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Invasive Saprochaete Infections: An Emerging Threat to Immunocompromised Patients
Said El Zein1, Joya-Rita Hindy2, Souha S Kanj2
1Internal Medicine Department, Wayne State University/Detroit Medical Center, Detroit, MI 48201, USA.
Abstract:
Saprochaete clavata and Saprochaete capitata are emerging fungal pathogens that are responsible for life threatening infections in immunocompromised patients, particularly in the setting of profound neutropenia. They have been associated with multiple hospital outbreaks mainly in Europe. In this article, we present a comprehensive review of the epidemiology, clinical presentation, diagnosis, antifungal susceptibility and treatment of these organisms. The diagnosis of invasive Saprochaete disease is challenging and relies primarily on the isolation of the fungi from blood or tissue samples. Both species are frequently misidentified as they are identical macroscopically and microscopically. Internal transcribed spacer sequencing and matrix-assisted laser desorption ionization-time of flight mass spectrometry are useful tools for the differentiation of these fungi to a species level. Saprochaete spp. are intrinsically resistant to echinocandins and highly resistant to fluconazole. Current literature suggests the use of an amphotericin B formulation with or without flucytosine for the initial treatment of these infections. Treatment with extended spectrum azoles might be promising based on in vitro minimum inhibitory concentration values and results from case reports and case series. Source control and recovery of the immune system are crucial for successful therapy.
Insights
Saprochaete clavata and Saprochaete capitata cause severe infections in immunocompromised patients. Accurate species identification and antifungal susceptibility testing are crucial for effective treatment, with amphotericin B formulations recommended.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Saprochaete clavata and Saprochaete capitata are emerging fungal pathogens.
- These fungi cause life-threatening infections in immunocompromised individuals, especially those with neutropenia.
- Hospital outbreaks have been reported, primarily in Europe.
Purpose of the Study:
- To provide a comprehensive review of Saprochaete clavata and Saprochaete capitata.
- To cover epidemiology, clinical presentation, diagnosis, antifungal susceptibility, and treatment strategies.
- To highlight diagnostic challenges and emerging therapeutic options.
Main Methods:
- Review of existing literature on Saprochaete infections.
- Analysis of diagnostic techniques, including molecular methods (ITS sequencing) and mass spectrometry (MALDI-TOF).
- Evaluation of antifungal susceptibility data and treatment outcomes from case reports and series.
Main Results:
- Saprochaete species are difficult to distinguish morphologically.
- Molecular and mass spectrometry methods are essential for accurate species-level identification.
- These fungi exhibit intrinsic resistance to echinocandins and high resistance to fluconazole.
Conclusions:
- Invasive Saprochaete disease diagnosis is challenging, relying on fungal isolation.
- Initial treatment recommendations include amphotericin B formulations, potentially with flucytosine.
- Extended-spectrum azoles show promise; source control and immune reconstitution are vital for successful therapy.
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