Femoral Osteomyelitis Due to Aspergillus nidulans in a Patient with Chronic Granulomatous Disease

Dotis, John; Panagopoulou, Paraskevi; Filioti, Joanna; Winn, Richard M.; Toptsis, C.; Panteliadis, Christos P.; Roilides, Emmanuel

doi:10.1007/s15010-002-2167-1

Cited by 40 publications

(33 citation statements)

References 24 publications

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“…echinulata) and 1 isolate from the National Collection of Pathogenic Fungi. Ten isolates were from our own culture collection (including the 4 encountered in the cluster of cases), and 11 isolates were from 5 other medical centers; some of these isolates had been cultured as causes of infection and previously reported (online Appendix Table, available from www.cdc.gov/ EID/content/14/4/566-appT.htm) (8,(9)(10)(11)(12). Seven isolates had been cultured from patients with confi rmed invasive aspergillosis, and 2 were from patients with probable cases (online Appendix Table).…”

Section: Data and Strain Collectionmentioning

confidence: 99%

Emericellaquadrilineataas Cause of Invasive Aspergillosis

Verweij

Varga

Houbraken

et al. 2008

Emerg. Infect. Dis.

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We noted a cluster of 4 cases of infection or colonization by Emericella spp., identifi ed by sequence-based analysis as E. quadrilineata. Sequence-based analysis of an international collection of 33 Emericella isolates identifi ed 12 as E. nidulans, all 12 of which had previously been identifi ed by morphologic methods as E. nidulans. For 12 isolates classifi ed as E. quadrilineata, only 6 had been previously identifi ed accordingly. E. nidulans was less susceptible than E. quadrilineata to amphotericin B (median MICs 2.5 and 0.5 mg/L, respectively, p<0.05); E. quadrilineata was less susceptible than E. nidulans to caspofungin (median MICs, 1.83 and 0.32 mg/L, respectively, p<0.05). These data indicate that sequence-based identifi cation is more accurate than morphologic examination for identifying Emericella spp. and that correct species demarcation and in vitro susceptibility testing may affect patient management.T he genus Aspergillus includes >250 species; ≈20 have been reported to cause opportunistic infections in humans. The most important human pathogens in this genus are A. fumigatus, A. fl avus, A. niger, A. terreus, and Emericella nidulans (anamorph: A. nidulans) (1). A. fumigatus is the most common cause of invasive aspergillosis, a condition associated with substantial severity and mortality rates (2). Invasive infections caused by E. nidulans are uncommon in animals and humans (3-5); in humans they appear to occur predominantly in patients who have chronic granulomatous disease (CGD), a rare disorder of phagocytes in which the absence of both superoxide and hydrogen peroxide production in phagocytes predisposes patients to bacterial and fungal infections. Invasive E. nidulans infections in this patient group are associated with higher mortality rates than those caused by A. fumigatus (6,7). The most common site of infection is the lungs; other manifestations are subcutaneous abscesses or liver abscesses, suppurative adenitis, osteomyelitis, fungemia, cellulitis, and meningitis (7,8). Within the genus Emericella, other species have only rarely been identifi ed as agents of human or animal infections.The identifi cation of E. nidulans in clinical microbiology laboratories is commonly based on the characteristic microscopic morphology, the production of hülle cells, or the production of ascospores. A. fumigatus is identifi ed by its heat tolerance; other species fail to grow when incubated at high temperature, typically 48°C.We recently noted a cluster of infection or colonization by E. quadrilineata, a species closely related to E. nidulans. Within a 3-month period, 4 cases were identifi ed at the Radboud University Nijmegen Medical Center. No apparent epidemiologic link between the cases was found because each patient was cared for in a different ward, and 2 patients with invasive aspergillosis were admitted directly from home. One of the latter 2 patients was a 10-year-old boy with X-linked CGD and a probable diagnosis of invasive pulmonary aspergillosis (9); the other patient was a 60-year-old man...

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Section: Data and Strain Collectionmentioning

confidence: 99%

Emericellaquadrilineataas Cause of Invasive Aspergillosis

Verweij

Varga

Houbraken

et al. 2008

Emerg. Infect. Dis.

