Abstract
Saprochaete clavata and Saprochaete capitata are emerging fungal pathogens that are responsible for life threatening infections in immunocompromised patients, particularly in the setting of profound neutropenia. They have been associated with multiple hospital outbreaks mainly in Europe. In this article, we present a comprehensive review of the epidemiology, clinical presentation, diagnosis, antifungal susceptibility and treatment of these organisms. The diagnosis of invasive Saprochaete disease is challenging and relies primarily on the isolation of the fungi from blood or tissue samples. Both species are frequently misidentified as they are identical macroscopically and microscopically. Internal transcribed spacer sequencing and matrix-assisted laser desorption ionization-time of flight mass spectrometry are useful tools for the differentiation of these fungi to a species level. Saprochaete spp. are intrinsically resistant to echinocandins and highly resistant to fluconazole. Current literature suggests the use of an amphotericin B formulation with or without flucytosine for the initial treatment of these infections. Treatment with extended spectrum azoles might be promising based on in vitro minimum inhibitory concentration values and results from case reports and case series. Source control and recovery of the immune system are crucial for successful therapy.
Highlights
Invasive fungal infections (IFIs) constitute a major cause of mortality and morbidity especially in severely immunocompromised patients
Despite advances in diagnostic microbiology, S. clavata and S. capitata can often be misidentified even in laboratories that are equipped with advanced diagnostic tools such as automated identification systems, internal transcribed spacer (ITS) sequencing or matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) [4,5]
S. capitata and S. clavata have emerged as causative agents responsible for multiple hospital outbreaks predominantly in Europe (Table 1) [3,9,11], with Italy having the highest number of reported cases to date
Summary
Invasive fungal infections (IFIs) constitute a major cause of mortality and morbidity especially in severely immunocompromised patients. Geotrichum capitatum, Blastoschizomyces capitatus, Magnusiomyces capitatus) are closely related organisms that are often misidentified due to their close phenotypical resemblances [3,4] They are arthroconidial yeast-like filamentous fungi whose taxonomy has undergone multiple revisions over the years, largely due to changes in the rules of fungal nomenclature [5]. Despite advances in diagnostic microbiology, S. clavata and S. capitata can often be misidentified even in laboratories that are equipped with advanced diagnostic tools such as automated identification systems, internal transcribed spacer (ITS) sequencing or matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) [4,5] Both organisms appear to be predominantly resistant to echinocandins and fluconazole [7]. The epidemiology, clinical presentation, diagnosis, antifungal susceptibility and treatment of these organisms will be reviewed in this article
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