Cornejo-Juárez P, Velásquez-Acosta C, Martínez-Roque V, Rangel-Cordero A, Volkow-Fernández P

Language: Spanish
References: 15
Page: 193-196
PDF size: 55.07 Kb.

ABSTRACT

Background: Microorganisms considered saprophytes have emerged as invasive or indolent pathogens among immunocompromised patients.
Material and methods: We detected an initial case of catheter-related Acremonium sp fungemia on a previously asymptomatic patient. We diagnosed a second case five weeks later. Both patients had a non-tunneled central venous catheter (CVC) that had been cared for following routine protocol by nurses in the Intravenous Therapy Team on a weekly basis. The sole risk factor that both patients shared was that they had received total parenteral nutrition (TPN) by a CVC 5 months prior to the date the catheter-related fungemia was detected. We retrospectively studied all patients who had received TPN during this period.
Results: We found two cases of Acremonium fungemia, patients had gastric adenocarcinoma and received TPN for an average of 19 days. Infection was resolved with catheter removal and antifungic therapy. Another eight patients received TPN from the same commercial firm during this period; average administration was 9.5 days (range, 6-20). Neither blood cultures nor tip-catheters culture reported Acremonium sp.
Conclusions: Patients with CVC for TPN should be closely monitored to identify colonization with a low pathogenic microorganism that could be mistakenly diagnosed as asymptomatic.

REFERENCES

1. Fincher RM, Fisher JF, Lovell RD, Newman CL, Espinel-Ingroff A, Shadomy HJ. Infection due to the fungus Acremonium (Cephalosporium). Medicine (Baltimore) 1991;70:398-409.

2. Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolkien RH. Manual of clinical microbiology. Washington, D.C., USA: ASM Press; 1999. pp. 1225-1226.

3. Brown NM, Blundell EL, Chown SR, Warnock DW, Hill JA, Slade RR. Acremonium infection in a neutropenic patient. J Infect 1992; 25:73-76.

4. Liu K, Howell DN, Perfect JR, Schell W A. Morphologic criteria for the preliminary identification of Fusarium, Paecilomyces, and Acremonium species by histopathology. Am J Clin Pathol 1998;109:45-54.

5. Volkow P. Manual del manejo ambulatorio de la terapia intravenosa para el enfermo con cáncer. Mexico D.F., Mexico: Noriega Editores; 2001.

6. Volkow P, Vázquez C, Téllez O, Aguilar C, Barrera L, Rodríguez E, et al. Polyurethane II catheter as long-indwelling intravenous catheter in patients with cancer. Am J Infect Control 2003;31:392-396.

7. Volkow P, Sánchez-Mejorada G, de la Vega SL, Vázquez C, Téllez O, Báez RM, et al. Experience of an intravenous therapy team at the Instituto Nacional de Cancerología (Mexico) with a long-Iasting, low-cost silastic venous catheter. Clin Infect Dis 1994;18:719-725.

8. Schell W A, Perfect JR. Fatal, disseminated Acremonium strictum infection in a neutropenic host. J Clin Microbiol 1996;34:1333-1336.

9. Warris A, Wesenberg F, Gaustad P, Verweij PE, Abrahamsen TG. Acremonium strictum fungaemia in a paediatric patient with acute leukaemia. Scand J Infect Dis 2000; 32:442-444.

10. Bren A. Fungal peritonitis in patients on continuous ambulatory peritoneal dialysis. Eur J Clin Microbiol Infect Dis. 1998; 17:839-843.

11. Fridkin SK, Jarvis WR. Epidemiology of nosocomial fungal infections. Clin Microbiol Rev 1996;9:499-511.

12. Lopes JO, Alves SH, Rosa AC, Silva CB, Sarturi JC, Souza CA. Acremonium kiliense peritonitis complicating continuous ambulatory peritoneal dialysis: report of two cases. Mycopathologia 1995;131:83-85.

13. Roilides E, Bibashi E, Acritidou E, Trahana M, Gompakis N, Karpouzas JG, et al. Acremonium fungemia in two immunocompromised children. Pediatr Infect Dis J 1995; 14:548-550.

14. Nedret Koc A, Erdem F, Patiroglu T. Case reporto Acremonium falciforme fungemia in a patient with acute leukaemia. Mycoses 2002; 45:202-203.

15. Guarro J, Gams W, Pujol I, Gene J. Acremonium species: new emerging fungal opportunists- in vitro antifungal susceptibilities and review. Clin Infect Dis 1997;25:1222-1229.