Fulminant Disseminated Pulmonary Adiaspiromycosis in Humans

Peres, Luíz César; Figueiredo, Florêncio; Peinado, Mirtes; Soares, Fernando Augusto

doi:10.4269/ajtmh.1992.46.146

Cited by 37 publications

(25 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The granulomata are in a similar stage of evolution, indicating a response to a single exposure (72). Grossly, there may be firm white nodules a few millimeters in diameter in the lung parenchyma (21,45). Necrosis and caseation are typically not observed but have been reported (9,45).…”

Section: Frommentioning

confidence: 86%

“…In such cases, the chest radiograph usually shows bilateral reticulonodular infiltrates suggestive of miliary tuberculosis. Disseminated pulmonary infection can have a severe or even fatal course (4,6,21,31,36,39,45,52,56). The patient reported herein suffered moderate restrictive lung disease after the infection, as observed in two prior cases (cases 13 and 14 from Table 1).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Adiaspiromycosis Causing Respiratory Failure and a Review of Human Infections Due to Emmonsia and Chrysosporium spp

2012

View full text Add to dashboard Cite

bWe report a case of a 27-year-old male who presented with respiratory distress that required mechanical ventilation. Transbronchial biopsy revealed adiaspores of the fungus Emmonsia crescens within granulomata, a condition known as adiaspiromycosis. The patient received amphotericin products and corticosteroids, followed by itraconazole, and made a full recovery. Emmonsia crescens is a saprobe with a wide distribution that is primarily a rodent pathogen. The clinical characteristics of the 20 cases of human pulmonary adiaspiromycosis reported since the last comprehensive case review in 1993 are described here, as well as other infections recently reported for the genus Emmonsia. Pulmonary adiaspiromycosis has been reported primarily in persons without underlying host factors and has a mild to severe course. It remains uncertain if the optimal management of severe pulmonary adiaspiromycosis is supportive or if should consist of antifungal treatment, corticosteroids, or a combination of the latter two. The classification of fungi currently in the genus Emmonsia has undergone considerable revision since their original description, including being grouped with the genus Chrysosporium at one time. Molecular genetics has clearly differentiated the genus Emmonsia from the Chrysosporium species. Nevertheless, there has been a persistent confusion in the literature regarding the clinical presentation of infection with fungi of these two genera; to clarify this matter, the reported cases of invasive Chrysosporium infections were reviewed. Invasive Chrysosporium infections typically occur in impaired hosts and can have a fatal course. Based on limited in vitro susceptibility data for Chrysosporium zonatum, amphotericin B is the most active drug, itraconazole susceptibility is strain-dependent, and fluconazole and 5-fluorocytosine are not active.A diaspiromycosis is primarily a pulmonary infection of rodents, fossorial mammals, and their predators and is caused by the soil fungi Emmonsia crescens and Emmonsia parva (17,30,35,53). It is a rare human infection. In this infection, inhaled Emmonsia conidia enlarge to form nonreplicating adiaspores. As in other mammals, the infection in humans usually involves the lungs, with only a few other cases of infection at other sites (17,30,35,53). About 70 cases of human adiaspiromycosis have been described, but much of the literature on this infection has been dispersed in less-accessible, non-English journals. Furthermore, the inconsistent nomenclature and taxonomy of Emmonsia species and their confusion with Chrysosporium species has resulted in an overall lack of consistent information on adiaspiromycosis and Chrysosporium infections. Herein, we report a case of adiaspiromycosis that resulted in respiratory failure. We also review the true cases of adiaspiromycosis that have been reported since the seminal monographs of England and Hochholzer in 1993 (21) and Sigler in 2005 (53) or omitted from those reports. Furthermore, we differentiate the cases of adiaspiromycosis from the tr...

show abstract

Section: Frommentioning

confidence: 86%

Section: Resultsmentioning

confidence: 99%

Adiaspiromycosis Causing Respiratory Failure and a Review of Human Infections Due to Emmonsia and Chrysosporium spp

2012

View full text Add to dashboard Cite

show abstract

“…The adiaspores of E. parva grow to up to 20 to 40 mm (Burek, 2001), whereas E. crescens adiaspores reach diameters of up to 500 mm (Simpson and Gavier-Widen, 2000). Despite cases of fatal adiaspiromycosis being reported in humans (Peres et al, 1992) and wild animals (Simpson and Gavier-Widen, 2000), this case, though severe, would not seem to be directly responsible for death. The multiple fractures of pelvis and posterior legs with severe and diffuse edema and hemorrhages suggest a traumatic event, probably by motor vehicle.…”

mentioning

confidence: 85%

Disseminated Pulmonary Adiaspiromycosis in a Crested Porcupine (Hystrix cristata Linnaeus, 1758)

