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Yanyan Jiang,1 Zhengzheng Chen,1 Huoyang Lv,2 Lihua Jiang,1 Zhiyuan Fan3 1Medical Laboratory Center, Tongxiang First People’s Hospital, Jiaxing, Zhejiang, People’s Republic of China; 2Medical Laboratory Center, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Emergency Medicine, Tongxiang First People’s Hospital, Jiaxing, Zhejiang, People’s Republic of ChinaCorrespondence: Zhiyuan Fan, Department of Emergency Medicine, Tongxiang First People’s Hospital, Jiaxing, Zhejiang, People’s Republic of China, Email fanzhiyuan19880916@126.comBackground: Magnusiomyces capitatus (M. capitatus) is a dimorphic opportunistic fungus that is a rare yeast and rarely reported in Asia. Owing to the absence of established clinical breakpoints, the treatment of this fungus poses challenges.Case Presentation: We report a rare case of a young, non-immunocompromised man with cerebral palsy, spinal deformity, and pulmonary M. capitatus infection. The patient’s condition improved after treatment with voriconazole and became stable.Conclusion: M. capitatus infection is commonly associated with hematologic tumors and compromised immunity. Reports of M. capitatus infection in patients with non-immunocompromised host are uncommon. Insufficient understanding of these fungi may lead to underdiagnosis of fungal infection and clinical misdiagnosis, potentially resulting in delayed treatment and increased mortality.Keywords: invasive fungal infection, Magnusiomyces capitatus, MALDI-TOF MS, ITS, cerebral palsy, spinal deformity

Magnusiomyces capitatus is an uncommon opportunistic fungal pathogen primarily affecting immunocompromised individuals. While rare, cases have been reported in immunocompetent patients. We present a documented case of Magnusiomyces capitatus invasive infection in an immunocompetent patient with no previous medical history. This case shows that invasive fungal infections by Magnusiomyces capitatus might affect even the immunocompetent patients.

Magnusiomyces capitatus (M. capitatus) is an emerging opportunistic yeast, rarely found as a causal agent of invasive fungal infection. In this study, we report a 31-year-old man infected with M. capitatus in the oral cavity, with a history of heroin and amphetamine abuse. M. capitatus was isolated through culture and microscopic analysis and identified by PCR amplification of the ITS DNA region. Based on the in vitro antifungal susceptibility test, the lowest MICs for M. capitatus were recorded for nystatin, itraconazole, and amphotericin, while higher MICs were observed for caspofungin and fluconazole. Treatment with nystatin successfully eliminated M. capitatus and relieved the clinical symptoms. This study presents the first case of M. capitatus in a patient with substance use disorder, manifesting as a plaque-like ulcer in the oral cavity. [ABSTRACT FROM AUTHOR]

Magnusiomyces capitatus (M. capitatus) is an emerging opportunistic yeast in the Mediterranean region typically isolated from immunocompromised patients, usually affected by blood malignancies. We reported a rare case of M. capitatus infection, isolated from a drainage fluid in a patient affected by lung cancer recovered in the University Hospital of Campania “Luigi Vanvitelli”, Naples, Italy. The isolate was identified by phenotypic methods, i.e., Gram and Lactophenol cotton blue (LCB) staining, and matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) analysis. We identified M. capitatus on the third day from Sabouraud Dextrose Agar supplemented with chloramphenicol and gentamicin. Antifungal susceptibility test revealed that 5-fluorocytosine was the most active drug against M. capitatus, followed by itraconazole and voriconazole, micafungin, amphotericin B and fluconazole, posaconazole, anidulafungin, and caspofungin. Our data showed the importance of an early cultural and fast microbiology diagnosis based on the characteristic morphologic features observed in Gram-stained smears of blood culture positive bottles, and the validation via MALDI-TOF MS. This dual approach has significant impact in the clinical management of infectious diseases and antibiotic stewardship, by integrating sample processing, fluid handling, and detection for rapid bacterial diagnosis.

