|Peterson, Stephen - Steve|
Submitted to: Medical Mycology
Publication Type: Peer reviewed journal
Publication Acceptance Date: 7/17/2014
Publication Date: 8/7/2014
Publication URL: http://handle.nal.usda.gov/10113/60405
Citation: Farrell, J.J., Kaspar, D.M., Tenaja, D., Baman, S., O'Rourke, L.M., Lowery, K.A., Sampath, R., Bonomo, R.A., Peterson, S.W. 2014. Acute respiratory distress caused by Neosartorya udagawae. Medical Mycology. 6:1-5. Interpretive Summary: The regional trauma center hospital asked for help identifying a mold suspected of causing fungal pneumonia in a patient. Using DNA sequencing technology, extensive DNA sequence databases of fungal diversity and phylogenetic theory we were able to quickly provide a definitive identification of the mold as Neosartorya udagawae. The physician used the identification to guide therapy for his patient. We document this rarely reported cause of pneumonia and the methods used for its identification. This research will be of interest to medical practitioners, clinical microbiology laboratories, and academic mycologists.
Technical Abstract: We describe the first reported case of acute respiratory distress syndrome (ARDS) attributed to Neosartorya infection. The mold grew rapidly in culture of both sputum and bronchoalveolar lavage (BAL) fluid from a previously healthy 43-year-old woman with ARDS, which developed as the culmination of an acute febrile illness that progressed over 5 days. Fungal cultures of endotracheal aspirate specimens as well as BAL fluid grew a fluffy white, non-sporulating mold within 48 hours. Because the cultures were initially sterile, (i.e., the colonies did not produce conidiophores in culture) phenotypic identification was not possible. A slant culture was submitted to a reference lab for identification. Our previous experience with rapid identification of invasive molds directly from BAL fluid prompted us to pursue PCR/ESI-MS testing. The latter analysis identified the mold directly from two BAL fluid samples within 48 hours as Neosartorya sp. (Aspergillus section Fumigati). After 12 days, the culture began to conidiate at 30 °C on both potato dextrose and Saubouraud agars, and the mold was identified phenotypically as Aspergillus fumigatus by our hospital lab and the reference lab. However, DNA sequence data from portions of two genes (calmodulin and ß-tubulin) strongly supported PCR/ESI-MS identification of a Neosartorya sp.