Aspergillus and Vaginal Colonization

Gary Ventolini
*
Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, USA
*
Corresponding author: Gary Ventolini, Regional Dean and Professor of Obstetrics and Gynecology, Texas Tech University Health Sciences Center-Permian Basin, 800
W. 4th Street, Odessa, TX, 79763, USA, Tel: 432-703-5134; Fax: 432-335-5104; E-mail: gary.ventolini@ttuhsc.edu
Rec date: Mar 02, 2014, Acc date: Apr 24, 2014, Pub date: Apr 26, 2014
Copyright: 2014 Ventolini G. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Aspergillus is a fungus with spores present in the air but usually
does not cause disease unless it reaches an individual with a
compromised immune system. Baggish and Ventolini concluded afer
their report on vaginal Aspergillus on no immune compromised
women that given the appropriate opportunistic settings Aspergillus
fungus can and will cause serious infections.
Keywords: Aspergillus; Colonization; Vagina; History
Introduction
Aspergillus is a fungus with spores present in the air but usually
does not cause disease unless it reaches an individual with a
compromised immune system.
History
In 1729, the Italian priest and biologist Pier Antonio Micheli
classifed the genus Aspergillus. He observed the fungus under a
microscope and compared the shape of it to a holy water sprinkler
called aspergillum (from the Latin spargere that means to sprinkle). It
was only in 1809 that Johann Heinrich Friedrich Link a German
mycologist described the fungus [1]. Much later in 1856 the famous
Rudolf Virchow reported the frst case of human pulmonary
aspergillosis [2].
Genus
Aspergillus is a genus composed of hundreds of mold species that
can be found in diferent environments worldwide. Tey are a
pervasive group of fungi, which from time to time, may produce
signifcant and occasionally deadly infections in humans. Aspergilli are
known to produce diverse toxins, including a very powerful carcinogen
known as afatoxin. Tese fungi may be found ubiquitous anywhere
there is waste, decomposing, or standing matter.
Egyptian Pharaohs Curse
It has been historically speculated that the curse of Egyptian
pharaohs associated with tomb diggings may in fact, be attributed to
thousand-year-old Aspergillus niger survived in the decomposing fesh
and wraps of the mummies. Moreover when those caskets were pried
open, the fungi was most probably aerosolized by way of dust and
inhaled by the excavator. Several weeks or months later, the digger was
aficted by a mysterious pneumonia, from which he subsequently died.
Immunocompromised Hosts
Typically only patients with compromised immune systems or who
sufer from other lung conditions [cystic fbrosis, chronic obstructive
pulmonary disease (COPD), severe asthma] are susceptible to
Aspergillus. Additionally patients with cancer, on chemotherapy or
chronic steroid therapy, transplant recipient patients, patients with
human immunodefciency virus (HIV) or acquired immunodefciency
syndrome (AIDS), chronic granulomatous disease (CGD) among
others are also susceptible hosts [3,4].
Infections
Te major forms of disease are predominantly paranasal sinus,
allergic bronco-pulmonary or pulmonary infections but cardiac,
orthopedic, and ophthalmic infections have also being reported [5-14].
Immunosuppression is a signifcant contributing factor to those
infections [15,16]. Aspergillus can spread to patients through air, food,
or direct contact. Tere are several reported cases in the literature,
including the lower extremities with multiple debridements for
extensive gangrene; others regarding burn patient with lesions
mimicking methicillin resistant staphylococcus aureus (MRSA) and a
cluster of cutaneous Aspergillus niger infections that transpired on a
transplant unit adjacent to a kitchen [15-17]. Aspergillus has been
isolated in 367 molds in hospital air and from 23 patients [18].
Modern Era
Dirty air conditioning units, compost piles and moist or food-
damaged houses can produce a high number of Aspergillus spores.
Although compromised immune system remains a crucial factor.
Vaginal Infections
Fungal infections of the vaginal tract account for a substantial
number of patient telephone and e-mail consultations, ofce visits, and
over the counter and prescription drug over utilization.
Identifying pseudo-hyphae on a potassium hydroxide (KOH) wet
mount preparation and obtaining a fungal culture are two necessary
steps before starting therapy. Identifying the specifc fungus is required
to achieve targeted therapeutic success.
Aspergillus is not a common fungus complicating chronic or
recurrent vaginal infections and there is only one publication found in
the recent literature that reports the prevalence of Aspergillus genital
infections in women [19].
In the same publication, Baggish and Ventolini described 16
Aspergillus infections in patients with chronic unresponsive infections
of the vulva, vestibule, and/or vagina. It is important to notice that
neither of those patients had a compromised immunity system. Te
Journal of Ancient Diseases &
Preventive Remedies
Ventolini, J Anc Dis Prev Rem 2014, 2:1
http://dx.doi.org/10.4172/2329-8731.1000e115
Editorial Open Access
J Anc Dis Prev Rem
ISSN:2329-8731 JADPR, an open access journal
Volume 2 Issue 1 1000e115
authors reported to have prescribed Itraconazole for 30 days and to
have efectively resolved the lower genital tract colonization in that
cohort of patients [19].
Itraconazole is a potent inhibitor of most human fungal pathogens
including Aspergillus sp. Baggish and Ventolini therefore concluded
that given the appropriate opportunistic settings (recurrent infections
and perhaps and altered local immune response), Aspergillus fungus
can and will cause serious infections. Additionally they recommended
keeping a high index of suspicion for Aspergillus species colonization
in patients which chronic vaginal fungal infections and to include
Aspergillus in the diferential diagnosis [19].
Fruiting bodies and hyphae of Aspergillus are also rarely observed
in routine Papanicolau smears. When discovered, diferentiating
between an infection and a contamination should be made; due to the
toxicity of the antifungal involved to treat a true infection, the
psychological impact that causes to the patient and the necessary
assessment of the immune status and follow-up requirements [20].
Vaginal Susceptibility
Regarding research on Aspergillus as a cause of opportunistic
vaginal infections, most of this research has focused on fnding their
growth patterns, the virulence factors produced by them as well as
developing new methods for their diagnosis and to assessing the efect
of environmental factors on their gene expression.
Fungi that grow over a widespread range of extracellular pH,
including the vaginal cavity, must have evolved to sense and respond
correctly to their environment. For instance Aspergillus, a human
opportunistic pathogen colonizes and infects anatomical sites of
diverse pH. Tis ability is governed by signal transduction pathways
like the one that activates the transcription factor Rim101p [21].
Additionally, in a house-to-house survey by means of cluster
sampling 1,344 married women from urban and rural areas of Upper
Egypt were interviewed and examined in 2002 by Sullam et al. [22], to
study the extent and causes of reproductive tract infections. Overall
prevalence was found to be 52.8% with Aspergillus species at 7.4%. Te
authors identifed women at high risk of developing reproductive tract
infections as those with an intrauterine device and those practicing
vaginal douching.
Conclusion
Aspergillus fungus can and will cause serious infections with the
right opportunistic vaginal settings: recurrent infections altered local
or systemic immune response. Terefore keeping a high index of
suspicion for Aspergillus species colonization in patients with
recurrent vaginal fungal infections and patients who are immuno
compromised is recommended.
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Citation: Ventolini G (2014) Aspergillus and Vaginal Colonization. J Anc Dis Prev Rem 2: e115. doi:10.4172/2329-8731.1000e115
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J Anc Dis Prev Rem
ISSN:2329-8731 JADPR, an open access journal
Volume 2 Issue 1 1000e115