Abstract
A case of allergic fungal sinusitis (AFS) caused by Exserohilum rostratum, proven by culture and histopathology of the biopsy material, is described. The identity of the isolate was confirmed by sequencing of ITS region of rDNA. To the best of our knowledge, this is the first report of allergic E. rostratum sinusitis from Kuwait and Arabian Peninsula. Ten previously described cases of AFS have been reviewed. The report highlights the emerging importance of E. rostratum as a human pathogen in this region and role of molecular methods in its accurate identification.
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Adler A, Yaniv I, Samra Z, Yacobovich J, Fisher S, Avrahami G, Levy I. Exserohilum: an emerging human pathogen. Eur J Clin Microbiol Infect Dis. 2006;25:247–53.
De Hoog GS, Guarro J, Gené J, Fígueras MJ. Atlas of clinical fungi, pilot version of. 3rd ed. Baarn: CD-ROM. Centraalbureau voor Schimmelcultures; 2009.
da Cunha KC, Sutton DA, Gené J, Capilla J, Cano J, Guarro J. Molecular identification and in vitro response to antifungal drugs of clinical isolates of Exserohilum. Antimicrob Agents Chemother. 2012;56:4951–4.
Katragkou A, Pana Z-D, Perlin SD, Kontoyiannis DP, Walsh TJ, Roilides E. Exserohilum infections: review of 48 cases before the 2012 United States outbreak. Med Mycol. 2012;2014(52):376–86.
Khan ZU, Ahmad S, Theyyathel AM. Detection of Aspergillus fumigatus-specific DNA, (1-3)-β -D-glucan and galactomannan in serum and bronchoalveolar lavage specimens of experimentally infected rats. Mycoses. 2008;51:129–35.
Khan ZU, Ahmad S, Al-Ghimlas F, Al-Mutairi S, Joseph L, Chandy R, Sutton D, Guarro J. Purpureocillium lilacinum as a cause of cavitary pulmonary disease: a new clinical presentation and observations on atypical morphologic characteristics of the isolate. J Clin Microbiol. 2012;50:1800–4.
Al-Wathiqi F, Ahmad S, Khan ZU. Molecular characterization and antifungal susceptibility profile of Aspergillus flavus isolates recovered from clinical specimens in Kuwait. BMC Infect Dis. 2013;13:126. https://doi.org/10.1186/1471-2334-13-126.
Padhye AA, Ajello L, Wieden MA, Steinbronn KK. Phaeohyphomycosis of the nasal sinuses caused by a new species of Exserohilum. J Clin Microbiol. 1986;24:245–9.
Adam RD, Paquin ML, Petersen EA, et al. Phaeohyphomycosis caused by the fungal genera Bipolaris and Exserohilum. A report of 9 cases and review of the literature. Med (Baltim). 1986;65:203–7.
Colton R, Zeharia A, Karmazyn B, Buller N, Levy Y, Inbal R, Zmira S, Yaniv E. Exserohilum sinusitis presenting as proptosis in a healthy adolescent male. J Adolesc Health. 2002;30:73–5.
Aviv JE, Lawson W, Bottone EJ, Sachdev VP, Som PM. Biller HF Multiple intracranial mucoceles associated with phaeohyphomycosis of the paranasal sinuses. Arch Otolaryngol Head Neck Surg. 1990;116:1210–3.
Friedman GC, Hartwick RW, Ro JY, Saleh GY, Tarrand JJ, Ayala AG. Allergic fungal sinusitis. Report of three cases associated with dematiaceous fungi. Am J Clin Pathol. 1991;96:368–72.
Manning SC, Schaefer SD, Close LG, Vuitch F. Culture-positive allergic fungal sinusitis. Arch Otolaryngol Head Neck Surg. 1991;117:174–8.
Torres C, Ro JY, el-Naggar AK, Sim SJ, Weber RS, Ayala AG. Allergic fungal sinusitis: a clinicopathologic study of 16 cases. Hum Pathol. 1996;27:793–9.
Cody DT 2nd, Neel HB 3rd, Ferreiro JA, Roberts GD. Allergic fungal sinusitis: the Mayo Clinic experience. Laryngoscope. 1994;104:1074–9.
Chakrabarti A, Kaur H. Allergic Aspergillus rhinosinusitis. J Fungi (Basel). 2016;2:2. https://doi.org/10.3390/jof2040032.
Taj-Aldeen SJ, Hilal AA, Schell WA. Allergic fungal rhinosinusitis: a report of 8 cases. Am J Otolaryngol. 2004;25:213–8.
