RESUMEN
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.
Asunto(s)
Dipodascus/aislamiento & purificación , Fungemia/cirugía , Leucemia Mieloide Aguda/microbiología , Antifúngicos/uso terapéutico , Drenaje/métodos , Fungemia/tratamiento farmacológico , Fungemia/patología , Humanos , Masculino , Pleuresia/microbiología , Pleuresia/patología , Esplenectomía/métodos , Enfermedades del Bazo/microbiología , Enfermedades del Bazo/patología , Enfermedades del Bazo/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
We describe our experience managing a case of fungal keratitis in a 71-year-old immunocompetent woman. Intracameral cultures isolated Magnusiomyces capitatus, a dimorphic commensal microbe with limited pathogenicity, in an immune competent patient. Repeated corneal cultures for bacteria and fungus were negative. Initial broad-spectrum topical fortified antibiotics were eventually escalated to include topical natamycin and voriconazole and oral voriconazole. The patient underwent emergent corneal transplantation, but recurrent infection eventually required anterior chamber washout and intracameral injection of amphotericin B. A combination of topical, systemic, intracameral administration of voriconazole, intracameral administration of amphotericin B, anterior chamber washout, and penetrating keratoplasty were required to clear the infection.
Asunto(s)
Dipodascus/aislamiento & purificación , Infecciones Fúngicas del Ojo/microbiología , Queratitis/microbiología , Anciano , Antifúngicos/uso terapéutico , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Femenino , Humanos , Huésped Inmunocomprometido , Queratitis/diagnóstico , Queratitis/tratamiento farmacológicoRESUMEN
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.
Asunto(s)
Humanos , Masculino , Adulto Joven , Leucemia Mieloide Aguda/microbiología , Fungemia/cirugía , Dipodascus/aislamiento & purificación , Pleuresia/microbiología , Pleuresia/patología , Esplenectomía/métodos , Enfermedades del Bazo/cirugía , Enfermedades del Bazo/microbiología , Enfermedades del Bazo/patología , Drenaje/métodos , Resultado del Tratamiento , Fungemia/patología , Fungemia/tratamiento farmacológico , Antifúngicos/uso terapéuticoRESUMEN
In August 2015, Dipodascus capitatus was isolated from two patients admitted to the neonatal intensive care unit. Nosocomial acquisition of the fungus was suspected and epidemiological studies were undertaken. The patients were simultaneously hospitalized, and the comparison of the two isolates by two independent molecular typing methods have confirmed clonal dissemination of a single strain of D. capitatus. Antimicrobial susceptibility testing was useful for identifying the appropriated antifungal therapy in micafungin. To our knowledge these are the first described cases of neonatal D. capitatus infection and also the first report of successful treatment by micafungin.
Asunto(s)
Infección Hospitalaria/microbiología , Dipodascus/efectos de los fármacos , Dipodascus/aislamiento & purificación , Micosis/microbiología , Dipodascus/genética , Dipodascus/inmunología , Femenino , Genotipo , Hospitales/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Masculino , SiciliaRESUMEN
We describe a 33-year-old man with relapsed acute myelogenous leukemia who developed subcutaneous nodules >6 months after allogeneic hematopoietic stem cell transplant. These nodules were caused by Blastoschizomyces capitatus. The lesions progressed after treatment with a posaconazole suspension. The lesions resolved after switching to voriconazole, which was given for 21 weeks. B. capitatus is a rare infection affecting immunocompromised patients, which responds to azoles.
