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Menu E, Filori Q, Dufour JC, Ranque S, L’Ollivier C. A Repertoire of the Less Common Clinical Yeasts. J Fungi (Basel) 2023; 9:1099. [PMID: 37998905 PMCID: PMC10671991 DOI: 10.3390/jof9111099] [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: 10/09/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
Invasive fungal diseases are a public health problem. They affect a constantly increasing number of at-risk patients, and their incidence has risen in recent years. These opportunistic infections are mainly due to Candida sp. but less common or rare yeast infections should not be underestimated. These so-called "less common" yeasts include Ascomycota of the genera Candida (excluding the five major Candida species), Magnusiomyces/Saprochaete, Malassezia, and Saccharomyces, and Basidiomycota of the genera Cryptococcus (excluding the Cryptococcus neoformans/gattii complex members), Rhodotorula, and Trichosporon. The aim of this review is to (i) inventory the less common yeasts isolated in humans, (ii) provide details regarding the specific anatomical locations where they have been detected and the clinical characteristics of the resulting infections, and (iii) provide an update on yeast taxonomy. Of the total of 239,890 fungal taxa and their associated synonyms sourced from the MycoBank and NCBI Taxonomy databases, we successfully identified 192 yeasts, including 127 Ascomycota and 65 Basidiomycota. This repertoire allows us to highlight rare yeasts and their tropism for certain anatomical sites and will provide an additional tool for diagnostic management.
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Affiliation(s)
- Estelle Menu
- Laboratoire de Parasitologie-Mycologie, IHU Méditerranée Infection, 13385 Marseille, France; (S.R.); (C.L.)
- Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, Aix Marseille Université, 13385 Marseille, France
| | - Quentin Filori
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Aix Marseille University, 13385 Marseille, France; (Q.F.); (J.-C.D.)
| | - Jean-Charles Dufour
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Aix Marseille University, 13385 Marseille, France; (Q.F.); (J.-C.D.)
- APHM, Hôpital de la Timone, Service Biostatistique et Technologies de l’Information et de la Communication, 13385 Marseille, France
| | - Stéphane Ranque
- Laboratoire de Parasitologie-Mycologie, IHU Méditerranée Infection, 13385 Marseille, France; (S.R.); (C.L.)
- Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, Aix Marseille Université, 13385 Marseille, France
| | - Coralie L’Ollivier
- Laboratoire de Parasitologie-Mycologie, IHU Méditerranée Infection, 13385 Marseille, France; (S.R.); (C.L.)
- Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, Aix Marseille Université, 13385 Marseille, France
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Thompson GR, Jenks JD, Baddley JW, Lewis JS, Egger M, Schwartz IS, Boyer J, Patterson TF, Chen SCA, Pappas PG, Hoenigl M. Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management. Clin Microbiol Rev 2023; 36:e0001923. [PMID: 37439685 PMCID: PMC10512793 DOI: 10.1128/cmr.00019-23] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Fungal endocarditis accounts for 1% to 3% of all infective endocarditis cases, is associated with high morbidity and mortality (>70%), and presents numerous challenges during clinical care. Candida spp. are the most common causes of fungal endocarditis, implicated in over 50% of cases, followed by Aspergillus and Histoplasma spp. Important risk factors for fungal endocarditis include prosthetic valves, prior heart surgery, and injection drug use. The signs and symptoms of fungal endocarditis are nonspecific, and a high degree of clinical suspicion coupled with the judicious use of diagnostic tests is required for diagnosis. In addition to microbiological diagnostics (e.g., blood culture for Candida spp. or galactomannan testing and PCR for Aspergillus spp.), echocardiography remains critical for evaluation of potential infective endocarditis, although radionuclide imaging modalities such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography are increasingly being used. A multimodal treatment approach is necessary: surgery is usually required and should be accompanied by long-term systemic antifungal therapy, such as echinocandin therapy for Candida endocarditis or voriconazole therapy for Aspergillus endocarditis.
