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Exclusion of Mucorales Co-Infection in a Patient with Aspergillus flavus Sinusitis by Fluorescence In Situ Hybridization (FISH)

Invasive fungal infections are associated with increased mortality in hematological patients. Despite considerable advances in antifungal therapy, the evaluation of suspected treatment failure is a common clinical challenge requiring extensive diagnostic testing to rule out potential causes, such as...

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Autores principales: Kessel, Johanna, Hogardt, Michael, Aspacher, Lukas, Wichelhaus, Thomas A., Gerkrath, Jasmin, Rosenow, Emely, Springer, Jan, Rickerts, Volker
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8955397/
https://www.ncbi.nlm.nih.gov/pubmed/35330308
http://dx.doi.org/10.3390/jof8030306
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author Kessel, Johanna
Hogardt, Michael
Aspacher, Lukas
Wichelhaus, Thomas A.
Gerkrath, Jasmin
Rosenow, Emely
Springer, Jan
Rickerts, Volker
author_facet Kessel, Johanna
Hogardt, Michael
Aspacher, Lukas
Wichelhaus, Thomas A.
Gerkrath, Jasmin
Rosenow, Emely
Springer, Jan
Rickerts, Volker
author_sort Kessel, Johanna
collection PubMed
description Invasive fungal infections are associated with increased mortality in hematological patients. Despite considerable advances in antifungal therapy, the evaluation of suspected treatment failure is a common clinical challenge requiring extensive diagnostic testing to rule out potential causes, such as mixed infections. We present a 64-year-old patient with secondary AML, diabetes mellitus, febrile neutropenia, and sinusitis. While cultures from nasal tissue grew Aspergillus flavus, a microscopic examination of the tissue was suggestive of concomitant mucormycosis. However, fluorescence in situ hybridization (FISH) using specific probes targeting Aspergillus and Mucorales species ruled out mixed infection. This was confirmed by specific qPCR assays amplifying the DNA of Aspergillus, but not of Mucorales. These results provided a rational basis for step-down targeted therapy, i.e., the patient received posaconazole after seven days of calculated dual therapy with liposomal amphotericin B and posaconazole. Despite clinical response to the antifungal therapy, he died due to the progression of the underlying disease within two weeks after diagnosis of fungal infection. Molecular diagnostics applied to tissue blocks may reveal useful information on the etiology of invasive fungal infections, including challenging situations, such as with mixed infections. A thorough understanding of fungal etiology facilitates targeted therapy that may improve therapeutic success while limiting side effects.
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spelling pubmed-89553972022-03-26 Exclusion of Mucorales Co-Infection in a Patient with Aspergillus flavus Sinusitis by Fluorescence In Situ Hybridization (FISH) Kessel, Johanna Hogardt, Michael Aspacher, Lukas Wichelhaus, Thomas A. Gerkrath, Jasmin Rosenow, Emely Springer, Jan Rickerts, Volker J Fungi (Basel) Case Report Invasive fungal infections are associated with increased mortality in hematological patients. Despite considerable advances in antifungal therapy, the evaluation of suspected treatment failure is a common clinical challenge requiring extensive diagnostic testing to rule out potential causes, such as mixed infections. We present a 64-year-old patient with secondary AML, diabetes mellitus, febrile neutropenia, and sinusitis. While cultures from nasal tissue grew Aspergillus flavus, a microscopic examination of the tissue was suggestive of concomitant mucormycosis. However, fluorescence in situ hybridization (FISH) using specific probes targeting Aspergillus and Mucorales species ruled out mixed infection. This was confirmed by specific qPCR assays amplifying the DNA of Aspergillus, but not of Mucorales. These results provided a rational basis for step-down targeted therapy, i.e., the patient received posaconazole after seven days of calculated dual therapy with liposomal amphotericin B and posaconazole. Despite clinical response to the antifungal therapy, he died due to the progression of the underlying disease within two weeks after diagnosis of fungal infection. Molecular diagnostics applied to tissue blocks may reveal useful information on the etiology of invasive fungal infections, including challenging situations, such as with mixed infections. A thorough understanding of fungal etiology facilitates targeted therapy that may improve therapeutic success while limiting side effects. MDPI 2022-03-16 /pmc/articles/PMC8955397/ /pubmed/35330308 http://dx.doi.org/10.3390/jof8030306 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Kessel, Johanna
Hogardt, Michael
Aspacher, Lukas
Wichelhaus, Thomas A.
Gerkrath, Jasmin
Rosenow, Emely
Springer, Jan
Rickerts, Volker
Exclusion of Mucorales Co-Infection in a Patient with Aspergillus flavus Sinusitis by Fluorescence In Situ Hybridization (FISH)
title Exclusion of Mucorales Co-Infection in a Patient with Aspergillus flavus Sinusitis by Fluorescence In Situ Hybridization (FISH)
title_full Exclusion of Mucorales Co-Infection in a Patient with Aspergillus flavus Sinusitis by Fluorescence In Situ Hybridization (FISH)
title_fullStr Exclusion of Mucorales Co-Infection in a Patient with Aspergillus flavus Sinusitis by Fluorescence In Situ Hybridization (FISH)
title_full_unstemmed Exclusion of Mucorales Co-Infection in a Patient with Aspergillus flavus Sinusitis by Fluorescence In Situ Hybridization (FISH)
title_short Exclusion of Mucorales Co-Infection in a Patient with Aspergillus flavus Sinusitis by Fluorescence In Situ Hybridization (FISH)
title_sort exclusion of mucorales co-infection in a patient with aspergillus flavus sinusitis by fluorescence in situ hybridization (fish)
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8955397/
https://www.ncbi.nlm.nih.gov/pubmed/35330308
http://dx.doi.org/10.3390/jof8030306
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