Breakthrough infection of Geotrichum capitatum during empirical caspofungin therapy after umbilical cord blood transplantation
- 198 Downloads
We experienced a breakthrough fungal infection caused by Geotrichum capitatum during empirical therapy with caspofungin. A 68-year-old male patient with refractory acute lymphoblastic leukemia had received umbilical cord blood transplantation after two courses of induction therapy. Empirical therapy with caspofungin was initiated 5 days before transplantation. Tacrolimus was continuously infused to prevent graft-versus-host disease. A minidose of methotrexate was intravenously administered on days 1 and 3 post-transplantation, which was changed to prednisolone from day 7 due to severe mucositis. During a recurrence of fever on day 11, blood cultures were found to be positive for a yeast-like organism, which was later confirmed by mass spectrometry to be G. capitatum. The serum levels of beta-d-glucan were elevated to 747 pg/mL. Caspofungin was switched to liposomal amphotericin B; however, radiological findings revealed pulmonary, splenic, and central nervous system involvement. Progressive renal and hepatic dysfunction subsequently developed. The patient died on day 25 post-transplantation secondary to the development of hemophagocytic syndrome and respiratory failure. We emphasize that recurrent febrile episodes, prolonged neutropenia, and underlying gastrointestinal mucosal damage require extreme caution due to the possibility of breakthrough infection caused by new fungal pathogens during empirical therapy with caspofungin.
KeywordsEmpirical antifungal therapy Breakthrough infection
We appreciate the contributions of Michitaka Hironaga at the microbiology laboratory of JCHO Kyushu Hospital, Kenichi Aoki, Ryosuke Ogawa, and other medical and nursing staff at the JCHO Kyushu Hospital. and the special comments of associate professor Issei Tokimatsu at Kobe university hospital.
Compliance with ethical standards
Conflict of interest
The authors declare no competing financial interests.
- 2.Girmenia C, Pagano L, Martino B, D’Antonio D, Fanci R, Specchia G, et al. Invasive infections caused by Trichosporon species and Geotrichum capitatum in patients with hematological malignancies: a retrospective multicenter study from Italy and review of the literature. J Clin Microbiol. 2005;43:1818–28.CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Rex JH, Pfaller MA, Galgiani JN, Bartlett MS, Espinel-Ingroff A, Ghannoum MA, et al. Development of interpretive breakpoints for antifungal susceptibility testing: conceptual framework and analysis of in vitro–in vivo correlation data for fluconazole, itraconazole, and candida infections. Subcommittee on Antifungal Susceptibility Testing of the National Committee for Clinical Laboratory Standards. Clin Infect Dis. 1997;24:235–47.CrossRefPubMedGoogle Scholar
- 11.Arendrup MC, Garcia-Effron G, Buzina W, Mortensen KL, Reiter N, Lundin C, et al. Breakthrough Aspergillus fumigatus and Candida albicans double infection during caspofungin treatment: laboratory characteristics and implication for susceptibility testing. Antimicrob Agents Chemother. 2009;53:1185–93.CrossRefPubMedGoogle Scholar