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Chest Infections |

Aspergillous terreus? A New Threat for Immunocompetent Patient? FREE TO VIEW

Hiram Maldonado, MD; Jose Nieves, MD; Ricardo Fernandez, MD
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San Juan City Hospital, San Juan, PA


Chest. 2015;148(4_MeetingAbstracts):105A. doi:10.1378/chest.2278744
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Abstract

SESSION TITLE: Chest Infections II: Student Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Aspergillous Terrus, also known as Aspergillus terrestrius, is a fungus found worldwide in soil. This saprotrophic fungus is prevalent in warm climates such as tropical and subtropical regions and is not as common as other Apergillus species causing opportunistic infection in people with deficient immune systems who lack specific immune cells. When affecting a human host, the fungus continues to grow as hyphae filaments not switching over to a different growth stage and requires a higher inoculum dose for dissemination, resulting in higher patient mortality, compared with other Aspergillus species. Lethal infections are regularly induced with 1-5 x 104 microorganisms. Aspergillus species causes infections ranging from superficial contagions to allergic bronchopulmonary aspergillosis, aspergilloma, and invasive disease in severely immunocompromised hosts but only 3% are produced by A. terrus. Mortality rates are as high as 100% due to its resistance to even the utmost antifungals which is the standard of care for the treatment of disturbing fungal infections.

CASE PRESENTATION: We present an extraordinary case of an immunocompetent patient with no past medical history who presented to the emergency department with progressive shortness of breath of three day evolution associated with cough productive yellow sputum, fever, chills, and diaphoresis. Physical examination notable for decreased breath sounds at right lung base which correlated with a right lower lobe consolidation and ground glass opacity by computed tomography of the chest. The patient was started on IV antibiotics for pneumonic process, nevertheless developed respiratory distress and severe sepsis requiring mechanical ventilation 48 hours after admission. Clinical course continued to deteriorate and an emergency bronchoscopy performed remarkable for the unusual Aspergilllus terrus species. Patient was started on voriconazole with outstanding clinical improvement.

DISCUSSION: Aspergillus terrus is an oportunistic organism known to be isolated from immunocompromised patients. No cases have been reported in patients with intact immune system, clearly demonstrating a new threat for the immunocompetent host.

CONCLUSIONS: This case unquestionably demonstrates the need for more sensitive diagnostic tests, more effective antifungal agents, and more experimental data to guide treatment in Aspergillous terrus infections.

Reference #1: Lass-Flo ̈rl C, Griff K, Mayr A, et al. Epidemiology and outcome of infections due to Aspergillus terreus: 10-year single centre experience. Br J Haematol 2005; 131:201-7.

Reference #2: Steinbach WJ, Benjamin DK Jr, Kontoyiannis DP, et al. Infections due to Aspergillus terreus: a multicenter retro- spective analysis of 83 cases. Clin Infect Dis 2004; 39:192-8.

Reference #3: Iwen PC1, Rupp ME, Langnas AN, Reed EC, Hinrichs SH. Invasive pulmonary aspergillosis due to Aspergillus terreus: 12-year experience and review of the literature. Clin Infect Dis. 1998 May;26(5):1092-7.

DISCLOSURE: The following authors have nothing to disclose: hiram maldonado, Jose Nieves, Ricardo Fernandez

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