Department of Microbiology, All India Institute of Medical Sciences, Phase 2 Industrial Area, 342005 Jodhpur, Rajasthan, India.
Department of Microbiology, All India Institute of Medical Sciences, Phase 2 Industrial Area, 342005 Jodhpur, Rajasthan, India.
J Mycol Med. 2020 Jun;30(2):100932. doi: 10.1016/j.mycmed.2020.100932. Epub 2020 Jan 22.
Acrophialophora fusispora is a soil-borne fungus rarely implicated in human infections. Here, we report a case of pulmonary infection due to A. fusispora in a 59-year-old male who presented with productive cough and gradually progressive dyspnoea for 20 days. He had a past history of pulmonary tuberculosis and was a known case of chronic obstructive pulmonary disease for past five years. He was diagnosed with mixed connective tissue disease and had been receiving oral azathioprine and prednisolone for three months. CECT thorax revealed an aspergilloma and serum Aspergillus fumigatus-specific IgG levels were raised, suggestive of chronic pulmonary aspergillosis. He was also tested positive for influenza A (H1N1) and received treatment with oral oseltamivir without any clinical benefit. Culture of sputum and bronchoalveolar lavage fluid showed growth of a fungus which was identified as Acrophialophora fusispora based on characteristic microscopic morphology and internal transcribed spacer sequencing of the ribosomal DNA. Antifungal susceptibility testing for six antifungal drugs showed itraconazole to have the most potent in vitro activity (MIC=0.25μg/mL) against A. fusispora in comparison to the other drugs tested. Treatment with itraconazole capsule 200mg twice daily was initiated and favourable clinical response was observed after 10 days of therapy. Follow-up visit after three months showed marked clinical and radiological improvement. A. fusispora is an emerging opportunistic fungus capable of causing invasive infections in immunocompromised hosts. Lack of knowledge about this fungus and confusion with morphologically similar opportunistic fungi have led to its misidentification and hence its prevalence remains largely underestimated. Accurate identification is crucial as it can help initiate early effective antifungal therapy and improve patient outcomes. To our knowledge, this is the first case of pulmonary infection due to A. fusispora reported from India.
土生青霉是一种很少引起人类感染的土壤真菌。在这里，我们报告了一例 59 岁男性因土生青霉引起的肺部感染。该患者表现为有痰咳嗽和逐渐加重的呼吸困难 20 天。他有肺结核病史，并且五年前被确诊为慢性阻塞性肺疾病。他被诊断为混合性结缔组织病，已接受口服硫唑嘌呤和泼尼松治疗三个月。胸部 CECT 显示曲霉菌球，血清烟曲霉特异性 IgG 水平升高，提示为慢性肺曲霉病。他还被检测出甲型流感（H1N1）阳性，并接受了口服奥司他韦治疗，但没有任何临床获益。痰和支气管肺泡灌洗液培养显示一种真菌生长，根据其特征性的微观形态和核糖体 DNA 的内部转录间隔区测序，鉴定为土生青霉。对六种抗真菌药物的药敏试验显示，与其他测试药物相比，伊曲康唑对土生青霉具有最强的体外活性（MIC=0.25μg/mL）。开始使用伊曲康唑胶囊 200mg，每日两次治疗，在 10 天的治疗后观察到良好的临床反应。三个月后的随访显示出明显的临床和影像学改善。土生青霉是一种新兴的机会性真菌，能够在免疫功能低下的宿主中引起侵袭性感染。由于对这种真菌缺乏了解以及与形态相似的机会性真菌混淆，导致其被错误鉴定，因此其流行率在很大程度上被低估。准确鉴定至关重要，因为它可以帮助早期启动有效的抗真菌治疗并改善患者的预后。据我们所知，这是印度首例报告的土生青霉引起的肺部感染。
