Date: 26 November 2013
cultures grown from BAL fluid showing formation of sclerotia.
Copyright:
Kindly donated by Dr Claudia Venturelli and Dr Giorgia Bertazzoni, Laboratory of Microbiology – Policlinico of Modena-Italy. © Fungal Research Trust
Notes:
These colonies were isolated from a BAL, (also with bacterial qrowth of S.aureus and S.maltophilia) from a patient with a VAP (undergoing corticosteroid treatment). The growth medium used is sabouraud dextrose agar , incubated at 37° C The identification is made by microscopic/macroscopic observation criteria.
Colonies on CYA 60-70 mm diam, plane, sparse to moderately dense, velutinous in marginal areas at least, often floccose centrally, sometimes deeply so; mycelium only conspicuous in floccose areas, white; conidial heads usually borne uniformly over the whole colony, but sparse or absent in areas of floccose growth or sclerotial production, characteristically Greyish Green to Olive Yellow (1-2B-E5-7), but sometimes pure Yellow (2-3A7-8), becoming greenish in age; sclerotia produced by about 50% of isolates, at first white, becoming deep reddish brown, density varying from inconspicuous to dominating colony appearance and almost entirely suppressing conidial production; exudate sometimes produced, clear, or reddish brown near sclerotia; reverse uncoloured or brown to reddish brown beneath sclerotia. Colonies on MEA 50-70 mm diam, similar to those on CYA although usually less dense. Colonies on G25N 25-40 mm diam, similar to those on CYA or more deeply floccose and with little conidial production, reverse pale to orange or salmon. No growth at 5°C. At 37°C, colonies usually 55-65 mm diam, similar to those on CYA at 25°C, but more velutinous, with olive conidia, and sometimes with more abundant sclerotia.
Sclerotia produced by some isolates, at first white, rapidly becoming hard and reddish brown to black, spherical, usually 400- 800 µm diam. Teleomorph not known. Conidiophores borne from subsurface or surface hyphae, stipes 400 µm to 1 mm or more long, colourless or pale brown, rough walled; vesicles spherical, 20-45 µm diam, fertile over three quarters of the surface, typically bearing both metulae and phialides, but in some isolates a proportion or even a majority of heads with phialides alone; metulae and phialides of similar size, 7-10 µm long; conidia spherical to subspheroidal, usually 3.5-5.0 µm diam, with relatively thin walls, finely roughened or, rarely, smooth.
Distinctive features
Aspergillus flavus is distinguished by rapid growth at both 25°C and 37°C, and a bright yellow green (or less commonly yellow) conidial colour. A. flavus produces conidia which are rather variable in shape and size, have relatively thin walls, and range from smooth to moderately rough, the majority being finely rough.
Images library
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Title
Legend
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A Colonies on MEA after one week, B conidial head x920, C atypical reduced conidial head x920, D conidial head x 920.
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A case of onychomycosis associated with Aspergillus ochraceopetaliformis as described in Med Mycol. 2009 Mar 9:1-5, 2009,Brasch J, Varga J, Jensen JM, Egberts F & Tintelnot K
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Histology of the infected nail (PAS stain) showing thick fungal elements and septate hyphae within nail material.
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culture and identified in a case of onychomycosis – Culture at higher magnification.
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culture and identified in a case of onychomycosis – Culture of Aspergillus ochraceopetaliformis on Sabouraud agar with cycloheximide at 26C
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This patient with chronic cavitary pulmonary aspergillosis was treated with itraconazole, with some success, but considerable gastrointestinal disturbance (diarrhoea, flatulence and uncomfortable feeling in his abdomen). He also developed a facial rash. Itraconazole was stopped and he reverted to voriconazole which he was unable to take because of a severe feeling of being generally unwell. His facial rash resolved. Application was made for funding posaconazole. He started this and after 6 weeks an almost identical facial rash to that seen with itraconazole appeared. He tolerated posaconazole well in other respects, and his chronic cavitary pulmonary aspergillosis is now significantly better (symptomatically and serologically). July 2007
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This patient with ABPA and chronic cavitary pulmonary aspergillosis has been stabilized on voriconazole treatment for >5 years. She had a degree of photosensitivity most of that time, noticed early in the course of voriconazole treatment. She is oxygen and wheelchair dependent and doesn’t go outside very much, so most of her light exposure has been indoor light. She developed rough scaly patches over her face, neck and lower arms. Dermatological review indicated multiple solar keratoses”. Skin biopsy from the right forearm confirmed this clinical diagnosis – “skin showing hyperkeratosis with a little parakeratosis and acanthosis. The keratinocytes have a glassy appearance but show nuclear atypia with dyskeratotic cells, and occasional suprabasal mitoses. The intraepidermal sweat ducts are spared. Appearances suggest an actinic keratosis with moderate to severe dysplasia.” These features are characteristic of a low grade premalignant change.
She was treated with local 5-fluorouracil cream (Efudix) (3 cycles) to the affected lesions. These photos were taken at the apogee of inflammation. The inflammation resolved after discontinuing the cream. This reaction is expected with application of this mild chemotherapy agent. Alternative or supplementary treatments include cryotherapy, curettage and cautery, if necessary. Following treatment her skin was much softer and considerably improved. Voriconazole has been stopped, and posaconazole substituted.
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