Disseminated Intravascular Infection Caused by Paecilomyces variotii: Case Report and Review of the Literature

Abstract

Paecilomyces variotii is a ubiquitous environmental saprophyte with worldwide distribution. Commonly found in soil and decomposing organic material [1, 2], P. variotii can also be isolated from drinking water [3] and indoor and outdoor air [4–6]. In immunocompetent hosts, P. variotii has been reported as a cause of locally invasive disease including prosthetic valve endocarditis [7, 8], endophthalmitis [9, 10], rhinosinusitis [11, 12], and dialysis-associated peritonitis [13, 14]. In contrast, disseminated infections are more commonly reported in immunocompromised patients, including those with chronic granulomatous disease [15], solid malignancy [16], acute leukemia [17], lymphoma [18], multiple myeloma [19], and after stem cell transplant for myelodysplasia [20]. In 1 case series examining invasive infections by non-Aspergillus molds, P. variotii was the most common cause after Fusarium spp. [21]. Here, we present the case of an immunocompetent patient with extensive intravascular infection involving prosthetic material. We describe successful induction therapy with combination antifungals and extended suppression with posaconazole with clinical quiescence and eventual normalization of serum fungal biomarkers.

“Not much room for mushrooms” in the heart: knowns and unknowns of fungal infective endocarditis

“…In many cases with negative cultures or difficulties in identifying the infecting fungal microorganism, beta-D-glucan testing was performed. This was needed in a minority of Candida infections [51,54,55] but more often in Aspergillus [81,84,87,90,92,96] and certain other fungal species [101,106,107,118,[120][121][122][123][124] . Detection for the presence of galactomannan was also performed in IE by Aspergillus [85,89,92,93] and other uncommon species [112][113][114]120,121,125] .…”

“…This was needed in a minority of Candida infections [51,54,55] but more often in Aspergillus [81,84,87,90,92,96] and certain other fungal species [101,106,107,118,[120][121][122][123][124] . Detection for the presence of galactomannan was also performed in IE by Aspergillus [85,89,92,93] and other uncommon species [112][113][114]120,121,125] . Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) has been developed to sequence proteins, map biomolecules in tissues, identify microorganisms, and analyze several biochemical assays in a short time.…”

“…Prior valve replacement might lead to sooner detection of fungal IE [106] . Third, immune compromised conditions [71,83,107,120] , such as post-splenectomy [82] organ transplantation or malignancy [45,85,100,[112][113][114]117,122,125] , or need for steroids for other reasons [16,46,81,93] , also offer an indication. However, some immunocompetent patients could suffer from fungal IE [121] and risk factors may either be absent [99,101] or restricted to an indwelling urinary catheter [59,67] .…”

“…Valve specimens, infected grafts [96] , abscesses [88] , and vegetations or emboli can be cultured and examined by histology and immunohistochemistry. Sometimes, identification can only be obtained postmortem [48,120] . Cultures and histology of cutaneous nodules [112,114] , systemic ulcers, or abscesses [55] can also give an early identification of the agent.…”

Characterization and expression of fungal defensin in Escherichia coli and its antifungal mechanism by RNA-seq analysis

“…In general, Paecilomyces variotii is distributed in air, soil, water, foods, and decaying plants. Recently, various cases of IFIs caused by P. variotii have been successively reported, such as pulmonary mycetoma, cutaneous mycetoma, intravascular infection, and pneumonia (Paixão Marques et al, 2019 ; Lazarus et al, 2020 ; Asif et al, 2021 ; Criado et al, 2021 ). Fluconazole is commonly used in patients with hematological malignancies, and it can effectively reduce the incidence of IFIs.…”