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An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
Published on: July 1, 2020
Clinical experience in invasive fungal infections
Patrícia Pacheco1, Ana Sofia Ventura, Teresa Branco
1Infectious Diseases Department, Hospital Prof. Dr. Fernando Fonseca, Amadora-Sintra, Portugal. patriciacorreiapacheco@gmail.com
Abstract:
Lung infections caused by invasive filamentous fungi are very rare conditions in AIDS, but must be considered in patients with profound immune suppression especially in the presence of additional risk factors, such as hematologic malignancies, corticosteroid therapy, neutropenia, and chemotherapy. The authors report a case of dual lung infection caused by Aspergillus and Mucor, which occurred in a 34-year-old AIDS patient who was treated with chemotherapy for oral plasmablastic lymphoma. The case presented clinically with low grade fever and pulmonary cavitation, which suggested tuberculosis. After extensive investigation the diagnosis of mucormycosis was established and the patient was treated sequentially with liposomal amphotericin B and posaconazole. Despite a reduction in the size of the pulmonary cavitation, improvement of the lung interstitial infiltrates and clinical recovery, the patient was submitted to cardiothoracic surgery given the aggressive behavior of this invasive fungus. Histology of the surgical specimen showed numerous hyphae with a morphologic pattern compatible with Aspergillus as well as hyphae that were suggestive of Mucor.
Insights
Dual fungal lung infections by Aspergillus and Mucor are rare in AIDS patients. This case highlights the need for considering invasive fungi in immunocompromised individuals with risk factors.
Area of Science:
- Mycology
- Infectious Diseases
- Pulmonology
Background:
- Invasive filamentous fungal infections are uncommon in individuals with acquired immunodeficiency syndrome (AIDS).
- Risk factors for these infections include profound immune suppression, hematologic malignancies, corticosteroid use, neutropenia, and chemotherapy.
- Prompt diagnosis and treatment are crucial for managing these rare but severe conditions.
Observation:
- A 34-year-old AIDS patient undergoing chemotherapy for oral plasmablastic lymphoma presented with low-grade fever and pulmonary cavitation.
- Clinical presentation initially suggested tuberculosis, necessitating extensive diagnostic investigations.
- The patient exhibited aggressive invasive fungal behavior in the lungs.
Findings:
- A dual lung infection caused by Aspergillus and Mucor was diagnosed.
- Treatment involved sequential administration of liposomal amphotericin B and posaconazole.
- Histological examination of surgical specimens confirmed the presence of both Aspergillus and Mucor hyphae.
Implications:
- This case underscores the importance of considering invasive filamentous fungal infections in immunocompromised patients, particularly those with AIDS and additional risk factors.
- Aggressive fungal infections require a high index of suspicion and comprehensive diagnostic workup.
- Multidisciplinary management, including antifungal therapy and potentially surgery, may be necessary for successful outcomes.
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