amphotericin-b and Geotrichosis

Invasive fungal infections, usually Aspergillus and Candida, represent a major cause of morbidity and mortality in patients with malignant haematological diseases, but in the last years rare fungal infections have more frequently been reported. Here, we report the clinical history of three patients affected with haematological malignancies who developed an infection caused by Geotrichum (G.) clavatum. Two out of three patients were affected by acute myeloid leukaemia (AML), and one by mantle cell lymphoma (MCL). All patients received cytarabine-based chemotherapeutic regimens and developed G. clavatum infection within 3 weeks from therapy initiation. In all cases, G. clavatum was isolated from central venous catheter and peripheral blood cultures. In vitro susceptibility test confirmed an intrinsic resistance to echinocandins and, in all cases, visceral localisations (spleen, liver and lung) were documented by total body computed tomography (CT) scan. A prolonged antifungal therapy with high doses liposomal amphotericin-B was necessary to obtain fever resolution. Only the patient with MCL died while the other two AML recovered, and one of them after received an allogeneic stem cell transplantation. We consecutively reviewed all published cases of infection caused by G. clavatum. Our experience and literature review indicate that G. clavatum can cause invasive infection in haematological patients, mainly in those with acute leukaemia.

Topics: Adult; Amphotericin B; Antifungal Agents; Central Venous Catheters; Drug Resistance, Fungal; Echinocandins; Fatal Outcome; Female; Geotrichosis; Geotrichum; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Humans; Invasive Fungal Infections; Italy; Leukemia, Myeloid, Acute; Liver; Lung; Lymphoma, Mantle-Cell; Male; Microbial Sensitivity Tests; Middle Aged; Spleen; Tomography, X-Ray Computed; Young Adult

Geotrichum capitatum is an uncommon cause of invasive infections in immunocompromised patients, particularly those with hematological malignancies and severe neutropenia. The aim of this study was to report the cases of invasive geotrichosis in our hospital. It is a retrospective study of invasive geotrichosis diagnosed in the Laboratory of Parasitology-Mycology of the UH Habib Bourguiba, Sfax, from January 2005 to August 2013. Six cases of invasive Geotrichum infections were diagnosed. There were three men and three women. The mean age was 35 years. Five patients have acute myeloid leukemia with a profound neutropenia, and one patient was hospitalized in the intensive care unit for polytraumatism. Clinically, the prolonged fever associated with pulmonary symptoms was the predominant symptom (n = 5). Geotrichum capitatum was isolated in one or more blood culture. Two patients had urinary tract infections documented by multiple urine cultures positive for G. capitatum. Five patients received conventional amphotericin B alone or associated with voriconazole. The outcome was fatal in four cases. Invasive geotrichosis is rare, but particularly fatal in immunocompromised patients. Approximately, 186 cases have been reported in the literature. The prognostic is poor with mortality over 50 %. So, early diagnosis and appropriate management are necessary to improve prognosis.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Fatal Outcome; Female; Geotrichosis; Geotrichum; Hospitals, University; Humans; Male; Middle Aged; Retrospective Studies; Sepsis; Tunisia; Voriconazole

Geotrichum capitatum sepsis are rare, occurring exclusively in immunocompromised patients.. We report the case of a patient with acute leukemia, presenting with chemotherapy-induced neutropenia and hospitalized in an intensive care unit for a severe sepsis. In spite of an antibiotic and antifungal treatment, the patient died of cardiorespiratory failure. Later on, blood cultures proved to be positive for Geotrichum capitatum.. If fungal infections are common in neutropenic patients, Geotrichum capitatum sepsis remain exceptional. The portal of entry is digestive or respiratory, and the invasion is favored by immunodepression and suppression of the normal microbial flora. Induced lesions can be multiorganic. The treatment is not well established, and the association of either amphotericine B and 5-fluorocytosine or amphotericine B and itraconazole would lead to better results. Nevertheless, the prognosis is still unfavorable, with a mortality rate of approximately 75%.

