Species

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Iceman of Austria 5300 year-old man dies from A. fumigatus infection? 5300 year-old man dies from A. fumigatus infection?
5300 year-old man dies from A. fumigatus infection? Iceman of Austria 5300 year-old man dies from A. fumigatus infection?

In September 1991 the corpse of a man was found protruding from a glacier
3200 meters above sea level in the Ötzal Alps, Austria. The body was carefully removed and taken to the Department of Forensic
Evidence at the University of Innsbruck, where it was identified as prehistoric and moved to the Department of Anatomy (click
here for more details) for further examination.

https://dl.dropboxusercontent.com/u/35589116/iceman.html

Aspergillus fumigatus A four day A. fumigatus culture on malt extract agar (above). Light microscopy pictures are taken at 1000x mag., stained with lacto-phenol cotton blue (right).
Aspergillus fumigatus A four day A. fumigatus culture on malt extract agar (above). Light microscopy pictures are taken at 1000x mag., stained with lacto-phenol cotton blue (right).

Colonies on CYA 40-60 mm diam, plane or lightly wrinkled, low, dense and velutinous or with a sparse, floccose overgrowth; mycelium inconspicuous, white; conidial heads borne in a continuous, densely packed layer, Greyish Turquoise to Dark Turquoise (24-25E-F5); clear exudate sometimes produced in small amounts; reverse pale or greenish. Colonies on MEA 40-60 mm diam, similar to those on CYA but less dense and with conidia in duller colours (24-25E-F3); reverse uncoloured or greyish. Colonies on G25N less than 10 mm diam, sometimes only germination, of white mycelium. No growth at 5°C. At 37°C, colonies covering the available area, i.e. a whole Petri dish in 2 days from a single point inoculum, of similar appearance to those on CYA at 25°C, but with conidial columns longer and conidia darker, greenish grey to pure grey.

Conidiophores borne from surface hyphae, stipes 200-400 µm long, sometimes sinuous, with colourless, thin, smooth walls, enlarging gradually into pyriform vesicles; vesicles 20-30 µm diam, fertile over half or more of the enlarged area, bearing phialides only, the lateral ones characteristically bent so that the tips are approximately parallel to the stipe axis; phialides crowded, 6-8 µm long; conidia spherical to subspheroidal, 2.5-3.0 µm diam, with finely roughened or spinose walls, forming radiate heads at first, then well defined columns of conidia.

Distinctive features

This distinctive species can be recognised in the unopened Petri dish by its broad, velutinous, bluish colonies bearing characteristic, well defined columns of conidia. Growth at 37°C is exceptionally rapid. Conidial heads are also diagnostic: pyriform vesicles bear crowded phialides which bend to be roughly parallel to the stipe axis. Care should be exercised in handling cultures of this species.

Aspergillus fumigatus A four day A. fumigatus culture on malt extract agar (above). Light microscopy pictures are taken at 1000x mag., stained with lacto-phenol cotton blue (right).
Aspergillus fumigatus A four day A. fumigatus culture on malt extract agar (above). Light microscopy pictures are taken at 1000x mag., stained with lacto-phenol cotton blue (right).

Colonies on CYA 40-60 mm diam, plane or lightly wrinkled, low, dense and velutinous or with a sparse, floccose overgrowth; mycelium inconspicuous, white; conidial heads borne in a continuous, densely packed layer, Greyish Turquoise to Dark Turquoise (24-25E-F5); clear exudate sometimes produced in small amounts; reverse pale or greenish. Colonies on MEA 40-60 mm diam, similar to those on CYA but less dense and with conidia in duller colours (24-25E-F3); reverse uncoloured or greyish. Colonies on G25N less than 10 mm diam, sometimes only germination, of white mycelium. No growth at 5°C. At 37°C, colonies covering the available area, i.e. a whole Petri dish in 2 days from a single point inoculum, of similar appearance to those on CYA at 25°C, but with conidial columns longer and conidia darker, greenish grey to pure grey.

