Search

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., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Saprochaete capitata , formerly known as Geotrichum capitatum , is an emerging fungal pathogen with low susceptibility to echinocandins. Here, we report the nucleotide sequence of the S. capitata hot spot 1 region of the FKS gene ( FKS HS1), which codifies for the catalytic subunit of β-1,3-d-glucan synthase, the target of echinocandins. For that purpose, we first designed degenerated oligonucleotide primers derived from conserved flanking regions of the FKS1 HS1 segment of 12 different fungal species. Interestingly, analysis of the translated FKS HS1 sequences of 12 isolates of S. capitata revealed that all of them exhibited the same F-to-L substitution in a position that is highly related to reduced echinocandin susceptibility., (Copyright © 2018 American Society for Microbiology.)

Saprochaete and Geotrichum spp. are rare emerging fungi causing invasive fungal diseases in immunosuppressed patients and scarce evidence is available for treatment decisions. Among 505 cases of rare IFD from the FungiScope ™ registry, we identified 23 cases of invasive infections caused by these fungi reported from 10 countries over a 12-year period. All cases were adults and previous chemotherapy with associated neutropenia was the most common co-morbidity. Fungaemia was confirmed in 14 (61%) cases and deep organ involvement included lungs, liver, spleen, central nervous system and kidneys. Fungi were S. capitata (n=14), S. clavata (n=5), G. candidum (n=2) and Geotrichum spp. (n=2). Susceptibility was tested in 16 (70%) isolates. All S. capitata and S. clavata isolates with the exception of one S. capitata (MIC 4 mg/L) isolate had MICs>32 mg/L for caspofungin. For micafungin and anidulafungin, MICs varied between 0.25 and >32 mg/L. One case was diagnosed postmortem, 22 patients received targeted treatment, with voriconazole as the most frequent first line drug. Overall mortality was 65% (n=15). Initial echinocandin treatment was associated with worse outcome at day 30 when compared to treatment with other antifungals (amphotericin B ± flucytosine, voriconazole, fluconazole and itraconazole) (P=.036). Echinocandins are not an option for these infections., (© 2017 Blackwell Verlag GmbH.)

Magnusiomyces capitatus may cause uncommon yet severe infections, especially in patients with haematologic disorders. Diagnosis may be difficult and time-consuming and newer approaches are required including the MALDI-TOF technique implemented with the detection of fungal antigens in the body fluids. The recommended treatment includes amphotericin B alone or in combination with flucytosine. We describe a case of a non-neutropenic patient with M. capitatus pleural infection, as identified by MALDI-TOF, positivity for galactomannan antigen in the BAL fluid, and successfully treated with oral posaconazole in single therapy.

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., (© 2016 Blackwell Verlag GmbH.)

Empirical antifungal therapy is most often given to patients with leukemia. However breakthrough fungal infections under antifungal therapy are not uncommon. Four children, with hematologic malignant disease developed mycotic breakthrough infections while on empirical caspofungin treatment for a median of 14 (range 11-19) days. Trichosporon asahii was detected in the blood culture of two patients and Geotrichum capitatum in the other two (one patient also had positive cerebrospinal fluid culture). Because the patients' clinical situation worsened, voriconazole was empirically added for two patients three and five days before the agent was detected. The first sterile blood culture was obtained 3-7 days of voriconazole treatment. All patients reached clear cultures but one patient died. One patient with central nervous system infection with G. capitatum had severe neurological sequelae. Very severe fungal infections can occur during empirical caspofungin therapy. Therefore, patients should be followed closely., (Copyright © 2015 Elsevier Editora Ltda. All rights reserved.)

Pulmonary geotrichosis is a rare mycosis caused by an arthrospore filamentous fungi of the genus Geotrichum. It is an opportunistic infection that develops when underlying conditions are present, particularly immunosuppression including neutropenia. Pulmonary mycoses in non-neutropenic patients affect two main populations: the solid organ transplanted patients and patients whose local pulmonary defenses are altered by a chronic underlying lung pathology. We report a case of pulmonary infection Geotrichum capitatum in an old tuberculosis patient., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Invasive Geotrichum clavatum fungal infections are extremely rare and unusual, occurring nearly exclusively in patients experiencing prolonged neutropenia during the treatment for acute myeloid leukaemia. Several groups of cases of fatal G. clavatum infection were reported in France between 2011 and 2012, but the ecological niche has not yet been identified. We report a case of a 32-year-old patient with acute myeloid leukaemia who developed G. clavatum sepsis with primary peritonitis, hepatic nodular lesions, and multivisceral failure during aplasia after induction followed by salvage chemotherapy. He was treated with voriconazole and is still alive 1 year after with controlled disease. We then discuss the epidemiological, clinical, and therapeutic features of these serious fungal infections compared to the published data.