Topics: Acute Disease; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Drug Combinations; Fatal Outcome; Flucytosine; Geotrichosis; Humans; Immunocompromised Host; Itraconazole; Leukemia; Male; Middle Aged; Neutropenia; Opportunistic Infections

Topics: Actinomycosis; Adolescent; Adult; Amphotericin B; Animals; Aspergillosis; Basidiomycota; Blastomycosis; Candidiasis; Cephalosporins; Child; Chromoblastomycosis; Coccidioidomycosis; Conjunctiva; Cryptococcosis; Drug Synergism; Eye Diseases; Female; Fungi; Geotrichosis; Guinea Pigs; Histoplasmosis; Humans; Male; Mucor; Mycetoma; Mycoses; Natamycin; Nystatin; Penicillium; Pityriasis; Rabbits; Rhinosporidiosis; Sporotrichosis; Tinea

Invasive fungal infections are one of the vital complications among acute leukemia patients undergoing induction chemotherapy. Among them, Geotrichum clavatum infections present extremely rarely with atypical clinical symptoms which make them difficult to diagnose. In this paper, we report a case of infection caused by Geotrichum clavatum in a 10-year old child with acute leukemia, which is the first documented case from mainland China. With underlying childhood leukemia, the child suffered from recurrent bacterial and fungal infection and even underwent abdominal surgery during the treatment. Fortunately, the therapeutic effect was finally achieved by adjusting the treatment program to dual anti-fungal treatment with micafungin and amphotericin B. Information regarding the epidemiological, clinical, and therapeutic features, in this case, shows significant perspectives for anti-fungal treatment for immunocompromised individuals, wherefore the rate of recovery and survival can be achieved.

Topics: Amphotericin B; Antifungal Agents; Child; China; Geotrichosis; Geotrichum; Humans; Invasive Fungal Infections; Leukemia; Male; Micafungin; Treatment Outcome

Topics: Aged, 80 and over; Amphotericin B; Antifungal Agents; Aspirin; Cellulitis; Dermatomycoses; Drug Combinations; Female; Flucytosine; Gastrostomy; Geotrichosis; Geotrichum; Humans; Magnesium Oxide; Microbial Sensitivity Tests; Surgical Wound Infection

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Echinocandins; Female; Fluconazole; Fungemia; Geotrichosis; Geotrichum; Humans; Immunocompromised Host; Invasive Fungal Infections; Lipopeptides; Male; Micafungin; Microbial Sensitivity Tests; Middle Aged; Neutropenia; Registries; Saccharomycetales; Voriconazole; Young Adult

Severe systemic Geotrichum capitatum (G. capitatum) infection is rare, especially in Japan. G. capitatum infection has been reported mainly in immunocompromised patients and the prognosis is poor with a mortality rate of approximately 50-75%. Here, we report a Japanese case of systemic G. capitatum infection in a severe neutropenic patient who was receiving chemotherapy for acute myelogeneous leukemia with multilineage dysplasia. G. capitatum was isolated from blood cultures, and also formed multiple nodular lesions in lung fields. The infection was successfully cured with a combination of amphotericin B, itraconazole, and voriconazole.

Topics: Amphotericin B; Antifungal Agents; Drug Therapy, Combination; Geotrichosis; Humans; Itraconazole; Japan; Male; Middle Aged; Pyrimidines; Remission Induction; Triazoles; Voriconazole

We report the first case, to our knowledge, of Blastoschizomyces capitatus infection occurring in a patient receiving empirical echinocandin therapy for neutropenic fevers. Clinicians should consider B. capitatus infection in those neutropenic patients who remain febrile despite echinocandin therapy or who develop yeast bloodstream infections while receiving an echinocandin.

Topics: Aged; Antifungal Agents; Echinocandins; Fatal Outcome; Geotrichosis; Geotrichum; Humans; Lipopeptides; Male; Micafungin; Microbial Sensitivity Tests; Neutropenia

In a murine model of blastoschizomycosis, amphotericin B combined with micafungin, flucytosine or voriconazole did not improve the efficacy of fluconazole. However, such combinations can constitute therapeutic options for those cases where fluconazole fails.