Asunto(s)
Antifúngicos/uso terapéutico , Dermatomicosis/tratamiento farmacológico , Dipodascus/aislamiento & purificación , Trasplante de Células Madre Hematopoyéticas , Leucemia Mieloide Aguda/terapia , Infecciones Oportunistas/tratamiento farmacológico , Voriconazol/uso terapéutico , Adulto , Dermatomicosis/complicaciones , Dermatomicosis/diagnóstico , Humanos , Leucemia Mieloide Aguda/complicaciones , Masculino , Infecciones Oportunistas/complicaciones , Infecciones Oportunistas/diagnósticoRESUMEN
BACKGROUND: Saprochaete capitata (formerly known as Geotrichum capitatum and Blastoschizomyces capitatus) is a ubiquitous fungus found in soil, water, air, plants and dairy products. It colonizes the skin, and bronchial and intestinal tract of healthy people producing serious opportunistic infections in patients with haematological malignancies, especially in those with acute leukaemia. Since 1960s its presence is being increasingly recognized in this group of patients. The clinical spectrum of S. capitata disseminated infections is very similar to that produced by Candida, being easily misinterpreted. The associated high mortality and low susceptibility to fluconazole and echinocandins of S. capitata require the acknowledgement of this emergent infection so that it can be properly treated. CASE REPORT: We report 5 new cases of S. capitata disseminated infection in patients with advanced haematological malignancies observed in the haematology unit between the years 2004 and 2010, and review the state-of-the-art for diagnosis and treatment of this infection. CONCLUSIONS: Based on our experience, the prophylactic use of or the empirical antifungal treatment with fluconazole and/or echinocandins would not be adequate for oncohaematological patients in those hospitals where S. capitata infection may be highly prevalent.
Asunto(s)
Antifúngicos/uso terapéutico , Infección Hospitalaria/microbiología , Dipodascus/aislamiento & purificación , Fungemia/microbiología , Leucemia/complicaciones , Infecciones Oportunistas/microbiología , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Linfoma de Burkitt/complicaciones , Linfoma de Burkitt/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/microbiología , Infección Hospitalaria/tratamiento farmacológico , Dipodascus/efectos de los fármacos , Farmacorresistencia Fúngica , Quimioterapia Combinada , Resultado Fatal , Neutropenia Febril/inducido químicamente , Femenino , Fungemia/tratamiento farmacológico , Humanos , Huésped Inmunocomprometido , Leucemia/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/tratamiento farmacológicoAsunto(s)
Micosis/microbiología , Animales , Dipodascus/aislamiento & purificación , Dipodascus/patogenicidad , Humanos , Malassezia/aislamiento & purificación , Malassezia/patogenicidad , Micosis/diagnóstico , Micosis/tratamiento farmacológico , Rhodotorula/aislamiento & purificación , Rhodotorula/patogenicidad , Saccharomyces cerevisiae/aislamiento & purificación , Saccharomyces cerevisiae/patogenicidadRESUMEN
BACKGROUND: The significant increase in systemic fungal infections is mainly due to the increase in immunocompromised patients. The high morbimortality of these infections, along with the high hospitalization costs they generate, makes them a problem of great importance in our hospital practice. Saprochaete capitata is a rare fungus that causes invasive infections, usually in immunocompromised patients, and for which there is still no consensus on the treatment regimen to be used. CASE REPORT: We present a case of disseminated infection by this fungus in a heavily immunosuppressed patient, who died as a result of multiple organ failure despite the life support measures taken and the wide spectrum antibiotics. CONCLUSIONS: It is vital to begin the antibiotic treatment as soon as possible, as well as the monitoring and follow-up cultures to test for fungi in neutropenic patients.
Asunto(s)
Antifúngicos/uso terapéutico , Dipodascus/aislamiento & purificación , Fungemia/microbiología , Insuficiencia Multiorgánica/etiología , Adulto , Antiinfecciosos/uso terapéutico , Bacteriemia/microbiología , Infecciones por Citomegalovirus/complicaciones , Diagnóstico Diferencial , Dipodascus/efectos de los fármacos , Quimioterapia Combinada , Esofagitis/virología , Resultado Fatal , Femenino , Fungemia/tratamiento farmacológico , Fungemia/etiología , Herpes Zóster/diagnóstico , Humanos , Huésped Inmunocomprometido , Infecciones por Klebsiella/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Pruebas de Sensibilidad Microbiana , Neutropenia/complicacionesRESUMEN
The infections caused by Dipodascus capitatus are rare, and the treatment is difficult. We reported a case of a patient with acute myeloid leukemia. The fungus was first isolated from hemocultures, and the phenotypic identification was based on mycological methods. The genotyping was carried out by sequencing the region D1/D2 from 26 rDNA. The susceptibility tests were assayed by Etest® and by the microdilution technique. None of the antifungal treatments employed were effective. The patient died on day 17 after the mycological diagnosis. The authors discussed the emergence of such infections as well as the difficulty regarding the diagnosis and treatment.
