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

Abstract

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.

Global guidelines and initiatives from the European Confederation of Medical Mycology to improve patient care and research worldwide: New leadership is about working together

“…During the last council meeting in Amsterdam (ISHAM 2018), eleven working groups were presented by council members. These are: “Fungal respiratory infections in cystic fibrosis,” “ECMM Candida III,” “ Aspergillus Resistance Surveillance,” “Exploration of fungal contamination in the sand and water around the Mediterranean Sea and other water bodies of ECMM countries,” “Next Generation Sequencing for mycobiota analysis,” “Epidemiological survey on zygomycosis in Europe,” “ Pseudallescheria/Scedosporium infections,” “FungiScope ® –Global Rare Invasive Fungal Infection Registry”, “Immunologic Markers for Diagnosis and Treatment Monitoring in Invasive Mold Infection,” “Chronic disseminated candidiasis in haematological malignancies” and “Chronic Pulmonary Aspergillosis – CPAnet.”…”

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

“…Our case series is unique compared to previously published reports of S clavata infections in that the majority (3/4) of patients treated at our centre survived. We believe this is a result of several factors.…”

“…In the Fungiscope™ international registry, only five cases of S clavata were reported over a 10‐year period from 10 countries contributing to the registry . The overall mortality was 65%, and initial echinocandin treatment was associated with poor outcomes.…”

“…Saprochaete clavata can be cultured from wood, soil, animals and dairy products and is reported to be a commensal yeast in humans living in Mediterranean climates that can be cultured from the respiratory secretions or gastrointestinal (GI) tract . In rare cases, S clavata may cause fulminant fungaemia with deep organ involvement, particularly during periods of severe neutropenia and mucositis following chemotherapy …”

A rare case of purpuric rash caused by Saprochaete clavata in a pediatric patient with acute leukemia

“…Suspected sources of S clavata in reported outbreaks include dairy products and medical devices. The most important risk factor for IFD due to Saprochaete spp .is profound and prolonged neutropenia . The infection usually presents with fungemia and deep organ involvement, for example, lung, liver, spleen, and central nervous system.…”