Magnusiomyces capitatus is a dimorphic yeast commonly isolated from the environment and was uncommonly reported as a disease in Asia. It may cause invasive infection in patients with hematological malignancies, especially those with neutropenia, and resulting in high mortality. Herein, we reported a man with nasopharyngeal carcinoma and hepatocellular carcinoma suffered from intermittent fever after pulmonary nodules resection. The histopathology showed yeast-like fungal elements. For further identification, we extracted the tissue DNA from formalin-fixed paraffin-embedded tissue and M. capitatus was confirmed using polymerase chain reaction amplification and sequencing of the ITS region of ribosomal DNA. After a 4-week amphotericin B and flucytosine treatment, his condition recovered well and then was followed by a 3-month oral fluconazole treatment. There was no evidence of recurrence within one year. Our case highlights that nucleic acids obtained from formalin-fixed tissue could be a feasible identification method, especially in those whose culture results are unavailable. [ABSTRACT FROM AUTHOR]

Magnusiomyces capitatus is an uncommon opportunistic fungal pathogen primarily affecting immunocompromised individuals. While rare, cases have been reported in immunocompetent patients. We present a documented case of Magnusiomyces capitatus invasive infection in an immunocompetent patient with no previous medical history. This case shows that invasive fungal infections by Magnusiomyces capitatus might affect even the immunocompetent patients. [ABSTRACT FROM AUTHOR]

Magnusiomyces capitatus is an emerging opportunistic yeast, thus far mainly reported from the Western world where fungemia is the most frequent presentation in immunocompromised patients with high mortality. We described a rare case of Magnusiomyces capitatus infection from our hospital in China and reviewed six further cases published to date in Chinese literature. It is noted that half more of the cases (4/7) presented with fungemia in younger, immunosuppressed patients, whereas the remaining cases were with pneumonia in elderly, immunocompetent patients. All seven Chinese cases had favourable outcome with antifungal therapy. Based on the limited in vitro and clinical data, a combination of amphotericin B either with 5-fluorocytosine or voriconazole for fungemia in immunocompromised patients, and although fluconazole is not recommended as first-line therapy in the guideline, in our study, fluconazole alone or with 5-fluorocytosine for local pulmonary infection in immunocompetent patients is effective with good outcome.

Magnusiomyces capitatus is a rare cause of fungal infection in immunocompromised patients, mainly seen in hematological malignancies. M capitatus infections are extremely rare in immunocompetent patients, as it is part of normal human microbial flora. We are presenting an extremely rare case of M capitatus peritonitis in an otherwise immunocompetent patient who suffered from gastrointestinal leakage due to pancreatitis. Fungal identification was performed at reference laboratory by phenotypic characteristics and DNA sequencing of target internal transcribed spacer region of the rRNA gene and the D1-D2 domain of the large-subunit rRNA gene and susceptibility testing by Clinical and Laboratory Standards Institute guidelines (document M27-S4) broth dilution method. He was successfully treated with a combination of surgical repair and voriconazole single therapy.

Magnusiomyces capitatus (also denominated "Geotrichum capitatum" and "the teleomorph stage of Saprochaete capitata") mainly affects immunocompromised patients with hematological malignancies in rare cases of invasive fungal infections (IFIs). Few cases have been reported for pediatric patients with acute lymphoblastic leukemia (ALL), in part because conventional diagnostic methods do not consistently detect M. capitatus in infections. The current contribution describes a systemic infection in a 15-year-old female diagnosed with ALL. She arrived at the Children's Hospital of Mexico City with a fever and neutropenia and developed symptoms of septic shock 4 days later. M. capitatus ENCB-HI-834, the causal agent, was isolated from the patient's blood, urine, bile, and peritoneal fluid samples. It was identified with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and a phylogenetic reconstruction using internal transcribed spacer (ITS) and 28S ribosomal sequences. The phylogenetic sequence of M. capitatus ENCB-HI-834 clustered with other M. capitatus-type strains with a 100% identity. In vitro antifungal testing, conducted with the Sensititre YeastOne susceptibility system, found the following minimum inhibitory concentration (MIC) values (μg/mL): posaconazole 0.25, amphotericin B 1.0, fluconazole > 8.0, itraconazole 0.25, ketoconazole 0.5, 5-flucytosine ≤ 0.06, voriconazole 0.25, and caspofungin > 16.0. No clinical breakpoints have been defined for M. capitatus. This is the first clinical case reported in Mexico of an IFI caused by M. capitatus in a pediatric patient with ALL. It emphasizes the importance of close monitoring for a timely and accurate diagnosis of neutropenia-related IFIs to determine the proper treatment with antibiotics, antifungals, and chemotherapy for instance including children with ALL. [ABSTRACT FROM AUTHOR]