Conidiophores borne from surface hyphae, stipes 200-400 µm long, sometimes sinuous, with colourless, thin, smooth walls, enlarging gradually into pyriform vesicles; vesicles 20-30 µm diam, fertile over half or more of the enlarged area, bearing phialides only, the lateral ones characteristically bent so that the tips are approximately parallel to the stipe axis; phialides crowded, 6-8 µm long; conidia spherical to subspheroidal, 2.5-3.0 µm diam, with finely roughened or spinose walls, forming radiate heads at first, then well defined columns of conidia.

Distinctive features

This distinctive species can be recognised in the unopened Petri dish by its broad, velutinous, bluish colonies bearing characteristic, well defined columns of conidia. Growth at 37°C is exceptionally rapid. Conidial heads are also diagnostic: pyriform vesicles bear crowded phialides which bend to be roughly parallel to the stipe axis. Care should be exercised in handling cultures of this species.

Aspergillus fumigatus A four day A. fumigatus culture on malt extract agar (above). Light microscopy pictures are taken at 1000x mag., stained with lacto-phenol cotton blue (right).
Aspergillus fumigatus A four day A. fumigatus culture on malt extract agar (above). Light microscopy pictures are taken at 1000x mag., stained with lacto-phenol cotton blue (right).

Colonies on CYA 40-60 mm diam, plane or lightly wrinkled, low, dense and velutinous or with a sparse, floccose overgrowth; mycelium inconspicuous, white; conidial heads borne in a continuous, densely packed layer, Greyish Turquoise to Dark Turquoise (24-25E-F5); clear exudate sometimes produced in small amounts; reverse pale or greenish. Colonies on MEA 40-60 mm diam, similar to those on CYA but less dense and with conidia in duller colours (24-25E-F3); reverse uncoloured or greyish. Colonies on G25N less than 10 mm diam, sometimes only germination, of white mycelium. No growth at 5°C. At 37°C, colonies covering the available area, i.e. a whole Petri dish in 2 days from a single point inoculum, of similar appearance to those on CYA at 25°C, but with conidial columns longer and conidia darker, greenish grey to pure grey.

Conidiophores borne from surface hyphae, stipes 200-400 µm long, sometimes sinuous, with colourless, thin, smooth walls, enlarging gradually into pyriform vesicles; vesicles 20-30 µm diam, fertile over half or more of the enlarged area, bearing phialides only, the lateral ones characteristically bent so that the tips are approximately parallel to the stipe axis; phialides crowded, 6-8 µm long; conidia spherical to subspheroidal, 2.5-3.0 µm diam, with finely roughened or spinose walls, forming radiate heads at first, then well defined columns of conidia.

Distinctive features

This distinctive species can be recognised in the unopened Petri dish by its broad, velutinous, bluish colonies bearing characteristic, well defined columns of conidia. Growth at 37°C is exceptionally rapid. Conidial heads are also diagnostic: pyriform vesicles bear crowded phialides which bend to be roughly parallel to the stipe axis. Care should be exercised in handling cultures of this species.

Aspergillus fumigatus
Aspergillus fumigatus

Colonies on CYA 40-60 mm diam, plane or lightly wrinkled, low, dense and velutinous or with a sparse, floccose overgrowth; mycelium inconspicuous, white; conidial heads borne in a continuous, densely packed layer, Greyish Turquoise to Dark Turquoise (24-25E-F5); clear exudate sometimes produced in small amounts; reverse pale or greenish. Colonies on MEA 40-60 mm diam, similar to those on CYA but less dense and with conidia in duller colours (24-25E-F3); reverse uncoloured or greyish. Colonies on G25N less than 10 mm diam, sometimes only germination, of white mycelium. No growth at 5°C. At 37°C, colonies covering the available area, i.e. a whole Petri dish in 2 days from a single point inoculum, of similar appearance to those on CYA at 25°C, but with conidial columns longer and conidia darker, greenish grey to pure grey.

