RESUMEN
Magnusiomyces and Geotrichum species are ascomycetous yeasts that can cause potentially life-threatening invasive fungal infections commonly referred to as geotrichosis. In this study, we aimed to estimate the incidence and mortality of these infections in a German tertiary care center. Furthermore, we evaluated the suitability of the fungal biomarkers galactomannan (GM) and ß-1,3-d-glucan (BDG), which are both recommended as surrogate markers for Magnusiomyces capitatus infection by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the European Confederation of Medical Mycology (ECMM) joint clinical guidelines for the diagnosis and management of rare invasive yeast infections for detection of invasive geotrichosis. Cases meeting the inclusion criteria for invasive Magnusiomyces/Geotrichum infection were retrospectively identified. Serum samples and culture supernatants were analyzed with two commercially available fungal antigen tests (Platelia Aspergillus Ag EIA and Wako ß-glucan test). For a control cohort, outpatient samples sent for lues testing were included. Thirty-eight cases of Magnusiomyces/Geotrichum infection were identified over an 11-year observation period. In the majority of cases, the fungus was isolated from intra-abdominal specimens of patients with a history of abdominal surgery/procedures (n = 32). All cases of fungemia occurred exclusively in haemato-oncologic patients (n = 14). Thirty-day survival was 42% in the fungemia and 43% in the intra-abdominal geotrichosis group. Serum samples were available for 23 patients (14 bloodstream and nine intra-abdominal infections). While BDG sensitivity was 65%, none of the sera was GM positive. This finding was supported by in vitro experiments analyzing fungal culture supernatants: M. capitatus secretes significant amounts of BDG but not GM. Specificity was 96% for BDG and 100% for GM. Magnusiomyces and Geotrichum infections are not limited to haemato-oncologic patients. Contrasting the current ESCMID/ECMM recommendation, our results indicate that GM is no suitable biomarker for the diagnosis of Magnusiomyces infection. Contrarily, BDG sensitivity is comparable to that of candidemia.
Asunto(s)
Geotricosis , Geotrichum , Infecciones Fúngicas Invasoras , Mananos , Proteoglicanos , Saccharomycetales , beta-Glucanos , Biomarcadores/sangre , Galactosa/análogos & derivados , Geotricosis/sangre , Geotricosis/diagnóstico , Geotrichum/aislamiento & purificación , Humanos , Infecciones Fúngicas Invasoras/sangre , Infecciones Fúngicas Invasoras/diagnóstico , Mananos/sangre , Proteoglicanos/sangre , Estudios Retrospectivos , Saccharomycetales/aislamiento & purificación , Sensibilidad y Especificidad , beta-Glucanos/sangreRESUMEN
We are reporting the case of an 82-year-old Yemeni patient, renal transplant recipient who was admitted to our institution and who subsequently developed disseminated infection with Saprochaete capitata. This pathogenic fungus is rarely reported in patients with solid organ trans-plants. Saprochaete capitata is an emerging fungal pathogen, ubiquitously spread in the environment. This is the second case to our knowledge of infection with Saprochaete capitata in a renal transplant patient. Our patient was treated for multiple nosocomial infections with prolonged antibiotic courses. He succumbed to the infection with Saprochaete capitate after several weeks spent in the intensive care unit.
Asunto(s)
Infección Hospitalaria/microbiología , Geotricosis/microbiología , Geotrichum/aislamiento & purificación , Trasplante de Riñón/efectos adversos , Anciano de 80 o más Años , Antifúngicos/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Equinocandinas/uso terapéutico , Resultado Fatal , Fungemia/tratamiento farmacológico , Fungemia/microbiología , Geotricosis/sangre , Geotricosis/tratamiento farmacológico , Geotrichum/patogenicidad , Humanos , Unidades de Cuidados Intensivos , Masculino , Receptores de TrasplantesRESUMEN
Invasive fungal infections, usually Aspergillus and Candida, represent a major cause of morbidity and mortality in patients with malignant haematological diseases, but in the last years rare fungal infections have more frequently been reported. Here, we report the clinical history of three patients affected with haematological malignancies who developed an infection caused by Geotrichum (G.) clavatum. Two out of three patients were affected by acute myeloid leukaemia (AML), and one by mantle cell lymphoma (MCL). All patients received cytarabine-based chemotherapeutic regimens and developed G. clavatum infection within 3 weeks from therapy initiation. In all cases, G. clavatum was isolated from central venous catheter and peripheral blood cultures. In vitro susceptibility test confirmed an intrinsic resistance to echinocandins and, in all cases, visceral localisations (spleen, liver and lung) were documented by total body computed tomography (CT) scan. A prolonged antifungal therapy with high doses liposomal amphotericin-B was necessary to obtain fever resolution. Only the patient with MCL died while the other two AML recovered, and one of them after received an allogeneic stem cell transplantation. We consecutively reviewed all published cases of infection caused by G. clavatum. Our experience and literature review indicate that G. clavatum can cause invasive infection in haematological patients, mainly in those with acute leukaemia.
Asunto(s)
Geotricosis/complicaciones , Neoplasias Hematológicas/complicaciones , Infecciones Fúngicas Invasoras/complicaciones , Adulto , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Catéteres Venosos Centrales/microbiología , Farmacorresistencia Fúngica , Equinocandinas/uso terapéutico , Resultado Fatal , Femenino , Geotricosis/sangre , Geotricosis/epidemiología , Geotricosis/microbiología , Geotrichum/efectos de los fármacos , Neoplasias Hematológicas/epidemiología , Trasplante de Células Madre Hematopoyéticas , Humanos , Infecciones Fúngicas Invasoras/diagnóstico por imagen , Infecciones Fúngicas Invasoras/epidemiología , Infecciones Fúngicas Invasoras/microbiología , Italia , Leucemia Mieloide Aguda/complicaciones , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia Mieloide Aguda/microbiología , Hígado/diagnóstico por imagen , Hígado/microbiología , Pulmón/diagnóstico por imagen , Pulmón/microbiología , Linfoma de Células del Manto/complicaciones , Linfoma de Células del Manto/tratamiento farmacológico , Linfoma de Células del Manto/microbiología , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Bazo/diagnóstico por imagen , Bazo/microbiología , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Intensive chemotherapy has prolonged survival in cancer patients. Unfortunately it has also predisposed them to unusual infections because of their immunocompromised state. We report a case of fungal septicaemia caused by Geotrichum candidum, an imperfect yeast of low virulence in a young girl with acute lymphoblastic leukaemia. It was successfully treated with amphotericin B. The morphological characteristics of this fungus leading to its identification are described.