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Journal of Clinical Microbiology, April 1998, p. 1146-1150, Vol. 36, No. 4
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Disseminated Invasive Infection Due to Metarrhizium anisopliae in an Immunocompromised Child

David Burgner,1 Gillian Eagles,1 Margaret Burgess,2 Peter Procopis,3 Maureen Rogers,4 David Muir,5 Robert Pritchard,5,* Ailsa Hocking,6 and Michael Priest7

Departments of Microbiology,1 Oncology,2 Neurology,3 and Dermatology,4 Royal Alexandra Hospital for Children, Westmead, NSW 2145, Australian National Reference Laboratory in Medical Mycology, Royal North Shore Hospital, St. Leonards, NSW 2065,5 CSIRO Division of Food Science and Technology, North Ryde, NSW 2113,6 and NSW Agriculture, Plant Pathology Herbarium, Agricultural and Veterinary Centre, Orange, NSW 2800,7 Australia

Received 15 July 1997/Returned for modification 19 August 1997/Accepted 9 January 1998

The first reported human case of possible disseminated infection with the insect pathogen Metarrhizium anisopliae var. anisopliae, a fungus which has been used commercially for biocontrol of insects, is described. The patient, a 9-year-old boy, had a 5-year history of pre-B-cell acute lymphoblastic leukemia and had been on chemotherapy throughout this period. After 10 days of profound neutropenia, lesions consistent with ecthyma gangrenosum appeared on his arms and legs. M. anisopliae was grown from specimens from three separate sites, collected at different times over a period of 1 month: a skin biopsy, a swab from the base of a lesion, and the core of another skin lesion which spontaneously discharged. The initial skin biopsy also showed histological evidence of epidermal necrosis and dermal invasion with fungal hyphae. A computed-tomography (CT) scan of the chest demonstrated a lesion in the superior segment of the lower lobe of the left lung. A CT scan of the brain revealed a lesion in the left temporoparietal region of the brain, consistent with an abscess. Despite antifungal treatment including liposomal amphotericin and 5-flucytosine, the patient eventually died. The initial portal of entry is unknown, but hematogenous dissemination to the skin appears likely because of the multiple ecthymic lesions, and the appearances of the brain lesion on the CT scan are consistent with a hematogenous fungal abscess.

* Corresponding author. Mailing address: Australian National Reference Laboratory in Medical Mycology, Royal North Shore Hospital, Pacific Hwy., St. Leonards, NSW 2065, Australia. Phone: 612-9926-8477. Fax: 612-9437-5746. E-mail: rcpmicro{at}med.usyd.edu.au.

Journal of Clinical Microbiology, April 1998, p. 1146-1150, Vol. 36, No. 4
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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