Pleuritis caused by Acremonium strictum in a patient with colon adenocarcinoma

Area of Science:

• Medical Mycology
• Clinical Microbiology
• Infectious Diseases

Background:

• Acremonium strictum is an opportunistic mold commonly found in the environment.
• Immunocompromised individuals are susceptible to infections caused by opportunistic fungi.
• Co-infections with bacteria and fungi can complicate patient outcomes.

Observation:

• Staphylococcus aureus and Acremonium strictum were isolated from the pleural fluid of a patient diagnosed with colon adenocarcinoma.
• The patient's condition deteriorated, leading to death before antifungal therapy could be administered.
• Minimal inhibitory concentrations (MICs) were determined for A. strictum against several antifungal agents.

Findings:

• The isolated Acremonium strictum strain demonstrated varying susceptibility to antifungal drugs.
• MIC values were: Amphotericin B (0.125 µg/mL), Fluconazole (256 µg/mL), Ketoconazole (2 µg/mL), Itraconazole (1.5 µg/mL), and Voriconazole (0.25 µg/mL).
• Amphotericin B and Voriconazole showed the lowest MICs, indicating higher in vitro activity.

Implications:

• This case highlights the potential for opportunistic molds like Acremonium strictum to cause severe infections in immunocompromised patients.
• The presence of co-infecting bacteria (Staphylococcus aureus) warrants consideration in the diagnosis and management of pleuritis.
• Clinicians should consider fungal and bacterial pathogens in immunocompromised patients presenting with pleuritis, especially those with underlying conditions like cancer.