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Dobias R, Filip M, Vragova K, Dolinska D, Zavodna P, Dujka A, Linzer P, Jurek P, Studena B, Cerna E, Mrazek J, Jaworska P, Kantorova M, Lyskova P, Krejci E, Hubka V. Successful surgical excision of cerebral abscess caused by Fonsecaea monophora in an immunocompetent patient and review of literature. Folia Microbiol (Praha) 2018; 64:383-388. [PMID: 30368648 DOI: 10.1007/s12223-018-0661-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/22/2018] [Indexed: 11/26/2022]
Abstract
Cerebral abscesses caused by dark-pigmented Fonsecaea fungi are rare, especially in otherwise healthy individuals. In this case report, we present a 61-year-old man from Moldova, living in the Czech Republic, who had worked as a locksmith on oil platforms in Turkmenistan, Kazakhstan, Sudan, and Iraq since 1999, and was admitted to a neurology ward for a sudden motion disorder of the right leg, dysarthria, and hypomimia. Imaging revealed presence of expansive focus around the left lateral ventricle of the brain and a pronounced peripheral edema. The intracranial infectious focus was excised under intraoperative SonoWand guidance. Tissue samples were histologically positive for dark-pigmented hyphae, suggesting dematiaceous fungi. Therefore, liposomal amphotericin B therapy was initiated immediately. Fonsecaea monophora was provisionally identified using ITS rDNA region sequencing directly from brain tissue. The identification was subsequently confirmed by cultivation and DNA sequencing from culture. The strain exhibited in vitro sensitive to voriconazole (MIC = 0.016 μg/mL) and resistance to amphotericin B (MIC = 4 μg/mL); therefore, the amphotericin B was replaced with voriconazole. Postoperatively, a significant clinical improvement was observed and no additional surgery was required. Based on the literature review, this is the third documented case of cerebral infection due to this pathogen in patients without underlying conditions and the first such case in Europe.
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Affiliation(s)
- Radim Dobias
- Department of Bacteriology and Mycology, Institute of Public Health in Ostrava, Ostrava, Czech Republic.
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic.
| | - Michal Filip
- Neurosurgery, Tomas Bata Regional Hospital, Zlin, Czech Republic
- Department of Rehabilitation, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Katerina Vragova
- Department of Infectious Diseases, Uherske Hradiste Hospital, Uherske Hradiste, Czech Republic
| | - Dagmar Dolinska
- Pathological and Anatomical Department, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Petra Zavodna
- Department of Infectious Diseases, Uherske Hradiste Hospital, Uherske Hradiste, Czech Republic
| | - Ales Dujka
- Radiodiagnostic Department, Uherske Hradiste Hospital, Uherske Hradiste, Czech Republic
| | - Petr Linzer
- Neurosurgery, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Patrik Jurek
- Neurosurgery, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Barbora Studena
- Pathological and Anatomical Department, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Eva Cerna
- Department of Infectious Diseases, Uherske Hradiste Hospital, Uherske Hradiste, Czech Republic
| | - Jakub Mrazek
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
- Department of Molecular Biology, Institute of Public Health in Ostrava, Ostrava, Czech Republic
| | - Pavla Jaworska
- Department of Bacteriology and Mycology, Institute of Public Health in Ostrava, Ostrava, Czech Republic
| | - Michaela Kantorova
- Department of Molecular Biology, Institute of Public Health in Ostrava, Ostrava, Czech Republic
| | - Pavlina Lyskova
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
- Department of Parasitology, Mycology and Mycobacteriology Prague, Public Health Institute in Usti nad Labem, Prague, Czech Republic
| | - Eva Krejci
- Department of Bacteriology and Mycology, Institute of Public Health in Ostrava, Ostrava, Czech Republic
- Department of Biomedical Science, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Vit Hubka
- Department of Botany, Faculty of Science, Charles University, Prague, Czech Republic
- Laboratory of Fungal Genetics and Metabolism, Institute of Microbiology of the AS CR, Prague, Czech Republic
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Dobias R, Jaworska P, Tomaskova H, Kanova M, Lyskova P, Vrba Z, Holub C, Svobodová L, Hamal P, Raska M. Diagnostic value of serum galactomannan, (1,3)-β-d-glucan, and Aspergillus fumigatus-specific IgA and IgG assays for invasive pulmonary aspergillosis in non-neutropenic patients. Mycoses 2018; 61:576-586. [PMID: 29575150 DOI: 10.1111/myc.12765] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 02/07/2023]
Abstract
Detection of serum galactomannan (GM) and (1,3)-β-d-glucan (BG) is considered useful for non-culture diagnosis of invasive pulmonary aspergillosis (IPA) in neutropenic patients. Only few studies evaluated these seromarkers in non-neutropenic patients suspected of having IPA. The aim of this study was to evaluate both tests together with the Aspergillus fumigatus-specific serum IgG and IgA (IgAG) test for serological IPA diagnosis in non-neutropenic patients. Sera from 87 patients suspected of having IPA were retrospectively analysed. Patients were categorised into groups of proven IPA (n = 10), putative IPA (n = 31) and non-IPA colonisation (n = 46). When the GM, BG and IgAG assays were used for patients included in the study, the sensitivity/specificity/positive predictive value (PPV)/negative predictive value (NPV) were 48.8%/91.3%/83.3%/66.7%, 82.9%/73.9%/73.9%/82.9% and 75.6%/95.7%/93.9%/81.5%, respectively. Thus, the highest specificity and PPV were confirmed for the IgAG assay. Improvements in the sensitivity and NPV were achieved by "at least one positive" analysis with the GM and BG assays, with the sensitivity/specificity/PPV/NPV values being 85.0%/69.6%/71.4%/84.2%. Nevertheless, the highest sensitivity and NPV were achieved by the "at least one positive" analysis combining the GM, BG and IgAG tests (97.6% and 96.8%, respectively). The involvement of the IgAG assay could improve IPA diagnosis in non-neutropenic patients by increasing the sensitivity and NPV when combined with the GM or BG assays. Furthermore, improvement was achieved by combining the GM, BG and IgAG assays using the "at least one positive test" strategy, especially if doubt exists.
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Affiliation(s)
- R Dobias
- Laboratory of Clinical Mycology, Bacteriology and Mycology, Institute of Public Health in Ostrava, Ostrava, Czech Republic.,Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - P Jaworska
- Laboratory of Clinical Mycology, Bacteriology and Mycology, Institute of Public Health in Ostrava, Ostrava, Czech Republic
| | - H Tomaskova
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic.,Center of Health Services, Institute of Public Health in Ostrava, Ostrava, Czech Republic.,Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - M Kanova
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Intensive Medicine, Emergency Medicine and Forensic Studies, University of Ostrava, Ostrava, Czech Republic
| | - P Lyskova
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic.,Laboratory of Mycology, Department of Parasitology, Mycology and Mycobacteriology Prague, Public Health Institute in Usti nad Labem, Prague, Czech Republic
| | - Z Vrba
- Lung Department, Krnov Combined Medical Facility, Krnov, Czech Republic
| | - C Holub
- Lung Department, Krnov Combined Medical Facility, Krnov, Czech Republic
| | - L Svobodová
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - P Hamal
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - M Raska
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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