RESUMO
Emergent fungal infections are uncommon conditions which frequently lead to death. To our knowledge, only a few cases of invasive infection by Cystobasidium minutum (previously known as Rhodotorula minuta) have been reported. Moreover, several factors are responsible for deep site infections, such as catheter-related fungemia. This report describes the first case report of Cystobasidium minutum causing fungemia in Brazil. The pathogens fungemia was demonstrated by catheter and blood culture-proven, and both yeasts were identified by sequences of D1/D2 rDNA region. After the end of antifungal therapy and catheter removal, a second blood culture was found to be negative and the clinical signs and symptoms of the patient improved.
Assuntos
Basidiomycota/isolamento & purificação , Fungemia , Neoplasias/complicações , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Basidiomycota/classificação , Basidiomycota/genética , Brasil , Infecções Relacionadas a Cateter/microbiologia , DNA Fúngico , DNA Ribossômico , Ácido Desoxicólico/administração & dosagem , Ácido Desoxicólico/uso terapêutico , Combinação de Medicamentos , Feminino , Fungemia/tratamento farmacológico , Fungemia/patologia , Humanos , Hospedeiro Imunocomprometido , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , NeutropeniaRESUMO
INTRODUCTION: Cases of invasive Trichosporon infections have increasingly emerged; it is now the second leading cause of yeast bloodstream infections after Candida spp., particularly in the immunosuppressed population, where it often causes breakthrough fungemia with high mortality. METHODS: We present a case report of a breakthrough Trichosporon asahii infection in a patient with acute myeloid leukemia and review all of the cases of breakthrough Trichosporon spp. infections published in the literature to date. RESULTS: We extracted 68 cases of breakthrough Trichosporon spp. infections, wherein 95.5% patients had hematological malignancy, 61.8% of them occurred in the presence of echinocandins, 22% of triazoles, 13.2% of amphotericin and 3% of other combinations of antifungals. The most prevalent manifestation was fungemia (94%); 82.8% of these were associated with the presence of a central venous catheter. The overall mortality was 68.7%; the patients who survived recovered from the neutropenic event. CONCLUSIONS: Invasive trichosporonosis is an acute fatal condition that occurs in immunosuppressed patients, usually under antifungal selective pressure. Typically, neutropenia and its underlying diseases are associated with adverse outcomes.
Assuntos
Leucemia Mieloide Aguda/complicações , Trichosporon/isolamento & purificação , Tricosporonose , Voriconazol/uso terapêutico , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Cateteres Venosos Centrais/efeitos adversos , Equinocandinas/uso terapêutico , Fungemia/patologia , Neoplasias Hematológicas/complicações , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Mortalidade , Neutropenia/complicações , Triazóis/uso terapêutico , Tricosporonose/complicações , Tricosporonose/tratamento farmacológico , Tricosporonose/patologiaRESUMO
Eremothecium coryli is a dimorphic fungus of the Saccharomycetes class. While species within this class are known to cause human infection, Eremothecium species have previously only been known as phytopathogens and never been isolated from a human sample. Here, we report the first known case of human E. coryli infection.
Assuntos
Eremothecium/fisiologia , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Leucemia Mieloide Aguda/complicações , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Hemocultura , DNA Fúngico/genética , Eremothecium/citologia , Eremothecium/efeitos dos fármacos , Eremothecium/genética , Feminino , Fungemia/microbiologia , Fungemia/patologia , Humanos , Testes de Sensibilidade Microbiana , RNA Ribossômico 28S/genética , Análise de Sequência de DNA , Falha de TratamentoRESUMO
A 48 year-old immunocompetent woman, who had a nodular lesion in the neck and a dense infiltrate at the lower lobe of the left lung, presented at the Mycology Unit of Muñiz Hospital of Buenos Aires City. The pulmonary infiltrate disappeared spontaneously 3 months later. The histopathological study of the nodular lesion showed capsulated yeasts (mucicarmin and alcian blue positive stains) compatible with Cryptococcus. The mycological study of a new sample, obtained by a nodular puncture, allowed the isolation of yeasts, identified as Cryptococcus gattii (VGII). Latex test for Cryptococcus capsular antigen in serum was positive (1/100). CSF cultures rendered negative results. Fluconazole at a daily dose of 800mg was given during 45 days with partial improvement; as cultures from a new clinical sample were positive for Cryptococcus, the antimycotic was changed to itraconazole 400mg/day for 5 months, with an excellent clinical response.
