Involvement of the opportunistic pathogen Aspergillus tubingensis in osteomyelitis of the maxillary bone: a case report

BMC Infectious Diseases

Pieter-Jan Haas⁴  Hans de Cock¹  Martin Meijer²  Shahrzad Sepehrkhouy³  Natalia Escobar Salazar¹  Erik Bathoorn¹ 

[1] Institute of Biomembranes, Faculty of Science, Utrecht University, Utrecht, The Netherlands;Applied and Industrial Mycology/Identification Service, CBS-KNAW Fungal Biodiversity Centre, Utrecht, the Netherlands;Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands;Department of Medical Microbiology, University Medical Center Utrecht, Postbox 85500, Utrecht, The Netherlands

关键词: Species identification;    Invasive mould infection;    Aspergillus section nigri;    Aspergillus tubingensis;   

Others  :  1158453
DOI  :  10.1186/1471-2334-13-59

 received in 2012-04-16, accepted in 2013-01-28,  发布年份 2013

【 摘 要 】

Background

Aspergillus tubingensis is a black Aspergillus belonging to the Aspergillus section Nigri, which includes species that morphologically resemble Aspergillus niger. Recent developments in species determination have resulted in clinical isolates presumed to be Aspergillus niger being reclassified as Aspergillus tubingensis by sequencing. We present a report of a patient with an osteomyelitis of the maxillary bone with a probable invasive Aspergillus tubingensis infection.

Case presentation

We describe an immune compromised patient suffering from osteomyelitis of the maxillary bone after tooth extraction. The osteomyelitis probably resulted in dentogenic pansinusitis presenting as an acute ethmoiditis. Histologic examination of biopsy samples showed osteomyelitis, and inflammation of the surrounding connective tissue. Cultures of the alveolar wound grew Aspergillus tubingensis. The patient was treated with liposomal amphoterocin B, which was changed to oral treatment with voriconazole based on susceptibility testing (MIC for voriconazole was 1 μg/ml).

Conclusion

This case shows that Aspergillus tubingensis may have the potential to cause severe invasive infections in immunocompromised hosts. A larger proportion of Aspergillus tubingensis isolates are less susceptible to azoles compared to Aspergillus niger. Therefore, correct species identification and susceptibility testing is crucial for the choice of anti-fungal treatment, screening of azole resistance, and characterization of the pathogenic potential of the various species within Aspergillus section Nigri.

【 授权许可】

   
2013 Bathoorn et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Mosseray R: Les aspergillus de la section “Niger” Thom et Church. La Cellule Journal 1934, 43:203-285.
• [2]Perrone G, Varga J, Susca A, Frisvad JC, Stea G, Kocsube S, et al.: Aspergillus uvarum sp. nov., an uniseriate black Aspergillus species isolated from grapes in Europe. Int J Syst Evol Microbiol 2008, 58:1032-1039.
• [3]Samson RA, Noonim P, Meijer M, Houbraken J, Frisvad JC, Varga J: Diagnostic tools to identify black aspergilli. Stud Mycol 2007, 59:129-145.
• [4]Perrone G, Stea G, Epifani F, Varga J, Frisvad JC, Samson RA: Aspergillus niger contains the cryptic phylogenetic species A. awamori. Fungal Biol 2011, 115:1138-1150.
• [5]Samson RA, Varga J: What is a species in Aspergillus? Med Mycol 2009, 47(Suppl 1):S13-S20.
• [6]Meijer M, Houbraken JA, Dalhuijsen S, Samson RA, de Vries RP: Growth and hydrolase profiles can be used as characteristics to distinguish Aspergillus niger and other black aspergilli. Stud Mycol 2011, 69:19-30.
• [7]Subcommittee on Antifungal Susceptibility Testing of the ESCMID European Committee for Antimicrobial Susceptibility Testing: EUCAST Technical Note on the method for the determination of broth dilution minimum inhibitory concentrations of antifungal agents for conidia-forming moulds. Clin Microbiol Infect 2008, 14:982-984.
• [8]Munguia R, Daniel SJ: Ototopical antifungals and otomycosis: a review. Int J Pediatr Otorhinolaryngol 2008, 72:453-459.
• [9]Winslow CP, Dichard A, McGuire KA: Osteomyelitis of the temporomandibular joint. Am J Otolaryngol 2001, 22:142-145.
• [10]Abrahams JJ, Berger SB: Oral-maxillary sinus fistula (oroantral fistula): clinical features and findings on multiplanar CT. AJR Am J Roentgenol 1995, 165:1273-1276.
• [11]Szigeti G, Sedaghati E, Mahmoudabadi AZ, Naseri A, Kocsube S, Vagvolgyi C, et al.: Species assignment and antifungal susceptibilities of black aspergilli recovered from otomycosis cases in Iran. Mycoses 2012, 55:333-338.
• [12]Arabatzis M, Kambouris M, Kyprianou M, Chrysaki A, Foustoukou M, Kanellopoulou M, et al.: Polyphasic identification and susceptibility to seven antifungals of 102 Aspergillus isolates recovered from immunocompromised hosts in Greece. Antimicrob Agents Chemother 2011, 55:3025-3030.
• [13]Szigeti G, Kocsube S, Doczi I, Bereczki L, Vagvolgyi C, Varga J: Molecular identification and antifungal susceptibilities of black Aspergillus isolates from otomycosis cases in Hungary. Mycopathologia 2012, 174(2):143-147.
• [14]Hendrickx M, Beguin H, Detandt M: Genetic re-identification and antifungal susceptibility testing of Aspergillus section Nigri strains of the BCCM/IHEM collection. Mycoses 2012, 55:148-155.
• [15]Balajee SA, Kano R, Baddley JW, Moser SA, Marr KA, Alexander BD, et al.: Molecular identification of Aspergillus species collected for the transplant-associated infection surveillance network. J Clin Microbiol 2009, 47:3138-3141.
• [16]Alcazar-Fuoli L, Mellado E, Alastruey-Izquierdo A, Cuenca-Estrella M, Rodriguez-Tudela JL: Species identification and antifungal susceptibility patterns of species belonging to Aspergillus section Nigri. Antimicrob Agents Chemother 2009, 53:4514-4517.
• [17]Howard SJ, Harrison E, Bowyer P, Varga J, Denning DW: Cryptic species and azole resistance in the Aspergillus niger complex. Antimicrob Agents Chemother 2011, 55:4802-4809.
• [18]Meletiadis J, Mavridou E, Melchers WJ, Mouton JW, Verweij PE: Epidemiological cutoff values for azoles and Aspergillus fumigatus based on a novel mathematical approach incorporating cyp51A sequence analysis. Antimicrob Agents Chemother 2012, 56(5):2524-2529.