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Successful Isavuconazole Salvage Therapy for a Cryptococcus deuterogattii (AFLP6/VGII) Disseminated Infection in a European Immunocompetent Patient

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Abstract

Members of the Cryptococcus gattii species complex are notorious causes of cryptococcosis as they often cause severe, life-threatening infections. Here we describe a case of a severe disseminated C. deuterogattii infection in a previously healthy patient who was initially treated with amphotericin B, 5-fluorocytosine and fluconazole, which led to a good neurological response, but the infection in the lungs remained unaltered and was not completely resolved until switching the antifungal therapy to isavuconazole. The infection was likely acquired during a one-month stay at the Azores Islands, Portugal. Environmental sampling did not yield any cryptococcal isolate; therefore, the source of this apparent autochthonous case could not be determined. Molecular typing showed that the cultured C. deuterogattii isolates were closely related to the Vancouver Island outbreak-genotype.

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Acknowledgements

The authors thank the patient for consenting to the publication of this case. We are grateful to Ms Isabel Martinez-Hervás Librarian of Severo Ochoa University Hospital for searching literature and to Ms Elisa Parrilla for her assistance in environmental sample collection in Azores Islands. We also want to thank Pablo Flores for his professional review of the English language and Amanda S. Cuétara for her assistance in the design of Fig. 4. Finally, we thank Master Labor SL Company for the donation of the Biosynex CryptoPS kit.

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Authors and Affiliations

  1. Department of Microbiology, Hospital Universitario Severo Ochoa, Avda. de Orellana S/N. 28914, Leganés, Madrid, Spain

    Maria Soledad Cuetara

  2. Department of Medicine, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain

    Juan José Jusdado Ruiz-Capillas

  3. Department of Radiology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain

    Maria Pilar Nuñez-Valentin

  4. Department of Neurology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain

    Elena Rodríguez Garcia

  5. Department of Pharmacy, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain

    Elena Garcia-Benayas

  6. Department of Immunology, Hospital Materno-Infantil-CHUAC, La Coruña, Spain

    Ricardo Rojo-Amigo

  7. Department of Immunology, Hospital Dr. Negrín, Palmas de Gran Canaria, Spain

    Jose Carlos Rodriguez-Gallego

  8. Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands

    Ferry Hagen

  9. Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands

    Ferry Hagen

  10. Laboratory of Medical Mycology, Jining No. 1 People’s Hospital, Jining, Shandong, People’s Republic of China

    Ferry Hagen

  11. Medical Mycology Laboratory, Department of Plant Production and Microbiology, University Miguel Hernández, Campus of Sant Joan D’Alacant, 03550, Alicante, Spain

    María Francisca Colom

  12. Institute for Healthcare and Biomedical Research of Alicante, Isabial, Spain

    María Francisca Colom

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  1. Maria Soledad Cuetara
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Correspondence to Maria Soledad Cuetara or María Francisca Colom.

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Cuetara, M.S., Jusdado Ruiz-Capillas, J.J., Nuñez-Valentin, M.P. et al. Successful Isavuconazole Salvage Therapy for a Cryptococcus deuterogattii (AFLP6/VGII) Disseminated Infection in a European Immunocompetent Patient. Mycopathologia 186, 507–518 (2021). https://doi.org/10.1007/s11046-021-00566-w

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