Aspergillosis: From Diagnosis to Prevention

Alessandro C. PasqualottoEditor

Aspergillosis: FromDiagnosis to Prevention

123

EditorProf. Alessandro C. Pasqualotto, MD PhDSanta Casa – Complexo Hospitalar and Universidade Federal do Rio Grande do Sul (UFRGS)Molecular Diagnostics LaboratoryHospital Dom Vicente Scherer, 8th floorAv Independência 155Porto Alegre, 90035-075, Brazilacpasqualotto@hotmail.com; pasqualotto@santacasa.tche.br

ISBN 978-90-481-2407-7 e-ISBN 978-90-481-2408-4DOI 10.1007/978-90-481-2408-4Springer Dordrecht Heidelberg London New York

Library of Congress Control Number: 2009926835

© Springer Science+Business Media B.V. 2010No part of this work may be reproduced, stored in a retrieval system, or transmitted in any form or byany means, electronic, mechanical, photocopying, microfilming, recording or otherwise, without writtenpermission from the Publisher, with the exception of any material supplied specifically for the purposeof being entered and executed on a computer system, for exclusive use by the purchaser of the work.

Cover illustration: Front cover image shows Aspergillus conidiophores (fruiting bodies) and conidia(asexual spores). Front cover image copyright Dennis Kunkel Microscopy, Inc.

Printed on acid-free paper

Springer is part of Springer Science+Business Media (www.springer.com)

Preface

The number of publications in recent years showing the importance of Aspergillusspecies as emergent pathogens is massive. In fact, aspergillosis has become so sig-nificant that even conferences and books are now dedicated to this subject. But thestory was not always like that. Aspergillosis has only been recognised in the last~220 years and no Aspergillus-related disease was known before that. Which meansthat Aspergillus and humans were apparently coexisting in peace (at least from thehuman perspective) for about 2 million years. So what has changed?

The answer probably relies on advanced medical care, with has resulted inprolonged survival for previously devastating diseases at the cost of increasedimmunossupression. Absolute avoidance of exposure to these airborne fungi is notsomething realistic, since Aspergillus conidia are widely dispersed in the environ-ment and can easily reach human lungs and/or paranasal sinuses. Despite that, mosthumans will never get aspergillosis, and the interaction between fungi and hostdefence cells is an area of intense research.

This is not a book about a fungus. Instead, this project aims to reveal whatlies beneath this big umbrella named “aspergillosis”, a generic term that groupsextraordinary diverse clinical conditions. For instance, invasive aspergillosis typi-cally affects severely immunocompromised patients such as those with prolongedneutropenia or receiving therapy with steroids. On the other pole of the diseasespectrum sits allergic forms of aspergillosis, with exuberant clinical syndromes thatmostly affect patients with asthma and cystic fibrosis. Slowly destructive lung dis-eases may also occur in the apparently immunocompentent host, especially in thecontext of previous damage to the lung architecture. These are difficult-to-diagnoseinfections, and diagnostic tests perform differently depending on the specific clinicalscenario.

This book summarizes the current knowledge about aspergillosis, coveringimportant aspects of its epidemiology, pathogenesis, clinical manifestations, diagno-sis, treatment and prevention. Editing this book was not an easy task and I would liketo thank Max Haring at Springer for giving me this duty – his expertise was of greatimportance during the whole process. I believe some of the existing overlap amongstchapters was nearly impossible to avoid, since most Aspergillus-related syndromesdo overlap. Retrospectively looking I have realised that many more topics couldhave been added to the book but at some stage the project had to be finalised. I am

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vi Preface

glad to announce that we have succeeded in obtaining collaboration from authorsfrom all over the globe, including most world-leaders in the Aspergillus field. If thisproject deserves any merit, that should be given to authors, who did their best toexpressed their knowledge in written words. Thank you for believing in this bookand for investing your precious time on this.

A few additional acknowledgements are needed. I am in debt with Luiz Car-los Severo who supervised my PhD thesis on Candida bloodstream infections – hefirst opened my eyes to the fantastic fungal world. Severo also convinced me thatI should go to England and work with David Denning, a brilliant and enthusiasticscientist who masters Aspergillus diseases. David has introduced me to aspergillosisand its many faces, and also to many scientists working on the field. He has givencontinuous support to my work and I guess I am very lucky for that. David is anexample on how to join people for a common purpose. And finally to Daniela, mybeloved wife and best friend who just gave birth to our little daughter Clara – I couldnot do this work without their support and affection.

