A Case Report on Aspergillus lentulus Pneumonia

Yıl 2013, Cilt: 2013 Sayı: 4, 429 - 431, 01.04.2013

Şaban Gürcan Melek Tikveşli Sedat Üstündağ Beyza Ener

https://doi.org/10.5152/balkanmedj.2013.8572

Öz

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.

Anahtar Kelimeler

Invasive pulmonary aspergillosis, immunocompromised host, Aspergillus lentulus

A Case Report on Aspergillus lentulus Pneumonia

Öz

Kaynakça

• Colonisation therapy history Chronic obstructive pulmonary Exacerbation of COPD Yes Bronchial aspirate Alhambra et al. (3) disease (COPD) 4 haematopoietic stem cell Invasive aspergillosis No data Not data Balajee et al. (9) transplant recipients Arterial hypertension and Pneumonia Yes Bronchoalveolar Montenegro et al. (8) end-stage chronic kidney lavage fluid disease (BAL) Cystic fibrosis Colonisation of the No Sputum Symoens et al. (13) airways Heart transplantation for Pneumonia Yes 1 BAL, 1 sputum, Zbinden et al. (14) ischaemic cardiomyopathy and 2 tracheal bronchial secretions Renal transplant recipient Pneumonia Yes Sputum The present study Mortensen KL, Mellado E, Lass-Flörl C, Rodriguez-Tudela JL, Johansen HK, Arendrup MC. Environmental study of azole-resistant Aspergillus fumigatus and other aspergilli in Austria, Denmark, and Spain. Antimicrob Agents Chemother 2010;54:4545-9. [CrossRef]
• Serrano R, Gusmão L, Amorim A, Araujo R. Rapid identification of Aspergillus fumigatus within the section Fumigati. BMC Microbiol 2011;11:82. [CrossRef]
• Alhambra A, Catalán M, Moragues MD, Brena S, Pontón J, Montejo JC, et al. Isolation of Aspergillus lentulus in Spain from a critically ill patient with chronic obstructive pulmonary disease. Rev Iberoam Micol 2008;25:246-9. [CrossRef]
• Mortensen KL, Johansen HK, Fuursted K, Knudsen JD, GahrnHansen B, Jensen RH, et al. A prospective survey of Aspergillus spp. in respiratory tract samples:prevalence, clinical impact and antifungal susceptibility. Eur J Clin Microbiol Infect Dis 2011;30:1355-63. [CrossRef]
• Alcazar-Fuoli L, Mellado E, Alastruey-Izquierdo A, Cuenca-Estrella M, Rodriguez-Tudela JL. Aspergillus section Fumigati: antifungal susceptibility patterns and sequence-based identification. Antimicrob Agents Chemother 2008;52:1244-51. [CrossRef]
• Mellado E, Alcazar-Fuoli L, Cuenca-Estrella M, Rodriguez-Tudela JL. Role of Aspergillus lentulus 14-α sterol demethylase (Cyp51A) in azole drug susceptibility. Antimicrob Agents Chemother 2011;55:5459-68. [CrossRef]
• Alcazar-Fuoli L, Cuesta I, Rodriguez-Tudela JL, Cuenca-Estrella M, Sanglard D, Mellado E. Three-dimensional models of 14α-sterol demethylase (Cyp51A) from Aspergillus lentulus and Aspergillus fumigatus: an insight into differences in voriconazole interaction. Int J Antimicrob Agents 2011;38:426-34. [CrossRef]
• Montenegro G, Sánchez Puch S, Jewtuchowicz VM, Pinoni MV, Relloso S, Temporitti E, et al. Phenotypic and genotypic characterization of Aspergillus lentulus and Aspergillus fumigatus isolates in a patient with probable invasive aspergillosis. J Med Microbiol 2009;58:391-5. [CrossRef]
• Balajee SA, Gribskov JL, Hanley E, Nickle D, Marr KA. Aspergillus lentulus sp. nov., a new sibling species of A. fumigatus. Eukaryot Cell 2005;4:625-32. [CrossRef]
• Clinical Laboratory Standard Institute. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi; approved standard. M38-A. PA: Wayne; 2002.
• Gürcan S, Demir M, Altiay G, Tikveşli M, Kiliç H, Otkun M. Aspergillus spp. isolations from respiratory tract samples in Trakya University Hospital. Tuberk Toraks 2007;55:160-6.
• Balajee SA, Kano R, Baddley JW, Moser SA, Marr KA, Alexander BD, et al. Molecular identification of Aspergillus species collected for the Transplant-Associated Infection Surveillance Network. J Clin Microbiol 2009;47:3138-41. [CrossRef]
• Symoens F, Haase G, Pihet M, Carrere J, Beguin H, Degand N, et al. Unusual Aspergillus species in patients with cystic fibrosis. Med Mycol 2010;48:S10-6. [CrossRef]
• Zbinden A, Imhof A, Wilhelm MJ, Ruschitzka F, Wild P, Bloemberg GV, et al. Fatal outcome after heart transplantation caused by Aspergillus lentulus. Transpl Infect Dis 2012;14:E60-3. [CrossRef]
• Staab JF, Kahn JN, Marr KA. Differential Aspergillus lentulus echinocandin susceptibilities are Fksp independent. Antimicrob Agents Chemother 2010;54:4992-8. [CrossRef]
• Gürcan Ş, Tikveşli M, Eryıldız C, Evci C, Ener B. Antifungal susceptibilities of Aspergillus spp. strains isolated from invasive aspergillosis cases. Mikrobiyol Bul 2010;44:273-8.
• Staab JF, Balajee SA, Marr KA. Aspergillus section Fumigati typing by PCR-restriction fragment polymorphism. J Clin Microbiol 2009;47:2079-83. [CrossRef] 431 Balkan Med J 2013; 30: 429-31 Gürcan et al.
• 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)