Invasive Saprochaete Infections: An Emerging Threat to Immunocompromised Patients

Abstract

Saprochaete clavata and Saprochaete capitata are emerging fungal pathogens that are responsible for life threatening infections in immunocompromised patients, particularly in the setting of profound neutropenia. They have been associated with multiple hospital outbreaks mainly in Europe. In this article, we present a comprehensive review of the epidemiology, clinical presentation, diagnosis, antifungal susceptibility and treatment of these organisms. The diagnosis of invasive Saprochaete disease is challenging and relies primarily on the isolation of the fungi from blood or tissue samples. Both species are frequently misidentified as they are identical macroscopically and microscopically. Internal transcribed spacer sequencing and matrix-assisted laser desorption ionization-time of flight mass spectrometry are useful tools for the differentiation of these fungi to a species level. Saprochaete spp. are intrinsically resistant to echinocandins and highly resistant to fluconazole. Current literature suggests the use of an amphotericin B formulation with or without flucytosine for the initial treatment of these infections. Treatment with extended spectrum azoles might be promising based on in vitro minimum inhibitory concentration values and results from case reports and case series. Source control and recovery of the immune system are crucial for successful therapy.

Bloodstream Infections Caused by Magnusiomyces capitatus and Magnusiomyces clavatus : Epidemiological, Clinical, and Microbiological Features of Two Emerging Yeast Species

“…S1). MICs of azoles were comparable to data from previous studies ( 6 , 8 , 9 , 28 , 29 ), and MICs of anidulafungin and caspofungin were high, as anticipated ( 9 , 30 ). In contrast, MICs of micafungin were lower, with M. clavatus isolates having significantly lower MICs (MIC 50 , 0.5 mg/L) compared to M. capitatus (MIC 50 , 2 mg/L; P < 0.001).…”

“…Infections with these species are associated with a high mortality rate of 40 to 80% ( 1 , 6 – 8 ). In recent years, the numbers of published cases of infections with M. clavatus and M. capitatus have increased, and both species are considered emerging pathogens ( 4 , 8 – 10 ). Additionally, outbreaks in hospitals have been described, the largest one in 2013 in France with 39 cases ( 4 ).…”

Saprochaete clavata Infection in Immunosuppressed Patients: Systematic Review of Cases and Report of the First Oral Manifestation, Focusing on Differential Diagnosis

“…In fact, fungi are responsible for approximately 20% of microbiologically documented intensive care unit (ICU) infections. In the last decade, the incidence of invasive fungal infections has steadily increased as a result of the increasing numbers of both immunocompromised and critically ill patients [ 1 , 2 , 3 , 4 , 10 , 11 , 28 ].…”

“…Disseminated infection initially arises with nonspecific symptoms (i.e., fever, diarrhea, and pulmonary symptoms), and most infections are mainly diagnosed by blood culture [ 10 ]. The clinical presentation in immunocompetent patients is less severe and rarely reported [ 11 ].…”

Saprochete capitata: Emerging Infections from Uncommon Microorganisms in Hematological Diseases

“…At this point (+20 days from chemotherapy start), from a peripheral vein and peripherally inserted central catheters (PICC) blood cultures, performed during a febrile peak, Saprochaete capitata was isolated ( Table 1 ) by real-time PCR assay. It is an arthroconidia yeast-like filamentous fungi, related to the ascomycetous yeasts increasingly recognized as an emerging threat to immunocompromised patients [ 5 ].…”