Laura Terracol, Samia Hamane, Victor Euzen, Blandine Denis, Stéphane Bretagne, Sarah Dellière
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Less common ones, such as Verruconis gallopava, initially described as responsible of encephalitis of turkeys, pose significant challenges for diagnosis and treatment.</p><p><strong>Material and methods: </strong>Following the description of a clinical case, we performed a comprehensive review of 48 cases of V. gallopava infection, a rarely reported species from 1986 to 2024.</p><p><strong>Results: </strong>Solid organ transplant recipients and patients with hematological malignancies are the population most at-risk. Clinical presentation is nonspecific but can be divided in two main entities, pulmonary and cerebral localizations. This later is associated with a mortality rate over 80% and was significantly more frequently reported in liver transplant recipients (p = 0.03). When tested, ß-D-glucans were positive in all cases. Antifungal susceptibility testing demonstrated low MICs for amphotericin B and all azoles but isavuconazole and fluconazole. Clinical outcomes support the use of amphotericin B, voriconazole, itraconazole and posaconazole as valid treatment options.</p><p><strong>Discussion: </strong>It is not known whether the cerebral cases are primary or secondary to pulmonary lesions. 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引用次数: 0
摘要
导言:拟真菌病是一种不常见的机会性真菌感染,人们对其了解甚少,临床表现多种多样,从局部皮肤病变到播散性疾病不等。最常见的真菌属有 Alternaria、Cladophialophora、Exophiala 或 Curvularia。较少见的菌属,如 Verruconis gallopava,最初被描述为火鸡脑炎的罪魁祸首,给诊断和治疗带来了巨大挑战:在描述了一例临床病例后,我们对1986年至2024年间48例V. gallopava感染病例进行了全面回顾:结果:实体器官移植受者和血液恶性肿瘤患者是高危人群。临床表现无特异性,但可分为肺部和脑部两大实体。这种疾病的死亡率超过 80%,肝移植受者中的发病率明显更高(p = 0.03)。经检测,所有病例中的ß-D-葡聚糖均呈阳性。抗真菌药敏试验显示,两性霉素 B 和所有唑类药物的 MIC 值较低,但异唑醇和氟康唑除外。临床结果支持使用两性霉素 B、伏立康唑、伊曲康唑和泊沙康唑作为有效的治疗方案:讨论:目前尚不清楚脑部病例是原发性还是继发于肺部病变。由于鉴别诊断是癌症病变,因此对肺部的惰性病变应进行全面检查,包括活检和病理学及真菌学检查。
Phaeohyphomycosis Due to Verruconis gallopava: Rare Indolent Pulmonary Infection or Severe Cerebral Fungal Disease?
Introduction: Phaeohyphomycoses are uncommon and poorly understood opportunistic fungal infections, characterized by a wide spectrum of clinical manifestations ranging from localized skin lesions to disseminated disease. Most frequent genera are Alternaria, Cladophialophora, Exophiala or Curvularia. Less common ones, such as Verruconis gallopava, initially described as responsible of encephalitis of turkeys, pose significant challenges for diagnosis and treatment.
Material and methods: Following the description of a clinical case, we performed a comprehensive review of 48 cases of V. gallopava infection, a rarely reported species from 1986 to 2024.
Results: Solid organ transplant recipients and patients with hematological malignancies are the population most at-risk. Clinical presentation is nonspecific but can be divided in two main entities, pulmonary and cerebral localizations. This later is associated with a mortality rate over 80% and was significantly more frequently reported in liver transplant recipients (p = 0.03). When tested, ß-D-glucans were positive in all cases. Antifungal susceptibility testing demonstrated low MICs for amphotericin B and all azoles but isavuconazole and fluconazole. Clinical outcomes support the use of amphotericin B, voriconazole, itraconazole and posaconazole as valid treatment options.
Discussion: It is not known whether the cerebral cases are primary or secondary to pulmonary lesions. The indolent pulmonary lesions should prompt a complete work-up including biopsy with pathology and mycology expertise since the differential diagnosis is a cancer lesion.
期刊介绍:
Mycopathologia is an official journal of the International Union of Microbiological Societies (IUMS). Mycopathologia was founded in 1938 with the mission to ‘diffuse the understanding of fungal diseases in man and animals among mycologists’. Many of the milestones discoveries in the field of medical mycology have been communicated through the pages of this journal. Mycopathologia covers a diverse, interdisciplinary range of topics that is unique in breadth and depth. The journal publishes peer-reviewed, original articles highlighting important developments concerning medically important fungi and fungal diseases. The journal highlights important developments in fungal systematics and taxonomy, laboratory diagnosis of fungal infections, antifungal drugs, clinical presentation and treatment, and epidemiology of fungal diseases globally. Timely opinion articles, mini-reviews, and other communications are usually invited at the discretion of the editorial board. Unique case reports highlighting unprecedented progress in the diagnosis and treatment of fungal infections, are published in every issue of the journal. MycopathologiaIMAGE is another regular feature for a brief clinical report of potential interest to a mixed audience of physicians and laboratory scientists. MycopathologiaGENOME is designed for the rapid publication of new genomes of human and animal pathogenic fungi using a checklist-based, standardized format.