Aspergillus and mucormycosis presenting with normal chest X-ray in an immunocompromised host

Abstract

Invasive aspergillus and mucormycosis infection are not uncommon in immunocompromised individuals. Endobronchial fungal infections have been reported in the literature, especially in patient's with diabetes complicated by diabetic ketoacidosis, but end bronchial coinfection with aspergillus and mucormycosis without pulmonary involvement has not been described in the literature. We report the case of a woman with diabetes who presented with gastrointestinal symptoms, ketoacidosis and respiratory distress, with an apparently normal chest X-ray. Investigations revealed a cavitatory lesion in the left lower lobe of the lungs on CT scan. Bronchoscopy revealed intense mucosal oedema and whitish plaques at the lower end of the trachea and right main stem bronchus with a normal left bronchial tree. Microbiological and pathological results confirmed aspergillus and mucormycosis. Despite aggressive medical management, the patient deteriorated and died of respiratory failure. Strong suspicion of invasive fungal infections in immunocompromised patients with respiratory failure and minimal chest infiltrates, early fibreoptic bronchoscopy and early aggressive treatment is crucial for the patient's survival.

Metatranscriptomics as a tool to identify fungal species and subspecies in mixed communities

“…The major advantages of metatranscriptomics over other HTS technologies include the selective sequencing of living organisms and the ability to detect a wide range of microorganisms in one step, which has multiple applications in biological research, surveillance and diagnosis. There is an increasing literature reporting that virulence and antimicrobial tolerance traits vary within species (Firacative et al 2016; Rizzetto et al 2013; Schauwvlieghe et al 2017; Strope et al 2015) and that multiple strains or species can co-infect a host (Desnos-Ollivier et al 2010; Gupta et al 2014; Seki et al 2014; Soll et al 1988; Tati et al 2016). The high discriminatory power obtained for closely-related lineages of Cryptococcus provides a good example of where metatranscriptomics would be valuable in precision medicine, where therapy practices are defined according to strain-specific pathogenicity and drug susceptibility traits.…”

Infections causing central airway obstruction: role of bronchoscopy in diagnosis and management

“…Mucor and Rhizopus are the most commonly reported pathogens of mucormycosis. The endoscopic appearance most commonly seen are mucoid plugs, yellowish or whitish in color, endobronchial mass or polypoid lesions, white cheese like masses, plaques, and areas of necrosis (18,46,59,(74)(75)(76)(77)(78). In patients with airway cryptococcal infections, the bronchoscopic appearance has been reported as whitish or yellowish masses, mucous plugs, red or white thrush-like plaques, mucosal granularity, white granulation tissue, elevated ulcerated lesions, and polypoid masses ( Figure 2) (6,44,64,(79)(80)(81).…”

Coinfection with Lichtheimia corymbifera and Aspergillus flavus in an Immune-Competent Patient Mimicking as Pulmonary-Renal Syndrome

“…Invasive fungal infections have remained a major cause of morbidity and mortality in immunocompromised individuals, particularly those with hematological malignancies, solid organ transplant and neutropenia [1]. Polymicrobial pulmonary fungal infection is a rare entity reported mainly in severely immunodeficient patients [2][3][4][5][6][7]. Aspergillus species and mucoraceous molds have been implicated mainly as a cause of coinfection.…”

“…Aspergillus species and mucoraceous molds have been implicated mainly as a cause of coinfection. Underlying risk factors in these cases have varied from poorly controlled diabetes, chronic steroid use, leukemia, HIV and cardiac transplant [2][3][4][5][6][7]. Agents of mycosis reported in dual infections have been Aspergillus fumigatus, Aspergillus flavus, Aspergillus alliaceus, Mucor species, Lichtheimia corymbifera, mucoraceous mold (not speciated).…”

“…Agents of mycosis reported in dual infections have been Aspergillus fumigatus, Aspergillus flavus, Aspergillus alliaceus, Mucor species, Lichtheimia corymbifera, mucoraceous mold (not speciated). Patient outcome with fungal coinfection has been poor with high mortality rates [2][3][4][5][6][7].…”