Acremonium kiliense peritonitis complicating continuous ambulatory peritoneal dialysis: report of two cases

Lopes, Jorge O.; Alves, Sydney Hartz; Rosa, Ana Claudia da; Silva, C. B.; Sarturi, J. C.; Souza, CA

doi:10.1007/bf01102883

Cited by 19 publications

(9 citation statements)

References 13 publications

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“…The diagnosis was established by repeated isolation of the fungus from peritoneal dialysate in culture and its identification by typical microscopic characteristics and sequencing of the ITS regions of rDNA. So far, nine cases of Acremonium peritonitis (including the present case) have been reported and are summarized in Table 1 (12,18,21,22,25,34). Three of these cases were caused by A. kiliense and two by Acremonium strictum; in the remaining four cases, the Acremonium species were not identified ( Table 1).…”

Section: Case Reportmentioning

confidence: 90%

Acremonium kiliense: Reappraisal of Its Clinical Significance

et al. 2011

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A case of Acremonium kiliense peritonitis is described. Diagnosis was established by repeated isolation of the fungus from peritoneal dialysate and by its identification on the basis of morphological characteristics and sequencing of internal transcribed spacer (ITS) regions of ribosomal DNA (rDNA). This report and available literature suggest that A. kiliense may have a greater clinical significance than hitherto recognized. CASE REPORTA 75-year-old Jordanian man with a long history of diabetes mellitus and hypertension developed end-stage kidney disease requiring continuous ambulatory peritoneal dialysis (CAPD). His course of CAPD was largely uneventful except for a single episode of bacterial peritonitis, for which he was hospitalized and treated with parenteral antibiotics, with an excellent response. In January 2010, he became febrile, with clinical evidence of peritonitis, and was admitted to the hospital. The peritoneal fluid was turbid, with a white blood cell (WBC) count of 2.1 ϫ 10 9 /liter. On initial microscopic examination, the presence of fungal elements in the peritoneal dialysate was missed. The peritoneal fluid sample was inoculated into aerobic Bactec blood culture bottles, which yielded a growth after 59 h of incubation. The Gram-stained smear from blood culture bottles showed branched hyphal elements. On Sabouraud dextrose agar (SDA; Oxoid Ltd., Basingstoke, England), the specimen yielded slimy colonies with a pinkish appearance ( Fig. 1). Microscopic examination of the primary culture (isolate Kw441-2010) showed hyaline hyphae, with scanty sporulation. A provisional identification of Acremonium/Fusarium species was made, and the growth was subcultured on Sabouraud dextrose agar and oatmeal agar (OMA; oatmeal [30 g], agar [20 g], distilled water [1 liter]) for further identification and antifungal susceptibility testing. Subsequent cultures of the peritoneal fluid yielded the same fungus on three occasions. A serum sample was obtained for the detection of galactomannan (Platelia Aspergillus enzyme immunoassay [EIA] kit; BioRad, Marnes-la-Coquette, France) and (1-3)-␤-D-glucan (Fungitell; Associates of Cape Cod); the latter test was positive (253 pg/ml). An Etest performed on RPMI 1640 medium supplemented with 2% glucose revealed that the isolate was resistant to amphotericin B and caspofungin but susceptible to voriconazole and posaconazole, with MIC values of Ͼ32 g/ml, Ͼ32 g/ml, 0.064 g/ml, and 0.75 g/ml, respectively. The patient was started on voriconazole, with a loading dose of 400 mg, followed by a maintenance dose of 200 mg, given every 12 h via the oral route. Although the patient showed clinical improvement after 2 weeks of voriconazole therapy, the peritoneal dialysate remained turbid (WBC counts, 2.0 ϫ 10 9 / liter). Abdominal ultrasound examination did not reveal any evidence of intraperitoneal adhesions or organ invasion. Since the response to treatment was not adequate, the Tenckhoff catheter was removed and the patient was temporarily switched to hemodialysis. After 1 week of a...

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Section: Case Reportmentioning

confidence: 90%

Acremonium kiliense: Reappraisal of Its Clinical Significance

et al. 2011

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“…Based on the clinical outcomes observed we recommend treatment with voriconazole (AII), amphotericin B (BII) and posaconazole (BII) . Surgery and catheter removal have also been reported as part of the successful management of these infections (CIII) ; however, a standard therapy is lacking.…”

Section: Acremonium Infectionsmentioning

confidence: 99%

ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others

Tortorano

Richardson

Roilides³

et al. 2014

Clinical Microbiology and Infection

402

387

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Mycoses summarized in the hyalohyphomycosis group are heterogeneous, defined by the presence of hyaline (non-dematiaceous) hyphae. The number of organisms implicated in hyalohyphomycosis is increasing and the most clinically important species belong to the genera Fusarium, Scedosporium, Acremonium, Scopulariopsis, Purpureocillium and Paecilomyces. Severely immunocompromised patients are particularly vulnerable to infection, and clinical manifestations range from colonization to chronic localized lesions to acute invasive and/or disseminated diseases. Diagnosis usually requires isolation and identification of the infecting pathogen. A poor prognosis is associated with fusariosis and early therapy of localized disease is important to prevent progression to a more aggressive or disseminated infection. Therapy should include voriconazole and surgical debridement where possible or posaconazole as salvage treatment. Voriconazole represents the first-line treatment of infections due to members of the genus Scedosporium. For Acremonium spp., Scopulariopsis spp., Purpureocillium spp. and Paecilomyces spp. the optimal antifungal treatment has not been established. Management usually consists of surgery and antifungal treatment, depending on the clinical presentation.

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“…Seven cases of peritonitis, from Turkey, Brazil, the United States and Greece, have so far been published. 30,31,[123][124][125][126] The species involved were A strictum, in two cases, and A kiliense in another two (identified by a reliable laboratory). The other three isolates were not identified to the species level.…”

Section: Peritonitismentioning

confidence: 99%

Sarocladium and Acremonium infections: New faces of an old opportunistic fungus

Pérez-Cantero

Guarro

2020

Mycoses

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The genera Sarocladium and Acremonium (order Hypocreales) are a very diverse group of morphologically and genetically related fungi that are generally found in the environment. Numerous species of these genera are soil saprobes and opportunistic pathogens of plants, other fungi, animals or humans. 1 They are distributed worldwide, and Acremonium isolates have even been found in rocks on continental Antarctica. 2 In addition, these fungi are very relevant in the clinical field, as they have been proven to be involved in a wide range of human conditions and manifestations. As will be discussed later, diagnosis and management of these infections are quite challenging, mostly due to the difficulties in the correct identification and to the poor antifungal response they generally show. As a matter of fact, Acremonium and Sarocladium species cannot be distinguished by histopathological examination from some other opportunistic fungi, such as Fusarium and its relatives; therefore, DNA sequence analysis is required. This review, based on an exhaustive literature search of the PubMed database, compiles and discusses the current knowledge of Sarocladium and Acremonium infections in terms of taxonomy, clinical presentations and prognoses, diagnosis, treatment, outcomes, antifungal susceptibility and their impact in animals.

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Acremonium kiliense peritonitis complicating continuous ambulatory peritoneal dialysis: report of two cases

Cited by 19 publications

References 13 publications

Acremonium kiliense: Reappraisal of Its Clinical Significance

Acremonium kiliense: Reappraisal of Its Clinical Significance

ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others

Sarocladium and Acremonium infections: New faces of an old opportunistic fungus

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