Assuntos
Criptococose/diagnóstico , Cryptococcus gattii/isolamento & purificação , Cistos/microbiologia , Fungemia/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Doenças da Glândula Tireoide/microbiologia , Antifúngicos/uso terapêutico , Antígenos de Fungos/sangue , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Criptococose/patologia , Cryptococcus gattii/imunologia , Feminino , Fluconazol/uso terapêutico , Fungemia/tratamento farmacológico , Fungemia/microbiologia , Fungemia/patologia , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/patologia , Pessoa de Meia-IdadeRESUMO
Saprochaete capitata (S. capitata) fungal sepsis is a severe condition with a clinical presentation that is similar to other yeast originated fungal sepsis. It is observed in patients with hematological malignancies such as acute myeloid leukemia and neutropenia. We report a 23 year old male presenting with cough, fever and malaise. A bone marrow biopsy led to the diagnosis of acute myeloid leukemia. During the first cycle of chemotherapy the patient presented fever: blood cultures were positive for Klebsiella pneumoniae. Despite antimicrobial treatment, fever persisted; a computed tomography showed a focal splenic lesion; a left exudative pleural effusion appeared. A Matrix Assisted Laser Desorption Ionization-Time of Flight mass spectrometry identified the presence of S. capitata. After multiple antifungal treatments and pleural cavity cleansing by means of videothoracoscopy and laparoscopic splenectomy, the infection resolved and the patient completed his chemotherapy.
Assuntos
Dipodascus/isolamento & purificação , Fungemia/cirurgia , Leucemia Mieloide Aguda/microbiologia , Antifúngicos/uso terapêutico , Drenagem/métodos , Fungemia/tratamento farmacológico , Fungemia/patologia , Humanos , Masculino , Pleurisia/microbiologia , Pleurisia/patologia , Esplenectomia/métodos , Esplenopatias/microbiologia , Esplenopatias/patologia , Esplenopatias/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
Saprochaete capitata (S. capitata) fungal sepsis is a severe condition with a clinical presentation that is similar to other yeast originated fungal sepsis. It is observed in patients with hematological malignancies such as acute myeloid leukemia and neutropenia. We report a 23 year old male presenting with cough, fever and malaise. A bone marrow biopsy led to the diagnosis of acute myeloid leukemia. During the first cycle of chemotherapy the patient presented fever: blood cultures were positive for Klebsiella pneumoniae. Despite antimicrobial treatment, fever persisted; a computed tomography showed a focal splenic lesion; a left exudative pleural effusion appeared. A Matrix Assisted Laser Desorption Ionization-Time of Flight mass spectrometry identified the presence of S. capitata. After multiple antifungal treatments and pleural cavity cleansing by means of videothoracoscopy and laparoscopic splenectomy, the infection resolved and the patient completed his chemotherapy.
Assuntos
Humanos , Masculino , Adulto Jovem , Leucemia Mieloide Aguda/microbiologia , Fungemia/cirurgia , Dipodascus/isolamento & purificação , Pleurisia/microbiologia , Pleurisia/patologia , Esplenectomia/métodos , Esplenopatias/cirurgia , Esplenopatias/microbiologia , Esplenopatias/patologia , Drenagem/métodos , Resultado do Tratamento , Fungemia/patologia , Fungemia/tratamento farmacológico , Antifúngicos/uso terapêuticoRESUMO
Sporopachydermia cereana is a rare yeast found in necrotic cactus tissue, predominantly in the Americas. Infection in humans with clinical data has only been reported in four patients so far, all of whom died, either directly from the pathogen or from other complications of immunosuppression. Treatment of the yeast is complicated by difficulties in identification of the pathogen with conventional diagnostic techniques and by intrinsic resistance to echinocandins. The first patient to survive a disseminated infection with S. cereana is presented herein. The patient had acute myeloid leukemia and was treated successfully with antifungal therapy and subsequently underwent a successful allogeneic hematopoietic stem cell transplantation.
Assuntos
Fungemia/diagnóstico , Leucemia Mieloide Aguda/complicações , Linfonodos/patologia , Saccharomycetales , Antifúngicos/uso terapêutico , Feminino , Fungemia/complicações , Fungemia/tratamento farmacológico , Fungemia/patologia , Transplante de Células-Tronco Hematopoéticas , Humanos , Terapia de Imunossupressão/efeitos adversos , Leucemia Mieloide Aguda/cirurgia , Linfonodos/microbiologia , Pessoa de Meia-Idade , NecroseRESUMO
Paecilomyces sp. are emerging pathogens in immunocompromised patients. We report here a case of Paecilomyces variotii fungemia, cured with amphotericin and anidulafungin, illustrating difficulties of early diagnosis and therapeutic choice in such rare fungal infection.
