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1.
Diagn Microbiol Infect Dis ; 109(4): 116343, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38781765

ABSTRACT

Saccharomyces cerevisiae is a yeast used mainly as a probiotic for prevention or treatment of diarrhoea. However, the prevalence of S. cerevisiae fungemia has risen over the past years, notably among patients with predisposing factors. This retrospective study presents 21 cases of S. cerevisiae fungemia at the University Hospital of Liege from 2000 to 2022, their clinical relevance and therapeutic management. Each patient presented one or several risk factors prior to fungemia. The isolated strains presented high minimal inhibitory concentration for fluconazole, while MICs for amphotericin B, voriconazole and echinocandins were low. Some patients received antifungal therapy, while for others only central and peripheral lines were removed and probiotics discontinued. The MICs obtained for voriconazole and echinocandins makes them an alternative treatment to fluconazole and amphotericin B as reported in other studies. Since a S. cerevisiae fungemia can induce the same complications as candidemia, follow-up blood cultures should be collected and metastatic foci should be looked for. This study showed an important discrepancy in the clinical management of infections due to S. cerevisiae and highlights the need for guidelines.


Subject(s)
Antifungal Agents , Fungemia , Microbial Sensitivity Tests , Saccharomyces cerevisiae , Humans , Antifungal Agents/therapeutic use , Retrospective Studies , Male , Saccharomyces cerevisiae/drug effects , Female , Fungemia/drug therapy , Fungemia/microbiology , Aged , Middle Aged , Adult , Risk Factors , Aged, 80 and over
2.
Med Mycol ; 62(7)2024 Jul 04.
Article in English | MEDLINE | ID: mdl-38806253

ABSTRACT

Candida lusitaniae fungemia is a serious infection that is rarely reported in children. The aim of this study is to describe a case series of C. lusitaniae fungemia and review previous publications regarding this rare pathogen. This is a multicenter case series of children diagnosed with C. lusitaniae fungemia. A total of 18 cases that occurred over a 15-year period in five tertiary hospitals were included. Additionally, a review of the literature regarding C. lusitaniae fungemia in children was performed. A total of 18 cases were enrolled; 11/18 (61%) were males, with a mean age of 2.3 years. All patients had severe underlying diseases and risk factors for opportunistic infection, most commonly prematurity and malignancies. More than one-third of cases occurred during the last 2 years of the study period. All isolates were susceptible to all tested antifungals. The survival rate following the acute infection was 94%, whereas the survival rate of 14 previously published cases was 71%, with the most common underlying diseases being CGD and malignancies. Candida lusitaniae fungemia is not a common event in the pediatric population, occurring exclusively in children with severe underlying diseases and significant risk factors. This cohort revealed better clinical outcomes than previously reported. All tested isolates were susceptible to all antifungal agents; variability in susceptibility as previously reported was not found in this study. The allegedly higher rate of infection in recent years is in need of further investigation in larger prospective studies in order to conclude if a real trend is at play.


Candida lusitaniae fungemia is a serious infection rarely reported in children. This cohort revealed better clinical outcomes than previously reported. All tested isolates were susceptible to all antifungal agents. The higher rate of infection in recent years is in need of further investigation.


Subject(s)
Antifungal Agents , Candida , Child, Preschool , Female , Humans , Male , Antifungal Agents/therapeutic use , Antifungal Agents/pharmacology , Candida/drug effects , Candida/genetics , Candida/isolation & purification , Candida/pathogenicity , Candidemia/microbiology , Candidemia/epidemiology , Fungemia/microbiology , Fungemia/mortality , Microbial Sensitivity Tests , Retrospective Studies , Risk Factors , Tertiary Care Centers/statistics & numerical data
3.
J Control Release ; 370: 626-642, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38734314

