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Kraft L, Ribeiro VST, Petroski LP, Herai RH, Peronni KC, Figueiredo DLA, Motta FA, Tuon FF. Saprochaete clavata invasive infection: characterization, antifungal susceptibility, and biofilm evaluation of a rare yeast isolated in Brazil. Rev Inst Med Trop Sao Paulo 2023; 65:e12. [PMID: 36722674 PMCID: PMC9886229 DOI: 10.1590/s1678-9946202365012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 12/07/2022] [Indexed: 02/02/2023] Open
Abstract
Rare emerging pathogens such as Saprochaete clavata are associated with invasive fungal diseases, high morbidity, mortality, rapidly fatal infections, and outbreaks. However, little is known about S. clavata infections, epidemiology, risk factors, treatment, biofilms, and disease outcomes. The objective of this study was to describe a new case of severe S. clavata infection in a patient diagnosed at a referral children's hospital in Brazil, including antifungal minimal inhibitory concentration, S. clavata biofilm characterization, and molecular characterization. The S. clavata isolated from an immunocompromised 11-year-old male patient was characterized using MALDI-TOF, Gram staining, scanning electron microscopy (SEM), and next generation sequencing (NGS) of genomic DNA. Biofilm production was also evaluated in parallel with determining minimal inhibitory concentration (MIC) and biofilm sensitivity to antifungal treatment. We observed small to medium, whitish, farinose, dry, filamentous margin colonies, yeast-like cells with bacillary features, and biofilm formation. The MALDI-TOF system yielded a score of ≥ 2,000, while NGS confirmed S. clavata presence at the nucleotide level. The MIC values (in mg L-1) for tested drugs were as follows: fluconazole = 2, voriconazole ≤ 2, caspofungin ≥ 8, micafungin = 2, amphotericin B = 4, flucytosine ≤ 1, and anidulafungin = 1. Amphotericin B can be active against S. clavata biofilm and the fungus can be susceptible to new azoles. These findings were helpful for understanding the development of novel treatments for S. clavata-induced disease, including combined therapy for biofilm-associated infections.
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Affiliation(s)
- Letícia Kraft
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Pós-Graduação em Ciências da Saúde, Laboratório de Doenças Infecciosas e Emergentes, Curitiba, Paraná, Brazil,Hospital Infantil Pequeno Príncipe, Curitiba, Paraná, Brazil
| | - Victoria Stadler Tasca Ribeiro
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Pós-Graduação em Ciências da Saúde, Laboratório de Doenças Infecciosas e Emergentes, Curitiba, Paraná, Brazil
| | - Luiz Pedro Petroski
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Pós-Graduação em Ciências da Saúde, Laboratório de Bioinformática e Neurogenética, Curitiba, Paraná, Brazil
| | - Roberto Hirochi Herai
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Pós-Graduação em Ciências da Saúde, Laboratório de Bioinformática e Neurogenética, Curitiba, Paraná, Brazil
| | | | | | | | - Felipe Francisco Tuon
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Pós-Graduação em Ciências da Saúde, Laboratório de Doenças Infecciosas e Emergentes, Curitiba, Paraná, Brazil
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Goupillou P, Costa D, Gargala G, Favennec L, Rouzaud C, Muraine M, Schneider P, Gueudry J. Saprochaete clavata Chorioretinitis in a Post-chemotherapy Immunocompromised 9-Year-Old Child. Ocul Immunol Inflamm 2022:1-4. [PMID: 35587644 DOI: 10.1080/09273948.2022.2070502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe the management of bilateral chorioretinitis with Saprochaete clavata in a post-chemotherapy immunocompromised young patient. METHOD A retrospective case report. RESULT A 9-year-old boy treated with chemotherapy for type 2 acute myeloid leukaemia was diagnosed with Saprochaete clavata (formerly called Geotrichum clavatum) fungaemia. Systematic ocular examination revealed chorioretinitis of the left eye becoming bilateral within the next 3 days. Therapy was based on systemic administration of voriconazole, amphotericin B and flucytosine associated with granulocytic stimulation without stabilizing the ophthalmological situation. Bilateral intravitreal injections of amphotericin B were administered. Voriconazole residual blood concentration was monitored to adjust daily dose. Final best corrected visual acuity in the right eye was 20/50 and 20/20 in the left eye. CONCLUSION This is the first report of chorioretinitis with Saprochaete clavata. Because of its unpredictable pharmacokinetics, especially in pediatric population, therapeutic drug monitoring of voriconazole is essential to control fungal infection.
