Breakthrough disseminated Saprochaete capitata infection in a child with acute myeloid leukaemia receiving caspofungin therapy

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.Keywords: Breakthrough infection; echinocandins; fungaemia; Saprochaete capitata. IntroductionSaprochaete 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). It is known to colonize the respiratory and digestive tracts of humans and appears to have similar pathogenesis to other yeast species colonizing mucosal surfaces (Birrenbach et al., 2012). Most cases of S. capitata infection have occurred in patients with haematological malignancies and persistent neutropenia receiving chemotherapy (Fouassier et al., 1998;Martino et al., 2004;Girmenia et al., 2005;Miceli et al., 2011; Lafayette et al., 2011;Ö zkaya-Parlakay et al., 2012;García-Ruiz et al., 2013). Disseminated S. capitata, infection is associated with high mortality, thus underscoring the need for accurate identification, prior antifungal susceptibility testing and early initiation of specific therapy (Girmenia et al., 2005). Here, we describe a fatal case of breakthrough S. capitata infection in a child who was on empirical caspofungin therapy. Case reportAn 11-year-old Egyptian female, a known case of acute myeloid leukaemia since December 2009, underwent allogeneic bone-marrow transplantation in August 2011. 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. During her PICU stay, she remained severely neutropenic (absolute neutrophil count ,100 mm 21 ) and experienced two more episodes of bacteraemia, one due to Staphylococcus epidermidis and the other due to Stenotrophomonas maltophilia from blood drawn through the Port-A-Cath. For these infections, she was treated with teicoplanin, colistin, meropenem, clarithromycin and cotrimoxazole. Caspofungin was added empirically in the treatment regimen. The Port-A-Cath was not change...

Disseminated Saprochaete capitata in a patient with Diabetes mellitus and HCV Hepatitis; A Case Report

“…She met her demise suffering from multiorgans dysfunction and failure. Here, Saprochaete capitata isolate was resistant to the tested antifungals, this agrees with the previously published literature from different authors that disseminated infection with Saprochaete capitata is usually difficult to treat and carries high mortality [2,7,8]. This is one of the rare cases of disseminated Saprochaete capitata in a patient without hematological malignancy; however the patient had a prolonged ICU stay, mechanical ventilation, and was exposed to several antibacterials, which are known risk factors for acquiring invasive candidiasis [10,11].…”

“…Mortality was about 60% and amphotericin was the mostly prescribed antifungal [2]. After their report, two cases were reported by other investigators as well as our current case [5,7]. Our patient did not have hematological malignancy like earlier reports, rather diabetes mellitus and HCV hepatitis as comorbidities.…”

“…Uncommonly, a related species i.e.Geotrichum clavatum was also reported to cause disseminated infections in few patients with acute myeloid leukemia [6]. Saprochaete capitata breakthrough was also reported in patients suffering from hematological malignancy while being treated with echinocandin therapy; caspofungin was the agent used in those reports [7,8,9]. As knowledge regarding this fungus piles up, both fluconazole and ecchinocandins are recognized for being inadequate strategy as prophylactic or empirical antifungal treatment in patient with hematological malignancy when cases of Saprochaete capitata were found colonizing hematology unit and a potential threat to patients.…”

Infection fongique disséminée à Magnusiomyces capitatus chez un patient transplanté hépatique

“…La greffe d'organes ne semble pas présenter un risque majeur puisque seulement 2 cas ont été décrits par Birrenbach et al [3] : L'expression clinique d'une géotrichose est peu spécifique avec une fièvre persistante sous antibiothérapie à large spectre [12,23]. La fièvre retrouvée chez la plupart des malades dans la littérature [3,4,6,9,[12][13][14]26,27] est apparue chez notre patient après 11 jours d'hospitalisation et a persisté malgré la mise sous antibiotique attirant l'attention vers un abcès profond ou une infection mycotique.…”

“…Seule la culture sur milieu de Sabouraud permet d'avoir un diagnostic de certitude [23]. M. capitatus a été isolé dans notre cas dans le sang, les urines, et le LBA comme dans les cas décrits par Birrenbach et al [3] et Purohit et al [26]. Dans d'autres observations, l'isolement s'est fait soit uniquement à partir du sang [4,6,9,14,15,20], soit à partir du sang et des expectorations [13,27], soit des urines [3,21], soit du liquide de dialyse [3].…”