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Colonization of a Central Venous Catheter by the Hyaline Fungus Fusarium solani Species Complex: A Case Report and SEM Imaging.

Colombo A, Maccari G, Congiu T, Basso P, Baj A, Toniolo A - Case Rep Med (2013)

Bottom Line: Results of blood cultures drawn from peripheral venous sites or through the CVC were compared.In the absence of systemic infection, catheter removal and prophylactic voriconazole therapy were followed by disappearance of febrile events and recovery.Thus, indwelling catheters are prone to contamination by environmental fungi.

View Article: PubMed Central - PubMed

Affiliation: Laboratory of Medical Microbiology, Department of Clinical and Experimental Medicine, University of Insubria and Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy.

ABSTRACT
The incidence of opportunistic infections by filamentous fungi is increasing partly due to the widespread use of central venous catheters (CVC), indwelling medical devices, and antineoplastic/immunosuppressive drugs. The case of a 13-year-old boy under treatment for acute lymphoblastic leukemia is presented. The boy was readmitted to the Pediatric Ward for intermittent fever of unknown origin. Results of blood cultures drawn from peripheral venous sites or through the CVC were compared. CVC-derived bottles (but not those from peripheral veins) yielded hyaline fungi that, based on morphology, were identified as belonging to the Fusarium solani species complex. Gene amplification and direct sequencing of the fungal ITS1 rRNA region and the EF-1alpha gene confirmed the isolate as belonging to the Fusarium solani species complex. Portions of the CVC were analyzed by scanning electron microscopy. Fungi mycelia with long protruding hyphae were seen into the lumen. The firm adhesion of the fungal formation to the inner surface of the catheter was evident. In the absence of systemic infection, catheter removal and prophylactic voriconazole therapy were followed by disappearance of febrile events and recovery. Thus, indwelling catheters are prone to contamination by environmental fungi.

No MeSH data available.


Related in: MedlinePlus

Scanning electron microscopy images of the tip and cuff of the central venous catheter removed from a child with intermittent fever of unknown origin. (a) Mycelial formation in the catheter lumen. Of note is the long fungal protrusion into the lumen. ((b) and (c)) Magnifications show adhesion of the fungal formation to the inner surface of catheter. (d) Detail of the aerial mycelium.
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fig2: Scanning electron microscopy images of the tip and cuff of the central venous catheter removed from a child with intermittent fever of unknown origin. (a) Mycelial formation in the catheter lumen. Of note is the long fungal protrusion into the lumen. ((b) and (c)) Magnifications show adhesion of the fungal formation to the inner surface of catheter. (d) Detail of the aerial mycelium.

Mentions: Tip and cuff of the removed CVC were cultured separately in Sabouraud dextrose agar plates. After 6-day incubation, fungal colonies developed. Again, morphological and molecular analysis identified the isolate as F. solani species complex. To investigate catheter colonization, CVC portions were prepared for scanning electron microscope (SEM) according to published methods [9]. SEM documented the adhesion of F. solani mycelia to the inner CVC wall (Figure 2). In the absence of positive blood cultures from peripheral venous sites, catheter removal and prophylactic antifungal therapy resulted in the disappearance of febrile events. The patient was discharged 30 days later and successfully completed chemotherapy at home.


Colonization of a Central Venous Catheter by the Hyaline Fungus Fusarium solani Species Complex: A Case Report and SEM Imaging.

Colombo A, Maccari G, Congiu T, Basso P, Baj A, Toniolo A - Case Rep Med (2013)

Scanning electron microscopy images of the tip and cuff of the central venous catheter removed from a child with intermittent fever of unknown origin. (a) Mycelial formation in the catheter lumen. Of note is the long fungal protrusion into the lumen. ((b) and (c)) Magnifications show adhesion of the fungal formation to the inner surface of catheter. (d) Detail of the aerial mycelium.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3713600&req=5

fig2: Scanning electron microscopy images of the tip and cuff of the central venous catheter removed from a child with intermittent fever of unknown origin. (a) Mycelial formation in the catheter lumen. Of note is the long fungal protrusion into the lumen. ((b) and (c)) Magnifications show adhesion of the fungal formation to the inner surface of catheter. (d) Detail of the aerial mycelium.
Mentions: Tip and cuff of the removed CVC were cultured separately in Sabouraud dextrose agar plates. After 6-day incubation, fungal colonies developed. Again, morphological and molecular analysis identified the isolate as F. solani species complex. To investigate catheter colonization, CVC portions were prepared for scanning electron microscope (SEM) according to published methods [9]. SEM documented the adhesion of F. solani mycelia to the inner CVC wall (Figure 2). In the absence of positive blood cultures from peripheral venous sites, catheter removal and prophylactic antifungal therapy resulted in the disappearance of febrile events. The patient was discharged 30 days later and successfully completed chemotherapy at home.

Bottom Line: Results of blood cultures drawn from peripheral venous sites or through the CVC were compared.In the absence of systemic infection, catheter removal and prophylactic voriconazole therapy were followed by disappearance of febrile events and recovery.Thus, indwelling catheters are prone to contamination by environmental fungi.

View Article: PubMed Central - PubMed

Affiliation: Laboratory of Medical Microbiology, Department of Clinical and Experimental Medicine, University of Insubria and Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy.

ABSTRACT
The incidence of opportunistic infections by filamentous fungi is increasing partly due to the widespread use of central venous catheters (CVC), indwelling medical devices, and antineoplastic/immunosuppressive drugs. The case of a 13-year-old boy under treatment for acute lymphoblastic leukemia is presented. The boy was readmitted to the Pediatric Ward for intermittent fever of unknown origin. Results of blood cultures drawn from peripheral venous sites or through the CVC were compared. CVC-derived bottles (but not those from peripheral veins) yielded hyaline fungi that, based on morphology, were identified as belonging to the Fusarium solani species complex. Gene amplification and direct sequencing of the fungal ITS1 rRNA region and the EF-1alpha gene confirmed the isolate as belonging to the Fusarium solani species complex. Portions of the CVC were analyzed by scanning electron microscopy. Fungi mycelia with long protruding hyphae were seen into the lumen. The firm adhesion of the fungal formation to the inner surface of the catheter was evident. In the absence of systemic infection, catheter removal and prophylactic voriconazole therapy were followed by disappearance of febrile events and recovery. Thus, indwelling catheters are prone to contamination by environmental fungi.

No MeSH data available.


Related in: MedlinePlus