Genotyping and Antifungal Susceptibility Profile of Dipodascus capitatus Isolates Causing Disseminated Infection in Seven Hematological Patients of a Tertiary Hospital

Abstract

Seven cases of disseminated infection due toCase 2. The patient in case 2 was a 76-year-old male with a relapse of an acute myeloblastic leukemia. Severe neutropenia developed, the patient became febrile, and blood cultures were obtained. Fever persisted in spite of empirical antibiotic treatment with ceftazidime, amikacin, and vancomycin. Three days after antibacterial treatment, skin nodules appeared and a chest radiograph revealed new bilateral lung infiltrates. Conventional AMB, 1 mg/kg of body weight/day, was added to his treatment regimen. The patient remained febrile and died 5 days later. D. capitatus grew on all blood cultures.Case 3. The patient in case 3 was a 42-year-old male with a relapse of an acute myeloblastic leukemia, type M2, who had been diagnosed 5 years before. Eight days after the chemotherapy was finished, he became febrile and neutropenic. Blood cultures were taken and yielded Escherichia coli and viridans group Streptococcus that responded to treatment with meropenem plus vancomycin. Three days later his fever reappeared, and it was accompanied by tachypnea, diarrhea, and stupor. Blood cultures were drawn, chest radiography revealed new bilateral infiltrates, and conventional AMB was added to his treatment regimen. The patient died of septic shock. Blood cultures yielded D. capitatus.Case 4. The patient in case 4 was a 44-year-old female with a B prolymphocytic leukemia with disease progression in spite of fludarabine and CHOP (cyclophosphamide, hydroxydaunomycin, vincristine [oncovin], and prednisone) treatment. Pentostatin-prednisone was administered but caused severe hematological toxicity. The patient developed pancytopenia, fever, and lung consolidation, and empirical antibacterial treatment and conventional AMB, 1 mg/kg/day, were administered in combination with granulocyte-macrophage colony-stimulating factor. The patient died of septic shock. D. capitatus grew from respiratory samples and blood cultures.Case 5. The patient in case 5 was a 76-year-old female who was diagnosed with acute myeloblastic leukemia. During the administration of chemotherapy, the patient became febrile and responded to treatment with piperacillin-tazobactam plus amikacin. Leptotrichia buccalis was isolated from blood cultures. While she was receiving the antibacterial agents, she became febrile again and a lung consolidation was seen upon chest radiography. Other blood cultures were performed, vancomycin was added to her treatment regimen with no response, and the patient was asked to join a double-blind clinical trial for febrile neutropenia of suspected fungal etiology. The clinical trial compared treatments with caspofungin and liposomal AMB. The patient accepted and was included in the clinical trial. The patient seemed to improve the first 2 days but suddenly worsened, showing jaundice, tachypnea, and pleural ef-* Corresponding author. Mailing address: Unidad de Micología,

Rol de la cirugía en el manejo de la infección invasora por Saprochaete capitata

“…Candida y Aspergillus spp siguen siendo los patógenos más frecuentemente aislados, sin embargo, es de importancia conocer la emergencia de nuevos patógenos. Saprochaete capitata en pacientes inmunocompetentes puede causar infecciones leves como onicomicosis, no obstante, en pacientes con neutropenias severas puede causar infecciones sistémicas graves, caracterizadas por su alta tasa de mortalidad, que alcanza cifras de hasta 60% [7][8][9][10] . Saprochaete capitata (Teleomorfo: Magnusiomyces capitatus, previamente Geotrichum capitatum, Trichosporon capitatum, Dipodascus capitatus o Blastoschizomyces capitatus) es una levadura ascomicética, no fermentadora, no capsulada, ureasa negativa, que habita el suelo, agua, aire y plantas 11 .…”

“…Se ha hallado también en fuentes animales incluyendo fecas de aves domésticas y en productos lácteos 2,3,12 . En humanos coloniza la piel, el árbol bronquial y el tubo digestivo de individuos sanos 8 . Recientemente se ha reportado su presencia en lavavajillas 13 .…”

“…Adicionalmente pueden aparecer erupciones máculo papulares generalizadas en la piel. En estudios de imágenes pueden observarse lesiones nodulares en hígado y/o bazo, tras la recuperación de la neutropenia 3,5,6,8,14,15 . Sin embargo, en contraste con la candidiasis diseminada, es común observar compromiso pulmonar en la infección diseminada de S. capitata 5 .…”

“…Similarmente, las equinocandinas muestran CIMs más altas que las observadas en otras levaduras y, en algunos casos, incluso resistencia 10 . Aún cuando falta mejor correlación entre los resultados in vivo e in vitro, anfotericina B (en monoterapia o combinada con 5-flurocitosina o voriconazol) y voriconazol se han sugerido como terapias de primera línea para esta infección 2,5,7,8,14,24 . Existe un caso publicado de manejo exitoso de la infección hepatoesplénica con terapia combinada de anfotericina e interferón-g 24 .…”

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

“…In vitro susceptibility data on G. capitatum has been limited (14)(15)(16). In a previous report AMPH-B and VRCZ showed the lowest MICs of various antifungal agents against 23 G. capitatum isolates in vitro (14).…”