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Volume 18, Number 1—January 2012

Dispatch

Emergence of Blastoschizomyces capitatus Yeast Infections, Central Europe

Tanja BirrenbachComments to Author , Sonja Bertschy, Franziska Aebersold, Nicolas J. Mueller, Yvonne Achermann, Konrad Muehlethaler, and Stefan Zimmerli
Author affiliations: University Hospital Bern, Bern, Switzerland (T. Birrenbach, S. Zimmerli); Kantonsspital Luzern, Lucern, Switzerland (S. Bertschy, F. Aebersold); University Hospital Zurich, Zurich, Switzerland (N.J. Mueller, Y. Achermann); University of Bern, Bern (K. Muehlethaler, S. Zimmerli)

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Table 1

Clinical characteristics of 5 patients with Blastoschizomyces capitatus yeast infection, Switzerland, June 2009–June 2010*

Patient no. 1 2 3 4 5
Age, y/sex 66/M 68/F 58/M 60/M 56/F
Underlying disease AML AML AML CAPD for renal failure after renal transplant Diabetes mellitus, renal/pancreas transplant
Immunosuppression Induction chemotherapy;
reinduction 2× Induction chemotherapy Induction chemotherapy CAPD;
CycA, PDN Tacrolimus, mycophenolate, PDN, thymoglobuline
Galactomannan assay Negative Negative BAL positive;
serum not done Not done Negative
Day of chemotherapy cycle at first isolation 14 13 22 NA NA
Neutrophil count at diagnosis, × 109 l–1 <0.1 <0.1 0.25 7.49 4.74
Days of neutropenia at diagnosis 16 8 18 NA NA
Days of persistent fungemia/funguria 6 4 3 NA 114
Sites involved clinically Lungs, skin, liver, spleen, brain Lungs Lungs, brain Peritoneal fluid Bladder, right kidney
Isolation of B. capitatus Blood, skin Blood Blood, urine, DTA Peritoneal fluid, peritoneal dialysis catheter, deep tissue biopsy Urine
Sequential treatment after isolation (duration, d) 1. L-AMB (7) 1. L-AMB (2) 1. L-AMB (1) 1. VRC (28) 1. VRC (17)
2. L-AMB + VRC (8) 2. VRC (3) 2. L-AMB + VRC (1) 2. FLC (8)
3. L-AMB (25) 3. FLC (11) 3. AMB (4)
4. VRC (145) 4. VRC (110, ongoing)
Days from collection of first positive sample to start of adequate treatment 0 1 3 4 3
Outcome (cause of death) Death 185 d after diagnosis (relapsing leukemia and MOF) Death 9 d after diagnosis (MOF) Death 15 d after diagnosis (MOF) Alive Alive
Contribution of B. capitatus to death + + NA NA
Travel history during previous year Trip to southern France 3 months before diagnosis None Unknown None None

*Diagnosis is defined as the day of collection of first sample positive for B. capitatus. No patients received antifungal prophylaxis. AML, acute myeloid leukemia; CAPD, continuous ambulatory peritoneal dialysis; CycA, cyclosporine A; PDN, prednisone; BAL, bronchoalveolar lavage; NA, not applicable; DTA, deep tracheal aspiration; L-AMB, liposomal amphotericin B; VRC, voriconazole; FLC, fluconazole; AMB, deoxycholate amphotericin B; MOF, multiorgan failure.

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