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. 2020 Nov;81(5):802-815.
doi: 10.1016/j.jinf.2020.08.015. Epub 2020 Aug 13.

Needles in a haystack: Extremely rare invasive fungal infections reported in FungiScopeⓇ-Global Registry for Emerging Fungal Infections

Jon Salmanton-García  1 , Philipp Koehler  2 , Anupma Kindo  3 , Iker Falces-Romero  4 , Julio García-Rodríguez  4 , Zdeněk Ráčil  5 , Sharon C-A Chen  6 , Nikolai Klimko  7 , Guillaume Desoubeaux  8 , George R Thompson , III  9 , Miguel-Ángel Benítez-Peñuela  10 , José-Yesid Rodríguez  10 , Donald C Sheppard  11 , Martin Hoenigl  12 , Yohann Le Govic  13 , Hamid Badali  14 , John W Baddley  15 , Jagdish Chander  16 , Paul R Ingram  17 , Diana L Pakstis  18 , Sibylle C Mellinghoff  19 , Serkan Atıcı  20 , Simone Cesaro  21 , Arunaloke Chakrabarti  22 , Damien Dupont  23 , Gloria M González  24 , Lóránt Hatvani  25 , Raoul Herbrecht  26 , Galina Klyasova  27 , Cornelia Lass-Flörl  28 , Mihai Mareș  29 , Kathleen Mullane  30 , Donald C Vinh  31 , Hilmar Wisplinghoff  32 , Michaela Lackner  28 , Oliver A Cornely  33 , Danila Seidel  34 ; ECMM/ISHAM working group
Collaborators, Affiliations

Needles in a haystack: Extremely rare invasive fungal infections reported in FungiScopeⓇ-Global Registry for Emerging Fungal Infections

Jon Salmanton-García et al. J Infect. 2020 Nov.

Abstract

Objectives: Emerging invasive fungal infections (IFI) have become a notable challenge. Apart from the more frequently described fusariosis, lomentosporiosis, mucormycosis, scedosporiosis, and certain dematiaceae or yeasts, little is known about extremely rare IFI.

Methods: Extremely rare IFI collected in the FungiScopeⓇ registry were grouped as Dematiaceae, Hypocreales, Saccharomycetales, Eurotiales, Dermatomycetes, Agaricales, and Mucorales.

Results: Between 2003 and June 2019, 186 extremely rare IFI were documented in FungiScopeⓇ. Dematiaceae (35.5%), Hypocreales (23.1%), Mucorales (11.8%), and Saccharomycetales (11.3%) caused most IFI. Most patients had an underlying malignancy (38.7%) with acute leukemia accounting for 50% of cancers. Dissemination was observed in 26.9% of the patients. Complete or partial clinical response rate was 68.3%, being highest in Eurotiales (82.4%) and in Agaricales (80.0%). Overall mortality rate was 29.3%, ranging from 11.8% in Eurotiales to 50.0% in Mucorales.

Conclusions: Physicians are confronted with a complex variety of fungal pathogens, for which treatment recommendations are lacking and successful outcome might be incidental. Through an international consortium of physicians and scientists, these cases of extremely rare IFI can be collected to further investigate their epidemiology and eventually identify effective treatment regimens.

Keywords: Invasive fungal infections; Mold; Rare; Registry; Yeast.

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Conflict of interest statement

Declaration of Competing Interest PK reports personal fees from Astellas Pharma GmbH, Gilead Sciences GmbH, Akademie für Infektionsmedizin e.V., MSD Sharp & Dohme GmbH, and University Hospital, LMU Munich; non-financial support from Miltenyi Biotec GmbH; and other support from Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany, outside the submitted work. SCAC reports grants from MSD Australia, outside the submitted work. NK reports personal fees from Astellas, Gilead, MSD, and Pfizer, outside the submitted work. DCS reports grants from Merck and personal fees from Merck, Astellas, and AVIR, outside the submitted work. MH reports grants from Gilead, outside the submitted work. SCM reports personal fees from Octapharma, outside the submitted work. RH reports grants from Gilead, Novartis, and Pfizer and personal fees from Astellas, Basilea, Gilead, MSD, Novartis, and Pfizer, outside the submitted work. GK reports personal fees from Astellas Pharma, Gilead Sciences, Merck Sharp and Dohme, Pfizer, and Sandoz outside the submitted work. CLF reports grants from Astellas Pharma and Gilead Sciences; personal fees from Angelini, Basilea, Biomerieux, Gilead Sciences, and Merck Sharp and Dohme; and other support from Astellas Pharma, Basilea, Biomerieux, Gilead Sciences, and Merck Sharp and Dohme, outside the submitted work. KM reports grants as a clinical trial investigator from Gilead Sciences, Inc., clinical research grants from Ansun, Astellas, Merck, Rebiotix, Scynexis, and Shire; and consultant fees/honoraria from Chimerix, GlaxoSmithKline, Merck, and Scynexis outside the submitted work. DCV reports support from Avir Pharma, Cidara Therapeutics, CSL Behring, and Fonds de la Recherche en Santé du Quebec, during the conduct of the study (salary support), outside the submitted work. OAC reports grants from Actelion, Amplyx, Astellas, Basilea, Cidara, Da Volterra, F2G, Gilead, Janssen Pharmaceuticals, Medicines Company, MedPace, Melinta Therapeutics, Merck/MSD, Pfizer, and Scynexis and personal fees from Actelion, Allecra Therapeutics, Amplyx, Astellas, Basilea, Biosys UK Limited, Cidara, Da Volterra, F2G, Entasis, Gilead, Grupo Biotoscana, Matinas, MedPace, Menarini Ricerche, Merck/MSD, Nabriva Therapeutics Octapharma, Paratek Pharmaceuticals, Pfizer, PSI, Rempex, Roche Diagnostics, Scynexis, Seres Therapeutics, and Tetraphase outside the submitted work. Other authors: none

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