Disseminated Infection Due to Acremonium Species in a Patient with Addison's Disease

Jeffrey, William; Hernández, Jaime E.; Zarraga, Antonio L.; Oley, Gretchen E.; Kitchen, Lynn W.

doi:10.1093/clinids/16.1.170

Cited by 17 publications

(18 citation statements)

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“…While a disseminated infection by an Acremonium sp. in a patient with Addison's disease was successfully treated with that drug (36), failure has mainly been reported in cases of fungemia or disseminated infections (21,23,32,33). Although this drug was able to reduce fungal load in some organs in our study, it was ineffective in prolonging survival for any of the strains tested, which suggests that this drug should be used with caution in cases of human infection.…”

Section: Discussioncontrasting

confidence: 55%

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Evaluation of the Efficacies of Amphotericin B, Posaconazole, Voriconazole, and Anidulafungin in a Murine Disseminated Infection by the Emerging Opportunistic Fungus Sarocladium (Acremonium) kiliense

Fernández-Silva

Capilla²,

Mayayo³

et al. 2013

Antimicrob Agents Chemother

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We evaluated and compared the efficacies of different antifungal drugs against Sarocladium kiliense (formerly Acremonium kiliense), a clinically relevant opportunistic fungus, in a murine model of systemic infection. Three clinical strains of this fungus were tested, and the therapy administered was as follows: posaconazole at 20 mg/kg of body weight (twice daily), voriconazole at 40 mg/kg, anidulafungin at 10 mg/kg, or amphotericin B at 0.8 mg/kg. The efficacy was evaluated by prolonged animal survival, tissue burden reduction, and (1¡3)-␤-D-glucan serum levels. In general, the four antifungal drugs showed high MICs and poor in vitro activity. The efficacy of the different treatments was only modest, since survival rates were never higher than 40% and no drug was able to reduce fungal load in all the organs for the three strains tested. Posaconazole, in spite of its high MICs (>16 g/ ml), showed the highest efficacy. The (1¡3)-␤-D-glucan serum levels were equally reduced by all drugs evaluated.A cremonium kiliense is a saprobic fungus with a worldwide distribution which has been reported in recent years as an emerging opportunistic pathogen able to cause a wide range of human infections (1-4). Localized infections, such as mycetoma, keratitis, or onychomycosis, are acquired mainly by immunocompetent patients through trauma (5-11). Invasive infections generally affect immunosuppressed hosts such as those undergoing transplantation or those with AIDS, resulting in a high degree of fatality (12-16). More rarely, though, invasive infections have also been reported in immunocompetent individuals (17,18). Recently, based on molecular studies, this fungus has been transferred to the genus Sarocladium as Sarocladium kiliense (1). This species is the most clinically relevant of the genus and apparently also the most virulent (4,19,20). Considering that the morphological identification of these fungi is difficult, it is likely that some clinical isolates of this species have been misidentified as Acremonium strictum, another clinically important species of Acremonium (19). Infections by Acremonium spp. are difficult to treat due to the intrinsic resistance to the current antifungal agents, and an effective treatment has not yet been determined (19,(21)(22)(23). Amphotericin B (AMB) is the drug most commonly used to treat severe fungal infections caused by opportunistic molds (4). Despite its poor in vitro activity and variable clinical results, this drug still remains the first therapeutic choice against invasive Acremonium infections (2, 4, 19). Clinical experience with other drugs, such as posaconazole (PSC), voriconazole (VRC), and the echinocandins, is very poor.To evaluate possible therapeutic strategies, we tested the efficacies of PSC, VRC, and anidulafungin (AFG) compared to that of AMB against S. kiliense in a recently developed murine model of disseminated infection (20). MATERIALS AND METHODSThree clinical strains of Sarocladium kiliense, UTHSC 01-2238, UTHSC 03-3197, and UTHSC 07-550, previously identified by...

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Section: Discussioncontrasting

confidence: 55%

“…AMB has been the drug most commonly used to treat Acremo- nium infection on the basis of its in vitro activity, with very variable results (14,19,21,23,(32)(33)(34)(35)(36). While a disseminated infection by an Acremonium sp.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Efficacies of Amphotericin B, Posaconazole, Voriconazole, and Anidulafungin in a Murine Disseminated Infection by the Emerging Opportunistic Fungus Sarocladium (Acremonium) kiliense

Fernández-Silva

Capilla²,

Mayayo³

et al. 2013

Antimicrob Agents Chemother

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“…Therefore, amphotericin B therapy, in combination with ketoconazole or another new azole or allylamine, is advocated (Fincher et al, 1991;Lau et al, 1995;Guarro et al, 1997;Koç et al, 1998;Anadolu et al, 2001;Nedret Koç et al, 2002). Despite this treatment regimen, there are still reports of clinical failure that results in death (Fincher et al, 1991;Jeffrey et al, 1993;Lau et al, 1995;Schell & Perfect, 1996). Disseminated infection caused by Acremonium species is a serious fungal disease, especially for neonates.…”

Section: Discussionmentioning

confidence: 99%

Fatal disseminated Acremonium strictum infection in a preterm newborn: a very rare cause of neonatal septicaemia

Yalaz

Hilmioğlu

Metin

et al. 2003

Journal of Medical Microbiology

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“…A. strictum was found in invasive pulmonary disease [2]. Other Acremonium species have been isolated from superficial human infections [4] and invasive infections of the kidney [5], peritoneum [6], blood [7], lung [2], knee joint [8], and esophagus [9]. More rarely, these fungi are associated with other types of human infection [1].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, susceptibility testing of filamentous fungi is poorly standardized, and in vitro sensitivity may not correlate with the clinical response. In some reports of clinical studies, amphotericin B was recommended in life-threatening infections [4, 5] and some azoles (fluconazole, itraconazole) were also considered to be the agent of choice [8]. In other studies, it was recommended that the treatment of invasive Acremonium infections requires combination therapy of amphotericin B and other antifungal agents such as fluconazole and itraconazole [4, 10].…”

Section: Introductionmentioning

confidence: 99%

Peritonitis due to <i>Acremonium strictum</i> in a Patient on Continuous Ambulatory Peritoneal Dialysis

Koç

Utaş²,

Oymak³

et al. 1998

Nephron

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Disseminated Infection Due to Acremonium Species in a Patient with Addison's Disease

Cited by 17 publications

References 0 publications

Evaluation of the Efficacies of Amphotericin B, Posaconazole, Voriconazole, and Anidulafungin in a Murine Disseminated Infection by the Emerging Opportunistic Fungus Sarocladium (Acremonium) kiliense

Evaluation of the Efficacies of Amphotericin B, Posaconazole, Voriconazole, and Anidulafungin in a Murine Disseminated Infection by the Emerging Opportunistic Fungus Sarocladium (Acremonium) kiliense

Fatal disseminated Acremonium strictum infection in a preterm newborn: a very rare cause of neonatal septicaemia

Peritonitis due to <i>Acremonium strictum</i> in a Patient on Continuous Ambulatory Peritoneal Dialysis

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