Al-Swiahb JN, Al-Ammar A, Al-Dousary SH. Allergic fungal sinusitis in Saudi Arabia. Saudi Med J. 2007;28:1711–4.
Chatterjee SS, Chakrabarti A. Epidemiology and medical mycology of fungal rhinosinusitis. Otorhinolaryngol Clinics. 2009;1:1–13.
Schubert MS. Allergic fungal sinusitis: pathophysiology, diagnosis and management. Med Mycol. 2009;47(Suppl. 1):S324–30.
McGinnis MR, Rinaldi MG, Winn RE. Emerging agents of phaeohyphomycosis: pathogenic species of Bipolaris and Exserohilum. J Clin Microbiol. 1986;24:250–9.
Gupta A, Xess I, Sharma SC, Mallick S. Invasive rhinosinusitis by Exserohilum rostratum in an immunocompetent child. BMJ Case Rep. 2014. https://doi.org/10.1136/bcr-2013-202380.
Kohashi S, Toyama T, Hashimoto N, Sakurai M, Kato J, Kikuchi T, Koda Y, Sugita K, Hasegawa N, Yarita K, Kamei K, Okamoto S, Mori T. Sinusitis caused by Exserohilum rostratum after cord blood transplantation for myelodysplastic syndrome: a case report and literature review. Transpl Infect Dis. 2017. https://doi.org/10.1111/tid.12805.
Centers for Disease Control and Prevention (CDC). Multistate outbreak of fungal infection associated with injection of methylprednisolone acetate solution from a single compounding pharmacy–United States, 2012. MMWR Morb Mortal Wkly Rep. 2012;61:839–42.
Casadevall A. Pirofski L Exserohilum rostratum fungal meningitis associated with methylprednisolone injections. Future Microbiol. 2013;8:135–7.
Kontoyiannis DP, Perlin DS, Roilides E, Walsh TJ. What can we learn and what do we need to know amidst the iatrogenic outbreak of Exserohilum rostratum meningitis? Clin Infect Dis. 2013;57:853–9.
Gauthier GM, Keller NP. Crossover fungal pathogens: the biology and pathogenesis of fungi capable of crossing kingdoms to infect plants and humans. Fungal Genet Biol. 2013;61:146–57.
Litvintseva AP, Hurst S, Gade L, Frace MA, Hilsabeck R, Schupp JM, Gillece JD, Roe C, Smith D, Keim P, Lockhart SR, Changayil S, Weil MR, MacCannell DR, Brandt ME, Engelthaler DM. Whole-genome analysis of Exserohilum rostratum from an outbreak of fungal meningitis and other infections. J Clin Microbiol. 2014;52:3216–22.
Revankar SG, Moudgal V, Chandrasekar P, Sobel JD. In vitro studies of Exserohilum rostratum with antifungal drugs and methylprednisolone. Antimicrob Agents Chemother. 2014;58:3564–5.
Sharma K, Goss EM, Dickstein ER, Smith ME, Johnson JA, Southwick FS, Ariena HC, van Bruggen AHC. Exserohilum rostratum: characterization of a cross-Kingdom pathogen of plants and humans. PLoS ONE. 2014;9:e108691.
Plonk DP, Luong A. Current understanding of allergic fungal rhinosinusitis and treatment implications. Curr Opin Otolaryngol Head Neck Surg. 2014;22:221–6.
Farmakiotis D, Shirazi F, Zhao Y, Saad PJ, Albert ND, Roilides E, Walsh TJ, Perlin DS, Kontoyiannis DP. Methylprednisolone enhances the growth of Exserohilum rostratum in vitro, attenuates spontaneous apoptosis, and increases mortality rates in immunocompetent Drosophila flies. J Infect Dis. 2014;210(9):1471–5. https://doi.org/10.1093/infdis/jiu289.
Nicot J. The ecology of soil fungi: some characteristics of the Microflora in desert sands. Liverpool: Liverpool University Press; 1958. p. 94–7.
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Technical support by Sandhya Vayalil and Omar Al-Musallam is thankfully acknowledged.
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Alajmi, S., Koratum, R.M., Khan, Z. et al. Allergic Fungal Sinusitis Caused by Exserohilum rostratum and Literature Review. Mycopathologia 184, 89–96 (2019). https://doi.org/10.1007/s11046-018-0288-z
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DOI: https://doi.org/10.1007/s11046-018-0288-z