Date: 26 November 2013
The growth isolated from the aspergilloma in the presence of living cells of the three bacterial species in culture.The most marked inhibition occurred with Pseudomonas aeruginosa(P) and Haemophilus influenzae(H) and to a much lesser extent with Staphylococcus aureus(S). C=control. Inhibitory factors were components of the bacterial slime layers.
Copyright:
Fungal Research Trust
Notes:
Colonies on CYA 40-60 mm diam, plane or lightly wrinkled, low, dense and velutinous or with a sparse, floccose overgrowth; mycelium inconspicuous, white; conidial heads borne in a continuous, densely packed layer, Greyish Turquoise to Dark Turquoise (24-25E-F5); clear exudate sometimes produced in small amounts; reverse pale or greenish. Colonies on MEA 40-60 mm diam, similar to those on CYA but less dense and with conidia in duller colours (24-25E-F3); reverse uncoloured or greyish. Colonies on G25N less than 10 mm diam, sometimes only germination, of white mycelium. No growth at 5°C. At 37°C, colonies covering the available area, i.e. a whole Petri dish in 2 days from a single point inoculum, of similar appearance to those on CYA at 25°C, but with conidial columns longer and conidia darker, greenish grey to pure grey.
Conidiophores borne from surface hyphae, stipes 200-400 µm long, sometimes sinuous, with colourless, thin, smooth walls, enlarging gradually into pyriform vesicles; vesicles 20-30 µm diam, fertile over half or more of the enlarged area, bearing phialides only, the lateral ones characteristically bent so that the tips are approximately parallel to the stipe axis; phialides crowded, 6-8 µm long; conidia spherical to subspheroidal, 2.5-3.0 µm diam, with finely roughened or spinose walls, forming radiate heads at first, then well defined columns of conidia.
Distinctive features
This distinctive species can be recognised in the unopened Petri dish by its broad, velutinous, bluish colonies bearing characteristic, well defined columns of conidia. Growth at 37°C is exceptionally rapid. Conidial heads are also diagnostic: pyriform vesicles bear crowded phialides which bend to be roughly parallel to the stipe axis. Care should be exercised in handling cultures of this species.
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Facial erythema: Voriconazole rash in ABPA patient resistant to corticosteroids, treated with voriconazole 200mg BID. Serum voriconazole levels were very low and the dose was raised to 250mg BID. Within 3 weeks patient had developed remarkable facial erythema. His trough voriconazole concentration at this time was 370ng/ml. When voriconazole was stopped because of the facial erythema and lack of impact on his ABPA his facial erythema resolved over 4 weeks.
Forearm erythema related to voriconazole. As with facial erythema patient developed remarkable forearm erythema with lesions similar to porphyria cutanea tarda all of which resolved with stopping voriconazole.
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Eosinophilic mucin containing numerous eosinophils and Charcot-Leyden crystals (arrow). Stain PAS x400. Patient with allergic fungal sinusitis
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A whole fungal ball removed from the sinus by endoscopic surgery. No staining x 10
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Crushed fungal material removed from sinus by endoscope. No staining x40
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This 68 year man with a history of hypertension and ischemic heart disease presented with nasal obstruction, localised swelling and pain in his right cheek for about two months. CT scan showed a soft tissue mass filling the right maxillary sinus adjacent to the floor of the orbit. Maxillotomy with mass removal was performed and culture grew A. fumigatus. Histology was not performed and the patient received no antifungal therapy. 5 months later localised relapse with progression along the medial wall of the orbit was seen on CT scan.
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Yamik catheter for rinsing nasal and paranasal cavities. Image D
