Skip directly to page options Skip directly to A-Z link
Volume 12, Number 3—March 2006
Research

Aspergillus ustus Infections among Transplant Recipients

Anil A. Panackal*†, Alexander Imhof*‡, Edward W. Hanley*, and Kieren A. Marr*†Comments to Author 
Author affiliations: *Fred Hutchinson Cancer Research Center; Seattle, Washington, USA; †University of Washington Medical Center, Seattle, Washington, USA; ‡University Hospital, Zürich, Zürich, Switzerland

Main Article

Table A1

Aspergillus ustus infections reported during the last 10 years*

Pt./ref. Age (y) Sex Underlying condition Diagnosis/site Coinfection Clinical indications Immuno-suppression Management Outcome
(4) 41 M Aortic valve replacement Femoral artery thrombus, endocarditis None Endocarditis with emboli N/A Ampho B and flucytosine, surgery Cure, survived
(5) 57 M Skin burns Skin† Bacterial pneumonia Sharp, demarcated white areas over dorsal hands and arms Prednisone emulsion Ampho B cream Failure, died
(6) 50 M Rheumatic heart disease, prosthetic valve replacement Femoral artery thrombus; endocarditis None Endocarditis with emboli N/A Ampho B and flucytosine, surgery Cure, died
(7) 72 M Cardiovascular disease Lung‡ Bacterial pneumonia Multilobar pneumonia, thyroid, lung, kidney, peritoneum abscesses N/A None Failure, died§
(8) 62 M Cirrhosis, orthotopic liver transplant Skin*‡ None Multiple crusted nodules, plaques Cyclosporin and tacrolimus for rejection Ampho B and terbinafine cream Cure, died
(9) 9 M Allogeneic HSCT Lung None Fever, chest pain, nodular pulmonary opacity N/A Ampho B Failure, died§
(10) 64 F Chronic obstructive pulmonary disease Skin* None Erythematous plaque with pustules, erosions Prednisone Itraconazole Failure, died§
(11) 46 F Allogeneic HSCT Lung, disseminated to skin, heart, thyroid‡ CMV, parainfluenza pneumonia; BK virus hemorrhagic cystitis Bilateral pulmonary consolidation, skin lesion Myeloablative conditioning Itraconazole → liposomal ampho B Failure, died§
(12) 38 M Allogeneic HSCT Lung‡ None Seizures, bronchopneumonia Myeloablative conditioning, GVHD Ampho B spray → ampho B Failure, died
(13) 77 F Frontotemporal astrocytoma Skin* None Ulcerative erythematous plaque, suppuration Dexamethasone Itraconazole + KMnO4 soaks Failure, died
(14) 19 F Allogeneic HSCT Skin* Bacteremia Skin ulcers Myeloablative conditioning, GVHD Ampho B Failure, died§
(15) 43 M Leukemia Lung None Neutropenic fever, pulmonary infiltrates cytarabine and idarubicin Ampho B → voriconazole surgery Cure, died
(16) N/A N/A Allogeneic HSCT Lung, skin N/A N/A Chronic GVHD Liposomal ampho B N/A
(17) 29 M Allogeneic HSCT Lung, skin, brain dissemination None Pulmonary infiltrates and skin lesions Myeloablative conditioning, GVHD Ampho B → liposomal ampho B and caspofungin Cure, died
(17) 17 M Allogeneic HSCT Lung disseminated to eye, brain, skin None Retinitis and skin lesions GVHD Voriconazole and ampho B Failure, died
This article (case 1) 42 M Allogeneic HSCT Proven lung Bacterial pneumonia Pleural-based nodules GVHD Liposomal ampho B and caspofungin Failure, Died §
This article (case 2) 29 M Allogeneic HSCT Probable lung A. fumigatus pneumonia Cough, dyspnea, and pulmonary nodules GVHD Liposomal ampho B and caspofungin Failure, died
This article (case 3) 62 M Leukemia Probable lung None Pulmonary consolidation Fludarabine, Rituximab, Corticosteroids Liposomal ampho B → voriconazole and caspofungin Cure, survived
This article (case 4) 59 M Allogeneic HSCT Probable lung Influenza B Fever, chills, and dyspnea, pulmonary consolidation GVHD Voriconazole and caspofungin Cure, survived
This article (case 5) 48 F Allogeneic HSCT Proven lung, skin dissemination CMV pneumonitis Pulmonary infiltrates and erythematous papular skin lesions GVHD Voriconazole and caspofungin → liposomal ampho B Failure, died§
This article (case 6) 69 M Allogeneic HSCT Probable lung CMV antigenemia Dyspnea and pulmonary opacity GHVD Voriconazole and Caspofungin Cure, survived

*GVHD, graft-versus-host disease; N/A, data not applicable or not reported; HSCT, hematopoietic stem cell transplant; CMV, cytomegalovirus; Ampho B, amphotericin V; KMnO4, potassium permanganate.
†Primary cutaneous infection.
‡Nosocomial acquired infection.
§Mortality attributed to A. ustus infection.

