Acremonium species are saprophytic molds widely distributed in nature, existing in soil and decaying vegetation. Penetrating wounds, intravascular catheters and immunosuppression are risk factors for invasive infections of Acremonium. The fungus can also cause cutaneous infections and mycetoma in the immunocompetent; such infections occur in extremities open to trauma. In this paper, a female patient with skin infection due to Acremonium strictum in both legs is described. These species are among common laboratory contaminants, but in the last 10 years there has been an increase in cases of Acremonium infection. The patient was a year-old female confined to wheelchair because of obesity and gonarthrosis.
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During the past two decades opportunistic fungal infections have emerged as important causes of morbidity and mortality in patients with severe underlying illnesses. A few cases of Acremonium spp. Peritonitis is a common clinical problem that occurs in patients with end-stage renal disease treated by continous ambulatory peritoneal dialysis CAPD. Yeasts, or rarely molds, may also cause peritonitis in patients on CAPD and we present here a case caused by Acremonium strictum.
Hyaline filamentous fungi which were previously uncommon as disease agents are increasingly encountered as the cause of life threatening invasive infections that are often refractory to conventional therapies 1. Infections with fungi such as Acremonium species have become significant problems in the treatment of immunocompromised hosts 2. Acremonium species have been reported to be the cause of localized or disseminated infections in patients with predisposing conditions such as Addison's disease, neutropenia, immune suppression and intravenous drug abuse 3—5.
We present a case of a fungal peritonitis caused by Acremonium strictum in patient undergoing continuous ambulatory peritoneal dialysis CAPD. A year-old woman with diabetes mellitus and chronic renal failure was admitted to the nephrology service of Ataturk Training and Research Hospital with dimness in peritoneal dialysis fluid. The patient's primary diagnosis was hypertensive nephropathy of eight years duration and she had been treated by CAPD for five years.
Abdominal pain was the main complaint of the patient. Physical examination revealed eudema in the pretibial region.
Tension arterial and pulses were normal. Cultures were inoculated with blood, nasal, peritoneal dialysis fluid and catheter samples. Staphylococcus aureus was recovered from the nasal specimens. Nasal mupirocin and systemic antibacterial therapy cefazolin and ciprofloxacine were started. Fungal colonies were isolated in cultures inoculated with peritoneal dialysis fluid.
Isolation and identification of Acremonium spp. Direct examination of the specimen of the peritoneal dialysis fluid revealed hyphae and leucocytes. The peritoneal fluid was cultured on sheep blood agar, eosin-methylene-blue agar and Sabouraud dextrose agar.
On microscopic examination with lactophenol cotton blue, septate hyphae, conidiogenous cells and needle-shaped awl phialides were seen. This fungus was identified as Acremonium spp. Molecular analysis was not performed. Micromorphology of a colony of Acremonium strictum lactophenol cotton blue preparation. In the last few years there has been an increase in mycoses caused by opportunistic fungal pathogens 6. Species of the genus Acremonium are widespread soil saprophytes which on rare occasions can be opportunistic pathogens in immunosuppressed individuals 7— Wang et al.
The patient failed to respond to high dose amphotericin B therapy and died. Chang et al. They successfully treated the patient with amphotericin B, granulocyte colony-stimulating factor G-CSF and surgical drainage. Disseminated Acremonium strictum infection in a neutropenic patient was reported by Schell and Perfect There are only a few reports for disseminated Acremonium infections.
Foell et al. They reported that the infections were rapidly fatal despite neutrophil recovery and early antifungal combination therapy with amphotericin B and caspofungin. In another study, fungal infections of dialysis fistulae were presented in two patients with recurrent infections were presented. Staphylococcus aureus and Acremonium species were isolated from the thromboses of their grafts The authors suggested amphotericin B therapy for fungal infections of dialysis fistulae.
However Mattei et al. Peritonitis is a frequent complication in patients with chronic renal failure on continuous ambulatory peritoneal dialysis CAPD treatment.
Manzano-Gayosso et al. Specimens of the peritoneal dialysis fluid from patients on CAPD treatment with peritonitis manifestations were submitted for mycological studies and Acremonium spp. Because reported cases are limited, optimal treatment of Acremonium species infections is not well-defined.
