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Published on: February 14, 2018
Breakthrough disseminated cryptococcosis during micafungin therapy.
Wen-Sen Lee1, Tai-Chin Hsieh1, Tsong-Yih Ou1
1Division of Infectious Disease, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan.
Summary
Echinocandins are ineffective against certain yeasts like Cryptococcus neoformans. A patient on micafungin for candidemia experienced a breakthrough cryptococcal infection, highlighting treatment limitations.
Area of Science:
- Mycology
- Infectious Diseases
- Pharmacology
Background:
- Echinocandins are a crucial class of antifungal drugs.
- They exhibit activity against Candida species but not all fungi.
- Basidiomycetous yeasts, including Cryptococcus neoformans, are intrinsically resistant to echinocandins.
Observation:
- A patient with renal failure presented with candidemia.
- The patient was treated with micafungin, an echinocandin antifungal.
- Despite micafungin therapy, the patient developed a breakthrough fungal infection.
Findings:
- The breakthrough infection was identified as cryptococcemia and cryptococcuria.
- This indicates a lack of efficacy of micafungin against Cryptococcus neoformans in this clinical scenario.
- The case highlights the known limitations of echinocandins against specific fungal pathogens.
Implications:
- This case underscores the importance of considering the spectrum of activity for antifungal agents.
- It highlights potential therapeutic challenges in immunocompromised patients with mixed or resistant fungal infections.
- Accurate pathogen identification and susceptibility testing are critical for guiding antifungal therapy, especially in breakthrough infections.
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