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Transmission electron microscopy of aspergillus endocarditis
Micron and Microscopica Acta, Vol.14, No.3, pp.263-264,
1983.
Printed in Great Britain
TRANSMISSION
ELECTRON MICROSCOPY
OF ASPERGILLUS
Shirley Slew, M.D. Professor of Pathology Michigan State University A622 East Fee Hall East Lansing, MI 48824
0739-6260/83 $3.00 + 0.00 01983 Pergamon Press Ltd.
ENDOCARDITIS
Barnabas Newton, M.D. Director of Laboratories Ingham Medical Center 401 West Greenlawn Lansing, MI 48909
Modern therapeutic procedures and the increase in intravenous drug abuse have led to an alteration of the host-parasite relationship. An ever widening variety of infective agents is being isolated as the causative factors. In former years, some of these agents, such as Aspergillus, had been considered to be of low pathogenicity to man. A 45 year old male, heroin addict, presented with the complaint of pleuritic chest pain and fever of 3 weeks' duration. There had been no response to a 2 weeks' oral course of tetracycline. Multiple blood cultures were negative. He was treated with gentamicin and penicillin, followed by cephalosporin, ampicillin and an amlnoglycoside. The temperature came down but there was deterioration of his clinical status. On auscultation, there was a murmur of aortic insufficiency and repeated echocardiography showed increasing abnormalities of the aortic valve. Open heart surgery was performed. The aortic valve was seen to have 3 large vegetations and there was an associated myocardial abscess. The valve was resected and replaced by an lonescu prosthesis and the abscess was drained. Part of the vegetation was taken for culture and grew Aspergillus glaucus. Gross examination of the resected aortic valve showed the presence of 3 large firmly adherent vegetations, which varied in size from I cm - 3 cm. The vegetations were pale to dark brown in color. Light microscopy confirmed the presence of florid vegetations composed mostly of dense fibrin, in which there were innumerable septate hyphae, with dichotomous "Y" shaped branching. There were some degenerated neutrophils within the vegetation. A more extensive polymorphonuclear cell infiltration was present in the underlying valve cusp. There was increased vascularity of the valve. Non-granular and mononuclear cells were noted in some areas and there was evidence of formation of granulation tissue with some fibrosis. The unaffected portion of the valve showed myxomatous degeneration. Transmission electron microscopy of the vegetation demonstrated the presence of septate fungal hyphae in a dense matrix of fibrin. Dichotomous branching was present (Fig. i). On the cytoplasmic surface of the plasmalemmal border of some of the septa, there were symmetrically placed, rounded electron dense bodies. It is considered that the structural features of these organelles are in keeping with those of Woronin bodies. The cell wall and plasmalemma were well defined as was the perlplasmlc space between them. Despite the variability of the plane of section, the cell walls were generally of uniform thickness, locally. The cytoplasm contained scattered ribosomes and electron lucent areas of polysaccharide storage. Nuclei were present. Some of the cells were multinucleated. The nuclear envelope had two parallel unit membranes which were perforated by numerous nuclear pores and wider discontinuities. There was a fine dispersal of euchromatin in the nucleoplasm with a prominent, peripheral nucleolar mass (Figs. i, 3). Mitochondria varied from a rounded to an elongated, rod shape. The cristae were of lamellar type. Some mitochondria were in close apposition to the nuclear membrane. A myelin figure was observed (Fig. 2). There were occasional profiles of endoplasmic reticulum and multivesicular bodies. Degenerative changes were present in some of the fungi (Fig. 4). There was fragmentation of the plasmalemma with clumping and/or dissolution of cytoplasmic components. In relation to s~ch areas, there was a cellular infiltration of lymphocytes (Fig. 4) and macrophages (Fig. 5). Lipid vacuoles and microfilaments were present in the cytoplasm of the macrophage. In addition, there were also intranuclear microfilaments and small electron dense inclusions, which were surrounded by an electron lucent halo. Higher magnifications failed to demonstrate a definitive viral structure of these inclusions. Key Words:
Transmission
electron microscopy,
Aspergillus, 263
Endocarditis,
Drug abuse
264
~f. S l e w ~md B.
Fig. i. TEM branching.
Septate
Fig. 2. TEM Septate b o d i e s (WB).
Fig.
3.
TL~ Septate
hyphae
with
Newto~l
dichotomous
Fig. 4. TEM Degenerate cytic infiltration.
fungi with
]yml>~io-
Fig.
infiltration.
hyphae with Woronin
5.
TEM Macrophage
hyphae.
CW - C e l l w a l l D - Degenerate fungi ER - Endoplasmic reticulum F - Fibrin I - Intranuclear inclusions L - Lipid vacuoles Ly - Lymphocyte M - Mitochondria MF - Microfilaments My - Myelin figure N - Nucleus Nu - Nucleolar mass P - Plasmalemma PS - P e r i p l a s m i c space Po - P o l y s a c c h a r i d e s t o r a g e R - Ribosomes S - Septa WB - Woronin bodies
1983.
