Saprochaete clavata Invasive Infections – A New Threat to Hematological-Oncological Patients

Abstract

BackgroundSaprochaete clavata (formerly Geotrichum clavatum, now proposed as Magnusiomyces clavatus) is a filamentous yeast-like fungus that has recently been described as an emerging pathogen mostly in patients with acute leukemia.MethodsThis is a retrospective study of patients diagnosed with proven and probable S. clavata infection at the University Hospital, Hradec Králové, Czechia between March 2005 and December 2017. Previous cases were identified from the literature and FungiScope® database.ResultsSix new cases (5 females, 1 male) of blood-stream S. clavata infections at the hemato-oncological department were described including epidemiological data of additional 48 patients colonized with the species. Overall, 116 strains of S. clavata were isolated from different clinical specimens of 54 patients; most of them belonged to the respiratory tract (60.3%). S. clavata was the most frequent species among arthroconidial yeasts (Trichosporon, Galactomyces, Magnusiomyces) recovered from the blood. All our patients with S. clavata infection had profound neutropenia, a central venous catheter, broad-spectrum antibiotics and antifungal prophylaxis; four had a history of a biliary tract system disease. The diagnosis was based on a positive blood culture in all patients. Four patients died of multiorgan failure and sepsis despite treatment with lipid-based amphotericin B and/or voriconazole. From the literature and FungiScope database, 67 previous cases of S. clavata infections were evaluated in context of our cases.ConclusionSaprochaete clavata infection represents a life-threatening mycosis in severely immunocompromised patients. The successful outcome of treatment seems to be critically dependent on the early diagnosis and the recovery of underlying conditions associated with immune dysfunction or deficiency.

Saprochaete clavata (Geotrichum clavatum) septicemia in a patient with multiple myeloma; An emerging case from Southeastern Turkey

“…Unlike other reported cases, the patient in our case had multiple myeloma, not leukemia. Due to ABMT and neutropenia, this patient was likely to be susceptible to invasive fungal infections similar to previously reported cases [ 2 , 8 - 10 ].…”

“…In a retrospective study about S. clavata infections, Buchta et al reported colonization and IFI in 48 and 6 patients in the Hemato-Oncology Department of a teaching hospital [ 10 ]. Over the past five years, the number of S. clavata -related infections, including FungiScope™ data, has reached about 80 cases [ 4 , 10 , 13 - 15 ].…”

“…All 12 cases of the FungiScope™ registry had blood culture positivity while polymerase chain reaction positivity was reported in only two cases [ 13 ]. Buchta et al also revealed that the diagnosis of all six patients was based on a positive blood culture [ 10 ].…”

“…A report about FungiScope™ registry cases revealed that all five isolates of S. clavata showed high (>32 mg/L) MICs to caspofungin [ 9 ]. Previous case reports have indicated that S. clavata was resistant to echinocandins and sensitive to voriconazole in [ 2 , 5 , 8 , 10 , 12 ]. In addition, voriconazole and/or liposomal amphotericin B treatments were reported as the most successful ones [ 8 , 9 , 14 , 20 ].…”

Emerging Invasive Fungal Infections in Critically Ill Patients: Incidence, Outcomes and Prognosis Factors, a Case-Control Study

“…By contrast, time duration to adequate antifungal therapy, type of antifungal agent and surgical management were not associated with mortality. It has been reported that surgical debridement [ 7 , 29 , 30 ] and early antifungal treatment [ 31 ] may improve outcome in patients with mucormycosis [ 2 , 9 , 22 , 24 , 32 , 33 , 34 , 35 ]. The use of combination antifungal therapy did not seem to impact the survival of our patients [ 36 ].…”