Abstract
Changes in the spectrum of clinically important fungal infection have been observed in recent years. Acremonium species has been responsible for eumycotic mycetomas but has also been increasingly implicated in systemic fungal diseases. A case of Acremonium kiliense fungemia with proven involvement of the lungs in an allogeneic hematopoietic stem cell patient is reported. A high-resolution computed tomography scan of the lungs showed nodules in both lungs. Multiple cultures of blood demonstrated narrow septate hyphae, cylindrical conidia, and solitary tapering phialides and microconidia that remained grouped in slimy heads. The isolate was identified as A. kiliense based on its morphological characteristics and DNA sequence analysis. Susceptibility testing of the clinical isolate was performed to four antifungal agents. Amphotericin B, fluconazole and itraconazole were found to be inactive in vitro against the isolate; however, it was found to be sensitive to voriconazole. This last drug was indicated, and a high-resolution computed tomography scan of the lungs was normal after 10 days. One year later, the patient was free of symptoms and her blood culture was negative for fungi. Thus, voriconazole was effective in treatment for life-threatening A. kiliense infections. In this work, we performed an overview of worldwide clinical infections caused by A. kiliense.
References
Das S, Saha R, Ahmad Dar S, Ramachandran VG. Acremonium species: a review of the etiological agents of emerging hyalohyphomycosis. Mycopathologia. 2010;170:361–75.
Pagano L, Caira M, Candoni A, Posteraro B, Fianchi L. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica. 2006;91:1068–75.
Pagano L, Caira M, Nosari A, et al. Fungal infections in recipients of hematopoietic stem cell transplants: results of the SEIFEM B-2004 study. Clin Infect Dis. 2007;45:1161–70.
De Pauw B, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46:1813–21.
Pagano L, Caira M, Valentini GC, Posteraro B, Fianchi L. Current therapeutic approaches to fungal infections in immunocompromised hematological patients. Blood Rev. 2010;24:51–61.
Marr KA, Carter RA, Crippa F, Wald A, Corey L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34:909–17.
Miyakis S, Velegraki A, Delikou S, et al. Invasive Acremonium strictum infection in a bone marrow transplant recipient. Pediatr Infect Dis J. 2006;25:273–5.
Koç AN, Erdem F, Patiroğlu T. Case report. Acremonium falciforme fungemia in a patient with acute leukemia. Mycoses. 2002;45:202–3.
Guarro J, del Palacio A, Gené J, Cano J, González CG. A case of colonization of a prosthetic mitral valve by Acremonium strictum. Rev Iberoam Micol. 2009;26:146–8.
Khan Z, Al-Obaid K, Ahmad S, Ghani AA, Joseph L, Chandy R. Acremonium kiliense: reappraisal of its clinical significance. J Clin Microbiol. 2011;49:2342–7.
Durbec M, Bienvenub AL, Picot S, Dubreuil C, Cosmidis A, Tringali S. Maxillary sinus fungal infection by Acremonium. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128:41–3.
Beltrame L, Sarmati L, Cudillo R, et al. A fatal case of invasive fungal sinusitis by Scopulariopsis acremonium in a bone marrow transplant recipient. Int J Infect Dis. 2009;13:488–92.
Ioakimidou A, Vyzantiadis TA, Sakellari I, et al. An unusual cluster of Acremonium kiliense fungaemias in a haematopoietic cell transplantation unit. Diagn Microbiol Infect Dis. 2013;75:313–6.
Raeder J, Broda P. Rapid preparation of DNA from filamentous fungi. Lett Appl Microbiol. 1985;1:17–20.
Alvarez E, Stchigel A, Cano J, et al. Molecular phylogenetic diversity of the emerging mucoralean fungus Apophysomyces: proposal of three new species. Rev Iberoam Micol. 2010;27:80–9.
Thompson JD, Gibson TJ, Plewniak F, Jeanmougin F, Higgins DG. The CLUSTAL X Windows interface: flexible strategies for multiple sequence alignment aided by quality analysis tools. Nucleic Acids Res. 1997;24:4876–82.
Tamura K, Dudley J, Nei M, Kumar S. MEGA 4: molecular evolutionary genetics analysis (MEGA) software version 4.0. Mol Biol Evol. 2007;24:1596–9.
Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi; approved standard. M38-A2, CLSI; (2008).
