Abstract
Introduction: We present a fatal case of disseminated infection in a child with leukaemia, caused by Saprochaete capitata, an ascomycetous yeast. Case presentation: The aetiological role of disseminated infection by S. capitata in a child with relapsed acute myeloid leukaemia following bone‐marrow transplantation was established by its repeated isolation from blood, tracheal secretion and urine samples. The identity of S. capitata was confirmed by phenotypic and molecular methods. The isolate showed reduced susceptibility to caspofungin. Conclusion: This report indicates that patients receiving echinocandin prophylaxis are at risk of breakthrough infections caused by S. capitata or other arthroconidial yeast species. To the best of our knowledge, this is the first well‐documented case of S. capitata infection from the Middle East.
Highlights
IntroductionWe present a fatal case of disseminated infection in a child with leukaemia, caused by Saprochaete capitata, an ascomycetous yeast
We present a fatal case of disseminated infection in a child with leukaemia, caused by Saprochaete capitata, an ascomycetous yeast.Case presentation: The aetiological role of disseminated infection by S. capitata in a child with relapsed acute myeloid leukaemia following bone-marrow transplantation was established by its repeated isolation from blood, tracheal secretion and urine samples
Disseminated S. capitata, infection is associated with high mortality, underscoring the need for accurate identification, prior antifungal susceptibility testing and early initiation of specific therapy
Summary
Saprochaete capitata, an anamorph of Magnusiomyces capitatus (de Hoog & Smith, 2004), previously known as Geotrichum capitatum or Blastoschizomyces capitatus, is a rarely reported cause of disseminated disease (Girmenia et al, 2005). She was admitted for a relapse and received chemotherapy with fludarabine, L-asparaginase and idarubicin During chemotherapy, she developed fever, cough, renal impairment and bacteraemia with Stenotrophomonas maltophilia (susceptible to cotrimoxazole and colistin), and she was transferred to the paediatric intensive care unit (PICU) and started on colistin, caspofungin and metronidazole. Tests for Clostridium difficile toxin and cytomegalovirus DNA were negative As she became stable and afebrile for 5 days, meropenem and teicoplanin were discontinued and the patient was shifted back to the ward with continued treatment with caspofungin, clarithromycin and cotrimoxazole. A week later she developed bacteraemia with Enterobacter cloacae (an AmpC and extended-spectrum b-lactamase producer) and Klebsiella pneumoniae, for which meropenem and amikacin were added to caspofungin, cotrimoxazole and clarithromycin As her condition deteriorated with signs and symptoms of tachycardia, tachypnoea, generalized petechiae and sepsis, she was shifted back to the PICU. There are no susceptibility breakpoints available for S. capitata or other arthroconidial yeast species, the isolates were considered susceptible to amphotericin B (MIC 0.094–0.19 mg ml21), fluconazole (MIC 0.75–1.0 mg ml21) and voriconazole (MIC 0.094–0.25 mg ml21) but showed reduced susceptibility to caspofungin (MIC .32 mg ml21) (Pfaller & Diekema, 2012; Garcıa-Ruiz et al, 2013)
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