Researchers from the Oswaldo Cruz Institute (IOC/Fiocruz) reported in a scientific article the first case in Brazil of meningoencephalitis caused by the fungus Penicillium chrysogenum.
The fungus is rarely identified as a cause of disease in humans. However, it caused a serious infection in the brain and meninges of a patient in the city of Rio de Janeiro, which led to her death. The report was published in the scientific journal International Journal of Infectious Diseases.
The case was followed up at Hospital Naval Marcílio Dias, in the North Zone of Rio de Janeiro. A 14-year-old girl was admitted to the medical center with headaches, photophobia and vomiting. According to the exams, the young woman had no comorbidities and appeared to have full capacity to react against infectious agents.
The presence of the fungus was observed in analyzes of the cerebrospinal fluid, the fluid that surrounds the brain and spinal cord. The samples were sent for more detailed taxonomic identification at the Laboratory of Taxonomy, Biochemistry and Bioprospection of Fungi at IOC/Fiocruz. Based on methodologies involving taxonomic characterization and molecular techniques, it was confirmed that the fungus found belonged to the species Penicillium chrysogenum.
“Meningoencephalitis is commonly associated with infections caused by bacteria or fungi of the genus Cryptococcus. It was astonishing to find out that this case was related to Penicillium, and of a species that had not yet been described in the country as the cause of this disease,” says Manoel Marques Evangelista de Oliveira, study coordinator, in a statement.
With the confirmation, doctors at Marcílio Dias started treating the young woman with two classes of antifungal medication. Despite efforts, the patient died due to septic and neurogenic shock.
“The severity of this case worries us because it occurred mainly in an immunocompetent patient, as it could mean that the P. chrysogenum has an immune response escape profile. The case could have had an even more rapid and complicated evolution in patients with compromised immunity, such as people with HIV/Aids or being treated for Covid-19”, explains Manoel.
For the researcher, the finding demonstrates the need for a quick and accurate identification of disease-causing agents and the importance of expanding studies on fungi.
“Our article serves as a warning for physicians to consider fungi more constantly in their diagnoses, as was done by Hospital Naval Marcílio Dias. Like viruses and bacteria, fungi can cause a variety of diseases. However, as they are not remembered much, several cases are treated late or go unnoticed, ”he says.
According to the researchers, the way in which the patient was infected by the P. chrysogenum it was not evident. Although the fungus is widely distributed in the environment, it is more common to find it in soils where there is decomposing matter, sewage passages and works.
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The publication also highlights a recent increase in the incidence of fungal infections in the human central nervous system. Among the main syndromes triggered by the contagion are meningitis, encephalitis and increased intracranial pressure.
“This increase is related to the growth, in the last two decades, of the number of immunosuppressed people, that is, with low immunity. The reasons are diverse: people living with HIV/AIDS, indiscriminate use of medication, cases of depression and, more recently, Covid-19. These individuals are prone to contracting fungal infections”, says the researcher.
Most occurrences are related to species of the genus Cryptococcus, which cause meningitis. Infection usually occurs by inhaling spores in soil dust contaminated with pigeon droppings.
“The fungi that cause cryptococcosis are widespread throughout the world. But there is also another factor that contributes to the large number of reported cases: the ease of diagnosis. Unlike most fungal infections, there are quick tests to identify Cryptococcus species, which allows a faster diagnosis to be made without the need to call a mycology laboratory”, he says.
For the researcher, the number could be even higher. “Cases may just be underreported, as there is a lack of specialized professionals in the area. It is important that there is constant exchange between mycology laboratories and hospitals”, he evaluates.
(With information from Instituto Oswaldo Cruz Communication)
Source: CNN Brasil
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