Invasive Geotrichum clavatum Fungal Infection in an Acute Myeloid Leukaemia Patient: A Case Report and Review

Saprochaete and Geotrichum spp. are rare emerging fungi causing invasive fungal diseases in immunosuppressed patients and scarce evidence is available for treatment decisions. Among 505 cases of rare IFD from the FungiScope registry, we identified 23 cases of invasive infections caused by these fungi reported from 10 countries over a 12-year period. All cases were adults and previous chemotherapy with associated neutropenia was the most common co-morbidity. Fungaemia was confirmed in 14 (61%) cases and deep organ involvement included lungs, liver, spleen, central nervous system and kidneys. Fungi were S. capitata (n=14), S. clavata (n=5), G. candidum (n=2) and Geotrichum spp. (n=2). Susceptibility was tested in 16 (70%) isolates. All S. capitata and S. clavata isolates with the exception of one S. capitata (MIC 4 mg/L) isolate had MICs>32 mg/L for caspofungin. For micafungin and anidulafungin, MICs varied between 0.25 and >32 mg/L. One case was diagnosed postmortem, 22 patients received targeted treatment, with voriconazole as the most frequent first line drug. Overall mortality was 65% (n=15). Initial echinocandin treatment was associated with worse outcome at day 30 when compared to treatment with other antifungals (amphotericin B ± flucytosine, voriconazole, fluconazole and itraconazole) (P=.036). Echinocandins are not an option for these infections.

Section: Resultsmentioning

confidence: 99%

Invasive infections due to Saprochaete and Geotrichum species: Report of 23 cases from the FungiScope Registry

Graeff

Seidel

Vehreschild

et al. 2017

“…Unlike Aspergillus and Candida , little is known about G. clavatum infection in immunosuppressed patients in terms of epidemiology, source of outbreak, risk factors, treatment and outcome. As for today, we have knowledge of G. clavatum infection in haematological patients by French authors . Overall, 31 cases were described, the majority of them being affected by AML and with a reported fatality rate at day 60 of 80% (Table ).…”

Section: Discussionmentioning

confidence: 99%

“…Misidentifications can be due to their similar phenotypes and/or limited information available in the databases. As a consequence, differentiation between G. clavatum and G. capitatum may be particularly difficult when based on the sole macroscopic and microscopic analyses . Colonies present white, farinose, dry with a frosted glass appearance in both species and microscopic features consist of true hyphae organised in acute angles often disarticulated into arthroconidia with rectangular or rounded ends .…”

Section: Discussionmentioning

confidence: 99%

“…As a consequence, differentiation between G. clavatum and G. capitatum may be particularly difficult when based on the sole macroscopic and microscopic analyses . Colonies present white, farinose, dry with a frosted glass appearance in both species and microscopic features consist of true hyphae organised in acute angles often disarticulated into arthroconidia with rectangular or rounded ends . However, recent developments in MALDI‐TOF analysis of pathogens paved the way to new diagnostic opportunities, providing a higher level of discriminatory power on a microbiologic ground.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A cluster of Geotrichum clavatum (Saprochaete clavata) infection in haematological patients: a first Italian report and review of literature

Principe

Sarmati

Cefalo

et al. 2016

Invasive fungal infections, usually Aspergillus and Candida, represent a major cause of morbidity and mortality in patients with malignant haematological diseases, but in the last years rare fungal infections have more frequently been reported. Here, we report the clinical history of three patients affected with haematological malignancies who developed an infection caused by Geotrichum (G.) clavatum. Two out of three patients were affected by acute myeloid leukaemia (AML), and one by mantle cell lymphoma (MCL). All patients received cytarabine-based chemotherapeutic regimens and developed G. clavatum infection within 3 weeks from therapy initiation. In all cases, G. clavatum was isolated from central venous catheter and peripheral blood cultures. In vitro susceptibility test confirmed an intrinsic resistance to echinocandins and, in all cases, visceral localisations (spleen, liver and lung) were documented by total body computed tomography (CT) scan. A prolonged antifungal therapy with high doses liposomal amphotericin-B was necessary to obtain fever resolution. Only the patient with MCL died while the other two AML recovered, and one of them after received an allogeneic stem cell transplantation. We consecutively reviewed all published cases of infection caused by G. clavatum. Our experience and literature review indicate that G. clavatum can cause invasive infection in haematological patients, mainly in those with acute leukaemia.

“…The optimal therapy of disseminated S clavata is uncertain. Echinocandins have no role in the treatment of S clavata due to high intrinsic resistance . Voriconazole, itraconazole, posaconazole, amphotericin B and 5‐fluorocytosine have more predictable potency in vitro and in vivo, while higher MICs have been reported for fluconazole and isavuconazole .…”

Section: Introductionmentioning

confidence: 99%

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

Stanzani

Cricca

Sassi

et al. 2019

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.