Conidiobolus pachyzygosporus invasive pulmonary infection in a patient with acute myeloid leukemia: case report and review of the literature

Abstract

Background Conidiobolus spp. (mainly C. coronatus ) are the causal agents of rhino-facial conidiobolomycosis, a limited soft tissue infection, which is essentially observed in immunocompetent individuals from tropical areas. Rare cases of invasive conidiobolomycosis due to C. coronatus or other species ( C.incongruus, C.lamprauges ) have been reported in immunocompromised patients. We report here the first case of invasive pulmonary fungal infection due to Conidiobolus pachyzygosporus in a Swiss patient with onco-haematologic malignancy. Case presentation A 71 year-old female was admitted in a Swiss hospital for induction chemotherapy of acute myeloid leukemia. A chest CT performed during the neutropenic phase identified three well-circumscribed lung lesions consistent with invasive fungal infection, along with a positive 1,3-beta-d-glucan assay in serum. A transbronchial biopsy of the lung lesions revealed large occasionally septate hyphae. A Conidiobolus spp. was detected by direct 18S rDNA in the tissue biopsy and subsequently identified at species level as C. pachyzygosporus by 28S rDNA sequencing. The infection was cured after isavuconazole therapy, recovery of the immune system and surgical resection of lung lesions. Conclusions This is the first description of C. pachyzygosporus as human pathogen and second case report of invasive conidiobolomycosis from a European country.

Clinical Value of sTREM-1, PCT, and 1,3-β-D Glucan in Diagnosis of Immune-Associated Pulmonary Interstitial Disease with Fungal Infection

“…Previous studies have mostly studied the relationship between sTREM-1 and PCT levels and pulmonary fungal infection and found that their levels can reflect the degree of pulmonary fungal infection [19,20]. A large number of studies have also confirmed that the serum level of 1,3-β-D It was reported that the levels of 1,3-β-D and sTREM-1 in the plasma of patients with pulmonary fungal infection increased.…”

“…Previous studies have mostly studied the relationship between sTREM-1 and PCT levels and pulmonary fungal infection and found that their levels can reflect the degree of pulmonary fungal infection [ 19 , 20 ]. A large number of studies have also confirmed that the serum level of 1,3- β -D glucan in patients with pulmonary fungal infection is increased, and the increase in the serum level of 1,3- β -D glucan in patients with fungal infection is more obvious than that in patients with bacterial infection.…”

Antifungal Drugs TDM: Trends and Update

“…However, PSZ tablets, which are widely used and unlikely to result in underexposure, may not justify routine TDM. 168,169,234,235,236,[238][239][240][241][244][245][246] Blood Trough 261,262,268,[281][282][283][284]314,315,320,323,327,330,331,333,340 Concentrations Targets 341,344,347,350,352,353,355,[358][359][360][361] and TDM Indications 364,522,[526][527][528][529][530][531][532][533][534][535][536]…”

“…AF TDM cases in real-life settings (pathogens, underlying diseases, 69,71–73,75,81 trends per year, 84,234,235,236,238,239,241,244,245,344–348 CNS 532–539 localization 541–566 ) 364,370,499,522,527–530 Trends are concerning a majority of mucomycosis and aspergillosis, in oncohematology and transplantation. VRZ, more recently PSZ tablets and ISZ are the most represented.…”

“…362 The inclusion of the pharmacological unit in hospital staff meetings 363 is one aspect of AFS programs that could increase the appropriateness of repetitive TDM and lead to the development of reciprocal levels of education in multidisciplinary collaborations. 364,365 However, the growing number of software suites for dose prediction may be affected by problems of sampling accuracy and infusion time documentation. 366…”