Magnusiomyces capitatus is an emerging opportunistic yeast, thus far mainly reported from the Western world where fungemia is the most frequent presentation in immunocompromised patients with high mortality. We described a rare case of Magnusiomyces capitatus infection from our hospital in China and reviewed six further cases published to date in Chinese literature. It is noted that half more of the cases (4/7) presented with fungemia in younger, immunosuppressed patients, whereas the remaining cases were with pneumonia in elderly, immunocompetent patients. All seven Chinese cases had favourable outcome with antifungal therapy. Based on the limited in vitro and clinical data, a combination of amphotericin B either with 5-fluorocytosine or voriconazole for fungemia in immunocompromised patients, and although fluconazole is not recommended as first-line therapy in the guideline, in our study, fluconazole alone or with 5-fluorocytosine for local pulmonary infection in immunocompetent patients is effective with good outcome. [ABSTRACT FROM AUTHOR]

Magnusiomyces capitatus (also denominated “Geotrichum capitatum” and “the teleomorph stage of Saprochaete capitata”) mainly affects immunocompromised patients with hematological malignancies in rare cases of invasive fungal infections (IFIs). Few cases have been reported for pediatric patients with acute lymphoblastic leukemia (ALL), in part because conventional diagnostic methods do not consistently detect M. capitatus in infections. The current contribution describes a systemic infection in a 15-year-old female diagnosed with ALL. She arrived at the Children’s Hospital of Mexico City with a fever and neutropenia and developed symptoms of septic shock 4 days later. M. capitatus ENCB-HI-834, the causal agent, was isolated from the patient’s blood, urine, bile, and peritoneal fluid samples. It was identified with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and a phylogenetic reconstruction using internal transcribed spacer (ITS) and 28S ribosomal sequences. The phylogenetic sequence of M. capitatus ENCB-HI-834 clustered with other M. capitatus-type strains with a 100% identity. In vitro antifungal testing, conducted with the Sensititre YeastOne susceptibility system, found the following minimum inhibitory concentration (MIC) values (μg/mL): posaconazole 0.25, amphotericin B 1.0, fluconazole > 8.0, itraconazole 0.25, ketoconazole 0.5, 5-flucytosine ≤ 0.06, voriconazole 0.25, and caspofungin > 16.0. No clinical breakpoints have been defined for M. capitatus. This is the first clinical case reported in Mexico of an IFI caused by M. capitatus in a pediatric patient with ALL. It emphasizes the importance of close monitoring for a timely and accurate diagnosis of neutropenia-related IFIs to determine the proper treatment with antibiotics, antifungals, and chemotherapy for instance including children with ALL.

We report the case of a 68-year-old immunocompetent patient with a dilatation of the ascending aorta, intraluminal vegetations, and pseudoaneurysmatic bulging who presented with unilateral fungal endogenous endophthalmitis 8 days after coronary angiogram. The isolated pathogen resulted to be Magnusiomyces capitatus, a filamentous, yeast-like fungus that can be commonly found in normal human microflora, with an immunosuppression-related pathogenicity. A literature research revealed a single case of ophthalmic infection – a keratitis – caused by this pathogen. Furthermore, we add a review of mycotic endophthalmitis related to aortic infection.

