Acremonium kiliense: Case Report and Review of Published Studies

Abstract

Changes in the spectrum of clinically important fungal infection have been observed in recent years. Acremonium species has been responsible for eumycotic mycetomas but has also been increasingly implicated in systemic fungal diseases. A case of Acremonium kiliense fungemia with proven involvement of the lungs in an allogeneic hematopoietic stem cell patient is reported. A high-resolution computed tomography scan of the lungs showed nodules in both lungs. Multiple cultures of blood demonstrated narrow septate hyphae, cylindrical conidia, and solitary tapering phialides and microconidia that remained grouped in slimy heads. The isolate was identified as A. kiliense based on its morphological characteristics and DNA sequence analysis. Susceptibility testing of the clinical isolate was performed to four antifungal agents. Amphotericin B, fluconazole and itraconazole were found to be inactive in vitro against the isolate; however, it was found to be sensitive to voriconazole. This last drug was indicated, and a high-resolution computed tomography scan of the lungs was normal after 10 days. One year later, the patient was free of symptoms and her blood culture was negative for fungi. Thus, voriconazole was effective in treatment for life-threatening A. kiliense infections. In this work, we performed an overview of worldwide clinical infections caused by A. kiliense.

SarocladiumandAcremoniuminfections: New faces of an old opportunistic fungus

“…53 Patients succumbed to the infection in seven cases. 8,25,27,28,59,61 These cases perfectly illustrate the need for mycological analysis of blood samples in febrile neutropenic patients. It is also worth mentioning that antifungal susceptibility testing of the isolates involved in the reported cases of fungaemia was crucial to selecting the best treatment, since traditional therapy with AMB failed in numerous cases.…”

“…Fungaemia is the most common clinical manifestation of Sarocladium/Acremonium infections, with 106 different cases described. [8][9][10]19,[25][26][27][28][51][52][53][54][55][56][57][58][59][60][61][62] This condition has affected patients ranging from 27 weeks to 74 years old, although 90% of the patients from the two biggest outbreaks (Colombia and Chile) were younger than 16 years old. Most of the cases were reported from Chile (67) and Colombia (16), and practically all of them resulted from receiving contaminated intravenous medication.…”

Systemic Acremonium species infection in a dog

“…According to reports newer azoles, like voriconazole and caspofungin, have good in vitro and in vivo activities against Acremonium spp. (5,12,13,21,26,29). Voriconazole, considered the medication of choice in this case based on susceptibility testing, was not affordable for the owner.…”

“…Localized infections account for nearly two thirds of the A. kiliense cases reported worldwide in human medicine, while the remaining third of cases are disseminated infections (13). Systemic spread of Acremonium spp.…”

Non-Aspergillus Hyaline Molds: Emerging Causes of Sino-Pulmonary Fungal Infections and Other Invasive Mycoses

“…116 Pulmonary involvement appears less common with Acremonium species as compared with other hyaline molds. Pulmonary nodules without halo sign are described in patients with chronic lymphocytic leukemia, acute lymphocytic leukemia, an allogeneic HSCT recipient, and a patient with chronic granulomatous disease, [117][118][119][120] and a lung abscess was reported in a patient not known to be immunocompromised. 121 Similar to immunocompromised patients with fusariosis, cutaneous lesions are common in patients with disseminated Acremonium infection and manifest as painful erythematous papules with or without central necrosis.…”