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Invasive infections with Purpureocillium lilacinum: clinical characteristics and outcome of 101 cases from FungiScope® and the literature
R. Sprute, J. Salmanton-García, E. Sal, X. Malaj, Z. Ráčil, C. Ruiz de Alegría Puig, I. Falces-Romero, A. Barać, G. Desoubeaux, AJ. Kindo, AJ. Morris, R. Pelletier, J. Steinmann, GR. Thompson, OA. Cornely, D. Seidel, J. Stemler, FungiScope®...
Language English Country Great Britain
Document type Journal Article, Research Support, Non-U.S. Gov't
NLK
Free Medical Journals
from 1996 to 1 year ago
Open Access Digital Library
from 1996-01-01
PubMed
33599275
DOI
10.1093/jac/dkab039
Knihovny.cz E-resources
- MeSH
- Amphotericin B MeSH
- Antifungal Agents therapeutic use MeSH
- Hypocreales MeSH
- Humans MeSH
- Microbial Sensitivity Tests MeSH
- Paecilomyces * MeSH
- Voriconazole MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
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 METHODS: Unpublished cases of invasive P. lilacinum infection from the FungiScope® registry and all cases reported in the literature were analysed.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.
Clinical Microbiology Laboratory LabPLUS Auckland City Hospital Auckland 1023 New Zealand
Department of Microbiology SriRamachandra Institute of Higher Education and Research Chennai India
Department of Parasitology Mycology Tropical Medicine Tours University hospital France
German Centre for Infection Research Partner Site Bonn Cologne Cologne Germany
Institute of Hematology and Blood Transfusion Prague Czech Republic
University Hospital Marqués de Valdecilla IDIVAL Santander Spain
References provided by Crossref.org
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