A cluster of Geotrichum clavatum (Saprochaete clavata) infection in haematological patients: a first Italian report and review of literature.

Maria Ilaria Del Principe, Loredana Sarmati, Mariagiovanna Cefalo, Carla Fontana, Giovanna De Santis, Francesco Buccisano, Luca Maurillo, Eleonora De Bellis, Massimiliano Postorino, Giuseppe Sconocchia, Giovanni Del Poeta, Maurizio Sanguinetti, Sergio Amadori, Livio Pagano, Adriano Venditti

Journal: Mycoses 2017;59(9):594-601

PMID: 27061932

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Abstract

Invasive fungal infections, usually Aspergillus and Candida, represent a major cause of morbidity and mortality in patients with malignant haematological diseases, but in the last years rare fungal infections have more frequently been reported. Here, we report the clinical history of three patients affected with haematological malignancies who developed an infection caused by Geotrichum (G.) clavatum. Two out of three patients were affected by acute myeloid leukaemia (AML), and one by mantle cell lymphoma (MCL). All patients received cytarabine-based chemotherapeutic regimens and developed G. clavatum infection within 3 weeks from therapy initiation. In all cases, G. clavatum was isolated from central venous catheter and peripheral blood cultures. In vitro susceptibility test confirmed an intrinsic resistance to echinocandins and, in all cases, visceral localisations (spleen, liver and lung) were documented by total body computed tomography (CT) scan. A prolonged antifungal therapy with high doses liposomal amphotericin-B was necessary to obtain fever resolution. Only the patient with MCL died while the other two AML recovered, and one of them after received an allogeneic stem cell transplantation. We consecutively reviewed all published cases of infection caused by G. clavatum. Our experience and literature review indicate that G. clavatum can cause invasive infection in haematological patients, mainly in those with acute leukaemia.

Address: Cattedra di Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli studi di Roma "Tor Vergata", Roma, Italia.; Clinica di Malattie Infettive, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Roma, Italia.; Dipartimento di Medicina e Chirurgia, Università Tor Vergata, Roma, Italia.; Istituto di Farmacologia Translazionale, Dipartimento di Medicina, CNR, Roma, Italia.; Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Roma, Italia.; Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma, Italia.

DOI: 10.1111/myc.12508

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MeSH Terms: Adult, Amphotericin B, Antifungal Agents, Central Venous Catheters, Drug Resistance, Fungal, Echinocandins, Fatal Outcome, Female, Geotrichosis, Geotrichum, Hematologic Neoplasms, Hematopoietic Stem Cell Transplantation, Humans, Invasive Fungal Infections, Italy, Leukemia, Myeloid, Acute, Liver, Lung, Lymphoma, Mantle-Cell, Male, Microbial Sensitivity Tests, Middle Aged, Spleen, Tomography, X-Ray Computed, Young Adult