Related Experiment Videos
Fatal, disseminated Acremonium strictum infection in a neutropenic host
1Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Abstract:
Disseminated Acremonium strictum infection in a neutropenic patient is reported. Positive fecal cultures preceded positive cutaneous and blood cultures by 18 and 21 days, respectively, which suggests gastrointestinal colonization and invasion as initiating events. Microscopic examination of cutaneous biopsy and pulmonary specimens revealed hyphae, phialides, and phialoconidia in vivo. These adventitious forms also can occur in infections due to other phialidic fungi such as Fusarium and Paecilomyces species and can be misdiagnosed as Candida species. Budding cells also can occur in vivo for species of Fusarium, Paecilomyces, and apparently Acremonium, further adding to the potential for misdiagnosis. The occurrence of adventitious forms in infections caused by species of Acremonium, Fusarium, Paecilomyces, Scedosporium, and Blastoschizomyces is suggested as a mechanism for dissemination of infection and as an explanation of the relatively higher frequency of positive blood cultures in these cases.
Insights
Disseminated Acremonium strictum infection in neutropenic patients may originate in the gastrointestinal tract. Microscopic identification of fungal forms can be challenging, risking misdiagnosis with other fungi like Candida.
Area of Science:
- Mycology
- Infectious Diseases
- Medical Microbiology
Background:
- Neutropenic patients are susceptible to opportunistic fungal infections.
- Acremonium strictum is a filamentous fungus that can cause invasive infections.
Observation:
- A case of disseminated Acremonium strictum infection in a neutropenic patient is presented.
- Gastrointestinal colonization preceded cutaneous and blood dissemination by several weeks.
- Microscopic examination revealed characteristic fungal structures (hyphae, phialides, phialoconidia) in biopsy and tissue specimens.
Findings:
- The study suggests gastrointestinal tract as a potential origin for Acremonium strictum dissemination.
- Adventitious fungal forms observed in vivo can resemble those of other fungi (Fusarium, Paecilomyces, Candida), increasing the risk of misdiagnosis.
- The presence of budding cells in Acremonium infections, similar to other fungi, further complicates identification.
Implications:
- Early recognition of gastrointestinal colonization may be crucial for preventing disseminated infection in neutropenic hosts.
- Awareness of potential misdiagnosis due to similar fungal morphology is essential for accurate patient management.
- Understanding the mechanisms of dissemination, including the role of adventitious fungal forms, can improve diagnostic strategies for infections caused by Acremonium and related fungi.