Conidiophores borne from surface hyphae, stipes 200-400 µm long, sometimes sinuous, with colourless, thin, smooth walls, enlarging gradually into pyriform vesicles; vesicles 20-30 µm diam, fertile over half or more of the enlarged area, bearing phialides only, the lateral ones characteristically bent so that the tips are approximately parallel to the stipe axis; phialides crowded, 6-8 µm long; conidia spherical to subspheroidal, 2.5-3.0 µm diam, with finely roughened or spinose walls, forming radiate heads at first, then well defined columns of conidia.

Distinctive features

This distinctive species can be recognised in the unopened Petri dish by its broad, velutinous, bluish colonies bearing characteristic, well defined columns of conidia. Growth at 37°C is exceptionally rapid. Conidial heads are also diagnostic: pyriform vesicles bear crowded phialides which bend to be roughly parallel to the stipe axis. Care should be exercised in handling cultures of this species.

Aspergillus fumigatus
Aspergillus fumigatus

Colonies on CYA 40-60 mm diam, plane or lightly wrinkled, low, dense and velutinous or with a sparse, floccose overgrowth; mycelium inconspicuous, white; conidial heads borne in a continuous, densely packed layer, Greyish Turquoise to Dark Turquoise (24-25E-F5); clear exudate sometimes produced in small amounts; reverse pale or greenish. Colonies on MEA 40-60 mm diam, similar to those on CYA but less dense and with conidia in duller colours (24-25E-F3); reverse uncoloured or greyish. Colonies on G25N less than 10 mm diam, sometimes only germination, of white mycelium. No growth at 5°C. At 37°C, colonies covering the available area, i.e. a whole Petri dish in 2 days from a single point inoculum, of similar appearance to those on CYA at 25°C, but with conidial columns longer and conidia darker, greenish grey to pure grey.

Conidiophores borne from surface hyphae, stipes 200-400 µm long, sometimes sinuous, with colourless, thin, smooth walls, enlarging gradually into pyriform vesicles; vesicles 20-30 µm diam, fertile over half or more of the enlarged area, bearing phialides only, the lateral ones characteristically bent so that the tips are approximately parallel to the stipe axis; phialides crowded, 6-8 µm long; conidia spherical to subspheroidal, 2.5-3.0 µm diam, with finely roughened or spinose walls, forming radiate heads at first, then well defined columns of conidia.

Distinctive features

This distinctive species can be recognised in the unopened Petri dish by its broad, velutinous, bluish colonies bearing characteristic, well defined columns of conidia. Growth at 37°C is exceptionally rapid. Conidial heads are also diagnostic: pyriform vesicles bear crowded phialides which bend to be roughly parallel to the stipe axis. Care should be exercised in handling cultures of this species.

Aspergillus fumigatus
Aspergillus fumigatus

Colonies on CYA 40-60 mm diam, plane or lightly wrinkled, low, dense and velutinous or with a sparse, floccose overgrowth; mycelium inconspicuous, white; conidial heads borne in a continuous, densely packed layer, Greyish Turquoise to Dark Turquoise (24-25E-F5); clear exudate sometimes produced in small amounts; reverse pale or greenish. Colonies on MEA 40-60 mm diam, similar to those on CYA but less dense and with conidia in duller colours (24-25E-F3); reverse uncoloured or greyish. Colonies on G25N less than 10 mm diam, sometimes only germination, of white mycelium. No growth at 5°C. At 37°C, colonies covering the available area, i.e. a whole Petri dish in 2 days from a single point inoculum, of similar appearance to those on CYA at 25°C, but with conidial columns longer and conidia darker, greenish grey to pure grey.

Conidiophores borne from surface hyphae, stipes 200-400 µm long, sometimes sinuous, with colourless, thin, smooth walls, enlarging gradually into pyriform vesicles; vesicles 20-30 µm diam, fertile over half or more of the enlarged area, bearing phialides only, the lateral ones characteristically bent so that the tips are approximately parallel to the stipe axis; phialides crowded, 6-8 µm long; conidia spherical to subspheroidal, 2.5-3.0 µm diam, with finely roughened or spinose walls, forming radiate heads at first, then well defined columns of conidia.

