Respirology | APSR Respiratory Medicine Journal

Exophiala Pneumonia Identified In Immunocompetent Woman With Lung Disease

Background

Exophiala, a genus of saprotrophic black fungi commonly found in the environment, is typically associated with cutaneous infections in immunocompromised hosts and rarely manifests as pneumonia. Here, we report the first case of Exophiala pneumonia in Pakistan, occurring in an immunocompetent, middle-aged female with interstitial lung disease.

Case presentation

A 56-year-old female presented with a two-week history of malaise and a cough productive of black sputum. On auscultation, fine crackles were heard in the bilateral posterior middle and lower lung fields. Chest radiography showed features of usual interstitial pneumonia with patchy and dense reticular opacities in the middle and lower lung lobes bilaterally. Bronchoscopy was performed, and bronchoalveolar lavage was sent to the microbiology laboratory for culture. Gram stain findings revealed numerous pus cells, primarily neutrophils, along with septate hyphae, which were also confirmed on potassium hydroxide smear. The results were communicated to the treating physician, and the patient was started on intravenous voriconazole. After four days of incubation at 25°C and 37°C, colonies of mold were observed on the culture, which were identified as Exophiala jeanselmei on Lactophenol Cotton Blue staining. After one week of treatment, the patient showed clinical improvement and was discharged on oral voriconazole with outpatient follow-up.

Conclusions

Bronchoalveolar lavage with an elevated neutrophil count and abnormal pulmonary imaging should be considered characteristic of both bacterial and fungal pneumonia. Cultures must be sent not only for bacterial workup but also for fungal culture, as it employs special techniques and prolonged incubation for the isolation of fungi. Good microbiological acumen and enhanced communication between the lab and clinical teams facilitate appropriate diagnosis and early initiation of therapy.

Source:

Journal reference:

Khan, M. A., et al. (2025). Breaking the Mold: A Rare Case of Exophiala jeanselmei Pneumonia in a Patient with Interstitial Lung Disease. Journal of Clinical and Translational Pathology. Doi.Org/10.14218/jctp.2024.00049.

CRISPR Offers Faster, Accurate Diagnosis Of Fungal Pneumonia

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Tulane University researchers have developed a CRISPR-based test that diagnoses Pneumocystis jirovecii pneumonia (PJP) — a life-threatening fungal infection primarily affecting children and immunocompromised patients — more quickly and less invasively, according to a new study published in the Journal of Clinical Investigation.

The highly accurate test detects RNA from live fungi in blood samples and throat swabs, eliminating the need for invasive bronchoscopy procedures currently used for diagnosis.

"Current diagnostic methods haven't evolved in decades, leaving many patients without timely or definitive answers," said study co-author Dr. Jay Kolls, the John W. Deming Endowed Chair in Internal Medicine at Tulane University School of Medicine. "Having a non-invasive throat swab test or a blood test really allows us to get a faster, but also more specific, diagnostic than we're able to get right now." 

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Kolls and study co-author Tony Hu, PhD, the Weatherhead Presidential Chair in Biotechnology Innovation and director of the Tulane Center for Cellular & Molecular Diagnostics, led a multidisciplinary team to develop the new tool, combining engineering innovation with clinical and biomedical expertise. 

The fungus that causes PJP rarely harms healthy people but can trigger dangerous lung infections in those with compromised immune systems, including cancer patients, transplant recipients, people with HIV/AIDS and patients on immune-suppressing drugs.

Traditional diagnostic methods for PJP rely on a bronchoscopy in which a tube is inserted into the patient's airways to collect samples, an expensive and invasive procedure. 

"It can take until the next day, sometimes two days, to receive bronchoscopy results," Hu said. "With the CRISPR-based assay, we can go from samples to results in 45 minutes." 

PCR swab tests, like those used for rapid COVID testing, often fail to detect active P. Jirovecii infections. Using the CRISPR-based detection tool alongside PCR testing significantly boosted diagnostic accuracy, correctly identifying 96% of infected infants (compared to 66% with PCR alone) and 93% of infected adults (compared to just 26% with PCR alone).

CRISPR, an acronym for "clustered regularly interspaced short palindromic repeats," is a gene editing technology that allows scientists to precisely modify DNA. For the PJP diagnostic test, CRISPR is used to detect RNA of the fungus causing PJP.

"That's novel," Kolls said. "And we have data that shows PJP may be more prevalent than thought. Better diagnosis can help us prove that." 