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Affiliation(s)
- Paul Goupillou
- Department of Ophthalmology, Rouen University Hospital, Rouen, France
| | - Damien Costa
- Department of Parasitology and Mycology, Rouen University Hospital, Rouen, France.,EA 7510 Epidemio-surveillance and circulation of parasites in the environment, Faculty of Medicine and Pharmacy, Rouen University, Rouen, France
| | - Gilles Gargala
- Department of Parasitology and Mycology, Rouen University Hospital, Rouen, France.,EA 7510 Epidemio-surveillance and circulation of parasites in the environment, Faculty of Medicine and Pharmacy, Rouen University, Rouen, France
| | - Loic Favennec
- Department of Parasitology and Mycology, Rouen University Hospital, Rouen, France.,EA 7510 Epidemio-surveillance and circulation of parasites in the environment, Faculty of Medicine and Pharmacy, Rouen University, Rouen, France
| | - Claire Rouzaud
- Infectious Diseases Department, University Hospital Necker Enfants Malades, APHP, Paris, France
| | - Marc Muraine
- Department of Ophthalmology, Rouen University Hospital, Rouen, France
| | | | - Julie Gueudry
- Department of Ophthalmology, Rouen University Hospital, Rouen, France.,EA 7510 Epidemio-surveillance and circulation of parasites in the environment, Faculty of Medicine and Pharmacy, Rouen University, Rouen, France
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Saprochaete clavata Infection in Immunosuppressed Patients: Systematic Review of Cases and Report of the First Oral Manifestation, Focusing on Differential Diagnosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052385. [PMID: 33804487 PMCID: PMC7957747 DOI: 10.3390/ijerph18052385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 12/22/2022]
Abstract
Background: Saprochaete clavata infection is an emerging issue in immunosuppressed patients, causing fulminant fungaemia. The purpose of this systematic review of cases is to retrieve all cases of S. clavata infection and describe oral lesions as the first manifestation of S. clavata infection. Methods: We report the first case of intraoral S. clavata infection in Acute Myeloid Leukemia (AML) affected subject, presenting as multiple grayish rapidly growing ulcerated swellings, and provide a review of all published cases of infection caused by S. clavata, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, conducted by searching SCOPUS, Medline, and CENTRAL databases. Only articles in English were considered. Individual patient data were analyzed to identify risk factors for S. clavata infection. Results: Seventeen of 68 retrieved articles were included in the review reporting data on 96 patients (mean age 51.8 years, 57 males and 38 females). Most cases were disseminated (86) with a 60.2% mortality rate. Ninety-five were hematological patients, with AML being the most common (57 cases). Conclusions:S. clavata infection in immunosuppressed patients has a poor prognosis: middle-age patients, male gender and Acute Myeloid Leukemia should be considered risk factors. In immunosuppressed patients, the clinical presentation can be particularly unusual, imposing difficult differential diagnosis, as in the reported case.