We all hope that the information here presented adds for a better understandingof aspergillosis, ultimately reducing the elevated morbidity and mortality associatedwith these complex diseases.

Porto Alegre, Brazil Alessandro C. Pasqualotto

Contents

PART I INTRODUCTION

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3David W. Denning

Differences and Similarities Amongst Pathogenic Aspergillus Species . . 7Josep Guarro, Melissa Orzechowski Xavier, and Luiz Carlos Severo

Immunology of Aspergillus and Aspergillosis: The Story So Far . . . . . 33Luigina Romani

Part IA Aspergillus and the Mycology Laboratory

Identification of Aspergillus at the Species Level

The Importance of Conventional Methods: Microscopy and Culture 55Elizabeth M. Johnson and Andrew M. Borman

Molecular Methods for Identification of Aspergillus Species . . . . . 75Eszter Deak and S. Arunmozhi Balajee

The Pathology of Aspergillus Infection . . . . . . . . . . . . . . . . . . . 87Richard Kradin

Galactomannan Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . 105Johan Maertens, Koen Theunissen, and Katrien Lagrou

β-D-Glucan Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125Minoru Yoshida

Polymerase Chain Reaction (PCR)-Based Tests . . . . . . . . . . . . . . 135P. Lewis White and Rosemary A. Barnes

Aspergillus Precipitins and Serology . . . . . . . . . . . . . . . . . . . . 159Richard C. Barton

Specific IgE Testing (RAST) . . . . . . . . . . . . . . . . . . . . . . . . . 171Reto Crameri

vii

viii Contents

Molecular Typing of Aspergillus fumigatus Isolates . . . . . . . . . . . . 177Corné H.W. Klaassen

Antifungal Susceptibility Tests of Aspergillus Species . . . . . . . . . . . 193Arnaldo Lopes Colombo, Viviane Reis, and Patricio Godoy

Antifungal Therapeutic Drug Monitoringfor Invasive Aspergillosis . . . . . . . . . . . . . . . . . . . . . . . . . . 217Susan J. Howard and William W. Hope

Part IB Antifungal Drug Profiles

Azoles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231George R. Thompson III and Thomas F. Patterson

Echinocandins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263David S. Perlin and William W. Hope

Polyene Antifungal Agents . . . . . . . . . . . . . . . . . . . . . . . . . 281Russell E. Lewis

5-Flucytosine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307Johan W. Mouton and Paul E. Verweij

Terbinafine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317Manuel Cuenca-Estrella and Juan Luis Rodriguez-Tudela

PART II INVASIVE PULMONARY ASPERGILLOSIS

Epidemiology of Invasive Pulmonary Aspergillosis . . . . . . . . . . . . 329Carol A. Kauffman and Nelson P. Nicolasora

Pathogenesis of Invasive Pulmonary Aspergillosis . . . . . . . . . . . . 345Ronen Ben-Ami and Dimitrios P. Kontoyiannis

Clinical Manifestations of Invasive Pulmonary Aspergillosis . . . . . . . 381John R. Wingard and Jack Hsu

Diagnosis

Diagnosing Aspergillosis: The Role of Invasive DiagnosticInterventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391Cornelia Lass-Flörl and Martin C. Freund

Optimising the Use of Non-invasive Tests: From Bloodto Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407Marcio Nucci and Elias J. Anaissie

Defining Invasive Aspergillosis: What the RevisedEORTC/MSG Definitions Have in Store . . . . . . . . . . . . . . . . 423J. Peter Donnelly

Contents ix

Treatment of Invasive Pulmonary Aspergillosis . . . . . . . . . . . . . . 437Kieren A. Marr

Antifungal Prophylaxis in Haematology . . . . . . . . . . . . . . . . . . 449Maria J.G.T. Rüping, Jörg J. Vehreschild, and Oliver A. Cornely

Part IIA Particularities in Special Populations

Invasive Aspergillosis in Paediatric Patients . . . . . . . . . . . . . . . . 461Andreas H. Groll, Emmanuel Roilides, and Thomas J. Walsh

Invasive Aspergillosis in the Intensive Care Unit: Beyond theTypical Haematological Patient . . . . . . . . . . . . . . . . . . . . . . . 485Wouter Meersseman

