Volume 18, Number 1—January 2012
Dispatch
Emergence of Blastoschizomyces capitatus Yeast Infections, Central Europe
Tanja Birrenbach
, Sonja Bertschy, Franziska Aebersold, Nicolas J. Mueller, Yvonne Achermann, Konrad Muehlethaler, and Stefan Zimmerli
, Sonja Bertschy, Franziska Aebersold, Nicolas J. Mueller, Yvonne Achermann, Konrad Muehlethaler, and Stefan Zimmerli
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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