Geotrichum spp. are ubiquitous, saprotrophic fungi found in soil, organic matter, and silage, as a contaminant in food products and in the digestive tracts of mammals. The current study reports a case of Geotrichum candidum infection with dermatitis in an aborted bovine fetus with skin and lung lesions. A 6-month-old aborted male Holstein Friesian fetus displayed unusual lesions on the skin of the abdomen, thorax, and head, which was excessively thickened and wrinkled. These changes corresponded to orthokeratotic hyperkeratosis, neutrophil accumulation in the stratum corneum, a pyogranulomatous inflammatory infiltrate, and superficial dermal necrosis. Moderate suppurative multifocal pneumonia was observed. Large numbers of mononuclear cells and occasional fibrin thrombi within blood vessels were found in the lungs, brain, and cerebellum. Gridley staining revealed fungal structures within the skin lesions. The mycological exam demonstrated the growth of G. candidum, and phase contrast microscopy conducted on the abomasal fluid revealed hyphae compatible with this agent. The skin lesions observed, in association with the fungus isolated, indicated that the abortion was due to G. candidum infection of the bovine fetus.

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.

Unlabelled: Fungemia is classically caused by a single species and the detection of more than one species in blood samples is uncommon. We report four cases of mixed fungemia (MF) diagnosed in the parasitology-mycology laboratory of Farhat-Hached hospital in Sousse, Tunisia. The MF episodes occurred in two neonates and two adults suffering from acute myeloid leukemia. Two fungal species were detected concomitantly within the same blood culture in all cases. Species combination was detected by the subculture of the blood culture on Candida ID(®) chromogenic medium in three cases and on Sabouraud agar in one case. Predisposing factors were: indwelling catheters (4/4), broad-spectrum antibiotics (3/4), neutropenia (2/4), exclusive parenteral nutrition (2/4) and Candida colonization (1/4). Patients presented febrile sepsis with no response to broad-spectrum antibiotic therapy in all cases. Outcome under antifungal treatment was favorable in two cases and the two other patients died., Conclusion: MF appears similar to the more common monomicrobial fungemia. The use of chromogenic media in routine can improve the detection of MF episodes allowing appropriate antifungal therapy., (Copyright © 2012. Published by Elsevier SAS.)

Geotrichum candidum was cultured from the tonsils of a free-ranging weaner pig that was presented with lethargy and inappetence. Histopathology indicated pyogranulomatous tonsillitis with intralesional fungal hyphae and arthrospores. Geotrichosis is a rare, opportunistic mycosis of immunocompromised hosts, usually human beings.

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.

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.

We describe a woman with relapsed acute myelogenous leukemia after allogeneic stem cell transplantation who developed disseminated Geotrichum candidum infection during chemotherapy-induced neutropenia. The isolate was susceptible to voriconazole, amphotericin B, and micafungin in vitro. We review the literature regarding invasive infections with G. candidum, which predominantly affect immunocompromised hosts, and discuss potential therapies for this rare pathogen.

Blastoschizomyces capitatus is an emerging opportunistic pathogen that may lead to invasive infections particularly in neutropenic patients. In this study, the in vitro activities of fluconazole, itraconazole and voriconazole against 15 clinical B. copitatus isolates were determined by microdilution method (MD) and Etest. The isolation and identification of the isolates were done by standard mycological methods. MD tests were done in accordance with CLSI microdilution method (M27A-2). Etest was performed according to the instructions of the manufacturer (AB Biodisk, Sweden) by using RPMI-2% glucose. Since susceptibility breakpoints were not yet established for B. copitatus, only the distribution of the MIC values obtained for the tested antifungals were given. MIC values were determined after 48 h incubation and by using MIC-2 value for all the drugs tested. At 48 h, MIC90 values obtained by MD and Etest were 16 and 32 microg/ml, 0.5 and 1 microg/ml, 0.5 and 1 microg/ml for fluconazole, itraconazole and voriconazole, respectively. These results suggested that voriconazole and itraconazole had favorable activity against B. capitatus isolates. However, the activity of fluconazole remained poor and limited at least for a significant number of isolates. Percent agreement of Etest with MD method within +/-1 dilution range and at 48 hour for fluconazole, itraconazole and voriconazole were 86.7%, 80% and 73.3%, respectively, suggesting a higher agreement of the two methods for fluconazole as compared to itraconazole and voriconazole. Etest tended to generate 1-2 fold higher MICs as compared to MD MICs for most of the isolates of this particular fungus. In conclusion, further studies are required for determination of the optimal susceptibility testing method and the MIC breakpoints for B. capitatus.