Aspergillosis in Surgical Patients . . . . . . . . . . . . . . . . . . . . . . 505Alessandro C. Pasqualotto

Invasive Aspergillosis in Chronic Granulomatous Disease . . . . . . . . 527Brahm H. Segal

Aspergillosis in Drug Addicts . . . . . . . . . . . . . . . . . . . . . . . . 545Juan-Carles Trullas, Josep Bisbe, and Jose M. Miro

Invasive Aspergillosis and HIV Infection . . . . . . . . . . . . . . . . . 559Marco Libanore, L. Sighinolfi, and F. Ghinelli

Invasive Pulmonary Aspergillosis in Solid Organ Transplant Recipients 567Fernanda P. Silveira and Shahid Husain

PART III CHRONIC CAVITARY PULMONARY ASPERGILLOSIS

Chronic Cavitary Pulmonary Aspergillosis and Fungal Balls . . . . . . 585Luciana Silva Guazzelli, Melissa Orzechowski Xavier,Flávio de Mattos Oliveira and Luiz Carlos Severo

Pathogenesis of Chronic Cavitary Pulmonary Aspergillosis: TheImportance of the Host Immune System . . . . . . . . . . . . . . . . . . 621Helen Sambatakou

Current Surgical Strategies for Chronic Cavitary PulmonaryAspergillosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 643Gerard Babatasi, Hashmatullah Nawabi, and Mambun Socheat

PART IV ALLERGIC PULMONARY SYNDROMESASSOCIATED WITH ASPERGILLOSIS

Overview of Aspergillus Allergens . . . . . . . . . . . . . . . . . . . . . 655R. Crameri, A.G. Glaser, M. Vilhelmsson, S. Zeller, and C. Rhyner

x Contents

Allergic bronchopulmonary aspergillosis (ABPA)

Epidemiology of Allergic Bronchopulmonary Aspergillosis . . . . . 671Ritesh Agarwal and Arunaloke Chakrabarti

ABPA as an Occupational Disease . . . . . . . . . . . . . . . . . . . 689Kazuo Akiyama

Pathogenesis of ABPA . . . . . . . . . . . . . . . . . . . . . . . . . . 695Peter A.B. Wark and Peter Gibson

Clinical Manifestations and Natural History ofAllergic Bronchopulmonary Aspergillosis . . . . . . . . . . . . . . . 707Ritesh Agarwal and Arunaloke Chakrabarti

How to Diagnose Allergic Bronchopulmonary Aspergillosis . . . . . 725Ashok Shah

The Treatment of ABPA . . . . . . . . . . . . . . . . . . . . . . . . . 747Sandra K. Gilley, Mark R. Goldblatt, and Marc A. Judson

Severe Asthma with Fungal Sensitisation (SAFS) . . . . . . . . . . . . . 761Curig Prys-Picard and Robert Niven

PART V ASPERGILLUS SINUSITIS

Aspergillus Sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 779Matthew W. Ryan and Bradley F. Marple

PART VI OVERLAP SYNDROMES

Aspergillus Overlap Syndromes . . . . . . . . . . . . . . . . . . . . . . . 817Ayman O. Soubani

PART VII OTHER PRESENTATIONS OF ASPERGILLOSIS

Cerebral Aspergillus Infections and Meningitis . . . . . . . . . . . . . . 835Stefan Schwartz

Osteoarticular and Epidural Infections . . . . . . . . . . . . . . . . . . 853Emmanuel Roilides and John Dotis

Aspergillosis of the Digestive Tract . . . . . . . . . . . . . . . . . . . . . 863Philippe Eggimann, David Bracco, and Didier Pittet

Cardiac Aspergillosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 889Philippe Lagacé-Wiens and Ethan Rubinstein

Aspergillus Thyroiditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 905Luciano Z. Goldani and Ana Luiza Maia

Aspergillus Endophthalmitis . . . . . . . . . . . . . . . . . . . . . . . . 913Philip A. Thomas

Contents xi

Urinary Tract Infections Caused by Aspergillus Species . . . . . . . . . 931Geetha Sivasubramanian and Jack D. Sobel

Superficial infections

Cutaneous and Wound Aspergillosis . . . . . . . . . . . . . . . . . . 939Arunaloke Chakrabarti, Shivsekhar Chatterjee, and Bishan D. Radotra

Onychomycosis Due to Aspergillus Species . . . . . . . . . . . . . . 961Ricardo Negroni

