Ventilator-associated pneumonia caused by a new-found opportunistic fungal pathogen——Myceliophthora heterothallica：A case report

Abstract

Background Myceliophthora heterothallica belonging to Myceliophthora is considered as an environmental fungus and has not been reported to be pathogenic or colonizing in recent literatures. The present case firstly reports an elderly ventilation-associated pneumonia caused by Myceliophthora heterothallica. Case presentation: A 67-years-old Asian female patient suffering from a sudden disturbance of consciousness for 3 hours was admitted to our hospital. Cardiac arrest occurred during emergency transport, and sinus rhythm was restored after cardiopulmonary resuscitation. Invasive mechanical ventilation was given to this patient for respiratory failure. After mechanical ventilation, the lung CT images showed multiple cuneiform nodules arranging subpleural accompanying with ground-glass opacity. On the 5th day of mechanical ventilation, Myceliophthora heterothallica was cultured from endotracheal aspirates. Two methods, namely automatic microbial identification system and internal transcribed spacer sequencing were employed to identify this fungus. The present case firstly uncovered the colonization ability and pathogenicity of Myceliophthora heterothallica in the respiratory tract. After 28d of treatment with piperacillin-tazobactam, this patient weaned from the ventilator and recovered consciousness with lung infection disappearance. Conclusions This is the first case report of ventilation-associated pneumonia in elderly patient caused by Myceliophthora heterothallica. This current case is worth for the clinical diagnosis and treatment of Myceliophthora heterothallica infection, and also enriches new pathogenic species found of Thermothelomyces species.