Morandi

Galuppi

Buitrago

et al. 2012

Journal of Wildlife Diseases

View full text Add to dashboard Cite

“…Despite its occurrence in animals throughout the world, this fungus has received little attention because it rarely affects humans. Nevertheless, Emmonsia crescens has been found to cause pulmonary infections and disseminated diseases leading to death (12,15). We report a case of disseminated adiaspiromycosis with a severe clinical manifestation.…”

Section: Case Reportmentioning

confidence: 99%

“…Clinically, the infection most commonly regresses spontaneously but may persist and require surgical intervention; the role of antifungals is controversial (1). Until now, only a few fatal cases of disseminated pulmonary infection have been documented, the first one reported in 1989 in a farm worker in Brazil with no prior medical history (12,15).…”

Section: Case Reportmentioning

confidence: 99%

Molecular Diagnosis of Disseminated Adiaspiromycosis Due toEmmonsia crescens

et al. 2009

View full text Add to dashboard Cite

Emmonsia crescens is a saprophytic fungus that is distributed worldwide, causing diseases mostly in rodents. It has also been described, though rarely, as an etiologic agent of pulmonary pathology in humans, potentially leading to death. A case of pulmonary adiaspiromycosis is reported in a 30-year-old immunocompetent man. The patient presented with a history of several weeks of weakness, cough, fever, and weight loss of 10 kg. Clinical and radiographic findings showed pulmonary lesions consistent with tuberculosis or histoplasmosis, but no pathogen was found with classical microbiological procedures. The diagnosis of adiaspiromycosis due to Emmonsia crescens was initially made using molecular biology techniques. Histological observations subsequently confirmed the presence of adiaspores in granulomas. To our knowledge, this is the first case of adiaspiromycosis diagnosed by PCR and sequencing. The patient was treated with itraconazole and was seen at 1 month with symptomatic improvement. Here we will discuss this rare fungal infection and its difficult treatment and diagnosis. As represented in this case, molecular biology is a powerful method to optimize diagnostic tests and therefore improve the care of the infected patient. CASE REPORTA 30-year-old man was admitted to the Hospital of Metz on 21 May 2008 with a 2-week history of unproductive cough, fever at 39°C, progressive dyspnea, thoracic pain, generalized weakness, and weight loss of 10 kg in 1 month. The chest radiography revealed diffuse bilateral interstitial pneumonia with a micronodular pattern (Fig. 1). Computerized tomography of the chest (high resolution) showed disseminated pulmonary nodules (Fig. 2). The peripheral blood leukocyte count was 12 g/liter with 76% neutrophils and 14% lymphocytes. Bronchoalveolar lavage (BAL) showed 13,330 leukocytes/l with 1,333 lymphocytes (CD4/CD8 ϭ 1.25). The CRP was increased to 287 mg/liter, but no other abnormalities were found.Based on the clinical symptoms and radiological features, the main differential diagnosis was tuberculosis or histoplasmosis as the patient had traveled several months and years earlier in areas where these diseases were endemic. Other noninfectious hypotheses, such as lymphoma or sarcoidosis, were also suspected based on the clinical and biological features with an important alteration of the patient status associated with polyadenopathies. All of these hypotheses were then excluded by corresponding analyses.Diagnostic procedures. Direct examination and bacterial and mycological cultures of a BAL sample were negative. Serological tests for Histoplasma capsulatum were performed at the Pasteur Institute of Paris and revealed negative immunodiffusion. The BAL sample was sent to the Mycology Unit of the Nancy Hospital for further investigation.The BAL was microscopically reexamined with chlorazole black, and any fungal elements were visualized. Cultures of the sample on Sabouraud agar containing cycloheximide (0.5 mg/ ml) at 30°C and 37°C yielded no growth.Molecular biology studies. In or...

show abstract

Fulminant Disseminated Pulmonary Adiaspiromycosis in Humans

Cited by 37 publications

References 0 publications

Adiaspiromycosis Causing Respiratory Failure and a Review of Human Infections Due to Emmonsia and Chrysosporium spp

Adiaspiromycosis Causing Respiratory Failure and a Review of Human Infections Due to Emmonsia and Chrysosporium spp

Disseminated Pulmonary Adiaspiromycosis in a Crested Porcupine (Hystrix cristata Linnaeus, 1758)

Molecular Diagnosis of Disseminated Adiaspiromycosis Due toEmmonsia crescens

Contact Info

Product

Resources

About