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Özkaya E, Tosun İ, Tüfekçİ EF, Buruk CK, Kaklıkkaya N, Aydın F. Identification and antifungal susceptibility of Saprochaete clavata from invasive infections in Turkey. Acta Microbiol Immunol Hung 2020; 67:252-257. [PMID: 33258797 DOI: 10.1556/030.2020.01301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 10/28/2020] [Indexed: 11/19/2022]
Abstract
Saprochaete clavata is an emerging opportunistic pathogen, that causes life-threatening infections, but there are limited evidence and information about the evaluation of in vitro antifungal susceptibility test results. The aim of this study was to determine S. clavata isolates from clinical specimens and to investigate their in vitro antifungal susceptibility. S. clavata was identified by API ID20C AUX (BioMérieux, Brussels, Belgium), MALDI TOF (Bruker Daltonik, Germany), and ITS gene region sequencing. In vitro susceptibility tests were performed using Sensititre YeastOne (TREK Diagnostic System, East Grinstead, UK). During the study period, 4,736 fungi were isolated from various clinical samples and, S. clavata was identified in eight patients with underlying diseases namely, pancreatic neoplasma, acute myeloid leukaemie, follicular lymphoma, cholelithiasis. Anidulafungin and micafungin minimum inhibitory concentration values were 1-2 and 1-4 mg/L, respectively, while those of the azole group antifungals were much lower. This is the first study in Turkey reporting isolation, identification and antifungal susceptibilities of S. clavata from clinical specimens. Higher MIC values seen in some isolates suggest that continuous monitoring of sensitivity rates and observation of regional differences will thus be useful guides in determining infection control and antifungal use policies.
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Affiliation(s)
- Esra Özkaya
- 1Department of Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - İlknur Tosun
- 1Department of Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Enİs Fuat Tüfekçİ
- 2Department of Clinical Microbiology, Kastamonu University School of Medicine, Kastamonu, Turkey
| | - Celal Kurtuluş Buruk
- 1Department of Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Neşe Kaklıkkaya
- 1Department of Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Faruk Aydın
- 1Department of Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
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El Zein S, Hindy JR, Kanj SS. Invasive Saprochaete Infections: An Emerging Threat to Immunocompromised Patients. Pathogens 2020; 9:pathogens9110922. [PMID: 33171713 PMCID: PMC7694990 DOI: 10.3390/pathogens9110922] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 12/16/2022] Open
Abstract
Saprochaete clavata and Saprochaete capitata are emerging fungal pathogens that are responsible for life threatening infections in immunocompromised patients, particularly in the setting of profound neutropenia. They have been associated with multiple hospital outbreaks mainly in Europe. In this article, we present a comprehensive review of the epidemiology, clinical presentation, diagnosis, antifungal susceptibility and treatment of these organisms. The diagnosis of invasive Saprochaete disease is challenging and relies primarily on the isolation of the fungi from blood or tissue samples. Both species are frequently misidentified as they are identical macroscopically and microscopically. Internal transcribed spacer sequencing and matrix-assisted laser desorption ionization-time of flight mass spectrometry are useful tools for the differentiation of these fungi to a species level. Saprochaete spp. are intrinsically resistant to echinocandins and highly resistant to fluconazole. Current literature suggests the use of an amphotericin B formulation with or without flucytosine for the initial treatment of these infections. Treatment with extended spectrum azoles might be promising based on in vitro minimum inhibitory concentration values and results from case reports and case series. Source control and recovery of the immune system are crucial for successful therapy.
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Affiliation(s)
- Said El Zein
- Internal Medicine Department, Wayne State University/Detroit Medical Center, Detroit, MI 48201, USA;
| | - Joya-Rita Hindy
- Division of Infectious Diseases, Internal Medicine Department, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
| | - Souha S. Kanj
- Division of Infectious Diseases, Internal Medicine Department, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
- Correspondence:
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Gao H, Yin X, Jiang X, Shi H, Yang Y, Wang C, Dai X, Chen Y, Wu X. Diversity and spoilage potential of microbial communities associated with grape sour rot in eastern coastal areas of China. PeerJ 2020; 8:e9376. [PMID: 32607286 PMCID: PMC7315622 DOI: 10.7717/peerj.9376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 05/27/2020] [Indexed: 02/05/2023] Open
Abstract
As a polymicrobial disease, sour rot decreases grape berry yield and wine quality. The diversity of microbial communities in sour rot-affected grapes depends on the cultivation site, but the microbes responsible for this disease in eastern coastal China, has not been reported. To identify the microbes that cause sour grape rot in this important grape-producing region, the diversity and abundance of bacteria and fungi were assessed by metagenomic analysis and cultivation-dependent techniques. A total of 15 bacteria and 10 fungi were isolated from sour rot-affected grapes. High-throughput sequencing of PCR-amplicons generated from diseased grapes revealed 1343 OTUs of bacteria and 1038 OTUs of fungi. Proteobacteria and Firmicutes were dominant phyla among the 19 bacterial phyla identified. Ascomycota was the dominant fungal phylum and the fungi Issatchenkia terricola, Colletotrichum viniferum, Hanseniaspora vineae, Saprochaete gigas, and Candida diversa represented the vast majority ofmicrobial species associated with sour rot-affected grapes. An in vitro spoilage assay confirmed that four of the isolated bacteria strains (two Cronobacter species, Serratia marcescens and Lysinibacillus fusiformis) and five of the isolated fungi strains (three Aspergillus species, Alternaria tenuissima, and Fusarium proliferatum) spoiled grapes. These microorganisms, which appear responsible for spoiling grapes in eastern China, appear closely related to microbes that cause this plant disease around the world.
