Mold-Associated Syndromes

Mold-Associated Syndromes

 

Molds may cause human disease that ranges in spectrum from colonization to uniformly fatal. Molds may also cause hypersensitivity reactions.

  • Invasive fungal disease occurs most commonly in immunocompromised patients
  • Molds most often associated with significant disease include:
    • Hyaline molds such as:
      • Aspergillus fumigatus
      • Fusarium spp
      • Scedosporium spp
    • Zygomycetes
      • Hallmarks of Zygomycetes infection are vascular invasion and tissue necrosis (presence of black tissue)
    • Dematiaceous molds
Mold-Associated Respiratory Signs and Symptoms
  Hyaline molds
A – Aspergillus fumigatus
F – Fusarium
S – Scedosporium		 Zygomycetes Dematiaceous
Phaehyphomycosis
Chromoblastomycosi
Mycetoma
At risk All immunocompromised patients
Special risk – patients with acute leukemia or organ transplant (prolonged neutropenia)		 All immunocompromised patients
Special risk – organ transplant recipients and patients with a propensity to be acidotic (diabetes, renal insufficiency) and patients treated with deferoxamine for iron overload		 All immunocompromised patients
Pneumonia Acute respiratory distress syndrome (ARDS)
Chronic inflammatory process in colonized cystic fibrosis patients (A,S)

Necrotizing pneumonias (halo and crescent signs) (A)

Pulmonary mycetoma (S)

Rapidly progressive consolidation; also have tracheobronchitis in lung transplantation (A,S)

 Infiltrate or cavity on X-ray

Hemoptysis

Necrotizing pneumonias

Mycotic pulmonary aneurysms

 Rare pulmonary chromoblastomycosis
Hypersensitivity Endobronchial saprophytic Scedosporium and aspergillus (fungal balls) (A,S)

Allergic bronchopulmonary aspergillosis (ABPA) and Scedosporium pneumonia (A,S)

Asthma (A)

    
Mold-Associated Signs and Symptoms – Sites Other Than Pulmonary
  Hyaline molds
A – Aspergillus fumigatus
F – Fusarium
S – Scedosporium		 Zygomycetes Dematiaceous
Phaeohyphomycosis
Chromoblastomycosis
Mycetoma
Ophthalmic Endophthalmitis  (A,S)
Keratitis (A,F)		    
Otorhinolaryngologic Otomycosis – growth on cerumen and detritus in ear canal (A,F,S)
Sinus (A,F,S)
  • Ball of hyphae with obstruction
  • Acute invasive rhinosinusitis
  • Chronic fibrosing granulomatous inflammation with tissue invasion
 Orbital cellulitis

Cranial nerve palsies

Cavernous sinus and internal artery thromboses

Invasive rhinosinusitis

 Phaeohyphomycoses (allergic)
Fungal sinusitis
Acute invasive rhinosinusitis
Central nervous system Brain abscess (A,F,S)
Meningitis (rare) (A,F,S)
Vascular infarcts in brain (A)		 Brain abscesses (generally invasive from sinuses)
Meningitis (rare)		 Chromomycosis – rare CNS dissemination
Phaeohyphomycoses – brain abscess, meningitis
Cardiac/mediastinum Endocarditis (A,F,S)
Pericarditis (A,F,S)		 Endocarditis  
Hepatosplenic or gastrointestinal (GI) system involvement   All portions of GI tract with ulcers (stomach most commonly affected)  
Dermatologic Onychomycosis (A,F,S)
Invasion of catheters (A,F)
Burns (A)
Necrotic skin lesions (S)
Papules, nodules (tender) (F)		 Ulcers
Necrosis		 Chromomycosis
Blastomycosis nodules turn into verrucous lesions and plaques
Mycetoma – usually lower extremity nodule with draining sinus tract and extrusion of granules
Phaeohyphomycoses – single red nodule on extremity
Chronic chromomycosis may lead to squamous cell carcinoma
Bone Vertebral (A,S; most common for A)
Long bones and joints (S)		 Rare bone necrosis  
Diagnosis of Mold-Associated Syndromes
  Hyaline molds
A – Aspergillus fumigatus
F – Fusarium
S – Scedosporium		 Zygomycetes Dematiaceous
Pneumonia Tracheal lavage with fungal stain Galactomannan tissue culture Tissue culture Not applicable
Hypersensitivity Clinical deterioration (increased cough, wheezing, exercise intolerance, exercise-induced asthma, increased sputum, decrease in pulmonary function)
– Immediate cutaneous reactivity to Aspergillus or presence of IgE to A. fumigatus
– Total serum IgE concentration >500 IU/mL (>1200 ng/mL)
– One of the following:
Precipitins (or IgG) to A. fumigatus, new or recent abnormalities on computed tomography (bronchiectasis) or chest radiograph (mucus plugging/infiltrates)
Fungal balls: sputum culture+ Aspergillus antibodies CF, ID		 Not applicable Not applicable
Ophthalmic Culture Not applicable Not applicable
Otorhinolaryngologic

Ball of hyphae with obstruction

  • CT scan and culture

Acute invasive rhinosinusitis associated with invasive disease

  • CT scan and tissue culture
  • Chronic fibrosing granulomatous inflammation with tissue invasion
 Tissue culture Allergic – CT with lack of invasion
Acute invasion – CT scan and tissue culture
Central nervous system Cerebral spinal fluid (CSF) stain and culture Tissue culture Chromomycosis – culture
Phaeohyphomycoses – culture
Cardiac/mediastinum Blood culture
Galactomannan
Antigen		 Blood culture  
Hepatosplenic or gastrointestinal (GI) system involvement   Tissue culture  
Dermatologic Fungal stain and culture of pus KOH/Calcofluor White Stain and culture Chromomycosis – fungal stain
Bone Bone marrow culture Bone marrow culture Mycetoma – stain of pus
Disseminated/invasive Blood culture
Galactomannan
Antigen		 Blood culture  

See Also