Topics: Amphotericin B; Animals; Antifungal Agents; Colony Count, Microbial; Disease Models, Animal; Drug Synergism; Drug Therapy, Combination; Echinocandins; Flucytosine; Geotrichosis; Geotrichum; Humans; Immunocompromised Host; Lipopeptides; Lipoproteins; Male; Micafungin; Mice; Mice, Inbred Strains; Microbial Sensitivity Tests; Mycoses; Peptides, Cyclic; Pyrimidines; Survival Analysis; Triazoles; Trichosporon; Voriconazole

Blastoschizomyces capitatus is an emerging pathogenic fungus that can cause deep invasive diseases in neutropenic patients. We developed a model of disseminated blastoschizomycosis in immunosuppressed mice to evaluate the effectiveness of amphotericin B, flucytosine, fluconazole and voriconazole. High-dose fluconazole was the most effective drug at prolonging the survival of mice and at reducing fungal burden in the kidneys, spleen and liver.

Topics: Amphotericin B; Animals; Antifungal Agents; Disease Models, Animal; Dose-Response Relationship, Drug; Fluconazole; Flucytosine; Geotrichosis; Geotrichum; Immunocompromised Host; Immunosuppressive Agents; Kidney; Liver; Male; Mice; Microbial Sensitivity Tests; Pyrimidines; Spleen; Survival Analysis; Treatment Outcome; Triazoles; Voriconazole

A rare case of an invasive cutaneous infection by Geotrichum candidum in an 80-year-old male patient with diabetes mellitus is reported. The primary site of infection manifested after trauma as an ulcerative lesion on the distal phalanx of the midfinger and extended throughout the right hand. Histological examination showed fungal invasion in the deep dermis without vascular involvement and G. candidum was grown in cultures from the biopsy material. Angiography revealed severe obstructive disease of the right brachial artery and its branches. Treatment, after susceptibility testing of the isolated strain, consisted of sequential administration of intravenous liposomal amphotericin B with oral voriconazole followed by liposomal amphotericin B, resulting in substantial improvement of the infection.

Topics: Aged, 80 and over; Amphotericin B; Antifungal Agents; Diabetes Mellitus; Geotrichosis; Geotrichum; Humans; Male; Pyrimidines; Triazoles; Voriconazole

Geotrichosis is an uncommon fungal infection. Geotrichum capitatum is commonly acknowledged as an opportunistic fungal pathogen that causes systemic geotrichosis in immunocompromised patients, especially patients with acute leukemia and severe neutropenia. Here, we report a case of oral geotrichosis caused by G. capitatum in an old patient with no hematological malignancies. Fungal cells were detected in clinical specimens obtained with oral swabs using the KOH technique. Yeast colonies with peripheral hairs were exclusively isolated as fungi from the oral mucosa and feces of the patient. The isolates were identified as G. capitatum by morphological findings, sugar-assimilation tests, and the nucleotide sequences of the ITS regions of the rDNA. Effective treatment of the patient was achieved with amphotericin B syrup in accord with the results of in vitro susceptibility tests. G. capitatum should be recognized as a fungal pathogen involved in superficial infections of older persons, as should Candida spp., even in the absence of hematological malignancies.

Topics: Aged, 80 and over; Amphotericin B; Geotrichosis; Geotrichum; Humans; Male; Mouth

Blastoschizomyces capitatus (formerly known as Geotrichum capitatum and Trichosporon capitatum) is a rare, yet an emerging, cause of invasive infections in immunosuppressed patients. Profound and prolonged neutropenia is the crucial predisposing factor for this yeast infection. Blastoschizomyces capitatus was isolated from peripheral blood cultures of a profoundly neutropenic patient with acute myeloid leukemia (M2 FAB). Despite administration of antifungal chemotherapy with liposomal amphotericin B at 4.5 mg kg(-1) daily, the patient succumbed 4 days after initiation of treatment. Infections attributed to B. capitatus have generally a poor prognosis, although the yeast shows in vitro susceptibility to antifungal agents. Low flucytosine, caspofungin acetate, voriconazole and amphotericin B minimum inhibitory concentration values were also recorded with our isolate. The clinical relevance of the in vitro susceptibility testing against the isolate and the current antifungal chemotherapy regimens against B. capitatus systemic infections are discussed.

