Geosmithia argillacea: An Emerging Cause of Invasive Mycosis in Human Chronic Granulomatous Disease

2011 
Chronic granulomatous disease (CGD) is a rare inherited disorder involving defective nicotinamide adenine dinucleotide phosphate oxidase function, which leads to defective production of antimicrobial superoxide anion and related oxygen intermediates critical for host defense [1]. Clinically, CGD patients develop recurrent life-threatening infections and extensive tissue granuloma formation, autoimmune diseases, and inflammatory bowel disease, which may require immunosuppressive or immunomodulatory therapy. The pathogens that commonly cause infection in CGD include the bacteria Staphylococcus aureus, Serratia marcescens, Burkholderia cepacia complex, and Nocardia species and the fungi Aspergillus species, especially Aspergillus fumigatus and Aspergillus nidulans [2]. Other less common fungi, such as Paecilomyces species and Trichosporon inkin, are encountered more frequently in patients with CGD than among the general population, highlighting the fact that patients with CGD have a unique susceptibility pattern [1]. New pathogens are continually being identified as a result of improvements in microbiologic culture and identification techniques. The use of genomic sequencing and the increasing number of sequences available in databases have permitted identification of emerging pathogens (eg, Granulibacter bethesdensis) [3] in CGD patients, as well as the reassignment of misidentified pathogens (eg, Neosartorya udagawae) [4, 5] to their correct taxa. Here we describe, to our knowledge, the first report of invasive mycoses caused by another emerging pathogen, Geosmithia argillacea, in 7 CGD patients. This disease was aggressive, involving invasion across tissue planes or metastatic dissemination in 3 patients. As shown by genomic sequencing of stored fungal isolates, isolates from 4 of these patients had been misidentified originally as Paecilomyces variotii, which resembles G. argillacea morphologically. Correct identification has important therapeutic and prognostic implications.
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