Blastoschizomyces capitatusInfection in Patients with Leukemia: Report of 26 Cases

Abstract

Twenty-six cases of Blastoschizomyces capitatus infection were diagnosed in 25 patients at 7 tertiary care hematology units in Spain over a 10-year period. Most patients (92%) had acute leukemia and developed infection during a period of severe and prolonged neutropenia. Two patients had esophagitis, and the rest had invasive infection. Fungemia (20 cases) was a common finding, with frequent visceral dissemination. The 30-day mortality associated with this infection was 52%, compared with 57% among patients with systemic infection. In a univariate analysis, the following 3 variables had a positive impact on 30-day survival: removal of the central venous catheter within 5 days after the onset of infection (P=.02), a good performance status (P=.003), and receipt of systemic prophylactic or empirical antifungal therapy before infection onset (P=.006). Outcome for neutropenic patients with B. capitatus infection is still poor. Rapid removal of the central venous catheter and novel antifungal therapies are recommended for treatment of this rare infection.

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

“…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 . Tos, expectoración, dolor torácico, neumotórax espontáneo e infiltrados pulmonares son hallazgos reportados 14 .…”

“…Se observa con mayor frecuencia en pacientes con neoplasias hematológicas, principalmente leucemia mieloide aguda (LMA), y se asocia en particular presencia de neutropenia [2][3][4] . La infección diseminada por S. capitata constituye un cuadro de elevada morbimortalidad, cuyo espectro clínico es muy similar al provocado por otras levaduras, lo que añade dificultad a su diagnóstico precoz 3,5,6 . La poca evidencia existente y lo contradictorio de los estudios in vivo e in vitro de la susceptibilidad a antifúngicos no han permitido determinar el tratamiento ideal ni su duración 2 .…”

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

“…Colonization in those sites sometimes leads to secondary localizations via hematogenous dissemination mainly in the lung and liver (4,6). Invasive G. capitatum infection is relatively rare, approximately 100 cases having been reported (1,3,4,7,8). Risk factors for systemic G. capitatum infection have been reported to be prolonged neutropenia, intensive chemotherapy, the use of broad-spectrum antibacterial agents and local disruption of skin and mucosal defenses (2, 9-11).…”

“…Combination treatment with AMPH-B and 5-fluorocytosine has been recommended (2), as has the use of novel antifungal agents such as VRCZ and caspofungin (8). Although the patients treated with each of those new antifungal agents died (8), combination therapy with VRCZ and caspofungin may be effective for systemic G. capitatum infection (12,13).…”

Invasive fungal infection caused by Trichosporon mucoides

“…Что касается новых противогрибковых препаратов, пока нет возможно-сти говорить об их стойкой клинической эффектив-ности. Опубликованы описания случаев, когда вори-коназол или каспофунгин использовали в качестве начальной терапии или терапии второй линии [13]. В нескольких опубликованных случаях продемонстри-рована хорошая эффективность азолов против рода Trichosporon, однако есть сообщения и о мультиле-карственной устойчивости к амфотерицину B, флюци-тозину, флюконазолу, итраконазолу [14].…”