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Case Reports
. 2018 Dec 12;18(1):648.
doi: 10.1186/s12879-018-3527-5.

Aspergillus pseudodeflectus: a new human pathogen in liver transplant patients

Nawel Aït-Ammar  1   2 , Eric Levesque  3 , Jean-Benjamin Murat  1   2 , Sébastien Imbert  4 , Françoise Foulet  1 , Eric Dannaoui  2   5 , Françoise Botterel  6   7
Affiliations
Case Reports

Aspergillus pseudodeflectus: a new human pathogen in liver transplant patients

Nawel Aït-Ammar et al. BMC Infect Dis. .

Abstract

Background: Liver transplant recipients are at high risk of developing invasive aspergillosis and in particular by Aspergillus fumigatus which is the most commonly encountered species in this population. Other non-fumigatus Aspergillus species with reduced susceptibility to antifungal drugs can also be involved. Accurate identification associated to antifungal susceptibility testing is essential for therapy adjustment. We report a case of invasive pulmonary aspergillosis due to Aspergillus pseudodeflectus in a liver transplant recipient. To our knowledge, this is the first reported case of invasive aspergillosis due to this species with a reduced susceptibility to azoles.

Case presentation: A 64 year-old woman with drug-induced fulminant hepatitis underwent liver transplantation. Prophylactic treatment with caspofungin was introduced due to aspergillosis risk factors consisting in hemodialysis and fulminant hepatitis. Six weeks after transplantation, CT scan showed a right pulmonary opacity associated with an increase of galactomannan (index 5.4). Culture of BAL grew with several colonies of Aspergillus sp. The diagnosis of invasive aspergillosis was probable according to the EORTC criteria. The antifungal susceptibility tests (Etest®) revealed low MICs to echinocandins and amphotericin B) but high MICs to azoles. After these results, voriconazole was switched to liposomal amphotericin B. The patient died one month after diagnosis from a refractory septic shock with multiple organ failure. A molecular identification of isolate, based on partial β-tubulin and calmodulin genes, was performed and identified A. pseudodeflectus.

Conclusions: Our case raises the question of pathogenicity of this species, which belongs to Aspergillus section Usti and is genetically and morphologically very close to Aspergillus calidoustus that was previously reported in human transplant recipients.

Keywords: Aspergillosis; Aspergillus pseudodeflectus; Azoles resistance; Liver transplantation; Molecular identification.

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Conflict of interest statement

Ethics approval and consent to participate

This study was carried out in compliance with the Helsinki declaration. All liver transplants of our institution have read and approved the hospital welcome book, which states that their biological samples, after use, may be used for publication in the context of biological collections (except for genetic analyzes). Henri Mondor ethical committee approved the study protocol and database has been declared to the Commission Nationale de l’Informatique et des Libertés (CNIL) (n°1,699,340).

Consent for publication

Written informed consent was obtained from the patient’s family for the publication of this manuscript. No images or videos relating to the individual person were included in this article.

Competing interests

ED has received grants from Gilead, Ferrer, and Biorad, and payment for lectures from Gilead, MSD, and Schering. ED has also been a consultant for Astellas and Innothera. FB received grants from Astellas, and payment for lectures from Merck. NAA, EL, JBM, SI, FF, declare no conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Aspergillus pseudodeflectus isolated from BAL. a. Colony at 25 °C after 7 days. A’. Malt Extract Agar (MEA). A". Czapek Yeast Autolysate Agar (CYA) + 20% sucrose. B. Microscopic aspect with blue lactophenol staining (CYA). b′. Magnification × 200. B″. Magnification × 1000. Arrows show curved conidiophores
Fig. 2
Fig. 2
Neighbour-joining tree based on β-tubulin and calmodulin genes sequence data of HMN Aspergillus pseudodeflectus. Numbers above the nodes represent bootstrap values. These values were generated from 1000 replicates. The bar length represents the specified genetic distance. Only values above 70% are indicated
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