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“…A 16 year old child with CGD with femoral osteomyelitis due to Aspergillus nidulans was poorly responsive to liposomal amphotericin B: the addition of G-CSF alongside surgical debridement and itraconazole cured the osteomyelitis [7]. A child with a primary monocyte killing defect developed Aspergillus vertebral osteomyelitis unresponsive to liposomal amphotericin B, intra-lesional amphotericin B, and itraconazole: the administration of granulocyte macrophage-colony stimulating factor (GM-CSF) induced clinical and radiological improvement [8].…”

Section: Discussionmentioning

confidence: 99%

Improvement of Chronic Osteomyelitis After Granulocyte Colony Stimulating Factor

Pearce

Cuthbert

Porter

2011

Indian J Hematol Blood Transfus

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Background: chronic osteomyelitis represents a persistent bone and bone marrow infection easy to diagnose in the presence of pain, erythema, swelling, and a draining sinus but more difficult to detect in the absence of the preceding features and with a painful orthopaedic prosthesis. Case Description: we report upon an elderly gentleman with myelodysplasia requiring revision surgery for a fractured prosthetic left knee. He had clinical, laboratory, and radiological features of chronic osteomyelitis that improved only with adminis-

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“…is an airborne hyaline mould found everywhere on various types of substrate, especially soil, and in hospital water systems (15,16). This Aspergillus species has been reported as the cause of diverse infections in humans, either alone or in combination with other opportunistic fungi, including pulmonary or cerebral infections, sinusitis, endophtalmitis, osteomyelitis, eumycotic mycetoma, nail infections, and disseminated aspergillosis (15,(17)(18)(19). These infections have been reported almost exclusively in children with chronic granulomatous disease (CGD) (20).…”

Section: Casementioning

confidence: 99%

“…These infections have been reported almost exclusively in children with chronic granulomatous disease (CGD) (20). In these patients A. nidulans is more virulent than other Aspergillus species, judging by its propensity to spread from the lungs to adjacent structures and the death rate it has in this population (17)(18)(19)(20).…”

Section: Casementioning

confidence: 99%

“…The patient was remarkably well before presenting with neurological symptoms. In contrast, cerebral aspergillosis arising from immunosuppression or malignancy is invariably associated with disseminated fungal disease (17)(18)(19)(20)(21). Chakrabarti et al (21) have already reported about cerebral aspergilloma caused by A. nidulans in two adult patients.…”

Section: Casementioning

confidence: 99%

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Two Rare Cases Of Central Nervous System Opportunistic Mycoses / Oportunističke Mikoze Središnjega Živčanog Sustava – Prikaz Dvaju Bolesnika

Missoni¹,

Baršić

2012

Archives of Industrial Hygiene and Toxicology

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This article presents two cases of opportunistic mycoses (OMs) of the central nervous system (CNS) caused by Cryptococcus neoformans and Aspergillus nidulans, respectively. The patients were hospitalised in local hospitals between 2009 and 2011 because of unspecifi c symptoms (fever, headache, and/or weight lost). Duration of symptoms varied from 4 days to over 2 weeks. The patients were treated with antibiotics and symptomatically. OM was not suspected in any of them. The patients became critically ill with symptoms of CNS involvement and were transferred to the Intensive Care Unit (ICU) of the University Hospital for Infectious diseases (UHID) in Zagreb. None of the patients belonged to the high-risk population for developing OMs. They were not HIV-infected, had no transplantation of bone marrow or solid organ, and were not on severe immunosuppressive chemotherapy. Fungi were isolated from cerebrospinal fl uid (CSF) samples and, in one patient, from aspirate of cerebral abscess. Isolation and mycological identifi cation of all fungal isolates and in vitro antifungal susceptibility testing of these isolates were done at the Reference Centre for Mycological Diagnostics of Systemic and Disseminated Infections (RCMDSDI) in Zagreb. The patient with cryptococcal meningitis was treated with amphotericin B and fl uconazole and the patient with cerebral aspergilloma with voriconazole.

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Femoral Osteomyelitis Due to Aspergillus nidulans in a Patient with Chronic Granulomatous Disease

Cited by 40 publications

References 24 publications

Emericellaquadrilineataas Cause of Invasive Aspergillosis

Emericellaquadrilineataas Cause of Invasive Aspergillosis

Improvement of Chronic Osteomyelitis After Granulocyte Colony Stimulating Factor

Two Rare Cases Of Central Nervous System Opportunistic Mycoses / Oportunističke Mikoze Središnjega Živčanog Sustava – Prikaz Dvaju Bolesnika

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