Olive mill wastewaters (OMW) are effluents originated from olive oil extraction. As an oil-rich residue, OMW is a potential source of lipase-producing microorganisms and a complex medium potentially suitable for lipase production. The aim of the present study was to isolate yeasts with the ability to produce extracellular lipases from OMW. Thirty-two yeast isolates were obtained and screening for esterase/lipase activity using rapid plate detection methods allowed the selection of five isolates. Subsequently, extracellular lipolytic activity was determined in shake-flasks, and the best activity was found in the isolate JT5 (0.85 U/mL). This isolate was identified as Magnusiomyces capitatus by DNA sequencing. Growth and lypolytic activities by M. capitatus JT5 were assessed in undiluted OMW, and optimization of lipase production was achieved by a positive interaction of two factors (oxygen availability and nitrogen concentration). The highest lipase activity (1.4 U/mL) was obtained at NH4Cl concentration of 2.8 g/L and kLa of 0.65 min−1. The growth of M. capitatus JT5 in a stirred tank bioreactor, using undiluted OMW, allowed the improvement of lipase production (up to 3.96 U/mL) by increasing olive oil concentration in the medium, under the selected conditions of nitrogen concentration and oxygen availability. This study highlighted the isolate M. capitatus JT5 as a lipase-producing microorganism that is able to grow in undiluted OMW under controlled conditions. Results obtained in shake-flasks have been reproduced satisfactorily in the stirred tank bioreactor. [ABSTRACT FROM AUTHOR]

Giriş: Magnusiomyces; Saccharomycetales takımında, Dipodascaceae familyasında yer alan artrokonidiyal fırsatçı bir mantardır. Daha önceleri Blastoschizomyces capitatus, Geotrichum capitatum, Trichosporon capitatum ve Dispodascus capitatus gibi çeşitli şekillerde adlandırılmıştır. Doğada yaygın olarak bulunur ve deri, solunum, gastrointestinal sistem mukozasında kolonize olabilir. Bağışıklık sistemi baskılanmış hastalarda, özellikle hematolojik malignitesi olanlarda invaziv enfeksiyonlara neden olabilir ve yüksek mortalite oranlarına sahiptir. Literatürde immünosüpresif olmayan hastalarda nadir de olsa fungemi, pnömoni, peritonit, üriner sistem enfeksiyonu gibi klinik tablolara sebep olduğu gösterilmiştir. Biz de bilinen immünosüpresyonu olmayan hastada duedonum perforasyonu sonrası Magnusiomyces capitatus'un neden olduğu intrabdomianal enfeksiyon olgusu sunduk. Olgu: Hipertansiyon dışında kronik hastalığı olmayan 79 yaşında kadın hasta, kalça protez enfeksiyonu nedeniyle ortopedi servisinde takip edilmekteydi. Takibinde akut batın kliniği gelişen hastada laboratuvar ve radyolojik değerlendirme sonrasında duedonum perforasyonu saptandı ve acil operasyona alındı. Protez enfeksiyonu nedeniyle piperasilin tazobaktam ve teikoplanin tedavisi alan hastanın mevcut tedavisine devam edildi. Operasyon esnasında alınan apse kültüründe üreme saptandı ve MALDITOF sisteminde Magnusiomyces capitatus olarak tanımlandı. Tansiyon arteryel değeri 115/56 mmHg, ateş 36,2 oC, nabız 95 atım/dk, oksijen saturasyonu %96 idi. Fizik muayenesinde genel durumu düşkün görünümde, akciğerde solunum seslerinde azalma mevcuttu, batında rebound defans yoktu, dren mevcuttu ve yara yeri temizdi. Laboratuvar değerlerinde beyaz kan hücresi: 7.660/mm3, hemoglobin: 11,3 g/dl, platelet: 413.000 μl, C-reaktif protein: 198 mg/l, aspartat aminotransaminaz: 10 U/l, alanin aminotransaminaz: 5 U/l, KAN üre azotu: 15 mg/dl, kreatinin: 0,4 mg/dl, prokalsitonin: 1,1 ng/ml idi. Genel durumu stabil olan hastaya intravenöz vorikonazol başlandı. Vorikonazol tedavisinin 10. gününde genel durumu iyi olan ve akut faz reaktanları gerileyen hasta peroral flukonazol ve amoksisilin-klavulonik asit ile taburcu edildi. Sonuç: Magnusiomyces capitatus'a bağlı enfeksiyonlar literatürde nadir olarak bildirilmiştir. Magnusiomyces türleri, diğer artokonidiyal mayalarla birlikte, invaziv kandidiyaz için genellikle ilk basamak tedavi olarak kullanılan ekinokandinlere karşı doğal olarak dirençlidir ve flukonazole karşı değişken minimal inhibitör konsantrasyon değerlerine sahiptir. Lipozomal amfoterisin B ve azoller, özellikle vorikonazol ve posakonazol ile klinik başarı bildirmiştir. Flukonazol ilk basamak tedavi olarak önerilmese de lokal enfeksiyonlarda iyi klinik sonuçlar alındığını gösteren çalışmalar olduğundan devam tedavisi olarak tercih edilebilir. [ABSTRACT FROM AUTHOR]

