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Cerebral Paecilomyces javanicus infection. An ultrastructural study
Abstract:
A 41-year-old diabetic woman developed Paecilomyces javanicus endocarditis and subsequent cerebral fungal embolism and vasculitis with massive infarction and hemorrhage 6 years after a mitral valve replacement with porcine heterograft. The organism was identified by the culture from the infected brain tissue and aortic valve. Cerebral infection due to fungus Paecilomyces is rare. This report documents the cerebral manifestations of fungus Paecilomyces javanicus and describes for the first time the ultrastructure of such an organism obtained from the infected tissue. Their ultrastructural findings, similar to those described in Paecilomyces farinosus derived from culture, include a double-layered cell wall, a triple unit plasma membrane, abundant cytoplasmic lipid droplets, vacuoles, membranous profiles and septal formation. This report further demonstrates hyphae with packed 50A filaments and granulofibrillary material and features suggestive of intrahyphal hyphae, not previously described in fungus Paecilomyces.
Insights
A rare case of Paecilomyces javanicus endocarditis in a diabetic patient led to cerebral fungal embolism. This study details the rare cerebral manifestations and provides the first ultrastructural analysis of the fungus in infected tissue.
Area of Science:
- Medical Mycology
- Neurology
- Cardiology
Background:
- Endocarditis following prosthetic valve replacement poses significant risks.
- Cerebral complications of fungal infections are uncommon, particularly with non-Aspergillus species.
- Diabetes mellitus is a known risk factor for invasive fungal infections.
Observation:
- A 41-year-old diabetic woman presented with endocarditis caused by Paecilomyces javanicus six years after mitral valve replacement.
- The patient developed a cerebral fungal embolism, vasculitis, infarction, and hemorrhage.
- Paecilomyces javanicus was identified from brain tissue and aortic valve cultures.
Findings:
- This report documents the rare cerebral manifestations of Paecilomyces javanicus infection.
- The study provides the first ultrastructural description of Paecilomyces javanicus from infected human tissue.
- Ultrastructural analysis revealed characteristic fungal cell wall and membrane structures, along with novel findings in hyphal morphology.
Implications:
- This case highlights the potential for rare fungal pathogens to cause severe neurological complications in immunocompromised or device-bearing patients.
- Understanding the ultrastructure of Paecilomyces javanicus may aid in diagnosis and treatment strategies for invasive fungal infections.
- Further research into fungal embolism and vasculitis is warranted.