Aspergillus Keratitis . . . . . . . . . . . . . . . . . . . . . . . . . . . 973Philip A. Thomas

Aspergillus Otitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 999Alexandro Bonifaz, Rogelio Chavolla-Magaña and Javier Araiza

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1007

Contributors

Ritesh Agarwal Department of Pulmonary Medicine, Postgraduate Institute ofMedical Education and Research, Chandigarh, India, riteshpgi@gmail.com

Kazuo Akiyama Clinical Research Center for Allergy and Rheumatology,National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan,k-akiyama@sagamihara-hosp.gr.jp

Elias Anaissie University of Arkansas for Medical Sciences, Little Rock, AR,USA, AnaissieEliasJ@uams.edu

Javier Araiza Dermatology Service & Mycology Department, General Hospitalof México DO, Mexico, Mexico, javier_arai2a5@yahoo.com.mx

Gerard Babatasi Department of Cardiothoracic Surgery University Hospital,Caen Cote de Nacre, France, babatasi-g@chu-caen.fr

S. Arunmozhi Balajee Mycotic Diseases Branch, Centers for Disease Controland Prevention (CDC), Atlanta, GA, USA, fir3@cdc.gov

Rosemary A. Barnes Department of Medical Microbiology, University Hospitalof Wales, Cardiff, Wales, UK, barnesra@cardiff.ac.uk

Richard C. Barton Department of Microbiology, Mycology Reference Centre,Leeds Teaching Hospitals Trust, Leeds, UK, Richard.Barton@leedsth.nhs.uk

Ronen Ben-Ami Department of Infectious Diseases, Infection Control andEmployee Health, The University of Texas M. D. Anderson Cancer Center,Houston, TX, USA, rbenami@mdanderson.org

Josep Bisbe Internal Medicine Service, Hospital Sant Jaume, Olot, Girona, Spain,jbisbe@hospiolot.com

Alexandro Bonifaz Dermatology Service & Mycology Department, HospitalGeneral de México OD, México, Mexico, a_bonifaz@yahoo.com.mx

Andrew M. Borman Mycology Reference Laboratory, Health Protection Agency,Bristol, UK, andy.borman@UHBristol.nhs.uk

xiii

xiv Contributors

David Bracco Department of Anesthesiology, CHUM Hotel Dieu, Montreal, QC,Canada

Arunaloke Chakrabarti Division of Medical Mycology, Postgraduate Institute ofMedical Education and Research, Chandigarh, India, arunaloke@hotmail.com

Shivsekhar Chatterjee Division of Infectious Diseases, Harper UniversityHospital, Detroit, MI, USA

Rogelio Chavolla-Magaña General Hospital of México DO, Mexico, Mexico,rchavo@hotmail.com

Arnaldo Lopes Colombo Special Mycology Laboratory, Division of InfectiousDiseases, Federal University of São Paulo (UNIFESP), São Paulo, Brazil,colomboal@terra.com.br

Oliver A. Cornely Department of Internal Medicine, University of Cologne, Köln50924, Germany, oliver.cornely@ctuc.de

Reto Crameri Swiss Institute of Allergy and Asthma Research (SIAF), Davos,Switzerland, crameri@siaf.uzh.ch

Manuel Cuenca-Estrella Servicio de Micología, Centro Nacional deMicrobiología, Instituto de Salud Carlos III, Madrid, Spain,mcuenca-estrella@isciii.es

Eszter Deak Mycotic Diseases Branch, Centers for Disease Control andPrevention (CDC), Atlanta, GA, USA, gufo@cdc.gov

David W. Denning National Aspergillosis Centre; Education and ResearchCentre, University Hospital of South Manchester (Wythenshawe Hospital),Manchester, UK, ddenning@manchester.ac.uk

J. Peter Donnelly Department of Haematology, Radboud University NijmegenMedical Centre, Nijmegen, The Netherlands, p.donnelly@usa.net

John Dotis Third Department of Pediatrics, Aristotle University, Thessaloniki,Greece, yandot@med.auth.gr

Philippe Eggimann Department of Intensive Care Medicine, Centre HospitalierUniversitaire Vaudois (CHUV), Lausanne, Switzerland,philippe.eggimann@chuv.ch

Martin C. Freund Deptartment of Radiology, Innsbruck Medical University,Innsbruck, Austria, Martin.freund@i-med.ac.at