Main Article

References
  1. McNeil  MM, Nash  SL, Hajjeh  RA. Trends in mortality due to invasive mycotic diseases in the United States, 1980–1997. Clin Infect Dis. 2001;33:641–7. DOIPubMedGoogle Scholar
  2. Warnock  DA, Hajjeh  RA, Lasker  BA. Epidemiology and prevention of invasive aspergillosis. Curr Infect Dis Rep. 2001;3:507–16. DOIPubMedGoogle Scholar
  3. Marr  KA, Carter  RA, Crippa  F, Wald  A, Corey  L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34:909–17. DOIPubMedGoogle Scholar
  4. Lawrence  T, Schockman  AT, McVaugh  H III. Aspergillus infection of aortic prosthetic valves. Chest. 1971;60:406–14. DOIPubMedGoogle Scholar
  5. Sandner  VK, Schönborn  C. Schimmelpilzinfektion der Haut bei ausgedehnter Verbrennung. Deutsch Ges-Wesen. 1973;28:125–8.
  6. Carrizosa  J, Levison  ME, Lawrence  T, Kaye  D. Cure of Aspergillus ustus endocarditis on prosthetic valve. Arch Intern Med. 1974;133:486–90. DOIPubMedGoogle Scholar
  7. Weiss  LM, Thiemke  WA. Disseminated Aspergillus ustus infection following cardiac surgery. Am J Clin Pathol. 1983;80:408–11.PubMedGoogle Scholar
  8. Stiller  MJ, Teperman  L, Rosenthal  SA, Primary cutaneous infection by Aspergillus ustus in a 62-year-old liver transplant recipient. J Am Acad Dermatol. 1994;31:344–7. DOIPubMedGoogle Scholar
  9. Bretagne  S, Marmorat-Khuong  A, Kuentz  M, Latge  JP, Bart-Delabesse  E, Cordonnier  C. Serum Aspergillus galactomannan antigen testing by sandwich ELISA: practical use in neutropenic patients. J Infect. 1997;35:7–15. DOIPubMedGoogle Scholar
  10. Ricci  RM, Evans  JS, Meffert  JJ, Kaufman  L, Sadkowski  LC. Primary cutaneous Aspergillus ustus infection: secondary reported case. J Am Acad Dermatol. 1998;38:797–8. DOIPubMedGoogle Scholar
  11. Iwen  PC, Rupp  ME, Bishop  MR, Rinaldi  MG, Sutton  DA, Tarantolo  S, Disseminated aspergillosis caused by Aspergillus ustus in a patient following allogeneic peripheral stem cell transplantation. J Clin Microbiol. 1998;36:3713–7.PubMedGoogle Scholar
  12. Verweij  PE, Van den Bergh  MFQ, Rath  PM, De Pauw  BE, Voss  A, Meis  JFGM. Invasive aspergillosis caused by Aspergillus ustus: case report and review. J Clin Microbiol. 1999;37:1606–9.PubMedGoogle Scholar
  13. Gené  J, Azón-Masoliver  A, Guarro  J. Cutaneous infection caused by Aspergillus ustus, an emerging opportunistic fungus in immunocompromised patients. J Clin Microbiol. 2001;39:1134–6. DOIPubMedGoogle Scholar
  14. Nakai  K, Kanda  Y, Mineishi  S. Primary cutaneous aspergillosis caused by Aspergillus ustus following reduced-intensity stem cell transplantation. Ann Hematol. 2002;81:593–6. DOIPubMedGoogle Scholar
  15. Azzola  P Jr, Habicht  JM. Use of lung resection and voriconazole for successful treatment of invasive pulmonary Aspergillus ustus infection. J Clin Microbiol. 2004;42:4805–8. DOIPubMedGoogle Scholar
  16. Baddley  JW, Stroud  TP, Salzman  D, Pappas  PG. Invasive mold infections in allogeneic bone marrow transplant recipients. Clin Infect Dis. 2001;32:1319–24. DOIPubMedGoogle Scholar
  17. Pavie  J, Lacroix  C, Hermose  DG. Breakthrough disseminated Aspergillus ustus infection in allogeneic hematopoietic stem cell transplant recipients receiving voriconazole and caspofungin prophylaxis. J Clin Microbiol. 2005;43:4902–4. DOIPubMedGoogle Scholar
  18. Ascioglu  S, Rex  JH, de Pauw  J. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis. 2002;34:7–14. DOIPubMedGoogle Scholar
  19. Rath  PM, Petermeier  K, Verweij  PE, Ansorg  R. Differentiation of Aspergillus ustus strains by random amplification of polymorphic DNA. J Clin Microbiol. 2002;40:2231–3. DOIPubMedGoogle Scholar
  20. Sneath  PHA, Sokal  RR, eds. Numerical taxonomy: the principles and practice of numerical classification. San Francisco: W.H. Freeman; 1973.