Distinctive features

This distinctive species can be recognised in the unopened Petri dish by its broad, velutinous, bluish colonies bearing characteristic, well defined columns of conidia. Growth at 37°C is exceptionally rapid. Conidial heads are also diagnostic: pyriform vesicles bear crowded phialides which bend to be roughly parallel to the stipe axis. Care should be exercised in handling cultures of this species.

IPA in lymphoma (Fig 1) Chest radiograph with 'classical' appearance of a pulmonary infarction - a wedge-shaped lesion peripherally set against the pleura. Chest radiograph with 'classical' appearance of a pulmonary infarction
Chest radiograph with 'classical' appearance of a pulmonary infarction IPA in lymphoma (Fig 1) Chest radiograph with 'classical' appearance of a pulmonary infarction - a wedge-shaped lesion peripherally set against the pleura.

His case has been previously reported (Denning DW, Williams AH). Invasive pulmonary aspergillosis diagnosed by blood culture and successfully treated. Br J Dis Chest (1987) 81, 300).

Chest radiograph with 'classical' appearance of a pulmonary infarction - a wedge-shaped lesion peripherally set against the pleura. This patient was receiving chemotherapy including corticosteriods, who had had a splenectomy previously presented with fever and right-sided pleuritic chest pain. Blood cultures grew Aspergillus fumigatus and he responded to amphotericin B and flucytosine.

IPA in lymphoma Chest X ray after 4 days, prior to treatment, showing massive increase in volume of lesion (Fig 2) Chest X ray after 4 days, prior to treatment
Chest X ray after 4 days, prior to treatment IPA in lymphoma Chest X ray after 4 days, prior to treatment, showing massive increase in volume of lesion (Fig 2)

His case has been previously reported (Denning DW, Williams AH). Invasive pulmonary aspergillosis diagnosed by blood culture and successfully treated. Br J Dis Chest (1987) 81, 300). 

Chest X ray after 4 days, prior to treatment, showing massive increase in volume of lesion. He started amphotericin B and flucytosineb that day and responded over 10 weeks.

Fatal haemoptysis post lung-transplant Fig1 Trachea and bronchi Fig1 Trachea and bronchi
Fig1 Trachea and bronchi Fatal haemoptysis post lung-transplant Fig1 Trachea and bronchi

Fig 1. Trachea and bronchi A 50+ year old woman received a double lung transplant for emphysema. She did well initially, but then Aspergillus fumigatus was grown from her airways, in association with mucous and a pseudomembrane covering parts of her anastomosis and airways. 2 months after her transplant she was undergoing bronchoscopy, and started to bleed. This rapidly became torrential and she suffered a cardiac arrest and died.

She underwent autopsy at which it was found that the larynx, trachea and major bronchi all contained blood (Fig 1).

The bronchial anastomoses were intact, but brown fluffy material was found overlying the stitches on both sides. On the right side plaques of similar material were seen distal to the anastomoses, overlying an ulcer and an obstructing the smaller bronchi.

On the left side an ulcer 1.5cm in diameter (with blood in it) was seen in the main bronchus distal to the anastomosis on the anterior wall (Fig 2). The sutures of the anastomosis are intact. The centre of the ulcer had ulcerated through into the left main pulmonary artery (Fig 3). The pulmonary artery shows necrosis and discolouration of the intimal surface over an area of 1.5-1.0cm.

Histopathology examination showed fungal hyphae perforating the bronchial wall and arterial wall around and in the ulcer. The ulcer on the right side showed hyphae perforating the wall and bronchial cartilage.

Fatal haemoptysis post lung-transplant Fig2 Left main bronchus Fig2 Left main bronchus
Fig2 Left main bronchus Fatal haemoptysis post lung-transplant Fig2 Left main bronchus

Fig 1. Trachea and bronchi A 50+ year old woman received a double lung transplant for emphysema. She did well initially, but then Aspergillus fumigatus was grown from her airways, in association with mucous and a pseudomembrane covering parts of her anastomosis and airways. 2 months after her transplant she was undergoing bronchoscopy, and started to bleed. This rapidly became torrential and she suffered a cardiac arrest and died.