F. Ghinelli Department Infectious Diseases St. Anna Hospital and University,Ferrara, Italy

Peter Gibson Centre for Asthma and Respiratory Disease, Hunter MedicalResearch Institute, University of Newcastle, New Lambton, NSW, Australia,Gibson@hnehealth.nsw.gov.au

Contributors xv

Sandra K. Gilley Pulmonary/Critical Care Fellows, Medical University of SouthCarolina, Charleston, South Carolina, USA, gilley@musc.edu

A. G. Glaser Swiss Institute of Allergy and Asthma Research (SIAF), Davos,Switzerland

Patricio Godoy Division of Microbiology, Austral University of Chile, Valdivia,Chile, pgodoymartine2@gmail.com

Luciano Z. Goldani Section of Infectious Diseases, Hospital das Clinicas dePorto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre,Brazil, lgoldani@ufrgs.br

Mark R. Goldblatt Pulmonary/Critical Care Fellows, Medical University ofSouth Carolina, Charleston, South Carolina, USA, goldbla@musc.edu

Andreas H. Groll Infectious Disease Research Program, Center for Bone MarrowTransplantation and Department of Pediatric Hematology/Oncology, UniversityChildren’s Hospital, Muenster, Germany, grollan@ukmuenster.de

Josep Guarro Unitat de Microbiologia, Departament de Ciències MèdiquesBàsiques, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili,Tarragona, Spain, josep.guarro@urv.cat

Luciana Silva Guazzelli Post-graduation Program in Pulmonary Sciences,Universidade Federal do Rio Grande do Sul (UFRGS), Mycology laboratory, SantaCasa-Complexo Hospitalar, Porto Alegre, Brazil, lucgua22elli@hotmail.com

William W. Hope Manchester Academic Health Science Centre, RegionalMycology Laboratory Manchester University Hospital of South ManchesterEducation and Research Centre, Southmoor Road, Manchester M23 9PT,Manchester, UK, william.hope@manchester.ac.uk

Susan J. Howard Manchester Academic Health Science Centre, The Universityof Manchester, Manchester, UK, susan.j.howard@manchester.ac.uk

Jack Hsu Division of Hematology/Oncology, University of Florida College ofMedicine, Gainesville, FL, USA, jack.hsu@medicine.ufl.edu

Shahid Husain Transplant Infectious Diseases, Division of Infectious Diseasesand Multi-organ Transplantation, University Health Network/University ofToronto, Toronto, ON, Canada, shahid.husain@uhn.on.ca

Elizabeth M. Johnson Mycology Reference Laboratory, Health ProtectionAgency, Bristol, UK, elizabeth.johnson@UHBristol.nhs.uk

Carol A. Kauffman Division of Infectious Diseases, Department of InternalMedicine, University of Michigan Medical School, Veterans Affairs Ann ArborHealthcare System, Ann Arbor, MI, USA, ckauff@umich.edu

xvi Contributors

Corné H.W. Klaassen Department of Medical Microbiology and InfectiousDiseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands,c.klaassen@cwz.nl

Dimitrios P. Kontoyiannis Department of Infectious Diseases, Infection Controland Employee Health, The University of Texas M. D. Anderson Cancer Center,Houston, TX, USA, dkontoyi@mdanderson.org

Richard Kradin Infectious Disease Pathology, Departments of Pathology andPulmonary/Critical Care Medicine, Massachusetts General Hospital, Boston, MA,USA, rkradin@partners.org

Philippe Lagacé-Wiens Department of Medical Microbiology and InfectiousDiseases, University of Manitoba, Winnipeg, MB, Canada,rubinste@cc.umanitoba.ca

Katrien Lagrou Department of Medical Diagnostic Sciences, UniversityHospitals Leuven, Leuven, Belgium, katrien.lagrou@u2.kuleuven.be

Cornelia Lass-Flörl Divison of Hygiene & Medical Microbiology, InnsbruckMedical University, Innsbruck, Austria, cornelia lass-floerl@i-med.ac.at

Russell E. Lewis University of Houston College of Pharmacy and, The Universityof Texas M.D. Anderson Cancer Center, Houston, TX, USA, rlewis@uh.edu

M. Libanore Department Infectious Diseases St. Anna Hospital and University,Ferrara, Italy, m.libanore@ospfe.it

Johan Maertens Department of Haematology, University Hospitals Leuven,Leuven, Belgium, johan.maertens@uz.kuleuven.be