We report the case of a 68-year-old immunocompetent patient with a dilatation of the ascending aorta, intraluminal vegetations, and pseudoaneurysmatic bulging who presented with unilateral fungal endogenous endophthalmitis 8 days after coronary angiogram. The isolated pathogen resulted to be Magnusiomyces capitatus, a filamentous, yeast-like fungus that can be commonly found in normal human microflora, with an immunosuppression-related pathogenicity. A literature research revealed a single case of ophthalmic infection – a keratitis – caused by this pathogen. Furthermore, we add a review of mycotic endophthalmitis related to aortic infection. [ABSTRACT FROM AUTHOR]

Saprochaete clavata and Saprochaete capitata are emerging fungal pathogens that are responsible for life threatening infections in immunocompromised patients, particularly in the setting of profound neutropenia. They have been associated with multiple hospital outbreaks mainly in Europe. In this article, we present a comprehensive review of the epidemiology, clinical presentation, diagnosis, antifungal susceptibility and treatment of these organisms. The diagnosis of invasive Saprochaete disease is challenging and relies primarily on the isolation of the fungi from blood or tissue samples. Both species are frequently misidentified as they are identical macroscopically and microscopically. Internal transcribed spacer sequencing and matrix-assisted laser desorption ionization-time of flight mass spectrometry are useful tools for the differentiation of these fungi to a species level. Saprochaete spp. are intrinsically resistant to echinocandins and highly resistant to fluconazole. Current literature suggests the use of an amphotericin B formulation with or without flucytosine for the initial treatment of these infections. Treatment with extended spectrum azoles might be promising based on in vitro minimum inhibitory concentration values and results from case reports and case series. Source control and recovery of the immune system are crucial for successful therapy.

Two cases of fungemia caused by Magnusiomyces capitatus, an arthroconidial yeast-like fungus, in non-hematologic immunocompromised patients are described. Both patients died before definite diagnosis of M. capitatus was made. The report highlights that pending confirmation of the isolate by phenotypic and/or molecular methods, the characteristic morphologic features observed in Gram-stained smears of blood culture positive bottles can lead to early preliminary diagnosis, thus significantly reducing time required for initiating appropriate antifungal therapy. [ABSTRACT FROM AUTHOR]

