Aureobasidium pullulansvar.melanigenumfungemia in a pediatric patient

Abstract

This report describes a chronically ill child who presented with high fever and was diagnosed with catheter-related sepsis. Aureobasidium pullulans variety melanigenum, a dematiaceous fungus that rarely causes opportunistic infections, was recovered from multiple blood cultures. Antifungal susceptibilities were performed and the minimum inhibitory concentration (MIC) for fluconazole was 64 mg/l, suggestive of fluconazole resistance. The patient made a full recovery after removal of the catheter line and treatment with liposomal amphotericin B. This is the first case report of an elevated in vitro fluconazole MIC of an A. pullulans isolate and only the third case of successful treatment of A. pullulans fungemia.

Fungal Contaminants in Drinking Water Regulation? A Tale of Ecology, Exposure, Purification and Clinical Relevance

“…These are not quantitative, but can be combined with quantitative PCR (qPCR) to provide taxon-specific concentrations of fungi [214], and thus be used for taxon-specific measurements of water-borne fungi. This is of crucial importance for fast detection of species of interest, particularly in hospital environment, where the above listed fungal genera are not only the most frequently reported in drinking water, but are also often being recognised as causative agents of diseases (Table 2) [215,216,217,218]. …”

Black Molds and Melanized Yeasts Pathogenic to Humans

“…Opportunistic infections are mostly caused by A. pullulans but also other taxa have been reported, such as Aureobasidium proteae Kutleša et al 2012). Most infections occur by traumatic inoculation, such as keratitis and cutaneous lesions; disseminated mycoses are very rare and occur only in severely immunocompromised patients (Kaczmarski et al 1986;Salkin et al 1986;Arranz et al 2006;Panda et al 2006;Mise et al 2008;Pikazis et al 2009;Chawla et al 2010;Joshi et al 2010;Mershon-Shier et al 2011). A. pullulans has an affinity for synthetic materials and surgically implanted devices, as evidenced by the relatively frequent isolation of the organism from peritoneal dialysis catheters and central venous lines (Clark et al 1995;Caporale et al 1996;Hawkes et al 2005;Mise et al 2008).…”

In Vitro Activities of Eight Antifungal Drugs against 104 Environmental and Clinical Isolates of Aureobasidium pullulans

“…While there are no established interpretive criteria for antifungal susceptibilities of A. pullulans, the high MICs of all isolates tested suggest fluconazole resistance. Previously, two cases in which A. pullulans was the etiologic agent reported both high (64 g/ml) and low (4 g/ml) MICs of fluconazole (10,13). Amphotericin B, itraconazole, and posaconazole were the drugs with the best overall activity.…”

“…melanigenum, which were found to be susceptible to posaconazole, itraconazole, and amphotericin B. Amphotericin B has been used successfully to treat A. pullulans infections in cases of systemic dissemination, meningitis, peritonitis (10), and two proven cases of fungemia (11,12). Previously, antifungal susceptibility testing (AFST) of solitary isolates of this fungus reported in two cases indicated amphotericin B MICs of 0.25 g/ml and 0.5 g/ml (10,12,13). Recently published guidelines on treatment of phaeohyphomycosis (14) also recommend therapy with amphotericin B in cases due to A. pullulans infections.…”