Ana Luiza Maia Endocrinology, Hospital das Clinicas de Porto Alegre,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,almaia@ufrgs.br

Bradley F. Marple Department of Otolaryngology, University of TexasSouthwestern Medical Center, Dallas, TX, USA,Bradley.Marple@UTSouthwestern.edu

Kieren A. Marr School of Medicine, Johns Hopkins University, Baltimore, MD,USA, kmarr@fhcrc.org

Wouter Meersseman Department of General Internal Medicine, GasthuisbergUniversity Hospital, Leuven, Belgium, wouter.meersseman@uzleuven.be

Jose M. Miro Infectious Diseases Service, Hospital Clinic – IDIBAPS, Universityof Barcelona, Barcelona, Spain, jmmiro@ub.edu

Johan W. Mouton Department of Medical Microbiology and Infectious Diseases,Canisius Wilhelmina Ziekenhuis Nijmegen, The Netherlands, Mouton@cwz.nl

Contributors xvii

Hashmatullah Nawabi French Medical Institute for Children, Surgeons of HopeFoundation, Kabul, Afghanistan

Ricardo Negroni Hospital Francisco Javier Muniz, Buenos Aires, Argentinas,ricardonegroni@intramed.net

Nelson P. Nicolasora Division of Infectious Diseases, Department of InternalMedicine, University of Michigan Medical School, Veterans Affairs Ann ArborHealthcare System, Ann Arbor, MI, USA, Nelson_nicolasora@yahoo.com

Robert Niven Wythenshawe Hospital, Manchester, UK,robert.niver@smuht.nwest.nhs.uk; Robert.Niven@uhsm.nhs.uk

Marcio Nucci University Hospital, Universidade Federal do Rio de Janeiro, Riode Janeiro, Brazil, mnucci@hucff.ufrj.br

Flávio de Mattos Oliveira Mycology laboratory, Santa Casa-ComplexoHospitalar, Porto Alegre, Brazil, flavio@santacasa.tche.br

Alessandro C. Pasqualotto Post-graduation Program in Pulmonary Sciences,Universidade Federal do Rio Grande do Sul (UFRGS), Molecular DiagnosticsLaboratory, Santa Casa-Complexo Hospitalar, Porto Alegre, Brazil,acpasqualotto@hotmail.com

Thomas F. Patterson Division of Infectious Diseases, The Department ofMedicine, University of Texas Health Science Center at San Antonio, San Antonio,TX, USA, patterson@uthscsa.edu

David S. Perlin Public Health Research Institute, UMDNJ-New Jersey MedicalSchool, Newark, NJ, USA, perlinds@umdnj.edu

Didier Pittet Infection Control Program, Department of Internal Medicine,University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland,didier.pittet@hcuge.ch

Curig Prys-Picard PACC Division, The University of Texas Medical Branch,Galveston, TX, USA, copryspi@utmb.edu

Bishan D. Radotra Department of Histopathology, Postgraduate Institute ofMedical Education & Research, Chandigarh, India

Viviane Reis Special Mycology Laboratory, Division of Infectious Diseases,Federal University of São Paulo (UNIFESP), São Paulo, Brazil,vi2017@yahoo.com

C. Rhyner Swiss Institute of Allergy and Asthma Research (SIAF), Davos,Switzerland

Juan Luis Rodriguez-Tudela Servicio de Micología, Centro Nacional deMicrobiología, Instituto de Salud Carlos III, Madrid, Spain,juanl.rodriguez-tudela@isciii.es

xviii Contributors

Emmanuel Roilides Third Department of Pediatrics, Aristotle University,Hippokration Hospital, Thessaloniki, Greece, roilides@med.auth.gr

Luigina Romani Microbiology Section, Department of Experimental Medicineand Biochemical, University of Perugia, Via del Giochetto, Perugia, Italy,lromani@unipg.it

Ethan Rubinstein Section of Infectious Diseases Departments of Medicine andMedical Microbiology, University of Manitoba, Winnipeg, MB, Canada,erubins@yahoo.com; rubinste@cc.umanitoba.ca

Maria J.G.T. Rüping Department of Internal Medicine, University of Cologne,Köln 50924, Germany, maria.rueping@ctuc.de

Matthew W. Ryan Department of Otolaryngology, University of TexasSouthwestern Medical Center, Dallas, TX, USA,matthew.ryan@utsouthwestern.edu

