Durán Graeff Luisa, Seidel Danila, Vehreschild Maria J G T, Hamprecht Axel, Kindo Anupma, Racil Zdenek, Demeter Judit, De Hoog Sybren, Aurbach Ute, Ziegler Maren, Wisplinghoff Hilmar, Cornely Oliver A
Division of Infectious Diseases, Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany.
Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany.
Mycoses. 2017 Apr;60(4):273-279. doi: 10.1111/myc.12595. Epub 2017 Feb 2.
Saprochaete and Geotrichum spp. are rare emerging fungi causing invasive fungal diseases in immunosuppressed patients and scarce evidence is available for treatment decisions. Among 505 cases of rare IFD from the FungiScope registry, we identified 23 cases of invasive infections caused by these fungi reported from 10 countries over a 12-year period. All cases were adults and previous chemotherapy with associated neutropenia was the most common co-morbidity. Fungaemia was confirmed in 14 (61%) cases and deep organ involvement included lungs, liver, spleen, central nervous system and kidneys. Fungi were S. capitata (n=14), S. clavata (n=5), G. candidum (n=2) and Geotrichum spp. (n=2). Susceptibility was tested in 16 (70%) isolates. All S. capitata and S. clavata isolates with the exception of one S. capitata (MIC 4 mg/L) isolate had MICs>32 mg/L for caspofungin. For micafungin and anidulafungin, MICs varied between 0.25 and >32 mg/L. One case was diagnosed postmortem, 22 patients received targeted treatment, with voriconazole as the most frequent first line drug. Overall mortality was 65% (n=15). Initial echinocandin treatment was associated with worse outcome at day 30 when compared to treatment with other antifungals (amphotericin B ± flucytosine, voriconazole, fluconazole and itraconazole) (P=.036). Echinocandins are not an option for these infections.
腐皮霉菌和地霉属是罕见的新兴真菌，可在免疫抑制患者中引起侵袭性真菌病，且治疗决策的证据稀缺。在真菌监测登记处的505例罕见侵袭性真菌病病例中，我们确定了12年间10个国家报告的23例由这些真菌引起的侵袭性感染病例。所有病例均为成年人，既往化疗伴发中性粒细胞减少是最常见的合并症。14例（61%）病例确诊为真菌血症，深部器官受累包括肺、肝、脾、中枢神经系统和肾脏。真菌为头状腐皮霉菌（n = 14）、棒状腐皮霉菌（n = 5）、白地霉（n = 2）和地霉属（n = 2）。对16株（70%）分离株进行了药敏试验。除1株头状腐皮霉菌（MIC 4mg/L）外，所有头状腐皮霉菌和棒状腐皮霉菌分离株对卡泊芬净的MIC均>32mg/L。对于米卡芬净和阿尼芬净，MIC在0.25至>32mg/L之间变化。1例为尸检确诊，22例患者接受了靶向治疗，伏立康唑是最常用的一线药物。总死亡率为65%（n = 15）。与其他抗真菌药物（两性霉素B±氟胞嘧啶、伏立康唑、氟康唑和伊曲康唑）治疗相比，初始棘白菌素治疗在第30天时与更差的预后相关（P = 0.036）。棘白菌素不是这些感染的治疗选择。
