Cutaneous geotrichosis due to Geotrichum candidum in a burn patient

Abstract

Geotrichum candidum is a saprophytic yeast known to colonize the human skin, respiratory tract and gastrointestinal tract. It can cause local or disseminated disease (geotrichosis), mainly in the immunocompromised host. Trauma, indwelling catheter use, prolonged broad-spectrum antibiotic treatment and critical illness have also been implicated as risk factors. Here we report the first case, to our knowledge, of cutaneous G. candidum infection in a burn patient. The isolate had a high amphotericin B minimum inhibitory concentration (MIC) and the patient experienced concomitant Candida orthopsilosis fungaemia, and so was treated with a combination of voriconazole and micafungin. This case highlights the importance of source control, rapid identification of G. candidum infection and MIC determination to guide antifungal therapy, which typically consists of amphotericin B with or without flucytosine or voriconazole alone. Clinicians should be aware of geotrichosis as a clinical entity in burn patients as well as in the immunocompromised. Antifungal resistance and breakthrough disease are an ongoing concern due to the increasing number of immunocompromised at-risk patients and the use of routine mould prophylaxis.

Superficial mycoses, a matter of concern: Global and Indian scenario‐an updated analysis

“…[87][88][89][90] Other yeast-like fungi, such as Geotrichum and Cryptococcus, have also been known to cause cutaneous infections. [91][92][93][94] Dimorphic fungi (existing either as mycelium when present in the environment or as yeast or spherules at host body temperature) usually cause endemic mycoses, such as blastomycosis (Blastomyces dermatitidis and Blastomyces gilchristii), coccidioidomycosis (Coccidioides immitis and Coccidioides posadasii), paracoccidioidomycosis (Paracoccidioides brasiliensis and Paracoccidioides lutzii), sporotrichosis (Sporothrix schenckii) and histoplasmosis (Histoplasma capsulatum). However, they also may rarely cause cutaneous and subcutaneous infections.…”

“…Yeast‐like fungi, such as Kodamaea ohmeri (Previously Pichia ohmeri or Yamadazyma ohmeri ) Trichosporon and Rhodotorula , have been reported to be common causal agents of onychomycosis 87‐90 . Other yeast‐like fungi, such as Geotrichum and Cryptococcus , have also been known to cause cutaneous infections 91‐94 . Dimorphic fungi (existing either as mycelium when present in the environment or as yeast or spherules at host body temperature) usually cause endemic mycoses, such as blastomycosis ( Blastomyces dermatitidis and Blastomyces gilchristii ), coccidioidomycosis ( Coccidioides immitis and Coccidioides posadasii ), paracoccidioidomycosis ( Paracoccidioides brasiliensis and Paracoccidioides lutzii ), sporotrichosis ( Sporothrix schenckii ) and histoplasmosis ( Histoplasma capsulatum ).…”

Geotrichosis Presenting As Funguria and Asymptomatic Urinary Tract Infection in a Patient with Renal Cyst

“…Other infections associated with Geotrichum spp. include septicemia, renal bezoar (fungal ball), non-invasive sinusitis, and burns wound infections [7][8][9][10]. The present report reviews a case funguria with asymptomatic UTI in a 65-year-old male patient who presented to the emergency department with insidious onset of weakness and slurring of speech.…”

Invasive Geotrichum klebahnii fungal infection: A case report

“…Geotrichum species are considered to be of low virulence, but they have been found to cause diseases [3, 10–13]. Geotrichosis affects mainly patients who have underlying immunocompromising conditions such as neoplasms, diabetes mellitus, renal impairment, organ transplant, burns and human immunodeficiency virus (HIV) infection [14, 15]. Traumatic inoculation can also lead to the development of disease in an apparently healthy and immunocompetent individual [14, 16].…”

“…Disease presentation is highly variable largely due to individual host predisposition. Pulmonary geotrichosis is the most frequently reported form of the disease, but bronchial, oral, vaginal, cutaneous and alimentary infections have also been reported [14, 17]. Patient recovery largely depends on risk factors and management of the underlying condition but Geotrichum fungemia is associated with poor prognosis, especially in patients with prolonged neutropenia as a complication of haematological malignancy [18, 19].…”