SarocladiumandAcremoniuminfections: New faces of an old opportunistic fungus

Abstract

The genera Sarocladium and Acremonium (order Hypocreales) are a very diverse group of morphologically and genetically related fungi that are generally found in the environment. Numerous species of these genera are soil saprobes and opportunistic pathogens of plants, other fungi, animals or humans. 1 They are distributed worldwide, and Acremonium isolates have even been found in rocks on continental Antarctica. 2 In addition, these fungi are very relevant in the clinical field, as they have been proven to be involved in a wide range of human conditions and manifestations. As will be discussed later, diagnosis and management of these infections are quite challenging, mostly due to the difficulties in the correct identification and to the poor antifungal response they generally show. As a matter of fact, Acremonium and Sarocladium species cannot be distinguished by histopathological examination from some other opportunistic fungi, such as Fusarium and its relatives; therefore, DNA sequence analysis is required. This review, based on an exhaustive literature search of the PubMed database, compiles and discusses the current knowledge of Sarocladium and Acremonium infections in terms of taxonomy, clinical presentations and prognoses, diagnosis, treatment, outcomes, antifungal susceptibility and their impact in animals.

Fatal disseminated infection due to Sarocladium kiliense in a diabetic patient with COVID‐19

“…Hematological malignancies, solid organ transplants, solid tumors, renal transplantation, and Crohn's disease are main predisposing factors for disseminated infection with Sarocladium spp. 14 , 15 , 16 ; nevertheless, the present case was diabetic with no abovementioned risk factors. Blood culture is essential for diagnosis of Sarocladium blood infections, because in almost all studies, 7 , 14 , 15 , 17 the fungus has been isolated from blood culture, similar to the present case.…”

“…Fever, maculopapular rash, tachycardia, and hematuria are popular symptoms of bloodstream infections in a great number of patients, 13,14 but our patient only had fever. Hematological malignancies, solid organ transplants, solid tumors, renal transplantation, and Crohn's disease are main predisposing factors for disseminated infection with Sarocladium spp 14‐16 . ; nevertheless, the present case was diabetic with no abovementioned risk factors.…”

“…Diagnosis is based predominantly on skin biopsy, which presents a typical granulomatous reaction with giant cells in histopathological examination, and the presence of hyaline fungal hyphae. 16 Since the skin sample was taken from necrotic lesions; so, we could not see activated macrophages and giant cells in histopathological reaction (Figure 2 ). Similar to the current case, Khan et al 28 presented a case of Sarocladium infection in a patient with long history of diabetes.…”

“…The cutaneous lesion of the current case was necrotic and revealed a lot of purulent exudate with no pustules, nodules, or scaly plaques. Diagnosis is based predominantly on skin biopsy, which presents a typical granulomatous reaction with giant cells in histopathological examination, and the presence of hyaline fungal hyphae 16 . Since the skin sample was taken from necrotic lesions; so, we could not see activated macrophages and giant cells in histopathological reaction (Figure 2).…”

Case Report: A Case of Sarocladium strictum Meningoencephalitis in an Immunocompetent Patient After Invasive Operation

“…Sarocladium strictum, initially isolated from Triticum aestivum, has increasingly been recognized as a clinically important species and was reallocated from Acremonium based on rDNA sequences in 2011 by Summerbell et al (1,2). Although there have been some reports of S. strictum infections in humans, most of them were derived from skin or blood, and the brain is considered one of the least susceptible organs (3). Until now, S. strictum meningoencephalitis has been reported only in three immunodeficient patients, all of whom died within a short time (4).…”