Bilateral Pulmonary Aspergilloma Caused by an Atypical Isolate of Aspergillus terreus

Abstract

A case of bilateral pulmonary aspergilloma caused by an atypical isolate of Aspergillus terreus is described. The diagnosis was established by the presence of septate, dichotomously branched fungal elements in freshly collected bronchoalveolar lavage and sputum specimens and by repeated isolation of the fungus in culture. Specific precipitating antibodies against the A. terreus isolate were demonstrated in the patient's serum. The isolate was atypical as it failed to produce fruiting structures on routine mycological media, but it did so on extended incubation on potato flake agar and produced globose, relatively heavy-walled, hyaline accessory conidia (formerly termed aleurioconidia) on both vegetative and aerial mycelia. Also, it produced an intense yellow diffusing pigment in the medium. The report underscores the increasing importance of A. terreus in the etiology of pulmonary aspergillosis. It is suggested that A. terreus antigen be included in the battery of serodiagnostic reagents to facilitate the early diagnosis of infections caused by this species.

Invasive pulmonary aspergillosis due to Aspergillus terreus: value of DNA, galactomannan and (1→3)-β-d-glucan detection in serum samples as an adjunct to diagnosis

“…Aspergilli are ubiquitous in the environment and nosocomial outbreaks of invasive aspergillosis have often occurred in association with construction activities in and around haematological wards (Vonberg & Gastmeier, 2006). In Kuwait, A. terreus has been reported to be 6.2 % of the total aspergilli in outdoor air and ,2 % in indoor air (Khan et al, 1999a), and it has also been implicated in two cases of pulmonary aspergillosis (Khan et al, 1999b(Khan et al, , 2000. The relative aerial prevalence of A. terreus in comparison to other Aspergillus species is rather low in most of the surveys (Curtis et al, 2005;Guinea et al, 2006).…”

Secondary sternal Aspergillus osteomyelitis in a diabetic hemodialysis patient with previous allograft rejection

“…In a large series, A. terreus is the cause of 7% of worldwide invasive aspergillosis, although it is much more common in cancer patients 6 . Documented sources of origin include hospital water and arable soil 6,7 . In our patient, the identification to the species level was critical for treatment decisions.…”

“…6 Documented sources of origin include hospital water and arable soil. 6,7 In our patient, the identification to the species level was critical for treatment decisions. Identification can sometimes be slow, as there are no rapid tests and the antigen tests do not distinguish species.…”

Aspergilloma in a pre-existing unoperated pulmonary echinococcosis

“…In the majority of cases, the lesion remains stable, but in 10% of cases the aspergilloma may decrease in size or resolve spontaneously without treatment. 5,6 Semi-invasive aspergillosis and chronic necrotizing aspergillosis occur in patients with mildly depressed immune system. In this case, the fungus develops its own cavity and then grows in it in a non-invasive form.…”

“…This explains the reason for the sputum and broncho-alveolar lavage fluid being negative for fungal elements in our case. 6 Radiologically an unruptured hydatid cyst is usually welldefined and round. More peripheral cysts conform to pressure from adjacent structures, and cysts in the interlobar fissures resemble loculated effusions.…”