Roilides E, Sigler L, Bibashi E, Katsifa H, Flaris N, Panteliadis C
Third Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
J Clin Microbiol. 1999 Jan;37(1):18-25. doi: 10.1128/JCM.37.1.18-25.1999.
We report the first case of Chrysosporium zonatum infection in a 15-year-old male with chronic granulomatous disease who developed a lobar pneumonia and tibia osteomyelitis while on prophylaxis with gamma interferon. The fungus was isolated from sputum and affected bone, and hyphae were observed in the bone by histopathology. Therapy with amphotericin B eradicated the osteomyelitis and pneumonia, but pneumonia recurred in association with pericarditis and pleuritis during therapy with itraconazole. These manifestations subsided, and no recurrences occurred with liposomal amphotericin B therapy. Infections caused by Chrysosporium species are very rare, and C. zonatum has not previously been reported to cause mycosis in humans. This species, the anamorph of the heterothallic ascomycete Uncinocarpus orissi (family Onygenaceae), is distinguished by its thermotolerance, by colonies which darken from yellowish white to buff, and by club-shaped terminal aleurioconidia borne at the ends of short, typically curved stalks. The case isolate produced fertile ascomata in mating tests with representative isolates. The median (range) MICs for our isolate as well as those for two other human isolates and a nonhuman isolate determined by the National Committee for Clinical Laboratory Standards method adapted for moulds were </=0.06 microg/ml (</=0.06 to 0.25 microg/ml) for amphotericin B, 0. 687 microg/ml (0.25 to 2 microg/ml) for itraconazole, >128 microg/ml (>128 microg/ml) for flucytosine, and 48 microg/ml (32 to >128 microg/ml) for fluconazole.
我们报告首例感染zonatum金孢子菌的病例，患者为一名15岁患有慢性肉芽肿病的男性，在接受γ干扰素预防治疗时发生了大叶性肺炎和胫骨骨髓炎。从痰液和患病骨骼中分离出该真菌，组织病理学检查在骨骼中观察到了菌丝。两性霉素B治疗根除了骨髓炎和肺炎，但在使用伊曲康唑治疗期间，肺炎复发并伴有心包炎和胸膜炎。这些症状消退，脂质体两性霉素B治疗后未再复发。金孢子菌属引起的感染非常罕见，此前尚未有zonatum金孢子菌引起人类真菌病的报道。该菌种是异宗配合子囊菌Orissi Uncinocarpus（Onygenaceae科）的无性型，其特点是耐热，菌落从黄白色变为浅黄色，以及在短的、通常弯曲的柄末端着生棒状末端粉孢子。病例分离株在与代表性分离株的交配试验中产生了可育子囊果。采用适用于霉菌的美国国家临床实验室标准委员会方法测定，我们的分离株以及另外两株人类分离株和一株非人类分离株的两性霉素B MIC中位数（范围）为≤0.06μg/ml（≤0.06至0.25μg/ml），伊曲康唑为0.687μg/ml（0.25至2μg/ml），氟胞嘧啶>128μg/ml（>128μg/ml），氟康唑为48μg/ml（32至>128μg/ml）。
