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

Abstract

Background: Saprochaete clavata infection is an emerging issue in immunosuppressed patients, causing fulminant fungaemia. The purpose of this systematic review of cases is to retrieve all cases of S. clavata infection and describe oral lesions as the first manifestation of S. clavata infection. Methods: We report the first case of intraoral S. clavata infection in Acute Myeloid Leukemia (AML) affected subject, presenting as multiple grayish rapidly growing ulcerated swellings, and provide a review of all published cases of infection caused by S. clavata, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, conducted by searching SCOPUS, Medline, and CENTRAL databases. Only articles in English were considered. Individual patient data were analyzed to identify risk factors for S. clavata infection. Results: Seventeen of 68 retrieved articles were included in the review reporting data on 96 patients (mean age 51.8 years, 57 males and 38 females). Most cases were disseminated (86) with a 60.2% mortality rate. Ninety-five were hematological patients, with AML being the most common (57 cases). Conclusions:S. clavata infection in immunosuppressed patients has a poor prognosis: middle-age patients, male gender and Acute Myeloid Leukemia should be considered risk factors. In immunosuppressed patients, the clinical presentation can be particularly unusual, imposing difficult differential diagnosis, as in the reported case.

Saprochete capitata: Emerging Infections from Uncommon Microorganisms in Hematological Diseases

“…The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the European Confederation of Medical Mycology (ECMM) guidelines recommend amphotericin B with or without flucytosine as initial therapy [ 19 ]. Our therapeutic choice was the association of voriconazole at loading doses (6 mg/kg two per day) and amphotericin-B 5 mg/kg/day, based on the few clinical studies—almost case reports—available in the literature [ 5 , 7 , 8 , 9 , 20 ], together with the close monitoring of laboratory and vital parameters. In these infections, the prompt recovery of blood counts seemed to be the only hope of survival in these patients, accompanied by the choice of therapy to guarantee a complete remission of the underlying hematological disease.…”

“…For this reason, antibiotic therapy was enhanced with the combination of fosfomycin 16 g/day divided into four administrations and ceftazidime/avibactam 2/0.5 g three times a day. After a slight but insufficient improvement in the patient’s clinical condition, we decided to intensify the antifungal therapy performed up to that point by combining voriconazole with amphotericin-B 5 mg/kg/day and by increasing the dose of voriconazole to 6 mg/kg twice a day, based on in vitro studies that show the efficacy of this combination against pathogens such as Aspergillus [ 6 ], plus a few case reports indicating the feasibility of this combination at standard dosages [ 5 , 7 , 8 , 9 ]. At the same time, we performed a re-evaluation of bone marrow aspirate, identifying post-chemotherapy aplasia without evidence of blasts.…”

Septic shock due to co-infection with Legionella pneumophila and Saprochaete clavata

“…Saprochaete clavata , formerly known as Geotrichum clavatum , is a ubiquitous, filamentous, yeast-like fungi, found worldwide in soil, water, air, wood, animals and dairy products [7] . Its transmission is poorly understood.…”

“…It has been recognized as an emerging pathogen, mostly in patients with haematological malignancies. Several risk factors have been described and resemble those of invasive fungal infection, the most common being haematological malignancy, prolonged neutropenia, high-dose corticosteroid therapy, cytarabine-based chemotherapy, broad-spectrum antibiotic therapy, previous gastrointestinal colonization and presence of central venous catheters [7] , [8] , [10] .…”

Disseminated Fungal Disease Caused by Magnusiomyces clavatus in a Pediatric Cancer Patient: First Case Report in North America and Review of the Literature

“…Invasive disease has been reported mostly in patients with hematologic malignancies and rarely with lymphoma, polycystic kidney disease, Crohn's disease, hemophagocytic lymphohistiocytosis, aplastic anemia, and multiple myeloma. Most cases have occurred in France and Italy with occasional reports elsewhere in Eastern Europe, the Middle East, China, and South America (Figure 2B) [10][11][12] . Case series have identified hematologic malignancy, chemotherapy, neutropenia, broad-spectrum antimicrobials, and central venous catheters as risk factors for infection 9,10 .…”