Skip to main content

Advertisement

SpringerLink
Log in

Spondylodiscitis Due to Aspergillus terreus in an Immunocompetent Host: Case Report and Literature Review

  • Published:
Mycopathologia Aims and scope Submit manuscript

Abstract

Aspergillus terreus, a saprophytic fungus, is recognized as an emerging pathogen responsible for various infections in human beings. However, bone and joint involvement is uncommon. We report a rare case of A. terreus spondylodiscitis in a 20-year-old male with a past history of recurrent, incompletely treated pulmonary tuberculosis. Clinical signs at the time of admission included cough, low-grade fever, general weakness and left-sided back pain. Histological examination of spinal biopsy samples revealed lesions of necrosis, granulomatous inflammation and septate hyphae with acute-angle branching. A. terreus was recovered from culture. The patient received antifungal therapy with voriconazole plus caspofungin and underwent surgical debridement. Further investigations revealed no cause of primary immunodeficiency such as chronic granulomatous disease, severe combined immunodeficiency syndrome or disorders of the IL-12/IFNγ signaling pathway. Moreover, HIV serological tests resulted negative and the patient was not under immunosuppressive therapy. Unfortunately, owing to precarity and medication non-adherence, vertebral sequelae occurred. This new report emphasizes the need to consider a fungal infection in patients with spondylodiscitis, regardless of the immune status.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Guerado E, Cerván AM. Surgical treatment of spondylodiscitis, An update. Int Orthop. 2012;36:413–20.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gabrielli E, Fothergill AW, Brescini L, Sutton DA, Marchionni E, Orsetti E, et al. Osteomyelitis caused by Aspergillus species: a review of 310 reported cases. Clin Microbiol Infect. 2014;20:559–65.

    Article  CAS  PubMed  Google Scholar 

  3. Horn D, Sae-Tia S, Neofytos D. Aspergillus osteomyelitis: review of 12 cases identified by the prospective antifungal therapy alliance registry. Diagn Microbiol Infect Dis. 2009;63:384–7.

    Article  PubMed  Google Scholar 

  4. Belzunegui J, Intxausti JJ, De Dios JR, Del Val N, Valverde VR, Gonzalez C, et al. Haematogenous vertebral osteomyelitis in the elderly. Clin Rheumatol. 2000;19:344–7.

    Article  CAS  PubMed  Google Scholar 

  5. McHenry MC, Easley KA, Locker GA. Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis. 2002;34:1342–50.

    Article  PubMed  Google Scholar 

  6. Pigrau C, Almirante B, Flores X, Falco V, Rodríguez D, Gasser I, et al. Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors, and outcome. Am J Med. 2005;118:1287.

    Article  PubMed  Google Scholar 

  7. Karadimas EJ, Bunger C, Lindblad BE, Hansen ES, Høy K, Helmig P, et al. Spondylodiscitis. A retrospective study of 163 patients. Acta Orthop. 2008;79:650–9.

    Article  PubMed  Google Scholar 

  8. Seligsohn R, Rippon JW, Lerner SA. Aspergillus terreus osteomyelitis. Arch Intern Med. 1977;137:918–20.

    Article  CAS  PubMed  Google Scholar 

  9. Glotzbach RE. Aspergillus terreus infection of pseudoaneurysm of aortofemoral vascular graft with contiguous vertebral osteomyelitis. Am J Clin Pathol. 1982;77:224–7.

    Article  CAS  PubMed  Google Scholar 

  10. Brown DL, Musher DM, Taffet GE. Hematogenously acquired Aspergillus vertebral osteomyelitis in seemingly immunocompetent drug addicts. West J Med. 1987;147:84–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Grandière-Perez L, Asfar P, Foussard C, Chennebault JM, Penn P, Degasne I. Spondylodiscitis due to Aspergillus terreus during an efficient treatment against invasive pulmonary aspergillosis. Intensive Care Med. 2000;26:1010–1.

    Article  PubMed  Google Scholar 

  12. Park KU, Lee HS, Kim CJ, Kim EC. Fungal discitis due to Aspergillus terreus in a patient with acute lymphoblastic leukemia. J Korean Med Sci. 2000;15:704–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Maman E, Morin A-S, Soussan M, Coignard H, Lortholary O, Fain O. Multifocal bone aspergillosis by Aspergillus terreus in an apparently immunocompetent patient. Presse Medicale Paris Fr. 1983. 2015.

  14. Gamaletsou MN, Rammaert B, Bueno MA, Moriyama B, Sipsas NV, Kontoyiannis DP, et al. Aspergillus osteomyelitis: epidemiology, clinical manifestations, management, and outcome. J Infect. 2014;68:478–93.

    Article  PubMed  Google Scholar 

  15. Arendrup MC. Update on antifungal resistance in Aspergillus and Candida. Clin Microbiol Infect. 2014;20(Suppl 6):42–8.

