Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague 5, Czech Republic.
Department of Botany, Faculty of Science, Charles University, Benátská 2, 128 01, Prague 2, Czech Republic.
Mycopathologia. 2018 Apr;183(2):423-429. doi: 10.1007/s11046-017-0223-8. Epub 2017 Nov 11.
Invasive fungal disease represents one of the severe complications in haematopoietic stem cell transplant recipients. We describe a case of a patient treated for relapse of chronic lymphoblastic leukaemia 6 years after HSCT. The patient was treated for invasive pulmonary aspergillosis but died 3 months later from multiple organ failures consisting of haemorrhagic necrotizing fungal pneumonia, refractory chronic hepatic graft versus host disease and cytomegalovirus hepatitis. Autopsy samples revealed histopathological evidence of fungal hyphae and an unusual Aspergillus nidulans-like species was isolated in pure culture. More precise identification was achieved by using scanning electron microscopy of ascospores and sequencing of calmodulin gene, and the isolate was subsequently re-identified as A. sublatus (section Nidulantes) and showed good in vitro susceptibility against all classes of antifungals. Commonly used ITS rDNA region and β-tubulin gene fail to discriminate A. sublatus from related pathogenic species, especially A. quadrilineatus and A. nidulans. Although this is the first case of proven IPA attributed to A. sublatus, we demonstrated that at least some previously reported infections due to A. quadrilineatus were probably caused by this cryptic species.
侵袭性真菌病是造血干细胞移植受者严重并发症之一。我们描述了一位 6 年前接受造血干细胞移植后复发慢性淋巴细胞白血病患者的病例。该患者因侵袭性肺曲霉病接受治疗，但 3 个月后因多器官衰竭死亡，包括出血性坏死性真菌性肺炎、难治性慢性肝移植物抗宿主病和巨细胞病毒肝炎。尸检样本显示真菌菌丝的组织病理学证据，并从纯培养物中分离出一种不寻常的拟青霉样物种。通过对分生孢子进行扫描电子显微镜观察和钙调蛋白基因测序，更精确地鉴定出该分离株为拟青霉（节 Nidulantes），对所有类别的抗真菌药物均显示出良好的体外敏感性。常用的 ITS rDNA 区和β-微管蛋白基因无法区分拟青霉与相关致病性物种，尤其是枝顶孢和拟青霉。尽管这是首例证实的归因于拟青霉的 IPA 病例，但我们证明，至少一些先前报道的归因于枝顶孢的感染可能是由这种隐生种引起的。