Infections by Geotrichum capitatum, occurring in leukemia patients, are rarely reported and generally are characterized by a poor prognosis. Here we reported a case of G. capitatum pneumonia in a patient with plasma cell leukemia, successfully treated with antifungal combination with voriconazole and caspofungin and supportive therapy.

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.

Blastoschizomyces capitatus is an emerging pathogenic fungus that can cause deep invasive diseases in neutropenic patients. We developed a model of disseminated blastoschizomycosis in immunosuppressed mice to evaluate the effectiveness of amphotericin B, flucytosine, fluconazole and voriconazole. High-dose fluconazole was the most effective drug at prolonging the survival of mice and at reducing fungal burden in the kidneys, spleen and liver.

We report three cases of invasive Geotrichum capitatum infection in patients with acute leukemia for which an enzyme-linked immunosorbent assay (ELISA) for Aspergillus galactomannan was positive, with no evidence of aspergillosis. Supernatants obtained from suspensions of 17 G. capitatum strains gave positive reactions with the Aspergillus galactomannan ELISA. These clinical and laboratory data seem to suggest that G. capitatum produces a soluble antigen that is cross-reactive with Aspergillus galactomannan.

Purpose: To describe a previously unreported case of polymicrobial mycotic keratitis caused by an association between Candida lusitaniae, C. parapsilosis, and Geotrichum candidum., Methods: A three-year-old child with an antecedent trauma with vegetable matter and a prolonged use of corticosteroid eyedrops developed fungal keratitis., Results: The isolates of the corneal scraping using Sabaraud dextrose agar grew C. lusitaniae, C. parapsilosis, and G. candidum. After topical 0.2% and systemic fluconazole treatment, the corneal lesion resolved with no recurrence., Conclusions: Corneal trauma with vegetables and the indiscriminate use of corticosteroids are important risk factors for mycotic keratitis. A combination of topical 0.2% and systemic fluconazole therapy was effective in the treatment of this mycotic association. This is the first report of fungal keratitis caused by C. lusitaniae and G. candidum.

The aim of this study was to evaluate the distributions of yeast species according to the years and to detect the emerging pathogens in intensive care units (ICU). For this purpose, yeast isolation rates were detected retrospectively, in the following time periods: Period I: April-December 2001; period II: January-December 2002; period III: January-December 2003; period IV: January-December 2004. A total of 490 yeast isolates recovered from 462 clinical specimens obtained from 360 different ICU patients were investigated during these periods. Urine (62.1%), blood (13.6%) and tracheal aspirate (8.7%) samples were detected as the most common specimens. Of these isolates, 53.3% were identified as Candida albicans, 14.5% as C. tropicalis, 12.2% as C. glabrata, 6.5% as C. parapsilosis, 4.5% as Trichosporon spp., 3.9% as C. kefyr, 1.6% as C. krusei, 1.4% as Geotrichum candidum and 2.1% as other Candida species. The isolation rates of C. albicans in the periods of I to IV were found as 47.7%, 55.5%, 41.7% and 62.4%, respectively. The decrease between the second and third periods, and increase between third and fourth periods were statistically significant (chi2 = 4.15, p = 0.04 and chi2 = 8.32, p = 0.004). C. glabrata was the second most common species in the first and second periods (14.8% and 15.5%, respectively), followed by C. tropicalis (12.5% and 10.0%, respectively), however this array has changed in the third and fourth periods (C. tropicalis was the second with the rates of 16.7% and 16.8%, while C. glabrata placed in the third line with the rates of 14.8% and 7.6%, respectively). It was concluded that C. albicans has still been the most frequent species among yeast isolates of ICU's in our hospital; however, the incidence of non-albicans species like C. glabrata and C. tropicalis has increased.

