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Infection due to the fungus Acremonium (cephalosporium)
R M Fincher1, J F Fisher, R D Lovell
1Department of Medicine, Medical College of Georgia Hospital and Clinics, Augusta.
Abstract:
Human infections due to fungi belonging to the genus Acremonium occur uncommonly, but unlike infections due to other filamentous fungi, usually affect immunocompetent individuals. Mycetoma, which usually develops following trauma, is the most common infection caused by Acremonium spp. Other sites of infection include the eye (generally following abrogation of ocular defenses), colonizing disease of the lung and gastrointestinal tract, as well as locally invasive infections such as osteomyelitis, sinusitis, arthritis, and peritonitis. Pneumonia and disseminated infections including meningitis, endocarditis, and cerebritis rarely have been reported. Optimal treatment of acremonium infections is not well defined both because infections due to these organisms are rare, and because many reports antedate effective antifungal therapy. In addition, susceptibility testing of filamentous fungi is poorly standardized, and in vitro sensitivity may not correlate with clinical response. Based on anecdotal reports, treatment of most invasive acremonium infections requires a combination of surgical intervention, when possible, and a regimen of amphotericin B. Some azoles also display inhibitory activity. Until more details are available regarding susceptibility of these organisms to antifungal agents, amphotericin B is recommended as initial therapy with the addition of either ketoconazole or fluconazole in infections of a life-threatening nature.
Insights
Acremonium fungal infections, though rare, typically affect healthy individuals, with mycetoma being the most common. Treatment often requires surgery and amphotericin B, especially for invasive cases.
Area of Science:
- Medical Mycology
- Infectious Diseases
Background:
- Human infections caused by Acremonium fungi are uncommon.
- Unlike other filamentous fungi, Acremonium infections typically affect immunocompetent individuals.
Observation:
- Mycetoma, often post-trauma, is the most frequent Acremonium infection.
- Infections can also affect the eye, lungs, gastrointestinal tract, and lead to invasive conditions like osteomyelitis and sinusitis.
- Rarely, pneumonia and disseminated infections such as meningitis and endocarditis are reported.
Findings:
- Optimal treatment for Acremonium infections remains undefined due to rarity and limited data on effective antifungal therapies.
- Susceptibility testing for filamentous fungi is not standardized, and in vitro results may not predict clinical outcomes.
- Anecdotal evidence suggests combining surgical intervention with amphotericin B is crucial for invasive Acremonium infections.
Implications:
- Amphotericin B is recommended as initial therapy for invasive Acremonium infections.
- Ketoconazole or fluconazole may be added for life-threatening infections.
- Further research is needed to establish standardized susceptibility testing and optimal treatment regimens for Acremonium infections.