Fatal disseminated Rasamsonia infection in cystic fibrosis post-lung transplantation

Hong, Gina; White, Marissa J.; Lechtzin, Noah; West, Natalie E.; Avery, Robin K.; Miller, Heather B.; Lee, Richard; Lovari, Robert; Massire, Christian; Blyn, Lawrence B.; Liang, Xiaoyan; Sutton, Deanna A.; Fu, Jianmin; Wickes, Brian L.; Wiederhold, Nathan P.; Zhang, Sean X.

doi:10.1016/j.jcf.2017.01.005

Cited by 28 publications

(20 citation statements)

References 16 publications

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“…Twenty‐three cases with confirmed invasive Rasamsonia spp. infection from the FungiScope ® registry (n = 6, 26.1%), and the literature (n = 18, 73.9%) were enrolled . One of the FungiScope ® cases (4.3%) was published previously (Figure ).…”

Section: Resultsmentioning

confidence: 99%

“…infection from the FungiScope ® registry (n = 6, 26.1%), and the literature (n = 18, 73.9%) were enrolled. 2,11,12,15,16,20,[25][26][27][28][29] One of the FungiScope ® cases (4.3%) was published previously 29 (Figure 1).…”

Section: Re Sultsmentioning

confidence: 97%

“…complex comprises filamentous fungi causing pneumonia and occasionally disseminated disease in immunocompromised patients. 1,2 Taxonomy introduced Rasamsonia spp. as a genus of the family Trichocomaceae only in 2011.…”

Section: Introductionmentioning

confidence: 99%

“…8 Typical hosts present with chronic lung diseases such as cystic fibrosis (CF) or with chronic granulomatous disease (CGD), but a wide range of immunosuppressed patients may be affected. 2,[9][10][11][12] Colonization precedes infection for an undetermined period, and coinfection with bacterial or other fungal pathogens may hamper diagnosis. [13][14][15] Along with imaging procedures, morphological, proteomic and genomic analyses have been used for diagnostics.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors and mortality in invasive Rasamsonia spp. infection: Analysis of cases in the FungiScope^® registry and from the literature

Stemler

Salmanton‐García

Seidel

et al. 2019

Mycoses

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Summary Background The new Rasamsonia spp. complex can develop invasive infection in immunosuppression or chronic pulmonary disease. It has potential to be misidentified as other genera due to morphological similarities. Nowadays, there is a gap of knowledge on this fungi. Objectives To provide knowledge base of risk factors and therapeutic decisions in invasive Rasamsonia spp. complex infection. Patients/Methods Cases of invasive infection due to Rasamsonia spp. (formerly Geosmithia/Penicillium spp.) from FungiScope® registry and all reported cases from a literature were included. Results We identified 23 invasive infections due to Rasamsonia spp., six (26.1%) in the FungiScope® registry. Main risk factors were chronic granulomatous disease (n = 12, 52.2%), immunosuppressive treatment (n = 10, 43.5%), haematopoietic stem cell transplantation (n = 7, 30.4%), graft‐versus‐host disease and major surgery (n = 4, 17.4%, each). Predominantly affected organs were the lungs (n = 21, 91.3%), disease disseminated in seven cases (30.4%). Fungal misidentification occurred in 47.8% (n = 11), and sequencing was used in 69.6% of the patients (n = 16) to diagnose. Breakthrough infection occurred in 13 patients (56.5%). All patients received antifungal treatment, mostly posaconazole (n = 11), caspofungin (n = 10) or voriconazole (n = 9). Combination therapy was administered in 13 patients (56.5%). Susceptibility testing showed high minimum inhibitory concentrations for azoles and amphotericin B, but not for echinocandins. No preferable treatment influencing favourable outcome was identified. Overall mortality was 39% (n = 9). Conclusion Rasamsonia spp. are emerging fungi causing life‐threatening infections, especially in immunocompromised and critically ill patients. Mortality is high. Treatment is challenging and clinicians dealing with this patient population should become aware of this infection constituting a medical emergency.

