Elsevier

Mayo Clinic Proceedings

Volume 60, Issue 8, August 1985, Pages 531-537
Mayo Clinic Proceedings

Clinical Significance of Pseudallescheria boydii: A Review of 10 Years' Experience

https://doi.org/10.1016/S0025-6196(12)60571-0Get rights and content

Pseudallescheria boydii is a recognized cause of mycetoma, a chronic fungal disease that usually affects the extremities. Isolated case reports have also implicated P. boydii in infections of other sites. We report the first large series (83 isolates) of P. boydii in 46 patients, including the second report of P. boydii brain abscess and disseminated infection in a noncompromised host. Between 1974 and 1984 at our institution, P. boydii was cultured from a variety of sites: respiratory tract, 36; soft tissue, 25; bone, 9; gastric aspirate, 4; maxillary sinus, 2; wound, 2; urine, 2; brain abscess, 1; ear, 1; and toenail, 1. Pulmonary colonization proved to be the most common form of pseudallescheriasis of the lung (34 of 36 cultures in this category); 28 of the 32 patients with pulmonary infections had received immunosuppressive therapy or had an underlying disorder. The importance of isolation of P. boydii from bone and soft tissue is supported in this series because all 9 cultures from bone and 21 of 25 cultures from soft tissue were associated with infection. Of 10 cases of infection, 5 were osteomyelitis and 2 were infected wounds; in addition, maxillary sinusitis, disseminated infection, and a lung abscess occurred in 1 patient each.

Section snippets

MATERIAL AND METHODS

All specimens submitted for culture were inoculated onto inhibitory mold agar; brain-heart infusion agar that contained 10% sheep blood, 5 μg/ml of gentamicin, and 16 μg/ml of chloramphenicol; brain-heart infusion agar that contained 10% sheep blood, 5 μg/ml of gentamicin, 16 μg/ml of chloramphenicol, and 500 μg/ml of cycloheximide; and Sabouraud's 2% dextrose agar. Cultures were incubated at 30°C for 30 days. Previously reported methods were used to identify isolates of P. boydii on the basis

CULTURE RESULTS

The time from submission of the 83 cultures to identification of P. boydii ranged from 2 to 30 days (median, 10 days). Of these specimens, 36 (43%) were from the respiratory tract, 25 (30%) from soft tissue, 9 (11%) from bone, and 13 (16%) from other sites (Table 1). Of the 36 cultures (from 32 patients) from the respiratory tract, 34 (94%) represented colonization and 2 (6%) were clinically significant (Table 2). Of the 30 patients with colonization, 26 (87%) had underlying pulmonary disease

REPORT OF CASES

The 10 cases of clinically significant P. boydii infection are summarized in Table 2. Additional detailed information is provided for six of these cases.

DISCUSSION

Only 10 previous reports have described substantiated P. boydii infection of the central nervous system.6, 30, 31, 32, 33, 39, 42, 51, 52, 53 In one of these cases, meningitis had resulted from contamination of the cerebrospinal fluid during spinal anesthesia.51 Granulomatous meningitis occurred in a second, presumably healthy, patient.52 The third case of P. boydii infection was associated with pansinusitis in a woman with diabetes.53 Brain abscesses were diagnosed in the remaining seven

ACKNOWLEDGMENT

We thank Roberta M. Kondert for secretarial assistance.

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