Invasive infections withPurpureocillium lilacinum: clinical characteristics and outcome of 101 cases from FungiScope® and the literature

Abstract

Objectives To provide a basis for clinical management decisions in Purpureocillium lilacinum infection. Methods Unpublished cases of invasive P. lilacinum infection from the FungiScope® registry and all cases reported in the literature were analysed. Results We identified 101 cases with invasive P. lilacinum infection. Main predisposing factors were haematological and oncological diseases in 31 cases (30.7%), steroid treatment in 27 cases (26.7%), solid organ transplant in 26 cases (25.7%), and diabetes mellitus in 19 cases (18.8%). The most prevalent infection sites were skin (n = 37/101, 36.6%) and lungs (n = 26/101, 25.7%). Dissemination occurred in 22 cases (21.8%). Pain and fever were the most frequent symptoms (n = 40/101, 39.6% and n = 34/101, 33.7%, respectively). Diagnosis was established by culture in 98 cases (97.0%). P. lilacinum caused breakthrough infection in 10 patients (9.9%). Clinical isolates were frequently resistant to amphotericin B, whereas posaconazole and voriconazole showed good in vitro activity. Susceptibility to echinocandins varied considerably. Systemic antifungal treatment was administered in 90 patients (89.1%). Frequently employed antifungals were voriconazole in 51 (56.7%) and itraconazole in 26 patients (28.9%). Amphotericin B treatment was significantly associated with high mortality rates (n = 13/33, 39.4%, P = <0.001). Overall mortality was 21.8% (n = 22/101) and death was attributed to P. lilacinum infection in 45.5% (n = 10/22). Conclusions P. lilacinum mainly presents as soft-tissue, pulmonary or disseminated infection in immunocompromised patients. Owing to intrinsic resistance, accurate species identification and susceptibility testing are vital. Outcome is better in patients treated with triazoles compared with amphotericin B formulations.

Interactions among the mycobiome, bacteriome, inflammation, and diet in people living with HIV

“… 1–5 As shown in Figure 5a and Figure S7, the bacterial translocation markers (lipoteichoic acid, LTA and lipopolysaccharide binding protein, LBP) and monocyte activation marker (soluble CD14, sCD14), which are metabolically related, clustered together and directly correlated with Purpureocillium lilacinum (r = 0.86, 0.72, 0.82, respectively), a filamentous fungus able to produce opportunistic infections in immunocompetent and immunocompromised hosts. 23 Also, bacterial members, such as Blautia, Streptococcus, Romboutsia , and Lachnospiraceae genus, showed a correlation with these three inflammation markers (Table S5), as previously reported. 21 , 22 Other correlations included a direct association between soluble CD163 (sCD163), a biomarker of macrophage activation, with lower association index with Purpureocillium lilacinum (r = 0.39), Romboutsia (r = 0.44) and Lachnospiraceae UCG-004 (r = 0.39) although they showed lower association index (Figure S7, Table S5).…”

Species Identification and In Vitro Antifungal Susceptibility of Paecilomyces/Purpureocillium Species Isolated from Clinical Respiratory Samples: A Multicenter Study

“…Significant differences in in vitro antifungal susceptibility were observed between P. variotii sensu lato and P. lilacinum , which is consistent with the findings of other studies [ 4 , 5 , 6 , 8 , 13 , 14 , 15 ]. In general, the antifungal susceptibility profiles of P. variotii stricto sensu , P. maximus , P. dactylethromorphus , and P. divaricatus appeared to be similar to what other studies had already shown, although a limited number of isolates were tested in those studies [ 13 , 14 , 15 ].…”

“…Paecilomyces fungi often infect immunocompromised patients, however immunocompetent patients are not spared and can become infected by direct inoculation of the fungus following trauma. Clinical presentations of Paecilomyces spp., such as cutaneous or catheter-related infections, ocular infections, peritonitis, sinusitis, pneumonia, osteomyelitis or fungemia have been reported in the medical literature [ 3 , 4 , 5 , 6 , 7 ].…”

Complicated multiple organ infection of Purpureocillium lilacinum and varicella-zoster virus infection in a patient with Evans’ syndrome

“…Its lilac obverse color and its characteristic to sporulate in infected tissues together help the identification of P lilacinum infections. 13,14 Species identification of the causative agent is crucial for treatment because different species of the genus Paecilomyces show variable susceptibilities to antifungal medicines. P lilacinum has a poor response to traditional antifungal agents.…”

“…The diagnosis of P lilacinum infection is based on the culture of the fungus and pathology of the lesions. Its lilac obverse color and its characteristic to sporulate in infected tissues together help the identification of P lilacinum infections 13,14 …”