Perdomo H, Sutton DA, García D, et al. Spectrum of clinically relevant Acremonium species in the United States. J Clin Microbiol. 2011;49:243–56.
Das S, Saha R, Bhattacharya SN, Mishra K, Dar SA. Hyalohyphomycosis: an unusual presentation and review of literature. Indian J Med Spec. 2010;1:123–9.
Albrecht MC, Fraenza LB, Ramonda GT. Onicomicosis por Acremonium kiliense. Rev Argent Dermatol. 2007;88:40–4.
Negroni R, Lopez DG, Arechavala A, Binachi MH, Robles AM. Clinical and microbiological study of mycetomas at the Muniz hospital of Buenos Aires between 1989 and 2004. Rev Argent Microbiol. 2006;38:13–8.
Pastorino AC, Menezes UP, Marques HHS, et al. Acremonium kiliense infection in a child with chronic granulomatous disease. Braz J Infect Dis. 2005;9:529–34.
Gupta A, Gupta V, Gupta A, Dogra MR, Panda SS. Risk factor for post cataract surgery endophthalmitis with poor outcome. North Zone J Ophthalmol. 2003;13:1–4.
Lacaz SC, Pereira AD, Castro MLG. Podalic eumycetoma caused by Acremonium kiliense: report of one case. An Bras Dermatol, Rio de Janeiro. 1999;74:591–5.
Le Guen P, Blancard A, Brisou P, Yvetot J, Muzellec Y. Kératomycose à Acremonium kiliense. Med Mal Infect. 1997;27:738–9.
Fridkin SK, Kremer FB, Bland LA, Padhye A, McNeil MM, Jarvis WR. Acremonium kiliense endophthalmitis that occurred after cataract extraction in an ambulatory surgical center and was traced to an environmental reservoir. Clin Infect Dis. 1996;22:222–7.
Venugopal PV, Venugopal TV. Pale grain eumycetomas in Madras. Australas J Dermatol. 1995;36:149–51.
Lopes JO, Kolling LC, Neumaier W. Kerionlike lesion scalp due to Acremonium kiliense in a noncompromised boy. Rev Inst Med Trop São Paulo. 1995;37:365–8.
Lopes JO, Alves SH, Rosa AC, Silva CB, Sarturi JC, Souza CA. Acremonium kiliense peritonitis complicating continuous ambulatory peritoneal dialysis: report of two cases. Mycopathologia. 1995;131:83–5.
Simon G, Rakoczy G, Galgoczy J. Acremonium kiliense in esophagus stenosis. Mycoses. 1991;34:257–60.
Lacroix C, Jacquemin J, Guillot F, Rabot MH, Burucoa C, de Bievre C. Septicemie a Acremonium kiliense avec dissemination secondaire chez une patiente d’un myelome a forte masse tumorale. Bull Soc Fr Mycol Med. 1988;17:93–8.
Brabender W, Ketchersidem J, Hodges GR, Rengachary S, Barnes WG. Acremonium kiliense osteomyelitis of the calvarium. Neurosurgery. 1985;16:554–6.
Lacaz CS, Porto E, Carneiro J, Pazianni IO, Pimenta WP. Endocardite em protese de dura-mater provocada pelo Acremonium kiliense. Rev Inst Med Trop São Paulo. 1981;23:274–9.
Schell WA, Perfect JR. Fatal disseminated Acremonium strictum infection in a neutropenic host. J Clin Microbiol. 1996;34:1333–6.
Kendirli T, Ciftci E, Ekim M, et al. Acremonium spp. peritonitis in an infant. Mycoses. 2008;51:455–7.
Foell JL, Fisher M, Seibold M, et al. Lethal double infection with Acremonium strictum and Aspergillus fumigatus during induction chemotherapy in a child with ALL. Pediatr Blood Cancer. 2007;49:858–61.
Mattei D, Mordini N, Lo Nigro C, et al. Successful treatment of Acremonium fungemia with voriconazole. Mycoses. 2003;46:511–4.
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Júnior, M.C., de Moraes Arantes, A., Silva, H.M. et al. Acremonium kiliense: Case Report and Review of Published Studies. Mycopathologia 176, 417–421 (2013). https://doi.org/10.1007/s11046-013-9700-x
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DOI: https://doi.org/10.1007/s11046-013-9700-x