Saprochaete clavata infections in patients undergoing treatment for haematological malignancies: A report of a monocentric outbreak and review of the literature

Abstract

Summary Saprochaete clavata is a rare cause of fungaemia with deep organ involvement in patients with haematological malignancies with reported mortality rates of 60%‐80%. We describe four cases of S clavata infection in a haematology unit over several months that were treated with voriconazole‐based regimens. We also review the literature on factors that could contribute to earlier recognition and effective treatment of S clavata. We included all cases of culture‐positive S clavata from sterile sites with associated signs of infection in patients undergoing treatment for a haematological malignancy. Isolates were identified by MALDI‐TOF MS, and spectrum profiles were used to prepare clustering analysis of isolates. Susceptibility testing was performed using a commercial microtitre methods. Saprochaete clavata was isolated from the bloodstream in three cases and bronchial alveolar lavage (BAL) fluid in one case. Clustering analysis suggested strains of S clavata were clonal without evidence of divergence although a common source was not identified. Susceptibility testing yielded elevated MICs to fluconazole (8 mg/L) and echinocandins (>1‐8 mg/L). All patients were treated with voriconazole‐based regimens resulting in survival of 3/4 patients, who continued chemotherapy for their underlying malignancy without evidence of relapse. Saprochaete clavata is a rare but aggressive cause of breakthrough yeast infection in patients undergoing treatment for haematological malignancies, particularly patients with a prior history of echinocandin treatment. Timely initiation of appropriate treatment, aided by more rapid identification in microbiology laboratory, can reduce the risk of deep organ dissemination and patient death.

Saprochaete clavata Outbreak Infecting Cancer Center through Dishwasher

“…In addition, we instituted mandatory guidelines for thorough cleaning and washing after each use. No study of S. clavata outbreaks has so far succeeded in identifying the contamination source (10). Contaminated milk jugs have been identified as the source of outbreaks from M. capitatus (17), and several reports have noted the role of food as a potential source of outbreaks of Geotrichum spp.…”

Outbreak of Saprochaete clavata Sepsis in Hematology Patients: Combined Use of MALDI-TOF and Sequencing Strategy to Identify and Correlate the Episodes

“…The first case of Geotrichum infection was reported in 1965, and to date other cases or small outbreaks have been described, predominantly in Italy and France (Gadea et al, 2004;Girmenia et al, 2005;Del Principe et al, 2016;Esposto et al, 2018;Stanzani et al, 2019). Clinical presentations were sepsis, pulmonary hepatic and splenic lesions, brain abscesses, and were characterized by a high mortality rate, due to peculiar antifungal resistance patterns, difficult identification and, consequently, delay in diagnosis and correct treatment (Gadea et al, 2004;Cuenca-Estrella et al, 2011;Esposto et al, 2018).…”

“…Interestingly, both systems highlighted that one different isolate did not strictly correlate with the other six. Few other reports have tried to discuss the usefulness of proteomic fungal typing by means of MALDI-TOF, which was able to describe and confirm strains' relatedness in an outbreak (Stanzani et al, 2019).…”

“…Invasive fungal infections (IFIs) represent a public health burden worldwide, especially in immunocompromised patients, and their incidence has risen over the last decades due to the increased use of immunosuppressive and cytotoxic therapies, improved diagnostic techniques, greater awareness, and clinical suspicion. They are still a major cause of morbidity and mortality in patients with hematology malignancies (Girmenia et al, 2005;Miceli et al, 2011;Garcia-Ruiz et al, 2013;Picard et al, 2014;Stanzani et al, 2019). Candida and Aspergillus spp.…”

Saprochaete clavata Infection in Immunosuppressed Patients: Systematic Review of Cases and Report of the First Oral Manifestation, Focusing on Differential Diagnosis

“…When a S. clavata infection arises in immunosuppressed patients, it may cause fulminant fungaemia with multi-organ involvement and it has a 60% to 80% mortality rate. Disseminated infection initially arises with nonspecific symptoms (i.e., fever, diarrhea, and pulmonary symptoms), and most infections are mainly diagnosed by blood culture [10]. The clinical presentation in immunocompetent patients is less severe and rarely reported [11].…”