Pseudozyma spp. human infections: A systematic review

Abstract

Pseudozyma spp. are described as environmental yeasts but have also been identified as rare human pathogens found in immunocompromised patients. This systematic review details the clinical manifestations, diagnostic methodology, and empirical anti-fungal therapy for this rare yeast. PubMed, LILACS, Scielo, and Web of Science databases were searched for articles about Pseudozyma spp. infections from inception to June 2019. Inclusion criteria were any published studies that included patients with Pseudozyma spp. infection. Infections were identified using criteria set forth by the European Organization for Research and Treatment of Cancer, and were further classified according to clinical, laboratory, or radiologic findings, microbiologic confirmation, and response to therapy. Eleven articles were included with 15 patients. Oncological and/or hematological disorders were the most reported risk factors. Nontraditional microbiological methods correctly identified Pseudozyma spp., whereas traditional methods failed to identify fungal genus. Species were identified by sequencing, and most demonstrated a higher minimal inhibitory concentration (MIC) for fluconazole and echinocandins. MICs for itraconazole, voriconazole, and posaconazole varied by species. All isolates were susceptible to amphotericin B, which was the most used treatment. Pseudozyma spp. infections usually present with fever and are diagnosed by blood culture. Most species studied appeared to be resistant to fluconazole and echinocandin. Voriconazole, posaconazole, and amphotericin were effective in treating P. aphidis. However, more studies are needed to evaluate voriconazole and posaconazole in species other than P. aphidis.

Risk Factors for Fungal Co-Infections in Critically Ill COVID-19 Patients, with a Focus on Immunosuppressants

“… Distribution ( a ) and co-occurrence ( b ) of fungal species across randomly selected 50 case studies, prospective and retrospective published reports on fungal co-infections in hospitalized COVID-19 patients [ 5 , 7 , 9 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ] (also see Supplementary Table S1 ). Searches were done on PubMed (Medline) and Google Scholar using query terms such as “Co-infections”, “coinfections”, “fungi” or “Fungal infections” in combination with either “COVID-19” or “SARS-CoV-2”.…”

Pseudozyma aphidis bloodstream infection in a patient with aggressive lymphoma and a history of intravenous drug use: Case report and review of the literature

“…Only few data are available about P. aphidis in the literature. Since 2003, 15 human infections due to Pseudozyma spp have been described [ 3 ] of which 9 identified in Asia [ [4] , [5] , [6] , [7] , [8] ], 3 in the US [ [9] , [10] , [11] ], 2 in South America [ 12 , 13 ] and 1 in Europe (France) [ 14 ]. Our case report is the first described in Italy.…”

“…The most common risk factors were hematologic malignancies (3/9, 33%) [ 8 , 11 , 12 ] and locally invasive or metastatic solid tumours (3/9, 33%) [ 5 , 13 , 14 ], a CVC in place (8/9, 88%) [ [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] ], previous antibiotic treatment (8/9, 88%) [ [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] ], and bowel diseases such as Crohn's and short bowel syndrome [ 9 , 10 ]. Disruption of gastrointestinal mucosal barrier due to chemotherapy mucositis or inflammatory bowel diseases could favour fungal translocation from the gastrointestinal tract to the bloodstream, thus representing an important risk factor for Pseudozyma spp invasive infections, especially considering that this yeast may contaminate edible cereals, so it could colonize the gut by oral-faecal route [ 3 ].…”

“…The choice of the first line antifungal therapy is important in case of non-Candida yeasts, as many other genera are resistant to caspofungin and/or azoles. It has been reported that Pseudozyma spp showed sensitivity to amphotericin B, decreased sensitivity to azoles and resistance to echinocandins [ 3 ]. A notable exception was P. aphidis , that proved to be sensitive to voriconazole and posaconazole [ 7 , 9 , [12] , [13] , [14] ].…”

“…has been occasionally recognised as a human pathogen, generally affecting immunocompromised patients, and causing mainly bloodstream infections. Infections due to this yeast present some challenges for the polymorphous clinical presentation, the difficult diagnosis, and the limited therapeutic options [ 3 ]. Here, we report a Pseudozyma aphidis bloodstream infection (BSI) in an intravenous drug user (IVDU) female patient suffering from aggressive lymphoma.…”