Wound infection caused by Lichtheimia ramosa due to a car accident.

A 32-year-old immunocompetent man sustained severe traumas contaminated with organic material due to a car accident. An infection caused by Lichtheimia ramosa at the site of contamination was early diagnosed and cured by multiple surgical debridement and daily cleansing with antiseptic solution only.

Species recognition and clinical relevance of the zygomycetous genus Lichtheimia (syn. Absidia pro parte, Mycocladus).

The zygomycete genus Lichtheimia (syn. Absidia pro parte, Mycocladus) consists of saprotrophic fungi inhabiting soil or dead plant material. Lichtheimia corymbifera (syn. Absidia corymbifera, Mycocladus corymbifer) and Lichtheimia ramosa (syn. Absidia ramosa, Mycocladus ramosus) may cause fulminant infections in patients with impaired immunity. The present study investigated the species boundaries in Lichtheimia using genealogical concordance phylogenetic species recognition (by comparison of the genealogies of the internal transcribed spacer [ITS] sequence, the D1/D2 region of the large subunit [LSU], and actin), biological species recognition by mating tests, as well as morphological and physiological characteristics. The three molecular markers used were selected by evaluating the polymorphisms and paralogies of several loci, including those for beta-tubulin, translation elongation factor 1alpha, the two largest subunits of the RNA polymerase II (RPB1 and RPB2), the mitochondrial cytochrome c oxidase subunit I (COI), and the mitochondrial small-subunit (mtSSU) rDNA, among four strains belonging to different putative species. Comparing the genealogies of the ITS, LSU, and actin genes, we recognized seven phylogenetic species. However, mating tests did not show intrinsic reproductive barriers for two pairs of the phylogenetic species. Therefore, we regard five species in Lichtheima to be confirmed: Lichtheimia corymbifera, L. ornata comb. nov., L. ramosa, L. hyalospora, and L. sphaerocystis sp. nov. Only the first three species seem to have clinical relevance. Lichtheimia blakesleeana is reduced to a synonym of Lichtheimia hyalospora. We provide a detailed description of Lichtheimia sphaerocystis sp. nov. and a key for the identification of all accepted species identified in the present study on the basis of their morphological traits and growth at different temperatures.

Fungal colonization in the neonatal intensive care unit: risk factors, drug susceptibility, and association with invasive fungal infections.

A prospective study was conducted to determine risk factors for fungal colonization, drug susceptibility, and association with invasive fungal infections (IFIs) in a neonatal unit. On admission and weekly thereafter, surveillance fungal cultures were taken from mouth, rectum, and trachea of neonates with expected stays of > 1 week. Fungal colonization was detected in 72 (12.1%) of 593 neonates during 12 months. CANDIDA ALBICANS was isolated from 42% of colonized neonates. Although early colonization (age 1.3 +/- 0.2 days) was found in 2.5% of the neonates, late colonization (age 17.6 +/- 1.4 days) was noted in 14.2% of neonates hospitalized for > 5 days. Neonates born vaginally were at higher risk for early colonization than those delivered after cesarean section ( P = 0.01). By multivariate logistic regression, very low birthweight was the only independent risk factor for late colonization. Ten IFIs (nine candidemias) were diagnosed, yielding a rate of 1.1%. These episodes occurred in 6.9% of colonized neonates, compared with 0.76% of noncolonized neonates ( P = 0.002). C. ALBICANS was susceptible to azoles, but some non- ALBICANS CANDIDA spp. exhibited decreased susceptibility to these drugs.

Fungemia due to Trichosporon asahii in a neutropenic child refractory to amphotericin B: clearance with voriconazole.

Disseminated Trichosporon infection in neutropenic patients carries a poor prognosis. Clinical evidence on the use of voriconazole for this infection is limited. The authors report a case of Trichosporon asahii fungemia refractory to liposomal amphotericin B treatment in a boy with acute lymphoblastic leukemia, which resolved after the addition of voriconazole. Both voriconazole and amphotericin B exhibited low minimal inhibitory concentrations and minimal fungicidal concentrations, and their combination was indifferent in vitro. The use of voriconazole for the treatment of trichosporonosis in patients with hematologic malignancies deserves further study.

Fungal peritonitis complicating peritoneal dialysis during an 11-year period: report of 46 cases.

The incidence of fungal peritonitis (FP) and the fungi that caused FP were evaluated in 422 patients treated with peritoneal dialysis. During an 11-year period, 804 episodes of peritonitis occurred, 46 (5.7%) of which were caused by fungi. Treatment was successful for 39 patients. Early diagnosis of FP and prompt therapy decreases morbidity and mortality.

Trichosporon asahii: an unusual cause of invasive infection in neonates.

Trichosporon asahii causes white piedra, an infection of hair shafts and onychomycosis in immunocompetent patients, as well as various localized or disseminated invasive infections in immunodeficient hosts. We describe a 26-week gestation 890-g vaginally delivered female neonate who had severe respiratory distress syndrome and on the sixth day of life developed Klebsiella pneumoniae sepsis. At the same time two blood cultures were positive for T. asahii. The neonate was also colonized with T. asahii in the pharynx and perineum. The infant was successfully treated with conventional amphotericin B.

Invasive candidosis in pediatric patients.

OBJECTIVE: To analyze invasive Candida infections in pediatric patients and to examine the outcome of disease. METHODS: An observational prospective study was carried out of microbiologically documented cases of invasive candidosis in neonates, infants and children at Hippokration Hospital from December 1993 to July 1995. RESULTS: Thirty-nine cases of invasive candidosis (mainly candidemia and candiduria) occurred in 38 patients aged 3 days to 14 years, 21 (54%) having occurred in patients aged <1 month. The incidence was 10.1/1000 admissions in the two neonatal departments versus 1.1/1000 for all other pediatric departments, including oncology (p<0.01). The most frequent causes of hospitalization were premature birth or perinatal problems and surgery. Thirty-five strains of Candida albicans, 10 of C. parapsilosis and eight of other or unidentified species were isolated. Non-C. albicans isolates, especially C. parapsilosis and C. glabrata, exhibited higher minimal inhibitory concentrations of azoles as compared with C. albicans. Thirteen patients (34%), all candidemic, died within 0--40 days. Untreated patients more frequently had positive cultures up to time of death (p<0.0001) and died (p=0.0006). CONCLUSIONS: Invasive candidosis is frequent in pediatric patients, especially premature neonates, and is associated with increased mortality. With early diagnosis and initiation of therapy the outcome is favorable.