曲霉属是常见的菌丝真菌。除了过敏和霉菌中毒,曲霉属可引起各种被称为曲霉病的感染。呼吸道曲霉病,中枢神经系统,皮肤和软组织是很好的描述。然而,由于侵袭性曲霉病引起的肌肉骨骼感染没有得到很好的描述。由侵袭性曲霉病引起的真菌关节感染是一种罕见的化脓性关节炎。在这个案例报告中,介绍了1例入院接受肝移植的患者,在此过程中出现了由黄曲霉/米曲霉引起的膝关节关节炎。一名28岁的男性自身免疫性肝炎患者因失代偿性肝硬化和脑病入院。病人,正在等待紧急肝移植,发达的疼痛,他的右膝肿胀和活动受限,并要求进行适当的咨询和测试。相隔一天和九天后进行的三次关节液培养对真菌生长呈阳性。霉菌生长的宏观检查和用乳酚棉蓝进行的显微镜检查表明属于A.flavus复合物的物种,该分离物被鉴定为A.flavus/A。通过基质辅助激光解吸/电离质谱(MALDI-TOFMS)(EXS2600,Zybio,中国)。作为ITS基因测序的结果,该物种被确定为A.oryza。由于已经报道了黄曲霉和米曲霉物种无法通过ITS基因测序进行区分的情况,病原体定义为黄曲霉/米曲霉。该患者在使用两性霉素B治疗期间死于肝病。文献中很少有由曲霉属引起的关节炎病例。在关节感染中发现的曲霉是,烟曲霉,A.flavus,黑曲霉和土曲霉物种复合物,按照频率的顺序。黄曲霉和米曲霉密切相关。用常规方法很难区分,MALDI-TOFMS或其区域测序,通常用于真菌中的属/种鉴定。曲霉菌关节炎病例的数量很少,并且在大多数研究中,用于报告为病原体的物种的鉴定方法可以在物种复杂水平上进行鉴定。此外,可以假设,由于鉴定方法的发展,可能会遇到以前未报告为病原体的物种。在文献中的少数出版物中,黄花复合物被报道为关节感染的病原体,似乎有些试剂可能是A.flavus,有些可能是A.oryzae,因为这些药物是在复杂水平上鉴定的。在文献中,A.oryzae是病原体的案例数量有限,尤其是在呼吸道。使用关键字\"A的PubMed搜索。水稻感染,关节炎,骨髓炎“没有揭示任何关于A.oryza引起的关节感染的文献。
Aspergillus species are common hyphal fungi. In addition to allergies and mycotoxicosis, Aspergillus species can cause various infections known as aspergillosis. Aspergillosis of the respiratory tract, central nervous system, skin and soft tissues is well described. However, musculoskeletal infections due to invasive aspergillosis are not well described. Fungal joint infection due to invasive aspergillosis is a rare form of septic arthritis. In this
case report, a patient who admitted to our hospital for liver transplantation and developed knee joint arthritis caused by Aspergillus flavus/Aspergillus oryzae during this process was presented. A 28-year-old male patient with autoimmune hepatitis was admitted to hospital with decompensated liver cirrhosis and encephalopathy. The patient, who was awaiting an emergency liver transplant, developed pain, swelling and limitation of movement in his right knee and appropriate consultations and tests were requested. Three joint fluid cultures taken one day apart and nine days later were positive for fungal growth. Macroscopic examination of the mould growth and microscopic examination with lactophenol cotton blue suggested a species belonging to the A.flavus complex and the isolate was identified as A.flavus/A.oryzae by matrix-assisted laser desorption/ionisation mass spectrometry (MALDI-TOF MS) (EXS 2600, Zybio, China). As a result of ITS gene sequencing, the species was determined to be A.oryzae. As cases have been reported where A.flavus and A.oryzae species could not be distinguished by ITS gene sequencing, the pathogen was defined as A.flavus/oryzae. The patient died of liver disease during treatment with amphotericin B. There are few cases of arthritis caused by Aspergillus species in the literature. Aspergillus species found in joint infections are, Aspergillus fumigatus, A.flavus, Aspergillus niger and Aspergillus terreus species complexes, in order of frequency. A.flavus and A.oryzae are closely related. They are difficult to distinguish by conventional methods, MALDI-TOF MS or ITS region sequencing, which is commonly used for genus/species identification in fungi. The number of Aspergillus arthritis cases is low and the identification methods applied to the species reported as causative agents in most studies can identify at the species complex level. In addition, it can be assumed that species not previously reported as causative agents may be encountered as a result of developments in identification methods. In the few publications in the literature where A.flavus complex was reported as the causative agent of joint infections, it seems possible that some of the agents may be A.flavus and some may be A.oryzae, since the agents were identified at the complex level. There are a limited number of cases in the literature where A.oryzae is the causative agent, particularly in the respiratory tract. A PubMed search using the keywords \"A.oryzae infections, arthritis, osteomyelitis\" did not reveal any literature on joint infections caused by A.oryzae.