Fatal disseminated Rasamsonia infection in cystic fibrosis post-lung transplantation

Gina Hong, Marissa White, Noah Lechtzin, Natalie E. West, Robin Avery, Heather Miller, Richard Lee, Robert J. Lovari, Christian Massire, Lawrence B. Blyn, Xinglun Liang, Deanna A. Sutton, Jianmin Fu, Brian L. Wickes, Nathan P. Wiederhold, Sean X. Zhang

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Abstract

Background Disseminated fungal infections are a known serious complication in individuals with cystic fibrosis (CF) following orthotopic lung transplantation. Aspergillus fumigatus and Scedosporium species are among the more common causes of invasive fungal infection in this population. However, it is also important for clinicians to be aware of other emerging fungal species which may require markedly different antifungal therapies. Case summary We describe the first laboratory-documented case of a fatal disseminated fungal infection caused by Rasamsonia aegroticola in a 21-year-old female CF patient status post-bilateral lung transplantation, which was only identified post-mortem. Molecular analysis revealed the presence of the identical Rasamsonia strains in the patient's respiratory cultures preceding transplantation. Discussion We propose that the patient's disseminated fungal disease and death occurred as a result of recrudescence of Rasamsonia infection from her native respiratory system in the setting of profound immunosuppression post-operatively. Since Rasamsonia species have been increasingly recovered from the respiratory tract of CF patients, we further review the literature on these fungi and discuss their association with invasive fungal infections in the CF lung transplant host. Conclusion Our report suggests Rasamsonia species may be important fungal pathogens that may have fatal consequences in immunosuppressed CF patients after solid organ transplantation.

Original languageEnglish (US)
Pages (from-to)e3-e7
JournalJournal of Cystic Fibrosis
Volume16
Issue number2
DOIs
StatePublished - Mar 1 2017

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Keywords

  • Cystic fibrosis
  • Fungal infection
  • Lung transplantation
  • Rasamsonia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

Cite this

Hong, G., White, M., Lechtzin, N., West, N. E., Avery, R., Miller, H., Lee, R., Lovari, R. J., Massire, C., Blyn, L. B., Liang, X., Sutton, D. A., Fu, J., Wickes, B. L., Wiederhold, N. P., & Zhang, S. X. (2017). Fatal disseminated Rasamsonia infection in cystic fibrosis post-lung transplantation. Journal of Cystic Fibrosis, 16(2), e3-e7. https://doi.org/10.1016/j.jcf.2017.01.005