Our patient was diagnosed with a severe pulmonary infection with Saprochaete capitata (teleomorph: Magnusiomyces capitatus, previously called Geotrichum capitatum, Trichosporon capitatum or Blastoschizomyces capitatus), most probably due to his immunocompromised state (determination method: MALDITOF). We continued therapy with voriconazole. On the ICU he was initially supported with non-invasive ventilation, but eventually he had to be intubated and mechanically ventilated. Despite full ICU treatment his situation worsened, and he died in cardio-respiratory arrest.
Saprochaete capitata is a non-fermentative, non-encapsulated, urease-negative ascomycetous yeast. It is part of the normal microbiota of human skin and is frequently isolated from the sputum and the digestive tract of healthy people.1 It is a rare, but emerging yeast responsible for severe infections in patients with profound neutropenia in the haematooncology setting.1-3 The prognosis is poor with a mortality rate exceeding 50%.2
Most cases of Saprochaete capitata infections have been diagnosed by means of blood cultures or cultures on BAL liquid. Galactomannan antigen enzyme-linked immunosorbent assay (GM-ELISA) is now widely used in the serological diagnosis of invasive Aspergillosis as an essential diagnostic method. As the serological G test (1,3-β-D-glucan), which detects 1,3-β-D-glucan as a component of the fungal wall and which is also applicable for early diagnosis of all fungal infections (especially Candida and Aspergillus and except for Cryptococcus and Zygomycetes), it can also be used for the diagnosis of other fungal infections such as Saprochaete capitata. However, neither of these tests can determine the specific infectious species.3
Saprochaete capitata is considered intrinsically resistant to echinocandins,1 several breakthrough infections in neutropenic patients have been reported.4 Voriconazole exhibits a promising activity in vitro, and voriconazole and amphotericin B combination therapy has been suggested.1
In case of severe illness in neutropenic patients, fungal infection should always be considered. Saprochaete capitata can play a role as an opportunist. Treatment with echinocandins is probably ineffective; therefore treatment with voriconazole (perhaps in combination with amphotericin B) is advised.