A cluster of Geotrichum clavatum (Saprochaete clavata) infection in haematological patients: a first Italian report and review of literature

Abstract

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.

Molecular Diagnostics of Arthroconidial Yeasts, Frequent Pulmonary Opportunists

“…Although Vaux et al (2) referred to two subgroups of M. clavatus with different virulence, no correspondence of subgroups with the source or transmission route could be identified, which is in agreement with the findings published in the literature (28)(29)(30). Notably, M. capitatus is the main clinical species, while M. clavatus is more frequently encountered in the drawers of household dishwashers.…”

The combination of bortezomib with chemotherapy to treat relapsed/refractory acute lymphoblastic leukaemia of childhood

“…The complex scenario in which these infections occur, especially in cases of relapsed or refractory disease, creates diagnostic and treatment challenges (Hale et al, 2010). In particular, new strains of yeasts and moulds like those observed in our population are isolated with increased frequency (Brunetti et al, 2016;Del Principe et al, 2016). We cannot exclude that the prophylaxis with antibiotics that we used may have contributed to these rare fungal infections (Ben-Ami et al, 2012).…”

Invasive infections due to Saprochaete and Geotrichum species: Report of 23 cases from the FungiScope Registry

“…Outbreaks with unclear source of infection have been described for S. clavata . Dairy products and medical devices were suspected as potential sources of IFD, but evidence for these sources of infection is scarce . Recently, an outbreak with multiple clusters of S. capitata occurred in Turkey without an identified environmental source .…”