Paecilomyces lilacinus causing debilitating sinusitis in an immunocompetent patient: a case report

Paecilomyces/Purpureocillium Infection in Children, Case Report, and Review of the Literature

Paecilomyces/Purpureocillium has recently been recognized as an emerging human pathogen, causing serious infection in immunocompromised and immunocompetent patients. Several predisposing factors have been reported, including foreign body implants, previous surgery, or trauma. Treatment with antifungal drugs often fails as species-specific differences in antifungal susceptibilities are one of the management challenges. Surgical debridement with or without antifungal therapy was sufficient to cure the infection in a few reported cases. Nonetheless, the surgical approach has been found to decrease the chance of dissemination and recurrence. Here, we report the first pediatric patient with chronic osteomyelitis of the femur secondary to Paecilomyces species, with no predisposing risk factors. Our case was successfully treated with a combination of antifungal therapy and surgical debridement. Additionally, we describe the first extensive literature review of previously reported Paecilomyces/Purpureocillium species infections in pediatric age groups.

Invasive infections with Purpureocillium lilacinum: clinical characteristics and outcome of 101 cases from FungiScope® and the literature

OBJECTIVES

To provide a basis for clinical management decisions in Purpureocillium lilacinum infection.

METHODS

Unpublished cases of invasive P. lilacinum infection from the FungiScope® registry and all cases reported in the literature were analysed.

RESULTS

We identified 101 cases with invasive P. lilacinum infection. Main predisposing factors were haematological and oncological diseases in 31 cases (30.7%), steroid treatment in 27 cases (26.7%), solid organ transplant in 26 cases (25.7%), and diabetes mellitus in 19 cases (18.8%). The most prevalent infection sites were skin (n = 37/101, 36.6%) and lungs (n = 26/101, 25.7%). Dissemination occurred in 22 cases (21.8%). Pain and fever were the most frequent symptoms (n = 40/101, 39.6% and n = 34/101, 33.7%, respectively). Diagnosis was established by culture in 98 cases (97.0%). P. lilacinum caused breakthrough infection in 10 patients (9.9%). Clinical isolates were frequently resistant to amphotericin B, whereas posaconazole and voriconazole showed good in vitro activity. Susceptibility to echinocandins varied considerably. Systemic antifungal treatment was administered in 90 patients (89.1%). Frequently employed antifungals were voriconazole in 51 (56.7%) and itraconazole in 26 patients (28.9%). Amphotericin B treatment was significantly associated with high mortality rates (n = 13/33, 39.4%, P = <0.001). Overall mortality was 21.8% (n = 22/101) and death was attributed to P. lilacinum infection in 45.5% (n = 10/22).

CONCLUSIONS

P. lilacinum mainly presents as soft-tissue, pulmonary or disseminated infection in immunocompromised patients. Owing to intrinsic resistance, accurate species identification and susceptibility testing are vital. Outcome is better in patients treated with triazoles compared with amphotericin B formulations.

Entomogenous fungi isolated from Cryptotympana atrata with antibacterial and antifungal activity

Although many entomogenous fungi have been discovered over the years, few studies on the crude extracts of fungi isolated from Cryptotympana atrata with antibacterial and antifungal activity were reported. In this study, total twenty entomogenous fungi were isolated for the first time. And among of them, two pure cultures were identified as Purpureocillium lilacinum and Aspergillus fumigatus with apparent morphology, microscopic identification and 18S rRNA gene sequence. The active strains were fermented to optimize in six different culture media at three different pH values. The antibacterial and antifungal activities of the metabolites were more potent and efficient in Fungal medium 3^# at a pH of 6.2 than in the other tested media or at the other tested pH values. Total seven human pathogens and one insect pathogen were used to evaluate the antibacterial and antifungal activity of crude extracts, among which 25% of the extracts exhibited antifungal activity against Verticillium lecanii, while 33.3% and 47.2% of the extracts exhibited antibacterial activity against the important human pathogens Staphylococcus aureus and Bacillus cereus, respectively. The range of the MICs was from 15.6 to 250 μg mL^-1, and 35% of the fungal metabolites exhibited antibacterial activity against Pseudomonas aeruginosa, Bacillus thuringiensis and Enterobacter aerogenes at 1000 μg mL^-1 except the previously described antibacterial activities. Furthermore, the phylogenetic relationships of the two identified fungi were also constructed. In brief, it is the first reporting about enthompathogenic fungi from Cryptotympana atrata and provides candidate strains with potential use as biological agents and against multidrug-resistant organisms.

Isavuconazonium for the treatment of Purpureocillium lilacinum infection in a patient with pyoderma gangrenosum

Purpureocillium lilacinum is a rare but emerging pathogen in immunocompromised patients that primarily infects the skin and subcutaneous tissue. We present a novel case of Purpureocillium lilacinum infection in a patient with pyoderma gangrenosum who was successfully treated with isavuconazonium, followed by a literature review of 13 total cases of infection with Purpureocillium lilacinum gathered from a review of the PubMed database. Previous reports have utilized voriconazole, an antifungal with significant toxic side effects. Our case highlights the importance of culture and biopsy in patients with pyoderma gangrenosum who are unresponsive to standard treatment irrespective of pathergy risk.