High mortality of invasive pulmonary aspergillosis caused by Aspergillus Nigri: a series of 4 cases and review of the literature

Author:

Hélène Guegan (FR)

Abstract:

Background:
Aspergillus section Nigri is an ubiquitous environmental mold. Its pathogenicity is much more moderate compared to Aspergillus fumigatus or Aspergillus flavus. However, it is sometimes involved in superficial infection such as external otitis, and very rarely responsible for invasive aspergillosis (IA).
Methods:
We describe four cases of IA due to Aspergillus section Nigri diagnosed in the intensive care unit (ICU) of Rennes teaching hospital, France. Identification was performed using MALDI-ToF mass spectrometry (Bruker) and MSI-2 database), galactomannan (GM) was determined using Platelia GM Aspergillus (Biorad), and in vitro antifungal sensitivity using E-test strips (Biomérieux). In addition, an analysis of the literature was performed using the key words: [Aspergillus niger or Aspergillus section Nigri or Aspergillus tubingensis] AND [Invasive aspergillosis]
Results:
Three men and one woman (mean age = 70) were infected either by Aspergillus niger or the cryptic species Aspergillus tubingensis. All cases occurred in non-neutropenic patients hospitalized in ICU for liver transplantation, chronic obstructive pulmonary disease (COPD), severe COVID-19 associated pulmonary aspergillosis (CAPA), and ANCA vasculitis (also positive for SARS-CoV2). Three out of 4 patients have a diabetes mellitus. All IA were documented with a positive culture and a highly positive GM determination on broncho-alveolar lavage (BAL). Serum GM was also positive except for the CAPA patient. Minimal inhibitory concentration ranges were [0.19-0.25µg/mL] for voriconazole and [0.38-1.25µg/mL] for isavuconazole. They were treated with voriconazole initially, and in some case switched to isavuconazole in order to increase tolerance. Three patients out of 4 died at days 16, 45 and 92. The fourth patient is still hospitalized in ICU
Conclusions:
We report a series of 4 IA due to Aspergillus section Nigri in non-neutropenic patients. It is remarkable that diabetes was a frequent risk factor associated with immunosuppressive therapies for various underlying conditions. And while A. section Nigri is considered as very little virulent, a high mortality rate was noted. Finally, a cross reactivity with A. fumigatus GM antigen allows good performance of this test and MIC of voriconazole are lower than those of isavuconazole. Only limited data are available in the literature with a series of eight cases in neutropenic patients and 17 cases of endocarditis occurring after surgery. In the communication, we will review the risk factors associated with A. section Nigri IA and their management.

Abstract Number: 18

Conference Year: 2024

Conference abstracts, posters & presentations

Showing 10 posts of 17325 posts found.

  • Title

    Author

    Year

    Number

    Poster