She underwent autopsy at which it was found that the larynx, trachea and major bronchi all contained blood (Fig 1).

The bronchial anastomoses were intact, but brown fluffy material was found overlying the stitches on both sides. On the right side plaques of similar material were seen distal to the anastomoses, overlying an ulcer and an obstructing the smaller bronchi.

On the left side an ulcer 1.5cm in diameter (with blood in it) was seen in the main bronchus distal to the anastomosis on the anterior wall (Fig 2). The sutures of the anastomosis are intact. The centre of the ulcer had ulcerated through into the left main pulmonary artery (Fig 3). The pulmonary artery shows necrosis and discolouration of the intimal surface over an area of 1.5-1.0cm.

Histopathology examination showed fungal hyphae perforating the bronchial wall and arterial wall around and in the ulcer. The ulcer on the right side showed hyphae perforating the wall and bronchial cartilage.

Fatal haemoptysis post lung-transplant Fig3 Pulmonary artery Fig3 Pulmonary artery
Fig3 Pulmonary artery Fatal haemoptysis post lung-transplant Fig3 Pulmonary artery

Fig 1. Trachea and bronchi A 50+ year old woman received a double lung transplant for emphysema. She did well initially, but then Aspergillus fumigatus was grown from her airways, in association with mucous and a pseudomembrane covering parts of her anastomosis and airways. 2 months after her transplant she was undergoing bronchoscopy, and started to bleed. This rapidly became torrential and she suffered a cardiac arrest and died.

She underwent autopsy at which it was found that the larynx, trachea and major bronchi all contained blood (Fig 1).

The bronchial anastomoses were intact, but brown fluffy material was found overlying the stitches on both sides. On the right side plaques of similar material were seen distal to the anastomoses, overlying an ulcer and an obstructing the smaller bronchi.

On the left side an ulcer 1.5cm in diameter (with blood in it) was seen in the main bronchus distal to the anastomosis on the anterior wall (Fig 2). The sutures of the anastomosis are intact. The centre of the ulcer had ulcerated through into the left main pulmonary artery (Fig 3). The pulmonary artery shows necrosis and discolouration of the intimal surface over an area of 1.5-1.0cm.

Histopathology examination showed fungal hyphae perforating the bronchial wall and arterial wall around and in the ulcer. The ulcer on the right side showed hyphae perforating the wall and bronchial cartilage.

