R. Horré

Successful treatment of multiple Pseudallescheria boydii brain abscesses and ventriculitis/ependymitis in a 2-year-old child after a near-drowning episode

RationaleWe report on a cerebral infection by Pseudallescheria boydii in a 21-month-old boy after a near-drowning episode. MRI revealed multiple (>60) intracerebral abscesses.MethodsThe surgical therapy included CSF drainage and microsurgical resection of one abscess for microbiological diagnosis. Antimycotic therapy included terbinafine and intraventricular caspofungin in addition to voriconazole.ResultsSystemic side effects of chemotherapy were not observed. After placement of a ventriculoperitoneal shunt, the boy was transferred to a rehabilitation clinic and improved neurologically. After 20 months, MRI documented a continuing remission of the disease.ConclusionOur case proves that an aggressive treatment should be undertaken and can be successful in CNS pseudallescheriasis.

Fungal respiratory infections in cystic fibrosis: a growing problem

tions increases as the life expectancy of patients improves. But in contrast to bacterial respiratory infections, relatively little progress has been made with regards to fungal respiratory infections. Aspergillus fumigatus is by far the most common causative agent with a reported prevalence rate varying from 5.9% to 58.3%, but a wide range of fungi may colonize the respiratory tract of CF patients. For example, other Aspergillus species like Aspergillus terreus , as well as Scedosporium spp. and Exophiala dermatitidis are increasingly described in the CF context, but their prevalence is certainly underestimated. Additionally, whether the colonization of the airways by fungi/micromycetes constitutes a clinically relevant problem is still a matter of debate. However, recent studies have clearly indicated an increase in their prevalence rate, and a relationship with increased numbers of hospital admissions. Moreover, due to their thermotolerance and to their propensity to disseminate in immunocompromised hosts, prior colonization of the airways by fi lamentous fungi constitutes a serious risk factor for invasive infections in cases of lung transplantation. The latter remains the ultimate treatment of CF patients. Numerous questions are created by fungal colonization of the airways, and basic research on the ecology of the fungi, their biochemistry, and their pathogenic mechanisms should be promoted in order to defi ne prophylactic measures or to develop more effi cient antifungal drugs. To address these questions, the International Society for Human and Animal Mycology (ISHAM) launched in October 2006, a working group on “Fungal Respiratory Infections in Cystic Fibrosis”, whose fi rst formal meeting was held in Angers, France, on June 7-8, 2009. Altogether 65 clinicians, mycologists or scientists from 14 different countries participated to this meeting, as well as numerous PhD students to guarantee dynamic discussions. Thirtyeight presentations were provided by attendees, covering a wide variety of topics, including (a) “clinical surveillance All authors are members of the ISHAM working group on Fungal Respiratory Infections in Cystic Fibrosis. Correspondence: Jean-Philippe Bouchara, Groupe d’Etude des Interactions Hote-Pathogene, UPRES-EA 3142, Laboratoire de ParasitologieMycologie, CHU, 4 rue Larrey, 49933 Angers cedex 9, France. Tel: 33 (0)2 41 35 34 72; Fax: 33 (0)2 41 35 36 16; E-mail: jean-philippe. bouchara@univ-angers.fr Fungal respiratory infections in cystic fi brosis: a growing problem

Fatal pulmonary scedosporiosis

We report on a case of scedosporiosis in a 72‐year‐old German woman. Her disease started with a purulent ulceration of unknown course at her left foot. Soon after onset of oral antibacterial therapy she needed in‐hospital treatment because of an acute pneumonia. The infection progressed despite the application of different antibiotics. Microscopic examination of tracheal fluid revealed fungal hyphae and therefore treatment with itraconazole was initiated. However, the patient developed renal failure, required mechanical ventilation and finally died in treatment‐resistant septic shock. Post‐mortem Scedosporium apiospermum was cultured from lung tissue taken during autopsy. This is the fourth case of human infection caused by Scedosporium species diagnosed in our laboratory during the last 4 years.

Wound infection due to Absidia corymbifera and Candida albicans with fatal outcome

A case of a mixed infection due to Candida albicans and the zygomycete Absidia corymbifera in a 38-year-old, previously healthy, Caucasian male is presented. The infection developed following serial rib fractures, and ruptures of kidney, liver and biliary tract as well as a pancreatic contusion resulting from a traffic accident. During intensive care treatment the patient underwent several surgical procedures but subsequently experienced multi-organ failure and sepsis. Some weeks later, fungal growth was observed macroscopically on the patients skin and wounds. From wound swabs C. albicans and A. corymbifera were grown. Histopathology of abdominal tissue yielded pseudohyphae and coenocytic hyphae. Although surgical debridement and antifungal treatment with amphotericin B and 5-flucytosine were started immediately, the patient died in therapy-refractory septic multi-organ failure.

Case Report. Maxillary sinus infection due to Emericella nidulans

Summary.  Fungal infections of the maxillary sinus are frequently caused by Aspergillus species, particularly A. fumigatus. In otherwise healthy persons there is an association with overfilling of dental root canals, when zinc‐containing filling materials were used. Below, a maxillary sinus aspergilloma is reported in a young immunocompetent female patient caused by Aspergillus (Emericella) nidulans.