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International Journal of Infectious Diseases (2009)

Received 12 July 2008; received in revised form 10 November 2008;
accepted 31 January 2009
 They are the largest phylum of Fungi
 when reproducing sexually, they produce nonmotile spores in
a distinctive type of microscopic cell called an “*****” means
"sac" or "wineskin”

 Commonly called “Sac Fungi”

Domain: Eukaryota
Kingdom: Fungi
Subkingdom: Dikarya
Phylum: Ascomycota
Subphylum: Pezizomycotina
Class: Euascomycetes

Subclass: Hypocreomycetidae
Order: Microascales
Family: Microascaceae

Taxonomy
 Hyphae are septate and hyaline.

 Conidiophores may occur singly or be penicillate

 Conidia are hyaline, occur in chains, truncate, and are ovoidal

 They are distinguished from most other hyaline species by have

a pointed apex
Scopulariopsis
acremonium
 Scopulariopsis is a cosmopolitan filamentous fungus that
thrives in soil, plant material, feathers, and insects.

 Thegenus Scopulariopsis is distinctive as it contains both

moniliaceous (hyaline) and dematiaceous species

 Scopulariopsis species is rarely a cause of human infection,

 immunocompromised patients. 
 Colonies on potato dextrose agar at 25°C grow slowly and
are initially white, becoming buff at maturity. Colonies are
powdery to granular
 Skin lesions, brain abscess, mycetoma, keratitis, endocarditis,
endophthalmitis, invasive sinusitis, and disseminated infections
due to Scopulariopsis species have been rarely reported. 

 Infections caused by Scopulariopsis are observed mainly in

immunocompromised patients such as bone marrow transplant
recipients.
 
 Of the group, Scopulariopsis brevicaulis is by far the most
common species encountered in an indoor environment.

 Other common species include: Scopulariopsis acremonium,

Scopulariopsis halophilica, and Scopulariopsis fimicola
 Invasive fungal sinusitis is a potentially fatal disease that
typically affects immunocompromised patients
 Invasive fungal sinusitis is a rare condition with a high
mortality rate.
 Fungal infection of the sinuses can occur when fungal
organisms are inhaled and deposited in the nasal passageways
and paranasal sinuses, causing inflammation. The dark, moist
environment of the sinuses is ideal for fungi, which can
reproduce without light or food
 Immunocompromised patients, such as those receiving
intensive chemotherapy or undergoing an allogeneic HSCT
or suffering from SCID.

 Infectionwith Scopulariopsis acremonium has only been

described in two immunocompromised patients.

 A rarecase of invasive fungal sinusitis caused by S.

acremonium in a bone marrow transplant patient, which
developed during antifungal prophylaxis with voriconazole.

CASE REPORT
 In January 2005, a 50-year-old woman, resident in Italy for
approximately 10 years, received the diagnosis of stage IIA
multiple myeloma
 January to April 2005- four courses of combined chemotherapy
and dexamethasone
 In August 2005- patient underwent to an autologous stem cell
transplant
 In March 2006- allogeneic HSCT
 In July 2006, biopsy-proven acute intestinal GVHD.
Appearance of sinusitis
 In August 2007, acute blindness and edema of the right eyelid
 An MRI scan showed maxillary, ethmoidal, and frontal sinusitis
and an ocular fundus evaluation revealed an ischemia of the
right retinal artery
Anatomy of the Sinuses
 After10 days of treatment- left-sided hemiplegia, large cerebral
ischemia of the right temporal area

 Fourteendays after admission, a culture from the sinus secretion

grew Scopulariopsis acremonium.

 The minimum inhibitory concentrations (MICs)

 Treatment with echinocandins (caspofungin) was started.

 But patient died two days later due to a new episode of brain
ischemia and hemorrhage.

 Autopsy was done.

Autopsy revealed the presence of thrombosis of the right carotid
artery and of the middle cerebral artery, with the consistent
presence of fungal filamentous hyphae in the vessel walls.
Necrotic material and a polymorphonuclear infiltrate were
found in the sinuses. The autopsy concluded that death was as
a result of a septic embolism from sinus to arterial circulation,
caused by Scopulariopsis acremonium

Autopsy
 Infections due to infrequently encountered fungi

 opportunistic molds are often refractory to conventional

antifungal agents

 Mold infections are frequently disseminated to numerous

other organs and tissues

 Only two cases of infection by S. acremonium have been

reported in the literature, one in a leukemic patient and one in
a lung transplant patient.
 S. acremonium infection in HSCT patients is rare but can be a
dramatic event due to the natural reduced sensitivity of the
pathogen to antifungal drugs and its potential to spread
rapidly by blood diffusion.

 Earlydiagnostic procedures such as biopsy, or at the least

endoscopic cultures, should be performed prior to starting
empirical antifungal treatment in order to improve the
outcome of this disease in the immunocompromised host

conclusion
Thank you…