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Affiliation(s)
- George R. Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis Medical Center, Sacramento, California, USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA
| | - Jeffrey D. Jenks
- Durham County Department of Public Health, Durham, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - John W. Baddley
- Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James S. Lewis
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
| | - Matthias Egger
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Johannes Boyer
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Thomas F. Patterson
- Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center, San Antonio, Texas, USA
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter G. Pappas
- Department of Medicine Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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Kidd SE, Abdolrasouli A, Hagen F. Fungal Nomenclature: Managing Change is the Name of the Game. Open Forum Infect Dis 2023; 10:ofac559. [PMID: 36632423 PMCID: PMC9825814 DOI: 10.1093/ofid/ofac559] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/18/2022] [Indexed: 01/09/2023] Open
Abstract
Fungal species have undergone and continue to undergo significant nomenclatural change, primarily due to the abandonment of dual species nomenclature in 2013 and the widespread application of molecular technologies in taxonomy allowing correction of past classification errors. These have effected numerous name changes concerning medically important species, but by far the group causing most concern are the Candida yeasts. Among common species, Candida krusei, Candida glabrata, Candida guilliermondii, Candida lusitaniae, and Candida rugosa have been changed to Pichia kudriavzevii, Nakaseomyces glabrata, Meyerozyma guilliermondii, Clavispora lusitaniae, and Diutina rugosa, respectively. There are currently no guidelines for microbiology laboratories on implementing changes, and there is ongoing concern that clinicians will dismiss or misinterpret laboratory reports using unfamiliar species names. Here, we have outlined the rationale for name changes across the major groups of clinically important fungi and have provided practical recommendations for managing change.
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Affiliation(s)
- Sarah E Kidd
- Correspondence: Sarah E. Kidd, BMedSc(Hons), PhD , National Mycology Reference Centre, SA Pathology, Frome Road, Adelaide, South Australia 5000, Australia ()
| | - Alireza Abdolrasouli
- Department of Medical Microbiology, King's College Hospital, London, United Kingdom,Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands,Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
As the at-risk population expands and new antifungal resistance patterns develop, it is critical to understand and recognize cutaneous manifestations of old and emerging fungal diseases. PURPOSE OF REVIEW The aim of this review is to provide an overview of the most frequent and emerging deep cutaneous fungal infections following either primary inoculation or secondary spread after haematogenous seeding in disseminated infections in different geographical areas. RECENT FINDINGS Fungal skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions based on the site of the infection, route of acquisition of the pathogen, epidemiological setting and the virulence of the fungus in relation to the host. The approach to a patient suspected of having a fungal SSTI is complex and usually poses a major diagnostic challenge. The treatment approach should include attempts at immune reconstitution, targeted antifungal therapy and/or aggressive surgical debridement. SUMMARY Fungal SSTIs can be an important cause of morbidity and mortality in both immunocompromised and immunocompetent patients and are being reported with increasing frequency worldwide.
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Mpakosi A, Siopi M, Demetriou M, Falaina V, Theodoraki M, Meletiadis J. Fungemia due to Moesziomyces aphidis (Pseudozyma aphidis) in a premature neonate. Challenges of species identification and antifungal susceptibility testing of rare yeasts. J Mycol Med 2022; 32:101258. [DOI: 10.1016/j.mycmed.2022.101258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/02/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
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Chang CC, Hall V, Cooper C, Grigoriadis G, Beardsley J, Sorrell TC, Heath CH. Consensus guidelines for the diagnosis and management of cryptococcosis and rare yeast infections in the haematology/oncology setting, 2021. Intern Med J 2021; 51 Suppl 7:118-142. [PMID: 34937137 DOI: 10.1111/imj.15590] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cryptococcosis caused by the Cryptococcus neoformans-Cryptococcus gattii complex is an important opportunistic infection in people with immunodeficiency, including in the haematology/oncology setting. This may manifest clinically as cryptococcal meningitis or pulmonary cryptococcosis, or be detected incidentally by cryptococcal antigenemia, a positive sputum culture or radiological imaging. Non-Candida, non-Cryptococcus spp. rare yeast fungaemia are increasingly common in this population. These consensus guidelines aim to provide clinicians working in the Australian and New Zealand haematology/oncology setting with clear guiding principles and practical recommendations for the management of cryptococcosis, while also highlighting important and emerging rare yeast infections and their recommended management.
