title: Fatal disseminated Rasamsonia infection in cystic fibrosis post-lung transplantation.
abstract: BACKGROUND
  Disseminated fungal infections are a known serious complication in individuals with cystic fibrosis (CF) following orthotopic lung transplantation. Aspergillus fumigatus and Scedosporium species are among the more common causes of invasive fungal infection in this population. However, it is also important for clinicians to be aware of other emerging fungal species which may require markedly different antifungal therapies.
  
  
  METHODS
  We describe the first laboratory-documented case of a fatal disseminated fungal infection caused by Rasamsonia aegroticola in a 21-year-old female CF patient status post-bilateral lung transplantation, which was only identified post-mortem. Molecular analysis revealed the presence of the identical Rasamsonia strains in the patient's respiratory cultures preceding transplantation.
  
  
  CONCLUSIONS
  We propose that the patient's disseminated fungal disease and death occurred as a result of recrudescence of Rasamsonia infection from her native respiratory system in the setting of profound immunosuppression post-operatively. Since Rasamsonia species have been increasingly recovered from the respiratory tract of CF patients, we further review the literature on these fungi and discuss their association with invasive fungal infections in the CF lung transplant host.
  
  
  CONCLUSIONS
  Our report suggests Rasamsonia species may be important fungal pathogens that may have fatal consequences in immunosuppressed CF patients after solid organ transplantation.
authors.affiliation: Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: Gina
authors.initials: G
authors.lastname: Hong
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, USA.
authors.forename: Marissa
authors.initials: M
authors.lastname: White
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Noah
authors.initials: N
authors.lastname: Lechtzin
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Natalie E
authors.initials: NE
authors.lastname: West
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University School of Medicine, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Avery
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Miller
authors.affiliation: Microbiology Laboratory, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.affiliation: Ibis Biosciences, Abbott, Carlsbad, CA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lovari
authors.affiliation: Ibis Biosciences, Abbott, Carlsbad, CA, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Massire
authors.affiliation: Ibis Biosciences, Abbott, Carlsbad, CA, USA.
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Blyn
authors.affiliation: Department of Geriatrics, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China.
authors.forename: Xinglun
authors.initials: X
authors.lastname: Liang
authors.affiliation: Fungus Testing Laboratory, 7703 Floyd Curl Drive, MC7750 San Antonio, TX 78229-3900, USA.
authors.forename: Deanna A
authors.initials: DA
authors.lastname: Sutton
authors.affiliation: Department of Microbiology and Immunology, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Fu
authors.affiliation: Department of Microbiology and Immunology, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Wickes
authors.affiliation: Fungus Testing Laboratory, 7703 Floyd Curl Drive, MC7750 San Antonio, TX 78229-3900, USA.
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Wiederhold
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, USA; Microbiology Laboratory, Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: szhang28@jhmi.edu.
authors.forename: Sean X
authors.initials: SX
authors.lastname: Zhang
mesh_terms: D000328:Adult; D003550:Cystic Fibrosis / Q000601:surgery*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D000072742:Invasive Fungal Infections / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods; D009894:Opportunistic Infections / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology
keywords: Cystic fibrosis; Fungal infection; Lung transplantation; Rasamsonia