Continuous Ambulatory Peritoneal Dialysis Complicated by &lt;i&gt;Aureobasidium pullulans &lt;/i&gt;Peritonitis

Clark, Edward C.; Silver, Solomon; Hollick, Gary E.; Rinaldi, Michael G.

doi:10.1159/000168863

Cited by 29 publications

(32 citation statements)

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“…Nosocomial infections caused by A. pullulans are rare and have been described only in some cases of peritonitis involving patients undergoing peritoneal dialysis and in one case of severe infection where the fungus was isolated from a splenic abscess (2,3,9,17). Even more uncommon are infections where A. pullulans can be isolated from blood cultures (5,10).…”

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confidence: 99%

Disseminated Nosocomial Fungal Infection by Aureobasidium pullulans var. melanigenum : a Case Report

Bolignano

Criseo

2003

J Clin Microbiol

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We report on a rare case of disseminated nosocomial fungal infection due to Aureobasidium pullulans var. melanigenum in a severely traumatized patient. Repeated blood and urine cultures yielded multicellular filamentous hyphal structures of varying size accompanied by budding yeast-like-cells of ellipsoidal morphology. The patient became asymptomatic after fluconazole therapy. CASE REPORTThe patient, a 28-year-old male, was admitted to the intensive care unit of the Ospedali Riuniti of Reggio Calabria, Reggio Calabria, Italy, following multiple traumas due to a road accident. The patient suffered a head trauma and had a Glasgow coma scale rating of III-IV. After initial treatment with standard life support measures to stabilize hemodynamic and respiratory parameters, the patient underwent a total-body computed tomography scan, which showed diffuse cerebral edema, hemoperitoneum, multiple fractures of the left femur and tibia, a suspected pelvic fracture, and multiple ruptures of the liver's right lobe, which made immediate surgery mandatory. After surgery, the patient underwent mechanical ventilation and prolonged total parenteral nutrition.Following the isolation of a methicillin-resistant strain of Staphylococcus epidermidis from a blood culture (BCB-Slide system; Roche Products Pty. Ltd.) antibiotic therapy was started, with teicoplanin at 800 mg/day plus vancomycin at 2 g/day, divided into two doses daily. Four days later, following the onset of dyspnea and fever (37.5 to 38°C), a pulmonary infection was suspected. Laboratory data included a total leukocyte count of 10.7 ϫ 10 9 /liter with 70% neutrophils, 26% lymphocytes, and 4% monocytes. Microbiological examination of a bronchial aspirate showed the presence of Acinetobacter anitratus var. anitratus. Antibiotic therapy was therefore changed, replacing teicoplanin with ceftazidime pentahydrate at 4 g/day. After an initial decrease in body temperature lasting 3 days, fever increased again to 40°C. Therefore, a new blood culture was carried out, leading to the isolation of Pseudomonas aeruginosa. On the basis of antibiogram results, antibiotic treatment was changed again, with aztreonam at 6 g/day plus tobramycin at 300 mg/day, divided into three doses daily. Six days later, since fever was stable at around 38°C and the patient's condition was not improving, new cultures from blood and urine were made. After 72 h of incubation, the blood culture became diffusely turbid and several smooth and mucoid colonies appeared on agar growth media (chocolate agar and malt agar) enclosed in the BCB-Slide Roche system (Fig. 1). The urine culture, in contrast, was negative.Microscopic examination of fungal cultures revealed multicellular filamentous hyphal structures of varying size accompanied by budding ellipsoidal yeast-like cells, both in the blood culture and in the colonies growing on agar media. These fungal isolates were subsequently classified as Aureobasidium pullulans.Immediately before starting antifungal therapy, a new set of blood and urine cultures and a cu...

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confidence: 99%

Disseminated Nosocomial Fungal Infection by Aureobasidium pullulans var. melanigenum : a Case Report

Bolignano

Criseo

2003

J Clin Microbiol

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“…A. pullulans strain NRRL Y-2331-1, which produces high yields of a nonpigmented form of pullulan, 9 was obtained from the United States Department of Agriculture (USDA). The growth media consisted of a complex nitrogen stock solution with sucrose as the carbon source, 5 containing (per 1 L of ultrapure water): 2.0 g of yeast extract, 0.5 g of (NH 4 ) 2 SO 4 , 1.0 g of NaCl, 0.2 g of MgSO 4 , 3.0 g of K 2 HPO 4 , 0.01 g of FeSO 4 , 0.01 g of MnSO 4 , 0.01 g of ZnSO 4 , and 50 g of sucrose. All ingredients, excluding ZnSO 4 , MnSO 4 , FeSO 4 , and MgSO 4 , were mixed and autoclaved for 45 min at 121°C.…”

