Susceptibility Testing and Molecular Classification of
            <i>Paecilomyces</i>
            spp

Castelli, María Victoria; Alastruey‐Izquierdo, Ana; Cuesta, Isabel; Monzón, Araceli; Mellado, Emilia; Rodríguez-Tudela, Juan Luis; Cuenca‐Estrella, Manuel

doi:10.1128/aac.00538-08

Cited by 73 publications

(72 citation statements)

References 16 publications

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“…This finding is also consistent with the susceptibility profile of our isolate. In contrast, P. variotii isolates were susceptible to amphotericin B, itraconazole, and echinocandins, but showed reduced susceptibility to voriconazole (5). Similar susceptibility results were reported by Gonzalez et al (11), where voriconazole, posaconazole, and ravuconazole demonstrated good in vitro activity against P. lilacinum.…”

supporting

confidence: 75%

“…Voriconazole and posaconazole were found to possess maximum activity, whereas amphotericin B was least active. Echinocandins have shown variable in vitro activity against P. lilacinum (5,8,29,38). Voriconazole, consistent with its in vitro activity against P. lilacinum, has been used successfully for treatment of several cases with different clinical manifestations, including the present case (6,10,18,21).…”

mentioning

confidence: 99%

“…The efficacy of voriconazole has also been demonstrated in an experimental murine model of P. lilacinum infection in comparison to amphotericin B (33). However, it is important to recognize that strains of P. lilacinum showing in vitro resistance to voriconazole have also been reported (5,29). Clinical experience with posaconazole or other newer triazoles does not exist.…”

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confidence: 99%

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Purpureocillium lilacinum as a Cause of Cavitary Pulmonary Disease: a New Clinical Presentation and Observations on Atypical Morphologic Characteristics of the Isolate

et al. 2012

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The first case of cavitary pulmonary disease caused by Purpureocillium lilacinum is described. The isolate showed atypical microscopic characteristics similar to Acremonium and Fusarium spp., which necessitated molecular identification by sequencing of multiple conserved loci. The patient responded to voriconazole, reinforcing its therapeutic efficacy for P. lilacinum infections. CASE REPORTA n 80-year-old asthmatic woman presented with a 3-week history of productive cough, associated with fever and pleuritic chest pain, which did not respond to a week of treatment with antibiotics and steroid therapy. She had a history of asthma, coronary artery disease, diabetes mellitus, hypertension, dyslipidemia, rheumatoid arthritis, and osteoporosis. Clinically, she presented with fever, tachypnea, tachycardia, and hypotension. Chest auscultation revealed bilateral scattered wheezes. The rest of the physical findings were unremarkable. Within 24 h of admission, her condition progressively deteriorated, requiring mechanical ventilation. As the patient was febrile, she was empirically started on ceftriaxone and clarithromycin. Her initial assessment revealed a normal white cell count, but the chest X-ray showed a consolidative lesion in the left upper lobe (LUL). The sputum culture showed heavy growth of Pseudomonas aeruginosa. Consequently, her antibiotic regimen was modified to include ciprofloxacin and meropenem for a course of 14 days, followed by a 3-week course of tazocin-ciprofloxacin. Despite an initial clinical improvement, the follow-up chest X ray showed persistence of the LUL lesion. Therefore, a computed tomography (CT) scan of the chest was performed on 7 October 2010, which revealed a cavitary lesion in the anterior segment of the LUL (Fig. 1A).Since her condition deteriorated further, as assessed by her oxygen requirements, sputum specimens were collected on 11 and 18 October 2010 and were sent to the Mycology Reference Laboratory (MRL), Faculty of Medicine, Kuwait University. Both specimens showed septate hyphal elements when examined with calcofluor-potassium hydroxide (Fig. 2) and grew a white mold after 5 days on Sabouraud dextrose agar (Difco, Becton, Dickinson and Company, Sparks, MD). On 21 October 2010, a bronchoalveolar lavage (BAL) specimen from the LUL was obtained and sent to the MRL to establish the role of this white mold in the etiology of her cavitary lung lesion. The BAL specimen also showed septate fungal elements in the calcofluor-KOH mount (Fig. 2) and yielded a morphologically identical mold culture. The mold was provisionally identified as Acremonium or Paecilomyces. Although no defined antifungal susceptibility breakpoints exist for these organisms, the isolate demonstrated high MICs to amphotericin B (Ն32 g/ml), caspofungin (4 g/ml), and itraconazole (Ն32 g/ml), suggesting resistance, but low MICs for posaconazole (0.5 g/ml) and voriconazole (0.064 g/ml), suggesting clinical efficacy. The patient was thus started on voriconazole, at 6 mg/kg of body weight at 12-h intervals for the fir...