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Affiliation(s)
- Christina C Chang
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Therapeutic and Vaccine Research Programme, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, KwaZulu Natal, South Africa
| | - Victoria Hall
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Celia Cooper
- Department of Microbiology and Infectious Diseases, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - George Grigoriadis
- Monash Haematology, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Haematology, Alfred Hospital, Prahran, Victoria, Australia
| | - Justin Beardsley
- Marie Bashir Institute for Infectious Diseases & Biosecurity, University of Sydney, Sydney, New South Wales, Australia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Infectious Diseases, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Tania C Sorrell
- Marie Bashir Institute for Infectious Diseases & Biosecurity, University of Sydney, Sydney, New South Wales, Australia.,Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, New South Wales, Australia.,Infectious Diseases and Sexual Health, Western Sydney Local Health District, Parramatta, New South Wales, Australia
| | - Christopher H Heath
- Department of Microbiology, Fiona Stanley Hospital Network, PathWest Laboratory Medicine, Murdoch, Western Australia, Australia.,Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Department of Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Murdoch, Western Australia, Australia
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Hu F, Wang C, Wang P, Zhang L, Jiang Q, Al-Hatmi AMS, Blechert O, Zhan P. First Case of Subcutaneous Mycoses Caused by Dirkmeia churashimaensis and a Literature Review of Human Ustilaginales Infections. Front Cell Infect Microbiol 2021; 11:711768. [PMID: 34796121 PMCID: PMC8593038 DOI: 10.3389/fcimb.2021.711768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/10/2021] [Indexed: 12/02/2022] Open
Abstract
Objective Dirkmeia churashimaensis, belonging to Ustilaginales fungi, has never been reported as clinical pathogenic until very recently. In this study, we report an unusual subcutaneous infection with Dirkmeia churashimaensis and reviewed all human Ustilaginales infections. The aim is to better understand their epidemiology, infection type, risk factors, and the sensitivity to antifungal agents. Methods An 80-year-old female farmer developed extensive plaques and nodules on her left arm within 2 years. Pathological and microbiological examinations identified a new pathological agent, Dirkmeia churashimaensis, as the cause of this infection. The patient was successfully cured by oral itraconazole. We reviewed a total of 31 cases of Ustilaginales cases, among of which only three were skin infections. Results Local barrier damage (i.e., surgery, trauma, and basic dermatosis) and systemic immunodeficiency (i.e., preterm and low birthweight, Crohn’s disease, malignant cancer, and chemotherapy) are risk factors for Ustilaginales infection. The D1/D2 and ITS regions are the frequently used loci for identifying the pathogens together with phenotype. Most patients could survive due to antifungal treatment, whereas seven patients died. Amphotericin B, posaconazole, itraconazole, and voriconazole showed good activity against these reported strains, whereas fluconazole, 5-flucytosine, and echinocandins usually showed low susceptibility. Itraconazole had good efficiency for subcutaneous infections. Conclusions The present case study and literature review reveal that Ustilaginales can be opportunistic pathogenic normally in immunocompromised and barrier damage people. A proper identification of fungi can be crucial for clinical treatment, and more data of antifungal are needed for choice of medication against this kind of infections.
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Affiliation(s)
- Fengming Hu
- Department of Integrated Chinese and Western Medicine, Dermatology Hospital of Jiangxi Province and Jiangxi Dermatology Institute, Nanchang, China
| | - Chong Wang
- Dermatology Department, Liaocheng People's Hospital, Liaocheng, China
| | - Peng Wang
- Department of Integrated Chinese and Western Medicine, Dermatology Hospital of Jiangxi Province and Jiangxi Dermatology Institute, Nanchang, China
| | - Lei Zhang
- Department of Integrated Chinese and Western Medicine, Dermatology Hospital of Jiangxi Province and Jiangxi Dermatology Institute, Nanchang, China.,Dermatology Department, The Second People's Hospital of Guiyang, Guiyang, China
| | - Qing Jiang
- Department of Integrated Chinese and Western Medicine, Dermatology Hospital of Jiangxi Province and Jiangxi Dermatology Institute, Nanchang, China
| | - Abdullah M S Al-Hatmi
- Natural & Medical Sciences Research Center, University of Nizwa, Nizwa, Oman.,Department of Biological Sciences & Chemistry, College of Arts and Sciences, University of Nizwa, Nizwa, Oman.,Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, Netherlands
| | - Oliver Blechert
- The Institute of Clinical Medicine & Dermatology Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Ping Zhan
- The Institute of Clinical Medicine & Dermatology Department, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