ABSTRACT

Severe nephrotoxicity and infusion-related side effects pose significant obstacles to the clinical application of Amphotericin B (AmB) in life-threatening systemic fungal infections. In pursuit of a cost-effective and safe formulation, we have introduced multiple phenylboronic acid (PBA) moieties onto a linear dendritic telodendrimer (TD) scaffold, enabling effective AmB conjugation via boronate chemistry through a rapid, high yield, catalysis-free and dialysis-free "Click" drug loading process. Optimized AmB-TD prodrugs self-assemble into monodispersed micelles characterized by small particle sizes and neutral surface charges. AmB prodrugs sustain drug release in circulation, which is accelerated in response to the acidic pH and Reactive Oxygen Species (ROS) in the infection and inflammation. Prodrugs mitigate the AmB aggregation status, reduce cytotoxicity and hemolytic activity compared to Fungizone®, and demonstrate superior antifungal activity to AmBisome®. AmB-PEG5kBA4 has a comparable maximum tolerated dose (MTD) to AmBisome®, while over 20-fold increase than Fungizone®. A single dose of AmB-PEG5kBA4 demonstrates superior efficacy to Fungizone® and AmBisome® in treating systemic fungal infections in both immunocompetent and immunocompromised mice.


Subject(s)
Amphotericin B , Antifungal Agents , Fungemia , Prodrugs , Animals , Amphotericin B/administration & dosage , Amphotericin B/pharmacology , Amphotericin B/chemistry , Amphotericin B/pharmacokinetics , Prodrugs/administration & dosage , Prodrugs/chemistry , Prodrugs/pharmacology , Antifungal Agents/administration & dosage , Antifungal Agents/pharmacology , Antifungal Agents/chemistry , Antifungal Agents/therapeutic use , Humans , Fungemia/drug therapy , Nanoparticles/chemistry , Drug Liberation , Micelles , Mice , Female , Click Chemistry , Candida albicans/drug effects , Polyethylene Glycols/chemistry , Polyethylene Glycols/administration & dosage
4.
Int J Infect Dis ; 143: 107040, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38580069

ABSTRACT

Fungemia is common in critically ill patient populations, and is associated with a high rate of mortality, especially when caused by nonalbicans Candida species. Herein, we describe a fatal case of fungemia following cardiothoracic surgery in which the organism, initially identified as Candida inconspicua, represents a novel species: Pichia alaskaensis.


Subject(s)
Fungemia , Pichia , Humans , Fungemia/microbiology , Fungemia/diagnosis , Fatal Outcome , Pichia/isolation & purification , Male , Cardiac Surgical Procedures/adverse effects , Antifungal Agents/therapeutic use , Aged , Middle Aged , Female
5.
Mikrobiyol Bul ; 58(2): 209-219, 2024 Apr.
Article in Turkish | MEDLINE | ID: mdl-38676587

ABSTRACT

Scedosporium/Lomentospora is an opportunistic fungal pathogen found worldwide. While Scedosporium apiospermum and Scedosporium boydii are commonly observed globally, Lomentospora prolificans, which mainly affects immunosuppressed individuals, is rarely encountered and is more prevalent in arid climates, particularly in Australia and Spain. L.prolificans is a fungus commonly found in environmental sources such as contaminated water and soil. This species is known as an opportunistic pathogen that can cause deep-seated fungal infections, especially in immunosuppressed individuals. In this case report, a fatal case of L.prolificans fungemia in a patient with T-cell large granular leukemia during profound neutropenia was presented. The patient admitted to the hospital with prolonged fever, neutropenia, and shortness of breath. Antibiotherapy was administered to the patient for febrile neutropenia, but the fever persisted and his clinical status rapidly deteriorated. L.prolificans was isolated from the blood culture, and considering its antifungal resistance, combination therapy of voriconazole and terbinafine was initiated. However, the patient died of septic shock and multiple organ failure. In conclusion, although L.prolificans infections are rare, they can be life-threatening, especially in immunosuppressed individuals. Diagnosis and treatment of such infections may be difficult, therefore rapid diagnostic methods and appropriate treatment protocols should be developed. Consideration of infections caused by rare fungal pathogens in patients with risk factors may be critical for patient care. The literature review revealed that the first case of L.prolificans fungemia from Türkiye was reported in 2023. This case presentation represents the second reported case. However, in our case, L.prolificans fungemia occurred in 2018, it can be considered that L.prolificans may have been an invasive fungal pathogen of significant concern in Türkiye much earlier than previously documented.


