First Human Case of Pulmonary Fungal Ball Due to a Perenniporia Species (a Basidiomycete)

Abstract

e Perenniporia species are basidiomycetes, resupinate shelf fungi responsible for white rot decay of wood. Here, we report for the first time an intracavitary pulmonary fungal ball due to a species of Perenniporia that has not been recognized so far as a human pathogen. The fungus was identified by sequencing of the partial ribosomal operon of a culture from a clinical specimen. CASE REPORTA 55-year-old nonsmoking male from Assam, India, presented with complaints of intermittent right-sided nonanginal chest pain and 5 to 6 episodes of minor hemoptysis over a period of 1 month. The patient gave a history of having received antitubercular therapy 3 years before with a 6-month-long regimen containing rifampin, isoniazid, ethambutol, and pyrazinamide for sputum-smear-positive pulmonary tuberculosis, with which he had been compliant until declared cured by his physician. The patient was found to have uncontrolled diabetes mellitus as revealed by an HbA 1c level of 13%. He was previously evaluated in Assam, where a chest radiograph showed a cavity in the right upper and middle pulmonary zone. A contrast-enhanced computerized tomography (CECT) scan of his thorax revealed the presence of fibroparenchymal lesions with mild traction bronchiectasis in the right lung (sequelae of healed pulmonary tuberculosis) associated with a fungal ball in the right lower lobe (Fig. 1). The patient was treated with CT-guided percutaneous intracavitary injection of amphotericin B, though records of the dosing schedule could not be obtained. The patient was then referred to Delhi for mycological diagnosis and further management of the case. The patient underwent a fiber optic bronchoscopy (FOB) to rule out the possibility of reactivation of tuberculosis and for an investigative work-up for hemoptysis. The FOB showed no endobronchial lesion, active bleeding, or blood clots in the bronchi. A diagnostic bronchoalveolar lavage (BAL) fluid sample was taken from the apical segment of the right lower and postero-anterior basal segment of the right upper lobe.Mycological investigations. Direct microscopy of KOH wet mounts of the BAL fluid specimen revealed hyaline septate hyphae ( Fig. 2A). Cultures yielded multiple white, cottony colonies of identical molds on Sabouraud's glucose agar (SGA) plates incubated for 7 days at 28°C and 37°C. Subcultures on potato dextrose agar (PDA) incubated at 28°C and 37°C showed dense white cottony growth after 7 days (Fig. 2B), and slide cultures of the mold isolates on PDA at 28°C revealed hyaline septate hyphae with chlamydospore-like cells (Fig. 2C). No clamp connections or hyphal pegs were seen during up to 3 weeks of incubation. The isolate was assigned accession no. VPCI 85/P/10 (CBS 130020) for molecular identification and antifungal susceptibility testing. BAL fluid was also investigated microscopically after Gram and Ziehl-Neelsen (ZN) staining and cultured for aerobic pathogens and Mycobacterium spp. The Gram and ZN stains were negative, and cytology was negative for any malignant cells. No Mycobacterium...

Clinical Significance and Molecular Characterization of Nonsporulating Molds Isolated from the Respiratory Tracts of Bronchopulmonary Mycosis Patients with Special Reference to Basidiomycetes

“…Also, for induction of sporulation, all isolates were cultured on PDA and malt extract agar plates for 3 to 4 weeks at 28°C, with periodic exposure to light. They were also cultured on autoclaved decayed wooden bark pieces from Syzygium cumini (blackberry tree, jambu) to provide them with their natural environment for sporulation, as described previously (15). All of the isolates were maintained on PDA slants at room temperature and also were stored in 40% glycerol and kept at Ϫ70°C.…”

“…The patient with a fungal ball due to Perenniporia sp. received intracavitary AMB treatment (15). All of the patients with fungal balls continue to be asymptomatic despite persistence of the fungal ball.…”

Clinical Significance of Filamentous Basidiomycetes Illustrated by Isolates of the Novel Opportunist Ceriporia lacerata from the Human Respiratory Tract

“…Lately, lesser known members from this class of molds, such as Bjerkandera adusta (11), Cyclomyces tabacinus (12), Irpex lacteus (13), Inonotus (Phellinus) tropicalis (14,15), Phellinus undulatus (16), Oxyporus corticola (17), Volvariella volvacea (18), and Perenniporia spp. (4), have been incriminated as agents of human disease. In the present communication, another filamentous basidiomycete, Ceriporia lacerata, isolated from 4 human cases, is presented with a discussion on its possible clinical significance.…”

“…(anamorph, Hormographiella spp. ), and Phanerochaete chrysosporium (anamorph, Sporotrichum pruinosum), possess some morphological characteristics specific for their identification (4)(5)(6)(7)(8)(9)(10). Lately, lesser known members from this class of molds, such as Bjerkandera adusta (11), Cyclomyces tabacinus (12), Irpex lacteus (13), Inonotus (Phellinus) tropicalis (14,15), Phellinus undulatus (16), Oxyporus corticola (17), Volvariella volvacea (18), and Perenniporia spp.…”

Sporotrichum pruniosum causing a rare invasive infection in an immunocompromised patient

“…A species of Perenniporia, a basidiomycete was isolated highlighting invasive fungal infection by a hitherto lesser known basidiomycete similar to our case in patients with immune suppression. 7 We also wish to emphasize that in the initial stages fungi with dimorphic behaviour (coccidioides look alike) may cause confusion in phenotypic identification because of similar histological patterns and growth on culture media as was demonstrated in our case.…”