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 METHODS: Unpublished cases of invasive P. lilacinum infection from the FungiScope® registry and all cases reported in the literature were analysed.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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Hoenigl M, Salmanton-García J, Walsh TJ. et al. Global guideline for the diagnosis and management of rare mold infections: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology and American Society for Microbiology. Lancet Infect Dis 2021; in press: 10.1016/S1473-3099(20)30784-2. PubMed DOI

Luangsa-Ard J, Houbraken J, van Doorn T. et al. Purpureocillium, a new genus for the medically important Paecilomyces lilacinus. FEMS Microbiol Lett 2011; 321: 141–9. PubMed

Mesquita-Rocha S, Godoy-Martinez PC, Gonçalves SS. et al. The water supply system as a potential source of fungal infection in paediatric haematopoietic stem cell units. BMC Infect Dis 2013; 13: 289. PubMed PMC

Ali-Shtayeh MS, Khaleel T, Jamous RM.. Ecology of dermatophytes and other keratinophilic fungi in swimming pools and polluted and unpolluted streams. Mycopathologia 2002; 156: 193–205. PubMed

Jacobs H, Gray SN, Crump DH.. Interactions between nematophagous fungi and consequences for their potential as biological agents for the control of potato cyst nematodes. Mycol Res 2003; 107: 47–56. PubMed

Orth B, Frei R, Itin PH. et al. Outbreak of invasive mycoses caused by Paecilomyces lilacinus from a contaminated skin lotion. Ann Intern Med 1996; 125: 799–806. PubMed

Pettit TH, Olson RJ, Foos RY. et al. Fungal endophthalmitis following intraocular lens implantation. A surgical epidemic. Arch Ophthalmol 1980; 98: 1025–39. PubMed

Todokoro D, Yamada N, Fukuchi M. et al. Topical voriconazole therapy of Purpureocillium lilacinum keratitis that occurred in disposable soft contact lens wearers. Int Ophthalmol 2014; 34: 1159–63. PubMed

Khalique Z, Hatipoğlu S, Rosendahl U. et al. Unusual complicated fungal endocarditis in a patient with vascular Ehlers-Danlos syndrome. Ann Thorac Surg 2019; 107: e269–e271. PubMed

Chen YT, Yeh LK, Ma DHK. et al. Paecilomyces/Purpureocillium keratitis: a consecutive study with a case series and literature review. Med Mycol 2020; 58: 293–9. PubMed

Pastor FJ, Guarro J.. Clinical manifestations, treatment and outcome of Paecilomyces lilacinus infections. Clin Microbiol Infect 2006; 12: 948–60. PubMed

Labriola L, Ercam VB, Swinne D. et al. Successful treatment with voriconazole of prolonged Paecilomyces lilacinus fungemia in a chronic hemodialyzed patient. Clin Nephrol 2009; 71: 355–8. PubMed

Westenfeld F, Alston WK, Winn WC.. Complicated soft tissue infection with prepatellar bursitis caused by Paecilomyces lilacinus in an immunocompetent host: case report and review. J Clin Microbiol 1996; 34: 1559–62. PubMed PMC

Wong G, Nash R, Barai K. et al. Paecilomyces lilacinus causing debilitating sinusitis in an immunocompetent patient: a case report. J Med Case Rep 2012; 6: 86. PubMed PMC

Wolley M, Collins J, Thomas M.. Paecilomyces lilacinus peritonitis in a peritoneal dialysis patient. Perit Dial Int 2012; 32: 364–5. PubMed PMC

Salazar-González MA, Violante-Cumpa JR, Alfaro-Rivera CG. et al. Purpureocillium lilacinum as unusual cause of pulmonary infection in immunocompromised hosts. J Infect Dev Ctries 2020; 14: 415–9. PubMed

Khan Z, Ahmad S, Al-Ghimlas F. et al. Purpureocillium lilacinum as a cause of cavitary pulmonary disease: a new clinical presentation and observations on atypical morphologic characteristics of the isolate. J Clin Microbiol 2012; 50: 1800–4. PubMed PMC

Seidel D, Durán Graeff LA, Vehreschild M. et al. FungiScope(™) -Global Emerging Fungal Infection Registry. Mycoses 2017; 60: 508–16. PubMed

Donnelly JP, Chen SC, Kauffman CA. et al. Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis 2020; 71: 1367–76. PubMed PMC

Cornely OA, Hoenigl M, Lass-Flörl C. et al. Defining breakthrough invasive fungal infection-Position paper of the mycoses study group education and research consortium and the European Confederation of Medical Mycology. Mycoses 2019; 62: 716–9. PubMed PMC

Benbarkat H, Addetia K, Salehi AH. et al. A case of indolent endocarditis. Can J Infect Dis Med Microbiol 2012; 23: e51–52. PubMed PMC

Peixoto ML, Santos DO, Souza Ide C. et al. Interaction of an opportunistic fungus Purpureocillium lilacinum with human macrophages and dendritic cells. Rev Soc Bras Med Trop 2014; 47: 613–7. PubMed

Liu K, Howell DN, Perfect JR. et al. Morphologic criteria for the preliminary identification of Fusarium, Paecilomyces, and Acremonium species by histopathology. Am J Clin Pathol 1998; 109: 45–54. PubMed

Saberhagen C, Klotz SA, Bartholomew W. et al. Infection due to Paecilomyces lilacinus: a challenging clinical identification. Clin Infect Dis 1997; 25: 1411–3. PubMed

Barker AP, Horan JL, Slechta ES. et al. Complexities associated with the molecular and proteomic identification of Paecilomyces species in the clinical mycology laboratory. Med Mycol 2014; 52: 537–45. PubMed

Castelli MV, Alastruey-Izquierdo A, Cuesta I. et al. Susceptibility testing and molecular classification of Paecilomyces spp. Antimicrob Agents Chemother 2008; 52: 2926–8. PubMed PMC

Garzoni C, Garbino J.. New azoles as first line therapy for Paecilomyces lilacinus in transplant patients. Transplant Infect Dis 2008; 10: 149–50. PubMed

Lamoth F, Alexander BD.. Antifungal activities of SCY-078 (MK-3118) and standard antifungal agents against clinical non-Aspergillus mold isolates. Antimicrob Agents Chemother 2015; 59: 4308–11. PubMed PMC

Miyazaki M, Horii T, Hata K. et al. In vitro activity of E1210, a novel antifungal, against clinically important yeasts and molds. Antimicrob Agents Chemother 2011; 55: 4652–8. PubMed PMC

Astvad KMT, Jørgensen KM, Hare RK. et al. Olorofim susceptibility testing of 1423 Danish mould isolates 2018–2019 confirms uniform and broad-spectrum activity. Antimicrob Agents Chemother 2020; 65: e01527-20. PubMed PMC

Krumholz HM. Registries and selection bias: the need for accountability. Circ Cardiovasc Qual Outcomes 2009; 2: 517–8. PubMed

Jenks JD, Seidel D, Cornely OA. et al. Voriconazole plus terbinafine combination antifungal therapy for invasive Lomentospora prolificans infections: analysis of 41 patients from the FungiScope® registry 2008-2019. Clin Microbiol Infect 2020; 26: 784.e781–784.e785. PubMed

Lamoth F, Kontoyiannis DP.. Therapeutic challenges of Non-Aspergillus invasive mold infections in immunosuppressed patients. Antimicrob Agents Chemother 2019; 63: e01244–19. PubMed PMC