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Mycopathologia

, Volume 181, Issue 3–4, pp 267–271 | Cite as

Pseudallescheria boydii with Aspergillus fumigatus and Aspergillus terreus in a Critically Ill Hematopoietic Stem Cell Recipient with ARDS

  • Tobias Lahmer
  • Marlena Messer
  • Ursula Ehmer
  • Stefan Eser
  • Analena Beitz
  • Lisa Fekecs
  • Roland M. Schmid
  • Wolfgang Huber
Article

Abstract

Pseudallescheria boydii is a fungal organism known to affect immunocompromised patients. This organism is known to cause, in severe cases, invasive infection of various organs such as the central nervous, cardiovascular, and respiratory systems. We report an unusual case of pulmonary P. boydii pneumonia in an immunocompromised critically ill patient with a co-infection of Aspergillus fumigatus and Aspergillus terreus with ARDS. This case highlights the importance of a high index of suspicion for superimposed fungal infections in patients who are critically ill and immunocompromised. Uncommon fungal pathogens should be considered in the differential diagnosis of respiratory failure, especially if diagnostic markers such as galactomannan (from BAL and serum) or 1,3-beta-d-glucan are elevated. Further diagnostic interventions are warranted when insufficient clinical improvement is observed to prevent treatment failure and adverse outcomes.

Keywords

Pseudallescheria boydii Critically ill Aspergillus terreus Aspergillus fumigatus 

Notes

Compliance with Ethical Standards

Conflict of interest

None.

References

  1. 1.
    Panackal AA, Marr KA. Scedosporium/Pseudallescheria infections. Semin Respir Crit Care Med. 2004;25:171–81.CrossRefPubMedGoogle Scholar
  2. 2.
    Katragkou A, Dotis J, Kotsiou M, Tamiolaki M, Roilides E. Scedosporium apiospermum infection after near-drowning. Mycoses. 2007;50:412–21.CrossRefPubMedGoogle Scholar
  3. 3.
    Wood GM, McCormack JG, Muir DB, et al. Clinical features of human infection with Scedosporium inflatum. Clin Infect Dis. 1992;14:1027–33.CrossRefPubMedGoogle Scholar
  4. 4.
    Segal BH. Aspergillosis. N Engl J Med. 2009;360:1870.CrossRefPubMedGoogle Scholar
  5. 5.
    Ben-Ami R, Lewis RE, Kontoyiannis DP. Enemy of the (immunosuppressed) state: an update on the pathogenesis of Aspergillus fumigatus infection. Br J Haematol. 2010;150:406.PubMedGoogle Scholar
  6. 6.
    Meersseman W, Lagrou K, Maertens J, Van Wijngaerden E. Invasive aspergillosis in the intensive care unit. Clin Infect Dis. 2007;45:205.CrossRefPubMedGoogle Scholar
  7. 7.
    Daben R, de Lucas M, Cuesta L, et al. Imaging findings of pulmonary infection caused by Scedosporium prolificans in a deep immunocompromised patient. Emerg Radiol. 2008;15:47–9.CrossRefGoogle Scholar
  8. 8.
    Koga T, Kitjima T, Tanaka R, et al. Chronic pulmonary scedosporiosis simulating aspergillosis. Respirology. 2005;10:682–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Guarner J, Brandt ME. Histopathologic diagnosis of fungal infections in the 21st century. Clin Microbiol Rev. 2011;24:247–80.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Maertens J, Maertens V, Theunissen K, et al. Bronchoalveolar lavage fluid galactomannan for the diagnosis of invasive pulmonary aspergillosis in patients with hematologic diseases. Clin Infect Dis. 2009;49:1688.CrossRefPubMedGoogle Scholar
  11. 11.
    Husain S, Clancy CJ, Nguyen MH, et al. Performance characteristics of the platelia Aspergillus enzyme immunoassay for detection of Aspergillus galactomannan antigen in bronchoalveolar lavage fluid. Clin Vaccine Immunol. 2008;15:1760.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Woods G, Miceli MH, Grazziutti ML, et al. Serum Aspergillus galactomannan antigen values strongly correlate with outcome of invasive aspergillosis: a study of 56 patients with hematologic cancer. Cancer. 2007;110:830.CrossRefPubMedGoogle Scholar
  13. 13.
    Koo S, Bryar JM, Baden LR, Marty FM. Prognostic features of galactomannan antigenemia in galactomannan-positive invasive aspergillosis. J Clin Microbiol. 2010;48:1255.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Pickering JW, Sant HW, Bowles CA, et al. Evaluation of a (1→3)-beta-D-glucan assay for diagnosis of invasive fungal infections. J Clin Microbiol. 2005;43:5957.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Karageorgopoulos DE, Vouloumanou EK, Ntziora F, et al. β-D-glucan assay for the diagnosis of invasive fungal infections: a meta-analysis. Clin Infect Dis. 2011;52:750.CrossRefPubMedGoogle Scholar
  16. 16.
    Lamoth F, Cruciani M, Mengoli C, et al. β-Glucan antigenemia assay for the diagnosis of invasive fungal infections in patients with hematological malignancies: a systematic review and meta-analysis of cohort studies from the Third European Conference on Infections in Leukemia (ECIL-3). Clin Infect Dis. 2012; 54:633.Google Scholar
  17. 17.
    Sulahian A, Porcher R, Bergeron A, et al. Use and limits of (1–3)-β-d-glucan assay (Fungitell), compared to galactomannan determination (Platelia Aspergillus), for diagnosis of invasive aspergillosis. J Clin Microbiol. 2014;52:2328.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Cuétara MS, Alhambra A, Moragues MD, González-Elorza E, Pontón J, Palacio A. Detection of (1→3)-β-d-glucan as an adjunct to diagnosis in a mixed population with uncommon proven invasive fungal diseases or with an unusual clinical presentation. Clin Vaccine Immunol. 2009;16(3):423–6.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Nomdedeu J, Brunet S, Martino R, Altes A, Ausina V, Domingo-Albos A. Successful treatment of pneumonia due to Scedosporium apiospermum with itraconazole: case report. Clin Infect Dis. 1993;16:731–3.CrossRefPubMedGoogle Scholar
  20. 20.
    Walsh M, White L, Atkinson K, Enno A. Fungal Pseudoallescheria boydii lung infiltrates unresponsive to amphotericin B in leukaemic patients. Aust N Z J Med. 1992;22:265–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Meletiadis J, Meis JF, Mouton JW, et al. In vitro activities of new and conventional antifungal agents against clinical Scedosporium isolates. Antimicrob Agents Chemother. 2002;46:62–8.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Tong SY, Peleg AY, Yoong J, Handke R, Szer J, Slavin M. Breakthrough Scedosporium prolificans infection while receiving voriconazole prophylaxis in an allogeneic stem cell transplant recipient. Transpl Infect Dis. 2007;9:241–3.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Tobias Lahmer
    • 1
  • Marlena Messer
    • 1
  • Ursula Ehmer
    • 1
  • Stefan Eser
    • 1
  • Analena Beitz
    • 1
  • Lisa Fekecs
    • 1
  • Roland M. Schmid
    • 1
  • Wolfgang Huber
    • 1
  1. 1.II. Medizinische Klinik und PoliklinikKlinikum rechts der Isar der Technischen Universität MünchenMunichGermany

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