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Affiliation(s)
- Huanhuan Gao
- Shandong Academy of Grape, Jinan, China.,Shandong Academy of Agricultural Sciences, Institute of Plant Protection, Jinan, China
| | | | | | | | - Yang Yang
- Shandong Academy of Grape, Jinan, China
| | | | - Xiaoyan Dai
- Shandong Academy of Grape, Jinan, China.,Shandong Academy of Agricultural Sciences, Institute of Plant Protection, Jinan, China
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Erman B, Fırtına S, Aksoy BA, Aydogdu S, Genç GE, Doğan Ö, Bozkurt C, Fışgın T, Çipe FE. Invasive Saprochaete capitata Infection in a Patient with Autosomal Recessive CARD9 Deficiency and a Review of the Literature. J Clin Immunol 2020; 40:466-474. [PMID: 32020378 DOI: 10.1007/s10875-020-00759-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Autosomal recessive (AR) CARD9 deficiency is an inherited immune disorder which results in impaired innate immunity against various fungi. Superficial and invasive fungal infections, mainly caused by Candida or Trichophyton species, are the hallmark of CARD9 deficiency. Together with the increasing number of CARD9-deficient patients reported, different pathogenic fungal species have been described such as Phialophora, Exophiala, Corynespora, Aureobasidium, and Ochroconis. Saprochaete capitata is an opportunistic infectious agent in immunocompromised patients and is a common cause of invasive fungal disease in patients with hematological malignancies. In this study, we investigated the causative genetic defect in a patient with S. capitata fungal infection which disseminated to lymph nodes and common bile duct. METHODS The identification of the isolated yeast strain was made by direct microscopic examination and confirmed by internal transcribed spacer (ITS) sequencing. We applied whole exome sequencing to search for the disease-causing mutation. Sanger sequencing was used to validate the mutation in the patient and his parents. RESULTS S. capitata was isolated from the biopsy specimen as the causative microorganism responsible for the invasive fungal disease in the patient. Whole exome sequencing revealed a homozygous c.883C > T, (p.Q295*) mutation in CARD9, confirmed by Sanger sequencing. CONCLUSIONS This is the first report of invasive Saprochaete infection associated with autosomal recessive (AR) CARD9 deficiency in the literature and thereby further extends the spectrum of fungal diseases seen in these patients.
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Affiliation(s)
- Baran Erman
- Department of Molecular Biology and Genetics, Istinye University, Istanbul, Turkey.
- Institute of Child Health, Hacettepe University, 06100, Ankara, Turkey.
| | - Sinem Fırtına
- Department of Molecular Biology and Genetics, Istinye University, Istanbul, Turkey
| | - Başak Adaklı Aksoy
- Department of Pediatrics, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Selime Aydogdu
- Department of Hematology-Oncology, Medical Park Hospital, Istanbul, Turkey
| | - Gonca Erköse Genç
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Öner Doğan
- Department of Pathology, Medical School of Koc University, Istanbul, Turkey
| | - Ceyhun Bozkurt
- Department of Pediatrics, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Tunç Fışgın
- Department of Pediatrics, Altınbaş University Faculty of Medicine, Istanbul, Turkey
| | - Funda Erol Çipe
- Department of Pediatrics, Istinye University Faculty of Medicine, Istanbul, Turkey
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