Significance and impact of study: Free-living amoebae promote survival and proliferation of multidrugresistant Candida auris. These data indicate that C. auris could be found in the same environmental reservoir than free-living amoeba. A water environmental or hospital reservoir of C. auris can therefore be considered through free-living amoebae. C. auris must be sought in these environments and hospital water network management must be adapted to prevent life-threatening infection.

The epidemiology of invasive fungal diseases (IFDs) is hard to delineate given the difficulties in ascertaining the diagnosis that is often based on the confrontation of clinical and microbiological criteria. The present report underlines the interest of active surveillance involving mycologists and clinicians to describe the global incidence and that of the main IFDs.

A 94-year-old patient in France with no remarkable medical history was hospitalized because of a fall. During hospitalization, the patient had digestive disorders with postprandial regurgitations, leading to undernutrition. At hospital day 24, we performed an abdominal computed tomography scan, which indicated a dolicho-mega esophagus. Because of undernutrition, we introduced parenteral nutrition through peripheral venous catheter on day 36. We performed endoscopic pneumatic dilation to treat achalasia of the esophagus lower sphincter on day 51. One day later (day 52), the patient had a fever, triggering a bloodstream culture, which was positive after 24 hours (day 53) for Streptococcus mitis/oralis and S. gordonii. Parenteral nutrition was stopped, the peripheral catheter was removed, and the patient received piperacillin/ tazobactam. On day 56, a catheter culture was positive for S. mitis/oralis and for a yeast. We identified this yeast by using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry with the Vitek MS 3.2 system (bio-Mérieux, https://www.biomerieux-diagnostics. com), which revealed Candida slooffiae with a maximal score of probability.We performed bloodstream cultures on day 57. Aerobic culture was positive on day 58 for a yeast again, which we identified as C. slooffiae by using

ObjectivesWe aimed to describe patients with autoimmune diseases (AID) developing invasive fungal disease (IFD) and identify factors associated with short-term mortality.MethodsWe analysed cases of IFD associated with AID from the surveillance network of invasive fungal diseases (Réseau de surveillance des infections fongiques invasives, RESSIF) registry of the French national reference centre for invasive mycoses. We studied association of AID-specific treatments with 30-day mortality. We analysed total lymphocyte and CD4-T cell counts in patients withPneumocystis jiroveciipneumonia (PCP).ResultsFrom 2012 to 2018, 549 individuals with IFD and AID were included, mainly with PCP (n=227, 41.3%), fungemia (n=167, 30.4%) and invasive aspergillosis (n=84, 15.5%). Rheumatoid arthritis (RA) and anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV) were the most frequent AID in PCP (n=55 and 25, respectively) and invasive aspergillosis (n=15 and 10, respectively), inflammatory bowel diseases (IBDs) were predominant in fungemia (n=36). At IFD diagnosis, 365 (66.5%) patients received glucocorticoids (GCs), 285 (51.9%) immunosuppressants, 42 (7.7%) tumor necrosis factor (TNF)-α blockers, 75 (13.7%) other biologics. Mortality at 30 days was 28.1% (143/508). Fungemia and high-dose GCs were independently associated with higher 30-day mortality. In PCP patients, lymphopenia <1500/mm3was frequent (132/179, 73.7%) even if CD4+T cell count exceeded 200/mm3in 56/78 patients (71.8%) (median 472.5/mm3, IQR 160–858).ConclusionIFD associated with AID occurs primarily in RA, AAV and IBD, especially when treated with GCs and immunosuppressants. Mortality is high, especially for patients on high-dose GCs. Lymphopenia may help identify risk of PCP, but normal CD4+T cell count does not rule out the risk. Further studies are needed to assess the individual risk factors for IFD.