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Successful Posaconazole Therapy of Disseminated Alternariosis due to Alternaria infectoria in a Heart Transplant Recipient

Lyskova, Pavlina
Author Lyskova, Pavlina ORCID Laboratory of Medical Mycology, Department of Parasitology, Mycology and Mycobacteriology Prague, Public Health Institute in Usti nad Labem, Sokolovska 60, 186 00, Prague 8, Czech Republic. pavlina.lyskova@zuusti.cz Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Hnevotinska 3, 775 15, Olomouc, Czech Republic. pavlina.lyskova@zuusti.cz
Kubanek, Milos
Author Kubanek, Milos Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 1958, 140 21, Prague 4, Czech Republic
Hubka, Vit
Author Hubka, Vit Department of Botany, Faculty of Science, Charles University in Prague, Benatska 2, 128 01, Prague 2, Czech Republic Laboratory of Fungal Metabolism, Institute of Microbiology of the AS CR, Videnska 1083, 142 20, Prague 4, Czech Republic
Sticova, Eva
Author Sticova, Eva Department of Pathology, Institute for Clinical and Experimental Medicine, Videnska 1958, 140 21, Prague 4, Czech Republic
Voska, Ludek
Author Voska, Ludek Department of Pathology, Institute for Clinical and Experimental Medicine, Videnska 1958, 140 21, Prague 4, Czech Republic
Kautznerova, Dana
Author Kautznerova, Dana Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Videnska 1958, 140 21, Prague 4, Czech Republic
Kolarik, Miroslav
Author Kolarik, Miroslav Department of Botany, Faculty of Science, Charles University in Prague, Benatska 2, 128 01, Prague 2, Czech Republic Laboratory of Fungal Metabolism, Institute of Microbiology of the AS CR, Videnska 1083, 142 20, Prague 4, Czech Republic
Hamal, Petr
Author Hamal, Petr Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Hnevotinska 3, 775 15, Olomouc, Czech Republic
Vasakova, Martina
Author Vasakova, Martina Department of Respiratory Medicine, Thomayer Hospital, 1st Medical School and Charles University, Prague Videnska 800, 140 59, Prague 4, Czech Republic

Mycopathologia. 2017 Apr ; 182 (3-4) : 297-303. [epub] 20161119

ISSN 1573-0832 | 0301-486X
Source

Language English Country Netherlands Media print-electronic

Document type Case Reports, Journal Article

Persistent link https://www.medvik.cz/link/pmid27866319

PubMed 27866319
DOI 10.1007/s11046-016-0094-4
PII: 10.1007/s11046-016-0094-4
Knihovny.cz E-resources

Keywords
Alternariosis, Heart transplantation, Phaeohyphomycosis, Pulmonary infection,
MeSH
Alternaria classification drug effects genetics isolation & purification MeSH
Antifungal Agents therapeutic use MeSH
Debridement MeSH
Dermatomycoses diagnosis drug therapy microbiology MeSH
DNA, Fungal chemistry genetics MeSH
Histocytochemistry MeSH
Middle Aged MeSH
Humans MeSH
DNA, Ribosomal Spacer chemistry genetics MeSH
Microscopy MeSH
Phaeohyphomycosis diagnosis drug therapy microbiology MeSH
Lung Diseases, Fungal diagnosis drug therapy microbiology MeSH
Transplant Recipients MeSH
Sequence Analysis, DNA MeSH
Heart Transplantation MeSH
Triazoles therapeutic use MeSH
Tubulin genetics MeSH
Treatment Outcome MeSH
Check Tag
Middle Aged MeSH
Humans MeSH
Male MeSH
Publication type
Journal Article MeSH
Case Reports MeSH
Names of Substances
Antifungal Agents MeSH
DNA, Fungal MeSH
DNA, Ribosomal Spacer MeSH
posaconazole MeSH Browser
Triazoles MeSH
Tubulin MeSH

We report a case of phaeohyphomycosis caused by Alternaria infectoria in a 61-year-old heart transplant recipient with multiple skin lesions and pulmonary infiltrates. The infection spread via the haematogenous route from the primary cutaneous lesions into the lungs. The diagnosis was based on the histopathological examination, direct microscopy, skin lesion cultures and detection of Alternaria DNA in the bronchoalveolar lavage fluid using molecular methods. The treatment consisted of a combination of surgical excision and systemic antifungal therapy. Voriconazole was the first agent used but had a weak effect. Posaconazole was subsequently used to achieve a successful response. The isolate was identified as A. infectoria by sequencing of the rDNA ITS region and the partial β-tubulin gene.

Department of Botany Faculty of Science Charles University Prague Benatska 2 128 01 Prague 2 Czech Republic

Department of Cardiology Institute for Clinical and Experimental Medicine Videnska 1958 140 21 Prague 4 Czech Republic

Department of Diagnostic and Interventional Radiology Institute for Clinical and Experimental Medicine Videnska 1958 140 21 Prague 4 Czech Republic

Department of Microbiology Faculty of Medicine and Dentistry Palacky University Olomouc Hnevotinska 3 775 15 Olomouc Czech Republic

Department of Pathology Institute for Clinical and Experimental Medicine Videnska 1958 140 21 Prague 4 Czech Republic

Department of Respiratory Medicine Thomayer Hospital 1st Medical School and Charles University Prague Videnska 800 140 59 Prague 4 Czech Republic

Laboratory of Fungal Metabolism Institute of Microbiology of the AS CR Videnska 1083 142 20 Prague 4 Czech Republic

Laboratory of Medical Mycology Department of Parasitology Mycology and Mycobacteriology Prague Public Health Institute in Usti nad Labem Sokolovska 60 186 00 Prague 8 Czech Republic

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