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Targeted Screening to Predict Magnusiomyces Infections in Hematopoietic Cell Transplant Recipients: Evidence from an
Claudia Bartalucci1, Chiara Russo2, Anna Maria Raiola3
1Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy.
Abstract:
Invasive infections caused by Magnusiomyces spp. are rare, but are associated with severe complications in hematopoietic cell transplantation (HCT) recipients and hospital outbreaks. Following a Magnusiomyces clavatus outbreak in our HCT unit, a prospective targeted screening protocol was implemented, which included pharyngeal and rectal swabs cultured on yeast-selective media with prolonged incubation. Clinical and microbiological data were analyzed, and whole-genome sequencing (WGS) was performed on the available isolates. During the study period (September 2022-July 2023), five colonizations and five invasive breakthrough Magnusiomyces infections were identified. Despite prompt initiation of antifungal treatment, 4/5 patients (80%) died. WGS demonstrated clonal relatedness among four M. clavatus isolates, supporting clonal transmission, although no environmental sources were identified. An enhanced two-phase screening strategy involving 71 patients showed limited benefit, identifying only one additional colonization case compared to routine surveillance cultures. A retrospective review (2007-2021) identified 58 Magnusiomyces spp. episodes, with only 10% occurring in patients with hematological malignancies. Our study describes a prolonged clonal outbreak confined to an HCT unit and provides a detailed evaluation of a targeted screening approach in this setting, highlighting the challenges of early identification and prediction of invasive infections. Further studies are needed to define the optimal surveillance and prevention strategies.
Insights
A rare fungal infection, Magnusiomyces, caused severe complications in hematopoietic cell transplantation (HCT) patients during an outbreak. Targeted screening showed limited benefit, and most infected patients died despite treatment.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Invasive infections by *Magnusiomyces* species are uncommon but linked to severe outcomes in hematopoietic cell transplantation (HCT) recipients.
- Outbreaks of *Magnusiomyces clavatus* can occur in hospital settings, posing significant risks to immunocompromised patients.
Purpose of the Study:
- To evaluate a prospective targeted screening protocol for *Magnusiomyces* infections in HCT recipients following an outbreak.
- To analyze clinical and microbiological data, including whole-genome sequencing (WGS), to understand transmission dynamics.
- To assess the effectiveness of enhanced screening strategies compared to routine surveillance.
Main Methods:
- Implementation of a prospective targeted screening protocol using pharyngeal and rectal swabs with prolonged incubation.
- Clinical and microbiological data collection and analysis.
- Whole-genome sequencing (WGS) of *Magnusiomyces* isolates to determine clonal relatedness and transmission.
- Retrospective review of *Magnusiomyces* spp. episodes from 2007-2021.
Main Results:
- Five colonizations and five invasive *Magnusiomyces* infections were identified during the prospective study period.
- Despite prompt antifungal treatment, 80% (4/5) of patients with invasive infections died.
- WGS confirmed clonal transmission of *M. clavatus* among isolates, but no environmental source was identified.
- Enhanced screening demonstrated limited additional benefit over routine surveillance.
Conclusions:
- A prolonged clonal outbreak of *Magnusiomyces clavatus* occurred in an HCT unit, highlighting challenges in early detection and prediction of invasive infections.
- Targeted screening strategies showed limited efficacy in this setting.
- Further research is required to establish optimal surveillance and prevention strategies for *Magnusiomyces* infections in HCT patients.
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