Abstract
BackgroundSaprochaete clavata (formerly Geotrichum clavatum, now proposed as Magnusiomyces clavatus) is a filamentous yeast-like fungus that has recently been described as an emerging pathogen mostly in patients with acute leukemia.MethodsThis is a retrospective study of patients diagnosed with proven and probable S. clavata infection at the University Hospital, Hradec Králové, Czechia between March 2005 and December 2017. Previous cases were identified from the literature and FungiScope® database.ResultsSix new cases (5 females, 1 male) of blood-stream S. clavata infections at the hemato-oncological department were described including epidemiological data of additional 48 patients colonized with the species. Overall, 116 strains of S. clavata were isolated from different clinical specimens of 54 patients; most of them belonged to the respiratory tract (60.3%). S. clavata was the most frequent species among arthroconidial yeasts (Trichosporon, Galactomyces, Magnusiomyces) recovered from the blood. All our patients with S. clavata infection had profound neutropenia, a central venous catheter, broad-spectrum antibiotics and antifungal prophylaxis; four had a history of a biliary tract system disease. The diagnosis was based on a positive blood culture in all patients. Four patients died of multiorgan failure and sepsis despite treatment with lipid-based amphotericin B and/or voriconazole. From the literature and FungiScope database, 67 previous cases of S. clavata infections were evaluated in context of our cases.ConclusionSaprochaete clavata infection represents a life-threatening mycosis in severely immunocompromised patients. The successful outcome of treatment seems to be critically dependent on the early diagnosis and the recovery of underlying conditions associated with immune dysfunction or deficiency.
Highlights
Invasive systemic infections caused by fungi have increasingly been recognized and represent relevant cause of mortality and morbidity in growing segment of immunocompromised patients for the last decades (Miceli et al, 2011; Armstrong-James et al, 2017)
Most systemic infections caused by those arthroconidial fungi are attributable to two species, Magnusiomyces capitatus and Trichosporon asahii
Majority of characteristics of epidemiology, diagnosis and therapy of S. clavata infections are similar to those caused by M. capitatus and T. asahii (Kaplan et al, 2017)
Summary
Invasive systemic infections caused by fungi have increasingly been recognized and represent relevant cause of mortality and morbidity in growing segment of immunocompromised patients for the last decades (Miceli et al, 2011; Armstrong-James et al, 2017). The predisposing conditions are largely associated with changing spectrum of patients (age structure, co-morbidities) who are associated with a more risky therapeutic management such as an extensive surgery or aggressive treatment modalities The majority of these risk factors are related to impaired immune defense mechanisms (hematological malignancies and transplantations, neutropenia, immunodeficiency, HIV), often as a result of the use of immunosuppressant drugs (e.g., corticosteroids, cyclosporine, biologics), the disruption of skin and mucosa integrity (extensive surgery, catheterization, burns, mucositis), and interference of antibiotics with the indigenous microbiota (dysbiosis) (Gulcan et al, 2016; Vallabhaneni and Chiller, 2016; Vallabhaneni et al, 2016; Colombo et al, 2017). Saprochaete clavata (formerly Geotrichum clavatum, proposed as Magnusiomyces clavatus) is a filamentous yeast-like fungus that has recently been described as an emerging pathogen mostly in patients with acute leukemia
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