Fatal Disseminated<i>Aspergillus Penicillioides</i>Infection in a 3-Month-Old Infant with Suspected Cystic Fibrosis: Autopsy Case Report with Review of Literature

Gupta, Kirti; Gupta, Parikshaa; Mathew, Joseph L; Bansal, Arun; Singh, Gangandeep; Singh, Meenu; Chakrabarti, Arunaloke

doi:10.2350/15-10-1729-cr.1

Cited by 13 publications

(13 citation statements)

References 19 publications

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“…Hubka et al have reported a case of disseminated aspergillosis due to Emericela rugulosa (A. rugulosus) [41]. Meanwhile, A. penicillioides has only rarely been reported as a human pathogen; it has caused fatal disseminated aspergillosis in an infant with cystic fibrosis [42]. Severe clinical entities include the rare and lifethreatening cerebral aspergillosis, for which the fatality rate is greater than 90% [43,44].…”

Section: Antifungal Susceptibility Of the New Aspergillus Speciesmentioning

confidence: 99%

Previously unknown species of Aspergillus

Gautier

Normand

Ranque

2016

Clinical Microbiology and Infection

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The use of multi-locus DNA sequence analysis has led to the description of previously unknown 'cryptic' Aspergillus species, whereas classical morphology-based identification of Aspergillus remains limited to the section or species-complex level. The current literature highlights two main features concerning these 'cryptic' Aspergillus species. First, the prevalence of such species in clinical samples is relatively high compared with emergent filamentous fungal taxa such as Mucorales, Scedosporium or Fusarium. Second, it is clearly important to identify these species in the clinical laboratory because of the high frequency of antifungal drug-resistant isolates of such Aspergillus species. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) has recently been shown to enable the identification of filamentous fungi with an accuracy similar to that of DNA sequence-based methods. As MALDI-TOF MS is well suited to the routine clinical laboratory workflow, it facilitates the identification of these 'cryptic' Aspergillus species at the routine mycology bench. The rapid establishment of enhanced filamentous fungi identification facilities will lead to a better understanding of the epidemiology and clinical importance of these emerging Aspergillus species. Based on routine MALDI-TOF MS-based identification results, we provide original insights into the key interpretation issues of a positive Aspergillus culture from a clinical sample. Which ubiquitous species that are frequently isolated from air samples are rarely involved in human invasive disease? Can both the species and the type of biological sample indicate Aspergillus carriage, colonization or infection in a patient? Highly accurate routine filamentous fungi identification is central to enhance the understanding of these previously unknown Aspergillus species, with a vital impact on further improved patient care.

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Section: Antifungal Susceptibility Of the New Aspergillus Speciesmentioning

confidence: 99%

Previously unknown species of Aspergillus

Gautier

Normand

Ranque

2016

Clinical Microbiology and Infection

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“…Although there are several hundred species in the Aspergillus genus, there are only a few species which have considerable impacts on human or animal health. Infections are typically caused by Aspergillus flavus , Aspergillus fumigatus , Aspergillus nidulans , Aspergillus niger and Aspergillus terreus , among other species (Baddley et al ., ; Perfect et al ., ; Enoch et al ., ; Gupta et al ., in press), with A. fumigatus being responsible for more than 90% of infections, followed in frequency by A. flavus and A. niger (Lass‐Flörl et al ., ; Balajee et al ., ,b). However, the actual contribution of different Aspergillus species in causing aspergillosis varies from country to country and depends on the patient population under study (for some examples, see Table S1 and references therein, supporting information).…”

Section: Introductionmentioning

confidence: 99%

Ecology of aspergillosis: insights into the pathogenic potency of Aspergillus fumigatus and some other Aspergillus species

Paulussen

Hallsworth

Álvarez‐Pérez

et al. 2016

Microbial Biotechnology

258

175

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SummaryFungi of the genus Aspergillus are widespread in the environment. Some Aspergillus species, most commonly Aspergillus fumigatus, may lead to a variety of allergic reactions and life‐threatening systemic infections in humans. Invasive aspergillosis occurs primarily in patients with severe immunodeficiency, and has dramatically increased in recent years. There are several factors at play that contribute to aspergillosis, including both fungus and host‐related factors such as strain virulence and host pulmonary structure/immune status, respectively. The environmental tenacity of Aspergilllus, its dominance in diverse microbial communities/habitats, and its ability to navigate the ecophysiological and biophysical challenges of host infection are attributable, in large part, to a robust stress‐tolerance biology and exceptional capacity to generate cell‐available energy. Aspects of its stress metabolism, ecology, interactions with diverse animal hosts, clinical presentations and treatment regimens have been well‐studied over the past years. Here, we synthesize these findings in relation to the way in which some Aspergillus species have become successful opportunistic pathogens of human‐ and other animal hosts. We focus on the biophysical capabilities of Aspergillus pathogens, key aspects of their ecophysiology and the flexibility to undergo a sexual cycle or form cryptic species. Additionally, recent advances in diagnosis of the disease are discussed as well as implications in relation to questions that have yet to be resolved.