Subject(s)
Antifungal Agents , Fungemia , Voriconazole , Humans , Fatal Outcome , Fungemia/microbiology , Fungemia/drug therapy , Fungemia/diagnosis , Fungemia/complications , Antifungal Agents/therapeutic use , Male , Voriconazole/therapeutic use , Terbinafine/therapeutic use , Shock, Septic/microbiology , Shock, Septic/drug therapy , Immunocompromised Host , Opportunistic Infections/microbiology , Opportunistic Infections/drug therapy , Opportunistic Infections/diagnosis , Opportunistic Infections/complications , Drug Therapy, Combination , Middle Aged , Scedosporium/isolation & purification
7.
Med Mycol ; 62(5)2024 May 03.
Article in English | MEDLINE | ID: mdl-38627248

ABSTRACT

Although Candida species are the most common cause of fungemia, non-Candida rare yeasts (NCY) have been increasingly reported worldwide. Although the importance of these yeast infections is recognized, current epidemiological information about these pathogens is limited, and they have variable antifungal susceptibility profiles. In this study, we aimed to evaluate the clinical characteristics for fungemia caused by NCY by comparing with candidemia. The episodes of NCY fungemia between January 2011 and August 2023 were retrospectively evaluated in terms of clinical characteristics, predisposing factor, and outcome. In addition, a candidemia group, including patients in the same period was conducted for comparison. Antifungal susceptibility tests were performed according to the reference method. A total of 85 patients with fungemia episodes were included: 25 with NCY fungemia and 60 with candidemia. Fluconazole had high minimal inhibitory concentration (MIC) values against almost all NCY isolates. The MIC values for voriconazole, posaconazole, and amphotericin B were ≤ 2 µg/ml, and for caspofungin and anidulafungin were ≥ 1 µg/ml against most of isolates. Hematological malignancies, immunosuppressive therapy, neutropenia and prolonged neutropenia, polymicrobial bacteremia/fungemia, preexposure to antifungal drugs, and breakthrough fungemia were associated with NCY fungemia, whereas intensive care unit admission, diabetes mellitus, urinary catheters, and total parenteral nutrition were associated with candidemia. In conclusion, the majority of fungemia due to NCY species was the problem, particularly in hematology units and patients with hematological malignancy. Preexposure to antifungal drugs likely causes a change in the epidemiology of fungemia in favor of non-albicans Candida and/or NCY.


Among all fungemia episodes, hematological malignancies, immunosuppressive therapy, neutropenia, and preexposure to antifungals were risk factors for non-Candida yeast fungemia; diabetes mellitus, urinary catheters, and total parenteral nutrition were risks for candidemia.


Subject(s)
Antifungal Agents , Candida , Candidemia , Fungemia , Microbial Sensitivity Tests , Tertiary Care Centers , Humans , Retrospective Studies , Tertiary Care Centers/statistics & numerical data , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Male , Female , Middle Aged , Aged , Candida/drug effects , Candida/isolation & purification , Candida/classification , Fungemia/microbiology , Fungemia/epidemiology , Fungemia/drug therapy , Adult , Candidemia/microbiology , Candidemia/epidemiology , Candidemia/drug therapy , Yeasts/isolation & purification , Yeasts/drug effects , Yeasts/classification , Aged, 80 and over , Fluconazole/pharmacology , Fluconazole/therapeutic use , Young Adult
8.
Int J Infect Dis ; 143: 107003, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38521451

