Emericella nidulansin a maxillary sinus fungal mass

Abstract

Sexual reproductive stages of fungi are very rarely found within mammalian tissues. We report here coexistence of cleistothecia associated with Emericella nidulans and its conidial state, Aspergillus nidulans, in a fungal mass which developed in a maxillary sinus.A 67-year-old woman complained of pain and discharge following an operation on her maxillary antrum 8 years previously. A clinical diagnosis was made of a cholesteatoma or a foreign body. Two biopsies were obtained, one mucosal and the other consisting of grey membranous tissue and greyish-brown debris. Histology showed the features of chronic inflammation but there was no evidence of malignancy or of a foreign body. The debris consisted almost entirely of dense mycelium within which several cleistothecia were embedded (Fig. 1). These were rounded, 120-130/tm in diameter, containing abundant lenticular ascospores ca. 4-0 × 4-5 #m with conspicuous paired equatorial crests. Cleistothecia were associated with Hiille cells ca. 20/zm in diameter. Confirmation of identity was provided by the presence in other parts of the sectioned fungal mass of short, smooth, sinuous conidiophores and conidia 3.0-3.5 /zm in diameter typical ofAspergillus nidulans (Fig. 2). In the routine histopathological sections stained with haematoxylin and eosin, details of sporing structures were clearly seen. The characteristic brown colour of the conidiophores was also readily visible, although the distinctive red colour of the ascospores of Emericella nidulans (the sexual sporing state) could not be distinguished. The patient was discharged after sinovectomy and was well when seen 2 years later.The literature contains only a few reports of similar findings. La Touche [4] observed cleistothecia and ascospores of A. glaucus and A. nidulans in debris removed from the human ear. Stedham et al. [6] noted the presence of sexual and asexual sporing forms ofA. nidulans in the lungs of captive egrets. Doby & Kombila-Favry [2] described a biopsy specimen from a human maxillary sinus which in histological sections showed cleistothecia surrounded by Hiille cells. Since only A. fumigatus was isolated in culture, the infection was regarded as a mixed one. In a brief note

A fungal ball within a maxillary sinus with dental root canal filler and rare fungal propagules

“…An additional interesting aspect of the present case was the simultaneous detection of cleistothecia, Hülle cells, conidial heads, and calcium oxalate crystals, all within the same fungal ball. To the best of our knowledge, the simultaneous detection of these structures has not previously been reported, although cleistothecia, Hülle cells, and conidial heads were detected simultaneously in two prior reports, but without calcium oxalate crystals . A cleistothecium is a sexual reproductive structure of Aspergillus , Pseudallescheria , and some other organisms; it is a completely closed structure that houses numerous ascospores .…”

“…Hülle cells surrounding cleistothecia are only observed in a few species including A. nidulans and Aspergillus flavipes in culture . In human tissues, both cleistothecia and Hülle cells have only been detected in colonized fungus within air‐abundant spaces, such as the paranasal sinus, external acoustic meatus, and bronchial stump, along with conidial heads …”

“…The combination of cleistothecia and Hülle cells is produced by several species of Aspergillus including Aspergillus nidulans . However, their detection in human tissues is exceptional . Co‐localization of cleistothecia and Hülle cells with conidial heads is particularly rare and has only been described in two cases .…”

Emericellaquadrilineataas Cause of Invasive Aspergillosis

“…However, fruiting bodies are usually formed after a rather long incubation period (1-2 weeks). And although E. nidulans was found to form cleistothecia in the human body (33) ascospores (34,35). Given these diffi culties, we anticipate that reliance on phenotypic characteristics alone would cause misidentifi cation of E. nidulans, rather than correct identifi cation of E. quadrilineata, as the cause of invasive aspergillosis.…”

The Pneumocystis life cycle

“…Some exceptions to this rule may nevertheless be noted. Aspergillus nidulans is sometimes able to sexually reproduce in vivo in human as well as in animal tissues, thus producing cleistothecia and Hülle cells (Doby & Kombila-Favry 1978, Dei-Cas & Vernes 1986, Mitchell et al 1987). More recently, the existence of an anamorph state of Candida lusitaniae was questioned since 100% of 76 clinical isolates were able to mate and undergo meiosis once put in contact with a sexually compatible strain (François et al 2001).…”