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Volume 31, Number 11—November 2025
Dispatch
Bjerkandera spp. Pulmonary Infection in Immunocompromised Hosts, Germany
, Danila Seidel, Katrin Mehler, Zoé Westhues, Sarina K. Butzer, Jannik Stemler, Oliver A. Cornely, and Philipp Koehler
Table
Characteristics of patients with probable invasive pulmonary disease by Bjerkandera spp., Germany*
| Patient no. | Age, y | Time of diagnosis and department | Underlying condition and treatment | Antifungal prophylaxis | Radiology | Microbiology | Antifungal Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|
| 1 | 32 | May 2017, inpatient hematology unit | Relapsed mediastinal T-cell lymphoma; allogeneic HSCT | None | Nodular infiltrates, ground-glass opacities | Mold culture from BAL fluid, Bjerkandera spp. identified by ITS sequencing† | Posaconazole | Deceased |
| 2 | 82 | Oct 2022, outpatient hematology department | AML, functional neutropenia; hydroxyurea | None | Nodular infiltrates, cavernous lesion | Mold culture from BAL fluid, B. adusta or B. fumosa identified by ITS sequencing‡ | Voriconazole, isavuconazole | Unknown |
| 3 | 4 | Nov 2022, inpatient pediatric hematology unit | AML; HAM regime | Micafungin | Nodular infiltrates, ground-glass opacities, cavernous lesion | Mold culture from tracheal aspiration, B. adusta or B. fumosa identified by ITS sequencing§ | Voriconazole, liposomal AmB | Alive, secondary prophylaxis with voriconazole |
*Microbiologic analyses were performed at the Institute of Medical Microbiology, Immunology, and Hygiene, University Hospital Cologne, Cologne, Germany. AmB, amphotericin B; AML, acute myeloid leukemia; BAL, bronchoalveolar lavage; HAM, high-dose cytarabine with mitoxantrone; HSCT, hematopoietic stem cell transplant, ITS, internal transcribed spacer. †Other causes of infectious disease were ruled out by negative blood cultures; negative Legionella antigen from urine; negative culture from BAL including Mycobacteria and Actinomyces culture; negative results for M. tuberculosis complex, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella pneumophilia, Aspergillus spp., Mucorales, Pneumocystis jirovecii, and Toxoplasma gondii by PCR from BAL; negative respiratory virus panel from BAL; and negative results on throat swab samples for viruses including influenza A, influenza B, parainfluenza, adenovirus, metapneumovirus, coronavirus, respiratory syncytial virus, rhinovirus, bocavirus, and enterovirus. There was no serologic evidence for C. pneumoniae or M. pneumoniae infection, no active hepatitis A–E, and negative results for cytomegalovirus, herpes simplex virus, varicella zoster virus, and parvovirus PCR from EDTA blood. We identified Epstein-Barr virus copies 14 IU/mL from EDTA blood, in control virus that was negative by PCR. ‡Other causes of infectious disease were ruled out by negative culture from BAL, including Mycobacteria and Actinomyces culture; negative results for M. tuberculosis complex, C. pneumoniae, M. pneumoniae, L. pneumophilia, Aspergillus spp., Mucorales, Pneumocystis jirovecii, and Toxoplasma gondii by PCR from BAL; negative influenza A, influenza B, parainfluenza, adenovirus, metapneumovirus, coronavirus, respiratory syncytial virus, rhinovirus, bocavirus, and enterovirus from BAL and throat swab samples; and negative Legionella and pneumococcal antigen from urine. §Other causes of infectious disease were ruled out by negative blood cultures, negative urine cultures, negative culture from tracheal aspiration, negative C. pneumoniae, L. pneumophilia, M. pneumoniae, Aspergillus spp., Mucorales, Pneumocystis carinii, and Toxoplasma gondii by PCR from tracheal aspiration; negative cytomegalovirus, human herpesvirus 6A, Epstein-Barr virus, influenza A, influenza B, parainfluenza, adenovirus, metapneumovirus, coronavirus, respiratory syncytial virus, rhinovirus, bocavirus, and enterovirus by PCR from tracheal aspiration.