ABSTRACT

OBJECTIVES: Fungal bloodstream infection (fBSI) following pediatric liver transplantation presents a significant challenge; however, there remains a paucity of guidance regarding antifungal prophylaxis in this population. This study aimed to evaluate the effectiveness of universal antifungal prophylaxis and propose a desirable strategy. METHODS: We enrolled 604 pediatric patients who underwent liver transplantation between 2020 and 2023, including 242 patients with empirical prophylaxis and 362 patients with universal prophylaxis. Univariate and multivariate logistic regression analyses were performed to identify independent factors for fBSI. RESULTS: Eight (2.2%) pediatric recipients in the universal prophylaxis group and 13 (5.4%) in the empirical group developed fBSI (P = 0.038). Universal prophylaxis was a protective factor (P = 0.044), while high-volume intraoperative plasma transfusion and deceased donor liver transplantation were independent risk factors for fBSI (P = 0.035 and 0.008, respectively). Universal antifungal strategy showed an increased overall survival trend after liver transplantation although without significant statistical difference (P = 0.217). Patients with fBSI had poorer survival than those without fBSI (P <0.001). CONCLUSIONS: Universal prophylaxis strategy for fBSI in pediatrics after liver transplantation is desirable as it could markedly decrease the occurrence of fBSI. Pediatric patients with deceased donors and high-volume intraoperative transfusion should be paid more attention to preventing fBSI.


Subject(s)
Antifungal Agents , Liver Transplantation , Humans , Liver Transplantation/adverse effects , Male , Female , Antifungal Agents/therapeutic use , Antifungal Agents/administration & dosage , Retrospective Studies , Child , Child, Preschool , Infant , Risk Factors , Adolescent , Fungemia/prevention & control , Fungemia/microbiology , Transplant Recipients
9.
Infect Dis (Lond) ; 56(6): 441-450, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38407125

ABSTRACT

INTRODUCTION: The epidemiological evolution of bloodstream infections (BSIs) in the last decade is not clearly defined. Our aim was to analyze the changes in the workload in our institution and to describe the evolution of the incidence and etiology of BSIs in a 12-year period, including the COVID-19 pandemic. METHODS: All blood cultures received in the laboratory of a tertiary general hospital between 2010 and 2021 were analyzed. Bloodstream infection episodes refer to each episode of bacteremia or fungemia in each patient. Incidence rates per 1000 admissions and per 100,000 population were calculated. RESULTS: No significant changes in the incidence of BSI episodes/1000 admissions were observed (mean, 31.1), while estimated population-based incidences showed declining trends (mean, 182.8/100,000 inhabitants). There was a slight increase in BSI episodes per 1000 admissions caused by Gram-negatives (mean, 16.6/1000 admissions) and E. coli was the most frequent pathogen (mean, 8.5/1000 admissions). There was no significant rise in episodes caused by ESBL- and carbapenemase-producing E. coli or K. pneumoniae, with a decline in those caused by methicillin-resistant S. aureus. A spike in BSI episodes, fungal BSIs and catheter-related infections was detected in 2020, during the COVID-19 outbreak. CONCLUSIONS: No clear increase in the incidence of BSI episodes was detected in our center over this period. Gram-negatives are the most frequent etiology, with no clear rise in antimicrobial resistance phenotypes. The COVID-19 pandemic accounted for a small increase in BSI episodes in 2020, probably related to the increase of catheter-related infections.


