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REVIEW 10.1111/j.1469-0691.2006.01481.x
Clinical manifestations, treatment and outcome of Paecilomyces lilacinus infections F. J. Pastor and J. Guarro
Unitat de Microbiologia, Facultat de Medicina I Cie`ncies de la Salut, Universitat Rovira i Virgili, Reus, Spain
ABSTRACT The fungus Paecilomyces lilacinus is an emerging pathogen that causes severe human infections, including devastating oculomycosis. Usually, it shows low susceptibility to conventional antifungal drugs in vitro, and variable susceptibility to novel triazoles. A review of the published literature identified 119 reported cases of human infection by P. lilacinus between 1964 and 2004. Most were cases of oculomycosis (51.3%), followed by cutaneous and sub-cutaneous infections (35.3%), and a smaller group of miscellaneous infections (13.4%). Lens implantation is the most frequent predisposing factor for oculomycosis. Cutaneous and sub-cutaneous infections occur mainly in solid organ and bone marrow transplant recipients, although surgery and primary or acquired immunodeficiency are also relevant predisposing factors. Infections in apparently immunocompetent patients have also been reported. Surgical debride- ment combined with antifungal drug therapy, or the correction of predisposing factors, such as neutropenia, are usually required to obtain improvement. Treatment with traditional antifungal drugs often fails. Voriconazole has demonstrated good activity in both cutaneous and ocular infections in the few cases in which this drug has been used. The new triazoles ravuconazole and posaconazole show good in- vitro activity against P. lilacinus and could be promising therapeutic alternatives. Keywords Fungal infections, oculomycosis, Paecilomyces lilacinus, review, risk-factors, voriconazole Accepted: 1 December 2005 Clin Microbiol Infect 2006; 12: 948–960
Paecilomyces is a hyaline hyphomycete that INTRODUCTION exists worldwide. It can be recovered from soil Fungal infections have become an important and air, and can cause the deterioration of grain, cause of morbidity and mortality in recent years, food and paper [2]. Its potential resistance to especially in the ever-expanding population of sterilising methods, its frequent contamination of immunocompromised patients. Antibacterial creams and lotions used clinically, and its coloni- treatment, bone marrow and solid organ sation of clinical materials, e.g., catheters and transplantation, oncological chemotherapy, and plastic implants, increases the clinical importance primary or acquired immunodeficiency are all of this fungus [3,4]. Although Paecilomyces spp. predisposing circumstances for the development are uncommon pathogens, they can produce of severe fungal infection [1]. In addition to the serious infections in immunocompromised pa- traditional and well-known opportunistic fungi, tients, and the incidence of infections in immu- such as Candida, Aspergillus and Cryptococcus, nocompetent hosts is increasing [5]. Paecilomyces many other fungi have now emerged as causes lilacinus and Paecilomyces variotii are the two of human infection. Paecilomyces is among the species associated most frequently with human latter, and is of clinical interest because of its disease. Other species reported to infect humans pathogenicity and resistance to antifungal agents. occasionally are Paecilomyces marquandii [6,7] and Paecilomyces javanicus [8]. This article reviews cases of P. lilacinus infection reported between Corresponding author and reprint requests: F. J. Pastor, Unitat 1964 and 2004, and summarises the available data de Microbiologia, Facultat de Medicina I, Cie`ncies de la Salut, Universitat Rovira I Virgili, 43201 Reus, Spain concerning the main clinical manifestations, pre- E-mail: [email protected] disposing factors, treatments and outcome. Data