Breakthrough Hormographiella aspergillata infections arising in neutropenic patients treated empirically with caspofungin.
Hormographiella aspergillata, a filamentous basidiomycete, has rarely been involved in human infections. We describe 2 febrile neutropenic patients who developed a severe pulmonary infection due to H. aspergillata while receiving empirical caspofungin therapy for presumed fungal pneumonia. After introduction of liposomal amphotericin B, one patient, who had neutrophil recovery, presented a favorable outcome, while the other, who remained neutropenic throughout the course of infection, died. Resistant fungi, including basidiomycetes, may emerge during empirical treatment with caspofungin in febrile neutropenic patients. A rapid switch to any other potent antifungal should be rapidly considered in case of failure of caspofungin in this setting.
Université Paris Descartes, Service d'Hématologie Adultes, Hôpital Necker-Enfants Malades, AP-HP, 149 Rue de Sèvres, 75743 Paris Cedex 15, France. felipe.suarez@nck.aphp.fr
Felipe
F
Suarez
Gaelle
G
Olivier
Dea
D
Garcia-Hermoso
Edouard
E
Randriamalala
David
D
Ghez
Julie
J
Bruneau
Catherine
C
Kauffmann-Lacroix
Marie-Elisabeth
ME
Bougnoux
Olivier
O
Lortholary
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D001487:Basidiomycota / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D000077336:Caspofungin; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D005335:Fever of Unknown Origin / Q000188:drug therapy*; D005658:Fungi; D006801:Humans; D055666:Lipopeptides; D008172:Lung Diseases, Fungal / Q000188:drug therapy*; D008297:Male; D008969:Molecular Sequence Data; D009181:Mycoses / Q000175:diagnosis* / Q000382:microbiology; D009503:Neutropenia / Q000188:drug therapy*; D017422:Sequence Analysis, DNA; D016896:Treatment Outcome
D000935:Antifungal Agents; D004271:DNA, Fungal; D054714:Echinocandins; D055666:Lipopeptides; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077336:Caspofungin