Subject(s)
Bacteremia , COVID-19 , Fungemia , Humans , Incidence , COVID-19/epidemiology , Bacteremia/epidemiology , Bacteremia/microbiology , Male , Female , Aged , Middle Aged , Fungemia/epidemiology , Fungemia/microbiology , SARS-CoV-2 , Adult , Aged, 80 and over , Tertiary Care Centers/statistics & numerical data , Retrospective Studies , Catheter-Related Infections/epidemiology , Catheter-Related Infections/microbiology
10.
Rev Soc Bras Med Trop ; 57: e008002023, 2024.
Article in English | MEDLINE | ID: mdl-38324809

ABSTRACT

Previously considered saprobe and non-pathogenic, the fungus Papiliotrema laurentii (formerly known as Cryptococcus laurentii), is rarely associated with human infection. Nevertheless, there has been an increase in reported infections by non-neoformans cryptococci. After a literature search on the Cochrane Library, LILACS, SciELO, MEDLINE, PubMed, and PMC (PubMed Central) databases, we conclude that this is the first case report of fungemia and probable meningitis caused by Papiliotrema laurentii in a previously immunocompetent host with associated COVID-19.


Subject(s)
Basidiomycota , COVID-19 , Cryptococcosis , Cryptococcus , Fungemia , Humans , Fungemia/complications , Fungemia/diagnosis , Fungemia/microbiology , Cryptococcosis/microbiology , COVID-19/complications , SARS-CoV-2
11.
Int J Infect Dis ; 140: 110-112, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38266977

ABSTRACT

Candida krusei disseminated infection is a rare complication of protracted neutropenia. Herein, we report a case of a 31-year-old male with relapsed acute myeloid leukemia who developed Candida krusei fungemia with cutaneous, ocular, splenic, renal, bone marrow and osseous involvement leading to severe hypercalcemia, treated with parenteral antifungals followed by oral ibrexafungerp.


Subject(s)
Candidiasis , Fungemia , Hypercalcemia , Pichia , Male , Humans , Adult , Hypercalcemia/complications , Hypercalcemia/drug therapy , Candidiasis/complications , Candidiasis/diagnosis , Candidiasis/drug therapy , Antifungal Agents/therapeutic use
12.
Infect Control Hosp Epidemiol ; 45(2): 157-166, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37593953

ABSTRACT

OBJECTIVE: Studies evaluating the incidence, source, and preventability of hospital-onset bacteremia and fungemia (HOB), defined as any positive blood culture obtained after 3 calendar days of hospital admission, are lacking in low- and middle-income countries (LMICs). DESIGN, SETTING, AND PARTICIPANTS: All consecutive blood cultures performed for 6 months during 2020-2021 in 2 hospitals in India were reviewed to assess HOB and National Healthcare Safety Network (NHSN) reportable central-line-associated bloodstream infection (CLABSI) events. Medical records of a convenience sample of 300 consecutive HOB events were retrospectively reviewed to determine source and preventability. Univariate and multivariable logistic regression analyses were performed to identify factors associated with HOB preventability. RESULTS: Among 6,733 blood cultures obtained from 3,558 hospitalized patients, there were 409 and 59 unique HOB and NHSN-reportable CLABSI events, respectively. CLABSIs accounted for 59 (14%) of 409 HOB events. There was a moderate but non-significant correlation (r = 0.51; P = .070) between HOB and CLABSI rates. Among 300 reviewed HOB cases, CLABSIs were identified as source in only 38 (13%). Although 157 (52%) of all 300 HOB cases were potentially preventable, CLABSIs accounted for only 22 (14%) of these 157 preventable HOB events. In multivariable analysis, neutropenia, and sepsis as an indication for blood culture were associated with decreased odds of HOB preventability, whereas hospital stay ≥7 days and presence of a urinary catheter were associated with increased likelihood of preventability. CONCLUSIONS: HOB may have utility as a healthcare-associated infection metric in LMIC settings because it captures preventable bloodstream infections beyond NHSN-reportable CLABSIs.


