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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Iatrogenic Exserohilum infection of the central nervous system: Mycological identification and histopathological findings
Modern Pathology, Volume 26, No. 2, Year 2013
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Description
An outbreak of fungal infections has been identified in patients who received epidural injections of methylprednisolone acetate that was contaminated with environmental molds. In this report, we present the mycological and histopathological findings in an index case of Exserohilum meningitis and vasculitis in an immunocompetent patient, who received a cervical spine epidural steroid injection for chronic neck pain 1 week before the onset of fulminant meningitis with subsequent multiple brain and spinal cord infarcts. The fungus was recovered from two separate cerebrospinal fluid specimens collected before initiation of antifungal therapy and at autopsy on standard bacterial and fungal culture media. The mold was identified phenotypically as Exserohilum species. DNA sequencing targeting the internal transcribed spacer region and D1/D2 region of 28S ribosomal DNA enabled further speciation as E. rostratum. Gross examination at autopsy revealed moderate brain edema with bilateral uncal herniation and a ventriculostomy tract to the third ventricle. The brainstem, cerebellum, and right orbitofrontal cortex were soft and friable, along with hemorrhages in the cerebellar vermis and thalamus. Microscopic examination demonstrated numerous fungi with septate hyphae invading blood vessel walls and inducing acute necrotizing inflammation. The leptomeninges were diffusely infiltrated by mixed inflammatory cells along with scattered foci of fungal elements. This is the first report of iatrogenic E. rostratum meningitis in humans. This report describes the microbiological procedures and histopathological features for the identification of E. rostratum (a pigmented vascularly invasive fungi), the cause of a current nationwide outbreak of fatal fungal meningitis. © 2013 USCAP, Inc. All rights reserved.
Authors & Co-Authors
McCall, Chad M.
United States, Baltimore
Johns Hopkins School of Medicine
Carroll, Karen Colleen
United States, Baltimore
Johns Hopkins School of Medicine
Lyons, Jennifer L.
United States, Baltimore
Johns Hopkins School of Medicine
Saylor, Deanna R.
United States, Baltimore
Johns Hopkins School of Medicine
Smith, Bryan R.
United States, Baltimore
Johns Hopkins School of Medicine
Tochen, Laura S.
United States, Baltimore
Johns Hopkins School of Medicine
Stevens, Robert David
United States, Baltimore
Johns Hopkins School of Medicine
Zhang, Sean X.
United States, Baltimore
Johns Hopkins School of Medicine
Statistics
Citations: 24
Authors: 8
Affiliations: 1
Identifiers
Doi:
10.1038/modpathol.2012.208
ISSN:
15300285
Research Areas
Genetics And Genomics
Health System And Policy