title: Involvement of the opportunistic pathogen Aspergillus tubingensis in osteomyelitis of the maxillary bone: a case report.
abstract: BACKGROUND
  Aspergillus tubingensis is a black Aspergillus belonging to the Aspergillus section Nigri, which includes species that morphologically resemble Aspergillus niger. Recent developments in species determination have resulted in clinical isolates presumed to be Aspergillus niger being reclassified as Aspergillus tubingensis by sequencing. We present a report of a patient with an osteomyelitis of the maxillary bone with a probable invasive Aspergillus tubingensis infection.
  
  
  METHODS
  We describe an immune compromised patient suffering from osteomyelitis of the maxillary bone after tooth extraction. The osteomyelitis probably resulted in dentogenic pansinusitis presenting as an acute ethmoiditis. Histologic examination of biopsy samples showed osteomyelitis, and inflammation of the surrounding connective tissue. Cultures of the alveolar wound grew Aspergillus tubingensis. The patient was treated with liposomal amphoterocin B, which was changed to oral treatment with voriconazole based on susceptibility testing (MIC for voriconazole was 1 μg/ml).
  
  
  CONCLUSIONS
  This case shows that Aspergillus tubingensis may have the potential to cause severe invasive infections in immunocompromised hosts. A larger proportion of Aspergillus tubingensis isolates are less susceptible to azoles compared to Aspergillus niger. Therefore, correct species identification and susceptibility testing is crucial for the choice of anti-fungal treatment, screening of azole resistance, and characterization of the pathogenic potential of the various species within Aspergillus section Nigri.
authors: Department of Medical Microbiology, University Medical Center Utrecht, Postbox 85500, Utrecht, The Netherlands. d.bathoorn@umcutrecht.nl
authors: Erik
authors: E
authors: Bathoorn
authors: Natalia
authors: N
authors: Escobar Salazar
authors: Shahrzad
authors: S
authors: Sepehrkhouy
authors: Martin
authors: M
authors: Meijer
authors: Hans
authors: H
authors: de Cock
authors: Pieter-Jan
authors: PJ
authors: Haas
mesh_terms: D001228:Aspergillosis / Q000175:diagnosis / Q000382:microbiology*; D001230:Aspergillus / Q000145:classification / Q000235:genetics; D006801:Humans; D008297:Male; D008437:Maxilla / Q000000981:diagnostic imaging / Q000382:microbiology*; D009894:Opportunistic Infections; D010019:Osteomyelitis / Q000175:diagnosis / Q000382:microbiology*; D010802:Phylogeny; D011859:Radiography; D014404:Tubulin / Q000235:genetics; D055815:Young Adult
chemical_list: D014404:Tubulin
references: Clin Microbiol Infect. 2008 Oct;14(10):982-4
references: 18828858
references: Mycoses. 2012 Jul;55(4):333-8
references: 21895787
references: Antimicrob Agents Chemother. 2011 Jun;55(6):3025-30
references: 21444701
references: Med Mycol. 2009;47 Suppl 1:S13-20
references: 19255907
references: Int J Pediatr Otorhinolaryngol. 2008 Apr;72(4):453-9
references: 18279975
references: Antimicrob Agents Chemother. 2012 May;56(5):2524-9
references: 22330922
references: Int J Syst Evol Microbiol. 2008 Apr;58(Pt 4):1032-9
references: 18398215
references: Antimicrob Agents Chemother. 2011 Oct;55(10):4802-9
references: 21768508
references: J Clin Microbiol. 2009 Oct;47(10):3138-41
references: 19675215
references: Mycopathologia. 2012 Aug;174(2):143-7
references: 22359155
references: Stud Mycol. 2007;59:129-45
references: 18490945
references: Am J Otolaryngol. 2001 Mar-Apr;22(2):142-5
references: 11283831
references: Mycoses. 2012 Mar;55(2):148-55
references: 21929560
references: Antimicrob Agents Chemother. 2009 Oct;53(10):4514-7
references: 19635955
references: Fungal Biol. 2011 Nov;115(11):1138-50
references: 22036292
references: AJR Am J Roentgenol. 1995 Nov;165(5):1273-6
references: 7572517
references: Stud Mycol. 2011 Jun 30;69(1):19-30
references: 21892240