Exclusion of Mucorales Co-Infection in a Patient with <i>Aspergillus flavus</i> 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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| Format: | Article |
| Language: | English |
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MDPI AG
2022-03-01
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| Series: | Journal of Fungi |
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| Online Access: | https://www.mdpi.com/2309-608X/8/3/306 |
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| author | Johanna Kessel Michael Hogardt Lukas Aspacher Thomas A. Wichelhaus Jasmin Gerkrath Emely Rosenow Jan Springer Volker Rickerts |
| author_facet | Johanna Kessel Michael Hogardt Lukas Aspacher Thomas A. Wichelhaus Jasmin Gerkrath Emely Rosenow Jan Springer Volker Rickerts |
| author_sort | Johanna Kessel |
| collection | DOAJ |
| 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 <i>Aspergillus flavus</i>, a microscopic examination of the tissue was suggestive of concomitant mucormycosis. However, fluorescence in situ hybridization (FISH) using specific probes targeting <i>Aspergillus</i> and Mucorales species ruled out mixed infection. This was confirmed by specific qPCR assays amplifying the DNA of <i>Aspergillus</i>, 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. |
| first_indexed | 2024-03-09T13:42:46Z |
| format | Article |
| id | doaj.art-e7cc01b82e0f429fbba4a0e445c6954a |
| institution | Directory Open Access Journal |
| issn | 2309-608X |
| language | English |
| last_indexed | 2024-03-09T13:42:46Z |
| publishDate | 2022-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Fungi |
| spelling | doaj.art-e7cc01b82e0f429fbba4a0e445c6954a2023-11-30T21:05:38ZengMDPI AGJournal of Fungi2309-608X2022-03-018330610.3390/jof8030306Exclusion of Mucorales Co-Infection in a Patient with <i>Aspergillus flavus</i> Sinusitis by Fluorescence In Situ Hybridization (FISH)Johanna Kessel0Michael Hogardt1Lukas Aspacher2Thomas A. Wichelhaus3Jasmin Gerkrath4Emely Rosenow5Jan Springer6Volker Rickerts7Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, GermanyInstitute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, GermanyDepartment of Internal Medicine, Hematology/Oncology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, GermanyInstitute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, GermanyRobert Koch Institute Berlin, FG16, Seestrasse 10, 13353 Berlin, GermanyRobert Koch Institute Berlin, FG16, Seestrasse 10, 13353 Berlin, GermanyMedizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, 97080 Wuerzburg, GermanyRobert Koch Institute Berlin, FG16, Seestrasse 10, 13353 Berlin, GermanyInvasive 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 <i>Aspergillus flavus</i>, a microscopic examination of the tissue was suggestive of concomitant mucormycosis. However, fluorescence in situ hybridization (FISH) using specific probes targeting <i>Aspergillus</i> and Mucorales species ruled out mixed infection. This was confirmed by specific qPCR assays amplifying the DNA of <i>Aspergillus</i>, 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.https://www.mdpi.com/2309-608X/8/3/306invasive fungal infectionfluorescence in situ hybridization (FISH)fungal sinusitis<i>Aspergillus</i>mixed infection |
| spellingShingle | Johanna Kessel Michael Hogardt Lukas Aspacher Thomas A. Wichelhaus Jasmin Gerkrath Emely Rosenow Jan Springer Volker Rickerts Exclusion of Mucorales Co-Infection in a Patient with <i>Aspergillus flavus</i> Sinusitis by Fluorescence In Situ Hybridization (FISH) Journal of Fungi invasive fungal infection fluorescence in situ hybridization (FISH) fungal sinusitis <i>Aspergillus</i> mixed infection |
| title | Exclusion of Mucorales Co-Infection in a Patient with <i>Aspergillus flavus</i> Sinusitis by Fluorescence In Situ Hybridization (FISH) |
| title_full | Exclusion of Mucorales Co-Infection in a Patient with <i>Aspergillus flavus</i> Sinusitis by Fluorescence In Situ Hybridization (FISH) |
| title_fullStr | Exclusion of Mucorales Co-Infection in a Patient with <i>Aspergillus flavus</i> Sinusitis by Fluorescence In Situ Hybridization (FISH) |
| title_full_unstemmed | Exclusion of Mucorales Co-Infection in a Patient with <i>Aspergillus flavus</i> Sinusitis by Fluorescence In Situ Hybridization (FISH) |
| title_short | Exclusion of Mucorales Co-Infection in a Patient with <i>Aspergillus flavus</i> Sinusitis by Fluorescence In Situ Hybridization (FISH) |
| title_sort | exclusion of mucorales co infection in a patient with i aspergillus flavus i sinusitis by fluorescence in situ hybridization fish |
| topic | invasive fungal infection fluorescence in situ hybridization (FISH) fungal sinusitis <i>Aspergillus</i> mixed infection |
| url | https://www.mdpi.com/2309-608X/8/3/306 |
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