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“…A number of recent studies indicate that Aspergillus penicillioides is active close to the water‐activity limit of Earth's biosphere (Stevenson et al ., 2015a; 2015b; Stevenson et al ., in press‐a; in press‐b). This species, sometimes implicated in aspergillosis (Gupta et al ., ; Paulussen et al , in press), has also been the focus of studies on production of secondary metabolites, ecology of hypersaline environments, food spoilage, damage to cultural artefacts and coal‐mine bioaerosols (Zhao et al ., ; Nazareth and Gonsalves, ; Okano et al ., ; Wei et al ., ; Micheluz et al ., ). A. penicillioides is at the same time xerophilic, osmophilic and halophilic (in relation to low water activity, high sugar‐ and NaCl concentrations, respectively), grows close to 0°C (and almost certainly at sub‐zero temperatures, as well) and can function anaerobically (Chin et al ., ; Zhang et al ., ; Nazareth and Gonsalves, ; Rummel et al ., ).…”

Section: Introductionmentioning

confidence: 99%

Aspergillus penicillioides differentiation and cell division at 0.585 water activity

Stevenson

Hamill

O'Kane

et al. 2017

Environmental Microbiology

105

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SummaryWater availability acts as the most stringent constraint for life on Earth. Thus, understanding the water relations of microbial extremophiles is imperative to our ability to increase agricultural productivity (e.g., by enhancing the processing and turnover of dead organic matter in soils of arid regions), reduce human exposure to mycotoxins in buildings and our foodsupply chain, prevent the spoilage of foods/animal feeds, books, museum specimens and artworks and better control microbiology of industrial fermentations. Only a small number of microbial systems can retain activity at <0.710 water activity (ISME J 2015 9: 1333-1351). It has long-been considered that the most resilient of these is Xeromyces bisporus, which inhabits sugar-rich substrates (Appl Environ Microbiol 1968 16: 1853-1858. The current study focused on germination of Aspergillus penicillioides, a xerophile which is also able to grow under low humidity and saline conditions. Investigations of germination differed from those reported earlier: firstly, aerially borne conidia were harvested, and then used for inoculations, in their dry condition; secondly, cultures were incubated at 248C, i.e. below optimum germination temperature, to minimize the possibility of water loss from the substrate; thirdly, cultures remained sealed throughout the 73-day study period (microscopic examination was carried out directly 48 through the Petri plate lid); fourthly, the germination parameters determined were: rates and extent of conidial swelling, production of differentiated germinationstructures and septate germlings, and subsequent development of mycelium and/or sporulation; fifthly, assessments were carried out over a range of wateractivity values and time points to obtain a complete profile of the germination process. Conidia swelled, formed differentiated germination-structures and then produced septate germlings at a water-activity of just 0.585 (58.5% relative humidity), outside the currently understood thermodynamic window for life. Furthermore, analyses of these data suggest a theoretical water-activity minimum of 0.565 for germination of A. penicilliodes. In relation to astrobiology, these findings have an application in understanding the limits to life in extraterrestrial environments. In light of current plans for exploration missions to Mars and other places, and the need to safeguard martian scientific sites and potential resources (including water) for future human habitation, a knowledge-based and effective policy for planetary protection is essential. As it is, Mars-bound spacecraft may frequently be contaminated with aspergilli (including A. penicillioides) and other organisms which, when transported to other planetary bodies, pose a contamination risk. In crafting countermeasures to offset this, it is important to know as precisely as possible the capabilities of these potential interplanetary visitors.

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Fatal DisseminatedAspergillus PenicillioidesInfection in a 3-Month-Old Infant with Suspected Cystic Fibrosis: Autopsy Case Report with Review of Literature

Cited by 13 publications

References 19 publications

Previously unknown species of Aspergillus

Previously unknown species of Aspergillus

Ecology of aspergillosis: insights into the pathogenic potency of Aspergillus fumigatus and some other Aspergillus species

Aspergillus penicillioides differentiation and cell division at 0.585 water activity

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