Usefulness of Gastric Aspirate Culture for Diagnosing Congenital Immunodeficiency in an Infant with Fungal Pneumonia Caused by Rasamsonia piperina

Usefulness of Gastric Aspirate Culture for Diagnosing Congenital Immunodeficiency in an Infant with Fungal Pneumonia Caused by Rasamsonia piperina

YUJI FUJITA,^1,2 NARUHIKO ISHIWADA,³ HARUKA TAKEI,¹ SHIN-ICHI SUWABE,² KYOKO YARITA,³ MISAKO OHKUSU,³ YASUNORI MURAOSA,³ KATSUHIKO KAMEI³ and NAOKI SHIMOJO¹

¹Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
²Department of Pediatrics, Kimitsu Chuo Hospital, Kisarazu, Chiba, Japan
³Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Chiba, Chiba, Japan

Chronic granulomatous disease (CGD) is a type of primary immunodeficiency disease, which increases susceptibility to recurrent bacterial and fungal infections. Sputum and bronchoalveolar lavage fluid are often obtained using bronchoscopy from adult patients for pathogenic diagnosis, although this approach is much more invasive for infants. We report the case of a 2-month-old boy with CGD, in which gastric aspirate culture was used to diagnose fungal pneumonia. Rasamsonia piperina was isolated from the gastric aspirate, and the patient was successfully treated with micafungin based on the drug susceptibility test results for the fungal isolate. The acid tolerance test revealed that R. piperina could grow at pH 2, indicating high acid resistance. Although we can only report our experience with a single case, gastric aspirate culture may be a useful tool for detecting fungal respiratory pathogens in children with primary immunodeficiency. Detecting these pathogens may help improve outcomes, as early diagnosis and appropriate treatment are extremely important for immunocompromised patients with respiratory infections.

keywords —— chronic granulomatous disease; fungal respiratory infection; gastric aspirate; primary immunodeficiency; Rasamsonia piperina

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Tohoku J. Exp. Med., 2019, 247, 265-269

Correspondence: Yuji Fujita, M.D., Department of Pediatrics, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan.

e-mail: ojifujita@gmail.com