  21. Pfaller  MA, Chaturvedi  V, Espinel-Ingroff  A. Reference method for broth dilution antifungal susceptibility testing of yeasts; approved standard. National Committee for Clinical Laboratory Standards document M27-A, 22:1-30. The Committee; 2003.
  22. Bartizal  C, Odds  FC. Influences of methodological variables on susceptibility testing of caspofungin against Candida species and Aspergillus fumigatus. Antimicrob Agents Chemother. 2003;47:2100–7. DOIPubMedGoogle Scholar
  23. Sutton  DA, Fothergill  AW, Rinaldi  MG. Aspergillus ustus. In: Guide to clinically significant fungi. 1st ed. Baltimore: Lippincott Williams and Wilkins; 1998.
  24. Kfir  R, Johannsen  E, Vleggaar  R. Mutagenic activity of austocystins—secondary metabolites of Aspergillus ustus. Bull Environ Contam Toxicol. 1986;37:643–50. DOIPubMedGoogle Scholar
  25. Rabie  CJ, Steyn  M, van Schalkwyk  GC. New species of Aspergillus producing sterigmatocystin. Appl Environ Microbiol. 1977;33:1023–5.PubMedGoogle Scholar
  26. Chexal  KK, Spinger  JP, Clardy  J. Austin, a novel polyisoprenoid mycotoxin from Aspergillus ustus. J Am Chem Soc. 1976;98:6748. DOIPubMedGoogle Scholar
  27. Vleggaar  R, Steyn  PS, Nagel  DW. Constitution and absolute configuration of austdiol, the main toxic metabolite from Aspergillus ustus. J Chem Soc [Perkin 1]. 1974;1:45–9.
  28. Nielsen  KF, Gravesen  S, Nielsen  PA. Production of mycotoxins on artificially and naturally infested building materials. Mycopathologia. 1999;145:43–56. DOIPubMedGoogle Scholar
  29. Nielsen  KF. Mycotoxin production by indoor molds. Fungal Genet Biol. 2003;39:103–17. DOIPubMedGoogle Scholar
  30. Marr  KA, Carter  RA, Boeckh  M, Martin  P, Corey  L. Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors. Blood. 2002;100:4358–66. DOIPubMedGoogle Scholar
  31. Fukuda  T, Boeckh  M, Carter  RA. Risks and outcomes of invasive fungal infections in recipients of allogeneic hematopoietic stem cell transplants after nonmyeloablative conditioning. Blood. 2003;102:827–33. DOIPubMedGoogle Scholar
  32. Warris  A, Klaassen  CHW, Meis  JFGM. Molecular epidemiology of Aspergillus fumigatus isolates recovered from water, air, and patients shows two clusters of genetically distinct strains. J Clin Microbiol. 2003;41:4101–6. DOIPubMedGoogle Scholar
  33. Lasker  BA. Evaluation of performance of four genotypic methods for studying the genetic epidemiology of Aspergillus fumigatus isolates. J Clin Microbiol. 2002;40:2886–92. DOIPubMedGoogle Scholar
  34. Geiser  DM, Timberlake  WE, Arnold  ML. Loss of meiosis in Aspergillus. Mol Biol Evol. 1996;13:809–17.PubMedGoogle Scholar
  35. Anaissie  EJ, Stratton  SL, Dignani  MC. Pathogenic Aspergillus species recovered from a hospital water system: a 3-year prospective study. Clin Infect Dis. 2002;34:780–9. DOIPubMedGoogle Scholar
  36. Hajjeh  RA, Warnock  DW. Counterpoint: invasive aspergillosis and the environment—rethinking our approach to prevention. Clin Infect Dis. 2001;33:1549–52. DOIPubMedGoogle Scholar
  37. Lass-Florl. Kofler G, Kropshofer G. In-vitro testing of susceptibility to amphotericin B is a reliable predictor of clinical outcome in invasive aspergillosis. J Antimicrob Chemother. 1998;42:497–502. DOIPubMedGoogle Scholar
  38. Denning  DW, Radford  SA, Oakley  KL, Hall  L, Johnson  EM, Warnock  DW. Correlation between in-vitro susceptibility testing to itraconazole and in-vivo outcome of Aspergillus fumigatus infection. J Antimicrob Chemother. 1997;40:401–14. DOIPubMedGoogle Scholar
  39. Dannaoui  E, Borel  E, Monier  MF, Piens  MA, Picot  S, Persat  F. Acquired itraconazole resistance in Aspergillus fumigatus. J Antimicrob Chemother. 2001;47:333–40. DOIPubMedGoogle Scholar
  40. Warris  A, Weemaes  CM, Verweij  PE. Multidrug resistance in Aspergillus fumigatus. N Engl J Med. 2002;347:2173–4. DOIPubMedGoogle Scholar

Main Article

Page created: January 27, 2012
Page updated: January 27, 2012
Page reviewed: January 27, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external