Rapid Identification of Aspergillus terreus from Bronchoalveolar Lavage Fluid by PCR and Electrospray Ionization with Mass Spectrometry

Modi, Dhruvangkumar; Farrell, John; Sampath, Rangarajan; Bhatia, Nisha; Massire, Christian; Ranken, Ray

doi:10.1128/jcm.00325-12

Cited by 13 publications

(15 citation statements)

References 9 publications

(8 reference statements)

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“…By identifying minute quantities and mixtures of nucleic acids without the need for a detection probe, PCR/ESI-MS offers a critical advantage of discovering unusual or unculturable pathogens and mixed infections. This was evidenced by a recent study Geber et al 1995 finding Aspergillus terreus in culture-negative bronchoalveolar lavage (BAL) fluid from a myelogenous leukemia patient who was on empiric amphotericin B therapy (Modi et al 2012). …”

Section: Primary Resistance Assessment By Molecular Methodsmentioning

confidence: 84%

Use of Novel Tools to Probe Drug Resistance in Fungi

Zhao

Perlin

2014

Handbook of Antimicrobial Resistance

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Antifungal drug resistance threatens therapeutic effectiveness and needs to be diagnosed in a timely manner. Currently, recognition of antifungal resistance still relies on culture-based susceptibility testing. Yet, antifungal susceptibility testing is not routinely performed and often comes too late to influence a timely decision on patient management. With the quantum leap of molecular technology and accrued insights on basic fungal cell biology and antifungal drug resistance mechanisms, some novel molecular techniques are now available to provide a faster and more accurate assessment of both primary and secondary resistance than classical methodologies. Validated targets for echinocandin resistance in Candida spp. and triazole resistance in Aspergillus fumigatus and Candida spp. are particularly well suited for molecular detection. Yet, implementation of a molecular diagnosis for drug resistance into the clinical settings requires validation in well-designed clinical trials, as well as improved methods for highly efficient primary sample preparation.

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Section: Primary Resistance Assessment By Molecular Methodsmentioning

confidence: 84%

Use of Novel Tools to Probe Drug Resistance in Fungi

Zhao

Perlin

2014

Handbook of Antimicrobial Resistance

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“…A patient with Acute Myelogenous Leukemia (AML) was found to have A. terreus growing in bilateral brain abscesses, thought to have arisen hematogenously from a pulmonary infection after induction chemotherapy [4]. Our case is very unique in that A. terreus has never been associated with angiosarcoma of the scalp as per our review of the literature [5].…”

Section: Discussionmentioning

confidence: 92%

Aspergillus Terreus Brain Abscess Complicated by Tension Pneumocephalus in a Patient with Angiosarcoma

et al. 2017

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Patient: Male, 67Final Diagnosis: Aspergillus terreus brain abscess complicated by tension pneumocephalusSymptoms: Blurred vision • hemiparesisMedication: —Clinical Procedure: —Specialty: Infectious DiseasesObjective:Rare co-existance of disease or pathologyBackground:Aspergillus terreus is an evolving opportunistic pathogen, and patients with A. terreus often have poor outcomes due to its intrinsic resistance to several systemic antifungal agents. Here we present a unique case of intracranial abscesses of A. terreus in a patient with recurrent angiosarcoma, complicated by development of tension pneumocephalus.Case Report:A 67-year old gentleman with history of scalp angiosarcoma with wide excision two years prior presented to the hospital for left arm clumsiness, altered mental status, and low-grade fever. Staphylococcus aureus and Proteus mirabilis bacteremia was detected, and Computed Tomography (CT) of the head showed right frontal lobe abscesses. He was started on steroids, intravenous vancomycin and cefepime, and was eventually discharged. He presented to the hospital again due to persistent and worsening symptoms. MRI showed progression of the brain lesions, and surgical biopsy and culture of lesions revealed A. terreus and gram-positive cocci. He was started on trimethroprim/sulfamethoxazole and voriconazole and symptoms improved. On post-op day four, he acutely decompensated with total loss of left arm strength; MRI demonstrated tension pneumocephalus. Conservative management was undertaken with continuous supplemental oxygen. Serial x-ray imaging over the next week demonstrated resolution of the pneumocephalus, and the patient was able to regain all proximal lower and upper extremity strength.Conclusions:Never before has a case of A. terreus been associated with angiosarcoma or tension pneumocephalus in the literature. Proper identification and prompt diagnosis of species is crucial in the immunocompromised patient. Tension pneumocephalus should be included in the differential diagnosis of nontraumatic hemiparesis for emergent evaluation and management.