Résumé Les infections fongiques disséminées à Magnusiomyces capitatus sont rares et surviennent exclusivement chez les patients immunodéprimés. Nous rapportons le premier cas chez un patient transplanté hépatique ayant fait un choc réfractaire sur fongémie avec un rejet chronique et thrombose porte. Malgré un traitement antibactérien et un traitement empirique antifongique par caspofungine, le patient est décédé d’une défaillance multiviscérale. Ultérieurement, l’examen mycologique des hémocultures, du liquide de lavage broncho-alvéolaire et des urines s’est révélé positif à M . capitatus , identifié par spectrométrie de masse et confirmé par séquençage. La souche était résistante à la caspofungine et au fluconazole. Le meilleur traitement semble être l’association amphotéricine B et voriconazole ou amphotéricine B et 5 fluorocytosine. Summary Disseminated fungal infections due to Magnusiomyces capitatus are rare, occurring exclusively in immunocompromised patients. We report the first case in a liver transplant patient with chronic rejection and portal thrombosis who had a M . capitatus fungemia with a refractory septic shock. Despite an antibacterial and antifungal treatment with caspofungin empirical treatment, the patient died from multiple organ failure. Subsequently, mycological examinations of blood cultures, bronchoalveolar lavage fluid and urine were positive to M . capitatus identified by mass spectrometry and confirmed by sequencing respectively. The stain was resistant to caspofungin and fluconazole. The best treatment appears to be the combination of amphotericin B and voriconazole or amphotericin B and 5 fluorocytosine. [ABSTRACT FROM AUTHOR]

Magnusiomyces capitatus is an emerging opportunistic yeast in the Mediterranean region. We report from Nepal one case of M. capitatus infection and six other cases of colonization/probable infection due to M. capitatus at a tertiary care center. Majority of the patients were immunocompromised, at extreme age, associated with comorbidities, and had history of close contact with livestock and poultry. The isolates were identified by phenotypic and genotypic (ITS and D1/D2 region of 26S rDNA sequence) methods. Molecular typing of the isolates was carried out by amplified fragment length polymorphism. Minimum inhibitory concentration (MIC) of the isolates for amphotericin B, caspofungin, fluconazole, itraconazole, voriconazole, posaconazole, anidulafungin, and micafungin were 2, 0.1-4, 2, 0.12-0.5, 0.12-0.5, 0.25, 1-4, and 1-4 µg/ml, respectively. Presence of M. capitatus infection was not known in Nepal, and the study should alert the clinicians and infectious disease specialists. [ABSTRACT FROM AUTHOR]

Urban life has led to the creation of human-made environments that, from a microbiological perspective, provide extreme life conditions. Certain non-ubiquitous microorganisms such as thermophilic members of the black yeast genus Exophiala are enriched within these habitats for which no counterpart is known in nature. Dishwashers consistently accumulate a number of specific black, white and red yeasts on the rubber seals of doors and in stagnant water at the interior. Several of these yeasts are primarily known as agents of human opportunistic infections. In this review, the literature data are supported by a screening study involving 937 households in 15 cities in Turkey. Fungi were detected in 230 samples (24.5 %). Using rDNA sequencing, the prevalent species were identified as Exophiala dermatitidis ( n = 116), Candida parapsilosis ( n = 44), E. phaeomuriformis ( n = 35), Magnusiomyces capitatus ( n = 22), Rhodotorula mucilaginosa ( n = 15), and C. lusitaniae ( n = 14). The possible role of dishwashers in transmitting disease is discussed. [ABSTRACT FROM AUTHOR]

Pneumonia is an important cause of morbidity and mortality in elderly patients. Magnusiomyces should be kept in mind as a rare cause of pneumonia, because of high mortality rates (>50%). A 93-year-old male patient was admitted with cough, sputum, confusion and elevated inflamatuar markers and diagnosed with pneumonia. Magnusiomyces capitatus was detected in tracheal aspirate culture and detection of galactomannan antigen in tracheal aspirate fluid supported the diagnosis. After 10 days of intravenous Amphotericin B therapy pneumonia was improved. Although Magnusiomyces has been previously reported in the pleural fluid, we found it in tracheal aspirate culture. We recommend that clinicians should take this agent into account in cases of pneumonia due to high mortality rates. [ABSTRACT FROM AUTHOR]