Asunto(s)
Dipodascus/aislamiento & purificación , Leucemia Mieloide Aguda/microbiología , Micosis/microbiología , Adolescente , ADN de Hongos/análisis , ADN Ribosómico/análisis , Dipodascus/genética , Resultado Fatal , Femenino , Genotipo , Humanos , Pruebas de Sensibilidad MicrobianaRESUMEN
As infecções causadas por Dipodascus capitatus são raras e de difícil tratamento. Aqui se relata um caso em paciente com leucemia mielocítica aguda. O isolamento fúngico ocorreu a partir de hemocultura e a identificação fenotípica baseou-se em métodos micológicos clássicos; a identificação genotípica foi realizada através do sequenciamento da região D1/D2 do 26 rDNA. Os testes de suscetibilidade foram realizados através do Etest® e microdiluição em caldo. A antifungicoterapia foi ineficaz, registrando-se óbito da paciente no 17° dia após o diagnóstico. Os autores comparam o caso com relatos similares e discutem a emergência destas infecções bem como suas dificuldades diagnósticas e terapêuticas.
The infections caused by Dipodascus capitatus are rare, and the treatment is difficult. We reported a case of a patient with acute myeloid leukemia. The fungus was first isolated from hemocultures, and the phenotypic identification was based on mycological methods. The genotyping was carried out by sequencing the region D1/D2 from 26 rDNA. The susceptibility tests were assayed by Etest® and by the microdilution technique. None of the antifungal treatments employed were effective. The patient died on day 17 after the mycological diagnosis. The authors discussed the emergence of such infections as well as the difficulty regarding the diagnosis and treatment.
Asunto(s)
Adolescente , Femenino , Humanos , Dipodascus/aislamiento & purificación , Leucemia Mieloide Aguda/microbiología , Micosis/microbiología , ADN de Hongos/análisis , ADN Ribosómico/análisis , Dipodascus/genética , Resultado Fatal , Genotipo , Pruebas de Sensibilidad MicrobianaRESUMEN
In July 2002, Blastoschizomyces capitatus was isolated from four neutropenic patients in a haematology unit. Two patients died due to disseminated infection while the other two had oropharyngeal colonisation. Nosocomial acquisition of the fungus was suspected and epidemiological and environmental studies were undertaken. To determine the potential source for the acquisition of the fungus, epidemiological relationships between the patients were investigated. We performed surveillance cultures on all patients and took environmental cultures of air, inanimate surfaces, food samples, blood products and chemotherapy drugs. No direct contact transmission between patients was found and B. capitatus was isolated only in vacuum flasks used for breakfast milk distribution. All isolates were compared by four independent molecular typing methods: pulsed-field gel electrophoresis, genomic DNA restriction endonuclease analysis, randomly amplified polymorphic DNA, and polymerase chain reaction fingerprinting using a single primer specific for one minisatellite or two microsatellite DNAs. Milk vacuum flasks and clinical strains were genetically indistinguishable by all typing techniques. Milk vacuum flasks were withdrawn from all hospital units and no further B. capitatus infection was detected. Our findings suggest that clonal dissemination of a single strain of B. capitatus from vacuum flasks used for milk distribution was responsible for this nosocomial outbreak in the haematological unit.
