Disseminated adiaspiromycosis in a patient with AIDS

Abstract

A case of disseminated adiaspiromycosis in an AIDS patient is described. The most notable characteristic of the infection was the extensive osteomyelitis exhibited by the patient. Positive cultures for Chrysosporium parvum var. parvum were obtained from pus taken from a lesion of the wrist during surgery as well as from sputum samples and a bone marrow aspirate. Treatment with amphotericin B controlled the fungal infection.Adiaspiromycosis is a rare fungal infection, usually confined to the lungs. The aetiological agents are Chrysosporiumparvum (Emmonsia crescens) var. cescens or var.parvum, which are characterized by their incapacity to multiply in host tissues; instead, the conidia increase in size and form large round bodies called adiaconidia [1-3, 6, 12]. Most of the cases published in the literature indicate that the pathological lesions occur more frequently in the lungs [1,4,5,8,13,14,18, 19]. Reports dealing with extrapulmonary lesions or disseminated lung disease are rare [7,[9][10][11][15][16][17]. We present a case of disseminated adiaspiromycosis with bone involvement in an HIV-positive patient. CASE REPORTA white 32-year-old homosexual male, who was receiving intermittent therapy with azidothymidine (AZT), oral nystatin and acyclovir, presented at the Hospital Pablo Tobon Uribe with pain and functional impotence of the right wrist, accompanied by slight tumefaction of the third distal portion of the radius. An X-ray of this lesion revealed an osteolytic area and slight elevation of the periostic prominence. Medical treatment included immobilization of the wrist for a month; the problem persisted, however, and a repeat X-ray revealed a defined area ofosteolysis and significant periostal eIevation (Fig. 1). At this time, the patient showed signs of severe clinical deterioration and with a presumptive diagnosis of osteomyelitis underwent surgical investigation. Direct examination of the pus obtained during surgery in KOH, as well as of a Gram stained smear, revealed the presence of peculiar oval to elongated, empty-looking cells with thick walls (Fig. 2), which were later recognized as adiaconidia. Cultures at room temperature (20_+ 4°C) produced abundant colonies of a white-tan mould while growth at 40°C in blood agar was pasty (Fig. 3). Microscopic examination of the former colonies revealed delicate septate hyphae with numerous oval and sesile conidia. At 40°C adiaconidia were formed; they appeared round, had thick walls and were large 00-25/~m) (Fig. 4). On the Correspondence address: Dr A. Restrepo, Corporacion para lnvestigaciones Biologicas (CIB), Apartado Aereo ~73-78, Medellin, Colombia. 91 Med Mycol Downloaded from informahealthcare.com by UB Wuerzburg on 11/01/14 For personal use only.

Unusual Fungal and Pseudofungal Infections of Humans

“…Fungal replication in the lungs does not occur; however, other organs may be involved (rarely), including the skin (42), peritoneum (23), and bone (24). Extrapulmonary dissemination causing extensive osteomyelitis and bone marrow involvement was found in a patient with AIDS (24).…”

“…Human adiaspiromycosis is uncommon (27), but it has been reported from South and Central America, Israel, Europe, and the United States (24,27,66,95,102). Both pulmonary and disseminated adiaspiromycosis have been found in patients with AIDS (24,95).…”

“…Both pulmonary and disseminated adiaspiromycosis have been found in patients with AIDS (24,95). Rodents may serve as a zoonotic reservoir for the disease, although the fungus causing disease in rodents, Emmonsia parva (formerly Chrysosporium parvum var.…”

“…Patients with the disseminated granulomatous form of pulmonary adiaspiromycosis may experience fever, cough, and progressive dyspnea due to compression and displacement of distal airways and alveolar parenchyma by the expanding granulomas (27,95). Fungal replication in the lungs does not occur; however, other organs may be involved (rarely), including the skin (42), peritoneum (23), and bone (24). Extrapulmonary dissemination causing extensive osteomyelitis and bone marrow involvement was found in a patient with AIDS (24).…”

“…Rodents may serve as a zoonotic reservoir for the disease, although the fungus causing disease in rodents, Emmonsia parva (formerly Chrysosporium parvum var. parvum), rarely infects humans (24,26,72,86). E. crescens is found in nature predominantly in temperate zones, and the likely mode of human infection is accidental inhalation of fungal conidia aerosolized from contaminated soil.…”