Case1-Aspergillus - Case 1 Lydyard, Peter; Cole, Michael;...

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1. What is the causative agent, how does it enter the body and how does it spread a) within the body and b) from person to person? Causative agent Aspergillosis is caused by Aspergillus, a saprophytic, filamentous fungus found in soil, decaying vegetation, hay, stored grain, compost piles, mulches, sewage facilities, and bird excreta. It is also found in water stor- age tanks (for example in hospitals), fire-proofing materials, bedding, pil- lows, ventilation and air conditioning, and computer fans. It is a frequent contaminant of laboratory media and clinical specimens, and can even grow in disinfectants! Although Aspergillus is not the most abundant fungus in the world, it is one of the most ubiquitous. There are more than 100 species of Aspergillus . Although about 10 000 genes have been identified in the Aspergillus genome, none of the gene sets is shared with other fungal pathogens. The cell wall of A. fumigatus contains various polysaccharides (Figure 2). Newly synthesized b (1-3)-glucans are modified and associated to the other cell wall polysaccharides (chitin, galactomannan, and b (1-3)-, b (1-4)-glucan) Case 1 Aspergillus fumigatus A 68-year-old Caucasian man was diagnosed with B-cell chronic lymphocytic leukemia (B-CLL) and received various regimens of chemotherapy. As a patient with chronic leukemia he attended the CLL clinic regularly. Ten years later the patient presented with pneumonia symptoms and was examined by chest CT scan . The results were suggestive of aspergillosis and additional laboratory tests were done. Positive Aspergillus serology allowed the doctors in the clinic to give a diagnosis of A. fumigatus pneumonia. The patient was not neutropenic and his condition improved following an 8-month course of itraconazole followed by voriconazole for 6 months. Two years later the patient was diagnosed with pulmonary aspergillosis. The diagnosis was based on a CT scan, cytology results, and a history of prior infection (Figure 1). He was treated with amphotericin B, monitored by radiography, followed by caspofungin for 9 days, but he died 2 days later of drug discontinuation. An autopsy was performed and the diagnosis of invasive pulmonary aspergillosis was confirmed. Figure 1. Chest X-ray showing that the fungus has invaded the lung tissue. There is a large cavity in the upper left lobe of the lung, with a fungus ball within the cavity. © Lydyard, Peter; Cole, Michael; Holton, John; Irving, Will; Porakishvili, Nino; Venkatesan, Pradhib; Ward, Kate, Jan 01, 201 Garland Science, Hoboken, ISBN: 9780203856871
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leading to the establishment of a rigid cell wall. Glycosyltransferases bound to the membrane by a glycosylphosphatidyl inositol (GPI) anchor play a major role in the biosynthesis of the cell wall. Fungal cell composition affects its virulence and susceptibility to immune responses. Of over 100 species of
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This note was uploaded on 09/14/2011 for the course PHARM mb taught by Professor Staff during the Spring '11 term at UCSD.

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Case1-Aspergillus - Case 1 Lydyard, Peter; Cole, Michael;...

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