In addition, conflicting results have been obtained in different studies 3—5 , Early catheter removal and prophylaxis have been suggested for peritoneal dialysis patients with fungal peritonitis Chan et al. The cure rate with fluconazole therapy alone without catheter removal was 9. They concluded that oral fluconazole can be safely used as initial therapy in patients with fungal peritonitis complicating CAPD.
Warris et al. General resistance to most antifungals, excluding amphotericin B and ketoconazole has been reported 5. Hence, amphotericin B therapy, in combination with ketoconazole or another new azole or allylamine, is advocated for Acremonium infections 3—5 , 16 , Although Acremonium infection is rare in humans, cases have been increased recently. This is due to recent advances in medical technology that have led to increased numbers of immunosuppressed patients, receiving broad-spectrum antibiotics or having indwelling medical devices We emphasize the importance of an active search for unusual organisms like Acremonium strictum in immunodeficient patients and early specific treatment against such microoganisms for the reduction of their morbidity and mortality.
Google Scholar. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Case report. Oxford Academic. Mine Yucesoy. Seckin Senturkun. Ilhan Afsar. Sureyya Gul Yurtsever. Meral Turk. Select Format Select format.
Permissions Icon Permissions. Abstract During the past two decades opportunistic fungal infections have emerged as important causes of morbidity and mortality in patients with severe underlying illnesses. Acremonium strictum , opportunistic fungal infection , peritonitis. Open in new tab Download slide. Microscopic appearance of Acremonium strictum colorless.
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Treatment of fungal peritonitis complicating continuous ambulatory peritoneal dialysis with oral fluconazole: a series of 21 patients. Acremonium strictum fungaemia in a paediatric patient with acute leukaemia. Invasive Acremonium falciforme infection in a patient with severe combined immunodeficiency. Human hyalohyphomycoses: a review of human infections due to Acremonium spp.
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Fatal, disseminated Acremonium strictum infection in a neutropenic host.
Acremonium strictum is an environmentally widespread saprotroph species found in soil, plant debris, and rotting mushrooms. The genus Acremonium is a large polyphyletic genus of approximately species, many of which are derived from a closely related families in the Sordariomycetes. Colonies are flat, with smooth, wet, velvety or floccose texture, sometimes resembling thin cottony mounds. Lower microscopy shows pin-head spore ball formation. Species of Acremonium are morphologically very similar, making identification difficult.
During the past two decades opportunistic fungal infections have emerged as important causes of morbidity and mortality in patients with severe underlying illnesses. A few cases of Acremonium spp. Peritonitis is a common clinical problem that occurs in patients with end-stage renal disease treated by continous ambulatory peritoneal dialysis CAPD. Yeasts, or rarely molds, may also cause peritonitis in patients on CAPD and we present here a case caused by Acremonium strictum. Hyaline filamentous fungi which were previously uncommon as disease agents are increasingly encountered as the cause of life threatening invasive infections that are often refractory to conventional therapies 1.
Disseminated Acremonium strictum infection in a neutropenic patient is reported. Positive fecal cultures preceded positive cutaneous and blood cultures by 18 and 21 days, respectively, which suggests gastrointestinal colonization and invasion as initiating events. Microscopic examination of cutaneous biopsy and pulmonary specimens revealed hyphae, phialides, and phialoconidia in vivo. These adventitious forms also can occur in infections due to other phialidic fungi such as Fusarium and Paecilomyces species and can be misdiagnosed as Candida species. Budding cells also can occur in vivo for species of Fusarium, Paecilomyces, and apparently Acremonium, further adding to the potential for misdiagnosis. The occurrence of adventitious forms in infections caused by species of Acremonium, Fusarium, Paecilomyces, Scedosporium, and Blastoschizomyces is suggested as a mechanism for dissemination of infection and as an explanation of the relatively higher frequency of positive blood cultures in these cases. National Center for Biotechnology Information , U.
The genus Acremonium previously known as Cephalosporium is a large and cosmopolitan group of filamentous Ascomycete fungi containing approximately different species that are largely saprophytes, living off of dead or decaying organic matter and contributing to the cycling of carbon in the environment. Some Acremonium species occur as plant endophytes or plant pathogens and some are animal pathogens, occasionally causing infection in immunocompromised humans. Acremonium strictum is one of the more common species, isolated largely from soils and plants as well as indoor environments. This species is a common fungal endophyte, associated with a variety of grasses as well as the roots of maize plants and mangrove trees.