Trichosporonosis is an uncommon but frequently fatal mycosis in immunocompromised patients. A multicenter retrospective study was conducted to characterize cases of proven or probable invasive trichosporonosis diagnosed over the past 20 years in Italian patients with hematological diseases. Of the 52 cases identified, 17 were classified as Trichosporon sp. infections and 35 were attributed to Geotrichum capitatum. Acute myeloid leukemia accounted for 65.4% of the cases. The incidence rates of Trichosporon sp. and G. capitatum infections in acute leukemia patients were 0.4 and 0.5%, respectively. Overall, 76.9% of cases had positive blood cultures. Pulmonary involvement was documented in 26.9% of cases. Death was reported for 57.1% of G. capitatum infections and for 64.7% of Trichosporon sp. infections. A literature review on trichosporonosis in patients with any underlying disease or condition reveals G. capitatum as a predominantly European pathogen, particularly in certain Mediterranean areas, while Trichosporon sp. infections are seen with similar frequencies on all continents. The majority of published Trichosporon sp. and G. capitatum infections occurred in patients with hematological diseases (62.8 and 91.7%, respectively). Well over half of these were suffering from acute leukemia (68 and 84% of patients with Trichosporon sp. and G. capitatum infections, respectively). Crude mortality rates were 77% for Trichosporon spp. and 55.7% for G. capitatum. The optimal therapy for trichosporonosis has yet to be identified; however, in vitro experiences are providing encouraging evidence of the potential role of the new triazoles, in particular, voriconazole.

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.

Fungal colonization was observed in the duodenal biopsy specimens of a nine-year-old girl who complained of anorexia and epigastric pain. Endoscopy revealed gastric redness and Geotrichum candidum was identified in the duodenum by histopathology and tissue culture. Immunologic work-up showed low serum levels of IgA and IgM. She was treated with ranitidine and antacids for gastritis. At follow-up, the levels of immunoglobulins had normalized, no fungal elements were detected, and clinical symptoms had disappeared. Duodenal invasion by G. candidum has not been described so far. Duodenal colonization by G. candidum may occur when mucosal immunity is disturbed and may be the source of dissemination in severe immunodeficiency states.

Geotrichosis affects mainly patients with systemic diseases like diabetes mellitus, leukoses, neoplasms etc. Clinically, it is similar to candidiasis and may occur as an oral, vaginal, skin, or systemic infection. Clinical specimens (98 sputa and 67 oral smears) were collected and studied using microscopic examination of Gram stained preparations and culture sampling between 1995 and 1997. Geotrichum candidum was isolated as a single pathogen in 8 sputum and 7 oral smear samples. Ten-day antifungal treatment with Nizoral was applied and resulted in relatively quick clinical improvement. The presented cases are the first cases of pulmonary and oral infections reported in our home practice in which Geotrichum candidum species was identified as a pathogen. The identification of Geotrichum candidum using combination of colonial and microscopic morphologic features increase the possibilities for diagnostic decision.

A case of active pulmonary secondary tuberculosis associated with bronchial tuberculosis and bronchial geotrichosis is presented. This association is infrequent. Favoring factors: local and general immunodepression (recurrent infection with pyogenic germs, rubella, neutropenia, aggressive antibiotherapy, iron deficiency). The diagnosis was based mainly on the bacteriological sputum examination for bK (smear and culture) and the mycologic examination (smear and culture) of the bronchial aspiration, identifying Geotrichum candidum. The treatment consisted of antituberculous and antimycotic drugs, bronchodilators, bronchial aspirations and local endoscopic administration of antimycotic drugs.

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.

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.

In three flamingos (Phoenicopterus ruber), which died showing extensive necrotic inflammation of the skin of the webs and the legs, the presence of abundant mycelium and arthrospores was shown in the altered dermis and epidermis. From all the lesions Geotrichum Candidum was isolated in pure culture. Inoculation of suspensions of the fungus into domestic chickens and mice produced granulomas or more purulent nodules with central growth of abundant mycelium. From 20 of 28 experimental animals, G. candidum was reisolated from the lesions in pure culture 2 weeks after the inoculation. It is suggested that alteration of the skin by e.g., prolonged contact with pondwater, the presence of small wounds and the advanced age of the birds, acting as predisposing factors may be necessary in establishing this disease.

Necrotizing mycotic dermatitis was diagnosed in 6 snakes. Cutaneous lesions involved ventral and lateral scales. Each clinical diagnosis was confirmed by fungal culture and light microscopic evaluation of biopsied scales. The differential clinical considerations included contact dermatitis and bacterial dermatitis.

Among the clinical isolates hitherto identified as Geotrichum capitatum, two groups were defined from DNA-DNA reassociation experiments. This confirms the existence of two closely related, human-pathogenic Geotrichum species, namely, G. capitatum and G. clavatum. A third group of strains from cactus rots, though morphologically identical to G. capitatum, has a lower moles percent G + C of DNA. The three groups can be recognized by a combination of morphological and physiological characters.

A 37-year-old patient with acute nonlymphatic leukemia developed gastrointestinal phycomycosis during failure in bone marrow production. The clinical presentation was of acute typhlitis. Laparotomy revealed a necrotic mass in the region of the iliocecal valve, and on histologic examination hyphae of phycomycetes with invasion of the blood vessels were seen. The patient died as a result of widespread infection.