title: Successful Posaconazole Therapy of Disseminated Alternariosis due to Alternaria infectoria in a Heart Transplant Recipient.
abstract: We report a case of phaeohyphomycosis caused by Alternaria infectoria in a 61-year-old heart transplant recipient with multiple skin lesions and pulmonary infiltrates. The infection spread via the haematogenous route from the primary cutaneous lesions into the lungs. The diagnosis was based on the histopathological examination, direct microscopy, skin lesion cultures and detection of Alternaria DNA in the bronchoalveolar lavage fluid using molecular methods. The treatment consisted of a combination of surgical excision and systemic antifungal therapy. Voriconazole was the first agent used but had a weak effect. Posaconazole was subsequently used to achieve a successful response. The isolate was identified as A. infectoria by sequencing of the rDNA ITS region and the partial β-tubulin gene.
authors.affiliation: Laboratory of Medical Mycology, Department of Parasitology, Mycology and Mycobacteriology Prague, Public Health Institute in Usti nad Labem, Sokolovska 60, 186 00, Prague 8, Czech Republic. pavlina.lyskova@zuusti.cz.|Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Hnevotinska 3, 775 15, Olomouc, Czech Republic. pavlina.lyskova@zuusti.cz.
authors.forename: Pavlina
authors.identifier: http://orcid.org/0000-0002-3131-5924
authors.initials: P
authors.lastname: Lyskova
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 1958, 140 21, Prague 4, Czech Republic.
authors.forename: Milos
authors.initials: M
authors.lastname: Kubanek
authors.affiliation: Department of Botany, Faculty of Science, Charles University in Prague, Benatska 2, 128 01, Prague 2, Czech Republic.|Laboratory of Fungal Metabolism, Institute of Microbiology of the AS CR, Videnska 1083, 142 20, Prague 4, Czech Republic.
authors.forename: Vit
authors.initials: V
authors.lastname: Hubka
authors.affiliation: Department of Pathology, Institute for Clinical and Experimental Medicine, Videnska 1958, 140 21, Prague 4, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Sticova
authors.affiliation: Department of Pathology, Institute for Clinical and Experimental Medicine, Videnska 1958, 140 21, Prague 4, Czech Republic.
authors.forename: Ludek
authors.initials: L
authors.lastname: Voska
authors.affiliation: Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Videnska 1958, 140 21, Prague 4, Czech Republic.
authors.forename: Dana
authors.initials: D
authors.lastname: Kautznerova
authors.affiliation: Department of Botany, Faculty of Science, Charles University in Prague, Benatska 2, 128 01, Prague 2, Czech Republic.|Laboratory of Fungal Metabolism, Institute of Microbiology of the AS CR, Videnska 1083, 142 20, Prague 4, Czech Republic.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Kolarik
authors.affiliation: Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Hnevotinska 3, 775 15, Olomouc, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Hamal
authors.affiliation: Department of Respiratory Medicine, Thomayer Hospital, 1st Medical School and Charles University, Prague Videnska 800, 140 59, Prague 4, Czech Republic.
authors.forename: Martina
authors.initials: M
authors.lastname: Vasakova
mesh_terms: D000528:Alternaria / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D000935:Antifungal Agents / Q000627:therapeutic use*; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000235:genetics; D003646:Debridement; D003881:Dermatomycoses / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D016027:Heart Transplantation; D006651:Histocytochemistry; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D060446:Phaeohyphomycosis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D017422:Sequence Analysis, DNA; D066027:Transplant Recipients; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*; D014404:Tubulin / Q000235:genetics
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D021903:DNA, Ribosomal Spacer; D014230:Triazoles; D014404:Tubulin; C101425:posaconazole
keywords: Alternariosis; Heart transplantation; Phaeohyphomycosis; Pulmonary infection