A rare case of Aspergillus terreus endogenous endophthalmitis in a non-immunocompromised patient and laboratory research

Ying Zhao


Aspergillus terreus is a common soil saprophyte which is also clinically important, causing infections
ranging from superficial infections, such as onychomycosis, to invasive aspergillosis (IA) in severe
immunocompromised hosts. Endophthalmitis caused by A. terreus is rarely reported in the literature.
We report a case of endogenous endophthalmitis caused by A. terreus in a nonimmunocompromised
patient with hypertension, taking regular medications and blood pressure controlled in the normal
range, but without prior intraocular eye surgery or history of immunosuppression.
A vitreous biopsy was taken for culture and direct smear microscopy and further identified the isolate
from culture positive plates by phenotype observation and molecular methods. In vitro antifungal
susceptibility test were done by Etest.
Fungal spores and septate hyphae were found in vitreous direct smear (Figure 1). Tiny hair-like
colonies grew on SDA after 7days’ culture but the colony morphology is still atypical after 10 days’
culture (Figure 2). We found attached spores by using scotch tape to stick the colonies on the side to
(Figure 3). After 2 times generation (nearly a month), the strain showed typical colony (Figure 4) and
microscopic morphology (Figure 5). The isolate was final identified as A. terreus according to
morphology and the results of phenotypic and molecular identification. The isolate’s MICs (μg/mL) to
itraconazole, voriconazole, amphotericin B were 0.25, 0.125, and 2, respectively.
Early diagnostic and therapeutic vitrectomy is useful for obtaining sufficient samples for organism
identification and also to reduce organism load and inflammatory mediators in the eye. Timely
reporting the results of direct smear to clinical physician is very meaningful for the initial selection of
antimicrobial agents. For the phenotype atypical but clinical important filamentous fungi, using ITS
sequence analysis and other molecular identification methods can help to identify the fungal pathogen



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26th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 26th (2016)