Aspergillus fumigatus

Date: 7 May 2013

Copyright: n/a

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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  • Title

    Legend

  • Subacute IPA in rhematoid nodules of the lung. in a patient with rheumatoid arthritis. Histology sections stained with H&E

    RAwithasposis2

  • Subacute IPA in rheumatoid nodules of the lung. in a patient with rheumatoid arthritis. Histology sections stained with H&E

    RArthritiswithasposis

  • Subacute IPA in rheumatoid nodules of the lung. in a patient with rheumatoid arthritis. Histology sections stained with H&E.

    Rarthr2withasposis3

  • 22/09/08 This chest radiograph shows bilateral hazy diffuse airspace disease predominating in the lower lungs with subtle nodularity in upper zones.

  • Further details

    Images 3a,b,c 02/07/07
    CT thorax, after 2 weeks high dose erythromycin,  showing a 2.8cm speculated lesion in the right upper lobe with a further 1.6cm similar mass on the left upper lobe also with a tendency for a central cavitation, and ill defined consolidation involving the peripheral aspect of both upper lobes and to a lesser extent right middle and both lower lobes.

    History:
    A 71 year old woman presents with persistent dry cough. Her second CT scan of thorax shows lesions in the right and left upper lobes with ill defined consolidation in other areas (see images 3a, 3b and 3c). A PET scan is positive. She underwent right thoracotomy and sub-lobar wedge resection. Aspergillus grown from tissue and sputum grows Pseudomonas. Histology confirms the nodule to be non-small cell carcinoma (adenocarcinoma) but other lung areas show organizing pneumonia and another abscess formation with a cluster of branching septate hyphae. Despite starting itraconazole and oral ciprofloxacin she deteriorated with Type 1 respiratory failure. She was intubated and ventilated and switched to intravenous voriconazole and ceftazidime. She developed acute renal failure and then Enterococcus faecium bacteremia and she died 3 days later.

    Image 1 24/05/07 Chest X ray showing a solitary nodule in right upper lobe, for which a sub-lobar wedge resection was done, Image 2 29/05/08 CT thorax showing a 2.8cm nodular opacity in the right upper lobe. , Image 3a., Image 3b., Image 3c .,  Image 4 06/08/07 CXR showing extension of consolidation to both lung bases and right basal pneumothorax despite antibiotics and itraconazole.

  • Fig2 Left main bronchus

    Fig2 Left main bronchus

  • Fig1 Trachea and bronchi

    Fig1 Trachea and bronchi

  • Chest x ray showing needle biopsy

    Chest x ray showing needle biopsy