micafungin and Thrombophlebitis

Kodamaea (Pichia) ohmeri is an unusual yeast-form fungus that has recently been identified as an important etiology of fungemia, endocarditis, cellulitis, funguria and peritonitis in immunocompromised patients. We report a case of K. ohmeri fungemia in a 34-year-old hospitalized patient with thrombophlebitis. The patient was admitted to the hospital for evaluation and management of an acquired tracheo-esophageal fistula secondary to an impacted denture. Fever developed on hospital day 22, and physical exam revealed right arm superficial thrombophlebitis at the site of the peripheral venous catheter that was confirmed by Doppler ultrasound. The peripheral vein was removed and blood cultures from hospital day 22 and 23 grew yeast species. The yeast was subsequently identified to be K. ohmeri by Vitek II and API20C and was confirmed by 18S rRNA gene sequencing. The fungemia and right arm phlebitis was successfully treated with a 2-week course of micafungin therapy. This is the first case of K. ohmeri fungemia in a patient that was successfully treated with micafungin.

Topics: Adult; Antifungal Agents; Catheter-Related Infections; Dentures; DNA, Fungal; DNA, Ribosomal; Echinocandins; Fungemia; Genes, rRNA; Humans; Lipopeptides; Male; Micafungin; Mycological Typing Techniques; RNA, Fungal; RNA, Ribosomal; Saccharomycetales; Sequence Analysis, DNA; Thrombophlebitis; Tracheoesophageal Fistula

We report a case with Clavispora lusitaniae-induced purulent thrombophlebitis. The patient had multiple risk factors for the development of fungal thrombophlebitis including surgical procedure, mechanical ventilation, admission to intensive care unit, total parenteral nutrition and long-term antimicrobial therapy in addition to the insertion of central venous catheter. The symptoms finally improved by a combination therapy of micafungin and flucytosine, but the therapy did not rapidly resolve candidemia. The appropriate antifungal therapy for C. lusitaniae-induced purulent thrombophlebitis is uncertain. Further study is desired to seek the appropriate therapy for the disease.

Topics: Antifungal Agents; Humans; Micafungin; Saccharomycetales; Thrombophlebitis

We herein report the case of an 85-year-old woman presenting with right internal jugular vein candidal thrombophlebitis associated with central venous catheters (CTCVC). The infecting agent was Candida albicans, which caused recurrent candidemia five times in total. Micafungin (MCFG) alone was ineffective; however, the combination of MCFG with fosfluconazole (F-FLCZ) successfully treated the patient without a need for any anticoagulant or surgical therapies. To the extent of our knowledge, this is the first report of CTCVC being successfully treated with a combination of F-FLCZ and MCFG. These new antifungal agents have better efficacy, tolerability and bioavailability; therefore, they can be useful alternatives to classical combination therapies such as amphotericin-B and 5-fluorocytosine.

Topics: Aged, 80 and over; Antifungal Agents; Candidemia; Catheter-Related Infections; Central Venous Catheters; Drug Therapy, Combination; Echinocandins; Female; Fluconazole; Humans; Jugular Veins; Lipopeptides; Micafungin; Organophosphates; Recurrence; Thrombophlebitis; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color