Obstructing bronchial aspergillosis in AIDS, pt PW The patient was a 37-year old man in whom P.carinii pneumonia developed in August 1987, followed by esophageal candidiasis and upper gastrointestinal bleeding in September. Chronic perineal herpes led to the formation of rectourethral fistula and read more... , This chest radiograph was taken immediately after bronchoscopy and shows major improvement.
, This chest radiograph was taken immediately after bronchoscopy and shows major improvement. Obstructing bronchial aspergillosis in AIDS, pt PW The patient was a 37-year old man in whom P.carinii pneumonia developed in August 1987, followed by esophageal candidiasis and upper gastrointestinal bleeding in September. Chronic perineal herpes led to the formation of rectourethral fistula and read more...
Chronic cavitary invasive aspergillosis in a non-immunocompromised patient, pt RW. Further detailsImage A. December 1991. The lesions were considered to be possibly malignant and surgically resected. Histological examination showed granulomata containing hyphae consistent with Aspergillus. Fungal cultures were not done.Image B. read more... Image A. December 1991 Close up view of right upper-lobe of the lung in a 45 year old man who smoked cigarettes showing an ill-defined shadow behind the clavicle and additional abnormalities inferior to this in the right upper-lobe., Image B. June 1992 Recurrence of disease.Chest radiograph demonstrating cavitary invasive aspergillosis., Image C. September 1992 Chest radiograph demonstrating further progression of pulmonary aspergillosis with multiple cavities in the right upper-lobe., Image D. September 2002 Well, although had a respiratory infection. CRP and ESR normal in August 02, aspergillus precipitins positive at a titre of 1:2. , Image E. January 03 Much worse with lethargy, anorexia, weight loss and radiological deterioration on Chest Xray (link). Aspergillus precipitins rose to a titre of 1:32 , and CRP to 30, and ESR to 49. He was restarted on itraconazole., Image F. April 03 No better on itraconazole despite high concentrations of itraconazole in blood. , Image G. October 03 Stable and reasonable, with weight loss reversed, CRP <5, ESR 13 and Aspergillus precipitins at a titre of 1:16 . Further evolution of radiological features. , Image H. April 04 Back to where he was in terms of symptoms when he stopped itraconzole. CRP, <5, ESR 20, Aspergillus precipitins titre 1:8. Further radiological change. , Image I. June 08 Patient remained well no cough, no sputum despite radiological signs., Image J. Oct 09 X ray showed litle change over last 16 months in reasonable health, continuing on itraconazole., Image Image K. A CT scan section of a part of the right upper-lobe lesion shown in 2IPA9. , Image L. This CT scan of the thorax illustrates the formation of multiple cavities, without aspergillomas previously in ‘normal’ lung a non immunocompromised patient. The appearances are reminiscent of tuberculosis and coccidioidomycosis., Image M., Image N., Image O. Patient RW: Voriconazole rash. Facial erythema following 9 weeks of oral therapy with voriconazole. The patient noted a sensation of tightness on the skin of his forehead and discomfort in hot water.
Image A. December 1991 Close up view of right upper-lobe of the lung in a 45 year old man who smoked cigarettes showing an ill-defined shadow behind the clavicle and additional abnormalities inferior to this in the right upper-lobe., Image B. June 1992 Recurrence of disease.Chest radiograph demonstrating cavitary invasive aspergillosis., Image C. September 1992 Chest radiograph demonstrating further progression of pulmonary aspergillosis with multiple cavities in the right upper-lobe., Image D. September 2002 Well, although had a respiratory infection. CRP and ESR normal in August 02, aspergillus precipitins positive at a titre of 1:2. , Image E. January 03 Much worse with lethargy, anorexia, weight loss and radiological deterioration on Chest Xray (link). Aspergillus precipitins rose to a titre of 1:32 , and CRP to 30, and ESR to 49. He was restarted on itraconazole., Image F. April 03 No better on itraconazole despite high concentrations of itraconazole in blood. , Image G. October 03 Stable and reasonable, with weight loss reversed, CRP <5, ESR 13 and Aspergillus precipitins at a titre of 1:16 . Further evolution of radiological features. , Image H. April 04 Back to where he was in terms of symptoms when he stopped itraconzole. CRP, <5, ESR 20, Aspergillus precipitins titre 1:8. Further radiological change. , Image I. June 08 Patient remained well no cough, no sputum despite radiological signs., Image J. Oct 09 X ray showed litle change over last 16 months in reasonable health, continuing on itraconazole., Image Image K. A CT scan section of a part of the right upper-lobe lesion shown in 2IPA9. , Image L. This CT scan of the thorax illustrates the formation of multiple cavities, without aspergillomas previously in ‘normal’ lung a non immunocompromised patient. The appearances are reminiscent of tuberculosis and coccidioidomycosis., Image M., Image N., Image O. Patient RW: Voriconazole rash. Facial erythema following 9 weeks of oral therapy with voriconazole. The patient noted a sensation of tightness on the skin of his forehead and discomfort in hot water. Chronic cavitary invasive aspergillosis in a non-immunocompromised patient, pt RW. Further detailsImage A. December 1991. The lesions were considered to be possibly malignant and surgically resected. Histological examination showed granulomata containing hyphae consistent with Aspergillus. Fungal cultures were not done.Image B. read more...

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