Cutaneous geotrichosis due to Geotrichum candidum in a burn patient

Abstract

Geotrichum candidum is a saprophytic yeast known to colonize the human skin, respiratory tract and gastrointestinal tract. It can cause local or disseminated disease (geotrichosis), mainly in the immunocompromised host. Trauma, indwelling catheter use, prolonged broad-spectrum antibiotic treatment and critical illness have also been implicated as risk factors. Here we report the first case, to our knowledge, of cutaneous G. candidum infection in a burn patient. The isolate had a high amphotericin B minimum inhibitory concentration (MIC) and the patient experienced concomitant Candida orthopsilosis fungaemia, and so was treated with a combination of voriconazole and micafungin. This case highlights the importance of source control, rapid identification of G. candidum infection and MIC determination to guide antifungal therapy, which typically consists of amphotericin B with or without flucytosine or voriconazole alone. Clinicians should be aware of geotrichosis as a clinical entity in burn patients as well as in the immunocompromised. Antifungal resistance and breakthrough disease are an ongoing concern due to the increasing number of immunocompromised at-risk patients and the use of routine mould prophylaxis.

Keywords: antifungal therapy; burn; geotrichosis; immunocompromise; invasive fungal infection.

Fig. 1.

Failed anterior torso skin graft on hospital day 28.

Fig. 2

(a) G. candidum grown on Sabouraud agar at 30 °C for 5 days. (b) Lactophenol cotton blue (LPCB) wet mount of G. candidum at 400× magnification. (c) Hyaline hypha with developing arthroconidia (left) and separate individual arthroconidia (400×). (d) Chains of arthroconidia and separate arthroconidia (1000×+10 % digital magnification). Images courtesy of Yuri Amatnieks.