Arthrographis Kalrae Research Articles

Refractory Post-Operative Wound Infection by Arthrographis Kalrae: A Case Report and Review of Literature

Arthrographis kalrae (A. Kalrae) infections, although rare, have often demonstrated an extended clinical course. We report a case of refractory post-operative wound infection with A. Kalrae after radical soft tissue and femur resection following total femoral replacement. Identification of A. Kalrae was done based on detailed microscopic and phenotypic characteristics and biochemical tests. Additionally, it was confirmed with sequencing. Although antifungal therapy was started on the basis of the breakpoints observed, clinical failure was met. However, wound infection was subsequently controlled with extensive tissue debridement and a combination of antifungal drug therapy over a period of 33 weeks. The rarity of global data about such unusual fungal infections adds to diagnostic and therapeutic challenges.

Non-Aspergillus Hyaline Molds: A Host-Based Perspective of Emerging Pathogenic Fungi Causing Sinopulmonary Diseases.

The incidence of invasive sino-pulmonary diseases due to non-Aspergillus hyaline molds is increasing due to an enlarging and evolving population of immunosuppressed hosts as well as improvements in the capabilities of molecular-based diagnostics. Herein, we review the following opportunistic pathogens known to cause sinopulmonary disease, the most common manifestation of hyalohyphomycosis: Fusarium spp., Scedosporium spp., Lomentospora prolificans, Scopulariopsis spp., Trichoderma spp., Acremonium spp., Paecilomyces variotii, Purpureocillium lilacinum, Rasamsonia argillacea species complex, Arthrographis kalrae, and Penicillium species. To facilitate an understanding of the epidemiology and clinical features of sino-pulmonary hyalohyphomycoses in the context of host immune impairment, we utilized a host-based approach encompassing the following underlying conditions: neutropenia, hematologic malignancy, hematopoietic and solid organ transplantation, chronic granulomatous disease, acquired immunodeficiency syndrome, cystic fibrosis, and healthy individuals who sustain burns, trauma, or iatrogenic exposures. We further summarize the pre-clinical and clinical data informing antifungal management for each pathogen and consider the role of adjunctive surgery and/or immunomodulatory treatments to optimize patient outcome.

First case of <em>Arthrographis kalrae</em> pulmonary infection in a patient with AIDS

Arthrographis kalrae is a hyaline fungus. It is a saprophyte of the environment, mainly found in soil and compost. It is a rare isolate in clinical specimen. In recent years this pathogen has been attributed to various cases of opportunistic infections. Our patient was a 51-year-old Indian woman, farmer by occupation, who had HIV infection and was under HAART treatment. She presented with complaints of cough with scanty expectoration for 2 months. Her CD4 count was 75 cells/μl. Induced sputum was collected and sent for detailed microbiological examination. Bacteriological and mycological profile was checked. The causal agent was identified as Arthrographis kalrae based on morphological characteristics (culture). Unfortunately, samples could not be preserved and sent for ITS region sequencing due to COVID-19 outbreak. The case is of interest because, to the best of our knowledge, Arthrographis kalrae has not been reported so far from our country, India.

Fine-scale temporal variation of intertidal marine fungal community structure: insights from an impacted Baja California sandy beach in Mexico

