First case of breakthrough pulmonary Aspergillus niveus infection in a patient after allogeneic hematopoietic stem cell transplantation

Aspergillus niveus is a species uncommon in clinical samples, and to date, invasive fungal infections caused by this fungal pathogen have not been described. This is the 1st report on a pulmonary breakthrough aspergillosis caused by A. niveus in a 21-year-old woman after allogeneic hematopoietic stem cell transplantation for Fanconi anemia.     

八种化学消毒剂对黑曲霉菌杀灭效果的研究

目的了解8种常用化学消毒剂对黑曲霉菌的杀灭效果。方法用悬液定量杀菌试验法进行了观察。结果75%乙醇作用1 m in、4000 mg/L长链季铵盐作用5 m in、4000 mg/L聚醇醚碘作用45 m in、250 mg/L二氧化氯作用2.5 m in、3000 mg/L有效氯的84消毒液作用10 m in,对黑曲霉菌的杀灭对数值均>4.00。用8000 mg/L醋酸氯己定作用20 m in、5000 mg/L对氯间二甲苯酚作用30 m in、4000 mg/L聚维酮碘作用60 m in,对黑曲霉菌的杀灭对数值依次分别为0.60、0.86、0.83。结论在常规使用浓度下,乙醇、长链季铵盐、聚醇醚碘、二氧化氯和84消毒液对黑曲霉菌杀灭效果较好;醋酸氯己定、对氯间二甲苯酚、聚维酮碘对黑曲霉菌杀灭效果较差。     

Fermented Brown Rice and Rice Bran with Aspergillus oryzae (FBRA) Prevents Inflammation-Related Carcinogenesis in Mice,through Inhibition of Inflammatory Cell Infiltration

We have established an inflammation-related carcinogenesis model in mouse, in which regressive QR-32 cells subcutaneously co-implanted with a foreign body—gelatin sponge—convert themselves into lethal tumors due to massive infiltration of inflammatory cells into the sponge. Animals were fed with a diet containing 5% or 10% fermented brown rice and rice bran with Aspergillus oryzae (FBRA). In 5% and 10% FBRA diet groups, tumor incidences were lower (35% and 20%, respectively) than in the non-treated group (70%). We found that FBRA reduced the number of inflammatory cells infiltrating into the sponge. FBRA administration did not cause myelosuppression, which indicated that the anti-inflammatory effects of FBRA took place at the inflammatory lesion. FBRA did not have antitumor effects on the implanted QRsP-11 tumor cells, which is a tumorigenic cell line established from a tumor arisen after co-implantation of QR-32 cells with sponge. FBRA did not reduce formation of 8-hydroxy-2′-deoxyguanine adducts, a marker of oxidative DNA damage in the inflammatory lesion; however, it reduced expression of inflammation-related genes such as TNF-α, Mac-1, CCL3 and CXCL2. These results suggest that FBRA will be an effective chemopreventive agent against inflammation-related carcinogenesis that acts by inhibiting inflammatory cell infiltration into inflammatory lesions.     

The clinical management of invasive mold infection in children with cancer or undergoing hematopoietic stem cell transplantation

Introduction: Invasive fungal disease (IFD) is a significant cause for morbidity and mortality in children receiving chemotherapy or undergoing hematopoietic stem cell transplantation (HSCT). As compared to adults, children may differ from adults in specific aspects regarding epidemiology, diagnosis and management of IFD.

Areas covered: The review provides an overview over the epidemiology of IFD in children with cancer or undergoing HSCT, diagnostic tools, preventive and therapeutic strategies.

Expert opinion: Whereas the risk for IFD is highest in children with acute myeloid leukemia, relapse of acute leukemia, and allogeneic HSCT, the individual risk for IFD needs to be better defined in the large and heterogenous group of children with acute lymphoblastic leukemia. In contrast to galactomannan, pediatric data on beta-D-glucan and PCR testing are scarce. Findings of imaging studies in children are often not typical, but may prompt invasive diagnostic procedures. No substantial differences exist between children and adult regarding antifungal chemoprophylaxis, empirical, pre-emptive and specific therapy. However, antifungal strategies in children are limited as a number of antifungal compounds are not licensed for children or their pediatric dosage is unknown.     

