Aspergillus niger causing tracheobronchitis and invasive pulmonary aspergillosis in a lung transplant recipient: case report

Abstract

A case of invasive aspergillosis caused by Aspergillus niger in a lung transplant recipient is described. The patient presented hyperglycemia starting postoperatively, with other complications such as cytomegalovirus infection. The associated predisposing factors and other implications are discussed. Aspergillus niger seems to be a fungal species of low virulence that requires the presence of a severely immunosuppressed host to cause invasive disease.Key-words: Aspergillosis. Tracheobronchitis. Aspergillus niger. Lung transplantation.Lung transplantation. RESUMODescreve-se um caso de aspergilose invasiva causada por Aspergillus niger em um paciente transplantado de pulmão com quadros hiperglicêmicos desde o pós-operatório e outras complicações como infecção por citomegalovírus. Os fatores predisponentes associados e outras implicações são discutidos. Aspergillus niger parece ser uma espécie fúngica de baixa virulência, necessitando a presença de um hospedeiro gravemente imunodeprimido para causar doença invasiva. Aspergillus tracheobronchitis and invasive pulmonary aspergillosis are frequent clinical presentations of Aspergillus infections in lung transplant recipients 11 . It has been documented that aspergillosis is associated with at least 9% of the deaths following lung transplant procedures. The vast majority of infections are caused by Aspergillus fumigatus 8 10 , followed by other species such as Aspergillus flavus, Aspergillus terreus and Aspergillus niger. Here, we report the unusual occurrence of Aspergillus niger infection following lung transplantation. The implications of these findings are discussed. Palavras CASE REPORTA 48-year-old woman had undergone right lung transplantation in 1993 due to idiopathic pulmonary fibrosis. Her early postoperative period was marked by the occurrence of hyperglycemia.Acute rejection was suspected five days after the surgical procedure because of oxygen desaturation events. Broad-spectrum antibacterial therapy was started, including amikacin, ceftazidime and vancomycin. She was also started on a three-day course of high-dose methylprednisolone (1,000mg/day). A transbronchial biopsy revealed the presence of hyaline hyphae infiltrating the lung parenchyma. The hyphae were septate, with acute-angle branching, which was consistent with aspergillosis. Lung biopsy culturing revealed growth of Aspergillus niger. This mould was also recovered from sputum and bronchoalveolar lavage, both cultivated on Sabouraud dextrose agar with chloramphenicol at 25ºC. She was put on a combination of itraconazole (400mg daily) and amphotericin B (1.5mg/kg/day), which she took for two months. Further cultures for fungi were all negative.Over the next months, the patient presented cytomegalovirus pneumonia associated with steroid-resistant rejection. She was RELATO DE CASO/CASE REPORT

Clinical features of invasive bronchial-pulmonary aspergillosis in critically ill patients with chronic obstructive respiratory diseases: a prospective study

“…With corticosteroids and broad-spectrum antibiotics therapy, the infection could spread to the distal airways and lung parenchyma, presenting as IPA. Several reports have shown that lung parenchyma was usually involved together with ATB, and invasive ATB may indicate an advanced pulmonary lesion caused by Aspergillus [11-15]. In our study, two patients who had a tracheobronchial mucus and lung biopsy (cases 2 and 12) had specific radiologic findings on their CT scans, as well as positive GM tests.…”

“…Several reports have suggested that ATB might progress to or coexist with IPA [11,12]. A recent study showed that ATB could occur in moderately or non-immunocompromised patients with impaired airway structures or defense functions and may be an early stage of IPA [13].…”

Respiratory tract allergic disease and atopy: experimental evidence for a fungal infectious etiology

“…We therefore considered alternative means by which fungi could be linked to allergic lung disease through their secreted proteinases. Many species of Aspergillus have previously been shown to infect the human respiratory tract and cause invasive disease, but invasive disease due to A. niger is rare, usually being observed only in the setting of severe immune compromise [32,33]. In contrast, as many as 32% of immunologically normal asthma subjects demonstrate serum or skin prick test-based reactivity to fungal conidia antigens [34].…”

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“…Climate factors particularly temperature and humidity are important determinants of the presence of Aspergillus species in the air, with A. flavus being particularly frequent in certain countries and hospitals. A. niger is rarely a cause of invasive infection in immune compromised patients; this species is more likely to cause chronic pulmonary infection and colonise abnormal airways [21,27].…”