Ayşe KALKANCI, Zeynep Arzu YEGİN, Gülsan SUCAK TÜRKÖZ, Merih ÇAKAR KIZIL, Özlem GÜZEL TUNÇCAN, Ramazan CİVELEK, Gonca ERBAŞ

Acremonium Potronii Associated Pneumonia in an Allogeneic Stem Cell Transplantation

Enfeksiyonlar allojeneik kök hücre nakli yapılan hastalarda önemli morbidite ve mortalite nedenidir. Graft versus host hastalığı, steroid tedavisi, sitomegalovirus enfeksiyonu, nötropeni ve relaps/dirençli hastalık invaziv fungal enfeksiyonlar için bilinen risk faktörleri arasındadır. Acremonium toprakta, böceklerde, bitkilerde ve diğer çevresel yapılarda bulunabilen bir mantar türüdür. Nadir olarak immunsupresif hastalarda pnömoni, artrit, osteomyelit, endokardit, peritonit, menenjit ve sepsis gibi dissemine enfeksiyonlara neden olabilmektedir. İmidazol, florositozin, amfoterisin B gibi antifungal ajanlara karşı duyarlılığı düşüktür. Terbinafin dışındaki tüm antifungal ajanlar için minimum inhibitör konsantrasyonu yüksektir. Yavaş üreme özelliğine sahiptir, bu nedenle üremenin sağlanması için kültürler en az iki hafta süreyle bekletilmelidir. Acremonium, özellikle olgumuzda tespit edilen Acremonium potronii, allojeneik kök hücre nakli yapılan ağır immunsupresif hastalarda gelişen sistemik mantar enfeksiyonlarında düşünülmesi gereken bir mantar türüdür.

Allojeneik Kök Hücre Nakli Yapılan Bir Olguda Gelişen Acremonium Potronii İlişkili Pnömoni

Infections are one of the major causes of morbidity and mortality after allogeneic hematopoietic stem cell transplantation. Clinically significant graft versus host disease, steroid therapy, cytomegalovirus infection, recurrent neutropenia and relapsed/refractory disease are the recognized risk factors for invasive fungal infections. Acremonium, which is a large polyphyletic fungal genus, is present in soil, insects, plants and other environmental substrates. Disseminated infections are rare with the reported cases limited to immunocompromised patients with a large clinical spectrum including pneumonia, arthritis, osteomyelitis, endocarditis, peritonitis, meningitis and sepsis. Acremonium species present low susceptibility to most antifungals including imidazoles, fluorocytosine and amphotericin B. For the clinically relevant species, the minimum inhibitory concentrations for all antifungal agents are high, except terbinafine. As Acremonium spp grow slowly, cultures should be kept for at least 2 weeks to ensure detection of a positive sample. Clinicians should be aware that Acremonium spp, particularly A. Potronii, might be one of the causative fungi of systemic infection in severely immunocompromised allogeneic hematopoietic stem cell transplantation recipients.

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Reynolds C, Ratanatharathorn V, Adams P, Braun T, Silver S, Ayash L, Carson E, Eisbruch A, Dawson LA, McDonagh K, Ferrara J, Uberti J. Allogeneic stem cell transplantation reduces disease progression compared to autologous transplantation in patients with multiple myeloma. Bone Marrow Transplant 2001;27:801-7.
Efebera YA, Qureshi SR, Cole SM, Saliba R, Pelosini M, Patel RM, Koca E, Mendoza FL, Wang M, Shah J, Alousi A, Hosing C, Popat U, Kebriaei P, Anderlini P,Khouri IF, Champlin R, Giralt S, Qazilbash MH. Reduced-intensity allogeneic hematopoietic stem cell transplantation for relapsed multiple myeloma. Biol Blood Marrow Transplant 2010;16:1122-9.
Safdar A, Rodriguez GH, Mihu CN, Mora-Ramos L, Mulanovich V, Chemaly RF, Champlin RE, Khouri I. Infections in non-myeloablative hematopoietic stem cell transplantation patients with lymphoid malignancies: spectrum of infections, predictors of outcome and proposed guidelines for fungal infection prevention. Bone Marrow Transplant 2010;45:339-47.
Marr KA. Delayed opportunistic infections in hematopoietic stem cell transplantation patients: a surmountable challenge. Hematology Am Soc Hematol Educ Program 2012;2012:265-70.
Hagen EA, Stern H, Porter D, Duffy K, Foley K, Luger S, Schuster SJ, Stadtmauer EA, Schuster MG. High rate of invasive fungal infections following nonmyeloablative allogeneic transplantation. Clin Infect Dis 2003;36:9-15.
Yamazaki R, Mori T, Aisa Y, Nakazato T, Mihara A, Ikeda Y, Okamoto S. Systemic infection due to Acremonium after allogeneic peripheral blood stem cell transplantation. Intern Med 2006;45:989-90.
Ioakimidou A, Vyzantiadis TA, Sakellari I, Arabatzis M, Smias C, Douka V, Velegraki A, Anagnostopoulos A, Malissiovas N. An unusual cluster of Acremonium kiliense fungaemias in a haematopoietic cell transplantation unit. Diagn Microbiol Infect Dis 2013;75:313-6.
Herbrecht R, Letscher-Bru V, Fohrer C, Campos F, Natarajan-Ame S, Zamfir A, Waller J. Acremonium strictum pulmonary infection in a leukemic patient successfully treated with posaconazole after failure of amphotericin B. Eur J Clin Microbiol Infect Dis 2002;21:814- 7.
Schell WA, Perfect JR. Fatal, disseminated Acremonium strictum infection in a neutropenic host. J Clin Microbiol 1996;34:1333-6.
Perdomo H, Sutton DA, García D, Fothergill AW, Cano J, Gené J, Summerbell RC, Rinaldi MG, Guarro J. Spectrum of clinically relevant Acremonium species in the United States. J Clin Microbiol 2011;49:243-56.