Delayed Diagnosis of a Diffuse Invasive Gastrointestinal Aspergillosis in an Immunocompetent Patient

Invasive aspergillosis represents a clinical picture frequently associated with host’s immunosuppression which usually involves a high morbidity and mortality. In general, the most frequent fungal entry is the lungs with secondary hematogenous dissemination, but there are other hypotheses like a gastrointestinal portal of entry. There are some rare publications of cases with invasive aspergillosis in immunocompetent patients. We present the case of an immunocompetent patient without any risk factors except for age, ICU stay, and surgical intervention, who developed a septic shock by invasive gastrointestinal aspergillosis as primary infection. Due to the unusualness of the case, despite all the measures taken, the results were obtained postmortem. We want to emphasize the need not to underestimate the possibility for an invasive aspergillosis in an immunocompetent patient. Not only pulmonary but also gastrointestinal aspergillosis should be taken into account in the differential diagnosis to avoid a delay of treatment.

Microscopic, cultural and molecular evidence of disseminated invasive aspergillosis involving the lungs and the gastrointestinal tract

A patient with acute promyelocytic leukaemia developed invasive aspergillosis post chemotherapy during a pancytopenic episode, clinically involving the lungs and the gastrointestinal tract. Dichotomously branched septate fungal hyphae were demonstrated microscopically in stools and sputa. Cultures of the samples yielded Aspergillus flavus, which were identical by RFLP and random amplification of polymorphic DNA analyses and antifungal MICs, proving disseminated disease. To the best of the author's knowledge, this is the first time that boluses of fungal hyphae have been demonstrated microscopically in the stools of a patient with gastrointestinal aspergillosis.

Gastrointestinal Aspergillosis and Zygomycosis of Cattle

Gastrointestinal mycosis was diagnosed in 73 lesions of 32 cattle without a history of engorgement, and tissues of 29 animals were examined histopathologically. The omasum was the target organ for infection, followed by the rumen and reticulum. Acute necrohemorrhagic lesions dominated, with infiltration of neutrophils and thrombosis. The etiologic diagnosis was accomplished by indirect immunohistochemical staining of fungal elements with a panel of mono- and polyclonal antibodies raised against fungal antigens. Aspergillosis and zygomycosis were diagnosed in one or more organs of 11 (34.4%) and 20 (62.5%) cattle, respectively, and dual infections were found in three lesions of two animals. Candidosis was diagnosed in only one case. Hematogenous spread of fungi predominantly to the liver was seen in nine animals. Lymphogenic spread of aspergilli to mesenteric and omasal lymph nodes occurred in one and two animals, respectively. Factors that seemed to predispose to mycotic infection included presence of other diseases and intense antimicrobial therapy. These factors and post-partum status, which included 23 of 29 (79.3%) cows, predisposed to mycosis in several ways, e.g., reflux of acidic abomasal contents into the forestomachs, stasis of proventricular content, metabolic dysfunctions, and stress.