Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Hospital Medicine Program, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
J Med Microbiol. 2010 Jul;59(Pt 7):834-838. doi: 10.1099/jmm.0.018309-0. Epub 2010 Mar 18.
Infections due to Aspergillus species cause significant morbidity and mortality. Most are attributed to Aspergillus fumigatus, followed by Aspergillus flavus and Aspergillus terreus. Aspergillus niger is a mould that is rarely reported as a cause of pneumonia. A 72-year-old female with chronic obstructive pulmonary disease and temporal arteritis being treated with steroids long term presented with haemoptysis and pleuritic chest pain. Chest radiography revealed areas of heterogeneous consolidation with cavitation in the right upper lobe of the lung. Induced bacterial sputum cultures, and acid-fast smears and cultures were negative. Fungal sputum cultures grew A. niger. The patient clinically improved on a combination therapy of empiric antibacterials and voriconazole, followed by voriconazole monotherapy. After 4 weeks of voriconazole therapy, however, repeat chest computed tomography scanning showed a significant progression of the infection and near-complete necrosis of the right upper lobe of the lung. Serum voriconazole levels were low-normal (1.0 microg ml(-1), normal range for the assay 0.5-6.0 microg ml(-1)). A. niger was again recovered from bronchoalveolar lavage specimens. A right upper lobectomy was performed, and lung tissue cultures grew A. niger. Furthermore, the lung histopathology showed acute and organizing pneumonia, fungal hyphae and oxalate crystallosis, confirming the diagnosis of invasive A. niger infection. A. niger, unlike A. fumigatus and A. flavus, is less commonly considered a cause of invasive aspergillosis (IA). The finding of calcium oxalate crystals in histopathology specimens is classic for A. niger infection and can be helpful in making a diagnosis even in the absence of conidia. Therapeutic drug monitoring may be useful in optimizing the treatment of IA given the wide variations in the oral bioavailability of voriconazole.
曲霉菌属物种引起的感染会导致显著的发病率和死亡率。大多数归因于烟曲霉，其次是黄曲霉和土曲霉。黑曲霉是一种很少报道引起肺炎的霉菌。一名 72 岁女性患有慢性阻塞性肺疾病和颞动脉炎，长期接受类固醇治疗，出现咯血和胸膜炎胸痛。胸部 X 光片显示右肺上叶存在异质性实变伴空洞。诱导性细菌痰培养、抗酸染色和培养均为阴性。真菌痰培养长出黑曲霉。患者在经验性抗菌药物联合伏立康唑治疗后临床状况改善，随后转为伏立康唑单药治疗。然而，在伏立康唑治疗 4 周后，重复胸部 CT 扫描显示感染明显进展，右肺上叶几乎完全坏死。伏立康唑血清水平低（1.0μg/ml，该检测方法的正常范围为 0.5-6.0μg/ml）。再次从支气管肺泡灌洗液标本中分离出黑曲霉。进行了右肺上叶切除术，肺组织培养出黑曲霉。此外，肺组织病理学显示急性和机化性肺炎、真菌菌丝和草酸结晶，证实了侵袭性黑曲霉感染的诊断。与烟曲霉和黄曲霉不同，黑曲霉较少被认为是侵袭性曲霉病（IA）的病因。组织病理学标本中发现草酸钙结晶是黑曲霉感染的典型特征，即使没有孢子，也有助于诊断。鉴于伏立康唑口服生物利用度差异很大，治疗药物监测可能有助于优化 IA 的治疗。