Assuntos
Fungemia/diagnóstico , Fungemia/patologia , Insuficiência Hepática/complicações , Transplante de Fígado , Linfoma/complicações , Paecilomyces/isolamento & purificação , Anfotericina B/uso terapêutico , Anidulafungina , Antifúngicos/uso terapêutico , Equinocandinas/uso terapêutico , Fungemia/tratamento farmacológico , Insuficiência Hepática/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The majority of invasive fungal infections observed in non-neutropenic patients hospitalized in an intensive care unit are caused by Candida spp and current guidelines recommend echinocandins as the first-line treatment. Fungemias caused by filamentous or arthrosporic fungi such as Saprochaete capitata (previously named Geotrichum capitatum) are extremely rare. In fact, invasive infections due to S. capitata have been reported almost exclusively in neutropenic oncohematological patients. In this report, we describe a case of fungemia caused by S. capitata in a non-neutropenic patient hospitalized in an intensive care unit after aortic valve replacement. The prompt identification of S. capitata is extremely important because of its intrinsic resistance to echinocandins.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Fungemia/microbiologia , Hospitalização , Unidades de Terapia Intensiva , Saccharomycetales/isolamento & purificação , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/reabilitação , Infecções Relacionadas a Cateter/microbiologia , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/microbiologia , Farmacorresistência Fúngica , Equinocandinas/uso terapêutico , Fungemia/tratamento farmacológico , Fungemia/patologia , Humanos , Masculino , Testes de Sensibilidade MicrobianaRESUMO
We report a case of Trichosporon loubieri (T. loubieri) fungemia with likely liver involvement in a 39-year-old Caucasian patient with relapsed B-cell acute lymphoblastic leukemia after an allogeneic hematopoietic cell transplant. This is the fifth published case of T. loubieri infection and only the third case of T. loubieri fungemia, to our knowledge. All 3 cases of T. loubieri infection with fungemia had liver involvement.
Assuntos
Fungemia/diagnóstico , Fungemia/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras B/complicações , Trichosporon/isolamento & purificação , Tricosporonose/diagnóstico , Tricosporonose/patologia , Adulto , Basidiomycota , Feminino , Fungemia/microbiologia , Humanos , Técnicas Microbiológicas , Microscopia , Transplante Homólogo/efeitos adversos , Tricosporonose/microbiologia , População BrancaRESUMO
Neutropenic patients are at risk of the development of hyalohyphomycosis and mucormycosis. Correct identification is essential for the initiation of the specific treatment, but concomitant mold infections are rarely reported. We report one unprecedented case of concomitant mucormycosis and fusariosis in a neutropenic patient with acute myeloid leukemia. The patient developed rhino-orbital infection by Rhizopus arrhizus and disseminated infection by Fusarium solani. The first culture from a sinus biopsy grew Rhizopus, which was consistent with the histopathology report of mucormycosis. A second sinus biopsy collected later during the patient's clinical deterioration was reported as hyalohyphomycosis, and the culture yielded F. solani. Due to the discordant reports, the second biopsy was reviewed and two hyphae types suggestive of both hyalohyphomycetes and mucormycetes were found. The dual mold infection was confirmed by PCR assays from paraffinized tissue sections. Increased awareness of the existence of dual mold infections in at-risk patients is necessary. PCR methods in tissue sections may increase the diagnosis of dual mold infections. In case of sequential biopsies showing discrepant results, mixed infections have to be suspected.
Assuntos
Fusariose/complicações , Fusariose/diagnóstico , Fusarium/isolamento & purificação , Mucormicose/complicações , Mucormicose/diagnóstico , Rhizopus/isolamento & purificação , Fungemia/complicações , Fungemia/diagnóstico , Fungemia/microbiologia , Fungemia/patologia , Fusariose/microbiologia , Fusariose/patologia , Fusarium/genética , Humanos , Hospedeiro Imunocomprometido , Leucemia Mieloide Aguda/complicações , Masculino , Pessoa de Meia-Idade , Mucormicose/microbiologia , Mucormicose/patologia , Neutropenia/complicações , Patologia Molecular , Reação em Cadeia da Polimerase , Rhizopus/genética , Sinusite/complicações , Sinusite/diagnóstico , Sinusite/microbiologia , Sinusite/patologiaRESUMO
Candida krusei (C. krusei) is a multidrug-resistant opportunistic fungal pathogen that may cause disseminated infections in immunocompromised hosts. However, its clinical and histologic features are not well-characterized. We present a unique case to contribute to the growing knowledge base associated with this organism. During hospitalization for neutropenic fever, a 19-year-old man with acute myeloid leukemia, who underwent hematopoietic stem cell transplantation, developed a generalized folliculocentric eruption following initiation of antifungal therapy for newly diagnosed C. krusei fungemia. Despite adequate antifungal coverage and negative blood cultures, the follicular-based erythematous papules persisted. Biopsies demonstrated yeast within ruptured follicles, without angiotropism or involvement of the interfollicular dermis, subcutaneous tissue, or stratum corneum. Concurrent skin tissue cultures confirmed C. krusei. The patient remained febrile despite aggressive antifungal therapy, with relapse of leukemia and subsequent death. Our case is unusual given the development of cutaneous lesions following clearance of fungemia, with yeast limited to ruptured follicular lumina, possibly indicating a primary cutaneous source or early transfollicular/transepidermal elimination. Given the limited available descriptions of cutaneous histopathology for C. krusei, we seek to add to the understanding of its pathophysiology and aid in the diagnosis and treatment of this often fatal infection.