Limited data are available on breakthrough fungemia, defined as fungemia that develops on administration of antifungal agents, in patients with hematological disorders. We reviewed the medical and microbiological records of adult patients with hematological diseases who had breakthrough fungemia between January 2008 and July 2019 at Toranomon Hospital and Toranomon Hospital Kajigaya in Japan. A total of 121 cases of breakthrough fungemia were identified. Of the 121 involved patients, 83, 11, 5, and 22 were receiving micafungin, voriconazole, itraconazole, and liposomal amphotericin B, respectively, when the breakthrough occurred. Of the 121 causative breakthrough fungal strains, 96 were Candida species, and the rest were 13 cases of Trichosporon species, 7 of Fusarium species, 2 of Rhodotorula mucilaginosa, and 1 each of Cryptococcus neoformans, Exophiala dermatitidis, and Magnusiomyces capitatus. The crude 14-day mortality rate of breakthrough fungemia was 36%. Significant independent factors associated with the crude 14-day mortality rate were age of ≥60 years ( P =  0.011), chronic renal failure ( P =  0.0087), septic shock ( P <  0.0001), steroid administration ( P =  0.0085), and liposomal amphotericin B breakthrough fungemia ( P =  0.0011). An absolute neutrophil count of >500/μL was significantly more common in candidemia in the multivariate analysis ( P = 0.0065), neutropenia and nonallogeneic hematopoietic stem cell transplants were significantly more common in Trichosporon fungemia ( P =  0.036 and P =  0.033, respectively), and voriconazole breakthrough fungemia and neutropenia were significantly more common in Fusarium fungemia ( P =  0.016 and P =  0.016, respectively). The epidemiological and clinical characteristics of breakthrough fungemia of patients with hematological disorders were demonstrated. Some useful factors to predict candidemia, Trichosporon fungemia, and Fusarium fungemia were identified.

Magnusiomyces clavatus and Magnusiomyces capitatus are emerging yeasts with intrinsic resistance to many commonly used antifungal agents. Identification is difficult, and determination of susceptibility patterns with commercial and reference methods is equally challenging. For this reason, few data on invasive infections by Magnusiomyces spp. are available. Our objectives were to determine the epidemiology and susceptibility of Magnusiomyces isolates from bloodstream infections (BSI) isolated in Germany and Austria from 2001 to 2020. In seven institutions, a total of 34 Magnusiomyces BSI were identified. Identification was done by internal transcribed spacer (ITS) sequencing and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Antifungal susceptibility was determined by EUCAST broth microdilution and gradient tests. Of the 34 isolates, M. clavatus was more common ( n  = 24) than M. capitatus ( n  = 10). BSI by Magnusiomyces spp. were more common in men (62%) and mostly occurred in patients with hemato-oncological malignancies (79%). The highest in vitro antifungal activity against M. clavatus / M. capitatus was observed for voriconazole (MIC 50 , 0.03/0.125 mg/L), followed by posaconazole (MIC 50 , 0.125/0.25 mg/L). M. clavatus isolates showed overall lower MICs than M. capitatus . With the exception of amphotericin B, low essential agreement between gradient test and microdilution was recorded for all antifungals (0 to 70%). Both species showed distinct morphologic traits on ChromAgar Orientation medium and Columbia blood agar, which can be used for differentiation if no MALDI-TOF MS or molecular identification is available. In conclusion, most BSI were caused by M. clavatus. The lowest MICs were recorded for voriconazole. Gradient tests demonstrated unacceptably low agreement and should preferably not be used for susceptibility testing of Magnusiomyces spp.

