Aureobasidium melanogenum isolation from the cerebrospinal fluid of a patient with human immunodeficiency virus/acquired immunodeficiency syndrome: A novel report

A 22-year-old Brazilian man with untreated ulcerative colitis and human immunodeficiency virus (HIV) infection was admitted to the intensive care unit (ICU) for holocranial headache, fever, nausea, malaise, and diarrhea. Antiretroviral therapy (ART) was discontinued eight months earlier. Medical history included prior hospitalization due to pneumomediastinum secondary to perforated esophageal moniliasis. Laboratory tests showed leukocytosis, elevated C-reactive protein levels, high HIV viral load (133.627 copies/mL), low CD4+T-cell count (14 cells/mm³), and abnormal levels of cerebrospinal fluid (CSF) proteins and glucose. Treatment with ceftriaxone, metronidazole, and mebendazole was initiated. Further CSF analysis was negative for Cryptococcus spp., but fungal culture showed the growth of black, rough colonies (Figure 1a) with conidia as observed by optical microscopy (Figure 1b). The fungus was identified as Aureobasidium melanogenum using gene sequencing. Treatment with amphotericin B lipid complex was initiated for 14 days, and he was discharged from the ICU after re-initiating ART.

FIGURE 1:
(a): Macromorphology of A. melanogenum in Sabouraud Dextrose agar incubated for 7 days at 25 ºC. (b): Image showing dark brown conidia of A. melanogenum (black arrow) on a wet mount microscopy slide (40× objective lens).

A. melanogenum is ubiquitous in the environment. Although commonly considered a contaminant, this species has been increasingly associated with invasive infections in immunocompromised patients and seems to present a high pathogenic potential^1-3.

The prognosis of A. melanogenum infections depends on the extent of infection and host conditions¹ and on accurate species identification and therapy. To the best of our knowledge, this is the first report of A. melanogenum isolation from the CSF of a patient with acquired immunodeficiency syndrome (AIDS). Although such cases in HIV/AIDS patients are rare^1,2, physicians should be aware of the possibility of A. melanogenum infections in these individuals.

ACKNOWLEDGMENTS

We offer our deepest thanks to the institutions that provided technical support for the development and implementation of this study and to Rafael Sanches for his availability in advising on editing the image for this work.

REFERENCES

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• Ethical approval: The study was a retrospective analysis of laboratory data. No ethical approval was applied.
• Financial Support: No funding was received.

Publication Dates

• Publication in this collection
  18 Aug 2021
• Date of issue
  2021

History

• Received
  05 May 2021
• Accepted
  15 June 2021