Assuntos
Candidíase Cutânea/tratamento farmacológico , Candidíase Cutânea/patologia , Candidíase/tratamento farmacológico , Candidíase/patologia , Antifúngicos/uso terapêutico , Candidíase/imunologia , Candidíase Cutânea/imunologia , Evolução Fatal , Fungemia/tratamento farmacológico , Fungemia/imunologia , Fungemia/patologia , Humanos , Hospedeiro Imunocomprometido , Leucemia Mieloide Aguda/complicações , Masculino , Adulto JovemRESUMO
We report a case of invasive infection due to Saprochaete capitata in a patient with hematological malignancies after chemotherapy treatment and empiric antifungal therapy with caspofungin. Although severely immunocompromised the patient survived been treated with amphotericin B lipid complex associated with voriconazole.
Assuntos
Fungemia/diagnóstico , Fungemia/patologia , Neoplasias Hematológicas/complicações , Saccharomycetales/isolamento & purificação , Adolescente , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Caspofungina , Equinocandinas/uso terapêutico , Fungemia/microbiologia , Humanos , Lipopeptídeos , Pulmão/patologia , Masculino , Testes de Sensibilidade Microbiana , Técnicas Microbiológicas , Microscopia , Radiografia Torácica , Resultado do Tratamento , Voriconazol/uso terapêuticoRESUMO
Histoplasmosis is a progressive disease caused by dimorphic intracellular fungi and can prove fatal. Usually, it is present in immunocompromised individuals and immunocompetent individuals in the endemic zones. We report an unusual presentation of progressive disseminated histoplasmosis. The patient in the present case report was immunocompetent child and had fever, bone pains, gradual weight loss, lymphadenopathy and hepatosplenomegaly. Disseminated histoplasmosis (DH) was diagnosed on microscopic examination and fungal culture of bone marrow, blood, skin biopsy and lymph node aspirate. The patient died on seventh day of amphotericin B. In the absence of predisposing factors and classical clinical presentation of febrile neutropenia, lung, adrenal and oropharyngeal lesions, the disease posed a diagnostic challenge. Progressive disseminated histoplasmosis in children can be fatal despite timely diagnosis and therapy. In India, disseminated histoplasmosis is seen in immunocompetent hosts. All the pediatrics immunocompetent cases from India are also reviewed.
Assuntos
Fungemia/diagnóstico , Fungemia/patologia , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Histoplasmose/patologia , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Criança , Evolução Fatal , Feminino , Histoplasmose/tratamento farmacológico , Humanos , ÍndiaRESUMO
We report a case of invasive infection due to Saprochaete capitata in a patient with hematological malignancies after chemotherapy treatment and empiric antifungal therapy with caspofungin. Although severely immunocompromised the patient survived been treated with amphotericin B lipid complex associated with voriconazole.
Assuntos
Adolescente , Humanos , Masculino , Fungemia/diagnóstico , Fungemia/patologia , Neoplasias Hematológicas/complicações , Saccharomycetales/isolamento & purificação , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Equinocandinas/uso terapêutico , Fungemia/microbiologia , Pulmão/patologia , Testes de Sensibilidade Microbiana , Técnicas Microbiológicas , Microscopia , Radiografia Torácica , Resultado do Tratamento , Voriconazol/uso terapêuticoRESUMO
We report the first case of fungemia caused by Paracoccidioides lutzii in a 51-year-old male farm worker from the central-west region of Brazil. The fungus was isolated from blood cultures and the species was confirmed by phylogenetic identification. Despite specific treatment and intensive care, the patient died 39 days after admission.
