Objectives: The epidemiology of Invasive Fungal Infection in the hematological population has changed over the last two decades. Fusarium spp. represents the third most common cause of IFI among those patients. We aimed to evaluate the cases of Invasive Fusariosis (IF) in hematological patients from a Brazilian center. Methods: IF patients were collected between 2001 and 2011. IF was diagnosed by EORTC/MSG criteria. The patient’s charts were analyzed retrospectively for demographic, clinical and therapeuticalmicrobiological efficacy of micafungin in a cystic fibrosis patient chronically colonized with Geosmithia argillacea. O.D., a female F508Del-CFTR homozygous patient was diagnosed at birth with cystic fibrosis in January 1996. She was found chronically colonised with Aspergillus fumigatus from 2001 to 2006. She was treated alternatively with oral voriconazole and itraconazole from 2004 to 2008, and with posaconazole since february 2008. Geosmithia argillacea was first diagnosed in May 2007, and chronic colonisation was persistent from this date to August 2010 with 23/28 fungus positive sputum samples, in spite of posaconazole therapy. For an isolate obtained in October 2008, minimal inhibitory/effective concentrations (MIC/MEC, mg/mL) determined using the Eucast method were 2.0, 2.0, 16.0, 2.0, 0.25 and 0.015 for amphotericin B, itraconazole, voriconazole, posaconazole, caspofungin and micafungin, respectively. The FEV1 predicted value was 73% at the time of first fungus isolation and was decreased to 47% in October 2009. She then was given caspofungin for 21 days ((70 mg/day, later reduced to 50 mg) which resulted in clinical improvement (FEV1 = 64% in January 2010) without eradication of G. argillacea. O.D. was then treated from September, 23 to November 3, 2010 with micafungin (100 mg bid for 21 days and 100 mg/day for the following 21 days) which resulted in clinical and microbiological improvement. FEV1 predicted ranged 6768% in October and December 2010, and February and May 2011, and from the end of treatment to December 2010, 5/6 sputum samples were found negative for G. argillacea. The positive sample contained fungus of the same genotype as previous isolates. The present case is to our knowledge the first description of G. argillacea eradication in a chronically colonized cystic fibrosis patient. Since no change in bacterial colonization was observed before, during, and after G. argillacea colonization, the present case is consistent with a pathogenic role of the fungus in cystic fibrosis patients. In vitro antifungal susceptibility assays suggested that echinocandins are most effective agents against this fungus with a lowest MEC for micafungin (seven isolates studied, MEC range: 0.0150.03), although eradication could only be obtained with high dose micafungin for a long time (6 weeks).
Full conference title:
22nd European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 22nd (2012)