    Article  CAS  PubMed  Google Scholar 

  16. Lamoth F, Alexander BD. Comparing etest and broth microdilution for antifungal susceptibility testing of the most-relevant pathogenic molds. J Clin Microbiol. 2015;53:3176–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Steinbach WJ, Perfect JR, Schell WA, Walsh TJ, Benjamin DK. In vitro analyses, animal models, and 60 clinical cases of invasive Aspergillus terreus infection. Antimicrob Agents Chemother. 2004;48:3217–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Lass-Flörl C, Griff K, Mayr A, Petzer A, Gastl G, Bonatti H, et al. Epidemiology and outcome of infections due to Aspergillus terreus: 10-year single centre experience. Br J Haematol. 2005;131:201–7.

    Article  PubMed  Google Scholar 

  19. Hachem R, Gomes MZR, El Helou G, El Zakhem A, Kassis C, Ramos E, et al. Invasive aspergillosis caused by Aspergillus terreus: an emerging opportunistic infection with poor outcome independent of azole therapy. J Antimicrob Chemother. 2014;69:3148–55.

    Article  CAS  PubMed  Google Scholar 

  20. Dotis J, Roilides E. Osteomyelitis due to Aspergillus spp. in patients with chronic granulomatous disease: comparison of Aspergillus nidulans and Aspergillus fumigatus. Int J Infect Dis. 2004;8:103–10.

    Article  PubMed  Google Scholar 

  21. Camargo JF, Husain S. Immune correlates of protection in human invasive aspergillosis. Clin Infect Dis. 2014;59:569–77.

    Article  PubMed  Google Scholar 

  22. Hachem RY, Kontoyiannis DP, Boktour MR, Afif C, Cooksley C, Bodey GP, et al. Aspergillus terreus: an emerging amphotericin B-resistant opportunistic mold in patients with hematologic malignancies. Cancer. 2004;101:1594–600.

    Article  PubMed  Google Scholar 

  23. Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, et al. Treatment of Aspergillosis: clinical practice guidelines of the infectious diseases society of America. Clin Infect Dis. 2008;46:327–60.

    Article  CAS  PubMed  Google Scholar 

  24. Pascual A, Calandra T, Bolay S, Buclin T, Bille J, Marchetti O. Voriconazole therapeutic drug monitoring in patients with invasive mycoses improves efficacy and safety outcomes. Clin Infect Dis. 2008;46:201–11.

    Article  CAS  PubMed  Google Scholar 

  25. Barchiesi F, Spreghini E, Santinelli A, Fothergill AW, Fallani S, Manso E, et al. Efficacy of caspofungin against Aspergillus terreus. Antimicrob Agents Chemother. 2005;49:5133–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Bowman JC, Abruzzo GK, Flattery AM, Gill CJ, Hickey EJ, Hsu MJ, et al. Efficacy of caspofungin against Aspergillus flavus, Aspergillus terreus, and Aspergillus nidulans. Antimicrob Agents Chemother. 2006;50:4202–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Felton T, Troke PF, Hope WW. Tissue penetration of antifungal agents. Clin Microbiol Rev. 2014;27:68–88.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We especially thank Céline Ramanantsoa and Lucia Pérez for case consultation and critical analysis of this report.

Author information

Author notes

    Authors and Affiliations

    1. Laboratoire de Microbiologie, CH Le Mans, 194 Avenue Rubillard, 72037, Le Mans Cedex 9, France

      Pauline Comacle, Cyril Hoche-Delchet & Pascale Penn

    2. Laboratoire de Parasitologie-Mycologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d’Angers, 4 rue Larrey, 49933, Angers Cedex 9, France

      Yohann Le Govic

    3. Groupe d’Etude des Interactions Hôte-Pathogène, L’UNAM Université, Université d’Angers, UPRES-EA 3142, Angers, France

      Yohann Le Govic

    4. Laboratoire d’Anatomie et Cytologie Pathologique, CH Le Mans, 194 Avenue Rubillard, 72037, Le Mans Cedex 9, France

      Jeremy Sandrini

    5. Service des Maladies Infectieuses et Tropicales, Hôpital Necker–Enfants Malades APHP, 194 rue de sèvres, 75015, Paris, France

      Claire Aguilar

    6. Service de Chirurgie Orthopédique et Traumatologie, Hôpital Européen Georges-Pompidou APHP, 20 rue Leblanc, 75908, Paris, France

      Benjamin Bouyer

    7. Service des Maladies Infectieuses et Tropicales, CH Le Mans, 194 Avenue Rubillard, 72037, Le Mans Cedex 9, France

      Sophie Blanchi

    Authors
    1. Pauline Comacle
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Yohann Le Govic
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Cyril Hoche-Delchet
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Jeremy Sandrini
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Claire Aguilar
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Benjamin Bouyer
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Sophie Blanchi
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Pascale Penn
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Yohann Le Govic.

    Additional information

    Pauline Comacle and Yohann Le Govic have contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Comacle, P., Le Govic, Y., Hoche-Delchet, C. et al. Spondylodiscitis Due to Aspergillus terreus in an Immunocompetent Host: Case Report and Literature Review. Mycopathologia 181, 575–581 (2016). https://doi.org/10.1007/s11046-016-0007-6

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s11046-016-0007-6

    Keywords

    Search

    Navigation