PULMONARY ASPERGILLOSIS CAUSED BY NEOSARTORYA-FISCHERI (ASPERGILLUS-FISCHERIANUS) IN A LIVER-TRANSPLANT RECIPIENT

Introduction: Laboratory diagnosis of aspergillosis may be difficult w ithout confirmatory clinical and microscopic evidence. We report a cas e of pulmonary aspergillosis caused by Neosartorya Fischeri in a liver transplant recipient. Clinical case: The patient was a 42-year-old wh ite man with HCV Ab positive cirrhosis of the liver diagnosed in 1983. In January 1996 he was submitted to an orthotopic liver transplantati on from a cadaveric donor. In the 6th post operative day a primary gra ft non-function was suspected and the patient was retransplanted. On t he 2th post operative day a fungus was detected both by microscopic an d cultural examination, on samples obtained from bronchial washing. Re sult: Microscopic examination of the bronchial washing revealed the pr esence of a large amount of septate hyphae showing frequently terminal or intercalary globose bodies. At room temperature on Sabouraud's aga r, whitish fast-growing colonies developed. The isolate produced only scant amounts of conidiophores and uniseriate heads resembling those o f Aspergillus fumigatus. Within three weeks ascomata, asci and ascospo res developed and the fungus was identified as Neosartorya fischeri ta n. Aspergillus fischerianus). Conclusion: We think that globose bodies of septate hyphae, for their size and because present in large amount s, are ascospores rather than conidia. Neosartorya fischeri has seldom been reported in human infection. In our case the pathogenic role of this sexual state of Aspergillus has been clarified on the grounds of the correlation between positive cultures and microscopic findings.