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Paecilomyces Lilacinus: an Emerging Pathogen ISSN (Online) : 2456-2688 Journal of Health Science Research, Vol 1(2), 48-51, 2016 DOI: 10.18311/jhsr/2016/5023 Paecilomyces lilacinus: An Emerging Pathogen T. G. Ramya1, Sabitha Baby2* and R. K. Geetha1 1Department of Microbiology, Karuna Medical College, Chittur, Palakkad, Kerala, India 2Department of Microbiology Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, India; [email protected] Abstract Paecilomyces is a common saprophyte found in air and food and is also associated with many types of human infections. Pneumonia due to Paecilomyces Paecilomyces describe a case of atypical pneumonia is rare by Paecilomyces and the clinical lilacinus manifestations are unspecific. So distinguishing Theinfection female clinically patient andhad promptbreathlessness microbiological for over twoidentification years and willwas helpadmitted in adminiatering to hospital as empirical it worsened. antifungal Her X-ray therapy. revealed We in a patient with interstitial lung disease and cor pulmonale. Paecilomyces. right and left ventricular failure. Sputum was sent for fungal bacterial culture and KOH for fungal elements. The Culture on SabouroudsKeywords: Dextrose Paecilomyces Agar grew lilacinus purecolonies of 1. Introduction , Pneumonia, Lactophenol medication.Cotton Blue ,There Sabauraud’s was no Dextrose history Agarof haemoptysis. On general physical examination her vitals were Paecilomyces species are generally encountered as common stable. There were mild pallor and clubbing. There was no soil saprophytes and a rare airborne contaminant in cyanosis, lymphadenopathy or edema. She was conscious, diagnostic microbiology laboratories1. Literature search oriented and cooperative. Examination of respiratory reveals majority of the infections caused by paecilomyces system revealed wheeze, polyphonic rhonchi, inspiratory among healthy hosts due to endophthalmitis following and expiratory crepitations all over her chest. intraocular lens implantation2. In immuno compromised Chest X-ray showed features of left and right patients. Paecilomyces lilacinus causes cutaneous ventricular failure. Echocardiogram detected left and infection, catheter related fungaemia and disseminated right ventricular dysfunction with moderate pulmonary disease secondary to application of contaminated skin artery hypertension. Ejection fraction was 55%. Based on lotions3. the above investigations, a diagnosis of interstitial lung disease with cor pulmonale was made. Empirical therapy was started with Amoxyclav and clarithromycin. She was 2. Case Report also started on Oxygen. Also, with suspicion of atypical pneumonia, sputum A lady aged 56 years with known history of type 2 diabetes was sent for fungal staining and culture. After three days mellitus, Chronic Obstructive Pulmonary Disease of admission, her condition deteriorated clinically, she (COPD) and hypothyroidism presented to our hospital complained of headache became drowsy. She was shifted with complaints of productive cough and breathlessness to the ICU. Arterial blood gas analysis was carried out. for the past two days. Findings were suggestive of CO retention. Ryles tube was The patient had history of breathlessness for two years 2 put and she was started on continuous positive airway which had aggravated in the last two days. Breathlessness pressure. was gradual in onset, aggravated by dust and relieved by * Author for correspondence T. G. Ramya, Sabitha Baby and R. K. Geetha 2.1 Microbiology Work Up The patient was given oral fluconazole and Sputum gram stain showed normal bacterial flora. Acid posaconazole syrup. The patient improved clinically fast staining did not show any acid fast bacilli. Wet mount and was eventually discharged after five days. Further with KOH showed hyaline, septate hyphae. Sputum review after 2 weeks were uneventful. Complete cure was was inoculated into Blood agar, Mac Conkey agar and achieved during the follow-up period of 2 months. Sabouraud’s Dextrose Agar (SDA). Bacterial culture grew normal flora. After three days, slightly lilac coloured granular colonies were seen growing on SDA. Within one week the colour of the colonies turned to a darker shade of vinaceous. (Figure 1). Figure 2. Paecilomyces lilacinus hyaline septate hyphae with elongated, tapering phialides with several elliptical conidia. 