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Kohli U, Hazra A, Shahab A, Beaser AD, Aziz ZA, Upadhyay GA, Ozcan C, Tung R, Nayak HM. Atypical pathogens associated with cardiac implantable electronic device infections. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1549-1561. [PMID: 34245025 PMCID: PMC9290787 DOI: 10.1111/pace.14311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/21/2021] [Accepted: 07/04/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cardiovascular implantable electronic device (CIED) infections are associated with significant morbidity and mortality making the identification of the causative organism critical. The vast majority of CIED infections are caused by Staphylococcal species. CIED infections associated with atypical pathogens are rare and have not been systematically investigated. The objective of this study is to characterize the clinical course, management and outcome in patients with CIED infection secondary to atypical pathogens. METHODS Medical records of all patients who underwent CIED system extraction at the University of Chicago Medical Center between January 2010 and November 2020 were retrospectively reviewed to identify patients with CIED infection. Demographic, clinical, infection-related and outcome data were collected. CIED infections were divided into typical and atypical groups based on the pathogens isolated. RESULTS Among 356 CIED extraction procedures, 130 (37%) were performed for CIED infection. Atypical pathogens were found in 5.4% (n = 7) and included Pantoea species (n = 2), Kocuria species (n = 1), Cutibacterium acnes (n = 1), Corynebacterium tuberculostearicum (n = 1), Corynebacterium striatum (n = 1), Stenotrophomonas maltophilia (n = 1), and Pseudozyma ahidis (n = 1). All patients with atypical CIED infections were successfully treated with total system removal and tailored antibiotic therapy. There were no infection-related deaths. CONCLUSIONS CIED infections with atypical pathogens were rare and associated with good outcome if diagnosed early and treated with total system removal and tailored antimicrobial therapy. Atypical pathogens cultured from blood, tissue or hardware in patients with CIED infection should be considered pathogens and not contaminants.
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Affiliation(s)
- Utkarsh Kohli
- Section of Pediatric Cardiology, Department of Pediatrics, Comer Children's Hospital and the University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.,Division of Pediatric Cardiology/Electrophysiology, Department of Pediatrics, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases & Global Health, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Ahmed Shahab
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Andrew D Beaser
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Zaid A Aziz
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Cevher Ozcan
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Roderick Tung
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Hemal M Nayak
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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Maccaro A, Pascale R, Liberatore A, Turello G, Ambretti S, Viale P, Cricca M. Pseudozyma aphidis bloodstream infection in a patient with aggressive lymphoma and a history of intravenous drug use: Case report and review of the literature. Med Mycol Case Rep 2021; 33:5-8. [PMID: 34168955 PMCID: PMC8207174 DOI: 10.1016/j.mmcr.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 02/07/2023] Open
Abstract
Pseudozyma aphidis is an environmental fungus which causes opportunistic infections in immunocompromised patients. Here we report the case of a 54-year-old, intravenous drug user woman, newly diagnosed to have an aggressive lymphoma, who developed a bloodstream infection caused by P. aphidis treated successfully with amphotericin-B therapy. The precise identification was assessed by sequencing. We propose to consider intravenous drug use as a risk factor for invasive infections due to this environmental yeast.
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Affiliation(s)
- Angelo Maccaro
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, IRCCS S. Orsola-Malpighi Hospital, University of Bologna, 40138, Bologna, Italy
| | - Renato Pascale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, IRCCS S. Orsola-Malpighi Hospital, University of Bologna, 40138, Bologna, Italy
| | - Andrea Liberatore
- Center for Applied Biomedical Research (CRBA), University of Bologna, 40138, Bologna, Italy.,Unit of Microbiology, IRCCS S.Orsola-Malpighi Hospital, Via G. Massarenti, 9, 40138, Bologna, Italy
| | - Gabriele Turello
- Unit of Microbiology, IRCCS S.Orsola-Malpighi Hospital, Via G. Massarenti, 9, 40138, Bologna, Italy
| | - Simone Ambretti
- Unit of Microbiology, IRCCS S.Orsola-Malpighi Hospital, Via G. Massarenti, 9, 40138, Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, IRCCS S. Orsola-Malpighi Hospital, University of Bologna, 40138, Bologna, Italy
| | - Monica Cricca
- Center for Applied Biomedical Research (CRBA), University of Bologna, 40138, Bologna, Italy.,Unit of Microbiology, IRCCS S.Orsola-Malpighi Hospital, Via G. Massarenti, 9, 40138, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
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