Printed in Great Britain
TRANSMISSION
ELECTRON MICROSCOPY
OF ASPERGILLUS
Shirley Slew, M.D. Professor of Pathology Michigan State University A622 East Fee Hall East Lansing, MI 48824
0739-6260/83 $3.00 + 0.00 01983 Pergamon Press Ltd.
ENDOCARDITIS
Barnabas Newton, M.D. Director of Laboratories Ingham Medical Center 401 West Greenlawn Lansing, MI 48909
Modern therapeutic procedures and the increase in intravenous drug abuse have led to an alteration of the host-parasite relationship. An ever widening variety of infective agents is being isolated as the causative factors. In former years, some of these agents, such as Aspergillus, had been considered to be of low pathogenicity to man. A 45 year old male, heroin addict, presented with the complaint of pleuritic chest pain and fever of 3 weeks' duration. There had been no response to a 2 weeks' oral course of tetracycline. Multiple blood cultures were negative. He was treated with gentamicin and penicillin, followed by cephalosporin, ampicillin and an amlnoglycoside. The temperature came down but there was deterioration of his clinical status. On auscultation, there was a murmur of aortic insufficiency and repeated echocardiography showed increasing abnormalities of the aortic valve. Open heart surgery was performed. The aortic valve was seen to have 3 large vegetations and there was an associated myocardial abscess. The valve was resected and replaced by an lonescu prosthesis and the abscess was drained. Part of the vegetation was taken for culture and grew Aspergillus glaucus. Gross examination of the resected aortic valve showed the presence of 3 large firmly adherent vegetations, which varied in size from I cm - 3 cm. The vegetations were pale to dark brown in color. Light microscopy confirmed the presence of florid vegetations composed mostly of dense fibrin, in which there were innumerable septate hyphae, with dichotomous "Y" shaped branching. There were some degenerated neutrophils within the vegetation. A more extensive polymorphonuclear cell infiltration was present in the underlying valve cusp. There was increased vascularity of the valve. Non-granular and mononuclear cells were noted in some areas and there was evidence of formation of granulation tissue with some fibrosis. The unaffected portion of the valve showed myxomatous degeneration. Transmission electron microscopy of the vegetation demonstrated the presence of septate fungal hyphae in a dense matrix of fibrin. Dichotomous branching was present (Fig. i). On the cytoplasmic surface of the plasmalemmal border of some of the septa, there were symmetrically placed, rounded electron dense bodies. It is considered that the structural features of these organelles are in keeping with those of Woronin bodies. The cell wall and plasmalemma were well defined as was the perlplasmlc space between them. Despite the variability of the plane of section, the cell walls were generally of uniform thickness, locally. The cytoplasm contained scattered ribosomes and electron lucent areas of polysaccharide storage. Nuclei were present. Some of the cells were multinucleated. The nuclear envelope had two parallel unit membranes which were perforated by numerous nuclear pores and wider discontinuities. There was a fine dispersal of euchromatin in the nucleoplasm with a prominent, peripheral nucleolar mass (Figs. i, 3). Mitochondria varied from a rounded to an elongated, rod shape. The cristae were of lamellar type. Some mitochondria were in close apposition to the nuclear membrane. A myelin figure was observed (Fig. 2). There were occasional profiles of endoplasmic reticulum and multivesicular bodies. Degenerative changes were present in some of the fungi (Fig. 4). There was fragmentation of the plasmalemma with clumping and/or dissolution of cytoplasmic components. In relation to s~ch areas, there was a cellular infiltration of lymphocytes (Fig. 4) and macrophages (Fig. 5). Lipid vacuoles and microfilaments were present in the cytoplasm of the macrophage. In addition, there were also intranuclear microfilaments and small electron dense inclusions, which were surrounded by an electron lucent halo. Higher magnifications failed to demonstrate a definitive viral structure of these inclusions. Key Words:
Transmission
electron microscopy,
Aspergillus, 263
Endocarditis,
Drug abuse
264
~f. S l e w ~md B.
Fig. i. TEM branching.
Septate
Fig. 2. TEM Septate b o d i e s (WB).
Fig.
3.
TL~ Septate
hyphae
with
Newto~l
dichotomous
Fig. 4. TEM Degenerate cytic infiltration.
fungi with
]yml>~io-
Fig.
infiltration.
hyphae with Woronin
5.
TEM Macrophage
hyphae.
CW - C e l l w a l l D - Degenerate fungi ER - Endoplasmic reticulum F - Fibrin I - Intranuclear inclusions L - Lipid vacuoles Ly - Lymphocyte M - Mitochondria MF - Microfilaments My - Myelin figure N - Nucleus Nu - Nucleolar mass P - Plasmalemma PS - P e r i p l a s m i c space Po - P o l y s a c c h a r i d e s t o r a g e R - Ribosomes S - Septa WB - Woronin bodies