3. Discussion During the past decade, hyalohyphomycosis has been increasingly recognised. This could be because of 1. Increased awareness among clinicians 2. Improved diagnostic tools and 3. Increased host susceptibility4. Risk factors for non Aspergillus hyaline mold infections are similar to those for invasive aspergillosis. These Figure 1. Lilac coloured colonies of Paecilomyces lilacinus. environmental molds enter humans by inhalation or by cutaneous inoculation. LPCB (lactophenol Cotton Blue) mount from the Presence of Paecilomyces have been considered colonies produced hyaline septate hyphae and elongated, as contaminant, however several cases of infection in tapering phialides with several elliptical conidia. (Figure humans and animals have been reported. The rare case 2). Conidiogenous cells were branched, cylindrical, and reports in humans involve corneal ulcer, keratitis, and loosely clustered, tapering gradually to a fine point. The endophthalmitis following extended wear contact lens 5 conidia were globose and ellipsoidal and were produced use or ocular surgery . endogenously to form a very long chain. Based on the Also Paecilomyces predominanly cause diseases in colony morphology and microscopy findings, the isolate patients immunocompromised from haematopoietic was identified asPaecilomyces lilacinus. The vinaceous cell malignancies, diabetes, HIV/AIDS, chronic pigmentation of the colonies and a careful study of the granulomatous disease and by corticosteriods. It has microscopical features are the most useful criteria for also been implicated as the cause of cell mediated distinguishing this fungus from common contaminants, granulomatous allergic alveolitis (without pneumonia) in 6 e.g., Penicillium, which shows a similar arrangement of the individuals living in proximity to decaying wood . fertile hyphae, or from other more common pathogenic In the present case, the patient had diabetes and fungi, e.g., Aspergillus and Candida spp. hypothyroidism. The fungus Paecilomyces is a soil Vol 1 (2) | 2016 | www.informaticsjournals.com/index.php/jhsr Journal of Health Science Research 49 Paecilomyces lilacinus: An Emerging Pathogen saprophyte and this patient may have acquired the occur mainly in solid organ and bone marrow transplant infection during outdoor work when the fungal recipients, although surgery and primary or acquired spores were inhaled. Posaconazole, the novel triazole immunodeficiency are also relevant predisposing factors. demonstrated effectiveness in treatment of pneumonia Infections in apparently immunocompetent patients have from Paecilomyces in our patient. The clinical also been reported. Surgical debridement combined with manifestations of this fungal infection are unspecific and antifungal drug therapy, or the correction of predisposing include fever, pleuritic chest pain, productive cough, and factors, such as neutropenia, are usually required to dyspnea. Hilar lymphadenopathy, nodules, confluent obtain improvement13. and patchy opacities, and cavitary lesions are the most common imaging abnormalities. 4. Conclusion Paecilomyces variotii and Paecilomyces lilacinus are the two species most frequently associated with human The present case report provides us with an insight to disease. Other species reported to infect humans rarely consider opportunistic pathogens like Paecilomyces include Paecilomyces marquandii and Paecilomyces causing serious infections in immunocompromised 7 javanicus . Paecilomyces lilacinus, show poor susceptibility patients and increased awareness about this fungus will to amphotericin B, itraconazole, and echinocandins, help in prompt diagnosis and better patient care in future. while Paecilomyces variotii shows a different susceptibility This experience emphasizes the potential pathologic pattern, being susceptible to most antifungal agents nature of this fungus when immunity is compromised by apart from voriconazole. So determination of the precise poorly controlled diabetes and other underlying factors. specie of Paecilomyces is important for the appropriate management and treatment of these infections. Paecilomyces lilacinus has been reclassified under the 5. References genus Purpureocillium as the genus Paecilomyces was not 1. Chander J. A text book of Medical Mycology. 3rd ed. New monophyletic. Genus Purpureocillium contains the single Delhi: Mehtaprint; 2009. p. 266–90 8 species Purpureocillium lilacinum . P. lilacinum may 2. Pettit T. Fungal endophthalmitis following intraocular lens be entomopathogenic9,10, mycoparasitic11, saprophytic, implantation. Archives of Ophthalmology. 1980;98(6):1025. nematophagous as well as an emerging human pathogen. 3. Orth B. Outbreak of Invasive Mycoses Caused by Paecilo- A peculiar characteristic of P. lilacinus is its ability myces lilacinus from a Contaminated Skin Lotion. Annals of Internal Medicine. 1996; 125(10):799. to sporulate in infected tissue, can be helpful in the 4. Swami T, Pannu S, Kumar M, Gupta G. Chronic invasive diagnosis of these infections. This type of sporulation, fungal rhinosinusitis by Paecilomyces variotii: A rare case called ‘adventitious’ sporulation, involves the production report. Indian J Med Microbiol. 2016; 34:103–6. of reproductive
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