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 METHODS: Unpublished cases of invasive P. lilacinum infection from the FungiScope® registry and all cases reported in the literature were analysed.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.

Charles University 1st Faculty of Medicine Institute of Clinical and Experimental Hematology Prague Czech Republic

Clinic for Infectious and Tropical Diseases Clinical Center of Serbia Faculty of Medicine University of Belgrade Belgrade Serbia

Clinical Microbiology and Parasitology Department La Paz University Hospital Paseo de la Castellana 261 28046 Madrid Spain

Clinical Microbiology Laboratory LabPLUS Auckland City Hospital Auckland 1023 New Zealand

Department of Internal Medicine Division of Infectious Diseases University of California Davis Medical Center Sacramento CA USA

Department of Medical Microbiology and Immunology University of California Davis Medical Center Sacramento CA USA

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 for Clinical Hygiene Medical Microbiology and Clinical Infectiology Paracelsus Medical University Nuremberg Hospital Nuremberg Germany

Institute of Hematology and Blood Transfusion Prague Czech Republic

Laboratoire de Microbiologie L'Hôtel Dieu de Québec du Centre Hospitalier Universitaire de Québec Québec Canada

University Hospital Marqués de Valdecilla IDIVAL Santander Spain

University of Cologne Faculty of Medicine and University Hospital Cologne Center for Molecular Medicine Cologne Cologne Germany

University of Cologne Faculty of Medicine and University Hospital Cologne Chair Translational Research Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases Cologne Germany

University of Cologne Faculty of Medicine and University Hospital Cologne Clinical Trials Centre Cologne Cologne Germany

University of Cologne Faculty of Medicine and University Hospital Cologne Department 1 of Internal Medicine Excellence Center for Medical Mycology Cologne Germany

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