.1002/dc.23758] [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: 12/27/2016] [Revised: 04/20/2017] [Accepted: 05/08/2017] [Indexed: 11/06/2022]
Abstract
Histoplasma capsulatum is a saprophytic fungus that in immunocompetent individuals causes self-limited pulmonary infection; however, in immunosuppressed patients involvement of the reticuloendothelial system, alimentary tract, urinary tract, and central nervous system is fairly common. Rarely patients present with bilateral adrenal masses which mimic tuberculosis and metastasis on radiology because of associated central necrosis. Ultrasound guided FNAC aided by special stains like Periodic Acid Schiff (PAS) and Gomori Methenamine Silver (GMS) may help in early diagnosis in such dubious cases. Polka dot macrophages were the clue to diagnosis of histoplasmosis on toluidine blue rapid staining, Hematoxylin & Eosin, and Pap stained smears. We report this case because of its rarity, diagnostic difficulty on radiology, and rapidity of diagnosis by FNA due of its characteristic cytomorphology.
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Affiliation(s)
- Sumit Grover
- Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Pavneet Kaur Selhi
- Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Neena Sood
- Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Ridhi Sood
- Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Harpreet Kaur
- Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
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Jeanvoine A, Rocchi S, Reboux G, Grenouillet F, Benassarou M, Chirouze C, Millon L. Sinus aspergillosis due to an azole-resistant Aspergillus fumigatus strain carrying the TR34/L98H mutation in immunocompetent host. Infect Dis (Lond) 2016; 48:765-6. [PMID: 27315172 DOI: 10.1080/23744235.2016.1193791] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Audrey Jeanvoine
- a Parasitology-Mycology Department , University Hospital , Besançon , France
| | - Steffi Rocchi
- a Parasitology-Mycology Department , University Hospital , Besançon , France ;,b Chrono-Environnement UMR 6249 CNRS , Bourgogne Franche-Comté University , Besançon , France
| | - Gabriel Reboux
- a Parasitology-Mycology Department , University Hospital , Besançon , France ;,b Chrono-Environnement UMR 6249 CNRS , Bourgogne Franche-Comté University , Besançon , France
| | - Frederic Grenouillet
- a Parasitology-Mycology Department , University Hospital , Besançon , France ;,b Chrono-Environnement UMR 6249 CNRS , Bourgogne Franche-Comté University , Besançon , France
| | - Mourad Benassarou
- c Maxillofacial Surgery Department , University Hospital , Besançon , France
| | - Catherine Chirouze
- d Infectious Diseases Department , University Hospital , Besançon , France
| | - Laurence Millon
- a Parasitology-Mycology Department , University Hospital , Besançon , France ;,b Chrono-Environnement UMR 6249 CNRS , Bourgogne Franche-Comté University , Besançon , France
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