Globally, marine sandy beaches face increasing anthropogenic pressures. Long-term maintenance of their functional capacities depends strongly on robust autochthonous biotic community baseline data. However, fine-scale temporal patterns remain poorly understood in human-impacted sites, limiting our knowledge of beach response to stressors. Marine arenicolous fungi represent a neglected group of endopsamon microorganisms (living within sandy sediments) that fulfills key ecological roles mainly as saprobes. Preliminary data suggests that this fungal group is threatened by anthropogenic disturbances in tourist beaches, yet knowledge on their ecological plasticity and fine-scale patterns is lacking. To address this knowledge gap, we investigated marine fungal community composition changes over a fine temporal scale (biweekly, over a four-month period) at an impacted Pacific tourist sandy beach, and explored associations between community composition and key environmental variables. We identified 17 taxa, within four ecological groups: strict marine arenicolous fungi (Arenariomyces majusculus, Corollospora gracilis, Corollospora maritima, Corollospora sp. 1 and 2), non-arenicolous marine fungi (Nia sp.), terrestrial borne opportunistic pathogens (Arthrographis kalrae, Parengyodontium album, Neocosmospora solani, Scopulariopsis sp., and Exophiala sp.), and facultative marine species (Aspergillus terreus and Penicillium sp.). In agreement with our hypothesis, minor fine temporal scale changes in community structure suggest arenicolous fungi persist on the beach as inoculum. Nevertheless, we detected changes in the intertidal fungal community structure in response to environmental variables, shown by the increase of terrestrial borne pathogenic species in the rainy season. Lastly, our data warn against extensive beach grooming, which may lead to the direct reduction of strict marine arenicolous fungal groups.

Hindering of Cariogenic Streptococcus mutans Biofilm by Fatty Acid Array Derived from an Endophytic Arthrographis kalrae Strain.

Streptococcus mutans has been considered as the major etiological agent of dental caries, mostly due to its arsenal of virulence factors, including strong biofilm formation, exopolysaccharides production, and high acid production. Here, we present the antivirulence activity of fatty acids derived from the endophytic fungus Arthrographis kalrae isolated from Coriandrum sativum against Streptococcus mutans. The chemical composition of the fatty acids was analyzed by gas chromatography–mass spectrometry GC-MS and revealed nine compounds representing 99.6% of fatty acids, where unsaturated and saturated fatty acids formed 93.8% and 5.8 % respectively. Oleic and linoleic acids were the major unsaturated fatty acids. Noteworthy, the fatty acids at the concentration of 31.3 mg L–1 completely inhibited Streptococcus mutans biofilm, and water insoluble extracellular polysaccharide production in both polystyrene plates, and tooth model assay using saliva-coated hydroxyapatite discs. Inhibition of biofilm correlated significantly and positively with the inhibition of water insoluble extracellular polysaccharide (R = 1, p < 0.0001). Furthermore, Arthrographis kalrae fatty acids at a concentration of 7.8 mg L–1 exhibited acidogenesis-mitigation activity. They did not show bactericidal activity against Streptococcus mutans and cytotoxic activity against human oral fibroblast cells at the concentration used. On the other hand, saliva-coated hydroxyapatite discs treated with sub-minimum biofilm inhibitory concentration of fatty acids showed disturbed biofilm architecture with a few unequally distributed clumped matrices using fluorescence microscopy. Our findings revealed that the intracellular fatty acid arrays derived from endophytic Arthrographis kalrae could contribute to the biofilm-preventing alternatives, specifically Streptococcus mutans biofilms.

Non-Aspergillus Hyaline Molds: Emerging Causes of Sino-Pulmonary Fungal Infections and Other Invasive Mycoses.

Hyaline molds, widely distributed in nature, are an important and increasing cause of invasive fungal infections in humans, likely due to an expanding population of immunosuppressed hosts, increases in antifungal resistance, and improvements in laboratory diagnostics. Sinopulmonary disease and disseminated infection are common manifestations in neutropenic patients and transplant recipients, whereas, catheter-related and localized soft tissue infections predominate in immunocompetent hosts. These organisms are not reliably differentiated based on their morphology in tissue; rather, efforts should be made to establish a microbiologic diagnosis via culture or molecular-based methods to guide antifungal management and inform prognosis. Herein, we review the epidemiology, clinical manifestations, diagnosis, and management of these opportunistic pathogens known to cause hyalohyphomycoses: Scedosporium spp., Lomentospora prolificans, Fusarium spp., Scopulariopsis spp., Arthrographis kalrae, Trichoderma spp., Acremonium spp., Paecilomyces variotii, Purpureocillium lilacinum, and Penicillium species.