Section: Methodsmentioning

confidence: 99%

“…The growth media consisted of a complex nitrogen stock solution with sucrose as the carbon source, 5 containing (per 1 L of ultrapure water): 2.0 g of yeast extract, 0.5 g of (NH 4 ) 2 SO 4 , 1.0 g of NaCl, 0.2 g of MgSO 4 , 3.0 g of K 2 HPO 4 , 0.01 g of FeSO 4 , 0.01 g of MnSO 4 , 0.01 g of ZnSO 4 , and 50 g of sucrose. All ingredients, excluding ZnSO 4 , MnSO 4 , FeSO 4 , and MgSO 4 , were mixed and autoclaved for 45 min at 121°C. For the remaining metals, stock solutions were prepared and sterile-filtered using 0.45-µm syringe filters, to avoid possible precipitation of the metals during autoclaving.…”

Section: Methodsmentioning

confidence: 99%

“…Infections can range from subcutaneous to deep tissue, 2 and serious infections have been noted such as in the spleen 3 and in the serous membrane of the abdominal cavity. 4 A. pullulans produces and secretes pullulan, a high molecular weight polysaccharide that consists of repeating units of maltotriose connected by R-(1f6)-glycosidic links, with a lesser number of maltotetraose units. The pullulan produced by this microbe is usually black pigmented, caused by melanin contamination.…”

Section: Introductionmentioning

confidence: 99%

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Adhesion of Aureobasidium pullulans Is Controlled by Uronic Acid Based Polymers and Pullulan

et al. 2005

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Aureobasidium pullulans is a potentially pathogenic microfungus that produces and secretes the polysaccharide pullulan and other biomacromolecules, depending on the microbe's physiological state. The role of these macromolecules in mediating adhesion and attachment were examined. Interfacial forces and adhesion affinities of A. pullulans were probed for early-exponential phase (EEP) and late-exponential phase (LEP) cells, using atomic force microscopy (AFM). Biochemical assays showed that A. pullulans produces both pullulan and a uronic acid based polymer. The pullulan is not produced until the LEP, and it can be removed by treatment with pullulanase. Both adhesion forces between the microbe and the AFM tip (silicon nitride) and attachment of the cells to quartz sand grains were controlled by the density of the uronic acid polymer. Uronic acid polymers doubled in density between the EEP and the LEP and were unaffected by the enzyme pullulanase. Retention to quartz in a packed column was quantified using the collision efficiency (R), the fraction of collisions between the microbes, and the sand grains, that result in attachment. Adhesion forces and retention on glass were well correlated, with these values being higher for EEP cells (F adh ) 7.65 ( 4.67 nN; R ) 1.15) than LEP (F adh ) 2.94 ( 0.75; R ) 0.49) and LEP + pullulanase cells (F adh ) 2.33 ( 2.01 nN; R ) 0.43). Steric interactions alone do not describe the adhesion behavior of this fungus, but they do provide information regarding the length and density of the macromolecules studied.

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“…Amphotericin-B alone or in combination with azoles has been tried with variable success. [3][4][5]8,9 Combination therapy is probably the treatment of choice. The duration of treatment is not certain, though most patients received antifungal treatment for 4-8 weeks.…”

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confidence: 99%

Subcutaneous mycosis and fungemia by Aureobasidium pullulans: a rare pathogenic fungus in a post allogeneic BM transplant patient

Joshi

Singh

Shah

et al. 2009

Bone Marrow Transplant

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Continuous Ambulatory Peritoneal Dialysis Complicated by <i>Aureobasidium pullulans </i>Peritonitis

Cited by 29 publications

References 10 publications

Disseminated Nosocomial Fungal Infection by Aureobasidium pullulans var. melanigenum : a Case Report

Disseminated Nosocomial Fungal Infection by Aureobasidium pullulans var. melanigenum : a Case Report

Adhesion of Aureobasidium pullulans Is Controlled by Uronic Acid Based Polymers and Pullulan

Subcutaneous mycosis and fungemia by Aureobasidium pullulans: a rare pathogenic fungus in a post allogeneic BM transplant patient

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