A cluster of Geotrichum clavatum (Saprochaete clavata) infection in haematological patients: a first Italian report and review of literature.

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.

Geotrichum capitatum septicemia in a hematological malignancy patient with positive galactomannan antigen: case report and review of the literature.

Geotrichum capitatum, formerly known as Trichosporon capitatum, is an uncommon but frequently fatal invasive fungal infection in immunocompromised patients, especially in hematological malignancies. We report a seven-year-old patient with acute myeloid leukemia with Geotrichum septicemia with involvement of the lungs, liver, spleen, and kidneys, who had a favorable outcome after therapy. Alteration of antifungal treatment to liposomal amphotericin B resolved the fever with favorable clinical response.

Breakthrough Saprochaete capitata infections in patients receiving echinocandins: case report and review of the literature.

We report a rare case of a fatal Saprochaete capitata breakthrough infection in a patient with acute myeloid leukemia receiving empirical caspofungin therapy. S. capitata is an uncommon, yet emerging cause of invasive infections, especially in patients with haematological malignancies. Blood cultures from our patient yielded S. capitata which was found to be resistant, in vitro, to caspofungin. We consecutively reviewed all published cases of breakthrough infections caused by S. capitata in patients receiving echinocandins. S. capitata should be considered in those patients who remain febrile or who develop invasive mould infections while under echinocandin therapy.

Oral geotrichosis: report of 12 cases.

Oral geotrichosis is an uncommon opportunistic infection caused by Geotrichum candidum, a habitual contaminant and component of the flora of various parts of the body. This communication reports both a 20-year retrospective study of clinically and mycologically proven cases of oral geotrichosis, and a prospective study of fungal oral flora in 200 individuals divided into two groups: normal individuals and individuals with associated conditions. Twelve patients with proven oral geotrichosis were included: 9 females and 3 males, with a mean age of 48.5 years; the associated conditions were diabetes mellitus (66.6%), leukemia, Hodgkin's lymphoma and HIV/AIDS infection. The oral geotrichoses showed three clinical varieties: pseudomembranous (75%), hyperplastic, and palatine ulcer. G. candidum was isolated in 11 cases and G. capitatum in one. Positive fungal cultures were obtained from the two groups, and 48% and 78% of cultures were positive, respectively, for Candida spp. In 2.8% and 6.33% of the cases, G. candidum was isolated, respectively, together with one strain of G. capitatum. Oral geotrichosis is an exceptional infection that clinically presents, and is treated, as oral candidiasis. G. candidum may be isolated from the oral flora of a small proportion of patients, either normal individuals or those with associated conditions.

Case of fatal Blastoschizomyces capitatus infection occurring in a patient receiving empiric micafungin therapy.

We report the first case, to our knowledge, of Blastoschizomyces capitatus infection occurring in a patient receiving empirical echinocandin therapy for neutropenic fevers. Clinicians should consider B. capitatus infection in those neutropenic patients who remain febrile despite echinocandin therapy or who develop yeast bloodstream infections while receiving an echinocandin.

Invasive cutaneous infection with Geotrichum candidum: sequential treatment with amphotericin B and voriconazole.

A rare case of an invasive cutaneous infection by Geotrichum candidum in an 80-year-old male patient with diabetes mellitus is reported. The primary site of infection manifested after trauma as an ulcerative lesion on the distal phalanx of the midfinger and extended throughout the right hand. Histological examination showed fungal invasion in the deep dermis without vascular involvement and G. candidum was grown in cultures from the biopsy material. Angiography revealed severe obstructive disease of the right brachial artery and its branches. Treatment, after susceptibility testing of the isolated strain, consisted of sequential administration of intravenous liposomal amphotericin B with oral voriconazole followed by liposomal amphotericin B, resulting in substantial improvement of the infection.

[A 19-year-old patient with acute promyelocytic leukemia and knee swelling]. / 19-jährige Patientin mit akuter Promyelozytenleukämie und Knieschwellung.

We report on a case of a 19-year-old female patient with acute promyelocytic leukemia suffering from febrile monarthitis of the right knee during neutropenia after consolidation chemotherapy caused by Geotrichum capitatum. Apparently this infection occurred due to a hematological reactivation since the patient had already developed Geotrichum capitatum fungemia during induction therapy. Under antimycotic therapy with voriconazole, flucytosine, and caspofungin as well as after two arthroscopic synovectomies with cleansing of the right knee, the infection could be controlled and the full clinical function of the knee joint could be preserved.

Fatal Blastoschizomyces capitatus sepsis in a neutropenic patient with acute myeloid leukemia: first documented case from Greece.