Assuntos
Fungemia/microbiologia , Paracoccidioides/genética , Paracoccidioidomicose/microbiologia , Brasil , Evolução Fatal , Fungemia/diagnóstico , Fungemia/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Paracoccidioides/classificação , Paracoccidioides/patogenicidade , Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/patologia , FilogeniaAssuntos
Fungemia/complicações , Fungemia/patologia , Fusariose/complicações , Fusariose/patologia , Leucemia Mieloide Aguda/complicações , Infecções Oportunistas/complicações , Pele/patologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Fungemia/microbiologia , Fusariose/microbiologia , Fusarium/isolamento & purificação , Humanos , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Infecções Oportunistas/microbiologiaRESUMO
Triadelphia pulvinata is a rare dematiaceous fungus found in soil. We report the first case of invasive disease in a patient with acute myeloid leukemia who had a bloodstream infection with possibly both lung and brain involvement. Identification was by combined phenotypic features and fungal ribosomal DNA sequence analysis.
Assuntos
Ascomicetos/isolamento & purificação , Fungemia/diagnóstico , Fungemia/patologia , Leucemia Mieloide Aguda/complicações , Ascomicetos/classificação , Ascomicetos/genética , Infecções Fúngicas do Sistema Nervoso Central/complicações , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Infecções Fúngicas do Sistema Nervoso Central/patologia , DNA Fúngico/química , DNA Fúngico/genética , DNA Ribossômico/química , DNA Ribossômico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Feminino , Fungemia/complicações , Fungemia/microbiologia , Humanos , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/patologia , Microscopia , Pessoa de Meia-Idade , Dados de Sequência Molecular , Radiografia Torácica , Análise de Sequência de DNA , Tomografia Computadorizada por Raios XRESUMO
The Sporopachydermia cereana species lives in decaying stems of cactus and is exceptionally rare as a human pathogen. A 57-year-old man with therapy-refractory acute promyelocytic leukaemia developed severe neutropaenia. After about 3 weeks of micafungin used as prophylaxis, he developed high fever, multiple pulmonary nodular infiltrates and a painful leg lesion. Blood culture yielded a yeast which was not identified by the Vitek 2 system. On ITS1-5.8S-ITS2 gene sequencing, the isolate was identified as S. cereana. Antifungal sensitivity by the Etest showed that the minimum inhibitory concentration for fluconazole was 0.75 µg/mL, and for anidulafungin, it was >32 µg/mL. He responded to liposomal amphotericin B but later died of Escherichia coli septicaemia. There were no cactus plants in the vicinity, suggesting that S. cereana might have alternative habitats.
Assuntos
Antifúngicos/uso terapêutico , Quimioprevenção/métodos , Equinocandinas/uso terapêutico , Fungemia/diagnóstico , Leucemia Promielocítica Aguda/complicações , Lipopeptídeos/uso terapêutico , Infecções Oportunistas/diagnóstico , Saccharomycetales/isolamento & purificação , DNA Fúngico/química , DNA Fúngico/genética , DNA Ribossômico/química , DNA Ribossômico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/diagnóstico , Evolução Fatal , Fungemia/complicações , Fungemia/microbiologia , Fungemia/patologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Micafungina , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Neutropenia/complicações , Neutropenia/diagnóstico , Infecções Oportunistas/complicações , Infecções Oportunistas/microbiologia , Infecções Oportunistas/patologia , Radiografia Torácica , Saccharomycetales/classificação , Saccharomycetales/genética , Sepse/complicações , Sepse/diagnóstico , Análise de Sequência de DNA , Pele/patologia , Tomografia Computadorizada por Raios XRESUMO
Our aim was to examine whether systemic inflammatory response (SIR) is associated with perioperative central venous catheter-related bloodstream infection (CVC-RBSI) in patients undergoing surgery for colorectal cancer (CRC) with administration of parenteral nutrition (PN). Between May 2002 and August 2009, 310 patients undergoing CRC surgery were enrolled. A CVC was inserted in all patients for administration of PN. Among these patients, 117 developed fever, and blood cultures for diagnosis of CVC-RBSI were obtained from them. A final total of 22 patients were diagnosed as having CVC-RBSI. Univariate analysis was performed to evaluate the risk factors for CVC-RBSI using the clinical characteristics of the patients. The results of univariate analyses revealed that only the Glasgow Prognostic Score was an independent risk factor for CVC-RBSI (odds ratio 3.733; 95% confidence interval 1.416-9.844; p=0.008). The Glasgow Prognostic Score is associated with CVC-RBSI in patients undergoing CRC surgery with administration of PN.