Helen Sambatakou Second Department of Internal Medicine and InfectiousDiseases Unit, Hippokration General Hospital, The University of Athens, 11527,Athens, Greece, helensambatakou@msn.com

Stefan Schwartz Medizinische Klinik III, Universitätsmedizin Berlin, Berlin,Germany, stefan.schwartz@charite.de

Brahm H. Segal Division of Infectious Diseases, Roswell Park Cancer Institute;The State University of New York (SUNY), Buffalo, NY, USA,brahm.segal@roswellpark.org

Luiz Carlos Severo Post-graduation Program in Pulmonary Sciences,Universidade Federal do Rio Grande do Sul (UFRGS), Mycology laboratory, SantaCasa-Complexo Hospitalar, Porto Alegre, Brazil, Brazilsevero@santacasa.tche.br

Ashok Shah Department of Respiratory Medicine, Vallabhbhai Patel ChestInstitute, University of Delhi, Delhi, India, ashokshah99@yahoo.com

L. Sighinolfi Department Infectious Diseases St. Anna Hospital and University,Ferrara, Italy

Fernanda P. Silveira Division of Infectious Diseases, University of PittsburghMedical Center, Pittsburgh, PA, USA

G. Sivasubramanian Division of Infectious Diseases, Wayne State UniversitySchool of Medicine, Detroit, MI, USA, gsivasub@med.wayne.edu

Jack D. Sobel Division of Infectious Diseases, Harper University Hospital,Detroit, MI, USA, jsobel@med.wayne.edu

Mambun Socheat Cardiothoracic Center, Phnom-Penh, Cambodia

Contributors xix

Ayman O. Soubani Division of Pulmonary, Allergy, Critical Care and SleepMedicine, Wayne State University School of Medicine, Detroit, MI, USA,asoubani@med.wayne.edu

Koen Theunissen Department of Haematology, Virga Jesse Hospital, Hasselt,Belgium, k-theunissen@virgajesse.be

Philip A. Thomas Department of Microbiology, Institute of Ophthalmology,Joseph Eye Hospital, Tiruchirapalli, India, philipthomas@satyam.net.in

George R. Thompson Division of Infectious Diseases, The Department ofMedicine, University of Texas Health Science Center at San Antonio, San Antonio,USA, thompsong2@uthscsa.edu

Juan-Carles Trullas Internal Medicine Service, Hospital Sant Jaume, OlotGirona, Spain, jctv5153@comg.cat

Jörg J. Vehreschild Department of Internal Medicine, University of Cologne,Köln 50924, Germany, Janne.Vehreschild@ctuc.de

Paul E. Verweij Department of Medical Microbiology, Radboud UniversityNijmegen Medical Centre, Nijmegen, The Netherlands; Nijmegen UniversityCentre of Infectious Diseases, Radboud University Nijmegen Medical Centre,Nijmegen, The Netherlands, P.Verweij@mmb.umcn.nl

M. Vilhelmsson Department of Medicine, Clinical Allergy Research Unit,Karolinska Institutet and Karolinska University Hospital Solna, Stockholm,Sweden

Thomas J. Walsh Immunocompromised Host Section, Pediatric OncologyBranch, National Cancer Institute, National Institutes of Health, Bethesda, MD,USA, walsht@mail.nih.gov

Peter A.B. Wark Centre for Asthma and Respiratory Disease, Hunter MedicalResearch Institute, University of Newcastle, New Lambton, NSW, Australia,peter.wark@hnehealth.nsw.gov.au

P. Lewis White NPHS Microbiology Cardiff, University Hospital of Wales,Cardiff, Wales, UK, lewis.white@nphs.wales.nhs.uk

John R. Wingard Division of Hematology/Oncology, University of FloridaCollege of Medicine, Gainesville, FL, USA, wingajr@medicine.ufl.edu

Melissa Orzechowski Xavier Post-graduation Program in Pulmonary Sciences,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil,melissaxavier@ig.com.br

Minoru Yoshida Fourth Department of Internal Medicine, Teikyo UniversitySchool of Medicine, Kawasaki city, Japan, myoshida@med.teikyo-u.ac.jp

S. Zeller Department of Medicine, Clinical Allergy Research Unit, KarolinskaInstitutet and Karolinska University Hospital Solna, Stockholm, Sweden