A Case Report on Aspergillus lentulus Pneumonia

Abstract

Background: Aspergillus lentulus was described as a new species in 2005 but it was isolated from Turkey for the first time. Case report: A. lentulus was isolated as the cause of pneumonia from a patient who had renal transplantation 4 months ago. The patient received immunosuppressive treatment after transplantation. A. lentulus was isolated from his sputum as an agent in pneumonia developed 4 months after the transplantation. Leukocytes, blastospores, and hyphae were seen in both Gram- and Giemsa-stained smears of the sputum. The isolate was identified by using the Maren A. Klich algorithm and molecular methods and confirmed by the reference laboratory of the CBS Fungal Biodiversity Centre (The Netherlands). In the susceptibility tests of the isolate, minimal inhibitory concentrations for amphotericin B, voriconazole, posaconazole, and caspofungin were found to be 0.5 µg/mL, 0.25 µg/mL, 0.125 µg/mL, and 0.25 µg/mL, respectively. The patient recovered with voriconazole treatment (2x200 mg/day). Conclusion: The use of the molecular tests is important for identification of A. lentulus strains because they are very easily confused with A.fumigatus strains according to phenotypic characteristics. Turkish Başlık:Aspergillus Lentulus Pnömonisi Olgu Sunumu Anahtar Kelimeler:İnvaziv pulmoner aspergillosis, immunkompromize konak, Aspergillus lentulus Arkaplan: Aspergillus lentulus 2005 yılında yeni bir tür olarak tanımlandı ancak Türkiye'den ilk kez izole edildi. Olgu Sunumu: Dört ay önce renal transplantasyon olan bir hastadan pnömoni etkeni olarak A.lentulus izole edildi. Transplantasyon sonrası hasta immünsüpresif tedavi aldı. Transplantasyondan dört ay sonra gelişen pnömonide hastanın balgamından etken olarak A.lentulus izole edildi. Balgamın Gram ve Giemsa boyalı yaymalarının her ikisinde lökositler, blastosporlar ve hifler görüldü. İzolat Maren A. Klich algoritması ve moleküler yöntemler kullanılarak isimlendirildi ve CBS Fungal Biodiversity Centre (Hollanda) Referans Laboratuvarı'nda doğrulandı. İzolatın duyarlılık testlerinde amfoterisin B, vorikonazol, posakonazol ve kaspofungin için minimal inhibitor konsantrasyonlar sırasıyla 0.5 µg/mL, 0.25 µg/mL, 0.125 µg/mL ve 0.25 µg/mL olarak saptandı. Hasta vorikonazol (2x200 mg/gün) tedavisiyle iyileşti. Sonuç: A.lentulus kökenleri fenotipik özelliklerine göre A.fumigatus kökenleriyle çok kolay karışabildiğinden isimlendirmede moleküler testlerin kullanımı önemlidir.

Keywords

• Invasive pulmonary aspergillosis, immunocompromised host, Aspergillus lentulus

A Case Report on Aspergillus lentulus Pneumonia

Öz

Kaynakça

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18. Aspergillus lentulus Pneumonia Figure 1. a-d. Colony appearance in Czapek Agar (37˚C) (a), Czapek Yeast Agar (37˚C) (b), 20% sucrose Czapek Yeast Agar (25˚C) (c), malt extract agar (25˚C) (d) Figure 2. a-d. Leucocytes (arrow) and hyphae (arrowhead) in direct microscopic analysis of sputum (Gram staining) (a), colony appearance in Saboraud Dextrose Agar (SDA; 42˚C, 3 days) (b), conidiospore structure of the strain in slide culture (SDA, 25˚C) (c), and microscopic appearance of the branched conidiophores (arrow) in SDA (25˚C) (d)