Magnusiomyces capitatus is an emerging opportunistic yeast, thus far mainly reported from the Western world where fungemia is the most frequent presentation in immunocompromised patients with high mortality. We described a rare case of Magnusiomyces capitatus infection from our hospital in China and reviewed six further cases published to date in Chinese literature. It is noted that half more of the cases (4/7) presented with fungemia in younger, immunosuppressed patients, whereas the remaining cases were with pneumonia in elderly, immunocompetent patients. All seven Chinese cases had favourable outcome with antifungal therapy. Based on the limited in vitro and clinical data, a combination of amphotericin B either with 5-fluorocytosine or voriconazole for fungemia in immunocompromised patients, and although fluconazole is not recommended as first-line therapy in the guideline, in our study, fluconazole alone or with 5-fluorocytosine for local pulmonary infection in immunocompetent patients is effective with good outcome., Competing Interests: All authors do not have any conflicts of interest to disclose., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Saprochaete clavata and Saprochaete capitata are emerging fungal pathogens that are responsible for life threatening infections in immunocompromised patients, particularly in the setting of profound neutropenia. They have been associated with multiple hospital outbreaks mainly in Europe. In this article, we present a comprehensive review of the epidemiology, clinical presentation, diagnosis, antifungal susceptibility and treatment of these organisms. The diagnosis of invasive Saprochaete disease is challenging and relies primarily on the isolation of the fungi from blood or tissue samples. Both species are frequently misidentified as they are identical macroscopically and microscopically. Internal transcribed spacer sequencing and matrix-assisted laser desorption ionization-time of flight mass spectrometry are useful tools for the differentiation of these fungi to a species level. Saprochaete spp. are intrinsically resistant to echinocandins and highly resistant to fluconazole. Current literature suggests the use of an amphotericin B formulation with or without flucytosine for the initial treatment of these infections. Treatment with extended spectrum azoles might be promising based on in vitro minimum inhibitory concentration values and results from case reports and case series. Source control and recovery of the immune system are crucial for successful therapy. [ABSTRACT FROM AUTHOR]

Magnusiomyces capitatus is a rare cause of fungal infection in immunocompromised patients, mainly seen in hematological malignancies. M capitatus infections are extremely rare in immunocompetent patients, as it is part of normal human microbial flora. We are presenting an extremely rare case of M capitatus peritonitis in an otherwise immunocompetent patient who suffered from gastrointestinal leakage due to pancreatitis. Fungal identification was performed at reference laboratory by phenotypic characteristics and DNA sequencing of target internal transcribed spacer region of the rRNA gene and the D1-D2 domain of the large-subunit rRNA gene and susceptibility testing by Clinical and Laboratory Standards Institute guidelines (document M27-S4) broth dilution method. He was successfully treated with a combination of surgical repair and voriconazole single therapy., Competing Interests: Declaration of Conflicting Interests: The authors(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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.

We describe the interspecies transmission of the plasmid-mediated blaKPC-3 gene, which confers carbapenem resistance, between clinically relevant gram-negative bacteria in a single patient. A KPC-3 producing Enterobacter aerogenes was isolated from a hospitalized patient previously colonized and then infected by a Klebsiella pneumoniae ST101 carrying the blaKPC-3 gene. The strains showed identical plasmids. Since intense horizontal exchanges among bacteria can occur in the gut, clinicians should be aware that patients colonized by carbapenem-resistant K. pneumoniae could become carriers of other carbapenem-resistant Enterobacteriaceae.

Disseminated fungal infections due to Magnusiomyces capitatus are rare, occurring exclusively in immunocompromised patients. We report the first case in a liver transplant patient with chronic rejection and portal thrombosis who had a M. capitatus fungemia with a refractory septic shock. Despite an antibacterial and antifungal treatment with caspofungin empirical treatment, the patient died from multiple organ failure. Subsequently, mycological examinations of blood cultures, bronchoalveolar lavage fluid and urine were positive to M. capitatus identified by mass spectrometry and confirmed by sequencing respectively. The stain was resistant to caspofungin and fluconazole. The best treatment appears to be the combination of amphotericin B and voriconazole or amphotericin B and 5 fluorocytosine., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)