In addition to diagnosing patients, the test can be used on throat swabs already gathered in clinics to improve epidemiology and mapping of pneumocystis in the United States. 

This study also shows the growing use of CRISPR as a way to streamline disease detection. Looking ahead, the research team sees potential for the CRISPR diagnostic platform to detect other respiratory infections.

"This tool is an example of the collaborative spirit at Tulane University, where cutting-edge engineering can work alongside extensive clinical practice to address a very critical issue," Hu said. "Hopefully we can soon deploy this as a clinical test and improve outcomes for patients."

Reference: Youngquist BM, Mnguni AT, Pungan D, et al. CRISPR-mediated detection of Pneumocystis transcripts in bronchoalveolar, oropharyngeal, and serum specimens for Pneumocystis pneumonia diagnosis. J Clin Invest. 2025. Doi: 10.1172/JCI177241

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Ultra-Low Dose CT Aids Pneumonia Diagnosis In Immunocompromised Patients

Denoised ultra-low dose CT can effectively diagnose pneumonia in immunocompromised patients using only 2% of the radiation dose of standard CT.

OAK BROOK, Ill., March 13, 2025 /PRNewswire-PRWeb/ -- Denoised ultra-low dose CT can effectively diagnose pneumonia in immunocompromised patients using only 2% of the radiation dose of standard CT, according to a study published today in Radiology: Cardiothoracic Imaging, a journal of the Radiological Society of North America (RSNA).

"For patients with weakened immune systems, lung infections can be life threatening," said lead study author Maximiliano Klug, M.D., a radiologist in the division of diagnostic imaging at the Sheba Medical Center in Ramat Gan, Israel. "CT scans are the gold standard for detecting pneumonia, but repeated scans can expose patients to significant radiation."

While the early diagnosis of lung infections in immunocompromised patients is important, the risks of cumulative radiation dose exposure from frequent CT scans is a concern.

Ultra-low dose CT reduces radiation exposure but can result in poor image quality due to added "noise," which manifests as a grainy texture throughout the image. This reduction in image quality can affect the accuracy of diagnosis. Therefore, Dr. Klug and colleagues sought to test the denoising capabilities of a deep learning algorithm on ultra-low dose CT scans.

From September 2020 to December 2022, 54 immunocompromised patients with fevers were referred to Dr. Klug's division to undergo two chest CT scans: a normal dose scan and an ultra-low dose scan. A deep learning algorithm was applied to denoise all 54 of the ultra-low dose CT scans.

Radiologists individually assessed and documented their findings from the normal dose CT, ultra-low dose CT and denoised ultra-low dose CT scans. They were blinded to all patient clinical information.

The deep learning algorithm significantly improved the image quality and clarity of the ultra-low dose CT scans and reduced false positives. Nodules were also more easily identified on the denoised scans.

The average effective radiation dose for ultra-low dose scans was 2% of the average effective radiation dose of the standard CT scans.

"This study paves the way for safer, AI-driven imaging that reduces radiation exposure while preserving diagnostic accuracy," Dr. Klug said.

The researchers note that deep learning-based denoising on ultra-low dose CT scans can be beneficial in other patient groups, such as young patients.

"This pilot study identified infection with a fraction of the radiation dose," Dr. Klug said. "This approach could drive larger studies and ultimately reshape clinical guidelines, making denoised ultra-low dose CT the new standard for young immunocompromised patients."

Story Continues

Future studies with larger sample sizes will help validate the findings from this study.

"Denoised Ultra-Low-Dose Chest CT to Assess Pneumonia in Individuals Who Are Immunocompromised Individuals." Collaborating with Dr. Klug were Tamer Sobeh, M.D., Michael Green, M.Sc., Arnaldo Mayer, Ph.D., Zehavit Kirshenboim, M.D., Eli Konen, M.D., and Edith Michelle Marom, M.D.

Radiology: Cardiothoracic Imaging is edited by Suhny Abbara, M.D., University of Texas Southwestern Medical Center, Dallas, and owned and published by the Radiological Society of North America, Inc. (https://pubs.Rsna.Org/journal/cardiothoracic)

RSNA is an association of radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research, and technologic innovation. The Society is based in Oak Brook, Illinois. (RSNA.Org)

For patient-friendly information on chest CT, visit RadiologyInfo.Org.

Media Contact

Linda Brooks, Radiological Society of North America (RSNA), 630-590-7762, lbrooks@rsna.Org, https://www.Rsna.Org/

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SOURCE Radiological Society of North America (RSNA)

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