Subject(s)
Bacteremia , Catheter-Related Infections , Catheterization, Central Venous , Cross Infection , Fungemia , Sepsis , Humans , Fungemia/epidemiology , Fungemia/prevention & control , Catheter-Related Infections/epidemiology , Retrospective Studies , Bacteremia/epidemiology , Bacteremia/prevention & control , Cross Infection/epidemiology , Cross Infection/prevention & control , Hospitals , Sepsis/epidemiology
15.
Curr HIV Res ; 21(4): 259-263, 2023.
Article in English | MEDLINE | ID: mdl-37877566

ABSTRACT

INTRODUCTION: Opportunistic infections caused by bacteria and fungi are common in human immunodeficiency virus (HIV)-infected patients. Cryptococcus neoformans and Pneumocystis jirovecii are the most common opportunistic infections in immunosuppressed individuals, but their coexistence is rare. To our knowledge, this is the first case presented in Turkey involving the coexistence of C.neoformans fungemia and P.jirovecii pneumonia. CASE PRESENTATION: A 26-year-old male patient presented with a cachectic appearance, cough, sputum, weakness, shortness of breath, and a weight loss of 15 kg in the last three months. It was learned that the patient was diagnosed with HIV three years ago, did not go to follow-ups, and did not use the treatments. CD4 cell count was 7/mm3 (3.4%), CD8 cell count was 100 (54%) mm3, and HIV viral load was 5670 copies/mL. In thorax computed tomography (CT), increases in opacity in diffuse ground glass density in both lungs and fibroatelectasis in lower lobes were observed. With the prediagnosis of P. jiroveci pneumonia, the HIV-infected patient was given trimethoprim-- sulfamethoxazole 15 mg/kg/day intravenously (i.v.). On the 4th day of the patient's hospitalization, mutiplex PCR-based rapid syndromic Biofire (Film Array) blood culture identification 2 (BCID2) test (Biomerieux, France) was applied for rapid identification from blood culture. C. neoformans was detected in the blood culture panel. The treatment that the patient was taking with the diagnosis of C. neoformans fungemia was started at a dose of liposomal amphotericin B 5 mg/kg/- day + fluconazole 800 mg/day. CONCLUSION: While the incidence of opportunistic infections has decreased with antiretroviral therapy (ART), it remains a problem in patients who are unaware of being infected with HIV or who fail ART or refuse treatment. High fungal burden, advanced age, low CD4+ cell count, and being underweight are risk factors for mortality in HIV-positive patients. Our case was a cachectic patient with a CD4 count of 7 cells/mm3. Despite the early and effective treatment, the course was fatal.


Subject(s)
AIDS-Related Opportunistic Infections , Fungemia , HIV Infections , Pneumonia, Pneumocystis , Male , Humans , Adult , Pneumonia, Pneumocystis/complications , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/drug therapy , HIV Infections/complications , HIV Infections/drug therapy , HIV , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Fungemia/complications , Fungemia/diagnosis , Fungemia/drug therapy , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
16.
Eur Rev Med Pharmacol Sci ; 27(16): 7437-7443, 2023 08.
Article in English | MEDLINE | ID: mdl-37667920

ABSTRACT

OBJECTIVE: Recent research has suggested that fungemia may demonstrate an epidemiologic shift in etiologic agents. This study focuses on the agents causing fungemia and antifungal resistance in a tertiary hospital. PATIENTS AND METHODS: We evaluated all-age fungemia cases admitted to Balikesir Ataturk City Hospital in 2017-2021. Blood cultures (BC) were studied using BacT/Alert® 3D (bioMérieux, Marcyl'Etoile, France) and Render BC128 System (Render Biotech Co. Ltd., Shenzhen, China). On the data, we explored only the first fungal positive samples or the first isolates in different episodes of the same patients. Upon The Clinical and Laboratory Standards Institute (CLSI) disk diffusion guidelines, conventional methods and the Phoenix™ 100 System (Becton Dickinson, Franklin Lakes, NJ, USA) were utilized for antifungal susceptibility identifications. RESULTS: The findings showed that 325 (0.84%) of 38,682 BC sets were positive for fungal growth. Except for four cases (1.2%) [Saprochaete capitata (n = 2); Trichosporon asahii (n = 1), and Saccharomyces cerevisiae (n = 1)], all positive cases yielded Candida spp. (98.8%) growth. In these patients, the following Candida spp. were isolated: Candida albicans complex (n = 155; 47.7%), Candida parapsilosis complex (n = 127; 39.1%), Candida glabrata complex (n = 19; 5.85%), Candida tropicalis (n = 12; 3.7%), Candida kefyr (n = 5; 1.54%), Candida krusei (n = 2; 0.62%), and Candida guilliermondii complex (n = 1; 0.31%). We also realized that while none of the Candida spp. had echinocandin resistance, 8 C. parapsilosis complex isolates were resistant to fluconazole, and 17 C. parapsilosis complex and 2 C. tropicalis isolates were susceptible dose-dependent to fluconazole. CONCLUSIONS: In brief, antifungal resistance is more likely to restrict therapeutic options, albeit it is, fortunately, not prevalent in Turkey despite a few recent reports. Yet, a robust detection or management of antifungal resistance requires species-level identification and strict compliance with relevant management guidelines. Besides, challenges in research may be compensated with a national data set built with data from local laboratories.


