Paecilomyces variotii in peritoneal dialysate

Abstract

Four cases of peritonitis caused by the filamentous fungus Paecilomyces variotii in patients on continuous ambulatory peritoneal dialysis are reported. Removal of the Tenckhoff catheter and antifungal chemotherapy led to resolution of symptoms in all cases. Possible contaminating events are discussed, and reported infections with P. variotii are reviewed.

Antifungal Susceptibilities ofPaecilomycesSpecies

“…Of the six drugs tested, only fluconazole showed poor activity against P. variotii, and P. variotii was the only species susceptible to flucytosine. Only a few clinical isolated of P. variotii have been tested by various investigators (5,7,15,22,23,27,31,35,37,38). More than one strain was tested in only two cases: three strains were tested by Marzek et al (22) and two strains were tested by Chan et al (5).…”

“…Only one strain was defined as being resistant to amphotericin B (27). Miconazole was tested with eight isolates, and four of the strains were resistant (5,22). Ketoconazole was assayed with nine isolates, and two were observed to be resistant (27,31).…”

“…Ketoconazole was assayed with nine isolates, and two were observed to be resistant (27,31). Fluconazole was tested with seven isolates and six of them were resistant (5,7,22). There is less information about the antifungal susceptibility of the other common species, P. lilacinus.…”

First reported case of subcutaneous hyalohyphomycosis caused by Paecilomyces variotii

“…3,4 Immunocompetent individuals can also be affected by direct inoculation following surgery, peritoneal dialysis, or trauma. 5,6 There have been numerous reports in the literature of human infections caused by P. lilacinus, including keratitis (following prolonged use of contact lenses or ocular surgery), endophthalmitis, sinusitis, pleural effusions, cutaneous infections, soft tissue infections, catheter infections, and prepatellar bursitis after joint aspiration. 7 A single report of eumycetoma caused by P. lilacinus has been published.…”

Paecilomyces variotii central nervous system infection in a patient with cancer

“…3 P. variotii is almost universally sensitive to AMB and 5FC, while P. lilacinus and P. marquandii are resistant to these antifungals and sensitive to imidazoles. 3 Marzec et al, 20 reported the succesful antifungal management of four P. variotii peritonitis by early removal of the cathether plus AMB administered intravenously in two patients and ketoconazole administered orally in two patients. Shing et al 23 reported a P. variotii fungemia in a bone marrow transplant patient who was receiving antifungal prophylaxis with FLZ and successful treatment was achieved by removal of the central venous catheter and application of intravenous AMB and oral ITZ.…”