Acremonium kiliense: reappraisal of its clinical significance

Area of Science:

• Medical Mycology
• Infectious Diseases
• Clinical Microbiology

Background:

• Peritonitis is a serious complication in patients undergoing peritoneal dialysis.
• Fungal peritonitis is less common than bacterial peritonitis but can be challenging to treat.
• Acremonium species are infrequently reported as causes of human infection.

Observation:

• A case of peritonitis caused by Acremonium kiliense in a peritoneal dialysis patient is presented.
• The diagnosis was confirmed through consistent isolation of the fungus from peritoneal dialysate.
• Fungal identification involved both traditional morphological assessment and modern sequencing of internal transcribed spacer (ITS) regions of ribosomal DNA (rDNA).

Findings:

• Morphological characteristics and ITS rDNA sequencing definitively identified the causative agent as Acremonium kiliense.
• Repeated isolation from dialysate confirmed the persistent nature of the fungal infection.
• The successful identification method provides a reliable approach for diagnosing rare fungal peritonitis.

Implications:

• This case suggests Acremonium kiliense may be an underrecognized pathogen in peritoneal dialysis-associated peritonitis.
• Enhanced diagnostic methods, including molecular techniques, are crucial for identifying unusual fungal causes of infection.
• Further research is warranted to understand the clinical significance and optimal management of Acremonium kiliense infections.