Blastoschizomyces infections seem to be increasing in leukemia patients

Blastoschizomyces capitatus is an emerging opportunistic yeast pathogen that seems to have a predilection for severely neutropenic patients with leukemia, according to a report from clinicians in Spain. Amphotericin B appears effective in treating the infection, although that is less than certain.

Blastoschizomyces capitatus is an emerging opportunistic yeast pathogen that seems to have a predilection for severely neutropenic patients with leukemia, according to a report from clinicians in Spain. Amphotericin B appears effective in treating the infection, although that is less than certain.In the February 1st issue of Clinical Infectious Diseases, Dr. Rodrigo Martino from Hospital de la Santa Creu i Sant Pau in Barcelona and colleagues note that, previously, reports of Blastoschizomyces capitatus infection have been rare and usually single cases. In their paper, the team describes 26 cases diagnosed in 25 patients at seven tertiary care hematology units in Spain during a 10-year period (1992-2002). All but two (92%) of the patients had acute leukemia and developed the infection during a period of severe and prolonged neutropenia, they report. Two had esophagitis and the remainder had invasive infection. In some ways the clinical presentation of Blastoschizomyces capitatus resembles that of invasive candidiasis, the authors note. Most patients have fungemia (20/26 in this series), but the percentage who develop deep organ involvement is greater, in the order of 60% to 80% compared with 10% to 20% of patients with candidemia. The 30-day mortality rate associated with Blastoschizomyces capitatus infection also appears to be higher than that associated with candidemia — 60% vs 24%, respectively. In univariate analyses, antifungal therapy before infection, prompt removal of the central venous catheter after infection, and a good performance status were associated with a higher 30-day survival. While the current study does not permit “evidence-based” treatment recommendations, Dr. Martino and colleagues report that 12 of 13 patients who were cured received amphotericin B either alone or with other agents, particularly voriconazole or high-dose fluconazole. (Source: Reuters Health,Clin Infect Dis 2004;38:335-341.)