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supporting

confidence: 75%

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confidence: 99%

mentioning

confidence: 99%

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Purpureocillium lilacinum as a Cause of Cavitary Pulmonary Disease: a New Clinical Presentation and Observations on Atypical Morphologic Characteristics of the Isolate

et al. 2012

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“…In vitro amphotericin B was active against clinical P. variotii isolates but not against P. lilacinus (8). Among the azoles, only itraconazole and posaconazole showed clinically relevant activity against P. variotii.…”

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confidence: 92%

“…Interestingly, the echinocandins, especially micafungin and anidulafungin, were highly active against P. variotii, with MIC values being as low as 0.016 mg/liter. Conversely, P. lilacinus was not inhibited by the echinocandins, underscoring the importance of correct species identification (8).…”

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confidence: 99%

Identification ofPaecilomyces variotiiin Clinical Samples and Settings

et al. 2010

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Paecilomyces variotii is a commonly occurring species in air and food, but it is also associated with many types of human infections and is among the emerging causative agents of opportunistic mycoses in immunocompromised hosts. Paecilomyces can cause hyalohyphomycosis, and two species, Paecilomyces lilacinus and P. variotii, are the most frequently encountered organisms. In the present study, a set of 34 clinical isolates morphologically identified as P. variotii or P. lilacinus were formally identified by sequencing intergenic transcribed spacer regions 1 and 2 (including 5.8S rDNA) and a part of the ␤-tubulin gene. Three isolates were identified as P. lilacinus, and five of the presumptive P. variotii isolates did not belong to the genus Paecilomyces but were identified as Talaromyces eburneus (anamorph, Geosmithia argillacea) or Hamigera avellanea (anamorph, Merimbla ingelheimense). Applying the most recent taxonomy, we found that the clinical P. variotii isolates could be identified as P. variotii sensu stricto (14 strains), P. formosus (11 strains), and P. dactylethromorphus (1 strain). These data indicate that P. formosus occurs in clinical samples as commonly as P. variotii. Susceptibility tests showed that the antifungal susceptibility profiles of P. variotii, P. formosus, and P. dactylethromorphus are similar and that all strains tested were susceptible to amphotericin B in vitro. P. lilanicus, T. eburneus, and H. avellanea had different susceptibility profiles; and flucytosine and voriconazole were the least active of the antifungal drugs tested against these species. Our results indicate that correct species identification is important to help guide appropriate antifungal therapy.Paecilomyces variotii is a commonly occurring species that has previously been isolated from various substrates, including (pasteurized) foods, soil, indoor air, and wood (23,36,41,42,43). However, it is also associated with many types of human infections and is listed among the emerging causative agents of opportunistic mycoses in immunocompromised hosts. Paecilomyces can cause hyalohyphomycosis (1), and two species, Paecilomyces lilacinus and P. variotii, are the most frequently encountered (20, 52). Both species are morphologically similar but can be differentiated on the basis of conidial color and growth rates (41). However, small-subunit ribosomal gene sequences showed that the two species are unrelated: P. variotii belongs to the order Eurotiales, while P. lilacinus is a member of the order Hypocreales (27). Although they are uncommon, Paecilomyces infections are associated with almost any organ or system of the human body (40). Most cases concern immunocompromised patients and are cutaneous or catheter related. However, dissemination, for example, that involving the central nervous system, has been observed in a number of cases (15,24). Ocular infections associated with prolonged contact lens use or ocular surgery have also been reported (40), as has peritonitis in patients with continuous ambulatory peritoneal dialy...

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Invasive Fungal Infections in Patients with Chronic Granulomatous Disease

Henriet

Verweij

Holland

et al. 2012

Advances in Experimental Medicine and Biology

103

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Invasive fungal infections are a major threat for chronic granulomatous disease (CGD) patients. The present study provides a comprehensive overview of published invasive fungal infections in the CGD host through an extensive review of epidemiological, clinical, diagnostic and therapeutic data. In addition to the often mild clinical presentation, the currently used diagnostics for invasive aspergillosis have low sensitivity in CGD patients and cannot be easily translated to this non-neutropenic host. Aspergillus fumigatus and A. nidulans are the most commonly isolated species. A. nidulans infections are seldom reported in other immunocompromised patients, indicating a unique interaction between this fungus and the CGD host. The occurrence of mucormycosis is mainly noted in the setting of treatment of inflammatory complications with immunosuppressive drugs. Candida infections are infrequently seen and do not cause mucocutaneous disease but do show an age-dependent clinical presentation. The CGD patient is susceptible to a wide range of fungal pathogens, indicating the need to determine the causative fungus, often by invasive diagnostics, to guide optimal and rational treatment. This review summarizes current understanding of invasive fungal infections in patients with CGD and will serve as a starting point to guide optimal treatment strategies and to direct further research aimed at improving outcomes.

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Susceptibility Testing and Molecular Classification of Paecilomyces spp

Cited by 73 publications

References 16 publications

Purpureocillium lilacinum as a Cause of Cavitary Pulmonary Disease: a New Clinical Presentation and Observations on Atypical Morphologic Characteristics of the Isolate

Purpureocillium lilacinum as a Cause of Cavitary Pulmonary Disease: a New Clinical Presentation and Observations on Atypical Morphologic Characteristics of the Isolate

Identification ofPaecilomyces variotiiin Clinical Samples and Settings

Invasive Fungal Infections in Patients with Chronic Granulomatous Disease

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