Aspergillus vertebral osteomyelitis after simultaneous kidney–pancreas transplantation

Abstract: Aspergillus osteomyelitis is a rare complication of invasive aspergillosis after organ transplantation. This is the report of a 46‐year‐old man who underwent a simultaneous pancreas and kidney transplantation, complicated by an Aspergillus osteomyelitis and diskitis of the lumbar spine. Prompt diagnosis with needle biopsy, followed by antifungal therapy using caspofungin, a new antifungal agent recommended for the treatment of refractory aspergillosis, in combination with amphotericin B and an early surgical intervention led to clinical resolution of the infection. Reported cases of spinal aspergillosis after transplantation are reviewed in terms of clinical presentation, risk factors, therapeutic options, and outcome.     

Allergic bronchopulmonary aspergillosis: a rare cause of pleural effusion

Aspergillus fumigatus is one of the most ubiquitous of the airborne saprophytic fungi. Allergic bronchopulmonary aspergillosis (ABPA) is a syndrome seen in patients with asthma and cystic fibrosis, and is characterized by hypersensitivity to chronic colonization of the airways with A. fumigatus. We report the case of a patient with ABPA presenting with pleural effusion. A 27-year-old male was referred with recurrent right pleural effusion. Past medical history was remarkable for asthma, allergic sinusitis, and recurrent pleurisy. Investigations revealed peripheral eosinophilia with elevated serum immunoglobulin E and bilateral pleural effusions with bilateral upper lobe proximal bronchiectasis. Precipitating serum antibodies to A. fumigatus were positive and the A. fumigatus immediate skin test yielded a positive reaction. A diagnosis of ABPA associated with bilateral pleural effusions was made and the patient was commenced on prednisolone. At review, the patient's symptoms had considerably improved and his pleural effusions had resolved. ABPA may present with diverse atypical syndromes, including paratracheal and hilar adenopathy, obstructive lung collapse, pneumothorax and bronchopleural fistula, and allergic sinusitis. Allergic bronchopulmonary aspergillosis is a rare cause of pleural effusion and must be considered in the differential diagnosis of patients presenting with a pleural effusion, in particular those with a history of asthma.     

Aspergillus endocarditis in lung transplant recipients: case report and literature review

M. Lázaro, A. Ramos, P. Ussetti, A. Asensio, R. Laporta, E. Muñez, I. Sánchez‐Romero, E. Tejerina, R. Burgos, V. Moñivas, A. Varela. Aspergillus endocarditis in lung transplant recipients: case report and literature review.
Transpl Infect Dis 2011: 13 : 186–191. All rights reserved Abstract: We present a case of endocarditis caused by Aspergillus in a lung transplant (LT) patient and review 6 previously reported cases. All cases were caused by Aspergillus fumigatus. Five patients (71%) were transplanted due to cystic fibrosis. None of the patients had any previously known valvular heart disease. The time that elapsed between LT surgery and the diagnosis of Aspergillus endocarditis was 8±6 months. Large peripheral emboli were observed in 6 patients (85%); blood cultures were negative in all. Transthoracic echocardiography did not detect the presence of vegetations in 3 patients (43%); the vegetations measured >1.5 cm in all cases. Five patients (71%) died from disseminated disease. Both survivors underwent combined therapy with antifungal drugs and surgical treatment.     

Aspergillus PCR testing: results from a prospective PCR study within the AmBiLoad trial

Objectives: Invasive fungal infection (IFI) is a major cause of morbidity and mortality in severely immunocompromised patients and is difficult to diagnose. The significance of molecular methods for diagnosis of IFI is still controversial. In a subset of patients treated within the AmBiLoad Trial, samples were investigated prospectively by a nested Aspergillus PCR assay to re‐evaluate the significance of PCR in this setting. Patients and methods: In the randomized, prospective multicenter AmBiLoad trial, patients with proven or probable IFI were randomized to receive liposomal amphotericin B (L‐AMB) 3 or 10 mg/kg QD for 14 d followed by L‐AMB 3 mg/kg QD. From 91 patients, 459 serial samples (98% blood samples) were investigated by a nested PCR assay for Aspergillus DNA. All samples were investigated in our laboratory with a previously described nested and a quantitative PCR assay. As required by the study protocol, serial Aspergillus antigen galactomannan was performed. IFI was defined according to modified EORTC/MSG 2002 criteria as applied in the AmBiLoad trial. Results: Seven and 52 patients had proven and probable IFI according to modified EORTC/MSG criteria, respectively. The median number of samples investigated per patient was 4. Seventy percent of samples were obtained during treatment with antifungal study medication. Forty‐three samples gave positive PCR results. Patients with an unfavorable outcome had a significantly higher rate of positive PCR results (48% versus 21%). Conclusions: The sensitivity of Aspergillus PCR testing is limited during antifungal therapy. The tendency for persistently positive PCR results to indicate a poor prognosis has to be confirmed in further studies.