Subject(s)
Fungemia , Humans , Fungemia/drug therapy , Fungemia/epidemiology , Fluconazole/pharmacology , Antifungal Agents/pharmacology , Candida , Candida albicans
17.
Diagn Microbiol Infect Dis ; 107(4): 116077, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37742427

ABSTRACT

Premature hospitalized neonates have a greater risk for candidemia, however, fungemia due to rare opportunistic yeasts have been recently reported and is associated with high mortality rates. We herein report the first case in Latin America of Lodderomyces elongisporus fungemia in a premature neonate with a fatal outcome.


Subject(s)
Candidemia , Fungemia , Infant, Newborn, Diseases , Saccharomycetales , Infant, Newborn , Humans , Fungemia/diagnosis , Fungemia/drug therapy , Latin America , Saccharomycetales/genetics , Candidemia/drug therapy , Yeasts , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use
18.
Biomedica ; 43(Sp. 1): 32-40, 2023 08 31.
Article in English, Spanish | MEDLINE | ID: mdl-37721920

ABSTRACT

Fungemia caused by Geotrichum spp. is rare and highly lethal. The Instituto Nacional de Cancerología in Bogotá reported just two cases: one in the period 2001-2007 and the other in 2012-2018. This type of infection is more common in any kind of immunocompromised patients, so it can occur in those with hematological malignancies. Here we present the case of a 27-year-old man, diagnosed with acute lymphoblastic leukemia in relapse and admitted with polyarthralgia for five days, febrile neutropenia, nonabscessed cellulitis, and bacteremia due to methicillin-sensitive Staphylococcus aureus. The patient received therapy with oxacillin and cefepime, but the febrile neutropenia persisted. A new set of blood cultures was taken, and antifungal treatment was started because of the suspicion of invasive fungal infection. Arthroconidia were identified in blood cultures and Geotrichum spp. was confirmed using matrix-assisted laser desorption-ionization mass spectrometry. The antifungal treatment was adjusted with amphotericin B deoxycholate for 14 days and voriconazole for four weeks, and after a prolonged stay, the patient was discharged. Although the incidence of fungemia caused by Geotrichum spp. is low, it must be considered in patients with hematological malignancies and persistent febrile neutropenia despite the broadspectrum antimicrobial treatment. The confirmation of fungemia causing agents, with proteomic tools such as the mentioned mass spectrometry, allows treatment adjustment and decreases complications, hospital stay, and mortality.


