Top

Infection

Published in:

Open Access 01-12-2006 | Brief Report

Primary Invasive Aspergillosis of the Digestive Tract: Report of Two Cases and Review of the Literature

Authors: P. Eggimann, J.-C. Chevrolet, M. Starobinski, P. Majno, M. Totsch, B. Chapuis, D. Pittet

Published in: Infection | Issue 6/2006

Abstract

Background:

Disseminated aspergillosis is thought to occur as a result of vascular invasion from the lungs with subsequent bloodstream dissemination, and portals of entry other than sinuses and/or the respiratory tract remain speculative.

Methods:

We report two cases of primary aspergillosis in the digestive tract and present a detailed review of eight of the 23 previously-published cases for which detailed data are available.

Results and Conclusion:

These ten cases presented with symptoms suggestive of typhlitis, with further peritonitis requiring laparotomy and small bowel segmental resection. All cases were characterized by the absence of pulmonary disease at the time of histologically-confirmed gastrointestinal involvement with vascular invasion by branched Aspergillus hyphae. These cases suggest that the digestive tract may represent a portal of entry for Aspergillus species in immunocompromised patients.

Bartlett JG: Aspergillosis update. Medicine (Baltimore) 2000; 79: 281–302.CrossRef

Denning DW, Stevens DA: Antifungal and surgical treatment of invasive aspergillosis: review of 2,121 published cases. Rev Infect Dis 1990; 12: 1147–1201.PubMed

Denning DW: Therapeutic outcome in invasive aspergillosis. Clin Infect Dis 1996; 23: 608–615.PubMed

Marr KA, Patterson T, Denning D: Aspergillosis. Pathogenesis, clinical manifestations, and therapy. Infect Dis Clin North Am 2002; 16: 875–894.CrossRefPubMed

Morrison VA, Haake RJ, Weisdorf DJ: The spectrum of non-candida fungal infections following bone marrow transplantation. Medicine (Baltimore) 1993; 72: 78–89.

Cahill BC, Hibbs JR, Savic K, Juni BA, Dosland BM, Edin-Stibbe C, Hertz MI: Aspergillus airway colonization and invasive disease after lung transplantation. Chest 1997; 112: 1160–1164.CrossRefPubMed

Libanore M, Prini E, Mazzetti M, Barchi E, Raise E, Gritti FM, Bonazzi L, Ghinelli F: Invasive Aspergillosis in Italian AIDS patients. Infection 2002; 30: 341–345.CrossRefPubMed

Wiley JM, Smith N, Leventhal BG, Graham ML, Strauss LC, Hurwitz CA, Modlin J, Mellits D, Baumgardner R, Corden BJ: Invasive fungal disease in pediatric acute leukemia patients with fever and neutropenia during induction chemotherapy: a multivariate analysis of risk factors. J Clin Oncol 1990; 8: 280–286.PubMed

Winston DJ, Chandrasekar PH, Lazarus HM, Goodman JL, Silber JL, Horowitz H, Shadduck RK, Rosenfeld CS, Ho WG, Islam MZ: Fluconazole prophylaxis of fungal infections in patients with acute leukemia. Results of a randomized placebo-controlled, doubleblind, multicenter trial. Ann Intern Med 1993; 118: 495–503.PubMed

10.

Goodman JL, Winston DJ, Greenfield RA, Chandrasekar PH, Fox B, Kaizer H, Shadduck RK, Shea TC, Stiff P, Friedman DJ: A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med 1992; 326: 845–851.PubMed

11.

Boon AP, O’Brien D, Adams DH: 10 year review of invasive aspergillosis detected at necropsy. J Clin Pathol 1991; 44: 452–454.CrossRefPubMed

12.

Young RC, Bennett JE, Vogel CL, Carbone PP, De Vita VT: Aspergillosis. The spectrum of the disease in 98 patients. Medicine (Baltimore) 1970; 49: 147–173.

13.

Meyer RD, Young LS, Armstrong D, Yu B: Aspergillosis complicating neoplastic disease. Am J Med 1973; 54: 6–15.CrossRefPubMed

14.

Fisher BD, Armstrong D, Yu B, Gold JW: Invasive aspergillosis. Progress in early diagnosis and treatment. Am J Med 1981; 71: 571–577.CrossRefPubMed

15.

