A case of Saprochaete capitata pulmonary infection in a neutropenic HIV-infected patient

Abstract

Introduction. Saprochaete capitata is an emerging opportunistic fungus that is responsible for an uncommon mycosis known as geotrichosis, mainly reported in patients with haematological malignancies. It is a life-threatening condition associated with a high mortality rate of over 52 %. S. capitata may affect any organ, with a predilection for the lungs. Case presentation. Here we report a case of pulmonary geotrichosis in a neutropenic HIV-infected patient with a prior history of treated tuberculosis. The main risk factor for pulmonary geotrichosis is profound and prolonged neutropenia. To our knowledge, this is the first reported case of S. capitata infection occurring on top of probable active miliary tuberculosis. Conclusion. The clinical and radiological features are non-specific and similar to those of other pulmonary fungal diseases, hence the importance of mycological examination to confirm the diagnosis. Through this report, we urge clinicians to vigilantly consider S. capitata as an aetiological agent in the differential diagnosis of fungal infections in HIV-infected individuals and to routinely screen for associated infections.

Necrotizing pneumonia due to Saprochaete capitata in a patient with diabetes mellitus. Case report

“…Radiologically, the lesions show a pattern similar to the damage caused by agents such as Mycobacterium Tuberculosis and Candida Spp , which is why they are usually the first diagnoses. In the case of our patient, the results of the cultures of bronchoalveolar lavage fluid, Gene Xpert® and Ziehl-Neelsen staining were negative [ 2 ].…”

“…Mycological diagnosis is based on the detection of hyaline septate filaments, arthroconidia and blastoconidia on direct examination. The morphology of the Saprochaete species is identical, making it necessary to make use of advanced diagnostic modalities such as MALDI-TOF MS® or PCR sequencing of ITS and large partial subunit (LSU) loci that can discriminate between the two species, MALDI-TOF MS® was permorf in our patient to confirm the diagnosis [ 2 ].…”

“…The MICs for amphotericin B tend to be in the moderate range (MIC 0.5–2 mg/L) therefore Amphotericin B alone or in combination with 5-flucytosine or voriconazole could be considered as the first choice of treatment [ 1 ]. Management of many rare fungal infections requires individualized approaches that take into account susceptibility results along with clinical presentation, in the case of our patient, the pathogen showed susceptibility to amphotericin B and itraconazole treatment, so treatment was given based on itraconazole showing a good clinical response [ 2 , 6 , [9] , [10] , [11] , [12] ].…”

“…Occasionally it can present in a context other than hematologic, causing prosthetic valve endocarditis, pneumonia, and meningitis associated with an overall mortality of 52–57% [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] ].…”

“…Known as part of the normal microbiota, Saprochaete capitata does not represent a threat for immunocompetent individuals; nevertheless, immunocompromised patients, especially those having hematological malignancies, are at high risk of systemic spread. Currently there is no standardized treatment and due to antifungal drug resistance, it can be responsible for longer hospital stay and worsening prognosis [ [2] , [3] , [4] , [5] ].…”