Rare severe mycotic infections in children receiving empirical caspofungin treatment for febrile neutropenia

Abstract

Empirical antifungal therapy is most often given to patients with leukemia. However breakthrough fungal infections under antifungal therapy are not uncommon. Four children, with hematologic malignant disease developed mycotic breakthrough infections while on empirical caspofungin treatment for a median of 14 (range 11-19) days. Trichosporon asahii was detected in the blood culture of two patients and Geotrichum capitatum in the other two (one patient also had positive cerebrospinal fluid culture). Because the patients' clinical situation worsened, voriconazole was empirically added for two patients three and five days before the agent was detected. The first sterile blood culture was obtained 3-7 days of voriconazole treatment. All patients reached clear cultures but one patient died. One patient with central nervous system infection with G. capitatum had severe neurological sequelae. Very severe fungal infections can occur during empirical caspofungin therapy. Therefore, patients should be followed closely.

Disseminated trichosporonosis with atypical histologic findings in a patient with acute lymphocytic leukemia

“…Trichosporon species is increasingly recognized as a dangerous and opportunistic fungus in recent decades; however, pediatric cases remain uncommon . Among 16 reported species of Trichosporon , T. asahii is the most common cause of disseminated infections with little propensity for cutaneous disease .…”

“…Trichosporon species is increasingly recognized as a dangerous and opportunistic fungus in recent decades 1 ; however, pediatric cases remain uncommon. [5][6][7][8][9][10][11][12] Among 16 reported species of Trichosporon, T. asahii is the most common cause of disseminated infections with little propensity for cutaneous disease. 1 The progression of superficial infection with T. asahii to deeper-set tissue involvement has been described, 1 and our case would suggest that skin involvement can also arise in the setting of therapy for invasive disease.…”

Identification of three yeast species using the conventional and internal transcribed spacer region sequencing methods as first or second global record from human superficial infections

“…They have been involved in a variety of opportunistic infections and have been recognised as emerging fungal pathogens in immunocompromised hosts . Studies also indicated that T. asahii , T. asteroids , T. cutaneum , T. faecale , T. inkin , T. mucoides or T. ovoides are involved in hypersensitivity pneumonitis, pulmonary infections and superficial infections, sinusitis, fungaemia, in HIV patients, a bone marrow transplant recipient, a solid organ transplant recipient and in a patient with severe aplastic anaemia . Members of the genus Trichosporon have occasionally been implicated as nail pathogens and in subcutaneous infections .…”

First case of invasive Magnusiomyces capitatus infection in Slovakia

“…This finding suggests that in vitro and in vivo activity of antifungals may differ. There are several publications on cases of infections in patients receiving echinocandins (caspofungin and micafungin) [7], [15], [16]. The removal of central venous catheter also seems to be an important aspect of treatment, as removal was shown as a prognostic indicator for success in one study [6].…”