To The Editors:
Infections with Geotrichum candidum species are rare 1–8 and can be lethal. 2 We report the case of a neonate with hepatoblastoma and chemotherapy-induced neutropenia who developed sepsis caused by G. candidum.
D., a young baby girl, was referred to our oncology pediatric unit for management of a localized hepatoblastoma. The general status was critical with severe malnutrition and dehydration. After administration of the first two courses of chemotherapy (vincristine-cyclophosphamide and Adriamycin-carboplatin), she developed Pseudomonas aeruginosa sepsis. She received treatment with ceftazidime for 10 days and amikacin 4 days; the outcome was favorable despite persistent altered general status. After the third course of chemotherapy (Adriamycin-carboplatin), she developed Staphylococcus hominis septicemia initially treated with ceftazidime and teicoplanin. G. candidum was also found in both blood cultures and blood smears staining. The patient responded well to intravenous administration of amphotericin B (1 mg/kg/day) for 5 weeks (total dose, 35 mg/kg) followed by oral treatment with itraconazole (10 mg/kg/day). Itraconazole treatment was maintained for 6 months (total dose, 1800 mg/kg). Hemocultures remained positive for G. candidum during 5 days after the beginning of the treatment. Treatment was clinically well-tolerated. The tumor was then removed surgically. D. was alive and free of disease >3 years after diagnosis.
G. candidum infections are rare. The biomedical literature can be confusing as several obsolete synonyms (Endomyces lactis, Oidium lactis, Oospora lactis, Oidium pulmoneum) or teleomorphs (Dipodascus Geotrichum, Galactomyces geotrichum) of this species can be found. 9 The pathogenicity of the fungus G. candidum in humans has not been clearly defined, but it has been proposed that infections are usually acquired via ingestion or inhalation. Thus Vasei and Imanieh 3 proposed that duodenal colonization by G. candidum can occur when mucosal immunity is disturbed and that it could be the source of dissemination in severe immunodeficiency states. G. candidum infections can be localized to the skin, bronchi, mouth, lung and intestine 1, 3, 6 or disseminated. 2, 5, 7, 8 The main predisposing factor is immunodepression which is mostly related to HIV infection 1 or chemotherapy. 2, 4, 8 The use of antibiotics and the age of the patients did not favor such infections, but they might have also contributed to the emergence of the infection in our patient. Treatment is not well-established. Nevertheless for our patient the association of amphotericin B and high cumulative doses of itraconazole was successful.
Nicolas André, M.D., Ph.D.
Carole Coze, M.D., Ph.D.
Jean Claude Gentet, M.D.
Rolande Perez, M.D.
Jean Louis Bernard, M.D., Ph.D.
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