Hong Gina, White Marissa, Lechtzin Noah, West Natalie E, Avery Robin, Miller Heather, Lee Richard, Lovari Robert J, Massire Christian, Blyn Lawrence B, Liang Xinglun, Sutton Deanna A, Fu Jianmin, Wickes Brian L, Wiederhold Nathan P, Zhang Sean X
Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Department of Pathology, Johns Hopkins University School of Medicine, USA.
J Cyst Fibros. 2017 Mar;16(2):e3-e7. doi: 10.1016/j.jcf.2017.01.005. Epub 2017 Feb 6.
Disseminated fungal infections are a known serious complication in individuals with cystic fibrosis (CF) following orthotopic lung transplantation. Aspergillus fumigatus and Scedosporium species are among the more common causes of invasive fungal infection in this population. However, it is also important for clinicians to be aware of other emerging fungal species which may require markedly different antifungal therapies.
We describe the first laboratory-documented case of a fatal disseminated fungal infection caused by Rasamsonia aegroticola in a 21-year-old female CF patient status post-bilateral lung transplantation, which was only identified post-mortem. Molecular analysis revealed the presence of the identical Rasamsonia strains in the patient's respiratory cultures preceding transplantation.
We propose that the patient's disseminated fungal disease and death occurred as a result of recrudescence of Rasamsonia infection from her native respiratory system in the setting of profound immunosuppression post-operatively. Since Rasamsonia species have been increasingly recovered from the respiratory tract of CF patients, we further review the literature on these fungi and discuss their association with invasive fungal infections in the CF lung transplant host.
Our report suggests Rasamsonia species may be important fungal pathogens that may have fatal consequences in immunosuppressed CF patients after solid organ transplantation.
播散性真菌感染是原位肺移植后囊性纤维化（CF）患者已知的严重并发症。烟曲霉和拟青霉属是该人群侵袭性真菌感染的较常见原因。然而，临床医生了解其他可能需要明显不同抗真菌治疗的新兴真菌种类也很重要。
我们描述了首例实验室确诊的由衰弱拟青霉引起的致命播散性真菌感染病例，患者为一名21岁的双侧肺移植术后CF女性患者，仅在尸检后才得以确诊。分子分析显示，移植前患者呼吸道培养物中存在相同的拟青霉菌株。
我们认为，患者的播散性真菌病和死亡是由于术后深度免疫抑制情况下，其原生呼吸系统中拟青霉感染复发所致。由于越来越多的CF患者呼吸道中分离出拟青霉属，我们进一步回顾了关于这些真菌的文献，并讨论了它们与CF肺移植宿主侵袭性真菌感染的关系。
我们的报告表明，拟青霉属可能是重要的真菌病原体，在实体器官移植后的免疫抑制CF患者中可能产生致命后果。