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Section: Resultsmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk factors and mortality in invasive Rasamsonia spp. infection: Analysis of cases in the FungiScope^® registry and from the literature

Stemler

Salmanton‐García

Seidel

et al. 2019

Mycoses

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“…He deteriorated further and subsequently received a lung transplant but died of a Gram‐negative bacterial sepsis posttransplantation. Notably, a fatal disseminated Rasamsonia infection in CF postlung transplantation has been reported …”

Section: Discussionmentioning

confidence: 99%

Airway persistence by the emerging multi‐azole‐resistant Rasamsonia argillacea complex in cystic fibrosis

Abdolrasouli

Bercusson

Rhodes

et al. 2018

Mycoses

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Infections caused by Rasamsonia argillacea complex have been reported in various clinical settings. Cystic fibrosis (CF) is one of the main underlying conditions. An observational cohort study of CF patients with Rasamsonia in respiratory samples was conducted. Eight isolates from 6 patients were identified as R. argillacea complex and tested for antifungal susceptibility. All isolates had high MICs to voriconazole and posaconazole and low MECs to echinocandins. Four patients experienced lung function decline in the year preceding first Rasamsonia isolation. This continued in the year following first isolation in 3 out of 4 cases. Antifungal therapy was initiated in 2 patients, to which only one exhibited a clinical response. Three out of 6 patients died within 3 years of isolating Rasamsonia. Genotyping suggests that similar genotypes of Rasamsonia can persist in CF airways. Consistent with other fungi in CF, the clinical impact of airway colonisation by Rasamsonia is variable. In certain patients, Rasamsonia may be able to drive clinical decline. In others, though a clear impact on lung function may be difficult to determine, the appearance of Rasamsonia acts as a marker of disease severity. In others it does not appear to have an obvious clinical impact on disease progression.

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Challenges in Laboratory Detection of Fungal Pathogens in the Airways of Cystic Fibrosis Patients

2017

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Study of the clinical significance of fungal colonization/infection in the airways of cystic fibrosis (CF) patients, especially by filamentous fungi, is challenged by the absence of standardized methodology for the detection and identification of an ever-broadening range of fungal pathogens. Culture-based methods remain the cornerstone diagnostic approaches, but current methods used in many clinical laboratories are insensitive and unstandardized, rendering comparative studies unfeasible. Guidelines for standardized processing of respiratory specimens and for their culture are urgently needed and should include recommendations for specific processing procedures, inoculum density, culture media, incubation temperature and duration of culture. Molecular techniques to detect fungi directly from clinical specimens include panfungal PCR assays, multiplex or pathogen-directed assays, real-time PCR, isothermal methods and probe-based assays. In general, these are used to complement culture. Fungal identification by DNA sequencing methods is often required to identify cultured isolates, but matrix-assisted laser desorption/ionization time-of-flight mass spectrometry is increasingly used as an alternative to DNA sequencing. Genotyping of isolates is undertaken to investigate relatedness between isolates, to pinpoint the infection source and to study the population structure. Methods range from PCR fingerprinting and amplified fragment length polymorphism analysis, to short tandem repeat typing, multilocus sequencing typing (MLST) and whole genome sequencing (WGS). MLST is the current preferred method, whilst WGS offers best case resolution but currently is understudied.

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Fatal disseminated Rasamsonia infection in cystic fibrosis post-lung transplantation

Abstract: Our report suggests Rasamsonia species may be important fungal pathogens that may have fatal consequences in immunosuppressed CF patients after solid organ transplantation.

Cited by 28 publications

References 16 publications

Risk factors and mortality in invasive Rasamsonia spp. infection: Analysis of cases in the FungiScope^® registry and from the literature

Risk factors and mortality in invasive Rasamsonia spp. infection: Analysis of cases in the FungiScope^® registry and from the literature

Airway persistence by the emerging multi‐azole‐resistant Rasamsonia argillacea complex in cystic fibrosis

Challenges in Laboratory Detection of Fungal Pathogens in the Airways of Cystic Fibrosis Patients

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Fatal disseminated Rasamsonia infection in cystic fibrosis post-lung transplantation

Abstract: Our report suggests Rasamsonia species may be important fungal pathogens that may have fatal consequences in immunosuppressed CF patients after solid organ transplantation.

Cited by 28 publications

References 16 publications

Risk factors and mortality in invasive Rasamsonia spp. infection: Analysis of cases in the FungiScope® registry and from the literature

Risk factors and mortality in invasive Rasamsonia spp. infection: Analysis of cases in the FungiScope® registry and from the literature

Airway persistence by the emerging multi‐azole‐resistant Rasamsonia argillacea complex in cystic fibrosis

Challenges in Laboratory Detection of Fungal Pathogens in the Airways of Cystic Fibrosis Patients

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Risk factors and mortality in invasive Rasamsonia spp. infection: Analysis of cases in the FungiScope^® registry and from the literature

Risk factors and mortality in invasive Rasamsonia spp. infection: Analysis of cases in the FungiScope^® registry and from the literature