The first case of persistent vaginitis due to Aspergillus versicolor complex in an immunocompetent patient

B.A. Borsa*, G. Ozgun, J. Houbraken, F. Okmen

Author address: 

Istanbul, Bursa, TR; Utrecht, NL; Mardin, TR

Abstract: 

Case Report: A 42 years old woman complained of pelvic pain, vaginal itching and discharge during one month. Her symptoms had been persistant in spite of the miconazole nitrate and topical clotrimazole therapy for probable candidal vaginitis. Her medical history was not notable and there was not any evidence for immunocomprimisation or usage of an intrauterin device. Fungal structures such as branched, septate hyphae together with the characteristic conidial forms were seen in the microscopic examination of the cervical smear which was sent to our pathology laboratory. Thereafter, we called the patient to take a vaginal swab sample for microbiologic evaluation. We plated this sample Sabouraud Dextrose Agar (SDA) in duplicate and incubated one of them at room temperature and the other one at 37 C. Gram stain of the second sample showed fungal structures similar with the first PAP smear. Microscopic characteristics of the microorganism showed structures of an Aspergillus species. We reported the preliminary result as Aspergillus sp. After 5 days, white, powdery and pure-looking fungal colonies were observed in SDA which was incubated at room temperature, while the SDA incubated at 37 C remained sterile. We sent the culture to the CBS-KNAW Fungal Biodiversity Center instantly for the advanced identification. Phenotypic identification showed that the isolated strain belongs to the Aspergillus versicolor complex and it was subjected to a molecular based identification for confirmation. The strain was grown for 7 days on Malt Extract Agar (MEA) and DNA extraction was performed using the UltracleanTM Microbial DNA isolation Kit (MoBio, Solana Beach, U.S.A.). The ITS regions were amplified with the primers V9G and LS266 and sequenced. The obtained sequences were compared to the NCBI sequence database and internal databases of the CBS-KNAW Fungal Biodiversity Centre and the identification was confirmed as Aspergillus versicolor complex. Unfortunately, we failed to follow-up the patient after the prelimiary report. Conclusion: Vaginitis in immunocompetent women has generally been associated with Candida species, Trichomonas vaginalis and bacteria causing mixed infections. A.versicolor is a rare human pathogen with several cases of onycomycosis, osteomyelitis, invasive pulmonary diseases and cutaneous diseases. This is the first report of vaginitis caused by a member of the A.versicolor complex supported by clinic, pathologic, microscopic, culture and molecular based data.
2013

abstract No: 

R2868

Full conference title: 

23rd European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 23rd (2013)