Acremonium strictum Fungaemia in a Paediatric Immunocompromised Patient: Diagnosis and Treatment Difficulties

Abstract

During the past two decades, an increasing number of unusual moulds has been reported as responsible for septicaemia and systemic or disseminated infections in immunocompromised patients. Investigation of fever in a 10-year-old boy with acute myeloblastic leukaemia, including blood cultures on selective media, allowed the diagnosis of a fungaemia due to the slow-growing fungus Acremonium strictum. The patient recovered with liposomal amphotericin B (AmB) and voriconazole, followed by voriconazole alone due to AmB resistance. Facing a neutropenic patient with fever, clinicians usually suspect bacterial or viral aetiologies. This case, however, illustrates the need for mycological analysis of blood samples in febrile neutropenic patients and for antifungal susceptibility testing.

Evaluation of the Efficacies of Amphotericin B, Posaconazole, Voriconazole, and Anidulafungin in a Murine Disseminated Infection by the Emerging Opportunistic Fungus Sarocladium (Acremonium) kiliense

“…While a disseminated infection by an Acremonium sp. in a patient with Addison's disease was successfully treated with that drug (36), failure has mainly been reported in cases of fungemia or disseminated infections (21,23,32,33). Although this drug was able to reduce fungal load in some organs in our study, it was ineffective in prolonging survival for any of the strains tested, which suggests that this drug should be used with caution in cases of human infection.…”

“…AMB has been the drug most commonly used to treat Acremo- nium infection on the basis of its in vitro activity, with very variable results (14,19,21,23,(32)(33)(34)(35)(36). While a disseminated infection by an Acremonium sp.…”

“…Although this drug was able to reduce fungal load in some organs in our study, it was ineffective in prolonging survival for any of the strains tested, which suggests that this drug should be used with caution in cases of human infection. Clinical experience with VRC is more limited; however, some cases of successful treatment with that drug have been reported, although the drug MICs for the Acremonium strains were high (21,23,37,38). Unfortunately, in almost all the cases the Acremonium isolates were not identified at the species level (38).…”

“…Infections by Acremonium spp. are difficult to treat due to the intrinsic resistance to the current antifungal agents, and an effective treatment has not yet been determined (19,(21)(22)(23). Amphotericin B (AMB) is the drug most commonly used to treat severe fungal infections caused by opportunistic molds (4).…”

Synergistic Effect of the Flavonoid Catechin, Quercetin, or Epigallocatechin Gallate with Fluconazole Induces Apoptosis in Candida tropicalis Resistant to Fluconazole

“…easts are the most common opportunistic agents in fungal infections of immunocompromised patients, and new fungal pathogens have emerged over the last decade (1,2). Throughout the last 20 years, the most commonly isolated yeasts from systemic fungal infections have been species of Candida (3).…”