Contributions
Abstract: PB1592
Type: Publication Only
Session title: Infections in hematology (incl. supportive care/therapy)
Background
Geotrichum Capitatum (G.Capitatum) is uncommon but frequently fatal mycosis in immunocompromised patients.
Aims
We report our experience of systemic Geotrichum Capitatum infection in severe neutropenic patients who were receiving chemotherapy for acute leukemia in the hematology department of sfax in Tunisia.
Methods
It was a retrospective study of cases of G. capitatum septicemia diagnosed in patients followed for acute leukemia in the hematology department of sfax in Tunisia from January 2005 to december2020. G.Capitatum was identified in blood cultures performed in laboratory of Parasitology. For each patient, we collected epidemiological clinical and imaging data, microbiological results, antifungal treatment and evolution disease .
Results
Eleven cases of of G. capitatum septicemia were identified in 4 mens and 7 womens (sex ratio 0,7 ). The mean age was 35 years ( 5-55 years).
Nine patients were diagnosed with acute myeloid leukemia and two with acute lymphoblastic leukemia. At the time of infection, all patients had a prolonged profound neutropenia and had received broad-spectrum antibiotics before the onset of the septicemia. Five patient had a central venous catheter.
Disseminated infection were reported in all of patients and pulmonary localization is the most commun. The computed tomography scan showed pulmonary nodules and/or ground glass opacities, in all cases. A concomitant proven invasive pulmonary aspergillosis was noted in one patient and probable pulmonary aspergillosis was suggested in four patients with ground glass opacities in radiographic findings and a positive aspergillus Galactomannan antigenemia.
Involvement of other deep organs (liver, spleen ) was reported in 5 patients (45%) . Papulo-vesicular or purpuric skin lesions of the trunk and the members were observed in two cases.
In vitro susceptibility findings showed that all fungi were sensitive for amphotericin B and Voriconazol, high Caspofongine and Fluconazole MICs have been found for four and two patients respectively. Resistance has been noted to Caspofongine in 2 patients and to Fluconazol in one patient.
Differents antifungal therapy was proposed to our patients . Monotherapy antifungal for five patients: conventional Amphotericin B in 2 cases , Voriconazol in 2 cases, and Fluconazol in 1 case, the infection was controlled only in one patient receiving Voricnazol.
Five patients were treated by a combination of Amphotericin B and Voriconazole
with favorable outcome in 3 cases. One patient received two combinations of antifungal therapy and a splenectomy because of the extension lesions in the spleen with a fatal outcomes. The mortality rate in our study was 64%.
Conclusion
G. capitatum is an opportunistic fungus in leukemia patients mostly with acute myeloid leukemia like our patients.
Disseminated infection were reported in 100% of our patients. Pulmonary localizations is the most common reported in G.capitatum septicemia, but lung infiltrates by G.capitatum and Aspergillus may be indistinguishable each other in some cases, like four of our patients.
The optimal therapy for G.capitatum has not been established, the combination of amphotericin B and voriconazole seem to have favorable outcomes in our study.
Despite antifungal therapy, mortality rate exceeding 50% , ( 64% in our study).
Keyword(s):
Abstract: PB1592
Type: Publication Only
Session title: Infections in hematology (incl. supportive care/therapy)
Background
Geotrichum Capitatum (G.Capitatum) is uncommon but frequently fatal mycosis in immunocompromised patients.
Aims
We report our experience of systemic Geotrichum Capitatum infection in severe neutropenic patients who were receiving chemotherapy for acute leukemia in the hematology department of sfax in Tunisia.
Methods
It was a retrospective study of cases of G. capitatum septicemia diagnosed in patients followed for acute leukemia in the hematology department of sfax in Tunisia from January 2005 to december2020. G.Capitatum was identified in blood cultures performed in laboratory of Parasitology. For each patient, we collected epidemiological clinical and imaging data, microbiological results, antifungal treatment and evolution disease .
Results
Eleven cases of of G. capitatum septicemia were identified in 4 mens and 7 womens (sex ratio 0,7 ). The mean age was 35 years ( 5-55 years).
Nine patients were diagnosed with acute myeloid leukemia and two with acute lymphoblastic leukemia. At the time of infection, all patients had a prolonged profound neutropenia and had received broad-spectrum antibiotics before the onset of the septicemia. Five patient had a central venous catheter.
Disseminated infection were reported in all of patients and pulmonary localization is the most commun. The computed tomography scan showed pulmonary nodules and/or ground glass opacities, in all cases. A concomitant proven invasive pulmonary aspergillosis was noted in one patient and probable pulmonary aspergillosis was suggested in four patients with ground glass opacities in radiographic findings and a positive aspergillus Galactomannan antigenemia.
Involvement of other deep organs (liver, spleen ) was reported in 5 patients (45%) . Papulo-vesicular or purpuric skin lesions of the trunk and the members were observed in two cases.
In vitro susceptibility findings showed that all fungi were sensitive for amphotericin B and Voriconazol, high Caspofongine and Fluconazole MICs have been found for four and two patients respectively. Resistance has been noted to Caspofongine in 2 patients and to Fluconazol in one patient.
Differents antifungal therapy was proposed to our patients . Monotherapy antifungal for five patients: conventional Amphotericin B in 2 cases , Voriconazol in 2 cases, and Fluconazol in 1 case, the infection was controlled only in one patient receiving Voricnazol.
Five patients were treated by a combination of Amphotericin B and Voriconazole
with favorable outcome in 3 cases. One patient received two combinations of antifungal therapy and a splenectomy because of the extension lesions in the spleen with a fatal outcomes. The mortality rate in our study was 64%.
Conclusion
G. capitatum is an opportunistic fungus in leukemia patients mostly with acute myeloid leukemia like our patients.
Disseminated infection were reported in 100% of our patients. Pulmonary localizations is the most common reported in G.capitatum septicemia, but lung infiltrates by G.capitatum and Aspergillus may be indistinguishable each other in some cases, like four of our patients.
The optimal therapy for G.capitatum has not been established, the combination of amphotericin B and voriconazole seem to have favorable outcomes in our study.
Despite antifungal therapy, mortality rate exceeding 50% , ( 64% in our study).
Keyword(s):