Laboratory of Host Defense, National Institutes of Allergy and Infectious Diseases, Bethesda, MD, USA.
Clin Infect Dis. 2011 Mar 15;52(6):e136-43. doi: 10.1093/cid/ciq250.
Chronic granulomatous disease (CGD) is an inherited disorder of the nicotinamide adenine dinucleotide phosphate oxidase that leads to defective production of microbicidal superoxide and other oxidative radicals, resulting in increased susceptibility to invasive infections, especially those due to fungi.
Geosmithia argillacea was identified from cultured isolates by genomic sequencing of the internal transcribed spacer region. Isolates previously identified as Paecilomyces variotii, a filamentous fungus closely resembling G. argillacea, were also examined.
We identified G. argillacea as the cause of invasive mycosis in 7 CGD patients. In 5 cases, the fungus had been previously identified morphologically as P. variotii. All patients had pulmonary lesions; 1 had disseminated lesions following inhalational pneumonia. Infections involved the chest wall and contiguous ribs in 2 patients and disseminated to the brain in 1 patient. Four patients with pneumonia underwent surgical intervention. All patients responded poorly to medical treatment, and 3 died.
We report the first cases of invasive mycosis caused by G. argillacea in CGD patients. G. argillacea infections in CGD are often refractory and severe with a high fatality rate. Surgical intervention has been effective in some cases. G. argillacea is a previously underappreciated and frequently misidentified pathogen in CGD that should be excluded when P. variotii is identified morphologically.
慢性肉芽肿病（CGD）是一种 NADPH 氧化酶的遗传性疾病，导致杀菌性超氧化物和其他氧化自由基的产生缺陷，从而导致易感染侵袭性感染，特别是真菌感染。
通过内部转录间隔区的基因组测序，从培养的分离物中鉴定出 Geosmithia argillacea。还检查了先前被鉴定为 Paecilomyces variotii 的分离物，一种与 G. argillacea 非常相似的丝状真菌。
我们确定 G. argillacea 是 7 例 CGD 患者侵袭性真菌感染的原因。在 5 例中，真菌以前在形态上被鉴定为 P. variotii。所有患者均有肺部病变；1 例因吸入性肺炎并发播散性病变。2 例患者的感染累及胸壁和相邻肋骨，1 例患者播散至大脑。4 例肺炎患者接受了手术干预。所有患者对药物治疗反应不佳，3 例死亡。
我们报告了 CGD 患者由 G. argillacea 引起的侵袭性真菌感染的首例病例。CGD 中的 G. argillacea 感染通常是难治性和严重的，死亡率很高。手术干预在某些情况下是有效的。G. argillacea 是 CGD 中一种以前被低估且经常被错误识别的病原体，当形态学上鉴定为 P. variotii 时应排除在外。