Asunto(s)
Infección Hospitalaria/epidemiología , Dipodascus/aislamiento & purificación , Brotes de Enfermedades , Enfermedades Transmitidas por los Alimentos/epidemiología , Leche/microbiología , Micosis/epidemiología , Animales , Infección Hospitalaria/microbiología , Dermatoglifia del ADN , ADN de Hongos/genética , Dipodascus/clasificación , Dipodascus/genética , Electroforesis en Gel de Campo Pulsado , Enfermedades Transmitidas por los Alimentos/microbiología , Genotipo , Hospitales , Humanos , Repeticiones de Microsatélite , Técnicas de Tipificación Micológica/métodos , Polimorfismo de Longitud del Fragmento de Restricción , Técnica del ADN Polimorfo Amplificado AleatorioAsunto(s)
Dipodascus/aislamiento & purificación , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/microbiología , Neumonía/diagnóstico , Neumonía/microbiología , Técnicas Bacteriológicas , Humanos , Masculino , Microscopía , Persona de Mediana Edad , Esputo/microbiologíaAsunto(s)
Discitis/inmunología , Síndrome Inflamatorio de Reconstitución Inmune/microbiología , Trasplante de Células Madre/efectos adversos , Dipodascus/aislamiento & purificación , Discitis/microbiología , Humanos , Síndrome Inflamatorio de Reconstitución Inmune/inmunología , Síndrome Inflamatorio de Reconstitución Inmune/terapia , Masculino , Persona de Mediana EdadAsunto(s)
Anfotericina B/administración & dosificación , Antifúngicos/administración & dosificación , Dipodascus/aislamiento & purificación , Leucemia Mieloide Aguda/complicaciones , Micosis/diagnóstico , Micosis/microbiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Adulto , Dipodascus/efectos de los fármacos , Femenino , Humanos , Hígado/patología , Persona de Mediana Edad , Micosis/tratamiento farmacológico , Vena Porta/patología , Radiografía Abdominal , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Infección Hospitalaria/epidemiología , Dipodascus/aislamiento & purificación , Brotes de Enfermedades , Fungemia/epidemiología , Geotricosis/epidemiología , Geotrichum/aislamiento & purificación , Hematología , Unidades Hospitalarias , Leche/microbiología , Adulto , Anciano , Animales , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Infección Hospitalaria/microbiología , Infección Hospitalaria/transmisión , Contaminación de Equipos , Femenino , Servicio de Alimentación en Hospital , Fungemia/microbiología , Geotricosis/microbiología , Geotricosis/transmisión , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/tratamiento farmacológico , Humanos , Huésped Inmunocomprometido , Masculino , España/epidemiologíaRESUMEN
The study includes a case report and a literature review. The main objective of this study is to present a case of spondylodiscitis due to a fungal pathogen, Blastoschizomyces capitatus and to review the published literature on this emergent fungus in etiology of spondylodiscitis, and osteomyelitis. Osteoarticular involvement due to B. capitatus has been reported in six cases, and vertebral involvement has been seen in five of them. All of these cases had underlying malignancy. Infection is usually advanced at presentation. Case notes and online databases were reviewed. Organism was isolated from bone material in all of the cases and antibiotic treatment by antifungal agents cured the infection. We present another case of infectious spondylodiscitis due to B. capitaus, which is reported first in Turkey and tried to attract attendance to this emergent fungal pathogen as an etiologic agent of spine infections in cancer patients.
Asunto(s)
Dipodascus/patogenicidad , Discitis/microbiología , Vértebras Lumbares/microbiología , Anciano , Anfotericina B/farmacología , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Dipodascus/efectos de los fármacos , Dipodascus/aislamiento & purificación , Fluconazol/farmacología , Humanos , Itraconazol/farmacología , Cetoconazol/farmacología , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/patología , Vértebras Lumbares/cirugía , Masculino , Pruebas de Sensibilidad Microbiana , Naftalenos/farmacología , Infecciones Oportunistas/tratamiento farmacológico , Radiografía , Terbinafina , Resultado del TratamientoRESUMEN
This single-center observational prospective study evaluated the performance of (1-->3)-beta-D-glucan as an adjunct diagnostic tool in 12 patients with proven invasive fungal disease with different risk factors. The infections were due to either uncommon fungal pathogens such as dematiaceous molds (Scedosporium apiospermum, Alternaria infectoria, and Cladosporium macrocarpum) and hyaline septate molds (Fusarium solani and Blastoschizomyces capitatus) or Aspergillus spp. with unusual clinical presentations.
Asunto(s)
Micosis/diagnóstico , beta-Glucanos/sangre , Anciano , Alternaria/aislamiento & purificación , Aspergillus/aislamiento & purificación , Preescolar , Cladosporium/aislamiento & purificación , Dipodascus/aislamiento & purificación , Femenino , Fusarium/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Proteoglicanos , Scedosporium/aislamiento & purificaciónRESUMEN
A 37-year-old woman, during her second remission of acute myeloid leukemia, presented with severe neck pain and cervico-brachial neuralgia. Investigation revealed a C5-C6 spondylodiscitis. A CT-guided anterior biopsy decompressed the mass, immediately alleviated the symptoms, and isolated a rare yeast: Blastoschizomyces capitatus. To our knowledge, only three cases of spondylodiscitis with this yeast have been described. Six months of voriconazole and liposomal amphotericin B treatment produced a complete resolution on CT and MRI imaging. However, the ongoing severe yeast infection prevented the planned bone marrow allograft.