Renal Aspergillosis in a Patient with Acquired Immunodeficiency Syndrome

Flores-Lovon, Kevin; Lozano, Noris; Cuba, Nicolas; Gutiérrez, Ericson L.

doi:10.4103/uros.uros_17_20

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…Although the use of voriconazole, posaconazole, itraconazole, and echinocandins has been described by literature as low urinary concentration, the patient was treated satisfactorily with voriconazole. Nephrectomies should be performed only as the last option [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Urinary Aspergillosis in a Patient with Systemic Lupus Erythematosus (SLE)

Toledo

Alves

Cambruzzi³

et al. 2023

Case Reports in Infectious Diseases

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Aspergillosis is an opportunistic mycosis that generally affects the lungs. The fungus was cleared by the immune system of a healthy host. Extrapulmonary forms are very rare, and there are few reports of urinary aspergillosis. In this case report, we describe a 62-year-old woman with systemic lupus erythematosus (SLE) with complaints of fever and dysuria. The patient had recurrent episodes of urinary tract infection and several hospitalizations. A computed tomography revealed an amorphous mass in the left kidney and bladder. After partial resection of the material was referred for analysis, Aspergillus infection was suspected and confirmed by culture. Successful treatment with voriconazole was provided. Diagnosis of localized primary renal Aspergillus infection in a patient with SLE requires careful investigation due to its benign presentation and lack of associated systemic clinical features.

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Section: Discussionmentioning

confidence: 99%

Urinary Aspergillosis in a Patient with Systemic Lupus Erythematosus (SLE)

Toledo

Alves

Cambruzzi³

et al. 2023

Case Reports in Infectious Diseases

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Isolated renal and urinary tract aspergillosis: a systematic review

Bongomin,

Morgan,

Ekeng

et al. 2023

Therapeutic Advances in Urology

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Background: Aspergillosis localized to the kidneys and the urinary tract is uncommon. We conducted a comprehensive systematic review to evaluate risk factors and clinical outcomes of patients with isolated renal and genito-urinary tract aspergillosis. Methods: We systematically searched Medline, CINAHL, Embase, African Journal Online, Google Scholar, and the Cochrane Library, covering the period from inception to August 2023 using the key terms ‘renal’ OR ‘kidney*’ OR ‘prostate’ OR ‘urinary bladder’ OR ‘urinary tract*AND ‘aspergillosis’ OR ‘aspergillus’ OR ‘aspergilloma’ OR ‘mycetoma’. We included single case reports or case series. Review articles, guidelines, meta-analyses, animal studies, protocols, and cases of genitourinary and /or renal aspergillosis occurring as a part of disseminated disease were excluded. Results: We identified 91 renal and urinary aspergillosis cases extracted from 76 publications spanning 1925–2023. Among the participants, 79 (86.8%) were male, with a median age of 46 years. Predominantly, presentations consisted of isolated renal infections (74 instances, 81.3%), followed by prostate (5 cases, 5.5%), and bladder (7 cases, 7.7%) involvement. Aspergillus fumigatus (42.9%), Aspergillus flavus (9.9%), and Aspergillus niger/glaucus (1.1% each) were isolated. Underlying risk factors included diabetes mellitus (29.7%), HIV (12.1%), haematological malignancies (11%), and liver cirrhosis (8.8%), while common symptoms encompassed flank pain (36.3%), fever (33%), and lower urinary tract symptoms (20.9%). An autopsy was conducted in 8.8% of cases. Diagnostic work-up involved histopathology (70.5%), renal CT scans and urine microscopy and culture (52.6% each), and abdominal ultrasound (17.9%). Treatments included amphotericin B (34 cases, 37.4%) and azole-based regimens (29 cases, 31.9%). Nephrectomy was performed in 16 of 78 renal cases (20.5%). All-cause mortality was 24.4% (19 cases). No significant mortality rate difference was observed among antifungal regimens ( p = 0.739) or nephrectomy status ( p = 0.8). Conclusion: Renal and urinary aspergillosis is an important cause of morbidity and mortality, particularly in immunocompromised and people with diabetes mellitus. While varied treatment strategies were observed, mortality rates showed no significant differences based on treatments or nephrectomy status. Further research is needed to refine diagnostics, optimize treatments, and enhance awareness among clinicians for early detection and management. PROSPERO registration number: CRD42023430959.

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Urinary Tract Aspergillosis in a Child with Pelviureteric Junction Obstruction

Raj,

Saha,

Singh

et al. 2024

Archives of Medicine and Health Sciences

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Aspergillus spp. are fungi which are mostly nonpathogenic, but some species such as Aspergillus fumigatus, Aspergillus flavus, and Aspergillus niger can cause aspergillosis in humans. Aspergillosis can manifest as pulmonary or extrapulmonary infections, with respiratory involvement being common but infections in other body parts being rare. Urinary aspergillosis, an uncommon manifestation of Aspergillus infection, presents unique challenges in diagnosis and management due to its rarity and varied clinical presentations. It is seen in immunocompromised individuals, patients with underlying structural urinary tract abnormalities, or those undergoing invasive procedures. Here, we present a case of an 8-month-old child who presented with intermittent fever and increased urination since birth. The child underwent bilateral open pyeloplasty with double-J (DJ) stenting. A month later, the child returned with anuria, fever, and abdominal mass, leading to infected DJ stent removal and bilateral percutaneous nephrostomy. Despite antibiotic treatment, fever persisted. A fungal culture was done which showed growth of A. flavus. Liposomal amphotericin B was started for the patient after which he became afebrile, and all the fungal cultures done, thereafter, were negative. Urinary tract aspergillosis is rare, particularly among individuals with a strong immune system. Persistence of urinary tract symptoms despite antibiotic and medical therapy may raise the possibility of fungal infection such as urinary tract aspergillosis.

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Renal Aspergillosis in a Patient with Acquired Immunodeficiency Syndrome

Cited by 3 publications

References 15 publications

Urinary Aspergillosis in a Patient with Systemic Lupus Erythematosus (SLE)

Urinary Aspergillosis in a Patient with Systemic Lupus Erythematosus (SLE)

Isolated renal and urinary tract aspergillosis: a systematic review

Urinary Tract Aspergillosis in a Child with Pelviureteric Junction Obstruction

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