Samuel W Mackrill, David C Schramm, Ali Amini, Riina Rautemaa-Richardson, Nicola Jones, Matthew O Brook, Katie Jeffery, Alexander J Mentzer
{"title":"英国一例肾移植受者感染播散性自体栉水母(Cladophialhora bantiana)病例","authors":"Samuel W Mackrill, David C Schramm, Ali Amini, Riina Rautemaa-Richardson, Nicola Jones, Matthew O Brook, Katie Jeffery, Alexander J Mentzer","doi":"10.1016/s1473-3099(24)00579-6","DOIUrl":null,"url":null,"abstract":"Disease associated with <em>Cladophialophora bantiana</em> infection is uncommon but can be characterised by severe and life-threatening CNS involvement. Diagnosis is challenging due to both the infection's rarity and non-specific clinical presentation, which can mimic malignancy and infection caused by more common organisms. Transmission can occur via inhalation or inoculation through compromised skin, followed by haematogenous dissemination to the brain and other organs. We report a case of a 42-year-old renal transplant recipient with no travel history presenting with neurological symptoms and skin and lung lesions due to <em>C bantiana</em> infection. An aggressive treatment approach comprising combination antifungal therapy, surgical debridement, and withdrawal of immunosuppression resulted in disease control, although this treatment was complicated by voriconazole-induced skeletal fluorosis. This organism, more commonly encountered in tropical regions, has traditionally been considered imported into the UK by returning travellers, therefore this case of autochthonous infection could reflect an expanding range alongside global climactic shifts.","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"87 1","pages":""},"PeriodicalIF":36.4000,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A case of disseminated autochthonous Cladophialophora bantiana infection in a renal transplant recipient in the UK\",\"authors\":\"Samuel W Mackrill, David C Schramm, Ali Amini, Riina Rautemaa-Richardson, Nicola Jones, Matthew O Brook, Katie Jeffery, Alexander J Mentzer\",\"doi\":\"10.1016/s1473-3099(24)00579-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Disease associated with <em>Cladophialophora bantiana</em> infection is uncommon but can be characterised by severe and life-threatening CNS involvement. Diagnosis is challenging due to both the infection's rarity and non-specific clinical presentation, which can mimic malignancy and infection caused by more common organisms. Transmission can occur via inhalation or inoculation through compromised skin, followed by haematogenous dissemination to the brain and other organs. We report a case of a 42-year-old renal transplant recipient with no travel history presenting with neurological symptoms and skin and lung lesions due to <em>C bantiana</em> infection. An aggressive treatment approach comprising combination antifungal therapy, surgical debridement, and withdrawal of immunosuppression resulted in disease control, although this treatment was complicated by voriconazole-induced skeletal fluorosis. This organism, more commonly encountered in tropical regions, has traditionally been considered imported into the UK by returning travellers, therefore this case of autochthonous infection could reflect an expanding range alongside global climactic shifts.\",\"PeriodicalId\":49923,\"journal\":{\"name\":\"Lancet Infectious Diseases\",\"volume\":\"87 1\",\"pages\":\"\"},\"PeriodicalIF\":36.4000,\"publicationDate\":\"2024-11-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Lancet Infectious Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/s1473-3099(24)00579-6\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/s1473-3099(24)00579-6","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
摘要
Cladophialophora bantiana 感染引起的疾病并不常见,但其特征是严重的中枢神经系统受累并危及生命。由于这种感染的罕见性和非特异性临床表现,诊断具有挑战性,因为它可能会模仿恶性肿瘤和由更常见的病原体引起的感染。传播途径可能是吸入或通过受损皮肤接种,然后经血源性传播到大脑和其他器官。我们报告了一例 42 岁的肾移植受者,该患者无旅行史,因感染 C bantiana 而出现神经系统症状以及皮肤和肺部病变。我们采取了积极的治疗方法,包括联合抗真菌治疗、手术清创和停用免疫抑制剂,最终控制了病情,但治疗过程因伏立康唑引起的骨骼氟中毒而变得复杂。这种病菌更常见于热带地区,传统上被认为是由回国旅行者传入英国的,因此这例自体感染病例可能反映出随着全球气候的变化,这种病菌的传播范围也在不断扩大。
A case of disseminated autochthonous Cladophialophora bantiana infection in a renal transplant recipient in the UK
Disease associated with Cladophialophora bantiana infection is uncommon but can be characterised by severe and life-threatening CNS involvement. Diagnosis is challenging due to both the infection's rarity and non-specific clinical presentation, which can mimic malignancy and infection caused by more common organisms. Transmission can occur via inhalation or inoculation through compromised skin, followed by haematogenous dissemination to the brain and other organs. We report a case of a 42-year-old renal transplant recipient with no travel history presenting with neurological symptoms and skin and lung lesions due to C bantiana infection. An aggressive treatment approach comprising combination antifungal therapy, surgical debridement, and withdrawal of immunosuppression resulted in disease control, although this treatment was complicated by voriconazole-induced skeletal fluorosis. This organism, more commonly encountered in tropical regions, has traditionally been considered imported into the UK by returning travellers, therefore this case of autochthonous infection could reflect an expanding range alongside global climactic shifts.
期刊介绍:
The Lancet Infectious Diseases was launched in August, 2001, and is a lively monthly journal of original research, review, opinion, and news covering international issues relevant to clinical infectious diseases specialists worldwide.The infectious diseases journal aims to be a world-leading publication, featuring original research that advocates change or sheds light on clinical practices related to infectious diseases. The journal prioritizes articles with the potential to impact clinical practice or influence perspectives. Content covers a wide range of topics, including anti-infective therapy and immunization, bacterial, viral, fungal, and parasitic infections, emerging infectious diseases, HIV/AIDS, malaria, tuberculosis, mycobacterial infections, infection control, infectious diseases epidemiology, neglected tropical diseases, and travel medicine. Informative reviews on any subject linked to infectious diseases and human health are also welcomed.