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“…PCR and electrospray ionization with mass spectrometry (PCR/ESI-MS) is a diagnostic modality that has demonstrated the capacity to detect pathogenic organisms in both environmental and clinical samples (3,5,9). Although cultures of CSF from our patient were negative, intracellular Gram-positive structures resembling cocci were noted in CSF from the EVD, suggesting that nonviable organisms may have been present.…”

mentioning

confidence: 96%

Identification of Streptococcus intermedius Central Nervous System Infection by Use of PCR and Electrospray Ionization Mass Spectrometry

Bhatia¹,

Farrell

Sampath

et al. 2012

J Clin Microbiol

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CASE REPORTA previously healthy 26-year-old male was transferred to a tertiary care medical center with a 5-day history of cough, highgrade fever, and 1-day history of delirium, combativeness, and complaints of photophobia. In the emergency department (ED) at the outlying hospital, he was alert and oriented. His temperature on presentation was 39.2°C. His white blood cell (WBC) count was 27,200 cells/mm 3 (with 85% neutrophils). A computed tomography (CT) scan of the brain noted areas of hypodensity that were suggestive of emboli and encephalitis. A lumbar puncture (LP) was performed, revealing a cerebrospinal fluid (CSF) WBC count of 6,200 cells/mm 3 with 74% neutrophils. The red blood cell (RBC) count, total protein, and glucose were 700 cells/ mm 3 , 472 mg/dl, and 56 mg/dl, respectively. Organisms were not seen on a Gram stain. The patient was stabilized in the outlying ED and then transferred to the medical intensive care unit (MICU), where treatment with intravenous (i.v.) vancomycin and ceftriaxone was initiated. One day following admission, the patient was transferred to the MICU at our facility.Upon presentation to our facility, he was afebrile and lucid. The physical exam was unremarkable, and the initial neurologic exam was normal. A second head CT without intravenous contrast at our hospital following transfer was notable only for mucosal thickening of the sphenoid sinuses. Intracranial abnormalities were not appreciated. CT examination of the chest, abdomen, and pelvis revealed pneumonia and mild prominence of right hilar and subcarinal lymph nodes. The patient was monitored closely in the ICU. Acyclovir and dexamethasone were both added to i.v. vancomycin and ceftriaxone treatment, which was continued following transfer. Blood and CSF cultures obtained on admission proved to be negative, and a two-dimensional (2D) transthoracic echocardiogram was unremarkable.In the next four hospital days, our patient began complaining of increased headache, with fluctuating alertness and combative behavior. On hospital day four, he developed new left arm weakness and a possible Kernig's sign. Pupils were 2 to 3 mm with equal bilateral light reaction, and hyperreflexia and pronator drift were noted in the left upper extremity, with sustained clonus in both lower extremities. The Babinski sign was absent. A magnetic resonance imaging (MRI) of the brain with contrast demonstrated multiple supratentorial, infratentorial, and deep nuclear 8-to 12-mm-thin, smooth-walled, ring-enhancing lesions with restricted diffusion throughout the brain (Fig. 1). These lesions were located predominantly at the gray-white junctions and the deep nuclear structures and were suggestive of thromboembolic septic emboli with multiple intra-axial abscesses. A transesophageal echocardiogram was negative for valvular vegetations or atrial mural thrombi. Intravenous metronidazole was substituted for acyclovir in the antimicrobial regimen. The patient experienced only mild improvement in symptoms with persistent headaches. Serologic testing, in...

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Rapid Identification of Aspergillus terreus from Bronchoalveolar Lavage Fluid by PCR and Electrospray Ionization with Mass Spectrometry

Cited by 13 publications

References 9 publications

Use of Novel Tools to Probe Drug Resistance in Fungi

Use of Novel Tools to Probe Drug Resistance in Fungi

Aspergillus Terreus Brain Abscess Complicated by Tension Pneumocephalus in a Patient with Angiosarcoma

Identification of Streptococcus intermedius Central Nervous System Infection by Use of PCR and Electrospray Ionization Mass Spectrometry

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