Successful treatment of invasive pulmonary aspergillosis caused by Aspergillus felis, a cryptic species within the Aspergillus section Fumigati: A case report

Abstract

Aspergillus species are a major cause of life-threatening infections in immunocompromised hosts, and the most common pathogen of invasive aspergillosis is Aspergillus fumigatus. Recently, the development of molecular identification has revealed cryptic Aspergillus species, and A. felis is one such species within the Aspergillus section Fumigati reported in 2013. We describe a case of invasive pulmonary aspergillosis caused by A. felis in a 41-yearold Japanese woman diagnosed with myelodysplastic syndrome. She presented with fever 19 days after undergoing autologous peripheral blood stem cell transplantation and was clinically diagnosed with invasive pulmonary aspergillosis. Bronchoscopy and bronchoalveolar lavage were performed for definitive diagnosis. The β-tubulin genes of the mold isolated from the bronchoalveolar lavage fluid, and sequenced directly from the PCR products using a primer pair were found to have 100% homology with A. felis. We successfully treated the patient with echinocandin following careful susceptibility testing. To the best of our knowledge, this is the first published case reporting the clinical course for diagnosis and successful treatment of invasive aspergillosis by A. felis.

Next-generation sequencing technology for detecting pulmonary fungal infection in bronchoalveolar lavage fluid of a patient with dermatomyositis: a case report and literature review

“…High-quality sequencing data were generated by removing low-quality and short (length < 35 bp) reads, followed by computational subtraction of human host sequences mapped to the human reference genome (hg19) using Burrows-Wheeler Alignment. The remaining data obtained by removal of low-complexity reads were classified by simultaneous alignment to four microbial genome databases consisting of viruses, bacteria, fungi, and parasites [22,23]. In recent years, the cost of NGS has decreased, and most patients can afford it.…”

Case report: a fatal case of Aspergillus felis infection in an immunocompetent host

“…Similarly, other case reports that have identified other cryptic Aspergillus species have been subsequently reidentified with the evolution of molecular methods to have been A. felis [1, 2, 13]. Two other cases of successfully treated invasive pulmonary aspergillosis with A. felis have been described in case studies, one involving a 42-year-old male with chronic granulomatous disease and the other a 41-year-old female with myelodysplastic syndrome who underwent autologous peripheral blood stem cell transplantation [3, 4]. A case of cranial aspergillosis with A. felis was reported in a 66-year-old male with chronic lymphocytic leukaemia on ibrutinib and was successfully managed with voriconazole and surgery followed by maintenance with posaconazole [5].…”

“…Few clinical cases of A. felis in humans have been described, which could be a result of cases being misidentified as a different species within the complex [1, 2]. The previously described cases in humans have been in the immunocompromised host and predominantly involving the sinopulmonary tract [3–5]. In cats and dogs, A. felis is more commonly associated with fungal rhinosinusitis and can cause lysis of the orbital lamina with localized invasion into the orbital cavity, resulting in exophthalmos [6].…”

Chronic pulmonary aspergillosis: comprehensive insights into epidemiology, treatment, and unresolved challenges

“… 25 – 33 Cryptic species that are pathogenic to humans and have shown low drug susceptibility include the following strains: A. fumigatus complex ( A. lentulus, A. udagawae, A. viridinutans, A. felis, A. fischeri , and A. thermomutatus ); A. niger complex ( A. welwitschiae, A. tubingensis ). 34 – 43 Reports from Indonesia indicate that cryptic species were identified in 24% of patients with CPA, emphasizing the need for accurate identification. 44 Matrix-assisted laser desorption ionization coupled to time-of-flight mass spectrometry (MALDI-TOF/MS) is increasingly being used for identification, and some closely related species can now be identified.…”