Indian Journal of Pathology and Microbiology
Home About us Instructions Submission Subscribe Advertise Contact e-Alerts Ahead Of Print Login 
Users Online: 3305
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size
IJPM is coming out with a Special issue on "Genitourinary & Gynecological pathology including Breast". Please submit your articles for these issues


 
  Table of Contents    
LETTER TO EDITOR  
Year : 2011  |  Volume : 54  |  Issue : 4  |  Page : 846-847
Blastoschizomyces capitatus pneumonia: A rare case


Department of Microbiology, M S Ramaiah Medical College and Teaching Hospital, Bangalore, Karnataka, India

Click here for correspondence address and email

Date of Web Publication6-Jan-2012
 

How to cite this article:
Sreeja S, Banashankari G S, Bhavana M V, Gayathri Devi D R. Blastoschizomyces capitatus pneumonia: A rare case. Indian J Pathol Microbiol 2011;54:846-7

How to cite this URL:
Sreeja S, Banashankari G S, Bhavana M V, Gayathri Devi D R. Blastoschizomyces capitatus pneumonia: A rare case. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Jun 16];54:846-7. Available from: http://www.ijpmonline.org/text.asp?2011/54/4/846/91519


Sir,

Blastoschizomyces capitatus is normally a colonizer of skin, respiratory system, and gastrointestinal system causing opportunistic fungal infection in an immunocompromised host. [1] Apart from the classic risk factors like neutropenia and immunosuppressive drug intake, a new risk group called as apparently immunocompetent" has been described, which predisposes the individual to opportunistic fatal fungal infections. [2],[3] This includes chronic obstructive pulmonary disease (COPD), cirrhosis, diabetes, iron overload, moderate to severe renal and hepatic impairment, sepsis, and malnutrition. [4]

A 58-year-old male patient was admitted with complaints of fever, cough, and breathlessness of seven days duration. Initially, the cough was dry and later became productive with yellowish white expectoration. He was hypertensive and was suffering from COPD for which he was frequently hospitalized earlier and was on treatment for the same. He has been a chronic smoker from 18 years. On physical examination, the patient was febrile with temperature of 102°F, pulse rate of 100/min, respiratory rate of 18/min, and blood pressure of 124/84 mmHg. Oxygen saturation was 88% in room air. On respiratory examination, there was decreased air entry in the left infrascapular and infra-axillary areas with bilateral basal crepitations.

Laboratory investigations revealed total leukocyte count of 10,420 cells/mm 3 with normal range of differential count. Blood urea nitrogen was 86.6 mg/dl and serum creatinine of 3.4 mg/dl. Procalcitonin level was within normal (< 0.5 ng/ml). Chest X-ray posterior-anterior (P/A) view revealed left lower lobe consolidation with parapneumonic effusion and mild pericardial effusion. Blood culture was sent on day two and did not yield any aerobic or anaerobic organisms.

He was started on Amikacin 250 mg IV BD, Meropenem 1 g IV 8 th hourly, and Levofloxacin 500 mg OD empirically from day two of admission. There was a slight initial improvement; however, the condition of the patient progressively deteriorated with increase respiratory distress. In view of the worsening condition of the patient, a diagnostic pleural tap was done and was sent for culture and sensitivity and cytological examination. Cytological examination revealed a total count of 118 cells/mm 3 , of which 90% were lymphocytes and 10% neutrophils. Glucose was 114 mg% and protein 3.3 g%. No malignant cells were observed. Pleural fluid culture did not yield any aerobic or anaerobic organisms.

The condition of the patient did not improve; his respiratory distress increased and a diagnosis of pulmonary edema was made. Suddenly, the patient started coughing out copious amount of sputum which was sent for culture and sensitivity. No repeat blood or pleural fluid culture was sent. The same evening (day six) the patient expired. Septic shock with multiorgan failure was mentioned as the underlying cause of death.

Sputum sent on day six was processed. Gram stain of sputum showed few pus cells, occasional epithelial cells, and plenty of Gram positive thick septate hyphae with acute angle branching and few annelloconidia (Bartlett's grading 1+) [Figure 1]. The sputum was cultured onto blood agar and Sabourauds Dextrose Agar (SDA). Blood agar showed pure growth of dry, cream colored circular colonies after overnight incubation. SDA incubated at 22°C and 37°C after overnight incubation showed similar type of colonies as on blood agar [Figure 2]. Gram stain of the colonies revealed yeast cells and septate hyphae. Further, Dalmau plate culture was put up and it showed septate hyphae with blastospores and annelloconidia. The isolate was resistant to cycloheximide and did not hydrolyze urea. The isolate was identified as Blastoschizomyces capitatus. Our case suggests a possible infection of B.capitatus as we obtained a pure growth from sputum sample, but were unable to cultivate it from the blood. [5] The pathogenic etiology of this fungus was determined by clinical correlation and other laboratory investigation like pleural fluid analysis.
Figure 1: Gram stain of sputum showing septate hyphae of B. capitatus (Gram's, × 1000) magnification)

Click here to view
Figure 2: Pure growth of B.capitatus from sputum on SDA plate after overnight incubation

Click here to view



   Acknowledgment Top


For confirmation of the isolate

  1. Mr. Prakash Peralam Yegneswaran, Kasturba Medical College, Manipal, Karnataka
  2. Dr. Hemshetter, Hy -tech laboratories, Belgaum
  3. Dr. Satish Amarnath, Manipal Cure and Care, Bangalore


 
   References Top

1.Wills TS, Degryse A, Lavina J, Sinnott TJ. Blastoschizomyces capitatus pneumonia in an immunocompetent male. South Med J 2004;97:702-4.  Back to cited text no. 1
    
2.Maertens J, Meersseman W, Bleyenbergh VP. New therapies for fungal pneumonia. Curr Opin Infect Dis 2009;22:183-90.  Back to cited text no. 2
    
3.Hartemink KJ, Paul MA, Spijkstra JJ, Girbes AR, Polderman KH. Immunoparalysis as a cause for invasive aspergillosis? Intensive Care Med 2003;29:2068-71.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Bulpa P, Dive A, Sibille Y. Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary diseases. Eur Respir J 2007;30:782-800.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Martino P, Vendtti M, Micozzi A, Morace G, Polonelli L, Mantovani MP, et al. Blastoschizomyces capitatus: An emerging cause of invasive fungal disease in leukemia patients. Rev Infect Dis 1990;12:570-82.  Back to cited text no. 5
    

Top
Correspondence Address:
S Sreeja
Department of Microbiology, M.S Ramaiah Medical College and Teaching Hospital, MSR Nagar, MSRIT Post, Bangalore - 560 054, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.91519

Rights and Permissions


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


   Acknowledgment
    References
    Article Figures

 Article Access Statistics
    Viewed2584    
    Printed58    
    Emailed0    
    PDF Downloaded89    
    Comments [Add]    

Recommend this journal