Emergence of fluconazole-resistant strains of Blastoschizomyces capitatus causing nosocomial infections in cancer patients

426

396

The mortality associated with invasive fungal infections remains high with that involving rare yeast pathogens other than Candida being no exception. This is in part due to the severe underlying conditions typically predisposing patients to these healthcare-related infections (most often severe neutropenia in patients with haematological malignancies), and in part due to the often challenging intrinsic susceptibility pattern of the pathogens that potentially leads to delayed appropriate antifungal treatment. A panel of experts of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Fungal Infection Study Group (EFISG) and the European Confederation of Medical Mycology (ECMM) undertook a data review and compiled guidelines for the diagnostic tests and procedures for detection and management of rare invasive yeast infections. The rare yeast pathogens were defined and limited to the following genera/species: Cryptococcus adeliensis, Cryptococcus albidus, Cryptococcus curvatus, Cryptococcus flavescens, Cryptococcus laurentii and Cryptococcus uniguttulatus (often published under the name Filobasidium uniguttulatum), Malassezia furfur, Malassezia globosa, Malassezia pachydermatis and Malassezia restricta, Pseudozyma spp., Rhodotorula glutinis, Rhodotorula minuta and Rhodotorula mucilaginosa, Sporobolomyces spp., Trichosporon asahii, Trichosporon asteroides, Trichosporon dermatis, Trichosporon inkin, Trichosporon jirovecii, Trichosporon loubieri, Trichosporon mucoides and Trichosporon mycotoxinivorans and ascomycetous ones: Geotrichum candidum, Kodamaea ohmeri, Saccharomyces cerevisiae (incl. S. boulardii) and Saprochaete capitatae (Magnusiomyces (Blastoschizomyces) capitatus formerly named Trichosporon capitatum or Geotrichum (Dipodascus) capitatum) and Saprochaete clavata. Recommendations about the microbiological investigation and detection of invasive infection were made and current knowledge on the most appropriate antifungal and supportive treatment was reviewed. In addition, remarks about antifungal susceptibility testing were made.

Section: Risk Factors/clinical Presentationmentioning

confidence: 95%

ESCMID and ECMM joint clinical guidelines for the diagnosis and management of rare invasive yeast infections

Arendrup

Boekhout

Akova

et al. 2014

426

396

“…B. capitatus can disseminate haematogenously to multiple organ sites including the liver, spleen, kidneys and bone in neutropenic patients. Blood cultures are usually positive at the time of acute infection, and fungal meningitis is more common than with disseminated candidiasis or trichosporonosis [151][152][153][154][155][156][157][158][159]. Cases of chronic disseminated infection have also been seen.…”

Section: Blastoschizomyces Capitatus (Formerly Trichosporon Capitatum)mentioning

confidence: 99%

“…Similar to that of Trichopsoron spp., B. capitatus may have decreased susceptibility to the fungicidal activity of amphotericin B and consequently poor clinical outcome after treatment with amphotericin B in the setting of neutropenia. Although fluconazole and flucytosine appear to be more active in-vitro, breakthrough infections have been reported in patients on fluconazole prophylaxis and resistant strains have been reported as nosocomial pathogens [158]. Optimal therapy remains to be defined.…”

Section: Blastoschizomyces Capitatus (Formerly Trichosporon Capitatum)mentioning

confidence: 99%

Infections due to emerging and uncommon medically important fungal pathogens

Walsh

Groll

Hiemenz

et al. 2004

522

405

The emergence of less common but medically important fungal pathogens contributes to the rate of morbidity and mortality, especially in the increasingly expanding population of immunocompromised patients. These pathogens include septate filamentous fungi (e.g., Fusarium spp., Scedosporium spp., Trichoderma spp.), nonseptate Zygomycetes, the endemic dimorphic pathogen Penicillium marneffei, and non-Cryptococcus, non-Candida pathogenic yeast (e.g., Trichosporon spp.). The medical community is thus called upon to acquire an understanding of the microbiology, epidemiology and pathogenesis of these previously uncommon pathogens in order to become familiar with the options for prevention and treatment.

“…Similar to Trichosporon, B. capitatus appears to have decreased susceptibility to amphotericin B [175,178,1174]. Fluconazole and flucytosine appear to be more active in vitro [177], but fluconazole-resistant strains have been reported as nosocomial pathogens [179]. Similar to Trichosporon, therapy with fluconazole plus amphotericin B and adjuvant immunotherapy [180] may be the most rational strategy at the present time ( Table 5).…”

Section: Blastoschizomyces Capitatusmentioning

confidence: 99%

Uncommon opportunistic fungi: new nosocomial threats

Groll

Walsh

2001

274

175

During the past two decades opportunistic fungal infections have emerged as important causes of morbidity and mortality in patients with severe underlying illnesses and compromised host defenses. While Aspergillus and Candida spp. collectively account for the majority of these infections, recent epidemiological trends indicate a shift towards infections by Aspergillus spp., nonalbicans Candida spp., as well as previously uncommon opportunistic fungi. Apart from an expanding number of different Zygomycetes, previously uncommon hyaline filamentous fungi (such as Fusarium species, Acremonium species, Paecilomyces species, Pseudallescheria boydii, and Scedosporium prolificans), dematiaceous filamentous fungi (such as Bipolaris species, Cladophialophora bantiana, Dactylaria gallopava, Exophiala species, and Alternaria species) and yeast-like pathogens (such as Trichosporon species, Blastoschizomyces capitatus, Malassezia species, Rhodotorula rubra and others) are increasingly encountered as causing life threatening invasive infections that are often refractory to conventional therapies. On the basis of past and current trends, the spectrum of fungal pathogens will continue to evolve in the settings of an expanding population of immunocompromised hosts, selective antifungal pressures, and shifting conditions in hospitals and the environment. An expanded and refined drug arsenal, further elucidation of pathogenesis and resistance mechanisms, establishment of in vitro/in vivo correlations, incorporation of pharmacodynamics, combination- and immunotherapies offer hope for substantial progress in prevention and treatment.