Invasive Geotrichum clavatum fungal infection in an acute myeloid leukaemia patient: a case report and review.

Invasive Geotrichum clavatum fungal infections are extremely rare and unusual, occurring nearly exclusively in patients experiencing prolonged neutropenia during the treatment for acute myeloid leukaemia. Several groups of cases of fatal G. clavatum infection were reported in France between 2011 and 2012, but the ecological niche has not yet been identified. We report a case of a 32-year-old patient with acute myeloid leukaemia who developed G. clavatum sepsis with primary peritonitis, hepatic nodular lesions, and multivisceral failure during aplasia after induction followed by salvage chemotherapy. He was treated with voriconazole and is still alive 1 year after with controlled disease. We then discuss the epidemiological, clinical, and therapeutic features of these serious fungal infections compared to the published data.

[Double fungemia. Report of four Tunisian cases]. / Les fongémies mixtes. À propos de quatre cas tunisiens.

UNLABELLED: Fungemia is classically caused by a single species and the detection of more than one species in blood samples is uncommon. We report four cases of mixed fungemia (MF) diagnosed in the parasitology-mycology laboratory of Farhat-Hached hospital in Sousse, Tunisia. The MF episodes occurred in two neonates and two adults suffering from acute myeloid leukemia. Two fungal species were detected concomitantly within the same blood culture in all cases. Species combination was detected by the subculture of the blood culture on Candida ID(®) chromogenic medium in three cases and on Sabouraud agar in one case. Predisposing factors were: indwelling catheters (4/4), broad-spectrum antibiotics (3/4), neutropenia (2/4), exclusive parenteral nutrition (2/4) and Candida colonization (1/4). Patients presented febrile sepsis with no response to broad-spectrum antibiotic therapy in all cases. Outcome under antifungal treatment was favorable in two cases and the two other patients died. CONCLUSION: MF appears similar to the more common monomicrobial fungemia. The use of chromogenic media in routine can improve the detection of MF episodes allowing appropriate antifungal therapy.

Isolation and identification of Geotrichum candidum as an etiologic agent of geotrichosis in Bulgaria.

Geotrichosis affects mainly patients with systemic diseases like diabetes mellitus, leukoses, neoplasms etc. Clinically, it is similar to candidiasis and may occur as an oral, vaginal, skin, or systemic infection. Clinical specimens (98 sputa and 67 oral smears) were collected and studied using microscopic examination of Gram stained preparations and culture sampling between 1995 and 1997. Geotrichum candidum was isolated as a single pathogen in 8 sputum and 7 oral smear samples. Ten-day antifungal treatment with Nizoral was applied and resulted in relatively quick clinical improvement. The presented cases are the first cases of pulmonary and oral infections reported in our home practice in which Geotrichum candidum species was identified as a pathogen. The identification of Geotrichum candidum using combination of colonial and microscopic morphologic features increase the possibilities for diagnostic decision.

Disseminated Geotrichum infection.

Intensive chemotherapy has prolonged survival in cancer patients. Unfortunately it has also predisposed them to unusual infections because of their immunocompromised state. We report a case of fungal septicaemia caused by Geotrichum candidum, an imperfect yeast of low virulence in a young girl with acute lymphoblastic leukaemia. It was successfully treated with amphotericin B. The morphological characteristics of this fungus leading to its identification are described.

Disseminated geotrichosis in two dogs.

Disseminated geotrichosis was diagnosed at necropsy of 2 unrelated dogs from the same household. Clinical signs of disease included fever, coughing, anorexia, listlessness, polydipsia, and dyspnea. The duration of clinical illness was less than 2 weeks. Pathologic findings in both dogs were similar and consisted of pyogranulomatous pneumonia, hepatitis, and nephritis. Geotrichum candidum was identified by fluorescent antibody technique.

Disseminated Geotrichum capitatum infection in a patient with acute myeloid leukemia.

A case of invasive Geotrichum capitatum infection is reported; a young patient had an acute leukemia for which he received a chemotherapy, and presented sepsis with blood cultures for Geotrichum capitatum, namely Dipodascus spicifer; this pathogen only described in cactus rot, is responsible for the first case of a human disseminated infection reported in literature. Then he developed a splenic and epididymic infection, with positive cultures for Geotrichum capitatum after splenectomy and castration. Treatment with amphotericin B and itraconazole was started with low minimal inhibitory concentration (0.1 microgram/ml). The patient died of massive hemoptisis. Autopsy findings demonstrated a lung, brain and kidneys seeding.

Mycoses in immunocompromised patients. An histopathologic study of 61 cases.

The histopathologic pattern of secondary mycoses in 61 immunocompromised patients is presented. The underlying diseases were: neoplasms, organ transplants, AIDS and a variety of other debilitating diseases. Three patients with AIDS had a double fungal infection. Candida spp. accounted for the majority of deep-seated mycoses, with 27 cases (44.2%); disseminated candidiasis was responsible of 18.5% of these patients death. Aspergillosis was seen in 23 subjects (37.7%), 18 of them (78.2%) died for systemic infection. These patients were severely debilitated by disease and/or iatrogenic procedures. The other fungal infections were: actinomycosis (10 cases), gerotrichosis (2 cases), histoplasmosis (1 case) and cerebral phaeohyphomycosis (1 case).

Disseminated Geotrichum candidum infection.

The pathogenicity of the fungus Geotrichum candidum in humans has not been clearly defined. A patient with acute leukemia who developed a fatal disseminated G. candidum infection while neutropenic is described. At autopsy examination, this patient was misdiagnosed on the basis of histopathology as having disseminated candidiasis until G. candidum was isolated from postmortem culture specimens. The emergence of this organism as an occasional pathogen in leukemic patients is of interest and illustrates the importance of obtaining fungal cultures. There is a need for more effective drugs for antifungal prophylaxis and therapy.

Systemic infection with Trichosporon capitatum in two patients with acute leukaemia.

Trichosporon capitatum was isolated from the blood of two patients with acute leukaemia who were undergoing induction chemotherapy. Both patients died of their infections, and the fungus was cultured from their tissues after death. Systemic infection was proved by demonstrating the same pattern of fluorescein-labelled lectin staining of fungal elements in the tissues as was shown by the fungal isolates.

Dermatomicosis: análisis retrospectivo de 2,336 pacientes, 1976-1980

Se presentan 2,336 casos de dermatomicosis observados en el periodo 1976-1980 en el Laboratorio de Micología de la Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia. El diagnóstico de dermatofitosis se comprobó en 1.276 casos (52.1 por ciento); candidiasis se presentó en 870 casos (35.5 por ciento), pitiriasis en 150 casos (6.1 por ciento), tricosporiasis en 90 casos (3.7 por ciento), geotricosis en 52 casos (2.1 por ciento) y varios en 13 casos (0.5 por ciento); de estos últimos es de resaltar el aislamiento de dos casos de M. persicolor y dos de T. verrucosum. El dermatofito más frecuentemente aislado fue el T. mentagrophytes (32.7 por ciento) seguido por el T. rubrum (23.0 por ciento), el E. floccosum (21.7 por ciento), el T. tonsurans (11.7 por ciento) y en último lugar los Microsporum sp. (10.9 por ciento)

Geotrichum candidum as a tissue invasive human pathogen.

Geotrichum candidum was identified as an invasive organism in the terminal ileum of a man with "hairy cell" leukemia. The organism was identified on the basis of histologic and cultural characteristics. The diagnostic features of G. candidum infection are compared to those of Aspergillus and Candida species.