FATAL, DISSEMINATED ACREMONIUM-STRICTUM INFECTION IN A NEUTROPENIC HOST

Disseminated Acremonium strictum infection in a neutropenic patient is reported. Positive fecal cultures preceded positive cutaneous and blo od cultures by 18 and 21 days, respectively, which suggests gastrointe stinal colonization and invasion as initiating events, Microscopic exa mination of cutaneous biopsy and pulmonary specimens revealed hyphae, phialides, and phialoconidia in vivo, These adventitious forms also ca n occur in infections due to other phialidic fungi such as Fusarium an d Paecilomyces species and can be misdiagnosed as Candida species, Bud ding cells also can occur in vivo for species of Fusarium, Paecilomyce s, and apparently Acremonium, further adding to the potential for misd iagnosis, The occurrence of adventitious forms in infections caused by species of Acremonium, Fusarium, Paecilomyces, Scedosporium, and Blas toschizomyces is suggested as a mechanism for dissemination of infecti on and as an explanation of the relatively higher frequency of positiv e blood cultures in these cases.