Albelda SM, Talbot GH, Gerson SL, Miller WT, Cassileth PA: Pulmonary cavitation and massive hemoptysis in invasive pulmonary aspergillosis. Influence of bone marrow recovery in patients with acute leukemia. Am Rev Respir Dis 1985; 131: 115–120.PubMed

16.

Duthie R, Denning DW: Aspergillus fungemia: report of two cases and review. Clin Infect Dis 1995; 20: 598–605.PubMed

17.

Ludwig M, Schneider H, Lohmeyer J, Ermert L, Sziegoleit A, Lommel D, Weidner W: Systemic aspergillosis with predominant genitourinary manifestations in an immunocompetent man: what we can learn from a disastrous follow-up. Infection 2005; 33: 90–92.CrossRefPubMed

18.

Vogeser M, Haas A, Aust D, Ruckdeschel G: Postmortem analysis of invasive aspergillosis in a tertiary care hospital. Eur J Clin Microbiol Infect Dis 1997; 16: 1–6.CrossRefPubMed

19.

Pagano L, Girmenia C, Mele L, Ricci P, Tosti ME, Nosari A, Buelli M, Picardi M, Allione B, Corvatta L, D’Antonio D, Montillo M, Melillo L, Chierichini A, Cenacchi A, Tonso A, Cudillo L, Candoni A, Savignano C, Bonini A, Martino P, Del Favero A: Infections caused by filamentous fungi in patients with hematologic malignancies. A report of 391 cases by GIMEMA Infection Program. Haematologica 2001; 86: 862–870.PubMed

20.

Denning DW, Lee JY, Hostetler JS, Pappas P, Kauffman CA, Dewsnup DH, Galgiani JN, Graybill JR, Sugar AM, Catanzaro A: Niaid mycoses study group multicenter trial of oral itraconazole therapy for invasive aspergillosis. Am J Med 1994; 97: 135–144.CrossRefPubMed

21.

Stevens DA, Lee JY: Analysis of compassionate use itraconazole therapy for invasive aspergillosis by the NIAID mycoses study group criteria. Arch Intern Med 1997; 157: 1857–1862.CrossRefPubMed

22.

Denning DW, Marinus A, Cohen J, Spence D, Herbrecht R, Pagano L, Kibbler C, Kcrmery V, Offner F, Cordonnier C, Jehn U, Ellis M, Collette L, Sylvester R: An EORTC multicentre prospective survey of invasive aspergillosis in haematological patients: diagnosis and therapeutic outcome. EORTC Invasive Fungal Infections Cooperative Group. J Infect 1998; 37: 173–180.CrossRefPubMed

23.

Case records of the massachusetts general hospital. Weekly clinicopathological exercises. Case 37-1976. N Engl J Med 1976; 295: 608–614.CrossRef

24.

Weingrad DN, Knapper WH, Gold J, Mertelsmann R: Aspergillus peritonitis complicating perforated appendicitis in adult acute leukemia. J Surg Oncol 1982; 19: 5–8.CrossRefPubMed

25.

Cohen R, Heffner JE: Bowel infarction as the initial manifestation of disseminated aspergillosis. Chest 1992; 101: 877–879.CrossRefPubMed

26.

Marterre WF Jr, Mong AT, Pulito AR: Locally invasive aspergillosis of the bowel. J Pediatr Surg 1992; 27: 1611–1613.CrossRefPubMed

27.

Catalano L, Picardi M, Anzivino D, Insabato L, Notaro R, Rotoli B: Small bowel infarction by aspergillus. Haematologica 1997; 82: 182–183.PubMed

28.

Shah SS, Birnbaum BA, Jacobs JE. Disseminated aspergillosis inciting intestinal ischaemia and obstruction. Br J Radiol 2001; 74: 1145–1147.PubMed

29.

Sousa AB, Ferreira G, Veiga J, Carvalho A: Clinical picture: bowel infarction due to aspergillosis. Lancet 2002; 359: 210.CrossRefPubMed

30.

Tresallet C, Nguyen-Thanh Q, Aubriot-Lorton MH, Spence D, Herbrecht R, Pagano L, Kibbler C, Kcrmery V, Offner F, Cordonnier C, Jehn U, Ellis M, Collette L, Sylvester R: Small-bowel infarction from disseminated aspergillosis. Dis Colon Rectum 2004; 47: 1515–1518.PubMed

31.

