Invasive Aspergillosis Caused by Aspergillus ustus : Case Report and Review

Abstract

A case of invasive pulmonary aspergillosis in an allogeneic bone marrow transplant recipient caused by Aspergillus ustus is presented. A. ustus was also recovered from the hospital environment, which may indicate that the infection was nosocomially acquired. A literature review revealed seven cases of invasive infections caused by A. ustus, and three of these were primarily cutaneous infections. In vitro susceptibility testing of 12A. ustus isolates showed that amphotericin B and terbinafine had fungicidal activity and that itraconazole and voriconazole had fungistatic activity.

Emerging moulds: epidemiological trends and antifungal resistance

“…Aspergillus ustus is an uncommon pathogen that has been recently recognised as an emerging cause of primary cutaneous infection, endophthalmitis and disseminated aspergillosis in immunocompromised and surgical patients. [21][22][23][24][25][26][27][28][29][30] Clustering of A. ustus endophthalmitis has been reported in four patients following cataract surgery. 31 Interestingly, environmental surveillance failed to find the potential source.…”

“…20,122 Similarly, A. ustus is an uncommon clinical species that may have a decreased susceptibility to AMB, VOR and itraconazole (ITR). 24,25,32 In addition, cases of breakthrough invasive aspergillosis due to A. ustus have been reported in HSCT recipients receiving secondary antifungal prophylaxis with VOR and echinocandins. 2,23,25,28,123 The newly described species A. calidoustus have reportedly shown high MICs to ITR, VOR and POS.…”

Emerging Bacterial, Fungal, and Viral Respiratory Infections in Transplantation

“…Among cases reviewing these pathogens in transplant recipients, infection involved the lungs in all but one case noted with A ustus. 51,[53][54][55][56][57][58][59][60][61][62][63] More than half disseminated and a third involved the central nervous system or skin. 62 A terreus is emerging as the next most common invasive pulmonary aspergillosis after A fumigatus and A flavus.…”

“…44 PCR analysis has advantages for rapid diagnosis because definitive speciation by culture takes weeks. 43,51,56,58,60,63 Early antifungal therapy is routinely initiated once a fungal pathogen is suspected or presumptively identified. However, this strategy is tempered by highly variable susceptibilities of A terreus and A ustus.…”

New clinical presentations of invasive aspergillosis in non-conventional hosts

“…ustus is a rarely described Aspergillus species. However, a number of recent reports have documented human infection with this fungus [63][64][65][66][67][68][69][70]. On malt extract agar, A. ustus colonies are dense, cottony, brownish grey, white at the periphery, with a yellow diffusing pigment.…”