Blastoschizomyces capitatus: An Emerging Cause of Invasive Fungal Disease in Leukemia Patients

Abstract

Blastoschizomyces capitatus (formerly named Trichosporon capitatum or Geotrichum capitatum) is a rare cause of invasive fungal disease in immunocompromised hosts. We retrospectively studied epidemiologie, clinical, pathologic, and microbiologie features of this infection during a 68-month period at the Division of Hematology of the University La Sapienza in Rome. Twenty patients with evidence of B. capitatus were identified: 12 were infected, four were possibly infected, and four had evidence of B. capitatus colonization but were not infected by this fungus. Pulmonary infiltrates were seen in seven infected patients; four of these patients eventualfy developed mycetomalike cavitations. Eight infected patients presented clinical and radiologie features of focal hepatitis compatible with hepatosplenic candidiasis. Of the 12 infected patients, two did not receive any antifungal treatment and died, five did not show any response to systemic antifungal therapy, and five received prolonged amphotericin B plus 5-fluorocytosine therapy. Of the last group, three patients achieved stable remission of their acute leukemia and were cured, and two improved but had an apparent relapse of B. capitatus infection after their acute leukemia recurred.

Successful Treatment of Systemic Geotrichum capitatum Infection by Liposomal Amphotericin-B, Itraconazole, and Voriconazole in a Japanese Man

“…However, it was also likely that systemic infection of G. capitatum caused secondary disseminations in lung fields, because there were multiple small lesions in bilateral lobes of lung determined by CT. The multiple nodular shadows revealed by chest CT in the present case might be similar to those of previous reports, but there has been no clear explanation for the mechanism of formation of multiple lesions in the lung (2,4). Another possibility was that G. capitatum might have invaded from skin via the central venous catheter, and then increased in the blood stream, and finally lung lesions appeared as dissemination.…”

“…The prognosis of disseminated G. capitatum infection has been reported to be extremely poor, with a mortality rate of approximately 50-75% despite intensive antifungal therapy with AMPH-B, ITCZ or flucytosine (1)(2)(3)(4)6). Combination treatment with AMPH-B and 5-fluorocytosine has been recommended (2), as has the use of novel antifungal agents such as VRCZ and caspofungin (8).…”

“…Combination treatment with AMPH-B and 5-fluorocytosine has been recommended (2), as has the use of novel antifungal agents such as VRCZ and caspofungin (8). Although the patients treated with each of those new antifungal agents died (8), combination therapy with VRCZ and caspofungin may be effective for systemic G. capitatum infection (12,13).…”

“…Invasive systemic Geotrichum capitatum (G. capitatum) infection is rare, and has been reported exclusively in immunocompromised patients, particularly those receiving intensive chemotherapies for hematological malignancies such as acute leukemia (1)(2)(3)(4). G. capitatum, formerly known as Trichosporon capitatum or Brastochizomyces capitatus, is an anamorph of Dipodascus capitatus, so that Dipodascus capitatus is a taxonomic teleomorph of G. capitatum (5).…”

“…G. capitatum, formerly known as Trichosporon capitatum or Brastochizomyces capitatus, is an anamorph of Dipodascus capitatus, so that Dipodascus capitatus is a taxonomic teleomorph of G. capitatum (5). Despite intensive antifungal therapy, the mortality rate is approximately 50-75% (1,2). The emergence of G. capitatum has been noted predominantly in European countries, particularly in Mediterranean areas (1).…”