A cystic fibrosis child with lung function decline

Respiratory infections are a major threat to cystic fibrosis patients. Besides bacteria, many fungi colonize the cystic fibrosis respiratory tract where an important fungal biota has been described. We report here the case of a 7-year-old cystic fibrosis child with pulmonary exacerbation and Arthrographis kalrae isolated from bronchoalveolar lavage fluid. To the best of our knowledge, this is the first reported case of lung infection due to Arhtrographis kalrae in a cystic fibrosis pediatric patient.

First case of Arthrographis kalrae fungemia in a patient with cystic fibrosis

Arthrographis kalrae is a hyalin fungus. It is a saprophyte of the environment, mainly found in soil and compost. In recent years, cases of opportunistic infections attributed to this pathogen have been described. Our patient was a 19-year-old woman with cystic fibrosis. She presented a bacterial and fungal pulmonary colonization with Aspergillus fumigatus and Arthrographis. kalrae. After her lung transplantation, she developed an A. kalrae fungemia, treated with caspofungin 50mg/day associated to liposomal amphotericin B i.v. 3mg/kg/day. The patient died 8 months after her transplantation as the result of a bacterial septic shock.

Arthrographis Kalrae Masquerading as a Pulmonary Nodule After Breast Irradiation

SESSION TITLE: Student/Resident Case Report Poster - Chest Infections II SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: The genus Arthrographis is a mold usually isolated from soil and decaying vegetation. The genus is consisted of 5 species. It is an extremely rare cause of human disease and usually affects immunocompromised hosts. There have been only 11 reported cases in the literature since first described in 1976. Their role in human disease is still not completely clear. To our knowledge, this is the first reported case of solitary pulmonary nodule due to A kalrae infection. CASE PRESENTATION: An 80 year old past smoker female was referred to pulmonary clinic for evaluation of enlarging right upper lobe (RUL) ground glass opacity (GGO). She had a past history of breast cancer and underwent left sided lumpectomy with axillary dissection and radiation therapy in 2007. She had a chest CT in 2012 for evaluation of chronic cough and was noted to have a 1.1cm GGO in the RUL. In 2015, her breast cancer recurred at the previous lumpectomy site and during further evaluation the GGO was noted to have increased to 2.4cm. She underwent local resection. CT guided lung biopsy was non diagnostic. In the clinic, she complained of chronic cough but denied any fever, night sweats, weight loss, sputum production or shortness of breath. Physical exam and laboratory evaluation was unremarkable. A PET-CT showed 2.4cm hypermetabolic RUL GGO. She underwent navigational bronchoscopy with biopsy. The biopsies revealed reactive bronchial cells but no malignant cells. Initial cultures were negative. Fungal culture came back positive for Arthrographis kalrae. DISCUSSION: A kalrae is the most commonly isolated species from clinical specimens. They have been described to cause keratitis,opthalmitis, sinusitis, meningitis, cerebral vasculitis, endocarditis, mycetoma of the hand, onychomycosis, endocarditis and lung abscess. The route of entry is either the respiratory tract or direct inoculation into the skin and subcutaneous tissue. Specific risk factors or this rare fungalinfection are yet to be identified. Radiation therapy to the chest is suspected to be a risk factor for pulmonary infection with this organism. Terbinafine seems to be the best anti-fungal agentavailable. The azoles are also effective. Amphotericin seems to have some effect but the echinocandins are ineffective. CONCLUSIONS: Arthrographis kalrae is an unusual human pathogen and rarely considered in the differential diagnosis. With the ever growing number of immunosuppressant medications, whether this organism will become a potential threat is uncertain. The role of the organism in pathogenesis is human disease also needs further elucidation. Reference #1: Biser S. A, Perry H. D, Donnenfeld E. D, Doshi S. J. & Chaturvedi V. (2004). Arthrographis keratitis mimicking acanthamoeba keratitis. Cornea 23, 314-317. DISCLOSURE: The following authors have nothing to disclose: Biplab Saha, Himani Sharma, Kristin Fless, Paul Yodice, Fariborz Rezai, Nirav Mistry, Vagram Ovnanian No Product/Research Disclosure Information

Immunomodulation over the course of experimental Arthrographis kalrae infection in mice.