Topics: Aged; Amphotericin B; Antifungal Agents; Blood; Fatal Outcome; Fungemia; Geotrichosis; Geotrichum; Greece; Humans; Leukemia, Myeloid, Acute; Male; Neutropenia; Sepsis

Data on the use of combination of liposomal amphotericin B and caspofungin followed by voriconazole, as maintenance or further rescue treatment, in 10 patients with invasive mycosis are reported.. The diagnoses were acute leukemia (7), myelodysplastic syndrome (1) and Hodgkin's lymphoma (1). All patients developed an invasive mycosis (proven, 3; probable, 6; and possible, 1) refractory to first-line antifungal treatment (liposomal amphotericin B in all patients except one who received fluconazole).. Rescue therapy with a combination of caspofungin and liposomal amphotericin B was well tolerated, hypokalemia, and thrombophlebitis being the most common side-effects. Combination therapy was administered for a median of 17 d, range 6-40. Among the nine patients with proven or probable mycosis, one was not evaluated because of early death caused by massive hemoptysis whilst in the remaining eight patients, the response was classified as complete, stable and failure in four, three, and one patients, respectively. Complete response was also observed in patient with possible mycosis. Eight of nine patients received voriconazole for a median of 75 d, range 42-194. Voriconazole was well tolerated although some drug interactions were observed during treatment with methotrexate and digoxin. After a median follow-up of 125 d, nine of 10 patients are alive. Overall, a favorable response to antifungal treatment (including the case of possible mycosis) was obtained in eight of 10 patients.. These data suggest that medical antifungal treatment may be intensified in severely ill patients without significantly compromising patient safety. The combination of synergistic antifungal drugs as well as their sequential use warrants further investigation by a larger randomized controlled study.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus flavus; Aspergillus fumigatus; Caspofungin; Child; Drug Synergism; Drug Therapy, Combination; Echinocandins; Female; Geotrichosis; Hodgkin Disease; Humans; Leukemia, Myeloid, Acute; Lipopeptides; Liposomes; Male; Mycoses; Myelodysplastic Syndromes; Peptides; Peptides, Cyclic; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrimidines; Survival Rate; Treatment Outcome; Triazoles; Voriconazole

Intensive chemotherapy has prolonged survival in cancer patients. Unfortunately it has also predisposed them to unusual infections because of their immunocompromised state. We report a case of fungal septicaemia caused by Geotrichum candidum, an imperfect yeast of low virulence in a young girl with acute lymphoblastic leukaemia. It was successfully treated with amphotericin B. The morphological characteristics of this fungus leading to its identification are described.

Topics: Amphotericin B; Antineoplastic Agents; Child, Preschool; Female; Fungemia; Geotrichosis; Humans; Immunocompromised Host; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Five cases of eosinophil lung are reported in which the fungus responsible for the affection was not Aspergillus. Documented data include reports on 19 similar cases with a clinical picture suggestive of allergic bronchopulmonary aspergillosis but with negative tests for Aspergillus. The various fungal species isolated included Candida albicans, Penicillium, Geotrichum candidum, Stemphylium lanuginosum, Culvularia lunata, and Drechsleria hawaïensis. Diagnostic criteria are discussed, with particular emphasis on the importance of the inhalation provocation test, as well as possible efficacy of antifungal treatment.

Topics: Adult; Aged; Amphotericin B; Aspergillosis, Allergic Bronchopulmonary; Bronchial Provocation Tests; Candidiasis; Diagnosis, Differential; Female; Flucytosine; Geotrichosis; Helminthosporium; Humans; Lung Diseases, Fungal; Male; Miconazole; Middle Aged; Penicillium; Pulmonary Eosinophilia

Topics: Aged; Amphotericin B; Bronchial Diseases; Colistin; Flucytosine; Geotrichosis; Humans; Lung Diseases, Fungal; Male; Microbial Sensitivity Tests; Middle Aged; Mitosporic Fungi; Mycoses; Neomycin; Potassium Iodide; Sulfadiazine

Topics: Amphotericin B; Candidiasis, Oral; Female; Geotrichosis; Glucocorticoids; Humans; Middle Aged; Mitosporic Fungi; Mouth Mucosa; Mycoses; Pemphigus