Vogeser M, Wanders A, Haas A, Ruckdeschel G: A four-year review of fatal Aspergillosis. Eur J Clin Microbiol Infect Dis 1999; 18: 42–45.CrossRefPubMed

32.

Kami M, Hori A, Takaue Y, Mutou Y: The gastrointestinal tract is a common target of invasive aspergillosis in patients receiving cytotoxic chemotherapy for hematological malignancy. Clin Infect Dis 2002; 35: 105–106.CrossRefPubMed

33.

Horvath JA, Dummer S: The use of respiratory-tract cultures in the diagnosis of invasive pulmonary aspergillosis. Am J Med 1996; 100: 171–178.CrossRefPubMed

34.

Janssen JJ, Strack van Schijndel RJ, van der Poest Clement EH, Ossenkoppele GJ, Thijs LG, Huijgens PC: Outcome of icu treatment in invasive aspergillosis. Intensive Care Med 1996; 22: 1315–1322.CrossRefPubMed

35.

Caillot D, Casasnovas O, Bernard A, Couaillier JF, Durand C, Cuisenier B, Solary E, Piard F, Petrella T, Bonnin A, Couillault G, Dumas M, Guy H: Improved management of invasive pulmonary aspergillosis in neutropenic patients using early thoracic computed tomographic scan and surgery. J Clin Oncol 1997; 15: 139–147.PubMed

36.

Kaiser L, Hugenin T, Lew PD, Chapuis B, Pittet D: Invasive aspergillosis. Clinical features of 35 proven cases at a single institution. Medicine (Baltimore) 1998; 77: 188–194.CrossRef

37.

Abbasi S, Shenep JL, Hughes WT, Flynn PM: Aspergillosis in children with cancer: a 34-year experience. Clin Infect Dis 1999; 29: 1210–1219.CrossRefPubMed

38.

Lortholary O, Ascioglu S, Moreau P, Herbrecht R, Marinus A, Casassus P, De Pauw B, Denning DW: Invasive aspergillosis as an opportunistic infection in nonallografted patients with multiple myeloma: a European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the Intergroupe Francais du Myelome. Clin Infect Dis 2000; 30: 41–46.CrossRefPubMed

39.

Nosari A, Oreste P, Cairoli R, Montillo M, Carrafiello G, Astolfi A, Muti G, Marbello L, Tedeschi A, Magliano E, Morra E: Invasive aspergillosis in haematological malignancies: clinical findings and management for intensive chemotherapy completion. Am J Hematol 2001; 68: 231–236.CrossRefPubMed

40.

Ringden O, Meunier F, Tollemar J, Ricci P, Tura S, Kuse E, Viviani MA, Gorin NC, Klastersky J, Fenaux P, Prentice HG, Ksionski G: Efficacy of amphotericin B encapsulated in liposomes (AmBisome) in the treatment of invasive fungal infections in immunocompromised patients. J Antimicrob Chemother 1991; 28(Suppl. B): 73–82.PubMed

41.

Patterson TF, Kirkpatrick WR, White M, Hiemenz JW, Wingard JR, Dupont B, Rinaldi MG, Stevens DA, Graybill JR: Invasive aspergillosis. Disease spectrum, treatment practices, and outcomes. Aspergillus Study Group. Medicine (Baltimore) 2000; 79: 250–260.CrossRef

42.

Denning DW, Ribaud P, Milpied N, Caillot D, Herbrecht R, Thiel E, Haas A, Ruhnke M, Lode H: Efficacy and safety of voriconazole in the treatment of acute invasive aspergillosis. Clin Infect Dis 2002; 34: 563–571.CrossRefPubMed

43.

Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, Kern WV, Marr KA, Ribaud P, Lortholary O, Sylvester R, Rubin RH, Wingard JR, Stark P, Durand C, Caillot D, Thiel E, Chandrasekar PH, Hodges MR, Schlamm HT, Troke PF, De Pauw B: Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002; 347: 408–415.CrossRefPubMed

44.

Bowden R, Chandrasekar P, White MH, Li X, Pietrelli L, Gurwith M, Van Burik JA, Laverdiere M, Safrin S, Wingard JR: A double-blind, randomized, controlled trial of amphotericin B colloidal dispersion versus amphotericin B for treatment of invasive aspergillosis in immunocompromised patients. Clin Infect Dis 2002; 35: 359–366.CrossRefPubMed

45.