La fungemia por Geotrichum spp. es poco frecuente y altamente letal. En el Instituto Nacional de Cancerología de Bogotá solo se han reportado dos casos: uno entre el 2001 y el 2007, y el otro entre el 2012 y el 2018. Este tipo de infección es más común en pacientes con algún grado de compromiso del sistema inmunitario, por lo que puede presentarse en pacientes con neoplasias hematológicas malignas. Se presenta el caso de un hombre de 27 años con recaída de leucemia linfoblástica aguda, que ingresó con poliartralgias de cinco días de duración. También cursaba con neutropenia febril, celulitis sin abscesos y bacteriemia por Staphylococcus aureus resistente a la meticilina para lo cual recibió terapia con oxacilina y cefepime. Sin embargo, persistía la neutropenia febril por lo que se sospechó una infección fúngica invasora. Se tomó un nuevo set de hemocultivos y se inició tratamiento antifúngico. En los hemocultivos se identificaron artroconidias y mediante espectrometría de masas por láser de matriz asistida de ionización-desorción se confirmó la presencia de Geotrichum spp. Se ajustó el tratamiento antifúngico con deoxicolato de anfotericina B por 14 días y voriconazol por cuatro semanas. Luego de una estancia prolongada se le dio de alta. Aunque la incidencia de la fungemia por Geotrichum spp. es baja, en pacientes con neoplasias hematológicas malignas debe considerarse en el contexto de una neutropenia febril que es persistente a pesar del tratamiento antimicrobiano de amplio espectro.


Subject(s)
Febrile Neutropenia , Fungemia , Geotrichosis , Hematologic Neoplasms , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Male , Humans , Adult , Fungemia/diagnosis , Fungemia/drug therapy , Antifungal Agents/therapeutic use , Proteomics , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Febrile Neutropenia/drug therapy
19.
Intern Med J ; 53(8): 1489-1491, 2023 08.
Article in English | MEDLINE | ID: mdl-37599232

ABSTRACT

Scedosporium and Lomentospora species are environmental moulds that are virulent in immunocompromised hosts and rarely cause bloodstream infection (BSI). Patients with Scedosporium and Lomentospora species BSI were identified by the state public laboratory service in Queensland, Australia, over a 20-year period. Twenty-two incident episodes occurred among 21 residents; one patient had a second episode 321 days following the first. Of these, 18 were Lomentospora prolificans, three were Scedosporium apiospermum complex and one was a nonspeciated Scedosporium species. Seventeen (81%) patients died during their index admission, and all-cause mortality at 30, 90 and 365 days was 73%, 82% and 91% respectively. All 20 patients with haematological malignancy died within 365 days of follow-up with a median time to death of 9 days (interquartile range, 6-20 days) following diagnoses of BSI.


Subject(s)
Fungemia , Immunocompromised Host , Leukemia , Scedosporium , Adult , Female , Humans , Male , Middle Aged , Australia/epidemiology , Fungemia/diagnosis , Fungemia/epidemiology , Fungemia/microbiology , Fungemia/mortality , Leukemia/epidemiology , Leukemia/mortality , Scedosporium/isolation & purification , Scedosporium/pathogenicity
20.
J Mycol Med ; 33(4): 101416, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37544071

ABSTRACT

Lomentospora prolificans is an opportunistic pathogen that can cause invasive lomentosporiosis in immunocompromised patients. Patients with hematological malignancies and those who have undergone stem cell or solid organ transplantations are in the highest risk group. In addition to the limitations and delays in diagnostic possibilities, L. prolificans has a high mortality due to its resistance to all available antifungal drugs. In a patient diagnosed with aplastic anemia, we described the first case of L. prolificans in Türkiye. L. prolificans was identified in the blood culture, and despite the initiation of antifungal treatments, the fungemia resulted in mortality on the 7th day of intensive care hospitalization. This case highlights the importance of early recognition and prompt initiation of appropriate antifungal therapy to improve the outcome of patients with rare mold infections.


Subject(s)
Anemia, Aplastic , Fungemia , Scedosporium , Humans , Antifungal Agents/therapeutic use , Fungemia/complications , Fungemia/diagnosis , Fungemia/drug therapy , Anemia, Aplastic/complications , Anemia, Aplastic/drug therapy , Immunocompromised Host
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