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International Journal of Infectious Diseases (2009)Received 12 July 2008; received in revised form 10 November 2008; accepted 31 January 2009

They are the largest phylum of Fungiwhen reproducing sexually, they produce

nonmotile spores in a distinctive type of microscopic cell called an “*****” means "sac" or "wineskin”

Commonly called “Sac Fungi”

Taxonomy

Domain: Eukaryota

Kingdom: Fungi

Subkingdom: Dikarya

Phylum: Ascomycota

Subphylum: Pezizomycotina

Class: Euascomycetes

Subclass: Hypocreomycetidae

Order: Microascales

Family: Microascaceae

Hyphae are septate and hyaline.

Conidiophores may occur singly or be penicillate

Conidia are hyaline, occur in chains, truncate, and are ovoidal

They are distinguished from most other hyaline species by have a pointed apex

Scopulariopsis acremonium

Scopulariopsis is a cosmopolitan filamentous fungus that thrives in soil, plant material, feathers, and insects.

The genus Scopulariopsis is distinctive as it contains both moniliaceous (hyaline) and dematiaceous species

Scopulariopsis species is rarely a cause of human infection,

immunocompromised patients. 

Colonies on potato dextrose agar at 25°C grow slowly and are initially white, becoming buff at maturity. Colonies are powdery to granular

Skin lesions, brain abscess, mycetoma, keratitis, endocarditis, endophthalmitis, invasive sinusitis, and disseminated infections due to Scopulariopsis species have been rarely reported. 

Infections caused by Scopulariopsis are observed mainly in immunocompromised patients such as bone marrow transplant recipients.

  Of the group, Scopulariopsis brevicaulis is by far the

most common species encountered in an indoor environment.

Other common species include: Scopulariopsis acremonium, Scopulariopsis halophilica, and Scopulariopsis fimicola

Invasive fungal sinusitis is a potentially fatal disease that typically affects immunocompromised patients

Invasive fungal sinusitis is a rare condition with a high mortality rate.

Fungal infection of the sinuses can occur when fungal organisms are inhaled and deposited in the nasal passageways and paranasal sinuses, causing inflammation. The dark, moist environment of the sinuses is ideal for fungi, which can reproduce without light or food

Immunocompromised patients, such as those receiving intensive chemotherapy or undergoing an allogeneic HSCT or suffering from SCID.

Infection with Scopulariopsis acremonium has only been described in two immunocompromised patients.

A rare case of invasive fungal sinusitis caused by S. acremonium in a bone marrow transplant patient, which developed during antifungal prophylaxis with voriconazole.

CASE REPORT

In January 2005, a 50-year-old woman, resident in Italy for approximately 10 years, received the diagnosis of stage IIA multiple myeloma

January to April 2005- four courses of combined chemotherapy and dexamethasone

In August 2005- patient underwent to an autologous stem cell transplant

In March 2006- allogeneic HSCTIn July 2006, biopsy-proven acute intestinal GVHD.

Appearance of sinusitisIn August 2007, acute blindness and edema of the

right eyelidAn MRI scan showed maxillary, ethmoidal, and

frontal sinusitis and an ocular fundus evaluation revealed an ischemia of the right retinal artery

Anatomy of the Sinuses

After 10 days of treatment- left-sided hemiplegia, large cerebral ischemia of the right temporal area

Fourteen days after admission, a culture from the sinus secretion grew Scopulariopsis acremonium.

The minimum inhibitory concentrations (MICs)

Treatment with echinocandins (caspofungin) was started.

But patient died two days later due to a new episode of brain ischemia and hemorrhage.

Autopsy was done.

Autopsy

Autopsy revealed the presence of thrombosis of the right carotid artery and of the middle cerebral artery, with the consistent presence of fungal filamentous hyphae in the vessel walls. Necrotic material and a polymorphonuclear infiltrate were found in the sinuses. The autopsy concluded that death was as a result of a septic embolism from sinus to arterial circulation, caused by Scopulariopsis acremonium

Infections due to infrequently encountered fungi

opportunistic molds are often refractory to conventional antifungal agents

Mold infections are frequently disseminated to numerous other organs and tissues

Only two cases of infection by S. acremonium have been reported in the literature, one in a leukemic patient and one in a lung transplant patient.

conclusion

S. acremonium infection in HSCT patients is rare but can be a dramatic event due to the natural reduced sensitivity of the pathogen to antifungal drugs and its potential to spread rapidly by blood diffusion.

Early diagnostic procedures such as biopsy, or at the least endoscopic cultures, should be performed prior to starting empirical antifungal treatment in order to improve the outcome of this disease in the immunocompromised host

Thank you…