Gina Hong1, Marissa White2, Noah Lechtzin3, Natalie E West3, Robin Avery4, Heather Miller2, Richard Lee5, Robert J Lovari6, Christian Massire6, Lawrence B Blyn6, Xinglun Liang7, Deanna A Sutton8, Jianmin Fu9, Brian L Wickes9, Nathan P Wiederhold8, Sean X Zhang10. 1. Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. 2. Department of Pathology, Johns Hopkins University School of Medicine, USA. 3. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 4. Division of Infectious Diseases, Johns Hopkins University School of Medicine, USA. 5. Microbiology Laboratory, Johns Hopkins Hospital, Baltimore, MD, USA. 6. Ibis Biosciences, Abbott, Carlsbad, CA, USA. 7. Department of Geriatrics, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China. 8. Fungus Testing Laboratory, 7703 Floyd Curl Drive, MC7750 San Antonio, TX 78229-3900, USA. 9. Department of Microbiology and Immunology, University of Texas Health Science Center, San Antonio, TX, USA. 10. Department of Pathology, Johns Hopkins University School of Medicine, USA; Microbiology Laboratory, Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: szhang28@jhmi.edu.
Abstract
BACKGROUND: Disseminated fungal infections are a known serious complication in individuals with cystic fibrosis (CF) following orthotopic lung transplantation. Aspergillus fumigatus and Scedosporium species are among the more common causes of invasive fungal infection in this population. However, it is also important for clinicians to be aware of other emerging fungal species which may require markedly different antifungal therapies. CASE SUMMARY: We describe the first laboratory-documented case of a fatal disseminated fungal infection caused by Rasamsonia aegroticola in a 21-year-old female CF patient status post-bilateral lung transplantation, which was only identified post-mortem. Molecular analysis revealed the presence of the identical Rasamsonia strains in the patient's respiratory cultures preceding transplantation. DISCUSSION: We propose that the patient's disseminated fungal disease and death occurred as a result of recrudescence of Rasamsonia infection from her native respiratory system in the setting of profound immunosuppression post-operatively. Since Rasamsonia species have been increasingly recovered from the respiratory tract of CF patients, we further review the literature on these fungi and discuss their association with invasive fungal infections in the CF lung transplant host. CONCLUSION: Our report suggests Rasamsonia species may be important fungal pathogens that may have fatal consequences in immunosuppressed CF patients after solid organ transplantation.
BACKGROUND: Disseminated fungal infections are a known serious complication in individuals with cystic fibrosis (CF) following orthotopic lung transplantation. Aspergillus fumigatus and Scedosporium species are among the more common causes of invasive fungal infection in this population. However, it is also important for clinicians to be aware of other emerging fungal species which may require markedly different antifungal therapies. CASE SUMMARY: We describe the first laboratory-documented case of a fatal disseminated fungal infection caused by Rasamsonia aegroticola in a 21-year-old female CF patient status post-bilateral lung transplantation, which was only identified post-mortem. Molecular analysis revealed the presence of the identical Rasamsonia strains in the patient's respiratory cultures preceding transplantation. DISCUSSION: We propose that the patient's disseminated fungal disease and death occurred as a result of recrudescence of Rasamsonia infection from her native respiratory system in the setting of profound immunosuppression post-operatively. Since Rasamsonia species have been increasingly recovered from the respiratory tract of CF patients, we further review the literature on these fungi and discuss their association with invasive fungal infections in the CF lung transplant host. CONCLUSION: Our report suggests Rasamsonia species may be important fungal pathogens that may have fatal consequences in immunosuppressed CF patients after solid organ transplantation.