Pulmonary Adiaspiromycosis in Man Caused by<i>Emmonsia crescens</i>: Report of a Unique Case

Kodousek, R; Vortel, V; Fingerland, A; Vojtek, V; Serý, Z; Hájek, Václav; Kucera, K

doi:10.1093/ajcp/56.3.394

Cited by 28 publications

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“…However, it is uncertain if antifungal treatment accelerated recovery or if this was merely the natural history of the infection. Patients appeared to benefit from corticosteroids in three previous cases (cases 4 and 21 from Table 1 and a case described in reference 29), and in the case described herein as well; this intervention seems reasonable in the immunocompetent patient because the major pathogenic effect of the fungus is due to the host granulomatous response. In severe pulmonary adiaspiromycosis in the immunocompetent host, it is reasonable to give both antifungal treatment to destroy the organism that provokes the inflammation and corticosteroid treatment to modulate that response.…”

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confidence: 52%

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Adiaspiromycosis Causing Respiratory Failure and a Review of Human Infections Due to Emmonsia and Chrysosporium spp

2012

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bWe report a case of a 27-year-old male who presented with respiratory distress that required mechanical ventilation. Transbronchial biopsy revealed adiaspores of the fungus Emmonsia crescens within granulomata, a condition known as adiaspiromycosis. The patient received amphotericin products and corticosteroids, followed by itraconazole, and made a full recovery. Emmonsia crescens is a saprobe with a wide distribution that is primarily a rodent pathogen. The clinical characteristics of the 20 cases of human pulmonary adiaspiromycosis reported since the last comprehensive case review in 1993 are described here, as well as other infections recently reported for the genus Emmonsia. Pulmonary adiaspiromycosis has been reported primarily in persons without underlying host factors and has a mild to severe course. It remains uncertain if the optimal management of severe pulmonary adiaspiromycosis is supportive or if should consist of antifungal treatment, corticosteroids, or a combination of the latter two. The classification of fungi currently in the genus Emmonsia has undergone considerable revision since their original description, including being grouped with the genus Chrysosporium at one time. Molecular genetics has clearly differentiated the genus Emmonsia from the Chrysosporium species. Nevertheless, there has been a persistent confusion in the literature regarding the clinical presentation of infection with fungi of these two genera; to clarify this matter, the reported cases of invasive Chrysosporium infections were reviewed. Invasive Chrysosporium infections typically occur in impaired hosts and can have a fatal course. Based on limited in vitro susceptibility data for Chrysosporium zonatum, amphotericin B is the most active drug, itraconazole susceptibility is strain-dependent, and fluconazole and 5-fluorocytosine are not active.A diaspiromycosis is primarily a pulmonary infection of rodents, fossorial mammals, and their predators and is caused by the soil fungi Emmonsia crescens and Emmonsia parva (17,30,35,53). It is a rare human infection. In this infection, inhaled Emmonsia conidia enlarge to form nonreplicating adiaspores. As in other mammals, the infection in humans usually involves the lungs, with only a few other cases of infection at other sites (17,30,35,53). About 70 cases of human adiaspiromycosis have been described, but much of the literature on this infection has been dispersed in less-accessible, non-English journals. Furthermore, the inconsistent nomenclature and taxonomy of Emmonsia species and their confusion with Chrysosporium species has resulted in an overall lack of consistent information on adiaspiromycosis and Chrysosporium infections. Herein, we report a case of adiaspiromycosis that resulted in respiratory failure. We also review the true cases of adiaspiromycosis that have been reported since the seminal monographs of England and Hochholzer in 1993 (21) and Sigler in 2005 (53) or omitted from those reports. Furthermore, we differentiate the cases of adiaspiromycosis from the tr...

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confidence: 52%

“…The first human case of Emmonsia, presenting as a solitary pulmonary nodule, was reported in 1964 (14). Disseminated human pulmonary disease was first observed in 1971 (29). Approximately 67 probable cases of human pulmonary adiaspiromycosis due to E. crescens have been described in the literature.…”

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confidence: 99%

Adiaspiromycosis Causing Respiratory Failure and a Review of Human Infections Due to Emmonsia and Chrysosporium spp

2012

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“…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].…”

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Disseminated adiaspiromycosis in a patient with AIDS

1993

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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.

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“…It is a common fungal infection of lower order mammals, most usually wild rodents, with wide geographical distribution. This disease is caused by a geophilic fungus, Emmonsia parva var crescens 14 18 , whose dustb o r n e m y c e l i a l p h a s e ( c o n i d i a ) m a y b e accidentally inhaled and produce a perifocal granulomatous inflammatory reaction in the lungs 14 . In immunocompetent patients, fungus dissemination to extra pulmonary sites has not been reported 8 10 11 17 19 .…”

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Pulmonary adiaspiromycosis: report of two cases

Santos

Fatureto

Saldanha

et al. 2000

Rev. Soc. Bras. Med. Trop.

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Two cases of human pulmonary adiaspiromycosis are reported. Patients were 29 and 54-year-old males, farm workers, with "grippe-like" symptoms and radiographic findings suggestive of granulomatous interstitial disease. Transthoracoscopic and transbronchial biopsies were performed. Pulmonary function was measured by spirometry. One patient used ketoconazole. Possibility of misdiagnosed pulmonary adiaspiromycosis is emphasized. Key-words: Pulmonary mycosis. Adiaspiromycosis. Emmonsia parva var crescens. Chrysosporium parvum var crescens. Pulmonary biopsy. Spirometry.Resumo Relatam-se casos de adiaspiromicose pulmonar em homens brancos de 29 e 54 anos, lavradores, com sintomas "gripais" e achados radiológicos sugestivos de doença granulomatosa intersticial. Biópsias transbrônquicas e transtoracoscópicas foram realizadas. A função pulmonar foi avaliada por espirometria. Um paciente usou cetoconazol. Enfatizam-se possibilidades de confusão diagnóstica na adiaspiromicose pulmonar.

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Pulmonary Adiaspiromycosis in Man Caused byEmmonsia crescens: Report of a Unique Case

Cited by 28 publications

References 0 publications

Adiaspiromycosis Causing Respiratory Failure and a Review of Human Infections Due to Emmonsia and Chrysosporium spp

Adiaspiromycosis Causing Respiratory Failure and a Review of Human Infections Due to Emmonsia and Chrysosporium spp

Disseminated adiaspiromycosis in a patient with AIDS

Pulmonary adiaspiromycosis: report of two cases

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