title: A fatal case of disseminated aspergillosis caused by a non-sporulating strain of Aspergillus fumigatus.
abstract: This report describes the case of a 38 year old pregnant woman with fatal disseminated aspergillosis and multiorgan failure, which was preceded by a long history of allergic bronchopulmonary aspergillosis. Postmortem revealed massive infarction and abscess formation in both lungs. Histology revealed a focal granulomatous response. Fungal infiltration with areas of necrosis were also seen in the liver, spleen, and paratracheal, mediastinal, para-aortic, and hilar lymph nodes. Culture of tissue samples produced a non-sporulating, beige coloured fungus that developed green pigmentation only after three weeks of incubation. Nucleotide sequencing of the D1-D2 region of the large ribosomal subunit revealed 100% homology with Aspergillus fumigatus. Minimum inhibitory concentrations for amphotericin B and itraconazole were both 0.25 mg/litre (susceptible). Further work is urgently required to determine the prevalence of such non-sporulating strains and their relevance to clinical infection.
authors.affiliation: Department of Critical Care, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, London SW3 6NP, UK.
authors.forename: M E
authors.initials: ME
authors.lastname: Callister
authors.forename: M J
authors.initials: MJ
authors.lastname: Griffiths
authors.forename: A G
authors.initials: AG
authors.lastname: Nicholson
authors.forename: A
authors.initials: A
authors.lastname: Leonard
authors.forename: E M
authors.initials: EM
authors.lastname: Johnson
authors.forename: M I
authors.initials: MI
authors.lastname: Polkey
authors.forename: J R
authors.initials: JR
authors.lastname: Kerr
mesh_terms: D000328:Adult; D001228:Aspergillosis / Q000175:diagnosis*; D001232:Aspergillus fumigatus / Q000302:isolation & purification / Q000502:physiology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008099:Liver / Q000382:microbiology; D008172:Lung Diseases, Fungal / Q000175:diagnosis*; D008198:Lymph Nodes / Q000382:microbiology; D016533:Mycological Typing Techniques; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D013154:Spleen / Q000382:microbiology; D013172:Spores, Fungal