Blastoschizomyces capitatus (formerly known as Geotrichum capitatum and Trichosporon capitatum) is a rare, yet an emerging, cause of invasive infections in immunosuppressed patients. Profound and prolonged neutropenia is the crucial predisposing factor for this yeast infection. Blastoschizomyces capitatus was isolated from peripheral blood cultures of a profoundly neutropenic patient with acute myeloid leukemia (M2 FAB). Despite administration of antifungal chemotherapy with liposomal amphotericin B at 4.5 mg kg(-1) daily, the patient succumbed 4 days after initiation of treatment. Infections attributed to B. capitatus have generally a poor prognosis, although the yeast shows in vitro susceptibility to antifungal agents. Low flucytosine, caspofungin acetate, voriconazole and amphotericin B minimum inhibitory concentration values were also recorded with our isolate. The clinical relevance of the in vitro susceptibility testing against the isolate and the current antifungal chemotherapy regimens against B. capitatus systemic infections are discussed.

Coinfection of Cryptosporidium and Geotrichum in a case of AIDS.

A 32 year old male, positive for human immunodeficiency virus (mY) antibodies, was found to be positive for multiple opportunistic infections by a parasite and a fungi, which is a very rare occurrence. Cryptosporidium and Geotrichum were simultaneously detected from his stool and sputum respectively.

[Herpes simplex and Geotrichum candidum pneumonia in a patient with moderate renal failure]. / Pneumopathie à Herpes simplex et Geotrichum candidum chez un patient présentant une insuffisance rénale modérée.

Viral or fungal pneumonia generally occurs in immunocompromised patients. We report a case of hypoxic pneumonia unresponsive to broad-spectrum antibiotic therapy in a patient whose only risk factor for immunodeficiency was mild silent renal failure. The causal association between Herpes simplex and Geotrichum candidum was retained on the basis of endobronchial samples and the favorable course after institution of specific treatment. It is thus useful to consider these pathogens in patients with lung infection in order to institute specific treatment.

Geotrichum capitatum septicaemia in neutropenic patients: case report and review of the literature.

We report a case of systemic infection with Geotrichum capitatum in a patient with acute myeloid leukaemia. Three days before death, the patient developed acute renal failure, probably caused by occlusion of glomerula with hyphae of G. capitatum. Up until now, prophylaxis and treatment of infections caused by Geotrichum capitatum have not been established. However, the prophylactic administration of high-dose itraconazole and the therapeutic use of liposomal amphotericin B are subjects of discussion.

[A clinical and biological study of parasitic and fungal diarrhea in immunosuppressed patients in an urban and suburban area of Yaoundé]. / Etude clinique et biologique des diarrhées parasitaires et fongiques chez les sujets immunodéprimés dans la zone urbaine et péri-urbaine de Yaoundé.

We studied 66 cases of intestinal mycosis and parasitosis in patients infected with the human immunodeficiency virus with chronic diarrhea. All subjects were from the Yaounde urban area and were followed between February and December 1996. They were recruited from 3 hospitals in the center of Yaounde and were aged between 2 and 52 years. There was weight loss in 80.3% and severe dehydration in 72.3% of cases. Feces consisted mostly of watery stools similar to those of cholera patients (50% of cases) and loose stools (43.9% of cases). Parasitic agents were detected in 31.8% and fungal agents in 80.5% of cases. The opportunistic Protozoans detected included Cryptosporidium parvum (15.8%), microsporidia (8.8%) and Isospora belli (3.5%). Six cases of helminthiasis were also identified. Candida albicans was the most common opportunistic mycosis agent (39.1%). Other fungal species detected included Geotrichum candidum, Candida pseudotropicalis and Trichosporon sp. but all of these were less common.

Osteomyelitis and intervertebral discitis caused by Blastoschizomyces capitatus in a patient with acute leukemia.

We describe the first known case of vertebral osteomyelitis and discitis caused by Blastoschizomyces capitatus in a leukemic patient and the results of therapy. We also reconfirm the microbiological characteristics which differentiate this species from other yeastlike pathogens.

Oral Geotrichum candidum infection associated with HIV infection. A case report.

Infections with Geotrichum species, although rare, are sometimes seen in immunocompromised hosts. We report a case of oral geotrichosis in a patient seropositive for human immunodeficiency virus who had erythematous mandibular and maxillary gingiva but was otherwise free of any active systemic disease. Geotrichum candidum was shown by both culture and histopathology to be present in the lesion and was deduced to be the causative organism. The patient responded well to several weeks of treatment involving oral topical administration of nystatin vaginal tablets.

Oral mycoses in HIV infection.

Oral mycoses in human immunodeficiency virus (HIV) infection are becoming increasingly common. Of these, oral candidiasis is by far the most prevalent; fewer than 10 cases of cryptococcosis, histoplasmosis, and geotrichosis have thus far been reported. Oral candidiasis is one of the earliest premonitory signs of HIV infection and may present as erythematous, pseudomembranous, hyperplastic, or papillary variants, or as angular cheilitis. Cumulative data from 23 surveys (incorporating 3387 adults) suggest that in general, oral candidiasis may develop in one third to half of HIV-seropositive persons. Almost equal numbers of cases manifest with either erythematous or pseudomembranous variants. These and related concepts pertaining to oral mycoses in HIV infection are reviewed.