Arthrographis kalrae is occasionally described as an opportunistic human pathogen. This study investigated the immune response to A. kalrae during murine experimental infection (7, 14, 28 and 56 days post infection). The fungal load was higher in the early phase and mice presented with neurological syndrome over the course of the infection. There was a gradual increase in the level of anti-A. kalrae IgG and increased levels of DTH at 14 days. There was decreased IFN-γ (14-56 days) and an increase in IL-4 (7 and 56 days). Decreased levels of cytokines (IFN-γ, IL-4, IL-10 and IL-17) were observed in the brain at 56 days p.i. The results suggest that the immune response during murine A. kalrae infection modulates to the pattern of Th2 response. This study shows for the first time the cytokines and cellular immunomodulation that occur in response to an experimental infection with A. kalrae in mice.

A rare case of Arthrographis kalrae keratomycosis in a non-contact lens wearer

&#x0D; Purpose: Keratomycoses secondary to Arthrographis kalrae are rarely reported. Previous cases involved patients with contact lens wear. Herein we report a rare case of severe fungal keratitis due to Arthrographis kalrae in a non-contact lens wearer.Methods: Case report.Results: A 52-year-old male presented with a left paracentral corneal ulcer with stromal infiltrates following contact with a foreign body while riding a motorbike. Initial treatment with intensive topical antibiotic drops failed. Antifungal therapy with hourly topical amphotericin B 0.15% and fluconazole 0.2%, as well as oral fluconazole was initiated. His ulcer progressed rapidly despite aggressive treatment. This led to a small, peripheral corneal perforation which was treated with corneal gluing and bandage contact lens. He also developed secondary glaucoma. Microbiological cultures of his corneal scrapings revealed Arthrographis kalrae. A single dose of subconjunctival amphotericin B 0.015% o.1mL was then given. At two months after presentation, he eventually underwent therapeutic penetrating keratoplasty (PK) for non-resolving keratomycosis. Following PK, he was maintained on topical amphotericin B 0.15%, fluconazole 0.2% and ciprofloxacin 0.3% four-hourly, together with fusidic acid ointment 2% twice daily. The graft failed three months post-transplant, albeit with no evidence of residual or recurrent infection.Conclusion: Arthrographis kalrae-related keratitis may occur in non-contact lens wearer. Management remains clinically challenging because this organism causes severe, rapidly progressive keratitis.&#x0D;

Arthrographis kalrae soluble antigens present hemolytic and cytotoxic activities.

Arthrographis kalrae is a dimorphic, cosmopolitan and neurotropic fungus that has been described as a rare human pathogen. This study investigated the hemolytic and cytotoxic activities of A. kalrae cell-free antigens (CFAs). Total CFAs and their Sephadex chromatography fractions were tested on mouse erythrocytes for hemolysis and on the P3U1 cell line for cytotoxicity. Hemolytic and cytotoxic activities were detected in distinct molecular mass (MM) fractions. Additionally, antibodies against isogenic erythrocytes sensitized with CFAs (anti-E-CFAs) inhibited hemolysis but not cytotoxicity. Hemolysis was not affected by heating, and a higher reactivity was detected in the carbohydrate-rich fractions, which decreased after reduction by periodate treatment. The pioneering nature of this work is due to the demonstration of the cytotoxic activity in A. kalrae and the suggestion that this activity may be due to molecules distinct from the hemolytic factor, with the latter potentially being a component with a high MM.