Lin S, Schranz J, Teutsch S: Aspergillosis case-fatality rate: systematic review of the literature. Clin Infect Dis 2001; 32: 358–366.CrossRefPubMed

46.

Morrison VA, Haake RJ, Weisdorf DJ: Non-candida fungal infections after bone marrow transplantation: risk factors and outcome. Am J Med 1994; 96: 497–503.CrossRefPubMed

47.

Prescott RJ, Harris M, Banerjee SS: Fungal infections of the small and large intestine. J Clin Pathol 1992; 45: 806–811.CrossRefPubMed

48.

Myoken Y, Sugata T, Kyo T, Kyo T, Fujihara M, Kohara T, Katsu M, Tamura M, Mikami Y: Invasive Aspergillus stomatitis in patients with acute leukemia: report of 12 cases. Clin Infect Dis 2001; 33: 1975–1980.CrossRefPubMed

49.

Nylander WA Jr: The acute abdomen in the immunocompromised host. Surg Clin North Am 1988; 68: 457–470.PubMed

50.

Johnson H, Smith TJ, Desforges J: Cytosine-arabinoside-induced colitis and peritonitis: nonoperative management. J Clin Oncol 1985; 3: 607–612.PubMed

51.

Vlasveld LT, Zwaan FE, Fibbe WE, Fibbe WE, Tjon RT, Tham TA, Kluin PM, Willemze R: Neutropenic enterocolitis following treatment with cytosine arabinoside-containing regimens for hematological malignancies: a potentiating role for amsacrine. Ann Hematol 1991; 62: 129–134.CrossRefPubMed

52.

Starnes HF Jr, Moore FD Jr, Mentzer S, Osteen RT, Steele GD Jr, Wilson RE: Abdominal pain in neutropenic cancer patients. Cancer 1986; 57: 616–621.CrossRefPubMed

53.

Chirletti P, Barillari P, Sammartino P, Cardi M, Caronna R, Arcese W, Petti C, Stipa V: The surgical choice in neutropenic patients with hematological disorders and acute abdominal complications. Leuk Lymphoma 1993; 9: 237–241.CrossRefPubMed

54.

Gomez L, Martino R, Rolston KV: Neutropenic enterocolitis: spectrum of the disease and comparison of definite and possible cases. Clin Infect Dis 1998; 27: 695–699.CrossRefPubMed

55.

Weinberger M, Hollingsworth H, Feuerstein IM, Young NS, Pizzo PA: Successful surgical management of neutropenic enterocolitis in two patients with severe aplastic anemia. Case reports and review of the literature. Arch Intern Med 1993; 153: 107–113.CrossRefPubMed

56.

Hori A, Kami M, Kishi Y, Machida U, Matsumura T, Kashima T: Clinical significance of extra-pulmonary involvement of invasive aspergillosis: a retrospective autopsy-based study of 107 patients. J Hosp Infect 2002; 50: 175–182.CrossRefPubMed

Title: Primary Invasive Aspergillosis of the Digestive Tract: Report of Two Cases and Review of the Literature
Authors: P. Eggimann
J.-C. Chevrolet
M. Starobinski
P. Majno
M. Totsch
B. Chapuis
D. Pittet
Publication date: 01-12-2006
Publisher: Urban & Vogel
Published in: Infection / Issue 6/2006
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI: https://doi.org/10.1007/s15010-006-5660-0

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Primary Invasive Aspergillosis of the Digestive Tract: Report of Two Cases and Review of the Literature

Abstract

Background:

Methods:

Results and Conclusion:

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background:

Methods:

Results and Conclusion:

Please log in to get access to this content

Other articles of this Issue 6/2006

Incidence of Surgical Site Infections in General Surgery in Italy

Mycoplasma pneumoniae Pericarditis and Cardiac Tamponade in a 7-Year-Old Girl with Cystic Fibrosis

Antibiotic Treatment of Diseases Without an Evident Infectious Etiology

ECDC's Growing Responsibilities in Defending Europe Against Infectious Diseases

Comparison of Risk Factors for Candidemia Versus Bacteremia in Hospitalized Patients

Development of Candidemia on Caspofungin Therapy: a Case Report

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page