Case report: Eumycetoma and mycotic arthritis of the knee caused by Arthrographis kalrae

A 33-year-old male presents following a penetrating injury to his right knee. Clinically he demonstrated pain, an effusion and fevers. At diagnostic arthroscopy, no microbiological growth was cultured. Delayed growth yielded the fungus Arthrographis kalrae. He was treated with a three-stage total knee arthroplasty. The first stage consisted of soft tissue debridement. The second stage involved femoral and tibial osteotomies and insertion of antifungal-impregnated cement spacers. Definitive total knee joint prosthesis were implanted during stage three. At 2 years follow up, he demonstrated a pain free range of motion and has returned to competitive tennis. To the authors' knowledge this is the first report implicating A. kalrae as an invasive pathogen of the knee in an immunocompetent host.

Refractory Arthrographis kalrae native knee joint infection

Rare reports of infection with Arthrographis kalrae have often demonstrated a protracted clinical course. We describe refractory infection of the native knee with Arthrographis kalrae after a penetrating injury and Yttrium synovectomy, finally controlled with two stage joint revision and combination antifungal therapy. The paucity of worldwide data about such uncommon invasive fungal infections contributes to the diagnostic and therapeutic challenges of these cases.

A rare pulmonary infection caused by Arthrographis kalrae

Arthrographis kalrae is a rare isolate in clinical specimens. Only ten cases of infection with this species have been described so far. To our knowledge, we report the first case of a pulmonary infection caused by A. kalrae in a patient with a past history of stage IIA Hodgkin's lymphoma and demonstrate that this organism can act as an opportunistic human pathogen.

Emerging & Rare Fungal Infections in Solid Organ Transplant Recipients

Emerging & Rare Fungal Infections in Solid Organ Transplant Recipients

Arthrographis kalrae, a rare causal agent of onychomycosis, and its occurrence in natural and commercially available soils

We report a rare case of onychomycosis due to Arthrographis kalrae, and describe an attempt to elucidate the source of the infection by fungal isolation and PCR-based methods for detection of A. kalrae. The patient was a 63-year-old Japanese man, whose fingernails, excluding the right index finger, were markedly dystrophic. Microscopic examination of his fingernails disclosed hyaline hyphae and arthroconidia. The causal agent was identified as A. kalrae based on morphological characteristics and ITS region sequencing. The fungus was susceptible in vitro to terbinafine, itraconazole, and miconazole. A therapeutic trial of oral terbinafine, 125 mg/day and topical 1% miconazole for seven months brought about a complete cure of the ungual lesion. We found that A. kalrae could be detected at 1.1 x 10(4) CFU/g (92.4% incidence) in soil from the patient's garden. Furthermore, varying CFUs of A. kalrae were recovered in 61% of the samples obtained from crop field soils, commercially available soils or allied products for gardening. Since the patient was working with soil that harbored A. kalrae, the possibility of acquiring the infection from this source should not be excluded.

イヌの口腔内より分離された本邦初の Arthrographis kalrae について

イヌの口腔内より分離された本邦初の Arthrographis kalrae について

Invasive Fungal Sinusitis and Meningitis Due to Arthrographis kalrae in a Patient with AIDS

We report the first described case of Arthrographis kalrae pansinusitis and meningitis in a patient with AIDS. The patient was initially diagnosed with Arthrographis kalrae pansinusitis by endoscopic biopsy and culture. The patient was treated with itraconazole for approximately 5 months and then died secondary to Pneumocytis carinii pneumonia. Postmortem examination revealed invasive fungal sinusitis that involved the sphenoid sinus and that extended through the cribiform plate into the inferior surfaces of the bilateral frontal lobes. There was also an associated fungal meningitis and vasculitis with fungal thrombosis and multiple recent infarcts that involved the frontal lobes, right caudate nucleus, and putamen. Post mortem cultures were positive for A. kalrae.

First report of mycetoma caused by Successful treatment with itraconazole

<h2>Abstract</h2> We report the first case of eumycetoma of the hand caused by <i>Arthrographis kalrae</i>. Cure was obtained with a 4 -month course of itraconazole. (J Am Acad Dermatol 1997;37:318-20.)